Nursing Home Managers Research Articles

Exploring mentorship practices in clinical education in nursing homes: A qualitative mixed-methods study.

To explore registered nurses' mentorship practices of first-year nursing students in nursing home placements. Enabling nursing students to develop professional competence through clinical placements relies heavily on registered nurses' mentorship practices. Despite renewed interest in nursing homes as an important clinical placement setting, studies are scarce on registered nurses' mentorship practices in this context. An exploratory, qualitative mixed-methods design. The data consisted of 126h' observation of two registered nurse mentor-student dyads, supplemented by in-depth interviews (n=12) with registered nurse mentors. The data were collected in three Norwegian nursing homes and analysed using content analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist were used to report the findings. The registered nurses' mentorship practices of first-year nursing students in nursing home clinical placement were characterised by (1) variability and uncertainty in pedagogical supervisory approaches, (2) lack of management support and engagement of staff members in supervision, (3) lack of supervisory continuity and (4) a peripheral role in formal assessment discussions. A marginal nursing home context, alongside a mismatch between registered nurses' roles and first-year students' learning objectives, introduces considerable vulnerability that impedes effective mentorship practices. Targeted efforts to enhance mentorship practices in nursing homes are warranted to promote full use of the learning potential in this context. Developing and testing educational interventions is necessary to effectively enhance registered nurses' pedagogical competence, alongside engagement and support from nurse managers and nurse educators. This study provides insight into barriers to effective mentorship practices of first-year nursing students in nursing home placements. These barriers warrant attention from nursing home managers and nurse education institutions towards improvements that enhance effective mentorship practices vital for students' learning, professional growth and future recruitment to care for older people.

Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes.

Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic has become a challenge for nursing homes in China. Nursing homes are particularly dangerous places in terms of the spread of COVID-19 given that they house vulnerable, high-risk populations. As such, several useful guidelines for coping with COVID-19 in nursing homes have been provided. However, the actual implementation rates of such guidelines are unknown. This study aims to document the adherence of nursing homes to the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes.MethodsA cross-sectional study was conducted among 484 nursing homes in 136 cities of 28 provinces in China. A self-report questionnaire was created based on the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes (first edition). The questionnaire and the Transformational Leadership in the Public Sector Scale were sent to nursing home managers via the Wenjuanxing app online from February 7 to 29, 2020. Ultimately, 461 of 960 nursing homes participated, for a response rate of 48.0%.ResultsThe average overall implementation rate of COVID-19 prevention and control measures was 80.0% (143.97/180). The average implementation rates for hygienic behaviour management and access management were lower, at 75.3 and 78.7%, respectively. Number of medical staff and transformational leadership score of nursing home’s manager were associated with total implementation score (p < 0.05). A total of 69.8% (322/461) of the nursing home managers had serious resource problems, and inadequate protective supplies (72.0%) and staff shortages (47.7%) were the two primary problems. The nursing homes that located in urban, with large nursing home size, had hospital-nursing home cooperation and the transformational leadership score of manager> 60, had a lower risk of having serious resource problems.ConclusionsOverall, the implementation of prevention and control measures by nursing homes are insufficient during the epidemic in China. More medical staff, adequate resource, cooperation with hospitals, and higher transformational leadership of manager are required to improve the implementation rate. It is urgent for nursing homes to maintain the safety of residents and staff.

Sexually Transmitted Diseases Among Residents in Nursing Homes: The Nurses' Perspective

Background: Examining registered nurses' perceptions of sexually transmitted disease (STD) education among residents in nursing homes allows for broader insight into why STDs continue to increase among older adults. Methods: A 4-page pilot survey was mailed to nursing home directors of nursing in Northwest Ohio (n=99) with a response rate of 32%. Directors of nursing were the target population as they are the most likely employee to hold registered nurse licensure. The health belief model formed the basis for the survey. Results: Most nurses did not see STDs or human immunodeficiency virus (HIV) as problems among their residents (100% and 96%, respectively) yet support for sex among residents was high. All (100%) agreed sex among married residents should be supported, while 77% agreed sex among nonmarried residents should be supported. Most nurses stated they were comfortable discussing HIV risk (84%), STD risk (84%), erectile dysfunction (75%), sexual desire and intimacy (72%), and correct condom use (66%). The most commonly reported perceived barriers to STD education were family opposition (63%), resident embarrassment (56%), and lack of education regarding the prevalence of STDs in older adults (53%). The most commonly reported perceived benefits to STD education were being seen as a leading facility for healthy initiatives (66%) and promotion of healthy sexual relationships among residents (56%). Conclusion: There was strong support for STD education among nurses though implementation remains rare. Addressing the most commonly perceived barriers and benefits may prove beneficial in increasing the number of LTCFs that provide STD education to residents.

