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Special Issue "Enhancing the Quality of Care in Long-Term Care Settings"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (1 May 2021).

Special Issue Editors

Prof. Tom Dening
E-Mail Website
Guest Editor
University of Nottingham, Nottingham, United Kingdom
Interests: epidemiological studies of very old people; mental health services for older people; mental health in care homes
Dr. Reena Devi
E-Mail Website
Guest Editor
University of Leeds, Leeds, United Kingdom
Interests: health care services; older people, long-term care, and implementation science
Prof. Adam Gordon
E-Mail Website
Guest Editor
University of Nottingham, Nottingham, United Kingdom
Interests: care of older people; healthcare professions; long-term care

Special Issue Information

Dear Colleagues,

The increasing older population is a phenomenon that is well recognised around the world. The number of people aged 60 years and older will increase from 900 million in 2015 to 2 billion in 2050 (World Health Organisation 2018) (https://www.who.int/news-room/fact-sheets/detail/ageing-and-health). The most vulnerable and frail, who are not able to live independently, will live in residential care. Residential care settings provide 24-hour functional support for people with health and care needs, may/may not be staffed with health care professionals, provide long-term care and/or rehabilitation, are not hospital based and may play a role in end-of-life care (Sanford et al., 2015). Over time, the care and health needs of older people are becoming increasingly complex (Kingston et al., 2018), and there is work to do to ensure that the sector delivers high-quality and evidence-based care that meets the needs of older people.

This Special Issue on ‘Enhancing the Quality of Care in Long-Term Care Settings’ is dedicated to publishing reports, which describe different ways that the quality of care delivered to older people living in long-term care settings can be enhanced. The aim is to give readers valuable insights into what works well when working towards enhancing the quality of care received by older people. The guest editors would like to invite original research, reviews, and narratives describing expert insights on the following topics:

  • Methodologies used to enhance the quality of care;
  • Evaluations of innovations implemented into long-term care;
  • Sustaining successful initiatives beyond the short term;
  • Addressing workforce-related challenges;
  • Advance care planning in long-term care;
  • Supporting and delivering end-of-life care.

The title 'Enhancing the Quality of Care in Long Term Care Settings' was inspired from recent feedback received while working on a local project in the UK (https://medicinehealth.leeds.ac.uk/directory_record/1033/niche-leeds). The long term care sector described that the phrase 'quality improvement' implies poor quality as the starting point, and the phrase 'enhancing the quality of care' is preferred. Thank you to Cyd Akrill, Head of Operations at Springfield Healthcare (https://www.springfieldhealthcare.com/) for this excellent insight.

Prof.  Tom Dening
Dr. Reena Devi
Prof. Adam Gordon
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Long-term care
  • Care homes
  • Residential homes
  • Nursing homes
  • Implementation science
  • Quality Improvement

Published Papers (22 papers)

