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01/2021 journal articles

QUALITY OF LIFE, PERSON-CENTRED CARE AND LIVED EXPERIENCES OF NURSING HOME RESIDENTS IN A DEVELOPED URBAN ASIAN COUNTRY: A CROSS-SECTIONAL STUDY

C.W. Tew, S.P. Ong, P.L.K. Yap, A.Y.C. Lim, N. Luo, G.C.H. Koh, T.P. Ng, S.L. Wee

Jour Nursing Home Res 2021;7:1-8

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Background: Literature emphasises the benefits of person-centred approaches in nursing homes. Objectives: To describe the quality of life, well/ill being and person-centred care of residents, and explore relationship between person-centred care and well/ill being in 7 nursing homes. Design: A cross-sectional study. Setting: Seven nursing homes of different built period and design typologies in Singapore. Participants: 696 nursing home residents. Measurements: Measures used were EQ-5D for quality of life, Dementia Care Mapping for well/ill being, Resident Satisfaction Score and Person-Directed Dementia Care Assessment Tool as measure of person-centred care. Results: Mean EQ-5D-5L index was 0.096 (SD=0.45). Most residents had at least moderate problems in mobility (66.5%), self-care (63.6%) and usual activities (63.0%). Mean well/ill being score was 1.69 (SD=0.98). A state of neutrality (WIB=+1) (48%) was most observed, followed by well-being (WIB>+1) (29%) and ill-being (WIB<+1) (6%). High positive potential behaviors were recorded 37% of the time, while low/no positive potential behaviors amount to 39%. The overall resident satisfaction score was 3.43/5 with borderline satisfaction with environment, food and activities, and low satisfaction with lifestyle and quality of interaction. The overall level of person-centred care was modest 2.3/4. Activities scored highest while the weakest domain was Environment. The overall level of person-centred care was positively correlated with resident well/ill being score (F=4.43, p<0.001). Conclusions: A higher level of person-centred care is associated with better resident well-being. Beyond their physical and custodial needs, the residents’ psychosocial needs can be better fulfilled. The areas of person-centred care amenable to improvement relate to environment, staff knowledge and training. These findings can inform resident care planning, policy development, and future research to support nursing homes in their endeavour to move towards more holistic and person-centric care.

CITATION:
C.W. Tew ; S.P. Ong ; P.L.K. Yap ; A.Y.C. Lim ; N. Luo ; G.C.H. Koh ; T.P. Ng ; S.L. Wee (2021): Quality of Life, Person-Centred Care and Lived Experiences of Nursing Home Residents in a Developed Urban Asian Country: a cross-sectional study. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.1

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SKINCARE AND QUALITY OF LIFE AMONG OLDER RESIDENTS LIVING IN JAPANESE NURSING HOMES

M. Nagae, T. Mitsutake, M. Sakamoto

Jour Nursing Home Res 2021;7:9-12

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This study aimed to clarify the practices of skincare such as bathing, face-washing, and using of skincare products, among older adults living in nursing homes in Japan. From July to August 2017, questionnaire surveys were mailed to 343 long-term care facilities in one prefecture in Japan, and 105 facilities returned the survey. Management policies on the use of facial skincare products was significantly associated with the number of resident/caregiver ratio. Meanwhile, residents in nursing homes with higher numbers of caregivers washed their faces and bathed at lower rates. There were no correlations between the number of resident/caregiver ratio, face-washing, and bathing times. When older residents could not independently perform their skin cleansing and care, that care is likely to happen less often. Sufficient manpower for the support of older residents’ skincare will improve the quality of life in long-term nursing facilities.

CITATION:
M. Nagae ; T. Mitsutake ; M. Sakamoto (2021): Skincare and quality of life among older residents living in Japanese nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.2

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NASAL IRRIGATION AND GARGLING WITH HYPERTONIC SALINE TO PREVENT TRANSMISSION OF SARS-COV-2 TO CARE HOME RESIDENTS – A FEASIBILITY CLUSTER TRIAL

R.M. Buchanan, K. Ibrahim, H.C. Roberts, B. Stuart, F. Webley, Z. Eminton, D. Ball, F. Chinnery, J. Parkes, J. Wyatt, T. Daniels

Jour Nursing Home Res 2021;7:13-16

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Hypertonic saline nasal irrigation and gargling (HSNIG) has the potential to reduce COVID 19 transmission. We present a pilot cluster randomised controlled trial to assess the feasibility and acceptability of a future trial to test the effectiveness of HSNIG in care homes (CHs). Staff in the intervention CHs were invited to perform HSNIG whereas control CHs carried on with their routine protection procedures. The acceptability of HSNIG was explored via interviews and online surveys. Seven (21%) of contacted CHs participated but following randomisation three (43%) dropped out leaving two intervention CHs and two control CHs. Facilitators to uptake of HSNIG included motivated ‘champions’ and integration into routines. Barriers included a lack of ownership and perceptions of reduced risk from COVID-19. Recruiting and retaining CHs in this study was challenging. Although HSNIG was reported to be safe and acceptable by staff, further work is required to quantify and optimise its acceptability.

