Quality Of Care For Older People Research Articles

Great geriatric syndromes: Acquisition of nursing competencies and undergraduate nursing students' perceptions through high-fidelity simulation training

BackgroundThe constant increase in the aging population will lead to a greater demand for high-quality nursing care for this population over the coming years. Early detection and proper treatment of great geriatric syndromes are essential and, consequently, geriatric nurses must acquire the necessary competencies for their adequate management. ObjectivesTo evaluate the acquisition of the necessary nursing competencies for adequate management of great geriatric syndromes through high-fidelity simulation training and to explore undergraduate nursing students' perceptions about this training. Methods80 undergraduate nursing students participated in a mixed methods study. The simulated scenarios recreated older patients with diagnoses of great geriatric syndromes using standardized patients. Nursing competencies were evaluated using a verification list. 10 focus groups were interviewed to explore their perceptions, conducting a qualitative study with an interpretative approach. ResultsMost of the students (86.55 %) acquired the necessary nursing competencies for adequate management of great geriatric syndromes. The nursing students stated that they improved their communication skills (provide solutions to older patients; facilitate and redirect the clinical interview; contrast the information given to the patient), psychological resources (psychological support; physical contact and accompaniment; empathy and persuasion), and geriatric knowledge (identify their lack of knowledge; recognize their limits in terms of healthcare and refer to other health professionals; know the patient's conditions) to provide quality care for older people diagnosed with great geriatric syndromes. ConclusionsThe use of high-fidelity simulation training including standardized patients makes it easier for nursing students to acquire the necessary nursing competencies for adequate management of great geriatric syndromes and improve their clinical skills. Geriatric nursing education should focus on equipping nursing students with the necessary clinical skills, integrating high-fidelity simulation training in geriatric study plans to train students in the nursing care to be provided to older patients, and preparing them for real clinical practice.

Social work's contribution to integrated primary health care teams in the UK for older adults with complex needs

PurposeThis study examined the contribution of adult social work in integrated teams in the UK.Design/methodology/approachThe study design was realist, evaluation research using a mixed methods approach. Data collection methods included interviews and focus groups. Types of social work activities were extracted from older adults' case records and used to calculate costs of care. The presence or absence of indicators of care quality was recorded using the same sample of case records. Data were collected from three primary care teams in which social work was integrated. They were compared with data from three social-work-only teams in the same districts. Narrative data was analysed thematically. Inferential and descriptive statistics were used to compare costs and care quality.FindingsWhen social work was embedded or attached to a primary care team, costs of care delivery were lower than in their social-work-only team and more indicators of good quality care outcomes were recorded. Results suggest that embedding social work in integrated primary care teams contributes to cost-effective, quality care for older people if certain conditions for integration are met.Originality/valueThis is the first study to triangulate three data sources to quantify the social work contribution to integrated primary health care teams for older adults.

Investigating the Relationship Between Perception and Attitude With Responsibility for Elderly Care in Nurses of Emergency Wards of Ardabil Hospitals in 2020.

Nurses’ knowledge, attitudes, and their professional responsibility regarding elderly people are vital determinants in delivery of quality care for older people. Thus, this study aimed to identify the perception and attitude of nurses toward elderly care and their correlation with professional responsibility in nurses working in emergency departments. This descriptive-correlational study was conducted on 252 nurses working in the emergency departments of five general hospitals located in the province of Ardabil, Iran. Data was collected a demographic questionnaire and standard questionnaire of nursing care for the elderly of Persoon et al. The majority of nurses reported a positive knowledge and attitude towards elderly care. Only half of the nurses had a desirable professional responsibility towards elderly care. Based on the results of multivariate regression model, the variables of knowledge, attitude, age, work experience, and previous care of older client had a significant relationship with nurses ‘professional responsibility for elderly care (p < 0.01). Knowledge, attitude, age, and previous history of elderly care are significant determinants for professional responsibility towards elderly care; therefore, periodical evaluation of elderly care and its related factors can help the hospital managers to construct the basics of healthcare delivery for older people in emergency departments.