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Research

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Article
Job Competency and Intention to Stay among Nursing Assistants: The Mediating Effects of Intrinsic and Extrinsic Job Satisfaction
Int. J. Environ. Res. Public Health 2021, 18(12), 6436; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126436 - 14 Jun 2021
Viewed by 408
Abstract
This study investigated the influences of nursing assistants’ job competency on their intrinsic and extrinsic satisfaction and intention to stay in the profession of long-term care institutions. Understanding the relationship between job competency and job satisfaction, both intrinsic and extrinsic, would enable institutions [...] Read more.
This study investigated the influences of nursing assistants’ job competency on their intrinsic and extrinsic satisfaction and intention to stay in the profession of long-term care institutions. Understanding the relationship between job competency and job satisfaction, both intrinsic and extrinsic, would enable institutions to strengthen service workers’ intention to stay and to retain essential personnel. This study was a cross-sectional study in which nursing assistants from 26 nursing homes and 15 elderly welfare institutions in Taiwan. The relationship between job competency and intention to stay was discovered to be significantly mediated by intrinsic and extrinsic job satisfaction. Given the staff shortages and difficulty retaining staff in long-term care environments, organizations must be able to strengthen employees’ intention to stay; one suggestion is to improve the employees’ competency, because higher competency results in higher quality of care and greater extrinsic job satisfaction. Furthermore, greater job competency is more likely to result in affirmation and accomplishment, both of which increase intrinsic job satisfaction and thus positively influence intention to stay. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
‘This Adds Another Perspective’: Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes
Int. J. Environ. Res. Public Health 2021, 18(8), 3995; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18083995 - 10 Apr 2021
Viewed by 651
Abstract
Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In [...] Read more.
Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease’s effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Higher Prevalence of Dementia but No Change in Total Comfort While Dying among Nursing Home Residents with Dementia between 2010 and 2015: Results from Two Retrospective Epidemiological Studies
Int. J. Environ. Res. Public Health 2021, 18(4), 2160; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18042160 - 23 Feb 2021
Viewed by 730
Abstract
Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence [...] Read more.
Important policy developments in dementia and palliative care in nursing homes between 2010 and 2015 in Flanders, Belgium might have influenced which people die in nursing homes and how they die. We aimed to examine differences between 2010 and 2015 in the prevalence and characteristics of residents with dementia in nursing homes in Flanders, and their palliative care service use and comfort in the last week of life. We used two retrospective epidemiological studies, including 198 residents in 2010 and 183 in 2015, who died with dementia in representative samples of nursing homes in Flanders. We found a 15%-point increase in dementia prevalence (p-value < 0.01), with a total of 11%-point decrease in severe to very severe cognitive impairment (p = 0.04). Controlling for residents’ characteristics, in the last week of life, there was an increase in the use of pain assessment (+20%-point; p < 0.03) but no change in total comfort. The higher prevalence of dementia in nursing homes with no change in residents’ total comfort while dying emphasizes an urgent need to better support nursing homes in improving their capacities to provide timely and high-quality palliative care services to more residents dying with dementia. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Pilot Study to Develop and Test Palliative Care Quality Indicators for Nursing Homes
Int. J. Environ. Res. Public Health 2021, 18(2), 829; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020829 - 19 Jan 2021
Viewed by 907
Abstract
An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, [...] Read more.
An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure while using a mixed-methods design. We developed the instrument in three phases: (1) literature search, (2) interviews with experts, and (3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy, and communication with family. The quantitative and qualitative analyses showed that the indicators were measurable, had good preliminary face validity and discriminative power, and were considered to be useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all of the residents in nursing homes. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Personal and Work-Related Factors Associated with Good Care for Institutionalized Older Adults
Int. J. Environ. Res. Public Health 2021, 18(2), 820; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020820 - 19 Jan 2021
Cited by 1 | Viewed by 946
Abstract
Despite efforts to promote good care, many institutionalized older adults (IOA) experience elevated neglectful conditions and reduced person-centered care approaches. Based on the job demand–control model, this study aimed to analyze the relationship between nursing home professionals’ personal and organizational factors and good [...] Read more.
