Factors influencing the employed caregiver burden for patients with dementia residing in nursing homes:A cross-sectional study from China

Objective:The institutionalization of care for patients with dementia is becoming a trend.Understanding the burden on employed caregivers and exploring associated factors are of great importance in practice.Therefore,this study aimed to examine the relationship between basic attributes,caring ability,and caregiver burden in employed caregivers practicing in nursing homes.Methods:This cross-sectional study included 541 employed caregivers in 11 four-star nursing homes in Zhejiang Province from April to December 2022.Caregiver burden was assessed using the Zarit Burden Interview(ZBI).Demographic characteristics of participants,characteristics of the older patients with dementia,caring characteristics,training in dementia care,and caring abilities were collected for analysis of influencing factors.A hierarchical multiple regression analysis was conducted to explore the factors influencing the burden on employed caregivers in nursing homes.Results:The ZBI score of employed caregivers in nursing homes was 40.42±10.18,representing a moderate caregiver burden.Factors such as age(U=27.82,P<0.001),residence(U=7.89,P<0.001),educational level(H=55.81,P<0.001),self-care of older patients with dementia(H=85.21,P<0.001),daily care hours(H=73.25,P<0.001),number of older people with dementia cared for(H=14.56,P<0.012)and training in dementia care(U=-9.43,P<0.001)were significantly associated with caregiver burden.Caring ability was negatively associated with caregiver burden(r=-0.22,P<0.01).Furthermore,after controlling for demographic characteristics,the characteristics of older people with dementia,caring characteristics,training in dementia care,and caring ability explained 8.5%,5.8%,and 4.8%of the caregiver burden,respectively.Conclusion:The burden of employed caregivers on patients with dementia in nursing homes can be attributed to various factors.We recommend tailored interventions,such as dementia care training and reviewing the number and duration of hours worked to reduce the burden experienced by caregivers.

Research on the Hotspots and Development of“Internet+Nursing Services”in China:A Bibliometric Analysis Based on CiteSpace

Objective:This study aims to explore the current research status,hotspots,and trends of the emerging nursing model of“Internet+nursing service”in China,and to provide theoretical references for further research and development.Methods:The literature related to“Internet+nursing service”was retrieved from the China National Knowledge Infrastructure(CNKI),Wanfang database,VIP database,and SinoMed.Subsequently,visual analysis was performed using the CiteSpace scientific knowledge mapping software.Results:A total of 1223 articles were included.The number of papers published in this field has been increasing yearly,and a core group of authors has been formed.Research institutions are mainly comprised of universities and hospitals and a high percentage of projects were funded provincially and municipally,while the least percentage of projects were funded nationally.The main research hotspots include the nurse standardized management for online appointments,the current application situation for the nursing model,and factors influencing its application amongst the elderly and also in women and children’s groups.Conclusion:Although the“Internet+nursing service”in China is still in its early stages,considerable progress has been made in relevant research.Future research should focus on identifying and omitting factors that hinder the industry’s growth,thereby establishing an effective long-term model of care.

Evolution of Programs to Improve Transfers between Hospitals and Nursing Homes at the Community Level

This study described the evolution of programs to improve the efficiency of patient movement between hospitals and nursing homes in the metropolitan area of Syracuse, New York. These programs were needed in order to improve coordination among providers in the absence of networks that included both acute and long term care providers. The mechanisms included the exchange of data and monitoring the movement of Difficult to Place patients from hospitals to nursing homes. Between 2006 and 2014, the annual number of Difficult to Place patients increased from 983 to 1836. During this period, annual hospital medical/surgical discharges increased by 7.5 percent, severity of illness increased by 13.7 percent, and the population aged 65 years and over increased by 9.8 percent. Most of the Difficult to Place patients were admitted by the four largest facilities in the community, which accounted for 60 percent of the nursing home beds. The initiatives also included Subacute and Complex Care Programs that provided financial incentives for admission of certain types of patients, such as intravenous therapy and extensive wound care. The programs described how these programs were implemented using minimal financial resources and without adding positions to the participating provider organizations.