186 OPTIMAL MANAGEMENT OF COVID-19 IN NURSING HOME PATIENTS: A QUALITY IMPROVEMENT PROJECT IN AN IRISH UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT

BackgroundThe Sars-CoV-2 global pandemic placed an unprecedented demand on acute health services and led to significant morbidity and mortality in older populations. Nearly half of attendances to this ED are over the age of 65 years and there are over 80 nursing homes in the catchment area. A pilot study in January 2021 showed that nursing home attendances increased significantly during the third wave of COVID-19 with many of these attendances potentially avoidable and suitable for optimised care in the nursing home.The primary objective of this quality improvement project was to enhance the older person’s care and experience when presenting to ED or being reviewed in the community with symptoms and signs of COVID-19. Secondary aims were reduced nursing home attendances to ED and subsequent admissions from these attendances.MethodsA guideline was constructed based on the RCEM standard for Quality Care for Older People and using the HSE guidelines for managing COVID-19 in nursing home patients. The guideline was introduced to staff and implemented in ED and via the EDITH service.ResultsTwo PDSA cycles were undertaken post guideline implementation. There were substantial improvements in the frequency of discussion and documentation of advanced directives with increased numbers of patients being discharged directly back to the nursing home or treated in the nursing home using the guideline. There was a decrease in the number of nursing home attendances throughout the project.ConclusionThis successful QIP shows the importance of manging older patients appropriately, while considering their wishes. Post-COVID work should centre on managing all older patients with optimised treatment and considering how they will benefit most from their attendance to ED.

Qualitative analysis of challenges and enablers to providing age friendly hospital care in an Australian health system

BackgroundWith ageing global populations, hospitals need to adapt to ensure high quality hospital care for older inpatients. Age friendly hospitals (AFH) aim to establish systems and evidence-based practices which support high quality care for older people, but many of these practices remain poorly implemented. This study aimed to understand barriers and enablers to implementing AFH from the perspective of key stakeholders working within an Australian academic health system.MethodsIn this interpretive phenomenenological study, open-ended interviews were conducted with experienced clinicians, managers, academics and consumer representatives who had peer-recognised interest in improving care of older people in hospital. Initial coding was guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Coding and charting was cross checked by three researchers, and themes validated by an expert reference group. Reporting was guided by COREQ guidelines.ResultsTwenty interviews were completed (8 clinicians, 7 academics, 4 clinical managers, 1 consumer representative). Key elements of AFH were that older people and their families are recognized and valued in care; skilled compassionate staff work in effective teams; and care models and environments support older people across the system. Valuing care of older people underpinned three other key enablers: empowering local leadership, investing in implementation and monitoring, and training and supporting a skilled workforce.ConclusionsProgress towards AFH will require collaborative action from health system managers, clinicians, consumer representatives, policy makers and academic organisations, and reframing the value of caring for older people in hospital.

The impact of participatory arts in promoting social relationships for older people within care homes.

Aims:Loneliness and social isolation negatively affect wellbeing and quality of life. Despite the proximity of others, older people living in care homes often experience loneliness and social isolation. The impact of participatory arts on wellbeing is widely acknowledged; however, relational impacts have received less attention. This article explores the impact of participatory arts in care homes on the social relationships between older people and older people and care staff.Methods:‘Creative Journeys’, an initiative led by Essex County Council, provides opportunities for older people living in care homes to participate in arts activities. In this study, three arts organisations (reminiscence arts, seated dance, and orchestral music participation) delivered participatory arts in three homes. Stage 1 of the research comprised mixed-methods case studies in each home. Stage 2 involved an online survey across care homes in Essex to provide a broader perspective, with follow-up interviews in three further homes, and a focus group with the arts organisations. Findings presented here focus on the qualitative data around the impact of participatory arts on the social relationships in care homes between older people and older people and care staff.Results:Participatory arts enhanced social relationships between older people and between older people and care staff in care homes. Through engagement in shared experiences leading to increased communication and interaction, participatory arts facilitated social connectedness between residents, and changed the relationship dynamics between older people and care staff, thus promoting reciprocity.Conclusion:Participatory arts enable older people to express themselves creatively, and make meaningful contributions to their social relationships. Policy makers and those working in the care sector should consider including participatory arts as an integral and necessary component of quality care for older people living in care homes.

