Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

BACKGROUND: Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. METHODS: We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. RESULTS: Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. CONCLUSION: This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

Compassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran.

BACKGROUND: Compassionate care is the main indicator of the quality regarding nursing care. The importance of this care in the recovery process for the elderly hospitalized for COVID-19 has been under-researched in studies. Therefore, this study aimed to determine the compassionate care level of nurses to the elderly hospitalized in the COVID-19 wards of teaching hospitals in the south of Iran. METHODS: This descriptive-analytical study was conducted on 212 nurses working in the COVID-19 wards of teaching hospitals in the south of Iran, who were selected through census in a cross-sectional study. The data were collected using the Tehranineshat et al. nurses' compassionate care questionnaire and then the data were analyzed using descriptive and analytical statistics along with SPSS software version 22. RESULTS: The mean score of nurses' compassionate care was 130.18 ± 9.42, which was at a high level. The highest and lowest scores were related to professional performance (43.17 ± 2.799) and empathic communication dimension (27.76 ± 2.970). No significant relationship was found between variables such as gender, marital status, education, work experience, and job position with the compassionate care score (P > 0.05). CONCLUSION: Nurses providing care for hospitalized elderly are recommended to consider all aspects of compassionate care, especially empathic communication, in their educational planning.

Family physicians' knowledge levels about elder abuse and neglect in a province of Türkiye and hesitations in reporting.

BACKGROUND: This study aimed to investigate the knowledge, attitudes and reservations of family physicians (FPs) in reporting elderly abuse and neglect (EAN). METHODS: Our cross-sectional study was conducted with 161 FPs in Kütahya, a city in Türkiye. A questionnaire including demographic characteristics, the frequency with which Elder Abuse Suspicion Index (EASI) questions were asked and knowledge level of EAN was applied to the FPs. RESULTS: Only about a quarter (24.2%) of the FPs felt competent regarding EAN. The rate of participants who had encountered EAN victims before was 46%. Of these, 40% reported psychological violence, 24.3% reported physical and psychological violence and 21.6% reported only physical violence. FPs also reported that inconsistency in anamnesis (87.0%), inconsistency between anamnesis and physical examination findings (85.1%) and frequent visits to the emergency department (59.6%) raised suspicion about EAN. It was also observed that 68.9% of the FPs knew that healthcare professionals had a legal obligation to report elder abuse. Only 23.0% of the FPs who encountered cases of violence and abuse stated that they had made a legal report. Among the FPs who did not report, 40.4% stated that they did not report because they had some reservations or did not know how to do so (35.1%). CONCLUSION: Due to a lack of knowledge and some concerns, the rate of reporting EAN to judicial authorities was also low. FPs were not aware of the importance of EAN in terms of elderly health.

Acceptance of preventive home visits by nurses - The user perspective.

OBJECTIVE: The aim of this study was to investigate acceptance of preventive home visits (PHVs) for older adults in rural Germany. DESIGN: Qualitative descriptive approach. SAMPLE: We investigated the personal, individual perspective of adults aged 65 to 85, who were not yet eligible for benefits from the long-term care insurance, were able to understand and speak German, and who lived in the municipality under study. MEASUREMENTS: Fifteen semi-structured interviews were conducted between 02/2019 and 08/2020. They were transcribed, coded using MAXQDA, and content analyzed. Ethical approval was obtained. RESULTS: The acceptance of PHVs was extremely high and characterized by five main effects: very close relationship with the nurse, well-being, empowerment, satisfaction, ambivalence. Participants wish to receive PHVs in the future and would recommend it to others. Even those with a healthy or health-promoting lifestyle are thankful to be able to refer to the counselling sessions if life circumstances should deteriorate. Those who became care-dependent wish to continue and perceive it as a valuable addition to their care. CONCLUSION: From the participants' point of view, this low-threshold counselling-and-support approach should be maintained in the future. PHVs can support health and independence in older adults and therefore prevent them from becoming care-dependent.

Provision of health services for elderly populations in rural and remote areas in Australia: A systematic scoping review.

INTRODUCTION: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. OBJECTIVE: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. DESIGN: A systematic scoping review of peer-reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). FINDINGS: Thirty-two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. DISCUSSION: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient-centred care for elderly populations in rural and remote areas. CONCLUSION: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents.

[The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. / Rôle des gériatres libéraux dans le système de santé (2/2) : analyse qualitative compréhensive par entretiens semi-dirigés.

Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.

[Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. / Rôle des gériatres libéraux dans le système de santé (1/2) : analyse quantitative descriptive par questionnaire.

Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.

Primary care provider notions on instituting community-based geriatric support in Uganda.

BACKGROUND: Understanding of the most economical and sustainable models of providing geriatric care to Africa's rising ageing population is critical. In Uganda, the number of old adults (60 years and above) continues to rise against absence of policies and guidelines, and models for providing care to this critical population. Our study explored public primary health care provider views on how best community-based geriatric support (CBGS) could be instituted as an adaptable model for delivering geriatric care in Uganda's resource-limited primary public health care settings. METHODS: We interviewed 20 key informants from four districts of Bukomansimbi, Kalungu, Rakai, and Lwengo in Southern Central Uganda. Respondents were leads (in-charges) of public primary health units that had spent at least 6 months at the fore said facilities. All interviews were audio-recorded, transcribed verbatim, and analysed based on Hsieh and Shannon's approach to conventional manifest content analysis. RESULTS: During analysis, four themes emerged: 1) Structures to leverage for CBGS, 2) How to promote CBGS, 3) Who should be involved in CBGS, and 4) What activities need to be leveraged to advance CBGS? The majority of the respondents viewed using the existing village health team and local leadership structures as key to the successful institutionalization of CBGS; leveraging community education and sensitization using radio, television, and engaging health workers, family relatives, and neighbors. Health outreach activities were mentioned as one of the avenues that could be leveraged to provide CBGS. CONCLUSION: Provider notions pointed to CBGS as a viable model for instituting geriatric care in Uganda's public primary healthcare system. However, this requires policymakers to leverage existing village health team and local governance structures, conduct community education and sensitization about CBGS, and bring onboard health workers, family relatives, and neighbors.

Implementation and evaluation of a pain assessment app and novel community platform for long-term care health professionals.

OBJECTIVE: A tablet app, based on the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II), has been shown to have clinical utility and unique advantages. We aimed to replicate and extend the previous validation of the app through the implementation and evaluation of a new community platform involving a quality indicator (QI) monitoring feature and a resource community portal (CP) that work in conjunction with an updated version of the app. METHODS: We employed a mixed-methods multiple-baseline design across 11 long-term care (LTC) units. Units were randomly assigned to conditions which varied in number of app features available. Data included unit-level QIs as well as questionnaires and semi-structured interviews with health professionals. RESULTS: Following use of the app, we found improvements in unit-level QIs regardless of availability of the QI/CP features. During interviews, participants expressed a preference for the app over a paper version of the PACSLAC-II due to reasons such as the app's ability to summarize information. Utilization of the community portal websites was unrelated to staff questionnaire-assessed stress/burnout. CONCLUSIONS: Despite the positive effects on the care of residents, the COVID-19 pandemic presented challenges and interfered with the long-term maintenance of the QI results.

Cases of intervention refusal encountered by public health nurses in Japan and characteristics of their support- qualitative analysis of described mother-child and elderly cases.

BACKGROUND: The purpose of this study is to clarify the actual situation of the cases and the characteristics of support, focusing on mothers and their children, and elderly persons among the cases of intervention refusal encountered by public health nurses (PHNs) in Japan. METHODS: The data were descriptions of intervention refusal cases that were freely described by PHNs working for prefectural and municipal governments in questionnaire surveys nationwide. The characteristics of the cases and the support were categorized according to the situation of the case, and the number of descriptions was summarized and interpreted. RESULTS: The results revealed that interventions involving mothers and children were refused in most of by mother or parents. The refusals were related to child abuse, parental mental illness, obsessiveness, and complex backgrounds. The actual status of intervention refusal in elderly persons, interventions are frequently refused by elderly persons themselves in the case of self-neglect and by family members living with the elderly in the case of abuse. The refusals were related to mental disorders or dementia and living alone. In both cases, PHNs provided support in collaboration with multi-disciplinary and multi-agencies, and attempts were made to alleviate the situation of refusal to intervene, from detecting cases through contact during home visits and in other settings, and by coordinating with appropriate team members as required. CONCLUSIONS: It is suggested that PHNs need to acquire practical skills depending on the characteristics of the case to cope with critical situations throughout the process of engagement.

[Care pathways and family caregivers]. / Parcours de soins et aidants familiaux.

In recent years, a number of actions have been carried out to develop assistance for caregivers in France. This assistance can be coordinated with the help of social services, which can be difficult for both the elderly person and their caregiver, for psychological reasons. If an adapted and rehabilitated care pathway is not put in place, the caregiver may be exposed to psychosocial risks.

From village health volunteers to paid care givers: the optimal mix for a multidisciplinary home health care workforce in rural Thailand.

BACKGROUND: Thailand is a rapidly aging society, which places high demand on home health care services for the elderly. The shortage of health care workforce in rural areas is a crucial obstacle to the delivery of adequate home health care services. The appropriate skill-mix between multidisciplinary health team and care givers (CGs) is an attractive solution for improving home health care services in rural Thailand. This study assessed the potential of trained CGs to provide home health care services and projected what the optimal mix for a multidisciplinary home health care team in rural Thailand would be in 2030. METHODS: Eleven pilot districts in Thailand were recruited for the study. Secondary data were collected along with surveys of home health care providers. A total of 130 care managers (nurses) and 351 care givers (CG) were recruited for the survey. Workload, skill-mix potential, and acceptance of care givers were assessed in the surveys. The results from secondary data and the survey were used to project the health workforce requirements in 2030. RESULTS: It is projected that in 2030 the number of elderly living in rural areas will be 7,156,700 (27% of the projected rural population). Of this, 20.3% will be home-bound, 1.1% will be bed-ridden and 1.6% will need rehabilitation. The main members of the multidisciplinary health workforce involved in home health care were nurses, doctors, and physiotherapists. The home health care services that were provided by the multidisciplinary health workforce included patient assessment, development of a care plan and case conference, home visits, and teaching and supervision of CGs. The CGs were village health volunteers trained to carry out regular home visits to patients. The CGs provided assistance with the activities of daily living, basic health services, moral support to patients and relatives, and surveillance of the home environment during home visits. CGs were well accepted by both the health professionals and the patients. Projections showed that 16,094 nurses, 1,542 doctors, 1,022 physiotherapists and 50,148 CGs will be required in 2030 to meet the needs of the dependent elderly for home health care in rural Thailand. CONCLUSION: With the increased need for home health care services in the future, appropriate team work between the members of the multidisciplinary health team and the CGs in the community is the appropriate solution for likely shortages of health professional workforce.

Hip Lift Transfer Assistive System for Reducing Burden on Caregiver's Waist.

In Japan, the aging population is expected to increase the number of elderly people in the future. The purpose of this study was to develop a hip lift transfer assistive system to improve the QOL of elderly living and to prevent back pain for caregivers. We extracted the impediment factor and the necessary scene for the assistance, decided on the transfer process from the wheelchair in the toilet, and considered the reduction method of the burden based on the quantitative evaluation of the caregiver's lumbar burden and developed the device. Then we proposed the algorithm of the system by grasping the behavior and lumbar burden characteristics at the time of using the hip lift transfer assistive system by the developed device in which the proposed support algorithm of standing seating assistance operation is implemented in the actual use environment. Through the assistive movement evaluation experiment and the actual operation in the toilet, we have verified that the use of this device can reduce the caregivers' lumbar burden below the standard value (3400 N) and have proved the effectiveness of the proposed transfer assistive system.

[Five years University Practice of Elderly Care: users, care provided, costs and experiences]. / Vijf jaar Universitaire Praktijk Ouderengeneeskunde: gebruikers, geleverde zorg, kosten en ervaringen.

The increasing number of elderly people living at home demands a strengthening of primary care for (vulnerable) older adults. Therefore, in 2015 the VU University Medical Centre in Amsterdam founded the Universitaire Praktijk Ouderengeneeskunde (UPO) (University Practice for Elderly Care). This practice makes the expertise of the Elderly Care physician (SO) available in primary care through a close and easy accessible collaboration between the SO and the General Practitioner. The aim of this research is an evaluation of the UPO, in order to determine the added value of this care innovation and to identify areas for improvement. This research consists of a quantitative part in which the characteristics of the 190 treated UPO patients have been assessed. Also, costs have been estimated of UPO care compared to expected usual care. The qualitative part of this study consists of 22 interviews with the most important UPO stakeholders. The results of this study show  that 1) the UPO seems to meet a demand from general practitioners to support them in the care of vulnerable elderly people with mostly cognitive disorders, 2) this care seems to save costs and 3) the UPO was appreciated by most of those involved. The current results call for applying this care innovation in other regions and to evaluate it on a larger scale.

Killing of Elderly Patients by Health Care Professionals: Insights From Coroners' Inquests and Inquiries in Three Cases.

