This study examined the effects of volunteer counselor training (empathy training versus information only) and age of volunteer (senior citizens versus adolescents) upon depression level of nursing home residents. Results showed that residents who received a volunteer counselor significantly improved (p < .01) in level of depression compared to the no volunteer control group. The empathy trained counselors were not significantly more effective than the information only group. The age of the. volunteer counselor was found not to be a significant variable.

Yes / Objectives To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. Design Pilot cluster randomised controlled trial. Setting 14 NHs (7 intervention, 7 control) in London and West Yorkshire. Participants NH residents, their family carers and staff. Intervention Complex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) ‘Stop and Watch (S&W)’ early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators. Outcome measures Data on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted. Results We recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm. Conclusions Recruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted.

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address the relationship between nursing home administrator turnover and resident quality of life. The Donabedian health services quality model was the framework for the study. Data were collected from 14 nursing homes, and included semistructured interview data with 7 nursing home administrators, and a review of other documents related to quality of care including site visit reports and surveys. An iterative process of coding and constant comparison was used to identify themes and categories from the data. The findings indicate that turnover likely caused an adverse impact on the nursing home overall, which was expected. The study also determined, however, that high turnover itself was not perceived to be associated to low resident quality of life. The implication for social change is that nursing home stakeholders may develop processes to retain competent administrators which in turn could reduce absent leadership presence in nursing homes. Consistent leadership presence may lead to improvement in quality of life regulatory compliance and reduction in unnecessary Medicare and Medicaid spending by nursing home residents.

<p>Vår åldrande befolkning har ett ökande behov av vårdande för att upprätthålla sitt välbefinnande. Kanske kan djur användas som en del av vårdandet för att främja boendes välbefinnande inom äldrevården. <strong>Bakgrund:</strong> Historiskt har djur oftast använts inom psykiatrin och då framförallt i vården av barn. Under 1990-talet började det bli vanligt att införa sällskapsdjur inom äldrevården och mycket forskning publicerades, som pekade på hälsofrämjande effekter av djurassisterat vårdande. <strong>Syfte:</strong> Syftet med detta examensarbete var att beskriva den inverkan djurassisterat vårdande kan ha på boendes välbefinnande inom äldrevården. <strong>Metod:</strong> En systematisk litteraturstudie genomfördes för att besvara syfte och frågeställning. Data samlades in både manuellt och genom databassökning. Endast vetenskapliga forskningsartiklar inkluderades och datamaterialet var både kvantitativt och kvalitativt. Datamaterialet analyserades för att identifiera kategorier. <strong>Resultat:</strong> Nio kategorier identifierades varav åtta beskriver hur djurs medverkan i vården främjat välbefinnande hos äldre. Den nionde kategorin beskriver på vilka sätt djuren orsakat uttryck för illabefinnande. <strong>Slutsats:</strong> Fördelarna med djurassisterat vårdande uppvägde nackdelarna med god marginal, vilket gör att författarna anser att examensarbetets resultat pekar på att djurassisterat vårdande kan användas i praktiken för att främja boendes välbefinnande inom äldrevården.</p> / <p>Our ageing population have an increasing need of caring to maintain their sense of well-being. Companion animals have the ability to listen without judging, they can offer friendship and make the elders feel needed. <strong>Background:</strong> Historically, animals have been used in the psychiatric setting and foremost when caring for children. During the 1990s, introduction of animals into the nursing home setting became common and a substantial amount of research was published, indicating health-promoting effects of animal-assisted caring. <strong>Aim:</strong> The aim of this exam paper was to describe the potential impact of animal-assisted caring on well-being of older adults in the nursing home setting. <strong>Method:</strong> A systematic review was conducted in response to the aim and study question. Data was collected both manually and by searching a database. Only research-based journal articles were included and both quantitative and qualitative data was retrieved. The data was analyzed to identify categories. <strong>Results:</strong> Nine categories were identified including eight categories describing how animal contribution led to promotion of well-being among the elderly. The ninth category describes the ways animal-assisted caring caused expressions of ill-being. <strong>Conclusion:</strong> The benefits of animal-assisted caring outweighed the disadvantages by far, which led the authors to conclude that the results of this exam paper supports the implementation of animal-assisted caring in practice to promote well-being in elderly nursing home residents.</p>