Care coordination in the health-care service delivery: an elderly care perspective

Purpose The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic conditions. Care coordination is defined as a process where physicians, nurses and allied professionals work together to clarify responsibilities, care objectives, treatment plans and discharge plans for delivery of unified care. Patient-centricity is defined as an approach of delivering quality care to patients that focuses on creating a positive experience for them. Design/methodology/approach A literature review was used to identify measures of care coordination and then partial least square structural equation modeling was used to assess interrelationship among patient-centricity, measures of care coordination and delivery of quality care. Findings Results reveal that care coordinated pathways consist of IT-enabled coordination, interprofessional teamwork, information sharing and facilitative infrastructure requirements and are influenced by patient-centricity. These are deliberate requisites for delivering of quality care. Results of this study present a validated model of care coordination for older people, which may be further explored to refine the concept of care coordination. Practical implications Based on these results, practitioners may develop an overarching strategy to deliver seamless care and to achieve better health outcomes. Measures of care coordination may be used as a performance benchmarking tool and will also help in the process mapping of hospitals. Social implications This paper highlights how patient-centricity may be achieved by focusing on coordinated care processes. This understanding may help in designing processes, which in turn deliver health as a social good in an effective manner. Originality/value Results of this study present such a validated model for care coordination, which can be used by researchers.

Perceived inequalities in care and support for older women from Black and minority ethnic backgrounds in Wales: findings from a survey exploring dignity from service providers’ perspectives

ABSTRACTObjective: As part of a large mixed-method study aimed at capturing understandings of dignity, and care expectations of community dwelling older women from Black and minority ethnic (BME) backgrounds living in Wales, the aim of this paper is to compare service providers’ perceptions of their care and support provided to older people in general, and to older women from BME backgrounds in particular, with a focus on two dignity indicators: care and support needs, and effective communication.Design: A survey design was used.Results: A total of 124 responses from service providers in Wales were received. Perceived inequalities in care and support were found. Although most respondents reported that care and support provision was generally acceptable, more respondents believed that compared to older people in general, older women from BME backgrounds were seldom or never offered opportunities and support to express their needs, were involved in their own care, were provided appropriate information, had their key needs especially less visible needs (psychological and religious needs) been taken into account, or were communicated with effectively (all p < 0.05). In some cases, respondents tended to report more positively in areas related to their own practice.Conclusion: We suggest that learning from the views and perceptions of service providers, as well as older people and their families, remains key to developing services for the UK's increasingly diverse and ageing population. A better understanding of how inequalities may occur, their impact on older people and their families, and how they may be minimised can inform the development of high quality care for older people regardless of their ethnic and cultural backgrounds in Wales, other parts of the UK and beyond.

Healthcare workers’ perceptions of organisational culture and the impact on the delivery of compassionate quality care

This paper explores the qualitative outcomes as part of a larger feasibility study which was developed to test a Cultural Health Check toolkit designed to assist healthcare workers and organisations in the provision of safe, dignified and compassionate quality care for older people. For the qualitative part of this project, 11 healthcare workers agreed to participate in a one-to-one semi-structured interview. The primary aim of the research was to identify the experiences of staff in relation to the different factors they feel contribute to the culture of the organisation. These data were analysed using Attride-Stirling thematic analysis. The data were coded and four global themes were evident: professional practice, support, workforce and service delivery. Professional practice included organisational themes of quality, communication and collaboration and how these impact on a health worker’s ability to carry out their role and the impact on the delivery of compassionate quality care. Support included organisation themes of personal and professional development, and facilitation by leaders and managers to access the available support. Workforce centred on the importance of having adequate levels of all staffing groups to be able to deliver safe, quality person-centred care and services. Service delivery identified the organisational themes of care, person-centred care and communication where staff have the desire, determination and enthusiasm to deliver safe, high quality compassionate person-centred care and services. These themes are key in the impact analysis relating to the delivery of compassionate quality care.

