Nursing Home Wards Research Articles

Effectiveness of the ‘SELF-program’ on nurses' activity encouragement behavior and nursing home resident's ADL self-reliance; a cluster-randomized trial

BackgroundNurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the ‘SELF-program’: a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents. ObjectiveThe aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living. MethodThe program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported. ResultsTwenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88–8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67–7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = −0.25; p = .07; 95 % CI -2.21 – 0.09) and at six months (d = −0.29; p = .07; 95 % CI -3.22 – 0.11). ConclusionThe SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation. Trial-registrationThe study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.

Students’ experiences with a hybrid learning environment in nursing homes: A qualitative study

AimThe aim of this study is to explore how students experience learning in a hybrid learning environment in a nursing home setting and their perceptions of relationship-centred care. BackgroundNursing homes are undergoing a culture shift from task-centred care to person- and relationship-centred care, requiring a different approach to how nursing home staff work and are educated. Hybrid learning environments aim to educate professionals who continuously work on their professional development by integrating and merging learning and working to facilitate the culture shift. DesignAn exploratory qualitative study design was used. The setting were nursing home wards organised according to a hybrid learning environment located in the Netherlands. Participants were students in two-year training for nurse assistants, three-year training for certified nurse assistants, or four-year training for vocationally trained registered nurses. Data were collected through semi-structured interviews and focus groups. Data were analysed using direct content analysis. ResultsAnalysis revealed three themes regarding how students experienced learning in the hybrid learning environment: 1) design of the learning process, 2) disconnection between working and learning and 3) learning resources. Regarding how learning in the hybrid learning environment influences students’ perceptions of relationship-centred care analyses revealed two themes: 1) recognising the essence of relationship-centred care and 2) overstaffing and student–resident interaction. ConclusionsThe hybrid learning environment in a nursing home setting remains underdeveloped. By considering some improvement points (e.g., clarity of the role of work supervisor and students’ awareness of learning while executing daily tasks), the hybrid learning environment can promote a shift from working task-centred to working relationship-centred. Additionally, students must grasp the essence of the concept of relationship-centred care and need support in developing reflection skills to provide it.

Hand hygiene compliance in nursing home wards: The effects of feedback with lights on alcohol-based hand rub dispensers

Hand hygiene (HH) among healthcare workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS). A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off.

Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub

Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant+18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and+13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean+27 percentage point difference (P < 0.0001). Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.

Surveillance of Infections and Antibiotic Use in 21 Nursing Home Wards during the COVID-19 Pandemic: A Systematic Assessment.

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering.

Video consulting for GP trainees

The COVID-19 pandemic prompted a dramatic shift towards remote and digital consulting in general practice. Supported by the wider political policy for ‘Digital-First’ primary care, many practices began offering a wider range of consultation modalities, including online, telephone and video options. Since the COVID-19 pandemic the proportion of appointments carried out remotely has slightly decreased, but still makes up a significant proportion of appointments. According to the latest data from NHS Digital, over a million video and online consultations took place in 2023 (the data does not differentiate between them). Video consulting is used more often in out-of-hours settings and for nursing home ward rounds. Remote consulting requires specific consultation skills, some interchangeable with other modes of consulting, and all important for future practice.

