Nursing Home Environment Research Articles

Exploring influencing factors to clinical leadership development: a qualitative study with healthcare professionals in Flemish nursing homes

BackgroundNursing homes face a critical need for competent healthcare professionals to deliver high-quality care. Focusing on clinical leadership is crucial for equipping healthcare professionals with the skills necessary to manage complex care needs, collaborate effectively within multidisciplinary teams, and improve care quality in nursing homes. Developing clinical leadership fosters professional growth and enhances healthcare professionals’ ability to tackle the challenges unique to the nursing home environment. However, the concept of clinical leadership in nursing homes remains poorly defined and investigated. This study aimed to explore and define influencing factors for the development of clinical leadership within healthcare professionals in nursing homes.MethodsA qualitative study was conducted in Flanders, Belgium, using semi-structured focus group interviews (n = 5) with healthcare professionals (n = 41), including nurse assistants, licensed practical nurses, registered nurses, occupational therapists, recreational therapists, psychologists, and gerontologists. Interviews were audio-taped, transcribed, analysed and interpretated by using a thematic analysis based on descriptive phenomenology.ResultsClinical leadership development within healthcare professionals’ hinges on four pivotal themes: (1) Cultivating an empowering working environment that fosters open feedback, encourages peer learning, and champions a stimulating learning climate. (2) Nurturing a supportive leadership style in formal leaders that exemplifies role modeling, accessibility, and a coaching approach. (3) Elevating well-developed professional identity through targeted training, experience, and a talent-oriented work approach. (4) Fostering team dynamics marked by commitment, collaboration, support, and trust.ConclusionsThe study’s findings on the influencing factors for clinical leadership development should be actively applied in nursing homes and guide the creation of targeted training programs and leadership development initiatives. Awareness of these factors are crucial to optimise and to support the development and implementation of clinical leadership in nursing homes in an attempt to reduce the workforce shortages.

Easing the Difficulty of Choosing a Nursing Home: Usability and Acceptability of Immersive Virtual Reality as a Spatial Presentation Tool for Older Adults

A suitable presentation of nursing home environments can assist older adults in efficiently understanding retirement living spaces and thereby making the right nursing home choice. This study focuses on exploring the potential of immersive virtual reality (IVR) applied to the display of nursing home environments. We compare IVR with photographs and 360° panoramas to detect the differences in presence, spatial perception, and technology acceptance among older adults. Findings suggest that IVR provides a more robust sense of presence and more accurate spatial estimation and detail memorization compared to the other two formats, and that there is a positive response at the level of perceived usefulness and willingness to use. In this study, the usability and acceptability of IVR as a spatial presentation tool for nursing homes was effectively demonstrated.

The palliative care experience in Irish nursing homes during the COVID-19 pandemic: a survey of residents, family, and staff

BackgroundNursing homes and other long-term care services account for a disparate share of COVID-19 cases and casualties worldwide. During COVID-19 there is a distinct need to preserve a holistic view of the wellbeing of residents of nursing homes, be mindful of their rights as citizens, and to be aware of protecting residents from infection. The delivery of health and social care throughout a pandemic must remain person-centred and adhere to a human rights-based approach.MethodsThis study aimed to capture nursing home residents, their families and staff’s perspective of the nursing homes residents experience, approaches of staff and the nursing home environment. An online survey was distributed via stakeholder networks and online platforms across Ireland. This study was performed and reported in line with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).Results25 residents, 42 family members and 51 staff completed the survey (n = 118). Across the domains measured all but one aspect scored above 50% (residents get up and go to bed when they want 41.5%) with the highest score of 89.1% scored for the nursing home is comfortable and well-kept. Results highlight evidence of positive experiences and endeavours to preserve social connections, residents were in a safe place cared for by staff who did their best in a difficult position and who went above and beyond their duty of care. However, some families reported poor communication, no internet connections, not enough phones or tablets, and that staff were busy and unable at times to assist residents who needed help using phones/tablets.ConclusionThis study highlights the importance of human rights and how they ought to inform and shape the advancement of public health advice and policy documents. Overall, nursing home residents, their families and staff reported favourably on the study measures. However, issues pertaining to communication are essential and there is a need to address issues such as the provision of accurate timely information, communication infrastructure and resources, and inconsistencies in communications. Of note is that while healthcare professionals have a duty to uphold the rights of nursing home residents, they themselves have human rights which must also be protected and supported.