Everyday life in a Swedish nursing home during the COVID-19 pandemic: a qualitative interview study with persons 85 to 100 years

ObjectiveTo understand and report on the impact of the COVID-19 pandemic on the everyday lives of frail older persons living in nursing homes by exploring their experiences of how the...

Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers

BackgroundTo support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care.MethodsWe conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript.ResultsSix dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention».ConclusionsTo support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.

Exploring Leadership, Stress of Conscience, and Person-Centered Care in Nursing Homes

On a daily basis, many care situations contain difficult issues and challenges for care providers. Stress of conscience, such as feelings of guilt, can be experienced by staff when not fulfilling ethical obligations to the residents. Although leadership has been advocated as a key component for staff work perceptions as well as for person-centred care, the impact of nursing home managers’ leadership on levels of stress of conscience among staff and the extent to which person-centred care (PCC) is provided is yet to be explored. Thus, the aim was to explore the relationship between leadership, stress of conscience and PCC as perceived by staff. The study was based on a cross-sectional national survey of 3084 staff and their managers in 189 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. The preliminary results showed that leadership was negatively associated to stress of conscience and positively associated to PCC. PCC were negatively associated to stress of conscience. Additional findings will be presented. This indicates that nursing home managers’ leadership seem to beneficially impact staff work situation in terms of stress of conscience and person-centred care provision.

COVID-19 Infections in Long-Term Care Facilities in Wuhan, China: Challenges and Lessons

The impact of the COVID-19 infection on older residents and the direct frontline workers in long-term care (LTC) facilities in Wuhan, China deserves close attention. The fatality rate for older residents infected by the COVID-19 is among the highest in China Viral outbreaks are likely to occur in LTC facilities due to group-living arrangements, lack of precautionary measures, and older residents’ vulnerability to diseases. In this study, we aimed to explore different stakeholders’ experiences and challenges in the midst of the spread of the virus in LTC facilities. We conducted telephone interviews with four groups from two LTC facilities and two hospitals: twelve older residents (Four suspected cases and two infected), ten family members, four direct frontline workers (two infected), two nursing home managers, and four health care professionals working in the two hospitals that infected older residents were transferred to. We found that the gap in the transition of care quality between LTC facilities and local hospitals was widened during the COVID-19 outbreak. LTC facilities were slow to take precautionary measures and underprepared to handle the crisis after the infections occurred. The wellbeing of older residents was significantly impacted during the transition, particularly for those with dementia. Health care professionals in local hospitals were under tremendous stress providing treatments for older residents while ensuring their safety. There is an urgent need to improve transitional care and the capacity in preventing and handling this type of crisis for older residents in LTC.

Everyday Life in a Swedish Nursing Home During the COVID-19 Pandemic: The Safest Isolation in the World?

Background: Older people living in nursing homes have been defined as one of the risk groups for severe COVID-19, due to their high age and frailty. Yet, there is a notable paucity of empirical research specifically relating to how older people themselves experience the threat of the virus and the pandemic. Close to nothing is known on what impact pandemic-related restrictions have had on the everyday life of older persons in nursing homes, and this study therefore set out to explore everyday life in a nursing home during the COVID-19, as experienced by the people living there.Methods: A random sample of 10 persons aged 85 to 100 years, living in a nursing home in an urban setting in Sweden were interviewed in June 2020. The nursing home was publicly run and had been impacted by visitor restrictions, cancelled activities and physical distancing requirements since March 2020. The participants were recruited through nursing home management and were interviewed over a two-week period using medically approved visors and physical distancing. The interviews were analysed using thematic analysis, which involves familiarisation, coding and definition of themes.Findings: The nursing home represented a bubble, protecting the persons living there from the virus but isolating them from the outside world. The older persons felt taken care of and lived one day at a time, without fear of the virus, but they also felt that they were in the hands of others, and they had lost the opportunity to do what really mattered.Interpretation: The findings provide empirical support for negative consequences of visitor restrictions, physical distancing and cancelled activities for people living in nursing homes. This knowledge could be applied internationally to understand how to support meaningfulness and health in everyday life despite strict restrictions to diminish the risk of contracting SARS-CoV-2.Funding: The Swedish Research Council for Health, Working Life and Welfare (FORTE).Conflict of Interest: None declared.Ethical Approval: Ethical approval was obtained from The regional ethical board in Gothenburg (ref. no. 813-18).