Despite efforts to promote good care, many institutionalized older adults (IOA) experience elevated neglectful conditions and reduced person-centered care approaches. Based on the job demand–control model, this study aimed to analyze the relationship between nursing home professionals’ personal and organizational factors and good care provided to institutionalized older people. Data was collected through a self-administered survey completed by 208 nursing home staff members. Three dimensions of personal factors (i.e., personal accomplishment, depersonalization, and negative old age stereotypes) were significant predictors of good care. Depersonalization and negative old age stereotypes were negatively associated with IOA, and both good care and personal accomplishment were positively associated with good care in nursing homes. Only one work-related factor (i.e., management support) was positively associated with good care. Personal factors may play a significant role in good care. Management support offers a promising mechanism to promote good care among nursing home professionals. The findings support the need to change the focus on entirely completing care tasks to providing good care of residents in nursing homes that promotes management support, personal accomplishment, personalization and positive old age consideration, attitudes, and behaviors. Policies and interventions should be developed to address in a more humanized way. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
A Cross-Sectional Study on the Impacts of Perceived Job Value, Job Maintenance, and Social Support on Burnout among Long-Term Care Staff in Hawaii
Int. J. Environ. Res. Public Health 2021, 18(2), 476; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18020476 - 08 Jan 2021
Viewed by 842
Abstract
Extensive research has demonstrated the factors that influence burnout among social service employees, yet few studies have explored burnout among long-term care staff in Hawaii. This study aimed to examine the impact of job value, job maintenance, and social support on burnout of [...] Read more.
Extensive research has demonstrated the factors that influence burnout among social service employees, yet few studies have explored burnout among long-term care staff in Hawaii. This study aimed to examine the impact of job value, job maintenance, and social support on burnout of staff in long-term care settings in Hawaii, USA. This cross-sectional study included 170 long-term care staff, aged 20 to 75 years, in Hawaii. Hierarchical regression was employed to explore the relationships between the key independent variables and burnout. The results indicate that staff with a higher level of perceived job value, those who expressed a willingness to continue working in the same job, and those with strong social support from supervisors or peers are less likely to experience burnout. Interventions aimed at decreasing the level of burnout among long-term care staff in Hawaii may be more effective through culturally tailored programs aimed to increase the levels of job value, job maintenance, and social support. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Nursing Home Residents Aged over 80—A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect
Int. J. Environ. Res. Public Health 2020, 17(24), 9583; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249583 - 21 Dec 2020
Viewed by 784
Abstract
Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines [...] Read more.
Admission to a care facility is assumed to enhance depressive symptoms and dependent behavior in old age. In this context, the relevance of participation in activities that make everyday life in a care facility more pleasant has been pointed out. This study examines if there is a relationship between participation in different activities as well as the frequency of this participation and the positive affect of nursing home residents aged over 80. Data from the unique cross-sectional representative study ‘Quality of life and subjective well-being of the very old in North Rhine-Westphalia’ in Germany (n = 150, aged 90.15 years in average) were used. The data were collected between 08/2017 and 02/2018 using computer-assisted personal interviewing. The variability in and frequency of activity participation functioned as independent, and positive affect as dependent variable. Multiple regression analysis was performed. Residents’ predicted positive affect significantly increased with a higher variability in activity participation. There was no independent effect of frequency in participation. Our findings indicate that there is a significant and positive relationship between participating in a high number of different activities and the overall positive affect of residents aged over 80 years. This does not hold true for the frequency of participation. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions
Int. J. Environ. Res. Public Health 2020, 17(24), 9413; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249413 - 15 Dec 2020
Viewed by 587
Abstract
With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs [...] Read more.
With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
Assessing Nursing Homes Quality Indicators’ between-Provider Variability and Reliability: A Cross-Sectional Study Using ICCs and Rankability
Int. J. Environ. Res. Public Health 2020, 17(24), 9249; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249249 - 10 Dec 2020
Viewed by 1193
Abstract
Nursing home quality indicators are often used to publicly report the quality of nursing home care. In Switzerland, six national nursing home quality indicators covering four clinical domains (polypharmacy, pain, use of physical restraints and weight loss) were recently developed. To allow for [...] Read more.
