The objective of the research is to assess the degree of adoption of high-involvement nursing work practices in long-term care organizations. It seeks to determine the organizational and workplace factors that are associated with the uptake/adoption of ten selected human resource high-involvement employee work practices.
A survey questionnaire was sent to 300 long-term care organizations (nursing homes) in western Canada. Results from 125 nursing home establishments (43 percent response rate) are reported herein.
Of the ten high-involvement nursing work practices examined, employee suggestion and recognition systems are the most widely adopted by homes in the sample, while shared governance and incentive/merit-base pay are used by a small minority of establishments.
The uptake of high-involvement nursing work practices is not adopted in a haphazard fashion. Their uptake is variously associated with a number of establishment and workplace factors, including the presence of a supportive and enabling workplace culture.
The objective of this research is to examine the extent and degree of adoption of high involvement work practices in a sample of long-term care establishments operating in the four provinces of western Canada.
Department of Interdisciplinary Health Sciences, Harald Schjelderups hus Forskningsveien 3a/2b, Post Box 1089, 0373, Oslo, Norway. lisbeth.thoresen@medisin.uio.no.
52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals' views on ACP is vital. The objective of this study is to explore nurses and physicians' aims and experiences with carrying out ACP in nursing homes.
Semi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data.
The primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear.
Our study add insights into how ACP is practiced in nursing homes and the professionals' agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents' needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.
The article explores how old people who live in their ordinary home, reason and act regarding their 'material room' (technical objects, such as household appliances, communication tools and things, such as furniture, personal belongings, gadgets, books, paintings, and memorabilia). The interest is in how they, as a consequence of their aging, look at acquiring new objects and phasing out older objects from the home. This is a broader approach than in most other studies of how old people relate to materiality in which attention is mostly paid either to adjustments to the physical environment or to the importance of personal possessions. In the latter cases, the focus is on downsizing processes (e.g. household disbandment or casser maison) in connection with a move to smaller accommodation or to a nursing home. The article is based on a study in which thirteen older people (median age 87), living in a Swedish town of medium size were interviewed (2012) for a third time. The questions concerned the need and desire for new objects, replacement of broken objects, sorting out the home or elsewhere, most cherished possessions, and the role of family members such as children and grandchildren. The results reveal the complexity of how one handles the material room. Most evident is the participants' reluctance to acquire new objects or even to replace broken things. Nearly all of them had considered, but few had started, a process of sorting out objects. These standpoints in combination resulted in a relatively intact material room, which was motivated by an ambition to simplify daily life or to facilitate the approaching dissolution of the home. Some objects of special value and other cherished objects materialized the connections between generations within a family. Some participants wanted to spare their children the burden of having to decide on what to do with their possessions. Others (mostly men), on the contrary, relied on their children to do the sorting out after they had died.
An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.
Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.
The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed =800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (=800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.
Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents' dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: 'A feeling of being abandoned'. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life.
Model-based practice was identified by the Nursing Department at Riverview Health Centre, a 320-bed long-term care facility located in Winnipeg, Manitoba, as having the potential to enhance care quality significantly. To achieve real impact in the clinical setting, however, the model selected would need to reflect closely the culture and values of the department. It was decided to explore these phenomena using cross-method triangulation involving a cultural assessment survey (the Nursing Unit Cultural Assessment Tool) and focus groups. Patient comfort and empathy emerged consistently as core values for staff. Greater appreciation of the depth and complexity of the nursing department culture and values has provided invaluable direction vis-à-vis conceptual model selection.