The Impact of Leadership Styles on Quality and Financial Performance in High Medicaid Nursing Homes

This study examines the association between leadership styles on resident quality and financial performance in under resourced nursing homes (70% or higher Medicaid census). The Bonoma/Slevin leadership model was used to classify managers into four categories, autocrat, consultative autocrat, consensus manager, and shareholder manager. Survey data from 391 nursing home directors (response rate of 37%) from 2017- 2018, were merged with secondary data from LTCFocus, Area Health Resource File, Medicare Cost Reports, and Nursing Home Compare. Two models were ran to examine the effect of leadership styles on the dependent variable(s) nursing home STAR data (quality) and operating margin (financial performance). The independent variables were composite scores for leadership styles, with autocrat as the reference group. Control variables included organizational (ownership, chain affiliation, size, occupancy, payer mix, staffing, and race/ethnicity), and county factors (Medicare Advantage penetration, per capita income, poverty, education, unemployment, and competition). Multivariate regression was used to model the relationship between leadership styles and nursing home quality and financial performance. The consultative autocrat was associated with lower quality (p < 0.05), while the consensus manager was associated with lower profit margin (p < 0.05), as compared to autocratic leadership. The consultative autocrat, who solicits information from the staff yet still makes all significant decisions, is associated in lower quality; however, a consensus manager, who delegates their authority to the group, is associated with lower financial performance. Under-resourced nursing homes who face dual pressures need to recognize trade-offs of different decision making styles for quality and financial performance.

React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse

BackgroundElder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse.MethodsA qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses.ResultsNursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken.ConclusionsNursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate.

The relationship of nursing home price and quality of life

BackgroundKnowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes.MethodsThe data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question.ResultsThe multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes.ConclusionOur findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.

The Psychological Consequences of the COVID-19 on Residents and Staff in Nursing Homes.

In this commentary, we overview the existing research on psychological consequences caused by COVID-19 for both residents and staff in the nursing homes. We identify loneliness and emotional anxiety as main psychological consequences for nursing home residents, whereas uncertainty, hopelessness, work overload, and role conflicts are the most salient psychological challenges for the staff in the nursing homes during the pandemic. We then summarize the existing strategies and interventions responsive to the above challenges. We suggest that this overview may help nursing home managers understand what are the key psychological challenges and how to deal with them during a crisis period. Finally, we also encourage future research to pay more attention to exploring interventions specifically designed for vulnerable older people, understanding the role of the nursing home leader team in managing emotional and ethical challenges in organizations, and developing community-wide collaboration with multiple external stakeholders.

How do performance gaps shape managerial strategy? The role of sector-differences in U.S. nursing homes

Despite the high volume of literature on managerial strategy, few studies have explored how performance gaps shape managerial strategy, particularly across sectors. Emerging studies indicate that different risk preferences, market competition, and financial incentives across sectors play important roles in shaping managerial strategy in response to performance gaps. Using U.S. nursing homes, this study examines how performance gaps shape prospecting and defending strategies, and whether the relationship is contingent on sector. The findings indicate that nursing home managers are more likely to be prospectors when they outperform past performance or other competitors. When considering sector-differences, this finding is consistent in only for-profit nursing homes. Regardless of performance gaps, for-profit nursing homes are also more likely to adopt a defending strategy compared to their nonprofit or public counterparts. The findings suggest that sector-differences should be carefully considered to understand the impact of performance gaps on managerial strategy.

Nursing home leaders' perception of factors influencing the reporting of elder abuse and neglect: a qualitative study

PurposeThe purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice.Design/methodology/approachA qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses.FindingsBoth ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect.Originality/valueThis paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

Improving oral health in nursing home residents: A process evaluation of a shared oral care intervention.