Study of the Possible Use of a Home-Visit Nursing Interventional Lymphedema Care Program for Secondary Lymphedema in the Elderly at Home

Objective: This study aimed to clarify the possible use of and points to improve a home-visit nursing interventional lymphedema care program (plan) we developed. Methods: The subjects were visiting nurses with at least three years of home-visit nursing experience and experience with lymphedema care for the elderly at home. Semi-structured interviews were conducted, and the collected opinions were aggregated and summarized. Results: Based on interviews with nine subjects, opinions regarding the use of the program, such as “The assessment perspective at the time of introduction helps to grasp the needs for a wide variety of subjects”, and regarding points to improve, such as “It is necessary to set the duration and timing of the section considering the frequency of visits and degree of edema at the time of introduction” and “It is necessary to have a perspective concerning efforts to maintain motivation for care of the elderly and their families”, were aggregated. Discussion: The results of the interviews were generally useful for the structure and development of the program, care methods and content, and interventions for influencing factors. Consideration of setting the timing according to the degree of lymphedema, modification of the program’s development, development of a program that fully considers the degree of edema at the time of introduction and the acceptance of edema among the elderly, and the need to consider the care content that should be given priority were suggested as points for improvement.

The Experience of Nurses Providing Home Nursing Care to Oldest Old Persons Living Alone in Rural Areas—An Interview Study

The rapidly increasing population of older persons worldwide, and the fact that the majority of them want to continue living in their own homes, mean there is a growing focus on home based care. Because of this, it is necessary to increase the number of studies, including rural areas, as earlier studies are sparse. Rural areas cannot be seen as a homogeneous phenomenon, meaning more research is needed to increase knowledge about cultural differences in rural areas. The aim of this study was therefore to describe registered nurses’ experiences of providing home nursing care to oldest old persons living alone in rural areas. A sample of 15 registered nurses in rural South Sami areas was chosen for this study, 13 women and 2 men. Narrative interviews were conducted, and qualitative content analysis was used to interpret the data. The analysis revealed four themes and eight subthemes in addition to a core-theme. The latent meaning of the themes “Feeling responsible”, “Trying to accommodate”, “Being challenged” and “Feeling significant” formed the core-theme: contradictions between nurses’ ideals of being professional and the reality faced in rural home nursing care with close social relationships. The findings in this study showed that the experiences of providing home nursing care in rural areas to oldest old persons were multifaceted and altering, as well as emotionally and socially contradictory.

Advance Directives in the Context of Uncertain Prognosis for Residents of Nursing Homes

This report documents the findings of a mixed-methods study focused on the advanced directives of 182 residents of three LTC facilities in southern Ontario, Canada. Although almost all had a completed advance directive within 3 months of death, most did not have a palliative designation or directive until a few days before they died. Each facility’s written Progress Notes revealed staff members usually sought additional confirmation of care preferences from residents’ substitute decision-makers within a few days of the death. It was thus common for advance directives to change from a more interventionist approach to the least interventionist approach near death. This change indicates that the meaning and significance of advance care planning and resulting advance directives must be considered in light of the processes and temporal factors involved in their completion and use within this distinct population. The relational nature of advance care planning and concern about ageism as a factor for withholding or withdrawing life support for LTC residents are considered as possible explanatory factors. These findings and their implications are described in relation to end-of-life care policies and practices in LTC facilities.

Testing of the Content Validity of a Modified OPCq Instrument—A Pilot Study in Norwegian Home Health Care

Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.

Perceptions and barriers that influence the ability to provide appropriate incontinence care in nursing home residents: Statements from nursing staff

Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. 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 findings from this study show 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 UI, are the most important barriers to provide appropriate incontinence care.

