Nursing Home Managers Research Articles

Effects of a nutrition education intervention on food-provision managerial decisions in Catalan old age nursing homes.

Existing research does not provide definitive conclusions on the most effective initiatives for preventing malnutrition among older adult residents in nursing homes. We aimed to assess whether a nutrition education intervention provided to nursing home managers can improve dietary managerial decisions within nursing homes. We performed a multicenter study, where each center was randomized to an intervention or a control group. To ensure homogeneous group representation, we stratified the sample based on the facility size and the availability of kitchen equipment. The baseline survey contained questions related to center characteristics, kitchen size and availability of cooking tools, availability of different daily menu options and the staff working in the kitchen. The follow-up survey included questions about the staff responsible for making nutritional decisions, the degree of food handling, the availability of texture-modification tools, and the residents' satisfaction. We use ordered probit regression models to estimate the effect of the educational intervention on decisions around food management. From the 238 nursing homes that responded to the initial survey, 176 were followed-up; 56 were allocated to the intervention group and 120 to the control group. There were 53.32 residents per center among the treated group and 40.82 residents in the non-treated institutions. The intervention increased by 24% the nursing homes' probability of increasing their stock of texture-modification tools, which rose to 26% after controlling for the effect of receiving specific training on textures or presentation, compared to the control group. The intervention improved managerial decisions in nursing homes concerning meal presentation through an increase in the number of cooking tools. Incorporating structured and comprehensive sessions to improve food texture and presentation could help fight the risk of residents' malnutrition.

“I Want to Tell You Something, but Not Here”: Governmental Inspection teams’ Challenges in Identifying Mistreatment in Nursing Homes

ABSTRACT This study explores the challenges faced by the Ministry of Health’s inspection teams in identifying mistreatment within Israeli nursing homes. Four focus groups with 19 multidisciplinary inspectors revealed two main themes. First, the interaction between nursing home management, staff, and inspectors ranged from denial and concealment of mistreatment to cooperation in reporting it. Second, inspectors adapted skills not part of their official duties, such as investigative techniques and organizational analysis, to identify mistreatment. The findings highlight the need to reassess inspection teams’ roles, skills, and their relationship with nursing home staff to improve detection of mistreatment.

A novel architecture for the detection, exploitation and historical archival of indoor semantic trajectories: a case study on nursing homes

Purpose This paper aims to build an indoor positioning system capable of tracking residents and caregivers and feeding a novel information system with this data. This information system introduces three main interesting modules: a compact data structure to efficiently store the gathered data, an activity deduction module that add semantics to the raw captured trajectories and a user-friendly interface able to display this spatio-temporal information. Design/methodology/approach Their proposal was built following an iterative and incremental development. Nursing home managers cooperated in the requirement composition phase, while some residents and caregivers contributed testing the system with their real trajectories. Findings Their contribution is a functional information system that can evaluate the quality of healthcare provided to residents and assess the efficiency of the nursing home as a business. This information system includes a novel state-of-the-art compact data structure to efficiently work with the captured data. Originality/value A new system has been designed and implemented using a wide range of technologies to support the necessities of a real enterprise. The rudimentary position tracking systems were upgraded to a feasible automatic indoor positioning solution. The amount of information generated by this new strategy is dealt with compact data structures, reducing space usage without jeopardizing query times. Those compressed positions are tagged with semantic information that enables individual activity analysis. Last, a user-friendly interface lets the final user interact with the gathered and calculated information. As future work, the authors plan to improve the integration of this new information system with other systems already in use in indoor mobile workforce environments.

Knowledge and Attitudes toward New Disease-Modifying Treatments for Alzheimer's Disease among Nursing Home Directors

ObjectivesNursing home (NH) administrator perceptions regarding the utility of Alzheimer's disease (AD) disease-modifying medications in NHs are important because many short and long-stay residents have mild AD. This study examined the interest of directors of nursing (DoNs) in using new AD disease-modifying treatments, changes in attitudes based on differences in costs to the NH, and characteristics (DoN and NH) associated with such changes. DesignThis is a cross-sectional study. Setting and ParticipantsThis study is based on a 2022 nationally representative survey of 340 NH DoNs, which was drawn from a stratified random sample of US NHs with ≥30 beds and with a 26.6% response rate. MethodsWe conducted a descriptive analysis to assess the awareness of new AD disease-modifying treatments and the support for their use. We applied logistic regression models to explore the associations between the interest of the DoN in using these new AD treatments and various characteristics. ResultsMost (86%) DoNs stated that they would at least sometimes support the usage of a new disease-modifying medication if there were no NH costs. This percentage was lower if the NH costs per resident were $2000 per year (51.3%) and $20,000 per year (14%). NHs with moderate shares of dual-eligible residents were more sensitive to cost. Conclusions and ImplicationsOur findings indicated that the interest of DoNs in using disease-modifying treatments for dementia varies widely according to the cost to the NHs. The uptake of new AD medications in the NH setting should be monitored, and targeted efforts may be needed to mitigate inequities in access for less-resourced NHs.

