Frailty in community-dwelling older people and nursing home residents: An adaptation and validation study.

AIM: The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. DESIGN: A cross-cultural adaptation and validation of instruments throughout the cross-sectional study. METHODS: Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. RESULTS: All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. CONCLUSIONS: The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. IMPACT: The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. NO PATIENT OR PUBLIC CONTRIBUTION: No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.

Emergency triage nurses' perceptions of caring behaviors and the safety of the patient during triage encounters: a grounded theory study.

BACKGROUND: Triage is a dynamic process prioritising the patient coming to the emergency department. Caring behaviour and patient safety during the triage process are essential for ensuring a good care experience and treatment outcome. OBJECTIVE: To describe triage nurses' perceptions on caring behaviors and patient safety in the triage area. DESIGN: Strauss and Corbin's Grounded theory method was used to develop the model. METHODS: The study was conducted in the emergency department in northeastern Slovenia. Semi-structured interviews were used for data collection, and 19 triage nurses were selected by theoretical sampling, guided by emerging categories between November 2021 and July 2022. The data analysis was conducted according to Strauss and Corbin's coding framework. RESULTS: The analysis of the interviews generated one category: The process of creating a caring and safe triage encounter for the patient, together with two categories that explain the key phenomenon: (1) Triage caring and (2) Safety in the triage process. Within the category "Triage caring", four subcategories were developed: (1) Assurance of triage nurses' presence, (2) Connectedness, (3) Respectful attitude, and (4) Knowledge and skills. The category Safety in the triage process consists of three identified subcategories: (1) Conception and perception of safety, (2) Factors influencing patient safety, and (3) Improving the triage safety. CONCLUSIONS: The triage nurses' perceptions about caring for the patient and his safety in the triage area show that caring and safety are inseparably linked and coincide when triaging a patient. Namely, caring for the patient means ensuring the patient's safety at the same time. IMPLICATIONS FOR THE NURSING FIELD: A better understanding of the importance of triage nurses' caring behavior and patient safety emerges from the findings, highlighting the challenges faced in a busy emergency department where nurses must balance providing care and responding to patients' needs while ensuring safety. Findings in the study show that patient care and safety are inseparably linked and coincide when triaging a patient. Moreover, applying caring behaviour during triage encounter results in greater patient safety. NO PATIENT OR PUBLIC CONTRIBUTION: The study's design, evaluation of the findings, and execution did not need the involvement of patients or the general public. Participants were triage nurses working in the emergency department. Triage nurses were interviewed about their perceptions of triage nurses on caring behaviors and patient safety during triage encounter.

Factors contributing to patient safety during triage process in the emergency department: A systematic review.

BACKGROUND: Triage is a dynamic environment in which large numbers of people can present. It presents a vulnerable assessment point, as a triage nurse must assess a patient's urgency level and analyse their health status and expected resource needs. Given the critical nature of triage, it is necessary to understand the factors contributing to patient safety. OBJECTIVES: To identify and examine the factors contributing to patient safety during the triage process. METHODS: A systematic review of the literature was undertaken, and a thematic analysis of the factors contributing to patient safety during the triage process. PubMed, CINAHL, Web of Sciences, Science Direct, SAGE, EMBASE and reference lists of relevant studies published in English until March 2022 were searched for relevant studies. The search protocol has been registered at the PROSPERO (CRD42019146616), and the review was conducted using the PRISMA criteria. RESULTS: Out of 5366 records, we included 11 papers for thematic synthesis. Identified factors contributing to patient safety in triage are related to the emergency's work environment, such as patient assessment, high workload, frequent interruptions and staffing, and personal factors such as nurse traits, experience, knowledge, triage fatigue and work schedule. CONCLUSIONS: This review shows that patient safety is influenced by the attitude, capabilities and experiences of triage nurses, the time when nurses can dedicate themselves to the patient and triage the patient without disruption. It is necessary to raise awareness among nursing administrators and healthcare professionals to provide a safe triage environment for patients. RELEVANCE TO CLINICAL PRACTICE: This review highlights the evidence on the factors contributing to patient safety in the triage process. Further research is needed for this cohort of triage nurses in the emergency department concerning ensuring patient safety. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was required to design or undertake this review.