Cross-Cultural Adaptation of the Scale of the Nursing Work Index With Nurses From Seven Countries

Background and Purpose:The aims of this study are as follows: to adapt and validate the psychometric properties of the Spanish version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) adapted to the nursing home environment across seven Spanish-speaking countries and to cross-culturally adapt the Scale of the Nursing Work Index with nurses from seven countries.Methods:Adaptation process and psychometric validation of the instrument included translation and back-translation, content validity, test–retest reliability, internal consistency, and construct validity.Results:A total of 134 nursing homes belonging to the same religious order were randomly selected from seven Spanish-speaking countries with a sample of 378 nurses. The exploratory factor analysis explained a five-factor structure (56% of the explained variance) with adequate goodness-of-fit indices in the final factor solution.Conclusions:The validation process indicates that the Spanish language version of the PES-NWI with five factors and 31 items, for long-term care facilities for the elderly, is valid and reliable in its current version and can be used to measure the environment of nurses working in clinical practice in Spanish-speaking nursing homes.

The Lives of Elderly Residents in Nursing Homes (Panti Jompo): Social Dynamics, Well-Being, and Challenges in Later Life

This study aims to examine the social dynamics, well-being, and challenges faced by elderly residents living in nursing homes. Using a qualitative approach, it explores the daily experiences of the elderly within the nursing home environment, including their social interactions with fellow residents, staff, and family members. The focus of this research is to understand how the elderly adapt to significant changes in their living environment and how social factors influence their emotional and physical well-being. The study also highlights the challenges faced by the elderly, such as feelings of loneliness, loss of independence, and limited access to healthcare facilities and social support. The findings of this research are expected to provide deeper insights into the needs and expectations of elderly residents in nursing homes and offer recommendations for policymakers and nursing home administrators to enhance the quality of life for the elderly. The conclusions emphasize the importance of creating an environment that fosters positive social interactions and provides holistic services to improve the well-being of the elderly in their later years.

LONG-TERM PAID CARE WORKFORCE: SHORTAGE, BURNOUT, TRAINING, TURNOVER, WHAT’S NEXT?

Abstract Although the long-term care workforce has struggled historically with staff satisfaction, safety, and retention, the pandemic triggered increased turnover and higher levels of staff burnout. As a result, many residential care organizations are using agency staff at unprecedented levels. Given that continuity of care is central to high-quality person-centered care, and the workforce should have access to a physically and psychologically safe environment, it is imperative that the gerontological research and practical community understand the changing conditions experienced by this workforce in crisis and offers solutions at the workplace, industry, and policy levels. In this symposium, authors explore different facets of paid long-term care workforce to stimulate thought and discussion. One paper contrasts the well-being of the workforce to that of the residents during COVID-19. A second paper presents workforce management capabilities and strategies and posits essential questions for the capacity of management and leadership needs of the workforce. Two papers highlight the struggles that are presented as paid long-term care relies increasingly on contract, short-term workers. Paper three discusses how the use of the contract workforce does not support the provision of person-centered care for conditions like dementia. Paper four uses payroll-based journal data to delve into short and long-term use of contract workforce and discusses the nature of contract staffing, and considers how contract staffing may be disruptive to both the direct care worker and the nursing home environment. The discussant will draw out the policy and practice implications arising from the papers. This is a collaborative symposium between the Aging Workforce and Paid Caregiving Interest Groups.