1440. Hand Hygiene in Nursing Homes During And After The Covid-19 Pandemic Outbreak

Abstract Background Residents in Norwegian nursing homes are vulnerable and fragile, and hand hygiene adherence is too low to prevent transmission of all infections. This study aimed to investigate hand hygiene in nursing homes during and after the COVID-19 pandemic, and if interventions targeting behavior change can improve adherence. Methods Observations of hand hygiene were collected in February and March 2021 and September and October 2022, using the WHO observation tool. The observations were carried out by trained nursing students and researchers. The first observations were during the pandemic when it was strict regulations in nursing homes, and the last observations were when there were no regulations related to COVID-19. Over 12 months, from August 2021 to August 2022, three of the 22 participating nursing home wards implemented interventions to improve hand hygiene. Multimodal interventions targeting behavior change, including education, UV-light box, and posters, were implemented. Results Hand hygiene adherence in total was 58.3% during the pandemic and decreased to 52.5% after the pandemic. The control wards experienced a decrease from 59.5% in 2021 to 51.3% in 2022, while the intervention wards experienced an increase from 54.7% to 60.9% (p-value: &amp;lt; 0.001). Hand hygiene adherence in total was lower when wearing gloves (32.8% vs. 61.7%), and inappropriate glove use was significantly higher after the pandemic. Hand hygiene adherence was 35.3% when using gloves in 2021, in 2022 the adherence had decreased to 27.7% (p-value: &amp;lt; 0.001). Conclusion This study shows that the implementation of interventions aimed at behavioral change increased hand hygiene adherence in nursing home wards. Despite hand hygiene adherence being lower, and inappropriate glove use higher than hoped for during the pandemic, we can see that attention and focus on hand hygiene during the pandemic probably had an increased effect on adherence. Attention to hand hygiene and activation of the motivation of healthcare workers is crucial, for receiving an effect of interventions. Hand hygiene adherence decreased after the pandemic when the focus on hand hygiene diminished. Behavior is likely to decline over time, and continuous reinforcement is needed to maintain a behavior change. Disclosures All Authors: No reported disclosures

Impact of multimodal interventions targeting behavior change on hand hygiene adherence in nursing homes: An 18-month quasi-experimental study

Nursing home residents are vulnerable and frail, and hand hygiene adherence is often too low to prevent transmission of infections. This study's aim was to investigate whether interventions targeting behavior change can improve hand hygiene adherence in nursing homes. Over 18 months, 22 nursing home wards participated in this quasi-experimental study. Three intervention wards were selected based on the mean values of hand hygiene adherence, infections, and antibiotic use. Multimodal interventions targeting behavior change, including education, UV-light boxes, and posters, were implemented. Hand hygiene adherence increased to 60.9% in the intervention wards and decreased to 51.3% in the control wards. The control wards experienced lower adherence in all indications of WHO's "My five moments for hand hygiene." Interventions should target proper hand hygiene before patient contact and glove use because health care workers have low adherence in these areas. The findings indicate that the type of intervention is less important than attention to hand hygiene and activating workers' motivation. Using a behavior change approach and continuous reinforcement is important because the effects of interventions diminish over time. Our findings showed that multimodal interventions targeting behavior change may increase hand hygiene adherence.

Enhancing Functionalization of Health Care Textiles with Gold Nanoparticle-Loaded Hydroxyapatite Composites.

Hospitals and nursing home wards are areas prone to the propagation of infections and are of particular concern regarding the spreading of dangerous viruses and multidrug-resistant bacteria (MDRB). MDRB infections comprise approximately 20% of cases in hospitals and nursing homes. Healthcare textiles, such as blankets, are ubiquitous in hospitals and nursing home wards and may be easily shared between patients/users without an adequate pre-cleaning process. Therefore, functionalizing these textiles with antimicrobial properties may considerably reduce the microbial load and prevent the propagation of infections, including MDRB. Blankets are mainly comprised of knitted cotton (CO), polyester (PES), and cotton-polyester (CO-PES). These fabrics were functionalized with novel gold-hydroxyapatite nanoparticles (AuNPs-HAp) that possess antimicrobial properties, due to the presence of the AuNPs' amine and carboxyl groups, and low propensity to display toxicity. For optimal functionalization of the knitted fabrics, two pre-treatments, four different surfactants, and two incorporation processes were evaluated. Furthermore, exhaustion parameters (time and temperature) were subjected to a design of experiments (DoE) optimization. The concentration of AuNPs-HAp in the fabrics and their washing fastness were critical factors assessed through color difference (ΔE). The best performing knitted fabric was half bleached CO, functionalized using a surfactant combination of Imerol® Jet-B (surfactant A) and Luprintol® Emulsifier PE New (surfactant D) through exhaustion at 70 °C for 10 min. This knitted CO displayed antibacterial properties even after 20 washing cycles, showing its potential to be used in comfort textiles within healthcare environments.