As the world's population ages, a question of who can be trusted to look after the increasing elderly population arises. Health care professionals are commonly considered one of the group of people we entrust with our health care and maintenance of a good quality of life. Unfortunately, some abuse this trust. Harold Shipman, Elizabeth Wettlaufer and Roger Dean are three examples of health care professionals held responsible for multiple homicides of patients aged 65 years and older in their care. Harold Shipman, a United Kingdom doctor, is suspected of killing potentially 400 patients over 27 years. However, the true number may never be known. Elizabeth Wettlaufer, a Canadian nurse, admitted to killing eight patients over seven years and Roger Dean, an Australian nurse, killed 11 patients in one night by deliberately lighting a fire in a health care facility. The subsequent inquiry reports into their actions resulted in multiple recommendations which aimed to prevent similar occurrences and to protect the lives of this vulnerable cohort of people. These recommendations included restrictions on the hiring process of health care professionals and increasing the accountability of access to Schedule Eight drugs by doctors and registered nurses. The governments responsible for responding to the inquiry reports have done so in various ways, although not all recommendations have been implemented and some may not be practical with current residential care infrastructure provisions and requirements. More work is required to determine the types of countermeasures that could be implemented to protect the elderly from maverick health care professionals.

Medical treatment of type 2 diabetes mellitus: Recommendations of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine. / Tratamiento médico de la diabetes mellitus tipo 2: recomendaciones del Grupo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna.

Type 2 diabetes mellitus is a major health problem with high prevalence, morbidity and mortality, and its medical treatment is growing in complexity due to patients' diverse clinical conditions. This article presents a consensus document by the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine, with recommendations for the medical treatment of type 2 diabetes mellitus. The main objective of this article is to facilitate the therapeutic decision-making process to improve the care of patients with diabetes. The document prioritises treatments with cardiovascular benefits, especially those that benefit patients with heart and renal failure.

[Evolution of the status of family carers]. / Évolution du statut des aidants familiaux.

Family carers play a key and indispensable role in today's society. What is their legal status and what have been the stages of their recognition? It would appear that their situation fluctuates between a status in the process of being constructed and the temptation of self-sacrifice.

Aspects of family caregiving as addressed in planned discussions between nurses, patients with chronic diseases and family caregivers: a qualitative content analysis.

BACKGROUND: Caregiving by family members of elderly with chronic conditions is currently intensifying in the context of an aging population and health care reform in the Netherlands. It is essential that nurses have attention for supporting roles of family caregivers of older patients and address family caregiving aspects on behalf of the continuity of care. This study aims to explore what aspects of family caregiving were addressed during planned discussions between nurses, patients and family caregivers in the hospital. METHODS: Qualitative descriptive research was conducted using non-participant observation and audio-recordings of planned discussions between nurses, older patients and their family caregivers as they took place in the hospital. Through purposive sampling eligible patients (≥ 65 years) with one or more chronic conditions were included. These patients were admitted to the hospital for diagnostics or due to consequences of their chronic illness. Retrospective chart review was done to obtain patient characteristics. Data were collected in November/December 2013 and April/May 2014 in four hospitals. Qualitative content analysis was performed using the inductive approach in order to gain insight into addressed aspects of family caregiving. RESULTS: A total of 62 patients (mean age (SD) 76 years (7.2), 52% male) were included in the study, resulting in 146 planned discussions (62 admission and discharge discussions and 22 family meetings). Three themes were identified regarding addressed aspects of family caregiving. Two themes referred to aspects addressing the patients' social network, and included 'social network structure' and 'social network support'. One theme referred to aspects addressing coordination of care issues involving family caregiving, referred to as 'coordination of care'. CONCLUSIONS: During discussions nurses mostly addressed practical information on the patients' social network structure. When specific family caregiving support was addressed, information was limited and nurses did not seem to explore the nature of the family support. Patients discharge and after care needs were addressed occasionally as aspects of coordination of care. Current nursing policies could be evaluated on nursing and family oriented theories. Implications for education could include mirroring study findings with nurses in a group discussion to enhance their awareness on family caregiving aspects.

[The occupational therapist and the assessment of the elderly person's home]. / Évaluation du domicile du sujet âgé par l'ergothérapeute.

The falls of elderly people in their home are frequently related to the environment. Plans and photographs of the home provided by the patient's relatives are useful and constitute relevant assessment tools. The home visit is even more effective as it helps to identify areas which pose a high risk of falling which cannot be picked up by the other tools.

[Nurse coordinator and doctor coordinator in a gerontology network]. / Infirmière coordinatrice et médecin coordonnateur dans un réseau gérontologique.

The Marseille gerontology network consists of a geriatric team providing support in patients' homes across the Marseille urban area. It forms an integral part of the geriatric care sector ensuring that elderly people living at home benefit from a global medical-psychological-social assessment. The aim is to enable elderly people to continue living and receiving care in their home.