EVALUATION OF DEMENTIA EDUCATION TRAINING IN GEORGIA NURSING HOMES

Abstract The increased use and misuse of antipsychotics and psychotropics in nursing homes have been well documented. Person-centered dementia care training that addresses skill development and practice change around communication strategies and non-pharmacologic approaches has the potential to impact the misuse of these drugs as chemical restraints. The goal of this study is to implement and evaluate an online team-based dementia education (Dementia Beyond Drugs: Changing the Culture of Care) program aimed at skill development and practice change. The program was delivered online over six weeks to teams of nursing home staff for a total of 12 hours of synchronous interactive learning. Teams were also assigned application exercises between meetings. Topics included “dementia, dementia beyond drugs, interpersonal approaches, and understanding personal expressions.” This study implemented the training with staff teams from 22 nursing homes in Georgia (N=97). Pre-post data analysis reveals a significant improvement in the nursing home environment and relationships as measured by the Kansas Culture Change Instrument, and increased attention to the use of antipsychotic drugs in staff meetings. This study indicates that team-based online learning has the potential to improve person-centered dementia care practices and attention to the use of non-pharmacological approaches to address behavioral expressions of residents living with dementia. Future research is needed to expand person-centered dementia care education programs to more nursing homes and evaluate their short and long-term effectiveness.

Personalised activity cards, goal‐directed daily (physical) activity and rest‐activity rhythm in institutionalised persons living with dementia

AbstractBackground(Physical) inactivity and disturbances in the rest‐activity rhythm (e.g. more daytime sleeping and more night‐time restlessness) are common in institutionalised persons living with dementia (iPwD). Both are associated with worse quality of life (QoL), which underlines the need for non‐pharmacological interventions. The purpose of this study was to examine if the implementation of personalised activity cards (PACs) could enhance the amount of time spent on goal‐directed daily (physical) activities and improve the rest‐activity rhythm in iPwD.MethodThis prospective longitudinal quasi‐experimental multicentre study was conducted on 11 wards in 8 nursing homes in the Netherlands. The intervention consisted of PACs, a structured method for offering personalised activities based on input from (professional) caregivers. The PACs were implemented on 5 wards. The other 6 wards received care as usual (control group). Intervention compliance was checked every two weeks with an online survey. Outcome variables included minutes spent on goal‐directed daily (physical) activity as measured with an adjusted version of the Physical Activity Survey in Long‐Term Care (PAS‐LTC; observations by researchers), and rest‐activity rhythm was assessed using Actiwatch activity monitors. Outcomes were assessed at baseline (T0), and after 12‐15 weeks (T1).ResultWe analysed the data of 84 iPwD; intervention group: n = 35, control group: n = 49 (Table 1). Intention‐to‐treat mixed model analyses showed no significant interaction effects of the intervention (group × time) on goal‐directed daily (physical) activity and rest‐activity rhythm variables (Table 2). One ward in the intervention group did not implement the PACs. The four wards that did implement the PACs reported diverging percentages of the execution of planned activities, even as low as 33.5% (range 33.5‐74.2%). The most reported reason for not executing activities on the PACs was that employees were too busy.ConclusionContrary to our expectations, implementing PACs did not show any effect on goal‐directed daily (physical) activity in iPwD. The lack of improvement in activity level might be an explanation for the lack of improvement in rest‐activity rhythm. These findings support previous research that it can be difficult to implement new methods in the nursing home environment, and underline the importance of more implementation research

Role of the contaminated environment in transmission of multidrug-resistant organisms in nursing homes and infection prevention

With aging of the population in the United States, there are more people in long-term care facilities than in hospitals. Nursing home residents have a high prevalence of colonization with multidrug-resistant organisms (MDROs). A shared environment with vulnerable patients can facilitate intra- and inter-facility transmission of MDROs. The aim of this paper is to examine the role of the nursing home environment in MDRO transmission and provide infection prevention strategies. We searched the published literature and reviewed selected articles on contamination, transmission, and infection associated with the nursing home environment. Nursing home residents were frequently colonized with MDROs, leading to contamination of the surrounding environment with the same pathogen. Surface contamination with MDROs was common in nursing home patient rooms, and to a substantial but lesser frequency in common rooms. Shared rooms were a risk factor for MDRO transmission between patients. Since outbreaks and infections via the environmental contamination cause substantial burden of morbidity and mortality in the nursing home residents, it is essential for healthcare personnel to recognize the role of the nursing home environment in infection transmission and adhere to the current infection prevention guidelines for cleaning and disinfection of environmental surfaces.