Staff characteristics and care in Chinese nursing homes: A systematic literature review

The need for institutional long-term care(LTC)services,including nursing homes(NHs),is increasing in China's Mainland in part due to the aging population and changing family structures.In developing NH staff training programs,a review is needed to synthesize knowledge about staff and resident characteristics,and care provided in NHs.This systematic review aims to describe,in Chinese NHs,(1)NH staff characteristics and the care they provide,(2)resident characteristics and care needs,and (3)the role of family members.The 45 articles included in this review covered both urban and rural areas of China's Mainland.We found that staff in Chinese NHs were older and had lower education levels in comparison with those in western countries.Most direct caregivers in urban areas were migratory workers from rural area.Chinese NHs had few qualification standards for staff preparation for their roles in NHs.Also,functional levels of residents in Chinese NHs were higher compared to NH residents in western countries.In addition,family members played important roles in caring for NH residents.These findings suggest a need for staff development programs that tailor for lower educated NH staff and care needs of residents with widely varying levels in function from independent to bedbound in China's Mainland.The findings also suggest that staff qualification standards require critically policy development to improve the capacity of Chinese NHs to provide competent and safe care.

Practical Experience in Home Care of Nursing Interns: A Qualitative Research

Purpose: To explore practical experience in home care of nursing interns. Methods: The phenomenological method for qualitative research was to interview 15 nursing interns in a semi-structured way, and then the collected data were analyzed and summarized by using the Colaizzi analysis method. Results: Interviewing results showed that there were five recurring themes, including: 1) personalized care;2) health education;3) humanistic care;4) solid professional foundation and sense of responsibility;5) expanded vision. Conclusion: Through home care practice, nursing interns deepened their cognitions of nursing connotation, stimulated their love for nursing and motivation of continuous learning, and improved their sense of identity to nursing career. In general, the practice of home care had a positive impact on nursing interns.

Nursing Students’Clinical Learning Environment in Norwegian Nursing Homes:Lack of Innovative Teaching and Learning Strategies

Background: Nursing students hesitate to choose aged care as a career, and the aged care sectors are on an edge regarding nursing positions. Clinical learning environments may influence nursing students’ career choices. Few studies have explored learning environments in nursing homes, although students increasingly have placements there. Objectives: The aim was to produce information for developing nursing students’ learning opportunities in nursing homes. Design: A cross-sectional survey design was used. Settings: The study was conducted at a university college in southeast Norway. Participants: Students in two cohorts of a bachelor degree program in nursing participated, N = 499. Methods: Data were collected on nursing students’ perceptions of clinical learning environments during placements in five nursing homes. A 42-item validated questionnaire with the subscales personalization, individualization, involvement, task orientation, innovation, and satisfaction was used. Data analysis used descriptive statistics, t-tests, and linear regression analysis. Results: Total scores showed overall satisfaction with clinical learning environments in nursing homes. However, innovation subscale scores were very low. First year students had significantly higher scores than third year students on the total scale, and most subscales. Age was significantly associated with total scale scores and subscale satisfaction scores. Higher education and work experience before entering nursing education were significantly associated with involvement subscale scores. Conclusions: Students are more positive than negative about their clinical learning environments. Low valuation of innovation seems to be a consistent finding in studies in both nursing homes and hospitals internationally. For innovative learning strategies to function they must be anchored at the organizational level. Future research should develop and test more innovative learning strategies for nursing students.

A descriptive-comparative study of medications used by older people prior to and following admission to a continuing care facility

Medications are beneficial for curing or managing acute and chronic illnesses. Medications typically have positive outcomes, although older people are prone to drug-related problems. Community-dwelling seniors are at particularly high risk of polypharmacy, as they tend to receive many prescriptions over time and from different care providers. Continuing-care facility admission presents an excellent opportunity for a comprehensive medication review. A research study was conducted to describe and compare medications taken by community-dwelling seniors prior to and following admission to a continuing-care facility. This pilot project involved data being gathered from the charts of deceased residents, as required by a University Health Research Ethics Board, who had been cared for at one large local continuing-care facility. The facility administrators also approved this study, in part to evaluate their policy to conduct a medication review for all new residents within six weeks of entry. This study revealed a slight but statistically significant reduction in the number of medications following this review. Other issues such as medication interactions and required dosage changes were addressed by this medication review. Although this study was confined to one continuing-care facility and a small number of residents, the findings suggest medication reviews would be beneficial upon admission to all continuing-care facilities, and annually perhaps through other means for older persons living in the community.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Home‑based treatment and nursing plan of a patient diagnosed with mild‑to‑common coronavirus disease 2019