Vår åldrande befolkning har ett ökande behov av vårdande för att upprätthålla sitt välbefinnande. Kanske kan djur användas som en del av vårdandet för att främja boendes välbefinnande inom äldrevården. Bakgrund: Historiskt har djur oftast använts inom psykiatrin och då framförallt i vården av barn. Under 1990-talet började det bli vanligt att införa sällskapsdjur inom äldrevården och mycket forskning publicerades, som pekade på hälsofrämjande effekter av djurassisterat vårdande. Syfte: Syftet med detta examensarbete var att beskriva den inverkan djurassisterat vårdande kan ha på boendes välbefinnande inom äldrevården. Metod: En systematisk litteraturstudie genomfördes för att besvara syfte och frågeställning. Data samlades in både manuellt och genom databassökning. Endast vetenskapliga forskningsartiklar inkluderades och datamaterialet var både kvantitativt och kvalitativt. Datamaterialet analyserades för att identifiera kategorier. Resultat: Nio kategorier identifierades varav åtta beskriver hur djurs medverkan i vården främjat välbefinnande hos äldre. Den nionde kategorin beskriver på vilka sätt djuren orsakat uttryck för illabefinnande. Slutsats: Fördelarna med djurassisterat vårdande uppvägde nackdelarna med god marginal, vilket gör att författarna anser att examensarbetets resultat pekar på att djurassisterat vårdande kan användas i praktiken för att främja boendes välbefinnande inom äldrevården. / Our ageing population have an increasing need of caring to maintain their sense of well-being. Companion animals have the ability to listen without judging, they can offer friendship and make the elders feel needed. Background: Historically, animals have been used in the psychiatric setting and foremost when caring for children. During the 1990s, introduction of animals into the nursing home setting became common and a substantial amount of research was published, indicating health-promoting effects of animal-assisted caring. Aim: The aim of this exam paper was to describe the potential impact of animal-assisted caring on well-being of older adults in the nursing home setting. Method: A systematic review was conducted in response to the aim and study question. Data was collected both manually and by searching a database. Only research-based journal articles were included and both quantitative and qualitative data was retrieved. The data was analyzed to identify categories. Results: Nine categories were identified including eight categories describing how animal contribution led to promotion of well-being among the elderly. The ninth category describes the ways animal-assisted caring caused expressions of ill-being. Conclusion: The benefits of animal-assisted caring outweighed the disadvantages by far, which led the authors to conclude that the results of this exam paper supports the implementation of animal-assisted caring in practice to promote well-being in elderly nursing home residents.

Bakgrund: Sjuksköterskor inom hemsjukvård har till uppgift att bland flera andra arbetsuppgifter även symtomlindra patienter med palliativt vårdbehov som lider på grund av fysiska, psykiska, psykosociala eller existentiella orsaker. Palliativ vård innebär ett personcentrerat synsätt där kärnan ligger i att se hela människan och inte bara sjukdomen eller det för stunden framträdande symtomet. Palliativ vård bedrivs inom flera verksamheter med olika huvudmän. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Metod: En kvalitativ litteraturöversikt utfördes på 16 artiklar som hittades genom sökningar i databaserna CINAHL, PubMed och PsycInfo. Artiklarnas resultat analyserades med inspiration av integrativ metod. Genom analys framkom tre kategorier med sex underkategorier gällande sjuksköterskors erfarenheter av symtomlindring vid palliativ vård i hemsjukvård. Resultat: Resultatet visar att sjuksköterskor som arbetar inom hemsjukvård behöver kunskap och kompetens inom palliativ vård och symtomlindring. Det behöver även finnas ett fungerande samarbete med ansvarig läkare för att kunna erbjuda patienten en personcentrerad vård och symtomlindring. Att arbeta som sjuksköterska i hemsjukvård kan i arbetet med palliativ vård ge en känslomässig påverkan i form av frustration och oro. Slutsats: För att patienter med palliativt vårdbehov inom hemsjukvård ska få optimal symtomlindring krävs att sjuksköterskor har kunskap och tidigare erfarenhet, vilket påverkar i vilken utsträckning patienters symtom blir lindrade. Det är även viktigt att det finns en fungerande samverkan med ansvarig läkare i primärvård. Läkares engagemang, kunskap, tid och intresse för palliativ vård är avgörande för kvaliteten på vården. / Background: Nurses in home care have the task of among several other tasks, also relieving symptoms of patients with palliative care needs who suffer due to physical, menthal, psychosocial or existential causes. Palliative care involves a person centered approach where the core lies in seeing the whole person, not just the disease or the currently prominent symptom. Palliative care is conducted in many different activities with different principals. Aim: The aim was to describe nurses experiences of symptom management in palliative care in home care services. Method: A qualitative literature review was performed on 16 articles found through searches in the databases CINAHL, PubMed and PsychInfo. The result of the articles were then analyzed with inspiration from an integrative method. Through analysis three categories emerged with six subcategories regarding nurses experiences of symptoms relief in palliative care in home care. Results: The result showed that in order for nurses to be able to offer the patient optimal symptom relief, conditions were required in form of time, right prescriptions, commitment and collaboration with the district physician. Nurses' experience and knowledge of palliative care were also important for the outcome of the effect of symptom relief, as increased experience provided greater security in symptom relief. Regardless of previous experience and knowledge level, more training in symptom relief was requested. Deficiencies in collaboration with the district physician could create anxiety and frustration among the nurses. Conclusion: In order for patients with palliative care needs in home care to receive optimal symptom relief, it is required that nurses have knowledge and previous experience, which affect the extent to which patient´s symptoms are alleviated. It is also important that there is a functioning collaboration with the responsible doctor in primary care. The doctor's commitment, knowledge, time and interest in palliative care are crucial for the quality of care.