The NASEM Report: Are the Solutions Part of the Problem?

The NASEM Report: Are the Solutions Part of the Problem?

Mitigating Weight Stigma in Long-Term Care With Trauma-Informed Principles

Mitigating Weight Stigma in Long-Term Care With Trauma-Informed Principles

Comparisons on factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes: a qualitative study

BackgroundStudies revealed that supporting residents fulfilling self-determination is positively associated with their health, wellbeing and quality of life. Cross-cultural care poses significant challenges for nursing home residents to fulfil their self-determination in control of own care and maintaining meaningful connections with others. The aim of the study was to compare factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes.MethodsA qualitative descriptive approach was applied to the study. Culturally competent care and person-centred care were employed as guiding frameworks. Individual interviews or a focus group with residents and family members were conducted to collect data.ResultsIn total, 29 participants participated in the study. Three main themes were identified: communicating needs and preferences; mastering own care; and maintaining meaningful relationships. Each theme includes sub-themes that detail similarities and differences of factors affecting residents fulfilling self-determination in the two type nursing homes. Findings indicate that residents from both types of nursing homes experienced challenges to communicate their care needs and preferences in daily care activities. Moreover, residents or their representatives from both types of nursing homes demonstrated motivation and competence to master residents’ care based on their individual preferences, but also perceived that their motivation was not always supported by staff or the nursing home environment. Residents’ competence in mastering their care activities in ethno-specific nursing homes was based on the condition that they were given opportunities to use a language of choice in communication and staff and the nursing home demonstrated culturally competent care for them. In addition, ethno-specific nursing homes showed more recourse to support residents to maintain meaningful relationships with peers and others.ConclusionsCulturally competent care created by staff, nursing homes and the aged care system is a basic condition for residents from ethnic minority groups to fulfil self-determination. In addition, person-centred care approach enables residents to optimise self-determination.

Evaluating Policies to Decrease the Risk of Introducing SARS-CoV-2 Infections to Nursing Home Facilities.

We used an individual-based microsimulation model of North Carolina to determine what facility-level policies would result in the greatest reduction in the number of individuals with SARS-CoV-2 entering the nursing home environment from 12/15/2021 to 1/3/2022 (e.g., Omicron variant surge). On average, there were 14,287 (Credible Interval [CI]: 13,477-15,147) daily visitors and 17,168 (CI: 16,571-17,768) HCW coming from the community into 426 nursing home facilities. Policies requiring a negative rapid test or vaccinated status for visitors resulted in the greatest reduction in the number of individuals with SARS-CoV-2 infection entering the nursing home environment with a 29.6% (26.9%-32.0%) and 24.0% (CI: 22.2%-25.5%) reduction, respectively. Policies halving visits (21.2% [20.0%-28.2%]), requiring all vaccinated HCW to receive a booster (7.8% [CI: 7.4%-8.7%]), and limiting visitation to a primary visitor (6.5% [CI: 3.5%-9.7%]) reduced infectious contacts to a lesser degree.

Psychosocial changes during COVID-19 lockdown on nursing home residents, their relatives and clinical staff: a prospective observational study

