Home Staff Research Articles

What makes communication work and for whom? Examining interprofessional collaboration among home care staff using structural equation modeling

ABSTRACT Up to 175 conditions influencing interprofessional practices have been identified. Still, little is known about to what extent these conditions interact, influence communication, and vary across professional groups and settings. We explored these knowledge gaps by examining communication among staff in home care and home nursing units in two Danish municipalities, Herning and Holstebro. Conditions were categorized into two types (programme and context) and two levels (professional and organizational). Structural Equation Modeling was used with a sample of 395 staff and 21 managers to analyze the condition categories’ interactions, influences on communication, and variations by unit type and municipality. Context conditions strongly influenced programme conditions on the professional and organizational levels. Organizational-level context conditions had no significant influence, organizational-level programme conditions had a weak influence, and professional-level programme and context conditions had moderate influences on communication. Lastly, professional-level programme conditions had the biggest influence on communication for staff in home care units and in Holstebro. In contrast, professional-level context conditions had the biggest influence on communication for staff in home nursing units and in Herning. These findings offer unique insights into conditions’ interactions, influences, and variances, contributing to our understanding of what makes communication work and for whom.

Qualitative analysis of forgiveness towards parents and examination of connections to current romantic relationship in adults from children's homes

The primary goal of this study was to find out how adults raised in children's homes perceive and experience forgiveness toward their parents, specifically their mother and father. The secondary goal was to examine any connections between them forgiving their parents and their current romantic relationship. The sample consisted of 10 individuals raised in children's homes, with an average age of 25.7 years (SD = 3.2) and average length of romantic relationship of 3.2 years (SD = 1.03). Data were obtained by semi-structured interview and analyzed using Consensual Qualitative Research (Hill & Knox, 2021). Participants understood forgiveness mainly as the absence of negative emotions and as moving forward. The main motivation for forgiving one’s parent was discussions with children’s home staff and volunteers, but also exhaustion from negative feelings. An important aspect of the forgiveness process was understanding the parent and their life. The process of forgiving one’s mother and father was similar; however, participants experienced greater difficulty forgiving their father and were more willing to reconcile with their mother. The consequences of forgiveness were described mainly in terms of an absence of negative feelings and achieving inner peace. Participants also stated that forgiving a parent was associated with greater satisfaction in their romantic relationship, more open communication and being more understanding of their partner. The results of this study reveal the importance of forgiveness in the lives of people raised in children’s homes, not just in terms of overall quality of life, but also quality of romantic relationship and healing relationships with parents.

COVID-19 vaccine hesitancy in nursing: Home staff and the need for ongoing education and vaccine access

COVID-19 vaccine hesitancy in nursing: Home staff and the need for ongoing education and vaccine access

Optimum models of hospice at home services for end-of-life care in England: a realist-informed mixed-methods evaluation

Background Many people prefer to die at home when the time comes. Hospice at home services aim to support patients to achieve this. A range of hospice at home services exist; some services have been evaluated, but there has been limited evidence synthesis. Objectives The main objective was to find out what models of hospice at home services work best, for whom and in what circumstances. Other objectives supported this aim, including an analysis of the health economic costs of hospice at home models. Design The study was an overarching, non-interventional, realist evaluation comprising three phases. Phase 1 was a survey of hospice at home services. Phase 2 involved 12 case studies, grouped into four models on the basis of size and 24 hours per day, 7 days per week (24/7), operations, from which quantitative and health economics data were gathered. Qualitative interview data from bereaved carers, commissioners and providers were analysed to generate context–mechanism–outcome configurations. Phase 3 comprised stakeholder consensus meetings. Setting Hospice at home services across England. Participants A total of 70 hospice at home managers responded to the survey. A total of 339 patient and family/informal carer dyads were recruited; 85 hospice at home providers and commissioners were interviewed. A total of 88 stakeholders participated in consensus meetings. Main outcome measures The quality of dying and death of patients was assessed by bereaved carers (using the Quality of Dying and Death questionnaire). A patient’s use of services was collected using the Ambulatory and Home Care Record. Results Hospice at home services varied; two-thirds were mainly charitably funded, and not all operated 24/7. Most patients (77%) had cancer. Hospice at home services overall provided care that was likely to deliver ‘a good death’, and 73% of patients died in their preferred place. Six context–mechanism–outcome configurations captured factors relevant to providing optimum hospice at home services: (1) sustainability (of the hospice at home service); (2) volunteers (use of, in the hospice at home service); (3) integration and co-ordination (with the wider health and social care system); (4) marketing and referral (of the hospice at home service); (5) knowledge, skills and ethos (of hospice at home staff); and (6) support directed at the carer at home. Key markers of a good service included staff who had time to care, providing hands-on care; staff whose knowledge and behaviour promoted supportive relationships and confidence through the process of dying; and services attending to the needs of the informal carer. Areas of potential improvement for most hospice at home services were the use of volunteers in hospice at home, and bereavement care. Limitations The study had the following limitations – heterogeneity of hospice at home services, variations in numbers and patient clinical statuses at recruitment, a low Quality of Dying and Death questionnaire response rate, and missing data. Only patients with an informal carer involved on a daily basis were eligible for the study. Conclusions Hospice at home services delivered high-quality care and a ‘good death’, with the majority of patients dying in their stated preferred place. Hospice at home providers can improve their impact by focusing on the features identified that deliver the best patient outcomes. Commissioners can facilitate patient preference and reduce the number of hospital deaths by working with hospice at home services to secure their financial sustainability and increase the numbers and range of patients admitted to hospice at home services. Future research Future research should explore the use of volunteers in the hospice at home setting and evaluate approaches to bereavement support. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 24. See the NIHR Journals Library website for further project information.