No description available.

Det overordnede målet med denne avhandling var å få en oversikt over ulike forstyrrelser i de nedre urinveier hos gamle. Dernest var målet å beskrive oppfatninger og barrierer som influerte på personalets muligheter for å gi riktig inkontinenspleie til beboere i sykehjem. Avhandlingen består av en kvantitativ studie (artikkel I, II, III), og en kvalitativ studie (artikkel IV). Artikkel I var en tverrsnittstudie. Artikkel II og III var en prospektiv tidsdesignstudie med en oppfølgingsperiode på ett år. 183 beboere fra seks sykehjem deltok i den kvantitative studien. I artikkel I ble prevalensen av urininkontinens hos norske sykehjembeboere evaluert. I tillegg ble det forsøkt å identifisere faktorer som var assosiert med urininkontinens i denne populasjonen. I artikkel II ble det undersøkt om residualurin var en risiko for å utvikle urinveisinfeksjon hos gamle på sykehjem. I artikkel III ble det undersøkt om bleiebruk per døgn er en pålitelig metode for å kvantifisere urininkontinens hos sykehjemsbeboere. Det ble også studert om det var sammenheng mellom urinveisinfeksjon, bleiebruk per døgn og væskeinntak. I den kvalitative studien var målet å identifisere oppfatninger og barrierer som influerte på pleiernes muligheter for å gi riktig inkontinenspleie. Fem avdelingsledere, fem sykepleiere og fem hjelpepleiere ble intervjuet i til sammen tre fokusgruppeintervjuer.Analysen i artikkel I viste at 122 beboere (69 %) var inkontinent for urin og 144 (83 %) brukte bleier. 14 % brukte bleier for sikkerhets skyld. Lav ADL-skår, demens og urinveisinfeksjon var assosiert med urininkontinens (P = &lt;0.01). I artikkel II hadde 98 beboere (63.3 %) residualurin mindre enn 100 ml, og 52 (34.7 %) hadde residualurin på 100 ml eller større. I løpet av oppfølgingsperioden hadde 51 beboere (34 %) utviklet en eller flere urinveisinfeksjoner. Forekomsten av urinveisinfeksjon var høyere hos kvinnene enn hos mennene (40.4 % versus 19.6 %; P = 0.02). Det ble ikke funnet noen signifikant forskjell i gjennomsnittlig residualurin mellom beboere som utviklet og som ikke utviklet urinveisinfeksjon (79 versus 97 ml, P = 0.26). Residualurin på 100 ml eller større var ikke assosiert med større risiko for utvikling av urinveisinfeksjon.I artikkel III brukte 118 (77 %) av beboerne bleier. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Beboere som brukte bleier hadde en økende risiko for å utvikle urinveisinfeksjon sammenlignet medvibeboere som ikke brukte bleier (41 versus 11 %; P = 0.001). Daglig væskeinntak var ikke assosiert med urinveisinfeksjoner (P = 0.46). Antall bleieskift viste ingen korrelasjon med risikoen for utvikling av urinveisinfeksjon (P = 0.62). Bleiene som beboerne brukte per døgn, viste stor variasjon i inkontinensvolum. I den kvalitative studien ledet innholdsanalysen fram til tre emner og åtte kategorier. Det første emnet, Oppfatninger og barrierer assosiert med beboerne, inneholdt en kategori ”fysiske og kognitive problemer”. Det andre emnet, Oppfatninger og barrierer assosiert med personalet, inneholdt tre kategorier: ”manglende kunnskaper”, ”holdninger og tro” og ”manglende tilgjengelighet”. Det tredje emnet, Oppfatninger og barrierer assosiert med den organisatoriske kulturen, inneholdt fire kategorier: ”rigide rutiner”, manglende ressurser”, ”manglede dokumentasjon” og ”svakt lederskap”. Resultatene i denne avhandlingen viser at forekomsten av urininkontinens i sykehjem er høy. Absorberende produkter er hyppig brukt uten en kjent historie av urininkontinens. Fysisk svekkelse, demens og urinveisinfeksjon er assosiert med urininkontinens. Residualurin er vanlig hos beboere i sykehjem. Det ble ikke funnet noen sammenheng mellom residualurin og urinveisinfeksjon. Bruk av absorberende bleier er assosiert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn og væskeinntak var ikke korrelert med økt risiko for utvikling av urinveisinfeksjon. Bleiebruk per døgn er et upålitelig mål på urininkontinens hos beboere i sykehjem. Funnene fra den kvalitative studien viser at det er mange barrierer som influerer