To date,there are no known specific antiviral medicines recommended for coronavirus disease 2019(COVID‑19).The treatment mainly focuses on the improvement of the immunity of the individual and the application of palliative treatment.A case of a patient diagnosed with mild COVID‑19 and then later developed common COVID‑19 which was treated and closely monitored at home will be presented.The patient was advised for self‑quarantine with several prescribed medications.Nursing home and self‑care advice were given to the patient,including a change of lifestyle for the duration of the isolation,medication advice,symptomatic care,change of diet,how to monitor the progress of the disease,psychological care,and follow‑up instructions.During the course of the nursing plan,the patient showed significant improvements,and normal life functions were restored.On February 05,2020,novel coronavirus nucleic acid test showed negative after re‑examination;the patient was cured.Therefore,providing adequate nursing plan for home‑based self‑care treatment can effectively cure mild and common cases of COVID‑19.

Content of nursing discharge notes: Associations with patient and transfer characteristics

Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.

Reasons for failure to continue home therapy in patients with hemophilia: A qualitative study

Background: Home therapy for hemophilia reduces pain, deformity and incidence of complicationinduced hospitalizations. Therefore, it is an important component of comprehensive hemophilia care.Unfortunately, most hemophilic families in Shanxi province, China do not continue home therapy.Objective: To analyze the reasons that hemophilic families do not continue home therapy and to provide a foundation for formulating targeted interventions by the Hemophilia Treatment Center(HTC) in Shanxi Province.Methods: A qualitative phenomenological approach using purposeful sampling of 17 hemophilic families, two physicians, and one nurse from 11 branches across 11 cities in Shanxi Province. Interviews were recorded, transcribed verbatim and analyzed using qualitative content analysis.Results: Four themes were identified:(1) home therapy was generally positively evaluated;(2) concerns about the safety of home therapy;(3) an imperfect social medical security system; and(4) inadequate continuous nursing of hemophilia.Conclusions: Home therapy for hemophilia remains in a preliminary stage in Shanxi Province, and inadequate family and social support systems have obstructed the implementation of home therapy. It is necessary to develop a home therapy model suitable for hemophilic families in Shanxi Province as soon as possible. Such a model would improve the community and home care medical systems for hemophilia and guarantee home therapy throughout the entire medical care system, thus enabling more hemophilic families to carry out home therapy. Achieving these goals requires urgent research and attention from medical staff.

Functional Contentment Model: Optimizing Quality of Life for Nursing Home Residents with Dementia

The Functional Contentment Model (FCM) attains two objectives: 1) building a relationship focused plan of care for nursing home residents diagnosed with dementia;and 2) maximizing and maintaining older adults’ contentment, peace, and happiness while living in dementia care environments. There are three essential components within the FCM: 1) Person/Family Centered Care;2) Slow Medicine;and 3) Team Care Management. The principles of “Person/Family-Centered Care” are coupled with the philosophy of “Slow Medicine,” and neither can exist without the engagement of “Team Care Management.” In short, the FCM maximizes the older adult’s potential functioning in activities of daily living, cognition, gross and fine motor skills, communication, and physical well-being, while maintaining the highest possible level of contentment, peace, and happiness. This is accomplished through dynamically utilized professional modalities adapted to the changing needs of the older adult resident—pharmacologic, physical and occupational therapies, family education and involvement, dietary, spiritual, stimulating activities, as well as any individualized modality. The lead for operationalizing the Functional Contentment Model is the nursing home medical director, whose key role is assuring a team approach to care including the older adult resident, the family, and all staff (dietary, housekeeping maintenance as well as care and administrative staff). The FCM is a culture change model that has implications in practice and policy for each nursing home.

