Comparisons on factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes: a qualitative study.

BACKGROUND: Studies revealed that supporting residents fulfilling self-determination is positively associated with their health, wellbeing and quality of life. Cross-cultural care poses significant challenges for nursing home residents to fulfil their self-determination in control of own care and maintaining meaningful connections with others. The aim of the study was to compare factors affecting residents fulfilling self-determination in ethno-specific and mainstream nursing homes. METHODS: A qualitative descriptive approach was applied to the study. Culturally competent care and person-centred care were employed as guiding frameworks. Individual interviews or a focus group with residents and family members were conducted to collect data. RESULTS: In total, 29 participants participated in the study. Three main themes were identified: communicating needs and preferences; mastering own care; and maintaining meaningful relationships. Each theme includes sub-themes that detail similarities and differences of factors affecting residents fulfilling self-determination in the two type nursing homes. Findings indicate that residents from both types of nursing homes experienced challenges to communicate their care needs and preferences in daily care activities. Moreover, residents or their representatives from both types of nursing homes demonstrated motivation and competence to master residents' care based on their individual preferences, but also perceived that their motivation was not always supported by staff or the nursing home environment. Residents' competence in mastering their care activities in ethno-specific nursing homes was based on the condition that they were given opportunities to use a language of choice in communication and staff and the nursing home demonstrated culturally competent care for them. In addition, ethno-specific nursing homes showed more recourse to support residents to maintain meaningful relationships with peers and others. CONCLUSIONS: Culturally competent care created by staff, nursing homes and the aged care system is a basic condition for residents from ethnic minority groups to fulfil self-determination. In addition, person-centred care approach enables residents to optimise self-determination.

Staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes.

AIMS AND OBJECTIVES: To explore and compare staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes. BACKGROUND: Staff and residents in ethno-specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio-demographic change poses significant challenges for staff to support resident self-determination of their own care. In-depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse-led nursing home care settings. METHOD: A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno-specific nursing homes and a mainstream nursing home in Australia between March-September 2020. The study report followed the COREQ checklist. RESULTS: Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno-specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno-specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home. CONCLUSIONS: Staff in ethno-specific nursing homes experience more challenges in supporting resident self-determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home. RELEVANCE TO CLINICAL PRACTICE: Findings provide new insights into challenges and practical solutions in supporting residents to self-determine their own care in cross-cultural aged care. PATIENT OR PUBLIC CONTRIBUTION: This study was co-designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study.

Understanding the planning and preparation for diabetes self-management of grey nomads when travelling in rural and remote Australia: An exploratory survey.

OBJECTIVE: Many older Australians with chronic health conditions, including diabetes, are taking to the road in a recreational vehicle following retirement and are colloquially known as grey nomads. This exploratory online survey aimed to ascertain the issues on the road for grey nomads with diabetes and their experiences of self-management of their diabetes whilst in rural and remote regions of Australia. METHODS: Following ethical approval and piloting, an online survey was distributed through social media sites used by grey nomads and those with diabetes. From the closed and open-ended responses from travelers with diabetes in rural and remote areas, the demographics of this cohort were explored, as well as their self-management of diabetes. RESULTS: A total of 103 grey nomads with diabetes responded and 81 completed all survey questions. There was wide variation in the respondents' answers in regard to their self-management including their preparation for travel; their knowledge of diabetes and accessing health-care services; their management of illness; and their experiences whilst travelling including the effects of COVID-19. It was identified that there was a need for an increase in preparation prior to travel, and several important checks were identified for this planning specific to rural and remote areas of Australia, including the expectations of health services in these regions. CONCLUSIONS: A pretravel checklist for travellers with diabetes is recommended to contribute to better self-management of grey nomads with diabetes on the road in order to alleviate the issues identified.

A call for culture-centred care: exploring health workers' perspectives of positive care experiences and culturally responsive care provision to Aboriginal women and their infants in mainstream health in South Australia.

BACKGROUND: Aboriginal women and their infants experience significant disadvantage in health outcomes compared to their non-Aboriginal counterparts. Access to timely, effective, and appropriate maternal and child health care can contribute to reducing these existing health disparities. This research sought to explore factors that contribute to continuity of care for Aboriginal women and their infants living in metropolitan South Australia. This paper reports on the perspectives of health care workers in mainstream health services from the antenatal period to the end of an infants' second birthday. It explores health workers' perspectives of what contributes to positive care experiences and satisfaction with care provided to Aboriginal women and their infants in mainstream health. METHODS: Eight focus groups were held with 52 health professionals. Participants included Aboriginal Cultural Child and Family Support Consultants (n = 7), Aboriginal Maternal Infant Care Workers (n = 3), Midwives (n = 3) and Child and Family Nurses (n = 39). Data was inductively coded and thematically analysed. RESULTS: Three key themes emerged: the system takes priority, culture is not central in approaches to care, and 'we've got to be allowed to do it in a different way'. CONCLUSIONS: This research highlights a lack of continuity of care for Aboriginal families accessing mainstream health services from the antenatal period through to an infants' first 1000 days of life. This research has implications for communities, and it calls for strategies to enhance continuity, and healthcare services to provide appropriate and culturally safe care. Findings will inform and guide future changes to improve continuity of care for Aboriginal families and infants in the first 1000 days.

Care workers' perspectives of factors affecting a sustainable aged care workforce.

AIMS: To identify the reasons why workers decide to enter, stay or leave the aged care workforce; and the factors influencing them to transition between community and residential sectors in Australia. BACKGROUND: Factors affecting the recruitment and retention of suitable care workers in aged care are complex and influenced by personal, institutional and societal factors. METHODS: A qualitative description study design. RESULTS: In total, 32 staff participated in the study. Five main themes were identified: entering aged care with a passion for the job; entering aged care as it is the only employment option; factors attracting care workers to stay in aged care; factors influencing care workers to leave the job; and preferring to work in residential aged care rather than community aged care. CONCLUSION: Issues relating to the attraction and retention of aged care workers are influenced by personal, institutional and societal factors. Critical shortages in the aged care workforce make the industry more susceptible to crises such as COVID-19 outbreaks. IMPLICATION FOR NURSING PRACTICE: Aged care organizations need to create a positive psychosocial work environment for staff to improve the attraction and retention of skilled care workers. They also need to develop staff recruitment guidelines to ensure care workers with the appropriate skills and training and a passion for working with older adults are selected. Staff development programmes need to focus on learning activities that enable staff to build peers support in the work environment. IMPLICATIONS FOR HEALTH POLICY: There is a need to mandate curriculum to enable nursing students to receive more gerontological education and exposure to aged care throughout their education. Aged care quality standards need to mandate transition support for new graduate nurses.

New Graduate Registered Nurses and the Spectrum of Comfort in Clinical Practice.

The comfort zone is where a person consistently performs his or her role in an affective state devoid of anxiety and without a feeling of risk. This study challenges the notion of a singular comfort zone and suggests that a spectrum of comfort is a more accurate reflection of the new graduate experience. A grounded theory methodology was used to identify and explain the spectrum of comfort considerations helpful to nine new graduates amid their transition to professional practice. Emerging from the data were themes that encompassed both the positive and negative regions of the spectrum of comfort. Negative themes were: Feeling Abandoned, Sometimes I Get Frightened, and Feeling Betrayed-Catching Hold. The more positive themes were: Moderation of Emotions, and Letting Go. Each of these themes requires an appropriate response from new graduates and experienced staff. The spectrum of comfort model and practical considerations of support could accomplish this. [J Contin Educ Nurs. 2019;50(12):563-571.].

Strategies new graduate registered nurses require to care and advocate for themselves: A literature review.

BACKGROUND: New graduate registered nurses (NGRNs) are confronted with a complex, demanding and resource-constrained environment where gaining acceptance into the workplace culture may be difficult. Existing evidence suggests that preparing undergraduate nursing students for this reality can assist with adjustment. OBJECTIVES: To identify the strategies that NGRNs require to care and advocate for themselves during their first year of practice. METHODS: A search of the literature published between 2001 and 2016 was undertaken. Individual articles were synthesized narratively and the results entered to a summary table. RESULTS: A total of 274 articles were considered relevant to this narrative review. This paper synthesized the narrative of 80 articles. Synthesis revealed 22 resilience factors and 33 issues. Eight strategies with potential to assist NGRNs to care and advocate for themselves were identified. All of them are socioemotional in nature. CONCLUSIONS: This review of the literature provides a valuable resource that can be used to prepare nursing students for the workplace culture during their first year as a registered nurse. Scenarios can be developed for educational activities such as simulation, role play, discussion and self-reflection. Further development through research is recommended.

Ways of Being: Preparing Nursing Students for Transition to Professional Practice.

BACKGROUND: The new graduate registered nurse (NGRN) does not work in isolation but within an organizational environment. Unfortunately for the NGRN, transition-to-practice programs are often variable and underresourced, which means that promised support is unlikely to eventuate. Many NGRNs learn the skills required to navigate the nursing culture on the job without support and by trial and error. METHOD: A grounded theory method was used to identify the strategies used by nine NGRNs to thrive during their transition to professional practice. RESULTS: Ways of being emerged from the data to explain the social and emotional strategies NGRNs use during the first year of practice. The ways of being model includes ways of feeling, ways of relating, and ways of doing. CONCLUSION: University preparation needs to ensure that the NGRN is provided with the skills to successfully navigate the workplace. Use of the ways of being model could help achieve this. J Contin Educ Nurs. 2016;47(7):330-340.