Testing for SARS-CoV-2 Infection in Care Home Residents and Staff in English Care Homes: A Service Evaluation

Testing for SARS-CoV-2 Infection in Care Home Residents and Staff in English Care Homes: A Service Evaluation

Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes

ABSTRACT Recent research has found that older lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have a negative attitude toward long term care services. To build upon this, we conducted a systematic review analyzing current research into the LGBTQ+ communities’ perspectives and experiences of care/nursing homes. Additionally, we sought to explore the attitudes of care/nursing home staff toward providing care for LGBTQ+ residents. To conduct this study, we used the databases Embase, Medline and Web of Science, which identified 19 articles for review. From this, we were able to draw several conclusions, including that LGBTQ+ participants were concerned that they would have to conceal their identity and experience abuse. Most staff had a positive attitude toward LGBTQ+ residents, but there were exceptions to this. Despite their positive attitude, staff often lacked awareness of LGBTQ+ issues. The results of this review suggest that care/nursing homes are not welcoming environments for sexual and gender minorities, and that staff require more training to support this community. We end with innovative suggestions to tackle these issues, such as designing coproduced services with the support of LGBTQ+ communities.

요양병원 개인보호장비와 인력 부족이 COVID-19 감염에 미치는 영향

During the COVID-19 pandemic, more than twenty percent of the total COVID-19 fatalities in the United States originated in nursing homes. While previous studies underline the shortages of personal protective equipment and staff as potential causes that led to the COVID-19 infection, the generalizability of their findings is limited because they focus on certain states or cross- sectional data. This study empirically investigates these effects using nationwide data spanning 29 weeks. Using longitudinal nursing home-level data and panel regression analyses with fixed effects, this study shows that both shortages led to rise in cases in nursing home residents and staff in the United States. In addition, nursing home quality intensifies the unfavorable effect of staff shortage on staff infection. The results imply that there is a trade-off between improving nursing home quality and preventing staff infection in nursing homes. This study contributes to the literature on the healthcare industry and provides practical implications for stakeholders on how they can mitigate the spread of COVID-19 in nursing homes. First, it suggests nursing home administrators develop contingency plans for personal protective equipment. Second, the study proposes amending the laws on nursing homes’ minimum staffing levels.

Care home uniforms: exploring stakeholders' views on clothing options for staff.

Views in the care home community are divided regarding whether or not staff should wear a uniform. There is little research on the topic and the views of care home residents and their relatives are rarely sought. To capture the views of staff, residents, relatives and visiting professionals in two care homes on the use of uniforms. This small-scale exploratory study used photographs showing three clothing options: a formal option, a polo shirt option and an 'own clothes' option. Each option was modelled in two different poses, one 'approachable' and the other 'unapproachable'. Staff, relatives, the wider care home team and visiting professionals expressed their preferences by replying to a short survey. Residents, all of whom had dementia, expressed their preferences through a table-top activity. Overall, the formal clothing option was preferred for formal care activities and the 'own clothes' option was preferred for social activities. The polo shirt option often obtained the second-highest number of preferences. The photographs featuring the 'unapproachable' pose were rarely selected. The approachability of staff is just as important as the clothes they wear. An alternative to formal uniforms could be for staff to wear polo shirts, possibly as an interim measure to explore the effects of changing the care home's staff uniform policy.

