A qualitative study of the relationships between residents and nursing homes nurses.

AIMS AND OBJECTIVES: To explore the relationships between residents and nurses in Spanish nursing homes. BACKGROUND: The nurses are one of the elements conditioning the life of the nursing home resident, influencing sense of security and mediating the relationships among residents. DESIGN: A qualitative phenomenological approach was applied. METHODS: An initial purposeful sampling of Spanish residents from nursing homes in the southern area of Madrid was conducted. The study included nursing home residents, aged 60 and over, with no cognitive impairment and who were able to communicate verbally in Spanish. Data were collected using unstructured and semi-structured interviews, researcher field notes, and personal diaries and letters from the residents. Data collection was concluded once theoretical saturation was reached, and data were analysed using the Giorgi proposal. RESULTS: Two main themes emerged: (1) 'meeting the nursing home nurses,' residents interact with nurses and establish relationships with them. The relationship is perceived as positive yet distant, and at times it is difficult to establish a closer relationship; and (2) 'managing relationships with the nursing home nurses,' residents learn to manage their relationships with the nurses, acquiring new behaviours to get closer to them, avoiding confrontations and helping each other. CONCLUSIONS: Residents manage their relationships with nurses using multiple behavioural strategies. They perceive these adjustments as necessary to facilitate daily life or avoid problems and/or confrontations. Deepening the relationships between residents and nurses could improve the management of nursing homes. RELEVANCE TO CLINICAL PRACTICE: Dialogue and active listening with residents must be incorporated into the daily nursing care. It should be given the same attention to all residents, with special attention to residents with cognitive and functional difficulties.

Is the influence of nurse care practices and nursing home organization understood? A qualitative study.

AIM: To describe residents' experience of nursing home organization and nursing care practices in a region of Spain. BACKGROUND: Nursing home organization, nursing practices and rules within the institution may all influence residents' daily living and their perception on the quality of care provided. DESIGN: A qualitative approach was conducted, using purposeful and theoretical sampling. Data were collected from nursing home residents, following unstructured and semi-structured interviews, researcher field notes and residents' personal diaries and letters. Giorgi analysis was conducted. RESULTS: Two main themes emerged. (1) 'Following nursing home rules'. Norms may be seen as boundaries, especially for those residents who were independent before admission. (2) 'Prioritizing nursing care in residents'. Prioritizing the nursing care may limit the autonomy of residents because it does not meet their preferences and needs. CONCLUSION: Understanding the meaning of nursing home organization and nursing care practices with nursing home residents might provide deeper insight into their expectations. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing staff should have greater involvement in the nursing home organization, as well as in prioritizing the care provision based on resident's needs and preferences.

Immediate effects on pressure pain threshold following a single cervical spine manipulation in healthy subjects.

DESIGN: A placebo, control, repeated-measures, single-blinded randomized study. OBJECTIVES: To compare the immediate effects on pressure pain threshold (PPT) tested over the lateral elbow region following a single cervical high-velocity low-amplitude (HVLA) thrust manipulation, a sham-manual application (placebo), or a control condition; and to analyze if a different effect was evident on the side ipsilateral to, compared to the side contralateral to, the intervention. BACKGROUND: Previous studies investigating the effects of spinal manual therapy used passive mobilization procedures. There is a lack of studies exploring the effect of cervical manipulative interventions. METHODS: Fifteen asymptomatic volunteers (7 male, 8 female; aged 19-25 years) participated in this study. Each subject attended 3 experimental sessions on 3 separate days, at least 48 hours apart. At each session, subjects received either the manipulation, placebo, or control intervention provided by an experienced therapist. The manipulative intervention was directed at the posterior joint of the C5-6 vertebral level. PPT over the lateral epicondyle of both elbows was assessed preintervention and 5 minutes postintervention by an examiner blinded to the treatment allocation of the subject. A 3-way analysis of covariance (ANCOVA) with intervention, side, and time as factors, and gender as covariate, was used to evaluate changes in PPT. RESULTS: The analysis of variance detected a significant effect for intervention (F = 31.46, P < .001) and for time (F = 33.81, P < .001), but not for side (F = 0.303, P > .5). A significant interaction between intervention and time (F = 15.74, P < .001) was also found. Gender did not influence the comparative analysis (F = 0.252, P > .6). Post hoc analysis revealed that the application of a HVLA thrust manipulation produced a greater increase of PPT in both elbows, as compared to placebo or control interventions (P < .001). No significant changes in PPT levels were found after the placebo and control interventions (P > .6). Within-group effect sizes were large for PPT levels in both elbows after the manipulative procedure (d > 1.0), but small after placebo or control intervention (d < 0.1). CONCLUSIONS: The application of a manipulative intervention directed at the posterior joint of the C5-6 vertebral level produced an immediate increase in PPT over the lateral epicondyle of both elbows in healthy subjects. Effect sizes for the HVLA thrust manipulation were large, suggesting a strong effect of unknown clinical importance at this stage, whereas effect sizes for both placebo and control procedures were small, suggesting no significant effect.

Non-capable residents: is the experience of dependence understood in nursing homes? A qualitative study.

OBJECTIVE: The aim of the present study was to describe how dependence was experienced by Spanish nursing home residents with functional limitations. METHODS: A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for-profit nursing homes in the southern area of Madrid was carried out. Theoretical sampling was also implemented in order to gain a more in-depth understanding of dependence. The inclusion criteria for nursing home residents were: aged 60 years old or older, having a functional impairment (Barthel Index <90), and lack of any cognitive impairment (Mini-Mental State Examination-Folstein >19) and able to communicate verbally in Spanish. Data were collected using unstructured and semi-structured interviews. The interviews were tape recorded and fully transcribed. Data collection was concluded once theoretical saturation was reached, and the data were analyzed using the Giorgi proposal. RESULTS: A total of 30 residents (15 female and 15 male) with a mean age of 83 years were included. Two main themes that describe the significance of dependence in nursing homes emerged from the data: (i) remaining "capable", with one subtheme named "building the difference", where residents described their own dependence classification of "non-capable" residents; and (ii) "sharing life", with two subthemes named "living together with non-capable residents" and "sharing the environment". Being considered as "non-capable" is labelling the resident forever. CONCLUSIONS: The dependence experience of Spanish nursing home residents might help us gain a deeper insight into their expectations about functional limitations, as well as to understand the change in the relationship between residents considered "non-capable", caregivers and the other residents.