Nursing home quality indicators are often used to publicly report the quality of nursing home care. In Switzerland, six national nursing home quality indicators covering four clinical domains (polypharmacy, pain, use of physical restraints and weight loss) were recently developed. To allow for meaningful comparisons, these indicators must reliably show differences in quality of care levels between nursing homes. This study’s objectives were to assess nursing home quality indicators’ between-provider variability and reliability using intraclass correlations and rankability. This approach has not yet been used in long-term care contexts but presents methodological advantages. This cross-sectional multicenter study uses data of 11,412 residents from a convenience sample of 152 Swiss nursing homes. After calculating intraclass correlation 1 (ICC1) and rankability, we describe between-provider variability for each quality indicator using empirical Bayes estimate-based caterpillar plots. To assess reliability, we used intraclass correlation 2 (ICC2). Overall, ICC1 values were high, ranging from 0.068 (95% confidence interval (CI) 0.047–0.086) for polypharmacy to 0.396 (95% CI 0.297–0.474) for physical restraints, with quality indicator caterpillar plots showing sufficient between-provider variability. However, testing for rankability produced mixed results, with low figures for two indicators (0.144 for polypharmacy; 0.471 for self-reported pain) and moderate to high figures for the four others (from 0.692 for observed pain to 0.976 for physical restraints). High ICC2 figures, ranging from 0.896 (95% CI 0.852–0.917) (self-reported pain) to 0.990 (95% CI 0.985–0.993) (physical restraints), indicated good reliability for all six quality indicators. Intraclass correlations and rankability can be used to assess nursing home quality indicators’ between-provider variability and reliability. The six selected quality indicators reliably distinguish care differences between nursing homes and can be recommended for use, although the variability of two—polypharmacy and self-reported pain—is substantially chance-driven, limiting their utility. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO
Int. J. Environ. Res. Public Health 2020, 17(22), 8621; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17228621 - 20 Nov 2020
Viewed by 867
Abstract
People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia [...] Read more.
People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot’s user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Improving the Quality of Care in Care Homes Using the Quality Improvement Collaborative Approach: Lessons Learnt from Six Projects Conducted in the UK and The Netherlands
Int. J. Environ. Res. Public Health 2020, 17(20), 7601; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207601 - 19 Oct 2020
Cited by 4 | Viewed by 1074
Abstract
The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts [...] Read more.
The Breakthrough Series Quality Improvement Collaborative (QIC) initiative is a well-developed and widely used approach, but most of what we know about it has come from healthcare settings. In this article, those leading QICs to improve care in care homes provide detailed accounts of six QICs and share their learning of applying the QIC approach in the care home sector. Overall, five care home-specific lessons were learnt: (i) plan for the resources needed to support collaborative teams with collecting, processing, and interpreting data; (ii) create encouraging and safe working environments to help collaborative team members feel valued; (iii) recruit collaborative teams, QIC leads, and facilitators who have established relationships with care homes; (iv) regularly check project ideas are aligned with team members’ job roles, responsibilities, and priorities; and (v) work flexibly and accept that planned activities may need adapting as the project progresses. These insights are targeted at teams delivering QICs in care homes. These insights demonstrate the need to consider the care home context when applying improvement tools and techniques in this setting. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
The Impact of Implementing a Namaste Care Intervention in UK Care Homes for People Living with Advanced Dementia, Staff and Families
Int. J. Environ. Res. Public Health 2020, 17(16), 6004; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17166004 - 18 Aug 2020
Cited by 2 | Viewed by 1165
Abstract
Care homes can struggle to provide optimal care for residents with advanced dementia. Namaste Care provides a structured daily programme of physical, sensory and emotional care delivered by regular care workers. A three-year, mixed method process study of implementation and impact created a [...] Read more.
Care homes can struggle to provide optimal care for residents with advanced dementia. Namaste Care provides a structured daily programme of physical, sensory and emotional care delivered by regular care workers. A three-year, mixed method process study of implementation and impact created a manualised Namaste Care Intervention for UK care homes (NCI-UK). This article reports on the impact of NCI-UK delivered consistently in five care homes for 12–24 weeks. Impact for residents was assessed using, pre-post data, showing significant positive effects for QUALID (t = 2.92, p = 0.01, n = 31) and CMAI (t = 3.31, p = 0.002, n = 32), alongside many qualitative examples of positive impacts on wellbeing, responsiveness and communication. Pre-post staff questionnaire data (n = 20) were not significant. Qualitative data indicated that NCI-UK is a positive staff experience, providing sense of purpose, improved wellbeing and relationships. The care homes reported benefiting from implementing NCI-UK in terms of reputation and quality improvement. Family interviews were also positive, relating to seeing the difference, improving relationships and being involved. NCI-UK can therefore be recommended as an impactful intervention for residents, staff and families. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Dry Eyes, Ocular Lubricants, and Use of Systemic Medications Known or Suspected to Cause Dry Eyes in Residents of Aged Care Services
Int. J. Environ. Res. Public Health 2020, 17(15), 5349; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155349 - 24 Jul 2020
Cited by 1 | Viewed by 847
Abstract
Ocular issues are common, burdensome, and under-researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry [...] Read more.