Contextualising knowledge translation in nursing homes: A transdisciplinary online workshop

Few studies describe workshops as a method for obtaining and integrating diverse participant perspectives for contextualisation. This article describes an online workshop as a transdisciplinary data collection method for contextualising theoretical elements of a framework for knowledge translation to improve wound care in South African nursing homes. Knowledge translation can be more effective when the theoretical components are contextualised and aligned with the specific needs in the context. The online workshop was conducted with 10 participants involved with wound care and change processes in nursing homes across South Africa. The participants consisted of healthcare professionals, family members of those in care and nursing home management staff. Participatory design principles were applied during the online workshop, which was hosted on BlackBoard CollaborateTM Ultra. In this qualitative study, live polls, facilitated discussion, virtual whiteboard posts, and breakaway activities were used to collect the data. The data were analysed and integrated using both deductive and inductive processes for a comprehensive understanding. The workshop enabled the researchers to ascertain integrated perspectives to contextualise the knowledge translation framework’s elements. Barriers to evidence-based wound care in nursing homes and nine values for dignified care for older persons were identified.Transdisciplinary contribution: This article shows how an online workshop was conducted with a group of participants from various healthcare disciplines, family members and institutional management to achieve a contextualised and pragmatic description of theoretical elements. Contextualisation aims to enhance the effectiveness of a knowledge translation framework for use in nursing homes.

Pemanfaatan Minyak Jelantah sebagai Bahan Dasar Pembuatan Lilin Aromaterapi di Panti Asuhan Vallery

Indonesia is one of the largest consumers of cooking oil in the world. Cooking oil functions to conduct heat in frying food. Used cooking oil or used cooking oil can be used and utilized. Disposal of used cooking oil can also cause environmental damage. Therefore, we need to be able to utilize used cooking oil into something that has economic value for society. This program is implemented to educate children at the Vallery orphanage so they can make an innovative aromatherapy candle product using used cooking oil. This activity aims to provide understanding to the children of the Vallery Orphanage as partners in the use of used cooking oil as an ingredient for making aromatherapy candles. This aromatherapy candle can provide a step that can potentially be developed as an alternative income for nursing home managers because it has economic value. This program is implemented as a real action from the leadership project course which aims to train the ability of PPG Pre-service students to lead through service learning activities or the ability to serve the community or society. Through this program, students are expected to be able to contribute to solving problems that exist in society. The implementation method for this activity is socialization by means of a presentation and followed by training in making aromatherapy candles made from used cooking oil.

Attitudes of Nursing Home Managers Regarding Cognitively Stimulating Activities in People With Dementia: A Multicentre Cross-Sectional Study.

Group-based cognitive stimulation has shown short-term benefits for the cognitive outcomes of people with dementia living in nursing homes (NH). However, group participation can be a barrier for people with advanced dementia, bedridden people or isolated people. The CogStim24 project seeks to develop and implement a new psychosocial intervention based on cognitively stimulating (CS) activities integrated into daily nursing care. As part of the intervention development process, this study aimed to survey NH managers' attitudes and describe currently used approaches to CS activities in German NH. We performed a multicentre cross-sectional study between September and December 2021 in randomly recruited NH in the German federal state of North Rhine-Westphalia. NH representatives were asked to fill in a self-developed online questionnaire. We analysed data descriptively, presenting means and standard deviations. For case scenario questions, we used a summative content analysis. We contacted 354 NH and 106 agreed to participate. Representatives of 64 facilities completed the survey. Almost all stated to have implemented CS activities. Cognitive exercises (98%), physical and relaxation exercises (98%) and reminiscence therapy (95%) were most often used. The majority (96%) thought that CS activities could support people with dementia in maintaining their cognitive functions and that nurses should have a key role in the implementation of CS activities. More than half believed that regular CS activities were easy to implement alongside routine nursing care. Results indicate that CS activities are frequently applied in German NH. The positive attitude of NH managers regarding the implementation and effects of CS activities is an important implementation resource. Nursing staff should be more involved in providing CS activities for people with dementia. Training, information, and implementation material must be made available for nursing staff who wish to have an active role in providing CS activities.

Ways of interdisciplinary approaches to advocating for nursing home residents with dementia.

To explore how nursing home staff advocate for residents with dementia. Phenomenographic qualitative research. Twenty nursing home staff from four disciplines (six nurses, four physical therapists, five social workers and five care workers) were purposively recruited from three different nursing homes. Data were collected through semi-structured interviews conducted from February 2023 to March 2023, and the analysis followed the sequential steps of phenomenographic analysis. The analysis identified five categories of description: focusing on what happened, finding the gaps in perspectives, how to bridge for finding a common perspective, how to tailor care such that each resident receives equitable care and how to establish interdisciplinary sharing for a consistent advocative pattern. Their structural relationship was also identified as an outcome space. The cyclical advocacy structure illustrated that nursing home staff engage in an ongoing process of advocacy during conflict situations as part of interdisciplinary care, emphasizing continuity of care rather than separate occurrences of care. This study revealed that, in advocating for residents with dementia, nursing home staff adopted an approach that fosters consistent care and proactive prevention, achieved through the formation of shared knowledge applicable uniformly across similar situations. This study contributes significantly to the continuing education or training of interdisciplinary staff in nursing homes. The revelations of the study hold significance not only for the practical application but also for the theoretical advancement of concepts related to safeguarding the dignity, human rights and personhood of residents with dementia, with the ultimate goal of enhancing their quality of life within nursing homes. Reporting complied with the COREQ criteria for qualitative research. Nursing home directors have contributed to the validation of data analysis and interpretation.

Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes

INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings. INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources. The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19-related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams. INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.

Perceived dilemma between protective measures and social isolation in nursing homes during the COVID-19 pandemic: a mixed methods study among Swiss nursing home directors.

Coronavirus pandemic (COVID-19) particularly affected older adults, with the highest risks for nursing home residents. Stringent governmental protective measures for nursing homes unintendedly led to social isolation of residents. Nursing home directors (NDs) found themselves in a dilemma between implementing protective measures and preventing the social isolation of nursing home residents. The objectives of this study were to describe protective measures implemented, to investigate NDs' perception of social isolation and its burden for nursing home residents due to these measures, and to explore experiences of NDs in the context of the dilemma. Cross-sectional embedded mixed-method study carried out by an online survey between April 27 and June 09, 2022, among NDs in the German-speaking part of Switzerland. The survey consisted of 84 closed-ended and nine open-ended questions. Quantitative findings were analyzed with descriptive statistics and qualitative data were evaluated using content analysis. The survey was completed by 398 NDs (62.8% female, mean age 55 [48-58] years) out of 1'044 NDs invited.NDs were highly aware of the dilemma. The measures perceived as the most troublesome were restrictions to leave rooms, wards or the home, restrictions for visitors, and reduced group activities. NDs and their teams developed a variety of strategies to cope with the dilemma, but were burdened themselves by the dilemma. As NDs were burdened themselves by the responsibility of how to deal best with the dilemma between protective measures and social isolation, supportive strategies for NDs are needed.

Exploring the implementation of multidisciplinary collaboration at nursing homes in Jakarta, Indonesia: A descriptive phenomenological study.

A well-functioning multidisciplinary team optimizes resource utilization and reduces care redundancy, fragmentation, and wastage. Collaborative efforts yield a clearer understanding of older people's needs and desires, significantly reducing hospitalization days. Despite limited studies, particularly in Indonesia, investigating professionals' experiences in implementing multidisciplinary collaboration in government nursing homes, nursing care quality remains a concern. This study aimed to explore the implementation of multidisciplinary collaboration in nursing homes from the perspectives of various disciplines. A descriptive phenomenological study was used with semi-structured interviews and focus group discussions with multidisciplinary care providers, including nurses, doctors, social workers, physiotherapists, psychologists, occupational and recreational activity instructors, and clergy in nursing homes owned by the Jakarta provincial government. A total of 64 participants were involved, and data were collected from September 2022 to July 2023. Data were analyzed using content-based analysis. Three main themes emerged: 1) context of multiple collaborations, 2) barriers to implementing multiple collaborations, and 3) impacts of non-optimal multidisciplinary collaborations. Nursing home management's multidisciplinary teams predominantly implement professional-centered care with limited support systems. While providers generally perceive collaboration positively, shared responsibility and joint work among professionals are lacking. This study highlights the need to improve multidisciplinary collaboration in nursing homes to enhance care quality for older individuals. While providers view collaboration positively, barriers like a lack of shared responsibility and joint work persist. Enhancing teamwork cohesion through improved communication and integrated case reporting systems is crucial. Addressing human resource and systemic barriers is also vital. By overcoming these challenges, nursing homes can optimize resource use, reduce care redundancy, and better meet the diverse needs of older residents.