Students\u2019 observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic

BackgroundHealthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not.MethodsThis observational study used the World Health Organization’s observation tool for studying hand hygiene indication and adherence: “My five moments for hand hygiene.” For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway.ResultsThe overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them.ConclusionsHand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers’ knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Healthcare leaders\u2019 use of innovative solutions to ensure resilience in healthcare during the Covid-19 pandemic: a qualitative study in Norwegian nursing homes and home care services

BackgroundThe Covid-19 pandemic introduced a global crisis for the healthcare systems. Research has paid particular attention to hospitals and intensive care units. However, nursing homes and home care services in charge of a highly vulnerable group of patients have also been forced to adapt and transform to ensure the safety of patients and staff; yet they have not received enough research attention. This paper aims to explore how leaders in nursing homes and home care services used innovative solutions to handle the Covid-19 pandemic to ensure resilient performance during times of disruption and major challenges.MethodsA qualitative exploratory case study was used to understand the research question. The selected case was a large city municipality in Norway. This specific municipality was heavily affected by the Covid-19 pandemic; therefore, information from this municipality allowed us to gather rich information. Data were collected from documents, semi-structured interviews, and a survey. At the first interview phase, informants included 13 leaders, Head of nursing home (1 participant), Head of Sec. (4 participants), Quality manager (4 participants), Head of nursing home ward (3 participants), and a Professional development nurse (1 participant), at 13 different nursing homes and home care services.At the second phase, an online survey was distributed at 16 different nursing homes and home care services to expand our understanding of the phenomenon from other leaders within the case municipality. Twenty-two leaders responded to the survey. The full dataset was analysed in accordance with inductive thematic analysis methodology.ResultsThe empirical results from the analysis provide a new understanding of how nursing homes and home care leaders used innovative solutions to maintain appropriate care for infected and non-infected patients at their sites. The results showed that innovative solutions could be separated into technology for communication and remote care, practice innovations, service innovations, and physical innovations.ConclusionThis study offers a new understanding of the influence of crisis-driven innovation for resilience in healthcare during the Covid-19 pandemic. Nursing home and home care leaders implemented several innovative solutions to ensure resilient performance during the first 6–9 months of the pandemic. In terms of resilience, different innovative solutions can be divided based on their influence into situational, structural, and systemic resilience. A framework for bridging innovative solutions and their influence on resilience in healthcare is outlined in the paper.

The impact of green care farms and other innovative nursing home models on BPSD symptoms in everyday life for people with dementia

