Improving Documentation of Nutritional Care in A Nursing Home: An Evaluation of A Participatory Action Research Project.

BACKGROUND: Nursing home patients at nutritional risk are often not identified, nor given entitled nutritional treatment. One approach proven suitable to facilitate change in clinical practise is participatory action research (PAR). This is a process which involves research participants in reflection, planning, action, observation, assessing and re-planning, targeted to bring about change. The aim of the present study was to evaluate whether a PAR project resulted in improved documentation of nutritional care in a nursing home ward. Method and sample: A quantitative evaluation. Documentation of the nutritional information was collected from medical records of residents in a nursing home ward at baseline and five months into the project period. RESULTS: Increased documentation of individual nutritional treatment measures was found from baseline to the follow-up. The number of residents with a nutritional care plan (NCP) also increased significantly. On the other hand, the study identified a significant decrease in the proportion of residents with documented weight and nutritional status. CONCLUSION: The evaluation found several improvements in the documentation of nutritional care practice in the nursing home ward as a result of the PAR project, indicating that a PAR approach is suitable to bring about change in practice.

Ethics and quality care in nursing homes: Relatives' experiences.

BACKGROUND: A total of 71,000 people in Norway suffer from some form of dementia in 2013, of whom approximately 30,000 are in nursing homes. Several studies focus on the experiences of those who have close relatives and who are staying in a nursing home. Results show that a greater focus on cooperation between nursing staff and relatives is a central prerequisite for an increased level of care. Benefits of developing systematic collaboration practices include relief for nursing staff, less stress, and greater mutual understanding. Going through studies focusing on the experiences of nursing home patients' relatives, negative experiences are in the majority. In this study, relatives are invited to share positive experiences regarding the care of their loved ones; a slightly different perspective, in other words. AIM: The aim of the study is to investigate relatives of persons with dementia's experiences with quality care in nursing homes. METHOD: The study is a part of a larger project called Hospice values in the care for persons with dementia and is based on a qualitative design where data are generated through narrative interviews. The chosen method of analysis is the phenomenological-hermeneutical method for the study of lived experiences. PARTICIPANTS AND RESEARCH CONTEXT: Participants in the project were eight relatives of persons with dementia who were living in nursing homes, long-term residences. The sampling was targeted, enrolment happened through collective invitation. All relatives interested were included. ETHICAL CONSIDERATIONS: The Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services approve the study. FINDINGS: Findings show that relatives have certain expectations as to how their loved ones ought to be met and looked after at the nursing home. The results show that in those cases where the expectations were met, the relatives' experiences were associated with engagement, inclusion and a good atmosphere. When the expectations were not met, the relatives experienced powerlessness, distrust and guilt. DISCUSSION: The results are discussed considering the concepts of trust, power and asymmetry. CONCLUSION: When asked about experiences with quality care, the relatives spoke both of expectations met and of expectations not met. Results in this study are important knowledge for developing units where performing quality care is the overall aim.

Quality dementia care: Prerequisites and relational ethics among multicultural healthcare providers.

BACKGROUND:: Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves. PURPOSE:: The aim of this study is to illuminate multi-ethnic healthcare providers' lived experiences of their own working relationship, and its importance to quality care for people with dementia. RESEARCH DESIGN:: The study is part of a greater participatory action research project: 'Hospice values in the care for persons with dementia'. The data material consists of extensive notes from seminars, project meetings and dialogue-based teaching. The text material was subjected to phenomenological-hermeneutical interpretation. PARTICIPANTS AND RESEARCH CONTEXT:: Participants in the project were healthcare providers working in a nursing home unit. The participants came from 15 different countries, had different formal qualifications, varied backgrounds and ethnic origins. ETHICAL CONSIDERATIONS:: The study is approved by the Norwegian Regional Ethics Committee and the Norwegian Social Science Data Services. FINDINGS:: The results show that good working relationships, characterized by understanding each other's vulnerability and willingness to learn from each other through shared experiences, are prerequisites for quality care. The healthcare providers further described ethical challenges as uncertainty and different understandings. DISCUSSION:: The results are discussed in the light of Lögstrup's relational philosophy of ethics and the concepts of vulnerability, ethic responsibility, trust and openness of speech. CONCLUSION:: The prerequisite for quality care for persons with dementia in a multicultural working environment is to create arenas for open discussions between the healthcare providers. Leadership is of great importance.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team.

BACKGROUND: The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges. PURPOSE: The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context. RESEARCH METHOD: The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care. ETHICAL CONSIDERATIONS: The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services. PARTICIPATION AND RESEARCH CONTEXT: Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit. FINDINGS: The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness. DISCUSSION: The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood. CONCLUSION: The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation between a multi-ethnic staff, the patients experiencing dementia and next of kin.

Ethical and cultural striving: Lived experiences of minority nurses in dementia care.

BACKGROUND: Nursing workforce in Western European health institutions has become more diverse because of immigration and recruitment from Asian, African, and East-European countries. Minority healthcare providers may experience communication problems in interaction with patients and coworkers, and they are likely to experience conflict or uncertainty when confronted with different cultural traditions and values. Persons with dementia are a vulnerable group, and the consequences of their illness challenge the ability to understand and express oneself verbally. The large number of minority healthcare providers in nursing homes underlines the importance to obtain better knowledge about this group's experiences with the care challenges in dementia care units. RESEARCH QUESTION: Can you tell about any challenges in the experiences in the encounter with persons suffering from dementia? Participants and research context: Five minority healthcare providers in a nursing home, in a dementia unit. All guidelines for research ethic were followed. Ethical consideration: The participants were informed that participation was voluntary, and they were guarantied anonymity. METHOD: We used a qualitative method, conducting individual interviews, using a narrative approach. In the analysis, we applied a phenomenological-hermeneutical method, developed for researching life experiences. FINDINGS: One theme and four subthemes: striving to understand the quality of care for persons with dementia. The subthemes: sensitivity to understand the patients' verbal and nonverbal expressions. To understand gratefulness, understand the patient as an adult and autonomous person, and understand the patient as a patient in a nursing home. Challenges comprise both ethical and cultural striving to understand persons with dementia. CONCLUSION: To care for persons with dementia in an unfamiliar context may be understood as a striving for acting ethically, when at the same time striving to adapt and acculturate to new cultural norms, in order to practice good dementia care.

A qualitative study of professional caregivers' perceptions of processes contributing to mealtime agitation in persons with dementia in nursing home wards and strategies to attain calmness.

AIM: Describe professional caregivers' perceptions of factors and processes contributing to mealtime agitation and strategies for attaining and maintaining calm mealtimes. DESIGN: Qualitative and descriptive. METHODS: A convenience sample of professional caregivers working in two wards for residents with dementia was used. Data were collected during two focus-group interviews and supplemented with field notes from six reflection groups. Thematic content analysis was conducted. Data collection occurred from 2010-2011. RESULTS: Professional caregivers perceived agitation during mealtime as resulting from negative feelings in residents triggered by a lack of or negative social interaction, too much or ambiguous stimuli or demands exceeding residents' capacity. Strategies for attaining calm mealtimes involved thorough planning beforehand. During mealtime, professional caregivers focused on establishing a positive community around the table, helping residents focus on eating and continuously observing residents for subtle signals indicating that agitation was about to develop. The prerequisites to succeed with the strategies were knowledge of the residents' preferences and abilities, knowledge sharing within the team and awareness of one's own communication style. Thus, the professional caregivers operationalized person-centred care in a mealtime context.