BackgroundPrevious works have observed an increase of depression and other psychological disorders on nursing home residents as a consequence of coronavirus disease 2019 (COVID-19) lockdown; however, there are few studies that have performed a comprehensive evaluation of all people involved in nursing homes environment. The objective of the work was to analyse the impact of lockdown on psychosocial factors of nursing home residents, relatives and clinical staff and how these variables have influenced residents’ survival.MethodsA prospective study was designed. Evaluations were performed at three different times: a) at the beginning of Spanish confinement, in March 2020; b) just before the second wave of the pandemic, with relaxation of security measures but in lockdown, and c) in January–February 2021, at the end of the second wave, when visits were already allowed. The study was conducted on three different nursing homes. Three hundred and one residents, 119 clinical staff and 51 relatives took part in the study. Anxiety and depression were evaluated in all participants. A scale on the meaning of suffering was also performed. In addition, burnout status was also determined in the clinical staff.ResultsAll participants showed lower depression during lockdown, while at the beginning and at the end of the confinement, these values were significantly increased. In residents, these changes were dependent of cognitive status (p = 0.012). Anxiety was significantly higher in residents. The evolution of anxiety was similar than with depression, with lower values during confinement, although clinical staff showed higher anxiety levels at the beginning. The feeling of suffering was significantly lower in the clinical staff than in resident and relative groups. Residents’ survival was dependent of cognitive status (p = 0.018) and voluntary confinement (p < 0.001).ConclusionsDuring the first COVID-19 lockdown, psychological wellbeing of residents cared in nursing homes, their relatives and staff did not seem to be seriously affected. Previous mental health in relatives and staff together with a resilient approach to the adversity might partly be protecting factors. The lack of consequences on residents’ anxiety, depression and perception of social support may reflect the special attention and care they received. Finally, as in the current study only data of the first two COVID-19 waves were analysed, its findings might be partly generalized to all the pandemic.

Optimization of Power Usage in a Smart Nursing Home Environment

This article presents a case study of using self-cognizant prognostics for the management of three key areas in a nursing home where a substantial proportion of power consumption is spent in a typical nursing home environment. Using a power-efficient monitoring system, our case study covers smart lighting, air conditioning, and meal preparation, with the aim of reducing the cost of operation through more efficient use of energy with smart and assistive technologies. The results show an overall enhancement of approximately 10% in energy efficiency while offering a safe environment for elderly patients in a smart nursing home.

The role of open space and green areas in the design of an inclusive nursing home environment during Covid-19 period

The paper highlights the importance of high-quality outdoor spaces in improving physical and social well-being in the residential environment of the elderly. The historical Swedish practice of green areas design was analysed as a role model to gain knowledge and understanding of the importance of open space and green areas in residential environments. During the Covid-19 pandemic, nursing homes were among the most critical living environments, as evidenced by a disproportionate number of infections and deaths among nursing home residents worldwide. The main objective of this study is to confirm the importance of architectural design quality with special attention to outdoor space, especially in situations comparable to Covid-19 pandemics. The methods used for the research were a literature review, selection of three case studies based on two dependent and one independent variable, on-site work analysis and use of the previously developed “Safe & Connected” assessment tool. The main findings show the positive influence of open space and green areas existence on reducing the risk of infections of SARS-CoV-2 in nursing homes at three different levels. In this context, it appears that the appropriate design of outdoor space can help contain the spread of viral infections while allowing nursing home residents to live with dignity and maximum social integration.

Family members' reasoning in relation to pleasant environments in nursing homes.

The physical environment plays an important role in how everyday life is shaped and experienced for persons living in nursing homes as well as for the residents' family and friends. Still, there is a scarcity of research exploring the perspectives of family members of residents regarding everyday life in common areas in nursing homes. In this study, we chose the term, 'a pleasant place', with the ambition of remaining open to various ideas and aspects that family members perceive as relevant when reasoning about the nursing home environment. The study aimed to explore how family members of nursing home residents reason in relation to pleasant places in nursing homes. Four focus group sessions were conducted with a total of 14 family members. Data were analysed using qualitative content analysis. The analysis resulted in four themes. 'A door ajar', highlighted the importance of a nursing home environment that provides potential opportunities for pleasurable everyday moments. 'Why does it have to be so ugly?', revealed how family members perceived institutional logics as guiding the design of the nursing homes, which were misaligned with the logics of a pleasant place. 'A place to care for?', emphasised the physical environment as an integrated aspect of care, in terms of being carefully arranged and used with sensitivity. Finally, 'allegiance to the place' showed that despite the family members' recognitions of shortcomings in the nursing home physical environments, their allegiance to the place provided a sense of the nursing home as a pleasant place. The study contributes knowledge regarding the perceived value of the design of the physical environment in nursing homes, particularly in common areas, as an integral aspect of care, and moves beyond the ideas of homelike and non-institutional nursing home environments.