Contents of Care and Perception of Home Hospice Nurses Who Work at Visiting Medical Treatment Hospitals

Goal: The aim of this study was to examine the perception of nurses who worked at the clinic which proposed home hospice and contents of care to better understand home hospice and enhance home care. Methods: Six nurses who worked at the clinic where proposed visiting medical treatment participated voluntarily. They received one interview for approximately one hour, in which they narrated their perception of home hospice and content of nursing care. The narrative was recorded by an IC recorder and analyzed as contents analysis. This study was approved by the Ethical Board at St. Mary’s College. Results: About the content of nursing care, some categories were selected such as “Understanding a patient as a living person,” “Examining if a patient and caregiver live at ease,” or “Caring for a caregiver accepting a loved one’s death and care given at death.” Nurses perceived the theme as “Time and space for listening carefully,” the theme as “Feeling of responsibility and attractiveness of work,” the theme as the “Economics and manpower to continue home hospice,” the as a “Required connection between hospitals and home hospice clinics.” Conclusion: Visiting medical treatment nurses understand a patient and a family as living people based on intimate relationships, support them as the disease progresses, and connect to a visiting nurse station. They perceived that “patients can enjoy freedom;the nurses had responsibility and strong relationships. They felt the economic or man-power needs to continue and the requirement of a connection between hospitals and home hospice clinics.

Barriers and facilitators to an outreach rehabilitation program delivered in nursing homes after hip fracture surgical repair

Objective: To identify and understand facilitators and barriers to implementing an Outreach rehabilitation program designed to improve post-operative recovery following hip fracture in long-term care residents. Residents of nursing home facilities are at considerable risk of hip fracture and minimal recovery following a hip fracture. Methods: Data were gathered over June-August, 2012 through semi-structured interviews or focus groups. Fifteen persons (n = 15) who were members of the Outreach rehabilitation team (n = 8) or relevant nursing home staff (n = 7) were interviewed. Data analysis was guided by principles of grounded theory method. Findings: Three major themes that contributed to or hindered the Outreach rehabilitation program emerged, namely, 1) the division, the separate operation and delivery of rehabilitation services;2) building bridges, or negotiating ways to communicate and work together, and 3) strength in the structure, the acceptance of the program and the perceived benefits of the program. One main challenge to program implementation con- cerned coordinating additional rehabilitation with the rehabilitation provided within the nursing homes. Facility staff was largely unaware of the program and were unprepared to work with Outreach team members. As the program progressed, the facility staff and Outreach team were able to collaborate to overcome resident health issues impeding recovery such as cognitive impairment, language barriers and post-surgical pain control needs. Facilitators included the consistency of Outreach team members and accessible facility staff, which contributed to effective communication and trust between the Outreach team and facility staff. Facilitators also included support for the program by the Outreach team and facility staff, as well as the potential benefits of improved mobility and functional status among some program recipients. Conclusion: Although planning, implementation, and delivery of an Outreach rehabilitation program present some challenges, this study suggests that it is possible to deliver rehabilitation to older residents who fracture their hips in nursing homes.

Survey of Bereavement Care Provided by Home-Visit Nurses for Bereaved Families in Japan

Purpose: This study aims to investigate the implementation conditions of bereavement care for bereaved families and the relationship between demographics of home-visit nurses and rates of provision of bereavement care. Methods: A self-rating anonymous questionnaire survey was conducted with 2200 facilities randomly selected from among the members of the Home-visit Nursing Stations of the National Nursing Business Association. Calculating the rates of provision of each pre- and post-bereavement care item of the survey, we performed a multiple logistic regression analysis to investigate the relationship between the demographics of home-visit nurses and rates of provision of care. Statistical processing employed SPSS ver. 21.0 with the significance level set at 5%. Results: A total of 688 responses were collected (collection rate, 31.3%), and 649 were included in the analysis. “Approval of the care that the family has provided” and “Involvement in the care together with the family and listening to their thoughts” were frequently provided in both pre- and post-bereavement care;however, the rate of provision of “Provided continued support/life planning until the family fully recovers social life” was low. More care services were provided by home-visit nurses working in facilities with 24-hour services in pre-bereavement, and by those with longer home-visit nursing experience in post-bereavement. Conclusions: Home-visit nurses provide many post-bereavement care services. However, continued care that helps bereaved families fully recover their social life, including life planning, is less frequently provided. Bereavement care provision rates vary depending on the facility type, whether the facility offers 24-hour services, and the length of home-visit nursing experience.