Medicare skilled nursing facilities' occupancy and payer source: The moderating role of financial performance.

While extensive research has focused on patient outcomes in skilled nursing facilities, a critical gap remains in understanding factors influencing their managerial performance, particularly occupancy rates. This study examines the occupancy rates of skilled nursing facilities and assesses the significance of two important drivers of managerial performance that have not received sufficient attention-the influence of payer mix and total profit margin. Specifically, we focused on the role played by a nursing home's financial performance (as assessed by profit margin) in influencing the relationship between payer mix and occupancy rate among skilled nursing facilities. Data were extracted from the 2019 to 2020 Joint Annual Report of Nursing Homes for a sample of 612 skilled nursing facilities in Tennessee, USA. Regression analysis was performed by fitting a generalized estimating equation of occupancy rate. Compared to skilled nursing facilities in the lowest quartile of profit margin, for example, those in the highest quartile had approximately 18 percentage points higher occupancy rates per unit increase in resident days of care covered by traditional Medicare (β = 0.18, p = 0.0028). Similarly, skilled nursing facilities in the second highest quartile of profit margin had a higher occupancy rate by approximately 23 percentage points per unit increase in Medicare Advantage (β = 0.23, p = 0.0375) when compared to those in the lowest quartile of profit margin. Skilled nursing facilities with stronger financial performance generally have higher occupancy rates, particularly notable in relation to an upswing in payer sources such as traditional Medicare and Medicare Advantage, when compared to skilled nursing facilities with weaker profitability. Given the increasingly larger role of Medicare in long-term care funding, policymakers and nursing home managers may find it useful to consider our findings when evaluating opportunities to enhance managerial performance of skilled nursing facilities.

Interventions to promote the implementation of pressure injury prevention measures in nursing homes: A scoping review.

To identify studies and the content of the interventions that have facilitated the implementation of pressure injury (PI) prevention measures in nursing home settings. A scoping review methodology was employed. The author has carried out the following steps successively: Identified this scoping review's questions, retrieved potentially relevant studies, selected relevant studies, charted the data, summarised the results, and consulted with stakeholders from nursing homes in China. Six electronic databases and three resources of grey literature-PubMed, CINAHL, Web of Science Core Collection, Embase, Cochrane Central Register of Controlled Trials, Psych INFO, Open Grey, MedNar, ProQuest Dissertations, and Theses Full Texts were searched from January 2002 through May 2022. Forty articles were included, among which the primary interventions were quality improvement, training and education, evidence-based practice, device-assisted PI prophylaxis, nursing protocols, and clinical decision support systems. Twenty-three outcome indicators were summarised in 40 articles, which included 10 outcome indicators, seven process indicators, and six structural indicators. Furthermore, only five articles reported barriers in the process of implementing interventions. The common interventions to promote the implementation of PI prevention measures in nursing homes are quality improvement, training, and education. Relatively limited research has been conducted on evidence-based practice, clinical decision support systems, device-assisted PI prophylaxis, and nursing protocols. In addition, there is a paucity of studies examining the impediments to implementing these measures and devising targeted solutions. Therefore, it is recommended that future studies include analysis and reporting of barriers and facilitators as part of the article to improve the sustainability of the intervention. This article reminds nursing home managers that they should realise the importance of implementation strategies between the best evidence of PI prevention and clinical practice. Also, this review provides the types, contents, and outcome indicators of these strategies for managers of nursing homes to consider what types of interventions to implement in their organisations. The protocol of this scoping review was published as an open-access article in June 2022 (Yang etal., 2022).

Moving between doing and being-Meanings of person-centredness as narrated by nursing home managers. Aphenomenological hermeneutical study.

This study aimed to illuminate meanings of person-centredness as narrated by nursing home managers in nursing homes rated as highly person-centred. A phenomenological hermeneutical approach was used. Twelve nursing home managers in 11 highly person-centred nursing homes in 7 municipalities in Sweden were included in this interview study. The findings were interpreted, reflected and discussed through the lens of Ricoeur. Meanings of person-centredness could be understand as moving between doing and being through knowing, sensing, sharing and giving for person-centredness. These aspects contributed via knowledge, understanding, interaction and action that involved doing for and being with older persons through these caring dimensions. By moving between doing for, being with and being part of the overall nursing home narrative, knowing, sensing, sharing and giving could support the persons' identity in different ways. This may also contribute to sense-making, preserving dignity and promoting self-esteem when aiming to provide a good life for older persons in nursing homes, within an ever-present ethical frame. This study illuminated meanings of person-centredness as narrated by nursing home managers. No patient of public contribution was investigated.