CITATION:
R.M. Buchanan ; K. Ibrahim ; H.C. Roberts ; B. Stuart ; F. Webley ; Z. Eminton ; D. Ball ; F. Chinnery ; J. Parkes ; J. Wyatt ; T. Daniels (2021): Nasal irrigation and gargling with hypertonic saline to prevent transmission of Sars-CoV-2 to care home residents – a feasibility cluster trial. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.3

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AN ECOLOGICAL ANALYSIS OF QUALITY RATINGS AND INSPECTIONS ASSOCIATED WITH COVID-19 OUTBREAKS IN SKILLED NURSING HOMES

M.D. Simon, S.D. Meshkat, N. Raja

Jour Nursing Home Res 2021;7:17-22

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Objectives: As COVID-19 spread across the United States, and most rapidly in skilled nursing homes, public health departments developed policies to mitigate the spread. Concerns grew over whether this spread linked to nursing home quality. Design: We collected data on nursing home quality, staffing, and COVID-19 cases from the Centers of Medicare and Medicaid Services. Demographic data was sourced from Long Term Care Focus. Settings and Participants: The analysis used cross-sectional data from 1,025 California skilled nursing homes including quality ratings and confirmed COVID-19 cases between May 17, 2020 and August 23, 2020. Methods: The dependent variable was confirmed COVID-19 cases among residents. The primary independent variables were Overall Rating and Health Inspection Rating, while also including nursing home beds, patient race composition, ownership and geographic classification. Results: 5-Star Overall Rating, 5-Star Health Inspection Rating, and a lower count of health inspection deficiencies each predicted a lower likelihood of having a confirmed COVID resident case (p<.05). Conclusions and Implications: Skilled nursing homes with higher quality ratings and fewer health inspection deficiencies were less likely to have a confirmed case of COVID-19 among residents.

CITATION:
M.D. Simon ; S.D. Meshkat ; N. Raja (2021): An Ecological Analysis of Quality Ratings and Inspections Associated with COVID-19 Outbreaks in Skilled Nursing Homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.4

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PHYSICIANS’ PERCEIVED BARRIERS AND PROPOSED SOLUTIONS FOR HIGH-QUALITY PALLIATIVE CARE IN DEMENTIA IN THE NETHERLANDS: QUALITATIVE ANALYSIS OF SURVEY DATA

L. Bavelaar, H.T.A. van der Steen, H. de Jong, G. Carter, K. Brazil, W.P. Achterberg, J.T. van der Steen

Jour Nursing Home Res 2021;7:23-31

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Background: The literature indicates that palliative care for people with dementia needs to be enhanced. Objectives: To assess barriers to providing high-quality palliative dementia care and potential solutions to overcome these barriers, as perceived by physicians responsible for end-of-life care with dementia. Design: Cross-sectional study. Setting: The Netherlands. Participants: A representative sample of 311 elderly care physicians of whom 67% (n=207) responded. Measurements: A postal survey in 2013 containing open-ended items probing for barriers in the elderly care physicians’ practices and possible solutions. Answers were coded and grouped using qualitative content analysis and presented to expert physicians in 2021. Results: Barriers to palliative care in dementia were (1) beliefs held by family, healthcare professionals or the public that are not in line with a palliative care approach, (2) obstacles in recognizing and addressing care needs, (3) poor interdisciplinary team approach and consensus, (4) limited use or availability of resources, and (5) poor family support and involvement. Suggested solutions were improving communication and information transfer, and educating healthcare staff, families and the public about palliative care in dementia. Timely and frequent communication with the family, including advance care planning, and more highly skilled nursing staff were also proposed as solutions. Conclusions: The results suggest a strong need for ongoing education for healthcare professionals about palliative dementia care. Strengthening interprofessional collaboration and shared responsibility for advance care planning is also key. Increasing public awareness of the dementia trajectory and the need for a proactive approach call for a broader societal agenda setting.

CITATION:
L. Bavelaar ; H.T.A. van der Steen ; H. de Jong ; G. Carter ; K. Brazil ; W.P. Achterberg ; J.T. van der Steen (2021): Physicians’ perceived barriers and proposed solutions for high-quality palliative care in dementia in the Netherlands: Qualitative analysis of survey data . The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.5

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ASSOCIATIONS OF INFECTION PREVENTION AND CONTROL MEASURES WITH COVID-19 CASES AND DEATHS IN NURSING HOMES

V. Guion, L. He, H. Blain, H. Villars, G. Durel, P. de Souto Barreto, Y. Rolland

Jour Nursing Home Res 2021;7:32-37

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Background/Objectives: To identify which infection prevention and control (IPC) precautions in long-term care facilities (LTCF) were associated with reduced COVID-19 incidence and mortality among residents and reduced COVID-19 incidence in health care professionals (HCP). Design: Retrospective data on self-assessment of adherence to 101 IPC measures collected via an online questionnaire sent to 825 nursing homes in France in December 2020. Setting and participants: Medical and administrative staff jointly reported data on IPC measures, characteristics of LTCF, counts of residents’ COVID-19 deaths and cases, and counts of HCP cases. Measurements: Random forest models were used to identify the most important IPC measures associated with reduced number of COVID-19 deaths and cases in residents and cases in HCP. The identified variables were then included in linear regression models to estimate the association between levels of adherence to each selected IPC measure and COVID-19 deaths and cases. No data on time of IPC measures implementation were collected. Results: Data from 307 LTCF (37.2%) were collected, accounting for 22,214 residents. A higher number of COVID-19 deaths in residents was associated with a better adherence to physical distancing in group activity rooms. A better adherence by HCP to physical distancing during their mealtimes and break times was associated with fewer COVID-19 cases among residents and HCP. Other IPC measures were not significantly associated with COVID-19 cases or deaths. Conclusion: Physical distancing between residents was more implemented when LTCF had been confronted with COVID-19 deaths. Physical distancing between HCP was associated with fewer COVID-19 cases in residents and HCP, suggesting it may prevent significantly COVID-19 spreading in LTCF. HCP should particularly adhere to physical distancing measures during their mealtimes and break times. A higher adherence to such preventive measures does not require extra material or human resources and may be easily achievable.

CITATION:
V. Guion ; L. He ; H. Blain ; H. Villars ; G. Durel ; P. de Souto Barreto ; Y. Rolland ; (2021): Associations of infection prevention and control measures with COVID-19 cases and deaths in nursing homes. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2021.6

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