Nursing students’ learning about person-centred dementia care in a nursing home: A qualitative study

It is unclear to what extent nursing students are able to apply person-centred care in practice, despite a mixture of educational support approaches. The aim of this study was to explore nursing students’ experiences of learning about person-centred dementia care after they participated in an adopted education programme in a nursing home. The education programme presented the main concepts of person-centred care. A qualitative explorative design was chosen where 32 bachelor-level nursing students participated in seven focus groups. The study is reported according to the COREQ checklist. Qualitative thematic content analysis revealed two main themes: care culture in the nursing home as joyful and inclusive, and the nursing student role as ambivalent and challenging. The nursing home management, staff members and patients, together with the programme, seemed to enhance students’ learning about person-centred dementia care.

Acceptance of virtual consultations among older adults and caregivers in Malaysia: a pilot study during the COVID-19 pandemic

ABSTRACT Aim The COVID-19 pandemic has disrupted the delivery of healthcare to vulnerable older adults, prompting the expansion of telemedicine usage. This study surveyed the acceptance of virtual medical consultations among older adults and caregivers within geriatric outpatient services in a tertiary hospital during the pandemic. Methods A cross-sectional survey was conducted among caregivers and patients attending geriatric outpatient services in Kuala Lumpur, Malaysia. The survey measured the availability of equipment for virtual consultations, prior knowledge and experience of telemedicine, and willingness to consult geriatricians through virtual technology, using the Unified Theory of Acceptance and Use of Technology (UTAUT) scale. Results A total of 197 caregivers and 42 older patients with a mean age of 54.28 (±13.22) and 75.62 (±7.32) years, respectively, completed the survey. One hundred and fifty-six (79.2%) of the caregivers were adult children accompanying patients. The mean UTAUT score was 65.97 (±13.71) out of 90, with 66.64 (±13.25) for caregivers and 62.79 (±15.44) for older adults, suggesting a high acceptance of adopting virtual consultations in lieu of face-to-face care. The independent predictors of acceptance of virtual consultation were : possession of an electronic device capable of video-communication, living with someone, living in a care home, weekly online banking usage, and perceived familiarity with virtual platforms. Conclusion Caregivers and patients indicated a high level of acceptance of virtual medical consultations, which is likely facilitated by caregivers such as adult children or spouses at home or staff in care homes. To minimize the transmission of COVID-19 in a highly vulnerable group, virtual consultations are an acceptable alternative to face-to-face consultations for older people and their caregivers in our setting.

The Impact of State Dementia Training Requirements for Nursing Homes on Resident Outcomes

In recent years, Western-originated technology products for older adults are rapidly spreading in Korea, but discussions on technology acceptance taking into account the socio-cultural characteristics of older adults in Korea are relatively insufficient. The purpose of this study is to analyze the influence of the socio-cultural characteristics of Korean older adults on their intention to use technology compared to the United States. Due to Covid-19, a telephone and non-face-to-face survey was conducted for older adults aged 65-95 residing in New York State in the U.S. and the metropolitan area of South ​​Korea from September 2020 to January 2021(N=155 in South Korea, N=180 in the U.S.).In this study, the expanded technology acceptance model for older adults was conceptualized, and socio-cultural factors were used as mediators or modulators. Results show that Korean older adults had higher expectations that technology use would have a positive impact on their lives, and their product purchase intentions were higher than those in the United States(p<0.001). The main reason was that Korean older adults were less anxious about the leakage of personal information, had higher national trust and were relatively less resistant to robots than American older adults. In addition, Korean older adults were more confident that they could receive help in case of problems with technology products than their counterparts in the United States. This study suggests practical and policy alternatives for securing technology acceptance of older adults, taking into account the social and cultural factors of Korea and the United States.