Conceptualizing violence in nursing home policy: A citizenship perspective

Violence is a pervasive, yet often hidden, issue within nursing homes, affecting residents, family members and care workers. Critical exploration of embedded understandings of violence within public policies can provide important insights into how violence is viewed and addressed in nursing home environments as well as the implications of violence for different groups and alternative ways of framing and addressing violence. To this end, this study explored how violence is conceptualized within 45 nursing home policy texts from two Canadian provinces - Manitoba and Nova Scotia. Using a critical policy analysis approach and a citizenship lens, we identified four dominant constructions of policy ‘targets’ associated with specific rights and conceptualizations of violence. Policy documents construct residents as either vulnerable and in need of protection or as challenging and requiring behavior management. Care workers are constructed as either clinical risk managers, responsible for mitigating violence, or as employees with rights and responsibilities. Overall, violence prevention policies governing nursing homes are fragmented and convey conflicting conceptualizations of violence, associated with divergent rights and responsibilities. Our findings highlight the need for comprehensive violence prevention policies that affirm the rights of nursing home residents and care workers alike.

The Role of the Built Environment on the Quality of Life for Residents in Long-Term Care Facilities in Asia: A Scoping Review.

Background and ObjectivesThe quality of the built environmental features in long-term care (LTC) homes significantly influences residents’ functioning (e.g., wayfinding, self-care, and social interaction) and well-being. There is limited research on the characteristics of the built environment of LTC and its influence on residents’ quality of life in countries in the Asia–Pacific region (e.g., East Asia and South Asia). The older adult population in this region is expected to increase significantly in the coming decades. There are distinctive perceptions of nursing home, nursing home environments, and sociocultural norms in this geographic region. Given this context, a better understanding of the built environment of LTC facilities in this region can inform design professionals and policymakers for evidence-based decision-making. The present study undertakes a scoping review of the empirical research on the characteristics and influence of the built environment of LTC facilities on residents’ quality of life in the Asia–Pacific context.Research Design and MethodsOnline relevant databases were used to identify articles published 2000–2021, from which we selected 33 publications.ResultsThree substantive themes were generated from the synthesis of the selected publications. These themes are (a) perceptions of nursing home, (b) impact of the built environment on residents’ quality of life, and (c) assessment of the LTC built environment.Discussion and ImplicationsWe identified research gaps in understanding the role of the built environment in nursing homes in the particular geographic context and future research directions. Five planning and design principles for LTC were derived from the synthesis of key findings to inform design professionals and policymakers.

No place like home - Or is there? Extended transformational potential of nursing homes during vital conjunctures.

The purpose of this study is to explore how the concept of 'feeling at home' manifests in nursing home environments and influences the transformational potential of such homes-servicescapes where customers experience vital conjunctures. Recent research on places highlights the potential of service venues as places that can promote well-being. Nursing homes bridge the concepts of 'home' and a service with transformational aspirations. Moving to a nursing home can be regarded as a vital conjuncture, yet despite the resultant mixed emotions, nursing homes can generate positive changes and meaningful relations. DESIGN; METHODS: A qualitative field study with ethnographic features was conducted in two Finnish nursing homes. The data consist of observations and 64 semi-structured interviews. COREQ guidelines were followed. 'Feeling at home' is built on: (1) artefacts and surroundings, (2) functions and activities and (3) relationality and atmosphere. A home-like experience related to each category is important in enabling customers to feel at home, thus assisting in dealing with the vital conjuncture, but the transformative power of nursing homes is linked most closely to respectful, kind attendance of the others and a positive atmosphere. The roles of nurses and a homely servicescape are essential in dealing with residents' vital conjunctures, whether those residents employ resistance or adjustment coping methods. Positive transformations that evoke residents' re-balancing and well-being are enabled in nursing homes that support residents' important relationships, identity, safety and self-efficacy. This positive transformation also aids family members with their associated vital conjunctures, thus multiplying the service's transformational potential. Service users and caregivers were involved in the design and conduct of the data in this study. Creating a homely atmosphere in nursing homes fosters not only residents' but also family members' re-balancing and well-being.