The aim of this paper was to explore carers' and nurses' appraisals concerning if and when nursing home placement for frail older people awaiting placement was needed and to illuminate ethical issues involved in decisions regarding nursing home placement.
Requesting nursing home placement can be a complicated decision for carers, causing feelings of failure, anxiety and guilt. After the necessity of nursing home care is determined, the names of the older people are put on waiting lists. While waiting, home health care provides support services. Even with this care, many of the older people and their carers face difficult life situations.
This is a descriptive and comparative cross-sectional study using qualitative methods.
The convenience sample (n = 36) comprised 11 carers of older people on a nursing home placement waiting list in Norway and 11 nurses caring for these older people. Every one willingly participated in interviews that were transcribed and analysed by qualitative content analysis.
Various similarities and differences between nurses' and carers' appraisals were found. Complex ethical issues of justice, equality, autonomy, beneficence and justifiability in nursing were involved in decision making concerning nursing home placement. Four categories constructed were: 'appraising nursing home to be the level of care needed', 'appraising the older people as able to continue living at home', 'being ambivalent about nursing home placement' and 'being sceptical about use of coercion regarding nursing home placement'.
Not all of the older people awaiting nursing home placements could be placed in nursing homes when beds became available. The situations were complex and involved ethical issues.
Despite insufficient resources in home health care, providing appropriate support for older people and their carers means that nurses have to consider individual concerns in each situation, cooperate with carers, respect their appraisals of needs and argue for the timely nursing home placement of older people.
Authors: Mari Wolff Skaalvik, MSc, RNT, RN, PhD Student, Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø; Hans Ketil Normann, PhD, MSc, RNT, RN, Associate Professor, Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø; Nils Henriksen, BSc of Arts, MSc, PhD, Associate Professor, Faculty of Health Sciences, Department of Health and Care Sciences, University of Tromsø, Tromsø, Norway.
Aim and objective. To measure nursing students' experiences and satisfaction with their clinical learning environments. The primary interest was to compare the results between students with respect to clinical practice in nursing homes and hospital wards. Background. Clinical learning environments are important for the learning processes of nursing students and for preferences for future workplaces. Working with older people is the least preferred area of practice among nursing students in Norway. Design. A cross-sectional design. Methods. A validated questionnaire was distributed to all nursing students from five non-randomly selected university colleges in Norway. A total of 511 nursing students completed a Norwegian version of the questionnaire, Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale in 2009. Data including descriptive statistics were analysed using the Statistical Program for the Social Sciences. Factor structure was analysed by principal component analysis. Differences across sub-groups were tested with chi-square tests and Mann-Whitney U test for categorical variables and t-tests for continuous variables. Ordinal logistic regression analysis of perceptions of the ward as a good learning environment was performed with supervisory relationships and institutional contexts as independent variables, controlling for age, sex and study year. Results. The participating nursing students with clinical placements in nursing homes assessed their clinical learning environment significantly more negatively than those with hospital placements on nearby all sub-dimensions. Conclusions. The evidence found in this study indicates that measures should be taken to strengthen nursing homes as learning environments for nursing students. Relevance to clinical practice. To recruit more graduated nurses to work in nursing homes, actions to improve the learning environment are needed.
Several instruments have been developed to monitor nursing students' subjective evaluation of clinical placement. The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale measures five dimensions. The purpose of this study was to translate and test the construct validity and internal consistency of the evaluation scale within a Norwegian context. The questionnaire was distributed to all students in four university colleges (n=1229) in 2009 with a response rate of 41.6 % (n=511). Only students from institutional practice settings (n=407) were included in the analysis. The instrument has properties suitable for evaluation also within a Norwegian context, despite some minor differences in factor structure, indicating common underlying properties regarding students' evaluation of the clinical learning environment and how they rate the premises of nursing on the ward.
The aim of this study was twofold: to compare the functional levels of elderly awaiting nursing home placement and nursing home residents, and to compare their nurses' physical and psychological workloads. In Norway, the demand for nursing home placement has increased greatly. Elderly awaiting placement can receive care from home health care services and/or from their families. Documenting elderly's functional levels may illuminate the extent of the carers' workloads and the need for support during the waiting period. The study was conducted in 2005 on two groups in northern Norway. Using the Multi-Dimensional Dementia Assessment Scale to assess functional levels, one group of nurses assessed elderly awaiting nursing home placement (n = 36) and another group of nurses assessed nursing home residents (n = 47). The nurses also reported physical and psychological workloads in caring for these elderly. A comparison of the functional levels between elderly awaiting nursing home placement and nursing home residents showed few statistically significant differences. Nursing home residents had two lower motor functions, needed more assistance with activities of daily living, more regular administration of enemas, were more often unable to speak, and showed lower orientation levels. Clinically significant similarities were found in five motor functions, including rising from lying to sitting, rising out of bed and walking, and in behavioural and psychiatric symptoms. Both groups of elderly had a high prevalence of sadness and fearfulness. The results of this study indicate that elderly awaiting nursing home placement can be as frail as nursing home residents. These results highlight the elderly's need for assistance and reveal the need for more nursing home beds. Nurses in home health care and nursing homes rated physical and psychological workloads similarly. As many carers provide care 24 hours a day, these results also illuminate the need to support carers during the waiting period.
The Sami people have historically been exposed to severe assimilation processes. The objective of this study was to explore elderly Samis' experiences of health. A total of 19 elderly Sami individuals in Norway were interviewed.This article is a dialogical narrative analysis of the life stories of 3 Sami women. The life stories are perceived as narratives of health and resistance. Postcolonial theory provides a framework for understanding the impact of historical and socioeconomic factors in people's lives and health. Narratives of resistance demonstrate that people are not passive victims of the legacy of colonialism. Resistance is not a passive state but an active process, as is health. Resistance is a resource that should be appreciated by health services, both at a systemic level--for example, through partnership with Indigenous elderly in the planning and shaping of services--and in individual encounters between patients and healthcare providers.
The aim of this study is to describe carers' and nurses' appraisals of workload in care of frail elderly awaiting nursing home (NH) placement.
Carers' workload of care for frail elderly awaiting NH placement has been studied separately from that of nurses' workload. The literature neither addressed a comparison of carers' and nurses' appraisals of psychological and physical workloads nor the most strenuous factors common to the workloads of both nurses and carers in care of the same elderly person. The terms 'carers' and 'nurses' in this paper refer to informal caregivers and to both enrolled nurses and Registered Nurses respectively, when no particular one is stated.
The sample comprised 11 nurses and 11 carers paired based on care provided to the same elderly person awaiting NH placement in Norway. Data collected by a workload-scale was analyzed by descriptive statistics. Data collected by individual interviews were analyzed by qualitative content analysis. Carers' and nurses' appraisals of workload were compared and contrasted and most strenuous factors described.
The findings show that both carers and nurses rated workload levels maximum. Carers' highest ratings concerned psychological workload, while nurses' highest ratings concerned physical workload. The workload ratings concerning elderly with advanced dementia disease were most similarly aligned. Qualitative content analysis showed three categories that describe the most strenuous factors common to the workloads of both carers and nurses. These were feeling responsible, burdened and ambivalent.
This study reports carers' and nurses' appraisals of workload in care of frail elderly awaiting NH placement. The results show many similarities and some differences. These results may help guide policy development to address resource allocations to elderly care. Further research is needed to address workloads of care for elderly awaiting NH placement.
The point of departure for this article is narrative gerontology's conceptualization of life as storied and the assumption that identity development and meaning making do not cease at any age, but rather continue throughout life. We suggest that if identity construction is considered to be a lifelong project, narrative gerontology would benefit from applying analytical perspectives focused on the situated activity of narration. In this article, we apply a three-level positioning analysis to segments of interviews with two elderly Sami women concerning missed opportunities or roads not taken and, more specifically, to narrations about missed opportunities for education. We argue that such narrations should not necessarily be considered expressions of regret or processes of reconciliation but rather as pivotal in here-and-now identity constructions. Narrations about missed opportunities demonstrate that what narrators choose to insert into their life stories is chosen for a purpose and for an audience in a specific interpersonal and discursive context. We suggest that narrative gerontology would benefit from a broader focus on the diversity of sites of engagement in which older adults perform identity constructions. This shift implies moving beyond traditional studies of older adults' life stories and biographical narratives as related in the context of qualitative research interviews (of which the present study of Sami older adults' life stories is indeed an example).
The Sami are an indigenous people living in Norway, Sweden, Finland, and Russia. Historically, national states have made strong efforts to assimilate the Sami people into the majority populations, and the Sami have experienced stigmatization and discrimination. However, after World War II, there has been a revitalization process among the Sami that was pioneered by the Sami Movement and gradually adopted in broader spheres of Norwegian society. The lifespans of the current cohort of elderly Sami unfold throughout a historical period in which contrasting public narratives about the Sami have dominated. The purpose of this study was to explore the relationship between elderly Sami's individual life stories and contrasting public narratives about the Sami. Nineteen elderly Sami individuals in Norway were interviewed. This article is a dialogical narrative analysis of the life stories of four elderly Sami. The article illuminates how individual life stories are framed and shaped by public narratives and how identifying is an ongoing process also in late life. A dialogical relationship between individual life stories and public narratives implies that individual stories have the capacity to shape and revise dominant public narratives. To do so, the number of stories that are allowed to act must be increased. A commitment in dialogic narrative research on minority elderly is to make available individual stories from the margins of the public narratives to reduce narrative silences and to prevent the reproduction of established "truths".