Ocular issues are common, burdensome, and under-researched among residents of aged care services. This study aims to investigate the prevalence of dry eyes or use of ocular lubricants among residents, and the possible association with systemic medications known or suspected to cause dry eyes. A cross-sectional study of 383 residents of six aged care services in South Australia was conducted. Data were extracted from participants’ medical histories, medication charts, and validated assessments. The main exposure was systemic medications known to cause, contribute to, or aggravate dry eyes. The primary outcome was documented dry eyes or regular administration of ocular lubricants. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between systemic medications and dry eyes/use of ocular lubricants. Dry eyes were documented for 53 (13.8%) residents and 98 (25.6%) residents were administered ocular lubricants. Overall, 116 (30.3%) residents had documented dry eyes/used ocular lubricants. Of these, half (n = 58) were taking a medication known to cause, contribute to, or aggravate dry eyes. Taking one or more medications listed as known to cause dry eyes was associated with having dry eyes/use of ocular lubricants (OR 1.83, 95% CI 1.15–2.94). In sub-analyses, no individual medication was associated with dry eyes/use of ocular lubricants. Dry eyes and use of ocular lubricants are common in residential aged care. Our hypothesis generating findings suggest the need for further research into the clinical significance of systemic medications as a possible cause of dry eyes. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
The Feasibility of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident’s Perspective
Int. J. Environ. Res. Public Health 2020, 17(14), 5118; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17145118 - 15 Jul 2020
Cited by 3 | Viewed by 856
Abstract
Currently, residents living in nursing homes and their caring relationships are being placed more centrally in the care experience. Experienced quality of care is influenced by the interactions between residents, family and caregivers, who each have their own experiences and needs. Connecting Conversations [...] Read more.
Currently, residents living in nursing homes and their caring relationships are being placed more centrally in the care experience. Experienced quality of care is influenced by the interactions between residents, family and caregivers, who each have their own experiences and needs. Connecting Conversations is a narrative method aimed at assessing experienced quality of care in nursing homes from the resident’s perspective by having separate conversations with residents, family and caregivers (triads), adopting an appreciative inquiry approach. This study presents how to use Connecting Conversations and its feasibility. Feasibility was assessed as performance completeness, protocol adherence and interviewers’ experiences. Conversations were conducted by trained nursing home staff (n = 35) who performed 275 Connecting Conversations in another nursing home than where they were employed (learning network). Findings show it is feasible to perform separate appreciative conversations with resident–family–caregiver triads by an interviewer employed in another nursing home; however, protocol adherence was sometimes challenging in conversations with residents. Interviewers valued the appreciative approach, the learning network and the depth of the separate conversations. Challenges were experienced with scheduling conversations and receiving time and support to perform the conversations. Stakeholders should continue collaboration to embed Connecting Conversations into daily practice in nursing homes. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
The Validity of Connecting Conversations: A Narrative Method to Assess Experienced Quality of Care in Nursing Homes from the Resident’s Perspective
Int. J. Environ. Res. Public Health 2020, 17(14), 5100; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17145100 - 15 Jul 2020
Cited by 2 | Viewed by 779
Abstract
It is important to assess experienced quality of care in nursing homes, as this portrays what is important to residents and helps identify what quality improvements should focus on. Connecting Conversations is a narrative method that assesses experienced quality of care from the [...] Read more.
It is important to assess experienced quality of care in nursing homes, as this portrays what is important to residents and helps identify what quality improvements should focus on. Connecting Conversations is a narrative method that assesses experienced quality of care from the resident’s perspective in nursing homes by having separate conversations with residents, family, and professional caregivers (triads) within a learning network. This study assessed the validity of performing the narrative method, Connecting Conversations. Trained nursing home staff (interviewers) performed the conversations in another nursing home than where they were employed. In total, 149 conversations were performed in 10 nursing homes. Findings show that experts deemed the narrative assessment method appropriate and complete to assess experienced quality of care (face validity). The questions asked appeared to capture the full construct of experienced quality of care (content validity). Additionally, there was a range in how positive conversations were and first results indicated that a nursing home scoring higher on satisfaction had more positive conversations (construct validity). More data are needed to perform additional construct validity analyses. In conclusion, Connecting Conversations shows promising results for its use as a valid narrative method to assess experienced quality of care. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Root Cause Analysis to Identify Medication and Non-Medication Strategies to Prevent Infection-Related Hospitalizations from Australian Residential Aged Care Services
Int. J. Environ. Res. Public Health 2020, 17(9), 3282; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17093282 - 08 May 2020
Cited by 2 | Viewed by 1441
Abstract
Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, [...] Read more.
Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infection, and models of care that facilitate timely access to medical services. The RCA and clinical panel findings provide a roadmap to assist targeting services to prevent infection and limit unnecessary hospital transfers from RACS. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(8), 2742; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082742 - 16 Apr 2020
Viewed by 1157
Abstract
Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully [...] Read more.
Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
Article
SettleIN: Using a Manualised Intervention to Facilitate the Adjustment of Older Adults with Dementia Following Placement into Residential Care
Int. J. Environ. Res. Public Health 2020, 17(7), 2606; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072606 - 10 Apr 2020
Cited by 1 | Viewed by 970
Abstract
The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A [...] Read more.
The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A pilot randomised controlled trial was conducted. Nineteen new residents with dementia and 21 staff participants were recruited. Residents were randomly assigned to receive the SettleIN programme or residential care as usual. Resident quality of life, mood and overall adjustment were measured at baseline and post-intervention, in week seven. Interviews were conducted with staff in week seven to explore intervention feasibility. Despite medium to large effect sizes, there was no significant difference in mean change scores between the two conditions, with regards to quality of life, psychological wellbeing or overall adjustment outcomes. Qualitative feedback indicated that SettleIN was not feasible across all areas, with problems around recruitment and practicality. However, SettleIN was deemed feasible in terms of retention and acceptability among staff. The majority of staff felt that SettleIN was beneficial for residents but that organisational and programme factors impacted upon intervention feasibility. Further exploration of organisational barriers is needed in order to reduce the impact of such factors on care home research. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Development and Validation of the Scale for Partnership in Care—for Family (SPIC-F)
Int. J. Environ. Res. Public Health 2020, 17(6), 1882; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17061882 - 13 Mar 2020
Viewed by 959
Abstract
This study aims to develop and validate the Scale for Partnership in Care between staff and families of older adult nursing home (NH) residents—for Family (SPIC-F). The components of partnership were identified on the basis of literature reviews and focus group interviews. The [...] Read more.
This study aims to develop and validate the Scale for Partnership in Care between staff and families of older adult nursing home (NH) residents—for Family (SPIC-F). The components of partnership were identified on the basis of literature reviews and focus group interviews. The content validity of 41 preliminary items was verified by 10 experts, and a pilot study was conducted. The reliability and validity of the instrument was tested on 330 families of older adult NH residents. The final instrument comprised 20 items in three categories: professional caring and support, cooperative relationship and information sharing, and participation in care. Each item is rated on a four-point Likert scale, with total scores ranging from 20–80. The reliability of the instrument was 0.95, and test–retest ICC was 0.83. This instrument could be utilized to develop interventions to establish an efficient partnership and assess its outcomes. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Setting Priorities to Inform Assessment of Care Homes’ Readiness to Participate in Healthcare Innovation: A Systematic Mapping Review and Consensus Process
Int. J. Environ. Res. Public Health 2020, 17(3), 987; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17030987 - 05 Feb 2020
Cited by 5 | Viewed by 1441
Abstract
Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. [...] Read more.
Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Article
Applying Intervention Mapping to Improve the Applicability of Precious Memories, an Intervention for Depressive Symptoms in Nursing Home Residents
Int. J. Environ. Res. Public Health 2019, 16(24), 5163; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16245163 - 17 Dec 2019
Viewed by 1270
Abstract
Precious memories (PM) is a life review intervention for depression in older adults with no to mild cognitive decline that has been implemented in multiple nursing homes (NHs) in the Netherlands. Previous research suggested its relevance but questioned its applicability. Therefore, this research [...] Read more.
Precious memories (PM) is a life review intervention for depression in older adults with no to mild cognitive decline that has been implemented in multiple nursing homes (NHs) in the Netherlands. Previous research suggested its relevance but questioned its applicability. Therefore, this research aimed to (1) investigate the applicability of PM, and (2) increase its applicability, if necessary. Intervention mapping (IM) was used to achieve these goals: process evaluation through semi-structured interviews with psychologists (n = 11) and clients (n = 2) to identify potential improvements for PM and to set an improvement goal (IM-step 1); three focus groups with stakeholders (n = 20) to specify behaviors necessary to reach the improvement goal (IM-step 2); and selection of behavior change techniques and applications to facilitate attainment of these behaviors (IM-step 3). Results showed that psychologists perceived a high drop-out rate, which was partly due to PM being provided to clients that did not belong to the target group. Although PM was generally considered relevant, psychologists articulated its longer-term effects should be improved. To improve PM’s applicability, concrete maintenance strategies were developed aiming to maintain clients’ well-being by stimulating positive contact with others. Future research must pilot, implement and evaluate these strategies. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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Review