AbstractBackgroundMany countries are introducing small‐scale, home‐like care facilities that represent a radically new approach to nursing home care for people with dementia. These facilities emphasize person‐centered care, focus on remaining strengths and value autonomy. Originated outside of the healthcare sector, green care farms (GCFs) are a new type of nursing home in the Netherlands. GCFs provide care in small‐scale, homelike environment, in which agricultural activities are combined with care and support services for a variety of client groups, including people with dementia. This study investigated effect of GCFs on residents, in particular on behavioral and psychological symptoms.MethodIn total, 115 residents with a formal diagnosis of dementia were included, living at GCFs (n=34), regular small‐scale living facilities (n=52) and traditional nursing homes (n=29). Residents were matched regarding cognitive status (S‐MMSE). Ecological momentary assessments (n=16,860) were conducted using the Maastricht Electronic Daily Life Observation Tool, assessing activity engagement, social interaction and emotional well‐being. Furthermore, neuropsychiatric symptoms (NPI‐NH), agitation (CMAI), depressive symptoms (CSDD), quality of life (Qol‐AD and QUALIDEM) and social engagement (RISE) were measured.ResultThe daily life of residents living at GCFs was significantly different compared with traditional nursing homes. Residents were significantly more active (p&lt;0.05, SE=0.9) and socially engaged (p&lt;0.05) at GCFs compared with traditional nursing home wards. Furthermore, residents living at GCFs scored significantly higher on the Qol‐AD (p&lt;0.05, ES=0.8) and on three domains of the Qualidem: positive affect, social relations and having something to do (p&lt;0.05, ES&gt;0.7) compared with traditional nursing homes. No significant differences were found regarding neuropsychiatric symptoms (mean NPI‐NH score 15.4), agitation (mean CMAI score 41.9) and depressive symptoms (mean CSDD score 5.4).ConclusionThis study showed that GCFs provide an attractive, homelike environment and activities that positively influence engagement and social interaction. GCFs appear to be a valuable alternative to existing nursing homes. This is important as people with dementia are a heterogeneous group with varying needs. In order to provide tailored care there also is a need for a variety of living environments.

Nursing home residents with cognitive impairment can participate in advance care planning: A qualitative study.

To describe advance care planning in nursing homes when residents with cognitive impairment and/or their next of kin participated and identify associated challenges. A qualitative study of nine advance care planning conversations in four Norwegian nursing home wards. During the implementation of advance care planning, we purposively sampled residents with cognitive impairment, their next of kin and healthcare personnel. The implementation followed a "whole-ward" approach aimed at involving the whole ward in fostering an inclusive, holistic advance care planning discussion. Involving as many residents as possible, preferably together with their next of kin, were central. From observed and audio-recorded advance care planning conversations that took place from November 2015 to June 2016, we conducted a thematic analysis of the transcripts and field notes. Reporting adhered to the COREQ guidelines. Residents actively relayed their preferences regarding healthcare and end-of-life issues, despite the cognitive impairment. Next of kin provided constructive support and conversations were largely resident-focused. However, involving residents was also challenging, findings included: residents' preferences were often vague, relevant medical information from healthcare personnel lacked and the next of kin were sometimes unaware of the resident's previously held preferences. Moreover, residents tended to focus more on the past and present than the future end-of-life care. Residents with cognitive impairment can participate actively and meaningfully in advance care planning, if the healthcare personnel actively listens. However, several challenges can arise. Supported decision-making can improve communication and resident involvement, reinforcing a relational understanding of autonomy. Persons with cognitive impairment should be invited to participate in advance care planning. Their participation may make its benefits and more person-centred care attainable to persons that are often not involved. Successful involvement of persons with cognitive impairment in advance care planning may rely on robust implementation.

Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study

BackgroundShared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently.MethodsThe study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency.ResultsAt ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ = 16.09) and 81.11/100 (σ = 19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ = 10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ = 0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ = 0.51) and competence (x̄=3.76/5, σ = 0.27) with which these skills were practiced (P < 0.001).ConclusionsResidents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.

Nurse managers' perspectives on working with everyday ethics in long-term care.

Background:Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers’ ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care.Objective:The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care.Design and participants:Qualitative individual interviews were performed with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data.Ethical considerations:The Norwegian Centre for Research Data granted permission for this study.Findings:The analysis resulted in seven subcategories that were grouped into three main categories: managers’ perception of the importance of the role, managers’ experiences of exercising the role and managers’ opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees.Discussion:The leaders tended to perceive ethics as a ‘personal matter’ and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals’ vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care.Conclusions:Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs’ ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means.

