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For elderly people the decision to enter an institution is usually the result of complex interactions which involves not only themselves but also professionals and family members. This research concerns the role of families in the decision‐making process over the admission of their elderly relatives to nursing homes in Taiwan. The families' views, including their influence and involvement in the process, were examined. It was found that most elderly people in Taiwan were cared for in their own homes by family members, but under certain circumstances, nursing home entry seemed inevitable. The decision‐making process, mainly within a family context, was influenced by the needs of the elderly people, by their adult children, including their availability, and by perceptions about nursing home entry. The pattern of family care and involvement may change and reasons are suggested for this.

Despite the new ‘needs driven’ criteria for public funded admission to nursing homes, there remains concern that older people are entering such care inappropriately. However, neither previous research or policy makers have sub‐divided such inappropriate entries into their constituent groups: those who are inappropriate because they are too independent and those who are inappropriate because they are too dependent. The aims of this study were to determine the extent of inappropriate nursing home admission amongst older people in nursing homes in six areas of England and Wales between 1995‐96. This was done through a retrospective case‐note review using a structured data‐collection pro forma. Although the study found no evidence of extensive inappropriate placement, extrapolation of these data suggests that 6,750 of those admitted to nursing care could have coped in a more independent environment. The inappropriately admitted group were more likely to have lived alone, be female, elderly and not to have seen a geriatrician. It is concluded that the most effective way to prevent such admissions would be to ensure the involvement of specialist geriatricians in the multidisciplinary team involved in admission decisions.

This article describes a partnership project between staff, residents and relatives at a nursing home for older people with dementia, and researchers at the University of Sheffield. The aim of the partnership is to develop care within the home and to create a positive environment for living, working and learning. The main principle guiding our work is the need to ensure that all participants: residents, relatives and staff, feel that they are valued members of the community. The project is using an action research approach and a range of methods, including: observation; interviews; questionnaires; process recording of meetings; and focus groups, to gather evidence about the research process and impact of the project. The article includes a summary of achievements to date and suggestions for future activity.

A long-established cultural norm of filial piety may cause ambivalent feelings for adult children who are considered the primary caregivers for their elderly parents in Turkish culture, and whose parents have been placed into nursing homes. The purpose of this paper is to provide an insight to the lived experiences of adult children of elderly people living in a nursing home in Turkey.

Drawing upon dramaturgical theory and phenomenological methodology, the authors conducted interviews with ten adult children whose elderly parents had been admitted to a nursing home in Izmir, Turkey. Multi-stage purposeful random sampling was used as the sampling scheme. Thematic analysis was performed to interpret the data.

Three themes emerged from the data: adult children’s coping strategies, the ways in which the adult children rationalize their decisions, and the ways in which the adult children manage the placement process. The interviews revealed that the adult children often feel like social outcasts and experience a wide range of difficulties, including social pressures, their own inner dilemmas, and negotiations with their elderly parents.

An exploration for the lived experiences of adult children relating to the nursing home placement of their elderly parents contributes an insight about the well-established cultural norms that produce feelings of ambivalence.

This paper highlights the need for researchers to work across disciplinary boundaries in order to capture the complexity that care practitioners have to engage with everyday in care home settings. Drawing on findings from a literature review on the complexity of loss in continuing care institutions for older people, the case is made for less victim blaming and more appreciative approaches to research. The way this thinking informed the development of a further literature review on quality of life in care homes (My Home Life) is discussed. Findings from this second study are shared by illustrating key messages with quotes from older residents, relatives and staff living, visiting and working in care homes. These best practice messages focus on: transition into a care home; working to help residents maintain their identity; creating community within care homes; shared decision‐making; health and health services; end‐of‐life care; keeping the workforce fit for purpose, and promoting positive culture. The importance of collaborative working in both research and practice is discussed. The paper is likely to be of interest to all those concerned with improving and developing evidence‐based practice in the care home sector, including users and service providers, managers, commissioners and inspectors, policy‐makers, researchers and teachers.

Respite care is one of the services most frequently requested by family carers, but places are often not taken up because of carers' concerns about the quality of the respite experience. This paper describes the formation of a new respite unit at St Ita's Hospital in Western Ireland and staff's efforts to create a respite experience that more closely reflects the older person's home environment. The initial focus was on providing more choice in terms of the food served and the times of meals. The challenges of introducing even small changes to the delivery of care are considered, and the need for a more widespread and sustained approach to culture change is promoted.

The purpose of this paper is to highlight the complexity surrounding the implementation of advanced electronic tracking, communication and emergency response technologies, namely, an extended safety and support (ESS) system for people with dementia (pwd) living at home. Results are presented from a Swedish demonstration study (2011-2012) conducted in 24 municipalities.

It is a descriptive intervention study with a pre-post test design. Questionnaires were administered to pwd, carers and professionals at the outset and eight months later. ESS logging data were analyzed.

ESS usage rates varied widely. A total of 650 alerts were triggered, mainly when the pwd was outdoors. Activities were reduced amongst pwd, most likely due to a progression of their disease. Carers noted that pwd were more independent than previously on those occasions when they engaged in outdoor activities. Staff considered that nearly half of pwd could remain living at home due to the ESS, compared with a third amongst carers. In total, 50 per cent of carers felt it was justified to equip their relative with an ESS without their explicit consent, compared to one in eight staff.

A limitation is the amount of missing data and high drop- out rates. Researchers should recruit pwd earlier in their illness trajectory. A mixed-methods approach to data collection is advisable.

Carers played a crucial role in the adoption of ESS. Staff training/supervision about assistive devices and services is recommended.

Overall, use of ESS for pwd living at home was not an ethical problem.

The study included key stakeholder groups and a detailed ethical analysis was conducted.

Recent years have seen an increasing reliance on social support at home for people with dementia and the advocacy of a person centred and integrated approach in its provision. However, little is known about the effective ingredients of this support and how they differ from more generic or health-based services. The purpose of this paper is to explore the existing evidence base.

A review of relevant literature was carried out, combining a systematic search and selection of articles with a narrative analysis.

The review identified 14 relevant studies of varying research designs which yielded conflicting findings with regard to the optimal timing of interventions and their overall impact. This highlights the problems of review and generalisability when attempting to compare findings of research in this area. This was exacerbated by the blurred divide between health and social care and ambiguities in the meaning of the latter.

This methodological heterogeneity demonstrates the need for consistency in research approaches if comparisons are to be made. Further questions include the precise components that distinguish social care from health care, the optimal timing for the introduction of this care and whether adherence to good practice in this area can be linked to cost effectiveness.

The review identifies relevant issues in need of further investigation and tentative themes emerging from the literature which suggest the utility of an adequately resourced, integrated and responsive approach to intervention.

This chapter is concerned with the varied legitimizing discourses used by midwives to frame their identities in relation to their work. This sociological issue is particularly important in the context of an occupation, such as this one, that exists at the border of competing service claims. Drawing on 26 in-depth interviews, I use narrative analysis to examine the stories that midwives tell about their work. Through these women’s work narratives, I show the complex intersection of narrative, culture, institution, and biography (Chase, 1995, 2001; DeVault, 1999).

This paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home.

The research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England.

Abuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive; therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to “do dignity”, an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults.

District nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients.

This paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults.