Implementation and evaluation of an education programme for nursing staff on recognising, reporting and managing resident-to-resident elder mistreatment in aged care facilities.

AIM: To implement an educational programme for nursing staff on recognising, reporting and managing resident-to-resident elder mistreatment in aged care facilities. BACKGROUND: The phenomenon of a growing ageing population increases the demand of optimum care for older people living in aged care facilities. Caring for older people is complex, but should include the management of aggressive interaction between them. Nursing staff play a vital role in identifying and managing those behaviours. However, many nurses may not recognise these aggressive interactions as abuse. Therefore, this study aims to manage and reduce this abuse through an educational programme. DESIGN: Cluster randomised trial registered on the Australia New Zealand Clinical Trial Registry (ACTRN 12617001618347). METHODS: This trial was undertaken in an aged care facility located in Melbourne, Australia and was funded in January 2017. Wards were randomly allocated (as the intervention and control group) by using sealed opaque envelopes. Nursing staff, who met eligibility, were consecutively recruited and supplied their informed consent. Nurses from the intervention group received an educational programme, while nurses from the control group continued with the usual standard care. Main outcomes included recognising, managing and reporting the abuse before and after the intervention and will be evaluated on an intention-to-treat analysis. DISCUSSION: It is vital to manage and reduce resident-to-resident elder mistreatment. This educational programme may assist nursing staff to protect vulnerable older people experiencing this abuse and may improve comprehensive evidence-based care for older people residing in aged care facilities.

Non-Pharmacological Approaches to Pain Management in Residential Aged Care: a Pre-Post-Test Study.

OBJECTIVES: The project aimed to evaluate a pain management program (PMP) using non-pharmacological approaches at five residential aged care facilities (RACFs) in Australia. METHODS: The PMP involved a physiotherapist implementing four sessions per week of treatments (massage therapy, TENS, exercises and stretching, or combinations of these). Ninety-five participants were recruited (average age, 83 years; SD = 7.6; 38% men, 62% women; 56% with dementia). Sessions lasted approximately 10 minutes, and residents' levels of pain were recorded using a 5-point scale before and after each treatment. The intervention period for each participant was the first consecutive 8 weeks in which they received the intervention. RESULTS: Data analyses showed: (1) a small but statistically significant decrease in the number of as required (PRN) medications; and (2) a decrease in average pain ratings from pre-session to post-session from 2.4 (some to moderate pain) to 1.1 (a little pain). Notably, residents with dementia received lower pain ratings than those without. CONCLUSIONS: Non-pharmacological approaches to pain in residential care settings are effective, especially when two or more are combined. Staff working in residential care settings should rely on best practice to recognise pain in residents with dementia. CLINICAL IMPLICATIONS: Non-pharmacological interventions may be effective in reducing pain and reliance on PRN medications in residential care settings, especially when two or more are used. Staff working in residential aged care settings should be provided with training in pain assessment and management, with particular attention to residents with dementia.

A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes.

AIM: To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. BACKGROUND: Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. DESIGN: Quantitative systematic review registered on PROSPERO (CRD42017080925). METHODS: A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. DISCUSSION: Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being.

Depression recognition and capacity for self-report among ethnically diverse nursing homes residents: Evidence of disparities in screening.

AIMS AND OBJECTIVES: To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire. BACKGROUND: Although depression is common among nursing homes residents, its recognition remains a challenge. DESIGN: Observational baseline data from a longitudinal intervention study. METHODS: Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for (i) self-report capacity, (ii) suicidal ideation, (iii) at least moderate depression, (iv) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analysed. The intraclass correlation coefficient was used to examine concordance and Cohen's kappa to examine agreement between clinicians and researchers. RESULTS: Moderate agreement (κ = 0.52) was observed in determination of capacity and poor to fair agreement in reporting suicidal ideation (κ = 0.10-0.37) across time intervals. Poor agreement was observed in classification of at least moderate depression (κ = -0.02 to 0.24), lower than the maximum kappa obtainable (0.58-0.85). Eight assessors indicated problems assessing Spanish-speaking residents. Among Spanish speakers, researchers identified 16% with Patient Health Questionnaire scores of 10 or greater, and 14% with thoughts of self-harm whilst clinicians identified 6% and 0%, respectively. CONCLUSION: This study advances the field of depression recognition in long-term care by identification of possible challenges in assessing Spanish speakers. RELEVANCE TO CLINICAL PRACTICE: Use of the Patient Health Questionnaire requires further investigation, particularly among non-English speakers. Depression screening for ethnically diverse nursing home residents is required, as underreporting of depression and suicidal ideation among Spanish speakers may result in lack of depression recognition and referral for evaluation and treatment. Training in depression recognition is imperative to improve the recognition, evaluation and treatment of depression in older people living in nursing homes.

Nurses' and personal care assistants' role in improving the relocation of older people into nursing homes.

AIMS AND OBJECTIVES: This article presents findings from a study that explored nurses' and personal care assistants' role in improving the relocation of older people into a nursing home. BACKGROUND: Suggestions for improving the relocation process for older people moving into a nursing home have been the outcomes of studies that have interviewed residents and their families. However, the views of nurses and personal care assistants working in nursing homes have not been previously explored. DESIGN: An exploratory, descriptive qualitative research design. METHODS: Individual interviews were conducted with 20 care staff (seven registered nurses, five enrolled nurses and eight personal care assistants) employed at four nursing homes. FINDINGS: Using thematic analysis, two key themes were identified: 'What it's like for them' - highlighted staffs' awareness of the advantages, disadvantages and meaning of relocation, and focused on staffing and nursing care; other services provided and the environment. The second theme - 'We can make it better', revealed suggestions for improving the relocation process, and included spending time with new residents and the importance of a person-centred approach to care. CONCLUSION: Care staff have an important role in improving the relocation process of older people into a nursing home, as well as contributing to the discussion on this important clinical topic. RELEVANCE TO CLINICAL PRACTICE: Challenging care staff to acknowledge the importance of their role in helping older people settle into a nursing home is a key requirement of nursing practice in aged care. Nursing practice guidelines, with a focus on person-centred care, on how to manage the relocation process for an older person and their family are required for this aspect of nursing home care. Education of staff on relocation policies and procedures is essential to ensure that residents and their families are supported through this process.

Managing resident-to-resident elder mistreatment in nursing homes: the SEARCH approach.

This article describes an educational program to inform nursing and care staff of the management of resident-to-resident elder mistreatment (R-REM) in nursing homes, using the SEARCH (Support, Evaluate, Act, Report, Care plan, and Help to avoid) approach. Although relatively little research has been conducted on this form of abuse, there is mounting interest in R-REM because such aggression has been found to be extensive and can have both physical and psychological consequences for residents and staff. The goal of the SEARCH approach is to support staff in the identification and recognition of R-REM as well as to suggest recommendations for management. The educational program and the SEARCH approach are described. Three case studies from the research project are presented, illustrating how nurses and care staff can use the SEARCH approach to manage R-REM in nursing homes. Resident and staff safety and well-being can be enhanced by the use of the evidence-based SEARCH approach.

Stabilising the aged care workforce: an analysis of worker retention and intention.

Concerns about the capacity of the aged care industry to attract and retain a workforce with the skills required to deliver high quality care are widespread, but poor conceptualisation of the problem can result in strategies to address turnover being poorly targeted. A census of residential and community aged care services conducted by the National Institute of Labour Studies (NILS) in 2007 provided a comprehensive empirical account of the workforce, and estimated turnover on the basis of retention: that is, the proportion of the workforce who had been in their job for 1 year or less. This paper adds the dimension of intention: that is, workers' expectations as to whether in 1 year's time, they would still be working in the same aged care service. The dual driver model that takes both retention and intention into account was applied in further analysis of the 2007 NILS data. Investigation of relationships between workforce instability and 13 variables covering worker attributes, organisational attributes and structural attributes of the industry demonstrated the usefulness of the dual driver model for reconceptualising and analysing stability and, in turn, refining strategies to address turnover.

Psychosocial modification of general self-efficacy in older adults: A restricted review.

OBJECTIVES: In recent years, the concept of general self-efficacy has increased in popularity. General self-efficacy is positively associated with quality of life and has the potential to act as a psychological buffer against adverse events and circumstances. However, due to the long-term influences that are said to shape general self-efficacy beliefs, they may be resistant to intervention, particularly within the older population. This restricted review aimed to explore whether psychosocial interventions could improve the general self-efficacy of older adults. Aspects of intervention design associated with improvements were also investigated. METHODS: A restricted review was undertaken. This included a keyword search of four major health databases (PubMed, CINAHL, PsycINFO and AgeLine). Search terms focused on general self-efficacy and the commonly used measures of this concept and were limited to the older adult population. RESULTS: In total, 848 articles were screened, with 20 studies proceeding to data extraction. The modification of general self-efficacy in older adults appears possible, with 7 out of the 20 included studies reporting improvements postintervention. Despite issues relating to the quality of included studies and the generalisability of their results, several aspects of intervention design coincided with intervention success, including intervention duration, and employing sufficiently-qualified staff. CONCLUSIONS: Future research must address the generalisability issues identified in this review. Studies comparing the effectiveness of individual- and group-based interventions, the efficacy of remote delivery platforms and the possibility for long-term transfer of any improvements are needed to contribute the high-quality data required for policy and practice decisions in this area.

The role of sanctions in Australia's residential aged care quality assurance system.

OBJECTIVE: To assess the role of sanctions as the highest level of enforcement in Australia's residential aged care quality assurance (QA) system. ANALYSIS: of secondary data on accreditation activities and outcomes from 1999-2000 to 2007-08, extracted from the Annual Report on the Aged Care Act 1997. SETTING: A total of 138 sanctioned homes among all aged care homes in Australia (n = 2830 in 2007-08). MAIN OUTCOME MEASURES: Chi-square test of differences between sanctioned and non-sanctioned homes, and z scores to identify variables underlying differences. RESULTS: Sanctions are a rare event as more frequent enforcement actions at lower levels of regulatory action mean that a diminishing number of homes are subject to higher levels of action. Relationships between the risk of sanctions and characteristics of homes (state, size, sector and level of care) were evident. Sanctions provide only limited signals on quality to potential users and do not reflect the full scope of the QA process and the range of quality of care found. CONCLUSIONS: The effectiveness of sanctions in contributing to quality improvement has to be seen within the wider regulatory framework, which in turn has to be set in the context of other factors driving quality of care. Quality improvement in Australia and elsewhere will depend on further development of QA systems but will also require attention to wider contextual factors that contribute to quality outcomes, including quality of the aged care workforce.

Psychological transition into a residential care facility: older people's experiences.

AIM: The aim of this paper is to discuss the complexity of admission into a residential care facility from a psychological perspective for residents and their relatives and the resulting implications for nursing care. BACKGROUND: Admission into a residential care facility can be a stressful time for older people, as well as for their relatives. Many relatives have requested continued, meaningful involvement in care in the home, and researchers have identified reasons why it is important to implement strategies for including relatives in care. DATA SOURCES: The background for the paper is published research from the year 2000 on relocation into nursing homes and psychological transitions. DISCUSSION: The concepts of transition from the theory of Personal Constructs are used to make sense of challenges faced by residents and their relatives. The psychological transition is experienced in very different ways by both residents and their relatives, and nurses can make a difference to how this major transition is experienced. However, nurses require improved communication strategies (based on the concepts of transition) that will support residents and their relatives during the admission phase. IMPLICATIONS FOR NURSING: Nurses in residential care facilities need to develop communication strategies that will have a positive impact on the psychological transition that occurs when an older person is admitted into care. CONCLUSION: Improving the psychological health of older people moving into care should be an important goal for all nurses in residential care facilities. Using the theory of personal constructs as a guide, nurses can intervene to make this psychological transition a more positive experience.

Laughter yoga activities for older people living in residential aged care homes: A feasibility study.

OBJECTIVE: To evaluate the effects of a laughter yoga activities (LY) program for older people living in residential aged care homes (RACHs). METHODS: A 6-week LY program was implemented at three RACHs with twenty-eight residents. A pre-post design was used to measure positive and negative affect, happiness, blood pressure and pulse. RESULTS: Post-session mean scores for positive mood, and happiness were significantly higher than pre-session scores in weeks 1, 3 and 6, and the post-session mean negative mood scores were significantly lower than pre-session scores in weeks 3 and 6. Post-session readings for mean systolic blood pressure were significantly lower than pre-session readings in weeks 1 and 6. CONCLUSION: This study demonstrates the potential for using LY to improve mood and lower blood pressure of older people living in RACHs.

The relationship between apathy and participation in therapeutic activities in nursing home residents with dementia: Evidence for an association and directions for further research.

Apathy is one of the most frequent and early symptoms of dementia. Because apathy is characterised by lack of initiative and motivation, it leads to considerable burden being placed on carers to ensure that the person living with dementia has a reasonable quality of life. The aim of this study was to investigate the relationship between apathy and participation in therapeutic activities for older people with dementia living in nursing homes. Ninety residents were recruited into the study, and apathy was measured by nursing home staff using the Apathy Evaluation Scale Clinician version. Staff also compiled data on each resident's involvement in therapeutic activities. Among this sample, the mean age was 84.8 years, and mean length of stay in the nursing home was 1.8 years. The mean apathy score was 50.4, indicating that on average the residents had a moderate level of apathy. Overall, residents participated in six activities per week and those residents who were involved in the most activities had the lowest levels of apathy. This paper provides evidence that residents involved in therapeutic activities have lower levels of apathy. Further research should be conducted on the direction of causality, whether apathy levels can be changed through participation in therapeutic activities, the relationship between dementia severity and modifiability of apathy, and the intensity of therapeutic activities required to maintain functioning.