Attitudes toward and willingness to work with older people among undergraduate nursing students in a public university in Sri Lanka: A cross sectional study

With the increased number of older people globally, caring for older people has become a challenge for many countries. Nurses have a pivotal role in providing quality care for older people and care is affected by their attitudes. The preparation of nurses to deliver quality care needs to be instilled during their studying in the Schools of Nursing. To examine the attitudes of nursing students toward and their willingness to work with older people in Sri Lanka. A purposive sample of 98 first to fourth year undergraduate nursing students in the Department of Nursing, University of Peradeniya completed a self-administered questionnaire consisting of socio-demographic variables, Kogan's Attitudes toward Older People Scale, and questions related to willingness to work with older people. Fifty percent of the respondents (n=49) held slightly positive attitudes toward older people while 45% (n=44) held slightly negative attitudes. About one-third of the respondents (29.9%, n=29) selected the elderly group as the least preferred group for their future career from the categorized seven age groups. Only 5.1% (n=5) of the respondents ranked the elderly group as the first preferred group. There was a significant difference in attitudes between students who lived with older people and students who did not live with older people (t=2.565, p=.012). There was a positive relationship between attitudes and preference for working with older people (r=.342, p=.001). Nursing students have moderately positive attitudes toward older people; however, they show little interest in working with older people. Living with older people develops positive attitudes of young people toward older people. Attitudes are related to the selection in area of specialty in nursing. Nursing curricula need to include Gerontological Nursing as a major area.

Identifying modifiable factors to improve quality for older adults in hospital: a scoping review

Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified. Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology. We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria. A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes. The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care. Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.

Relational practice as the key to ensuring quality care for frail older people: discharge planning as a case example

Discharging frail older people from acute hospital settings has been an issue of concern for over 40 years and recent studies suggest that enduring problems remain. This paper explores the experiences of discharge from three different units: an acute surgical ward, an acute medical ward and a specialist ward for older people. Based on extensive data from interviews with older people, their family carers and ward‐based staff, a grounded theory of the discharge experience is presented. This suggests that the quality of discharge hinges largely on whether the focus of efforts is on ‘pace’ (the desire to discharge older people as rapidly as possible) or ‘complexity’ (where due account is taken of the complex interaction of medical and wider social issues). When pace is the focus, ‘pushing’ and ‘fixing’ are the main processes driving discharge. However, when attention is given to complexity, far more subtle processes of ‘informing’ and ‘brokering’ are in evidence. These latter processes are conceived of as forms of ‘relational practice’ and it is argued that such practices lie at the heart of high quality care for older people.

Promoting quality care for older people in meal management: whose responsibility is it?

Objective: To examine the role of registered nurses and allied health workers in meal management, assessment, safe environment and care planning for older people in residential aged care. Primary Argument: Nurses and carers are often the first to observe and put into place strategies to prevent choking in residents with swallowing difficulties. Coroners’ reports have raised issues with regard to the role of the registered nurse, resident autonomy and the effectiveness of speech pathologist assessments in avoiding incidents that compromise resident’s health and well being. Conclusions: In residential aged care the role of the registered nurse involves managing a complex environment. In the area of meal management, nurses are struggling to have their knowledge and expertise recognised. Nurses need to develop strategies to articulate and demonstrate their contribution to meal management in order to promote their knowledge and skills. Nurses must actively continue to develop their body of knowledge through research; otherwise ‘expert’ knowledge will be accessed from elsewhere. This paper will outline a number of areas for future development and research which focuses on the needs of older people and staff in this area.

Nurses’ perceptions of quality and the factors that affect quality care for older people living in long‐term care settings in Ireland

The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long-term care settings in Ireland. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research. This was a mixed method study, which involved qualitative and quantitative approaches. A self-response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long-term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people. Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine. The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care. Long-term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this.