Less Is More: The Impact of Deprescribing Psychotropic Drugs on Behavioral and Psychological Symptoms and Daily Functioning in Nursing Home Patients. Results From the Cluster-Randomized Controlled COSMOS Trial

ObjectiveTo investigate the impact of medication reviews using collegial mentoring and systematic clinical evaluation on psychotropic prescriptions, behavioral and psychological symptoms of dementia (BPSD), and activities of daily living (ADL). DesignFour-month multicenter, multicomponent, cluster-randomized, single-blinded controlled trial. SettingThirty-three Norwegian nursing homes including 67 nursing home wards (clusters). ParticipantsA total of 723 enrolled patients, of which 428 participated in the study; 217 were randomized to the intervention and 211 to care as usual (control). InterventionThe COSMOS intervention consisted of Communication, Systematic pain management, Medication reviews, Organization of activities, and Safety. During medication review, the nursing home physician evaluated treatment with colleagues systematically using the results from validated clinical assessments. MeasurementsMean changes from baseline to month 4 in the number of prescribed psychotropic drugs (antipsychotics, anxiolytics, hypnotics or sedatives, antidepressants, and antidementia drugs); Neuropsychiatric Inventory Nursing Home Version (NPI-NH) and Cornell Scale of Depression in Dementia (CSDD); Lawton and Brody's Physical Self Maintenance Scale (PSMS). ResultsCompared to control, the mean change in prescribed psychotropic drugs was reduced both in total and regular number, while mean changes in NPI-NH and CSDD scores did not differ between the groups. Mean change in PSMS showed improvement in the intervention group, and deterioration in the control group. ConclusionMedication reviews using collegial mentoring and systematic clinical evaluation led to safe deprescribing, as the reductions in psychotropic drug use did not negatively affect BPSD, while ADL improved.

A work system analysis of the medication administration process in a Norwegian nursing home ward

Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements – tools & technology, organisation and tasks – and occur early in the medication administration process.

Improving shared decision-making in advance care planning: Implementation of a cluster randomized staff intervention in dementia care

ObjectiveIncreasing staff engagement level of shared decision-making in advance care planning for persons with dementia in nursing homes. Perceived importance, competence and frequency of staff members applying shared decision-making were measured. Additionally, facilitators and barriers in the implementation process were described. MethodsIn this pretest-posttest cluster randomized trial, 311 staff members from 65 Belgian nursing home wards participated. Key components of the intervention were knowledge on shared decision-making, role-play exercises and internal policies on advance care planning. Audio recordings of advance care planning conversations between residents, families and staff were compared before and after the intervention. Participants filled in questionnaires and provided feedback. ResultsWards demonstrated a higher level of shared decision-making after the intervention (p < 0.001) while time spent on the conversations did not increase. This effect persisted at 6 months follow-up (p < 0.001). Participants perceived shared decision-making as more important (p = 0.031) and felt more competent (p = 0.010), though frequency of use did not change (p = 0.201). High staff turnover and difficult co-operation with GP’s were barriers. ConclusionNursing home staff benefits from this training in shared decision-making. Practice implicationsLearning shared decision-making in advance care planning for persons with dementia is possible and sustainable in the time-constricted context of nursing homes.

THE SUPPORT OF AUTONOMY FOR NURSING HOME RESIDENTS WITH DEMENTIA: OBSERVATION OF MORNING CARE

People with dementia in nursing homes need their social environment in supporting their autonomy. This study explored how this relational autonomy is supported by staff for residents with dementia during morning care in nursing homes. Structured observations (n=1815) were carried out to assess how resident choice is supported within staff-resident interaction. Observation of morning care consisted of four main categories: ‘getting up’, ‘physical care’, ‘physical appearance’ and ‘breakfast’. In addition, qualitative field notes were taken to support observations. In total, 55 residents with dementia were included from eight nursing home wards in The Netherlands. Results indicated that resident autonomy during morning care was only limitedly supported. Individual staff members took over tasks, regardless of resident’s individual capabilities to make a choice. Staff controlled resident’s choice for almost all observed categories. The findings of this study implicate that person-centered care during morning routine can be improved by addressing individual needs

&lt;p&gt;Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers&lt;/p&gt;

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance.Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP.Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources.Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.