Health Care Administration and Organization

Collection of articles on Health Care Administration and Organization is available here.  

Certified nursing assistants as agents of creative caregiving in long-term care.
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J. Eaton, K. Cloyes, B. Paulsen, C. Madden and L. Ellington.
Int J Older People Nurs 2020 Mar;15(1):e12280
Certified nursing assistants (CNAs) provide most of the direct care for long-term care (LTC) residents, yet there are few CNA-led interventions aimed at improving quality of care. In our preliminary work developing a CNA art-based intervention, we describe CNA definitions and perceptions of creativity in relation to care of LTC residents. METHODS: Data from six sequential focus groups with CNAs (n = 14) in two LTC facilities were analysed to describe the concept of creativity in relation to LTC caregiving and its meaning to CNAs working in LTC. RESULTS: Certified nursing assistants defined creativity as formal art-making, yet they also described creative approaches to engaging residents in order to build relationships and reduce challenging behaviour. While most linked creativity with discerning and responding to resident needs, creativity was also foundational to time management, teamwork and navigating challenges. CONCLUSION: Developing CNA-centred interventions to promote creative caregiving may enhance both person-centred LTC and CNA empowerment, improving resident care. IMPLICATIONS FOR PRACTICE: CNA creativity should be viewed as a skill with the potential to enhance care and increase CNA empowerment. Interventions should be developed, in partnership with CNAs, to promote creative caregiving.

Function-focused care programme for older people in Korean long-term care facilities.
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D. Jung, H. Lee and M. Lee.
Int J Older People Nurs 2020 Mar;15(1):e12277
This study aimed to develop and test the effect of the Korean Function-Focused Care Programme (K-FFCP) on cognition and physical and psychological status in long-term care facilities’ (LTCs) residents. DESIGN: A quasi-experimental repeated-measures design was used. METHODS: The K-FFCP was developed to maintain and maximise functions of older people in LTCs. After implementing the K-FFCP for six weeks, differences in the cognitive status, activities of daily living (ADL) performance, physical capability, grip strength, fear of falling, depression and anxiety status of the two groups were examined using repeated-measures analysis of variance. Patient outcomes were evaluated at baseline and at 6 and 12 weeks after the intervention. RESULTS: In the experimental group, a significant group-time interaction effect was reported for ADL performance and depression. CONCLUSION: The current findings provided evidence of its feasibility and indicated significant improvement in older people’s functions using the K-FFCP. Although this study is a pilot test, these results may confirm the importance of the K-FFCP for the maintenance of ADL performance in older people in LTCs.

Older care home residents’ and their relatives’ knowledge, understanding and views of shift handovers: an exploratory, focused-ethnographic qualitative study using interviews and observations.
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K. Orellana, V. Lipman, J. Manthorpe, J. Moriarty, C. Norrie and R. Elaswarapu.
BMJ Open 2019 Dec 10;9(12):e032189-2019-032189
To investigate residents’ and relatives’ views and experiences of handovers in care homes. This paper reports residents’ and relatives’ awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents’ increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective. SETTING: Five purposively sampled care homes for older people in South East England. PARTICIPANTS: Home managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review. RESULTS: Shift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support. CONCLUSIONS: The care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers.

A communication model for nursing staff working in dementia care: Results of a scoping review.
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A. S. van Manen, S. Aarts, S. F. Metzelthin, H. Verbeek, J. P. H. Hamers and S. M. G. Zwakhalen.
Int J Nurs Stud 2020 Oct 2;113:103776
Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved in the communication process between nursing staff and people with dementia is limited and a comprehensive model of communication in dementia care is lacking. OBJECTIVES: To identify and visualize factors associated with communication between nursing staff and people with dementia. DESIGN: A scoping review of scientific literature. DATA SOURCES: Scientific articles were retrieved from the bibliographic databases of PubMed, CINAHL and PsycINFO. REVIEW METHODS: The reviewing process was directed by the Joanna Briggs guidelines for scoping reviews. Full-text articles describing the communication process between nursing staff and people with dementia were eligible for inclusion. A data extraction form was used to identify factors associated with communication. Following a directed content analysis approach, factors were categorized in one of three categories: nursing staff; people with dementia; or context. Each category was thematically analysed to identify themes and subthemes. Results were visualized into a communication model. RESULTS: The review included 31 articles; in total, 115 factors were extracted. Thematic analysis of nursing staff factors (n = 78) showed that communication is associated with professional characteristics, individual experiences, verbal- and non-verbal communication skills, communication approach and values. Factors attributed to people with dementia (n = 22) concerned client characteristics, functional status, behaviour, verbal communication skills and values. Contextual factors (n = 15) related to organization of care, time and situation. Based on these results, the Contac-d model was constructed. CONCLUSIONS: The Contac-d model gives a comprehensive overview of factors involved in the communication process between nursing staff and people with dementia, providing insight in potential starting points for communication improvement, e.g. respect for needs, identity and privacy of people with dementia, a flexible and adapted communication approach and matching language. Additionally, results suggest that an appealing location, longer duration of the interaction, and music in the surrounding may improve communication in certain situations. However, it was not feasible based on current literature to recommend what works to improve communication in which situations. Future studies should study factors and their interrelatedness in specific care situations. Authors further believe that more attention should be paid to strengths and capabilities of people with dementia and to non-modifiable factors that influence communication.