393. Characteristics of SARS-CoV-2 RNA Viral Loads among Nursing Home Residents and Staff with Repeat Positive Tests ≥ 90 Days After Initial Infection: 5 US Jurisdictions, July 2020–March 2021

BackgroundBackground. Understanding the viral load and potential infectivity of individuals in nursing homes (NH) with repeat positive SARS-CoV-2 tests ≥ 90 days after initial infection has important implications for safety related to transmission in this high-risk setting.MethodsMethods. We collected epidemiologic data by reviewing records of a convenience sample of NH residents and staff with respiratory specimens who had positive SARS-CoV-2 rRT-PCR test results from July 2020 through March 2021 and had a SARS-CoV-2 infection diagnosed ≥ 90 days prior. No fully vaccinated individuals were included. Each contributed one repeat positive specimen ≥ 90 days after initial, which was sent to CDC and retested using rRT-PCR. Specimens were assessed for replication-competent virus in cell culture if Cycle threshold (Ct) < 34 and sequenced if Ct < 30. Using Ct values as a proxy for viral RNA load, specimens were categorized as high (Ct < 30) or low (if Ct ≥ 30 or rRT-PCR negative at retesting). Continuous variables were compared using Wilcoxon signed-rank tests. Proportions were compared using Chi-squared or Fisher’s exact tests. ResultsResults. Of 64 unvaccinated individuals with specimens from 61 unique NHs, 14 (22%) were sent for culture and sequencing. Ten of 64 (16%) had a high viral RNA load, of which four (6%) were culture positive and none were known variants of interest or concern (Figure 1). Median days to repeat positive test result were 122 (Interquartile range (IQR): 103–229) and 201 (IQR: 139–254), respectively, for high versus low viral load specimens (p=0.13). More individuals with high viral loads (5/10, 50%) reported COVID-19 symptoms than with a low viral load (1/27, 4%, p=0.003). Most individuals (46/58, 79%) were tested following known or suspected exposures, with no significant differences between high and low viral load (p=0.18). ConclusionIn this study, nearly 1 in 6 NH residents and staff with repeat positive tests after 90 days demonstrated high viral RNA loads and viable virus, indicating possible infectivity. While individuals with high RNA viral load may be more likely to be symptomatic, distinguishing asymptomatic individuals who have high viral loads may be difficult with timing since initial infection, other test results, or exposure history alone. Disclosures John A. Jernigan, MD, MS, Nothing to disclose.

Older assistant workers in intermediate care facilities, and their influence on the physical and mental burden of elderly care staff

BackgroundAs there is a shortage of care staff in elderly care homes, seniors are expected to work as assistants to help the care staff. This study examined the influence of older assistant workers in intermediate elderly care facilities on care staff, specifically focusing on emotional exhaustion which is a sign of burnout. These facilities provide long-term nursing and supportive care to older residents.MethodsData from a mail survey of intermediate elderly care facilities with older assistant workers were analyzed. Care staff were asked about the advantages and disadvantages of introducing older assistant workers in elderly care work, and their degree of emotional exhaustion. We also assessed work self-evaluations of older assistant workers, including the benefits of the work, and physical and mental burdens.ResultsA significantly large number of care staff reported improvements in workload with the employment of older assistant workers. Intermediate elderly care facilities enrolling more older assistant workers showed lower mean emotional exhaustion among care staff, independent of possible covariates. While older assistant workers felt that their work contributed to helping both care users and staff, they also reported a mental burden.ConclusionsOur results suggest that older assistant workers can play a significant role in reducing the physical and mental burden of intermediate elderly care facility staff. Thus, employing older assistant workers can be an effective approach to addressing shortages of care staff in elderly care homes.

There Is No Place Like Home … But Things Could Be Better.

Increasing attention is being placed on the role of the built environment in promoting and sustaining health in long-term care home settings. Work that reconsiders the physical and work designs of the long-term care sector in the future is expected. In light of that, we urge full and reflective consideration of the tensions and complexities that have been brought to light through the pandemic and attending to what is known and knowable about the influences of the built environment on long-term care home residents and staff who provide their care.

A realist evaluation of a collaborative model to support research co-production in long-term care settings in England: the ExCHANGE protocol

BackgroundCollaborative working between academic institutions and those who provide health and social care has been identified as integral in order to produce acceptable, relevant, and timely research, and for outputs to be useful and practical to implement. The ExCHANGE Collaboration aims to bring together researchers and people working, living in and visiting care homes to build capacity, share and mobilise knowledge, and identify key areas for future research. This paper describes an embedded, formative, realist and theory-driven evaluation which aims to gather information about how successful the ExCHANGE Collaboration is perceived to be in achieving its aims. An existing realist programme theory from the literature – Closer Collaboration – will be supplemented by two substantive theories: Co-production and Knowledge Brokering. This will result in an initial programme theory which will be tested by this formative evaluation to refine understanding of how the ExCHANGE Collaboration works.MethodsThe evaluation will employ mixed qualitative methods, including: analysis of documents such as feedback forms, Knowledge Broker journal/diary, event attendance records, risk and issues logs and other relevant paperwork gathered as part of project delivery; observations of events/activities; and interviews with care home providers and staff, care home residents, residents’ family members, and researchers who are involved in the project (both project design/delivery, and also attendance or involvement in project activities/events). Framework Analysis will be used to interpret the data collected; analysis will be strategic, by focusing on particular key areas of importance in the developing theory of how the ExCHANGE Collaboration might achieve change.ResultsThe results of this study are expected to be published in 2022.DiscussionThis evaluation will investigate how successful the ExCHANGE Collaboration is perceived to be in achieving its aims, in what way, in which contexts, and how this may differ for those involved. It will do this by testing an initial programme theory about how the collaboration works, for whom, under which circumstances, and in what way. Findings will be shared through written publication, an end of project learning event for those involved/interested in the project, and a lay summary to be made publically available.

