Quality of institutional care of older people as evaluated by nursing staff.

AIMS: The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. BACKGROUND: The healthcare division of one Finnish city authorised an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re-survey was conducted in 2001, using the same criteria of quality assessment. METHODS: A survey research method was used. All the seven institutions providing long-term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78.6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76.8%. RESULTS: The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. RELEVANCE TO CLINICAL PRACTICE: The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long-term institutional care.

Family members' perceptions of the quality of long-term care.

The aim of the study is to assess family members' perceptions of the quality of nursing care of older people and its relationships between demographic factors and family involvement. Data were gathered from family members of four residential homes (N= 474) using structured questionnaires. Data were analyzed using descriptive statistics, correlation, and predictive analyses. The results imply that family members' perceptions of quality were fairly positive. Age, educational background, and the frequency of visits on the ward were related with the quality perception. The association between quality perceptions and family involvement in care proved to be strong. The information and support from the staff and possibilities to participate in decision making were associated with high-quality ratings. The results demonstrate the need for formulating ward policies and training the nursing staff to allow increased family involvement and to support it in an appropriate way.

Development of an instrument to test the middle-range theory for the self-care of home-dwelling elderly.

PURPOSE: This paper describes the process of developing an instrument to test the middle-range nursing theory for the self-care of home-dwelling elderly. BACKGROUND: Instrument development is a multiphase process, during which the researcher tests the reliability and validity of the instrument with various data and modifies it based on the test results. The aim of the study was to develop an instrument to test a theory, but also to be able to use it later in clinical settings to evaluate the self-care of home-dwelling elderly and factors associated with it. METHODS: The instrument development was done in four phases. At the first phase, the initial version was created on the basis of the theory. At the second phase, two home-dwelling elders were pilot-interviewed, and 20 elders completed the structured questionnaire and commented upon its ease of use. The results were used to develop the second version of the instrument. At the third phase, the second version of the instrument was used to collect data from home-dwelling elders aged 75 or more from different parts of Finland (n = 200). Face validity, exploratory factor analyses, correlation coefficients and Cronbach's alpha were used to test and further develop the instrument. At the fourth phase, the content validity of the third version was assessed by three home-dwelling elders. RESULTS: The agreement between the elders and the researchers about the contents of the instrument was acceptable, and exploratory factor analyses verified quite well the structure of the theory. Based on the Cronbach's alpha values (0.49-0.90), the internal consistency of the instrument was fairly good. CONCLUSION: The results provide sufficient evidence of the validity and reliability of the final version of the instrument, which has nine background questions and 82 items to measure the self-care of home-dwelling elderly and factors associated with it.

Family members' experiences of the quality of geriatric care.

The quality of institutional geriatric care is a topical issue in Finland. The study to be described here is part of a Finnish project on the quality assessment and development of long-term geriatric care provided by the City of Helsinki. The health care division of the City of Helsinki authorized an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of geriatric care were issued. In the years 1999-2000, a further education programme was arranged for ward nurses, chief nurses and heads of profit centres concerning leadership in long-term geriatric nursing. A re-survey was conducted in 2001, using the same criteria of quality assessment. The purpose of this paper is to report on the quality of institutional geriatric nursing as evaluated by family members in 2001 and to compare the responses to those obtained in 1998. The results are presented as frequency and percentage distributions, means and medians and cross-tabulations. The responding family members were generally content with the care of their elderly relatives: 92% said they were very satisfied or satisfied with the care, and the average of the marks given for geriatric care was 8.3 (range 4-10). Family members were more content now than in 1998, when the corresponding figures were 86% and 7.3 (range 4-10). Nevertheless, the results still highlight certain aspects that should be improved and developed.

Practical nurses in elder care and changes in Finnish society - a biographical study.

BACKGROUND: Substantial changes in the socio-economic circumstances in Finnish society over the past century have resulted in major changes in the case of older people, and in the status of nursing staff who care for them. AIM: The purpose of this study was to describe and analyse the work of practical nurses in elder care through the experiences and life cycles of two practical nurses with a long working experience. METHODS: The data consisted of oral biographical narratives produced by the two nurses in repeated interviews. The data were analysed using inductive content analysis. FINDINGS: The following chronological stages and periods of the work of the informants emerged as the core themes of elder care: (1) Collective institutionalized care in the 1950s-1970s: The lowest caste in training, obedient subordinates, undemanding service and routine work; (2) Elderly orientated institutionalized care in the 1980s and 1990s: From subordination to co-operation as an experienced nurse, recognizing the specific qualities of the elderly; (3) Prospects of elder care from the 1990s onwards: Returning to custodial care? CONCLUSIONS: The themes are related to the more general changes that have taken place in Finnish society and health care. The future prospects of practical nurses seem challenging because the principles of social work and health care in Finnish society have shifted from institutionalization towards community care. As a consequence, practical nurses are required to have higher qualifications.