U.S. nursing home leadership experiences with COVID-19 and its impact on residents and staff: A qualitative analysis.

To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff. Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach. A stratified sample frame defined by facility size (beds: 30-99, 100+) and quality ratings (1, 2-4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022. Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions. New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs.

Facilitators and barriers for using outdoor areas in the primary work tasks of eldercare workers in nursing homes

BackgroundEldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes.MethodsIn this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes’ outdoor environments to gain in-depth knowledge of eldercare workers’ and managers’ perspectives on using outdoor areas in their daily work. The data was thematically analysed using ‘The Behaviour Change Wheel’ (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas.ResultsFrequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents (‘star moments’), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas.ConclusionsThe identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers.Trial registrationAccording to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics).

Flanders Nursing Home (FLANH) project: Protocol of a multicenter longitudinal observational study on staffing, work environment, rationing of care, and resident and care worker outcomes.

While the demand for high quality of care in nursing homes is rising, it is becoming increasingly difficult to recruit and retain qualified care workers. To date, evidence regarding key organizational factors such as staffing, work environment, and rationing of care, and their relationship with resident and care worker outcomes in nursing homes is still scarce. Therefore, the Flanders Nursing Home (FLANH) project aims to comprehensively examine these relationships in order to contribute to the scientific knowledge base needed for optimal quality of care and workforce planning in nursing homes. FLANH is a multicenter longitudinal observational study in Flemish nursing homes based on survey and registry data that will be collected in 2023 and 2025. Nursing home characteristics and staffing variables will be collected through a management survey, while work environment variables, rationing of care, and care worker characteristics and outcomes will be collected through a care worker survey. Resident characteristics and outcomes will be retrieved from the Belgian Resident Assessment Instrument for long-Term Care Facilities (BelRAI LTCF) database. Multilevel regression analyses will be applied to examine the relationships between staffing variables, work environment variables, and rationing of care and resident and care worker outcomes. This study will contribute to a comprehensive understanding of the nursing home context and the interrelated factors influencing residents and care workers. The findings will inform the decision-making of nursing home managers and policymakers, and evidence-based strategies to optimize quality of care and workforce planning in nursing homes.

Nursing home managers' descriptions of multi-level barriers to leading person-centred care: A content analysis.

Research suggests that person-centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person-centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person-centred care. To explore barriers to leading person-centred care as narrated by nursing home managers. A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person-centred nursing homes. Data were analysed using content analysis. Multi-level barriers to leading person-centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers. Multi-level barriers influence nursing home managers' ability to lead and promote person-centred care. Promoting the development of person-centred practices requires efforts to eliminate barriers on person, team and organisational level. Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person-centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person-centred practices. Multi-level strategies are needed to target challenges at person-, team- and organisational level when striving to develop person-centred care.

First-Line Managers’ Perceptions of Their Psychosocial Work Environment in Nursing Homes: A Qualitative Analysis of the Influence of Ownership Type

In the wake of welfare sector reforms and the increasing marketisation of eldercare services, nursing home first-line managers (FLMs) are confronted with escalating work demands within streamlined organisations. Given this background, the aim was to investigate FLMs’ perceptions of their psychosocial work environment and of differences between nursing home ownership types. Nineteen managers from three Swedish municipalities from municipal, outsourced, and private nursing homes participated in semi-structured interviews focused on job demands, job resources, and ownership differences. The FLMs’ perceptions were interpreted as forming two themes. Navigating challenges: striving to cope with demands highlighted various challenges, including recruitment, workload, and lack of organisational support. Key stressors encompassed personnel struggles, time constraints, and complex interactions. Influence of ownership dynamics on the work environment explored variation across ownership types. Private nursing home managers enjoyed more decision-making autonomy but faced more scrutiny than did municipal ones. FLMs in outsourced homes described unique stressors, notably uncertainty and increased workload due to the procurement process. These findings underscore the potential need for tailored systemic changes across different ownership types. The policy implications include enhancing communication and support in municipal homes, reducing the span of control in private homes, and revising the procurement process in outsourced homes. These insights suggest that further research outlining differences between ownership types, particularly private and outsourced nursing homes, is warranted. Such research could aid in formulating specific strategies tailored to each ownership type in order to enhance the psychosocial work environment for FLMs in nursing homes.

Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study

BackgroundMore than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out.MethodsWe conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used.ResultsFear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia.ConclusionsAlthough the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.