The impact of the physical environment for caregiving in ordinary housing: Experiences of staff in home- and health-care services

The strong driving forces for ageing in place demand sustainable solutions for the housing and care of older people and the health and safety of home- and health-care staff. The aim of the study was to elucidate staff experiences of providing home- and health-care to older people living in ordinary housing. This study was part of a larger project investigating the relation between home design and conditions for care in ordinary housing. The data were gathered through focus group interviews with staff in home- and health-care. Three main themes were found according to staff experiences of particular rooms’ sizes and proportions, spatial configurations, and aspects to consider when designing new housing. This study contributes important knowledge about essential features of the physical environment for staff providing home- and health-care for older people in their own homes and to aid the development of functionally sustainable housing to minimise injuries to staff.

Nursing home staff networks and COVID-19

Nursing homes and other long-term care facilities account for a disproportionate share of COVID-19 cases and fatalities worldwide. Outbreaks in US nursing homes have persisted despite nationwide visitor restrictions beginning in mid-March. An early report issued by the Centers for Disease Control and Prevention identified staff members working in multiple nursing homes as a likely source of spread from the Life Care Center in Kirkland, WA, to other skilled nursing facilities. The full extent of staff connections between nursing homes-and the role these connections serve in spreading a highly contagious respiratory infection-is currently unknown given the lack of centralized data on cross-facility employment. We perform a large-scale analysis of nursing home connections via shared staff and contractors using device-level geolocation data from 50 million smartphones, and find that 5.1% of smartphone users who visited a nursing home for at least 1 h also visited another facility during our 11-wk study period-even after visitor restrictions were imposed. We construct network measures of connectedness and estimate that nursing homes, on average, share connections with 7.1 other facilities. Traditional federal regulatory metrics of nursing home quality are unimportant in predicting outbreaks, consistent with recent research. Controlling for demographic and other factors, a home's staff network connections and its centrality within the greater network strongly predict COVID-19 cases.

Risky Preferences: Nursing Staff Perceptions of Risks May Impede Delivery of Person-Centered Care

Nursing home (NH) staff perceptions of risks to residents’ health and safety is a major barrier to honoring resident preferences, the cornerstone of person-centered care delivery. This study examined direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents’ preferences for everyday living and care activities. Participants (N=27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs experiencing 6-12 health citations. Content analysis of 12 focus groups indicated nursing staff perceptions of risks may impede delivery of PCC. This is supported by the overarching theme: pervasive risk avoidance; and sub-themes of: staff values, supports for risk-taking, and challenges to honoring preferences. Findings will be discussed considering a newly modified risk engagement framework meant to understand and inform the clinical management of older adult preferences perceived to carry risks. Opportunities for future research will be discussed (e.g. measurement development). Part of a symposium sponsored by the Research in Quality of Care Interest Group.

Practice examples: Children's home staff and agencies take restorative approach to cut offending

Children and Young People NowVol. 2020, No. 11 Special Report PracticePractice examples: Children's home staff and agencies take restorative approach to cut offendingDan PartonDan PartonSearch for more papers by this authorDan PartonPublished Online:29 May 2021https://doi.org/10.12968/cypn.2020.11.41AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 November 2020Volume 2020Issue 11ISSN (print): 1755-8093ISSN (online): 2515-7582 Metrics History Published online 29 May 2021 Published in print 2 November 2020 Information© MA Education LimitedPDF download

Proactively providing training and education to care homes: a local initiative

Lack of regulation and oversight when it comes to training staff in care homes has often been an undermining factor in the provision of effective care to residents with more complex health needs. Natalie McCarthy outlines the training initiative launched in her local area and discusses its impact on staff confidence and proficiency and resident care