To evaluate the process of implementing an oral care intervention in nursing homes in a Danish municipality. Older people with aged natural dentition require preventive and curative oral health care. An intervention based on principles of situated learning was implemented to establish closer cooperation between dental and nursing staff in nursing homes, leading to improved oral hygiene in nursing home residents. An embedded multiple-case study combined with principles of realist evaluation unfolded in three phases: Formulation of initial programme theory, Testing and Refining the programme theory. The COREQ checklist is followed in reporting. Observations, six group interviews and 22 face-to-face interviews with dentists, dental practitioners, nursing home managers, care professionals and residents were conducted in three nursing homes (n=41). Three main outcomes of a programme theory were identified, relating to (a) residents, in the form of new oral care routines; (b) interdisciplinary working, in the form of professional pride in performing sufficient oral care; (c) organisational level changes, in the form of increased interdisciplinary knowledge sharing. The overarching supportive mechanisms were the creation of relationships between residents, dental practitioners and care professionals as well as nursing home management taking responsibility for structure, planning and knowledge sharing. The situated learning perspective supported residents and care professionals' competencies in performing sufficient oral care. The shared oral care intervention supports an individual and multidisciplinary assessment of nursing home residents' ability to self-care concerning oral care. Contextual factors, supportive and restraining mechanisms influence the intervention's success. Understanding the complexity within interdisciplinary cooperation in primary nursing and unravelling the necessary properties to enhance nursing home residents' oral health care are areas of improvement for care service in nursing homes.

Managers Shaping the Service Triangle: Navigating Resident and Worker Interests Through Work Design in Nursing Homes

Managers play a key role in shaping the service triangle and navigating stakeholder interests within this. In health care, labor shortages are prompting consideration of the consequences of care delivery for service users and staff. Here, the authors consider how senior nursing home managers tasked with balancing resident and worker interests manage tensions using work design. The findings identify a five-cluster typology, reflecting variations in how managers from 20 Flemish nursing homes operationalize the same resident-centered care model. Managers purposively shape a different service triangle in each operationalization, variously prioritizing benefits for residents, seeking the golden mean, or attempting to suppress tensions.

Use of Notification and Communication Technology (Call Light Systems) in Nursing Homes: Observational Study.

BackgroundThe call light system is one of the major communication technologies that link nursing home staff to the needs of residents. By providing residents the ability to request assistance, the system becomes an indispensable resource for patient-focused health care. However, little is known about how call light systems are being used in nursing homes and how the system contributes to safety and quality of care for seniors.ObjectiveThis study aimed to understand the experiences of nursing home staff who use call light systems and to uncover usability issues and challenges associated with the implemented systems.MethodsA mix of 150 hours of hypothetico-deductive (unstructured) task analysis and 90 hours of standard procedure (structured) task analysis was conducted in 4 different nursing homes. The data collected included insights into the nursing home’s work system and the process of locating and responding to call lights.ResultsThe data showed that the highest alarm rate is before and after mealtimes. The staff exceeded the administration’s expectations of time to respond 50% of the time. In addition, the staff canceled 10.0% (20/201) of call lights and did not immediately assist residents because of high workload. Furthermore, the staff forgot to come back to assist residents over 3% of the time. Usability issues such as broken parts, lack of feedback, lack of prioritization, and low or no discriminability also contributed to the long response time. More than 8% of the time, residents notified the staff about call lights after they waited for a long time, and eventually, these residents were left unattended.ConclusionsNursing homes that are still using old call light systems risk the continuation of usability issues that can affect the performance of the staff and contribute to declining staff and resident outcomes. By incorporating feedback from nurses, nursing home management will better understand the influence that the perceptions and usability of technology have on the quality of health care for their residents. In this study, it has been observed that the call light system is perceived to be an important factor affecting the outcomes of the care process and satisfaction of both residents and staff as well as the staff’s performance. It is important to recognize that communication and notification technology contributes to the challenges the staff faced during their work, making their working conditions more difficult and challenging.

The Effect of Hands-on Practice on the Skills Proficiency of Nursing Home Nurses

Background: The most recent nursing home regulations indicate that nurses must possess the skills sets needed to properly provide residents’ care (“Reform of Requirements,” 2016). Nursing home directors of nursing (DONs) frequently meet the requirement to train their nurses using online continuing education programs. However, the hands-on practice of fundamental clinical nursing skills necessary to maintain proficiency cannot be accomplished with this method. Purpose: This study aimed to determine whether an educational intervention including hands-on practice of two clinical skills would improve the skills proficiency of nursing home nurses. Method: The study used a pretest-posttest design with skills fair-style educational intervention for nursing home nurses recruited from two nursing homes. The pretest and posttest each included a multiple-choice quiz and hands-on demonstrations of two different clinical skills. Statistical analysis using paired t-tests showed significantly improved skills proficiency for the participating nurses following the educational intervention with hands-on practice of the two clinical skills. Findings: The findings suggest that nursing home DONs should consider educational interventions that include hands-on practice to maintain clinical skills proficiency.

Nursing home staff\u2019s perspective on end-of-life care of German nursing home residents: a cross-sectional survey

BackgroundNursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany.MethodsA cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested.Results486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement.ConclusionsTogether with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.