Experiences with dignity among older people confined to beds living in a nursing home: A qualitative descriptive study.

AIM: The aim of this study is to explore the concept of dignity from the experience of older people with limited mobility and confined to beds while living in a nursing home. BACKGROUND: Nursing staff have an important impact on the dignity of those older people confined to beds in nursing homes. Individuals' uniqueness with respecting dignity should be ensured. METHODS: A qualitative descriptive study was conducted. The study was carried out with 19 older people who were immobile and confined to bed and living in nursing homes. The individual in-depth interviews were conducted between July and October 2021. Inductive thematic analysis was used to synthesize data. RESULTS: The main theme 'Dignity of older people confined to bed' emerged from subthemes 'Emotions', 'Lived experience' and 'Failure to maintain care'. The participants expressed their dissatisfaction towards the nursing staff's disrespectful care, which evoked feelings of insignificance and inferiority. CONCLUSION: Undignified and disrespectful nursing care can cause feelings of suffering, sadness and anger in older people confined to their beds. Nurses must listen to this group of older people and learn from their experiences. Compassionate, person-centred care with kindness and empathy should be provided by all those providing and receiving care in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT: To provide dignified care, nursing staff must understand the importance of person-centred, individually oriented nursing care for older people living with immobility in nursing homes.

A qualitative study of family members' experiences of their loved one developing dementia and their subsequent placement in a nursing home.

AIM: To investigate the family members' experiences with receiving help and support while their loved one develops dementia and their subsequent placement in nursing homes. BACKGROUND: As the dementia disease progresses, some family members will struggle with the option of nursing home placement. This situation can precipitate feelings of anger, disappointment and guilt, all of which can be overwhelming. METHODS: A qualitative descriptive study with in-depth interviews (n = 19) was carried out in several nursing homes of Slovenia's North Eastern Region. RESULTS: Inductive thematic analysis identified two main themes: (i) developing the diagnosis and (ii) accommodation process. Family members noticed the progressive behavioural changes in their loved ones. While they were searching for help at the primary health care level, they experienced a lack of help and support. CONCLUSIONS: When family members detect behavioural changes in their loved ones, the primary health care team should establish an early diagnosis of dementia and provide adequate decision-making support. IMPLICATIONS FOR NURSING MANAGEMENT: The findings are useful to prepare guidance for a family member to inform them of the types of support available and from which associations and organisations. To achieve adequate management support, primary health care teams need to be aware of family member experiences.

Diabetes management of older adults in nursing homes: A retrospective study.

AIM: To examine the diabetes management of older adults in nursing homes. BACKGROUND: Diabetes is an increasing problem in nursing homes, and diabetes care is defined as a neglected clinical area. METHODS: A retrospective collected data review of 166 older adults with known diabetes from four nursing homes. RESULTS: 65% older than 75 years had HbA1c levels lower than 7.5% (58 mmol/mol), 74% older than 85 years had HbA1c levels lower than 8% (64 mmol/mol). The HbA1c levels were 7.3% (56 mmol/mol) for those who had three and more chronic disorders and 6.8% (51 mmol/mol) for those who had less than three chronic disorders. Individuals treated with insulin had higher HbA1c levels (p < .001) and glycaemia (p = .002). Age was associated with a number of chronic disorders (p = .031), a number of regularly prescribed medications (p = .038) and a number of medications as needed (p = .009). CONCLUSIONS: More than half to three quarters have diabetes well-managed. Nevertheless, there is still some potential for improving diabetes care, and these findings warrant further research for improving diabetes management of older adults in nursing homes. IMPLICATIONS FOR NURSING MANAGEMENT: Interventions designed to promote a healthy lifestyle, documenting individuals' target level and regular monitoring of glycaemia and HbA1c levels may help to improve diabetes management, which may result in better well-being and quality of life for older adults with diabetes in nursing homes.

Effectiveness of school-based mental well-being interventions among adolescents: A systematic review.

AIMS: This systematic review aimed to identify school-based interventions for ensuring mental health and well-being of adolescents, synthesize existing interventions, and summarize the quality of identified studies. DESIGN: A systematic review, analysis, and synthesis were performed. DATA SOURCES: Search was performed in Cochrane Library, PsychARTICLES, Web of Science, CINAHL, and Medline. REVIEW METHODS: Literature search was performed in March 2019 using inclusion and exclusion criteria. PRISMA guidelines were followed. Identified records were reviewed by title, abstract, and by the full text by two independent researchers. Three authors independently made a quality assessment of the included studies. Included studies were extracted and synthesized. A systematic review was registered in PROSPERO (CRD42019128919). RESULTS: The initial search yielded 1,199 articles. Of them, 57 articles were included in the final analysis and synthesis. Only four studies were assessed as high quality. Identified themes were mental health and well-being, positive psychology, problem-solving and stress reduction, mindfulness, and physical activity. More than half (N = 32, 56.14%) interventions showed a positive outcome after implementation. Most of those interventions focused on positive psychology and mindfulness. CONCLUSION: Mental well-being is important for the healthy development of adolescents. Countries are aware that healthy adolescents will become healthy adults who will contribute to his/her community and will lower costs of the absence of work and treatments. Thus, they support and invest in interventions that prevent mental disorders. There is a need for developing multidimensional mental well-being interventions that are effective in low- and secondary-income countries. IMPACT: This study ensured rigorous methodology, followed PRISMA recommendations and evaluated quality of identified literature using the GRADE guidelines. A critical synthesis was performed to produce an integrated conceptualization of the evidence. The synthesis represents a list of effective school interventions for the promotion of adolescents' mental well-being.

Nurses' perceptions of early person-centred palliative care: a cross-sectional descriptive study.

BACKGROUND: Palliative care is aimed at improving the quality of life of an individual with chronic noncommunicable disease and their care partners. Limitations in the provision of palliative care are mainly lack of knowledge and experience by nurses, fear of treating palliative persons, loss of control over treatment and fear of providing poor-quality palliative care to persons and care partners. AIM: The aim of this study was to investigate the perception, knowledge and attitudes of palliative care by nurses who use palliative care approaches in practice, as well as the difference in perception, knowledge and attitudes of palliative care between nurses in Slovenia and Finland. METHODS: We conducted a cross-sectional descriptive study. The survey included 440 nurses in clinical environments in Slovenia and Finland with a completed bachelor, master or doctoral level of education. RESULTS: We found statistically significant differences between both countries in the perception of palliative care. Differences between the two countries in the knowledge of palliative care were not confirmed. We confirmed statistically significant differences between both countries in the attitudes of palliative nursing care. CONCLUSION: Early person-centred palliative care is an important part of the holistic and integrative treatment of a person who has a disease with disturbing symptoms. For such an approach, it is important to educate nurses about knowledge, expectations, values and beliefs in developing a concept of person-centred palliative care to improve quality of life. The better perception, knowledge and attitudes of palliative care by nurses may help persons to improve and raise their quality of life, as well as diminish stress in their care partners and improve quality of life.

Person-Centred Care: A Support Strategy for Managing Non-Communicable Diseases.

BACKGROUND: Over the last decade, the inadequacy and unsustainability of current healthcare services for managing long-term co-morbid and multi-morbid diseases have become evident. METHODS: This study, involving 426 adults with at least one non-communicable disease in Slovenia, aimed to explore the link between quality of life, life satisfaction, person-centred care, and non-communicable disease management. RESULTS: Results indicated generally positive perceptions of quality of life, general health, and life satisfaction of individuals with non-communicable diseases. Participants assessed their physical health as the highest of the four quality of life domains, followed by the environment, social relations, and psychological health. Significant differences occurred in life satisfaction, general health, quality of life, and person-centred care for managing non-communicable diseases. But, there were no significant differences in person-centred care according to the living environment. The study revealed a positive association between person-centred care and effective non-communicable disease management, which is also positively associated with quality of life, general health, and life satisfaction. CONCLUSIONS: Person-centred care is currently the most compassionate and scientific practice conceived, representing a high ethical standard. However, implementing this approach in healthcare systems requires a cohesive national strategy led by capable individuals to foster stakeholder collaboration. Such an approach is crucial to address the deficiencies of existing healthcare services and ensure person-centred care sustainability in non-communicable disease management.

Long-Term Impact of Community Psychiatric Care on Quality of Life amongst People Living with Schizophrenia: A Systematic Review.

The review examines the long-term impact of community psychiatric care on improving the quality of life of people with schizophrenia. It addresses the global burden of this disorder and the need for effective community-based care strategies. A systematic literature search was conducted in databases such as CINAHL, Medline, Web of Science, Sage and ScienceDirect, with the search lasting until March 2024 and following the PRISMA guidelines. The inclusion criteria targeted studies that addressed the long-term effects of community mental health care for people aged 18 years and older with schizophrenia and included both quantitative and qualitative research designs. Studies unrelated to the research question or with significant methodological flaws were excluded. The risk of bias was assessed using GRADE and GRADECERqual, in addition to critical appraisal using the Joanna Briggs Institute (JBI) checklists. Independent screening and data extraction was performed, with results summarised by thematic analysis. In total, 11 studies met the inclusion criteria and included cross-sectional, cohort, qualitative and randomised controlled trial designs. The results showed that community psychiatric care significantly improves the quality of life, well-being and social integration of people with schizophrenia. Effective interventions identified include psychoeducation, cognitive behavioural therapy, social skills training and individualised care plans. However, challenges such as limited resources, labour shortages and social stigma, particularly in low-income neighbourhoods, were also identified. This study highlights the importance of continuous, personalised, multidisciplinary community-based care for sustainable mental health outcomes. Further research is recommended to investigate the long-term impact and strategies to overcome implementation challenges.

Associations between Sleep Quality, Frailty, and Quality of Life among Older Adults in Community and Nursing Home Settings.

Poor sleep quality is prevalent among older adults, but limited data document associations between frailty and quality of life comparing individuals living in the community with those in nursing homes. This cross-sectional study (conducted between August and November 2019) included 831 older adults (mean age 76.5 years) from Slovenia's community and nursing home settings. The results showed comorbidity in 38% of community-dwelling older adults and 31% of older adults in nursing homes. The prevalence of frailty among community-dwelling older adults was 36.5%, and among older adults in a nursing home was 58.5%. A total of 76% of community-dwelling older adults and 95.8% of nursing home residents reported poor sleep quality. Sleep quality and frailty predict 42.3% of the total variability of quality of life for older adults in nursing homes and 34.8% for community-dwelling older adults. The study's results indicate that the quality of life can be affected by factors (e.g., worse sleep quality and frailty) among older adults, regardless of being a resident or from the community. Understanding how sleep quality is affected by social, environmental, and biological factors can help improve sleep quality and potentially the quality of life of older adults.

E-Learning in Nursing and Midwifery during the COVID-19 Pandemic.

As the COVID-19 pandemic continues to spread, e-learning has increased. This is a challenge for nursing and midwifery students, as clinical training is an essential part of their education. The aim of this review was to identify the advantages and limitations of e-learning for nursing and midwifery students during the COVID-19 pandemic. A systematic review of the literature was conducted following the PRISMA guidelines. The international databases PubMed, CINAHL/MEDLINE, Web of Science, and ScienceDirect were searched. Articles were critically appraised. Thematic analysis was used to synthesise the data. The search resulted in 91 hits. Thirteen studies were included in the final analysis. Three main themes were identified: (1) the benefits of e-learning; (2) the challenges/limitations of e-learning; and (3) recommendations for e-learning. E-learning in nursing and midwifery is an effective alternative learning process during the COVID-19 pandemic. Students perceive several benefits and challenges related to internet access, technical equipment, financial aspects, and work and family commitments.

Perceptions of Patient Safety Culture among Triage Nurses in the Emergency Department: A Cross-Sectional Study.

The patient safety culture is key to ensuring patient safety in healthcare organizations. The triage environment is inherently demanding for patient safety and is characterized by high stress, rapid decision-making, and quick action. In several countries, including Slovenia, there is a lack of studies on the patient safety culture among triage nurses. This study aimed to assess the perceptions of the patient safety culture among triage nurses. A cross-sectional survey design was used. The Emergency Medical Services-Safety Attitudes Questionnaire, distributed to triage nurses, was used to collect data. A total of 201 triage nurses participated in this study. The results revealed that the overall average perception of the patient safety culture was 57.27% (SD = 57.27), indicating that the perception of the patient safety culture among triage nurses in the emergency department was non-positive and requires improvement. "Job Satisfaction" received the highest score (63.18%; SD = 17.19), while "Working Conditions" received the lowest (49.91%; SD = 17.37). The perception of positive and negative safety culture responses was statistically significant for age (χ2 (3) = 17.750, p ≤ 0.001), education (χ2 (2) = 6.957, p = 0.031) and length of working experience (χ2 (3) = 8.875, p = 0.031). The findings emphasize the significance of improving the safety culture in relation to several areas of patient care during the triage process. This research serves as a crucial foundation for enhancing patient safety in triage, providing quality care, and reducing adverse events.

Development of a slovenian version of the pittsburgh sleep quality index (PSQI-SLO) for use with older adults.

BACKGROUND: Poor sleep quality predicts poor quality of life, poor self-rated health, and chronic diseases and mental disorders among older adults. The Pittsburgh Sleep Quality Index (PSQI) is the most widely used self-report measure of sleep quality in older adults. OBJECTIVES: This study aimed to assess internal reliability, face validity, content validity and internal consistency of the Slovenian version of the PSQI (PSQI-SLO) for sleep quality in older adults. METHODS: A cross-sectional study was used to evaluate content and face validity as well as reliability (ɑ, ω and item-total correlations). Residents of 13 nursing homes and community-dwelling older adults from all regions of Slovenia were sampled. A total of 831 participants aged 65 years and older participated in the study between March and August 2019. RESULTS: All items were successfully translated to Slovenian. A minor cultural adaptation was made to improve the clarity of the meaning of all items. None of the items had an item content validity index (I-CVI) score lower than 0.50. Kappa indices were excellent for half of the items and good for the remainder. Internal consistency agreed with prior research (ɑ = 0.74). Intraclass correlation coefficient for global PSQI-SLO was 0.62 (p < 0.001). The total score of PSQI-SLO (8.09 ± 3.64 (95%, CI = 7.85-8.34)) was expected and comparable. Fifty-eight and four tenths' per cent (95%, CI = 55%-62%) had at least one chronic disease and 40% (95%, CI = 37%-42%) lived in a nursing home. CONCLUSIONS: PSQI-SLO showed adequate internal consistency and test-retest reliability, and adequate construct and criterion validity. The instrument can be important in assessing older adults' subjective sleep quality in nursing homes, home environment and clinical settings.

Efficacy of Direct or Indirect Use of Probiotics for the Improvement of Maternal Depression during Pregnancy and in the Postnatal Period: A Systematic Review and Meta-Analysis.

The mother and infant form a unique bond, with maternal mental health affecting the interactions with the infant and infant behaviours impacting maternal mental health. One of the possible mechanisms influencing maternal mental health is the manipulation of the gut-brain axis by consuming probiotic supplements. Probiotics can also have an indirect influence on maternal mental health via the modulation of the infant microbiome and consequently improving the infant's health and thus, indirectly leading to an improvement in maternal mood. This systematic review evaluated the efficacy of probiotics on maternal mental health by searching for randomised controlled trials via international databases: Cochrane Library, PubMed, Scopus, ScienceDirect, and Web of Science until January 2022. A meta-analysis was performed using the Cochrane Collaboration methodology where possible. We found seven clinical trials that included the word probiotics and addressed maternal depression and/or anxiety. Of these, five trials investigated the influence of maternal probiotic supplementation on the gut-brain axis. Two trials investigated the indirect influence of probiotics on maternal depression via supplementation of probiotics by infants and subsequent influence on the crying of colicky infants. Meta-analysis of two studies of pregnant and postnatal women and two studies of infants consuming probiotics on the outcome of the Edinburgh Postnatal Depression Scale for mothers showed no statistical difference. The findings indicate that maternal depression is very complex and is influenced by various bidirectional factors. One of the factors that can improve maternal mental health is probiotics, however, careful consideration must be given to correct strain selection as strain-specific effectiveness was observed. Further well-designed, robust clinical studies are warranted.

Components for providing person-centred palliative healthcare: An umbrella review.

BACKGROUND: Person-centred palliative healthcare is an important approach to maintaining and improving patients' quality of life living with a chronic non-communicable disease and their partners. Such an approach can reduce unnecessary hospitalisation, holistically address the patient and their partners' needs, and help develop an advance care plan. OBJECTIVES: Assess, analyse, and synthesise the currently existing international guidelines for providing person-centred palliative care and identify the key components for providing a high-quality approach. METHODS: An umbrella review methodology of systematic reviews with the method of examination, analysis and synthesis of literature and the compilation method. Relevant systematic reviews of guidelines for providing person-centred palliative care in English, German and/or Slovenian language in PubMed, CINAHL, Web of Science and Cochrane Library databases, until November 2020. RESULTS: Out of 3,910 records, we included seven reviews for thematic synthesis. We identified four key elements of flourishing in person-centred palliative healthcare: (i) Healthcare staff prerequisites and traits; (ii) Palliative healthcare environment; (iii) Palliative healthcare processes; and (iv) Palliative healthcare outcomes. CONCLUSIONS: We concluded that person-centred palliative healthcare plays an important role in the comprehensive treatment of patients living with a non-communicable disease accompanied by disturbing symptoms. Therefore, it is necessary to raise awareness amongst healthcare professionals and especially general practitioners about the possibilities of including patients with a non-communicable disease in early person-centred palliative healthcare. Tweetable Abstract: #UmbrellaReview of components for providing #personcentredpalliative #healthcare. Components provide healthcare professionals and interdisciplinary #palliative teams with the steps on how to give #personcentredpalliative #healthcare to #patient and #support to #carepartners.

Reduced Susceptibility and Increased Resistance of Bacteria against Disinfectants: A Systematic Review.

Disinfectants are used to reduce the concentration of pathogenic microorganisms to a safe level and help to prevent the transmission of infectious diseases. However, bacteria have a tremendous ability to respond to chemical stress caused by biocides, where overuse and improper use of disinfectants can be reflected in a reduced susceptibility of microorganisms. This review aims to describe whether mutations and thus decreased susceptibility to disinfectants occur in bacteria during disinfectant exposure. A systematic literature review following PRISMA guidelines was conducted with the databases PubMed, Science Direct and Web of Science. For the final analysis, 28 sources that remained of interest were included. Articles describing reduced susceptibility or the resistance of bacteria against seven different disinfectants were identified. The important deviation of the minimum inhibitory concentration was observed in multiple studies for disinfectants based on triclosan and chlorhexidine. A reduced susceptibility to disinfectants and potentially related problems with antibiotic resistance in clinically important bacterial strains are increasing. Since the use of disinfectants in the community is rising, it is clear that reasonable use of available and effective disinfectants is needed. It is necessary to develop and adopt strategies to control disinfectant resistance.

Family members' experiences with the spiritual care of older people living with dementia in nursing homes: A phenomenological hermeneutical study.

AIM: To illuminate family members experiences with the spiritual care provided to their family members living with dementia in nursing homes. DESIGN: A qualitative research design utilizing phenomenological hermeneutical approach. METHODS: Data were gathered by conducting twelve in-depth interviews with family members of older people living with dementia in nursing homes and analysed using the phenomenological hermeneutical analysis. The COREQ guidance was used for reporting of this study. RESULTS: Finding revealed that family members were worried and fearful when nursing care was routinely provided with little consideration given to spiritual needs and lacking compassion. Findings affirm that "riendliness" is an essential aspect of respectful caring from the family members' perspective. Family members want compassionate, loving, caring and dignified nursing care for their relative living with dementia in the nursing homes.