A Qualitative study explaining nurses’ perceptions of quality care for older people in long‐term care settings in Ireland

The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

Quality care for older people depends on a fair price

The King’s Fund report on trends in the London care market highlights local differentiation and thus the importance of good local commissioning (editorial October 19).

From the emergency department to home

The purpose of this study was to explore dimensions of the management of the older person following care in an emergency department in preparation for discharge home by identifying perceptions and attitudes of staff in both emergency department and primary care sectors. It is recognized that older people discharged home directly from the emergency department are a vulnerable group. Effective communication and liaison are seen to be keys to the provision of high quality care for older people in the emergency department and in ensuring a seamless care between sectors. A purposeful sample was collected that comprised the total population (n = 222) of all grades of medical and nursing staff in both the emergency department and all nursing (Public Health Nurses & Practice nurses) and medical staff (General Practitioners) in the primary care area. Methodology used was that of a survey approach of nursing and medical staff in both the emergency department and primary care services. Standardized questionnaires were employed which comprised both open and closed questioning style. Raw statistical data were analysed using SPSS for Windows while the qualitative data arising from the open-ended questions were content analysed for themes. Many staff in the primary care area reported the level of communication between the emergency department and the primary care area as unsatisfactory with confusion regarding follow-up care and a lack of support for older people on discharge. Hospital staff reported the level of communication to be much greater than that perceived by their colleagues in primary care. There was agreement of staff in both sectors in relation to the perceived usefulness of a discharge liaison nurse in the emergency department. Previous research highlights communication difficulties when patients are discharged from hospital. Findings from this study indicate that this problem can also be applied to the emergency department. Implications for practice include a need for a multidisciplinary approach to developing referral guidelines, staff training and a comprehensive dissemination of information between sectors ultimately to improve quality and continuity of care for the older person.

Mental health knowledge in residential aged care: A descriptive review of the literature

Health care staff knowledge of mental health is vital in the provision of quality care for older people in residential aged care settings. This paper aims to describe mental health knowledge competence of health care staff in residential aged care through a review of existing literature and to explore the link between knowledge, attitudes and education about older people and mental health.A literature review was conducted using electronic databases and library catalogues to identify articles published in English during the period 1982–2002.There is insufficient evidence within the literature to draw conclusions about staff knowledge levels in relation to mental health, however, the literature identified a link between continuing education, knowledge levels and staff attitudes to older people with mental health disorders. Future studies are needed to investigate existing levels of mental health knowledge among health care staff in residential aged care and to identify and evaluate strategies to enhance their ability to provide care for this population.

Person-centredness in gerontological nursing: an overview of the literature.

Person-centred practice is a recurring theme in gerontological nursing literature. While there are many descriptive accounts of attempts at developing person-centred practice, in reality, there are few studies that identify the benefits of this way of working. Thus far, systematic research into person-centred nursing practice is poorly developed. This paper aims to explore the concept of person-centredness and person-centred practice in order to add clarity to discussions about the term in the context of gerontological nursing. This literature-based exploration discusses the meaning of the word 'person' and the way this word is translated into person-centred practice. It is argued that there are four concepts underpinning person-centred nursing: (i). being in relation; (ii). being in a social world; (iii). being in place and (iv). being with self. The articulation of these concepts through existing models of person-centred practice in nursing raises the recurring themes of knowing the person, the centrality of values, biography, relationships, seeing beyond the immediate needs and authenticity. There is a need for further research and development work in gerontological nursing to distinguish between person-centred practice and good quality care for older people.

Ageism and the abuse of older people in health and social care.

Ageing is a natural process and yet ageism, ageist practice and abuse of older people occur among not only the general public but also in health and social care settings. Recent media reports have highlighted delays in meeting the needs of older people, physical and psychological abuse and that decisions are being made about whether or not to resuscitate an older patient without consultation with the patient and his/her family (e.g. British Journal of Nursing, 2000). This article looks at ageism and the abuse of older people and discusses what can be done to achieve quality care for older people while dealing with obstacles such as poor collaboration between agencies, a lack of support for carers and the belief that the needs of older people are less important than those of the young.