Jump to: Research

Review
Mapping Research Conducted on Long-Term Care Facilities for Older People in Brazil: A Scoping Review
Int. J. Environ. Res. Public Health 2021, 18(4), 1522; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041522 - 05 Feb 2021
Viewed by 782
Abstract
This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, [...] Read more.
This scoping review aimed to explore the characteristics, strengths, and gaps in research conducted in Brazilian long-term care facilities (LTCFs) for older adults. Electronic searches investigating the residents (≥60 years old), their families, and the LTCF workforce in Brazil were conducted in Medline, EMBASE, LILACS, and Google Scholar, within the timescale of 1999 to 2018, limited to English, Portuguese, or Spanish. The reference lists were hand searched for additional papers. The Mixed Methods Appraisal Tool (MMAT) was used for critical appraisal of evidence. Data were reported descriptively considering the study design, using content analysis: 327 studies were included (n = 159 quantitative non-randomized, n = 82 quantitative descriptive, n = 67 qualitative, n = 11 mixed methods, n = 6 randomized controlled trials, and n = 2 translation of assessment tools). Regardless of the study design, most were conducted in a single LTCF (45.8%), in urban locations (84.3%), and in non-profit settings (38.7%). The randomized trials and descriptive studies presented the lowest methodological quality based on the MMAT. This is the first review to provide an overview of research on LTCFs for older people in Brazil. It illustrates an excess of small-scale, predominantly qualitative papers, many of which are reported in ways that do not allow the quality of the work to be assured. Full article
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)
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