på personalets evne til å gi riktig inkontinenspleie til beboere i sykehjem. Det kan likevel se ut som om personalets oppfatninger og holdninger, samt manglende kunnskaper om urininkontinens, er de viktigste barrierene for å gi riktig inkontinenspleie. / The overall aim of this thesis was to get an overview over different dysfunction in the lower urinary tract in the elderly. Also, we wanted to describe the perceptions and barriers that influence the nursing staff`’s ability to provide appropriate incontinence care in nursing home residents. The thesis includes one quantitative study (paper I, II, III), and one qualitative study (paper IV). Paper I was a cross-sectional study. Paper II and III were a prospective surveillance with a follow-up period of 1 year. 183 residents from six Norwegian nursing homes participated. In paper I, the prevalence of urinary incontinence in Norwegian nursing home residents was evaluated. The factors possibly associated with urinary incontinence were also studied. In paper II, we investigated whether residual urine was a risk factor for developing urinary tract infections in the elderly in nursing homes. In paper III, the objective was to determine whether pads per day usage is a reliable measure of urinary incontinence in nursing home residents. Furthermore, we wanted to study the association between urinary tract infections, pads per day usage and fluid intake. In the qualitative study, the aim was to identify perceptions and barriers that influence the ability of nursing staff to provide appropriate incontinence care. Five charge nurses, five registered nurses and five certified nursing assistants participated in the focus group interviews.The analysis in paper I, showed that 122 (69 %) of the resident were incontinent for urine and 144 used absorbent pads (83 %). 14 % of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine (P = &lt;0.01). In paper II, 93 of the residents (65.3 %) had postvoid residual urine (PVR) &lt; 100 mL and 52 residents (34.7 %) had a PVR 100 mL. During the follow-up period, 51 residents (34.0 %) had one or more urinary tract infections (UTI). The prevalence of UTI among females was higher than among men (40.4 % versus. 19.6 %; P = 0.015). There was no significant difference in mean PVR among residents that did or did not develop UTI (79 mL versus 97mL; P = 0.26). A PVR 100 mL was not associated with an increased risk of developing UTI`s (P = 0.59).In paper III, 118 (77 %) used absorbent pads. Residents that used absorbent pads were at increased risk of developing UTIs compared to residents that did notviiiuse pads (41 % versus 11 %; P = 0.001). Daily fluid intake was not associated with UTIs (P = 0.46). The number of pad shifts had no relation with the risk of developing UTIs (P = 0.62). Residents with a given pad per day (PPD) presented a wide range of incontinence volumes.In paper IV, three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: ‘physical and cognitive problems’. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: ‘lack of knowledge’, ‘attitudes and beliefs’ and ‘lack of accessibility’. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: ‘rigid routines’, ‘lack of resource’, ‘lack of documentation’ and ‘lack of leadership’.The results of the thesis show that the prevalence of urinary incontinence in nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are associated with urinary incontinence. is common in nursing home residents. No association between PVR and UTI was found. The use of absorbent pads is associated with an increased risk of developing UTIs. PPD and daily fluid intake are not correlated with the risk of developing UTIs. PPD is an unreliable measure of urinary incontinence in nursing home residents. The findings from the qualitative study shows that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about urinary incontince, are the most important barriers to provide appropriate incontinence care.

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents. / May 2009

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents.