Identifying and Addressing the Spiritual Needs of Older Adults in Care Facilities: Administrators of Chinese Nursing Homes Relate Their Perspectives.

Addressing the spiritual needs of older adults is a central component of holistic service provision. Using a qualitative description design, this study identified: (1) common spiritual needs among Chinese nursing home residents, including the needs of residents with dementia, (2) the process staff use to identify these needs when residents are unable to verbalize them, and (3) the strategies staff implement to meet the identified needs. Semi-structured interviews were conducted with 21 nursing home administrators. Analysis produced five themes, including the need for older adults to express their faith, receive love and care, have contact with their children, interact with others, and participate in activities. For residents with dementia who are unable to verbalize their concerns, staff used two primary strategies to identify spiritual needs: careful observation and communication with family members. To address the identified spiritual needs, multiple strategies were offered including arranging clergy visits and personalizing care.

Exploring occupational therapy practice in Australian residential aged care facilities: A cross-sectional survey.

INTRODUCTION: Occupational therapy in residential aged care facilities (RACFs) can enhance residents' occupational engagement and wellbeing. However, industry reports suggest that occupational therapists in Australian RACFs have mostly provided physical therapies such as pain management via massage and not addressed residents' occupations. There is limited literature on what constitutes occupational therapists' practice in RACFs to inform policy and practice. The aim of this cross-sectional survey was to explore practice patterns of occupational therapists working in Australian RACFs and influences on their practice. METHODS: Occupational therapists working in Australian RACFs were invited from July 2019 to March 2020 to complete a self-report online questionnaire via email and advertisements on industry websites, newsletters, and social media. The questionnaire asked therapists about their caseload, referrals, assessments, and interventions. Data were analysed descriptively and presented as frequencies and percentages. RESULTS: A total of 214 occupational therapists completed the survey. Occupational therapists' daily practice largely focussed on pain management; other areas of practice included falls prevention, pressure care, and mobility. The Aged Care Funding Instrument in place at the time of the survey was identified as the leading factor influencing therapists' choice of assessments and interventions. Organisational policies and procedures were also perceived as key factors influencing occupational therapy practice. CONCLUSION: This paper highlights the influence of government funding and organisational policies in limiting occupational therapists' scope of practice and their ability to fully address the occupational needs of residents. Occupational therapists and the profession in general should be aware of factors in aged care funding models, and their application, that restrict occupational therapy practice and inhibit residents' function and advocate for change where needed. With the introduction of the Australian National Aged Care Classification funding model replacing Aged Care Funding Instrument, future research should explore potential changes to therapists practice following the implementation of the new funding model.

Dementia Enlightened?! A Systematic Literature Review of the Influence of Indoor Environmental Light on the Health of Older Persons with Dementia in Long-Term Care Facilities.

Light therapy for older persons with dementia is often administered with light boxes, even though indoor ambient light may more comfortably support the diverse lighting needs of this population. Our objective is to investigate the influence of indoor daylight and lighting on the health of older adults with dementia living in long-term care facilities. A systematic literature search was performed within PubMed, CINAHL, PsycINFO, Web of Science and Scopus databases. The included articles (n=37) were published from 1991 to 2020. These articles researched the influence of existing and changed indoor light conditions on health and resulted in seven categories of health outcomes. Although no conclusive evidence was found to support the ability of indoor light to decrease challenging behaviors or improve circadian rhythms, findings of two studies indicate that exposure to (very) cool light of moderate intensity diminished agitation. Promising effects of indoor light were to reduce depressive symptoms and facilitate spatial orientation. Furthermore, there were indications that indoor light improved one's quality of life. Despite interventions with dynamic lighting having yielded little evidence of its efficacy, its potential has been insufficiently researched among this study population. This review provides a clear and comprehensive description of the impact of diverse indoor light conditions on the health of older adults with dementia living in long-term care facilities. Variation was seen in terms of research methods, (the description of) light conditions, and participants' characteristics (types and severity of dementia), thus confounding the reliability of the findings. The authors recommend further research to corroborate the beneficial effects of indoor light on depression and to clarify its role in supporting everyday activities of this population. An implication for practice in long-term care facilities is raising the awareness of the increased lighting needs of aged residents.

Effects of Laughter Therapy on Life Satisfaction and Loneliness in Older Adults Living in Nursing Homes in Turkey: A Parallel Group Randomized Controlled Trial.

PURPOSE: This study examined the effects of laughter therapy on life satisfaction and loneliness in older adults living in nursing homes. DESIGN: A single-blind, parallel-group, randomized controlled trial (ClinicalTrials NCT03687788) with a pretest-posttest design was conducted. METHODS: There were 31 experimental participants and 31 controls. The experimental group received laughter therapy twice a week for 6 weeks, along with usual care. The control group received usual care only. Loneliness was measured with the De Jong Gierveld Loneliness Scale, and life satisfaction was measured with the Satisfaction With Life Scale. FINDINGS: After 6 weeks, there was a statistically significant difference in De Jong Gierveld Loneliness Scale total score between the two groups, and the subscale scores of the experimental group decreased. CONCLUSIONS: Laughter therapy may reduce loneliness in older adults. CLINICAL RELEVANCE: Healthcare professionals, especially nurses, can potentially use laughter therapy to reduce loneliness in older adults.

Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way.

The corona pandemic challenges countries worldwide in many different ways. Due to its magnitude and impact on global health, this health crisis exposes several shortcomings in their health systems and emphasizes their shortcomings and deficiencies. These deficiencies have quickly affected the most frail citizens, such as older people. The first wave of the COVID19 pandemic in Belgium has quickly shown that nursing homes were not prepared for these kinds of crises. The nature, speed and extent gave rise to an accelerated and more extensive collaboration between various nursing homes and Ghent University Hospital. Before this crisis, the level of integrated care between nursing homes and hospitals was mostly limited. But setting up a strong collaboration model and integrated care between nursing homes and hospitals enables the nursing homes to manage this specific and complex care in their own environment. IMPLICATIONS FOR PRACTICE: This case study shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. Investments in people, resources, training and guidance concerning transitional care and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes.

Reframing Holistic Patient Care in Nursing Homes Through the Lens of Relational Autonomy.

In nursing facilities, patient autonomy is more effective when it is reframed under the rubric of relational autonomy. Through this lens, patients, family, and staff, especially nurses, can share conversations that lead to effective decision-making that acknowledges the needs of the whole person within the nexus of the institutional setting.

The Effect of Aromatherapy on Elderly Persons With Dry Skin: A Randomized Controlled Trial.

Dry skin, which is one of the most frequent dermatological problems seen in the elderly population, is an important problem that increases with aging. This study was conducted as a randomized controlled experimental trial to determine the effect of aromatherapy, applied to elderly persons residing in a nursing home in a city center, on dry skin. Elderly persons were grouped into a control group (20 elderly persons), an olive oil group (20 elderly persons), and an aromatherapy group (20 elderly persons). When examining between-measurements differences of the groups in the study, skin moisture levels of the elderly individuals in the aromatherapy group increased in all zones, arm, leg, back, and chest, at measurements of the second and fourth weeks compared with the first measurements. This improvement was determined to be higher after the second week. Skin moisture levels of elderly persons in the olive oil group were determined to significantly increase at the arm zone in the fourth week and at the back zone in the second and fourth weeks compared with the first measurements. Skin moisture levels of elderly persons in the control group, on the contrary, did not change in the second and fourth weeks compared with the first measurements and their dry skin continued at the same level. The intervention performed in this manner in the present study can be used in the clinical practice as an effective nursing intervention to reducing dry skin among elderly persons.

Using Nonparticipant Observation as a Method to Understand Implementation Context in Evidence-Based Practice.

BACKGROUND: The uptake of evidence-based knowledge in practice is influenced by context. Observations are suggested as a valuable but under-used approach in implementation research for gaining a holistic understanding of contexts. AIM: The aim of this paper is to demonstrate how data from observations can provide insights about context and evidence use in implementation research. METHODS: Data were collected over 24 months in a randomised trial with an embedded realist evaluation in 24 nursing homes across four European countries; notes from 183 observations (representing 335 hours) were triangulated with interview transcripts and context survey data (from 357 staff interviews and 725 questionnaire responses, respectively). RESULTS: Although there were similarities in several elements of context within survey, interview and observation data, the observations provided additional features of the implementation context. In particular, observations demonstrated if and how the resources (staffing and supplies) and leadership (formal and informal, teamwork, and professional autonomy) affected knowledge use and implementation. Further, the observations illuminated the influence of standards and the physical nursing environment on evidence-based practice, and the dynamic interaction between different aspects of context. LINKING EVIDENCE TO ACTION: Although qualitative observations are resource-intensive, they add value when used with other data collection methods, further enlightening the understanding of the implementation context and how evidence use and sharing are influenced by context elements. Observations can enhance an understanding of the context, evidence use and knowledge-sharing triad in implementation research.

The Effect of Aromatherapy on Sleep Quality and Fatigue Level of the Elderly: A Randomized Controlled Study.

This randomized controlled experimental study was conducted to determine the effect of inhaled aromatherapy on the sleep quality and fatigue level of the institutionalized elderly. The sample of the study consisted of a total of 59 elderly individuals (30 in the intervention group and 29 in the control group) who met the inclusion criteria and agreed to participate in the study. Aromatherapy (lavender oil) inhalation was administered to individuals in the intervention group half hour before their sleep every day for a month in accordance with aromatherapy protocol. No administration was applied to the control group. The data were collected using the Elderly Description Form, Pittsburgh Sleep Quality Index, and Fatigue Severity Scale. Forms were completed in the beginning of administration and in the follow-up at the end of 4 weeks (baseline and last follow-up). In the study, it was determined that aromatherapy administration improved sleep quality (P < .001) and decreased fatigue severity in the elderly (P < .05). The study should be replicated in a different group.

The Effect of Aromatherapy Application on Cognitive Functions and Daytime Sleepiness in Older Adults Living in a Nursing Home.

Changes in the aging process affect the duration and quality of sleep. Not having a quality night's sleep leads to a reduction in daytime wakefulness in older adults. We examined the effect of aromatherapy on the cognitive functions and daytime sleepiness of older adults living in a nursing home. The research was a pretest and posttest design, which was conducted without a control group. The sample included 39 elders. A rosemary-lemon oil mixture was smelled by elders in the mornings for a week. After a 1-week washout period, lavender oils were smelled in the evenings for a week. After application of the rosemary-lemon oil mixture, the mean score of participants' daytime sleepiness was lower, but that decline was not statistically meaningful (P > .050). After the same application, the mean score of the participants' cognitive functions was significantly lower (P < .001). After application of lavender oil, the scores were significantly lower (P < .001). Lower scores on the scales used indicate lower sleepiness. The results showed that the 2 applications can be used to improve cognitive functions in older adults; in addition, lavender oil has an advantage in reducing daytime sleepiness.

Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings.

AIMS: To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. DESIGN: A qualitative study based on grounded theory developed by Corbin and Strauss. METHODS: Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. RESULTS: The core category, "guiding the rebuilt care community to assist the dying resident" comprised five categories: "assessing the resident's stage," "harmonizing care with the dying process," "rebuilding a care community," "helping community members care for the resident," and "encouraging community members to give meaning." The participants were described as "traditional village elders" who were the integral members of the care community, as well as guides who helped and encouraged the community. CONCLUSION: Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents' uncertainties and vulnerabilities as well as their cultural backgrounds. IMPACT: This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.

Influence of Nutrition and Nonnutrition Factors on Pressure Injury Outcomes Among At-Risk Asian Nursing Home Residents.

OBJECTIVE: Given evidence that malnutrition and immobility increase the risk of pressure injuries (PIs) in nursing home (NH) residents and that body mass index guidelines related to undernutrition may differ between Asian and non-Asian populations, the purpose of this study was to describe differences in overall nutrition, dietary intake, and nonnutrition risk factors for PIs between Asian and non-Asian NH residents. DESIGN AND SETTING: Secondary data analysis of a 3-week PI prevention randomized controlled trial in seven Canadian NHs. PATIENTS: Asian (n = 97) and non-Asian (n = 408) residents at moderate or high mobility-related risk of PI. MAIN OUTCOME MEASURE: Incident PI by racial subgroups. MAIN RESULTS: Asian residents (PI = 6) consumed significantly smaller meals and marginally different patterns of daily dietary consumption of protein types, liquid supplements, and snacks; took more frequent tub baths; and had marginally lower body mass index than non-Asian residents (PI = 4). CONCLUSIONS: Findings are consistent with earlier research suggesting that nutrition consumption and care patterns may predispose Asian NH residents to develop more PIs than their non-Asian counterparts. Future research should focus on the threshold for and types of nutrition support sufficient to improve nutrition status and reduce PI risk.

Quality and Safety in Aged Care Virtual Issue: What Australian research published in the Australasian Journal on Ageing tells us.

OBJECTIVE: To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions. METHODS: Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality. RESULTS: Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care. CONCLUSIONS: It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.

Improving Retention Among Certified Nursing Assistants Through Compassion Fatigue Awareness and Self-Care Skills Education.

Background: Retention of certified nursing assistants (CNAs) is an ongoing challenge for nursing homes. Purpose: To combat the effects of providing complex care needs to residents, this quality improvement project explored a 90-minute evidence-based education program on compassion fatigue awareness and multiple self-care skill strategies for CNA retention. Design: A single-group pre- and posttest design, mixed-methods approach. Method: A preintervention demographic survey, a postexperience survey, and the ProQOL (Professional Quality of Life; Version 5) tool measured the CNAs' level of compassion satisfaction, burnout, and secondary traumatic stress at three time points: preintervention, 1 month postintervention, and 3 months postintervention. Results: Forty-five CNAs participated. After 1 month, CNA retention increased by 43%, and at the end of the fourth month, the facility's retention rate was 100%. Forty-four percent of the full-time supplemental agency CNAs became full-time facility employees. The use of supplemental agency staff decreased to less than 5% of the total CNA hours worked. CNAs improved their compassion satisfaction, burnout, and secondary traumatic stress scores. Conclusion: This education program proved to be an effective, low-cost intervention. The quality improvement project highlighted the need for additional study on holistic interventions such as workplace education programs addressing compassion fatigue awareness and self-care skill strategies in this understudied group of formal caregivers.

The "Violent Resident": A Critical Exploration of the Ethics of Resident-to-Resident Aggression.

Resident-to-resident aggression is quite prevalent in long-term care settings. Within popular and empirical accounts, this form of aggression is most commonly attributed to the actions of an aberrant individual living with dementia characterized as the "violent resident." It is often a medical diagnosis of dementia that is highlighted as the ultimate cause of aggression. This neglects the fact that acts of aggression are influenced by broader structural conditions. This has ethical implications in that the emphasis on individual aberration informs public policy strategies for prevention with a focus on restricting the freedom of individuals using behavioural modification, drugs, or other restraints with the intent to protect others from harm. A more ethical approach requires attention to the structural conditions of long-term care that both foster aggression and constrain prevention efforts. To this end, we turn to a model of relational citizenship that offers a theory of embodied selfhood and relationality as essential to human dignity, thus entailing human rights protections. The application of an ethic based on this model offers a more holistic prevention strategy for resident-to-resident aggression by drawing attention to the critical need and obligation to promote human flourishing through system level efforts.

Investigating the effect of multisensory stimulation on depression and anxiety of the elderly nursing home residents: A randomized controlled trial.

PURPOSE: The aim was to determine the effect of multisensory stimulation (MSS) on the depression and anxiety status among nursing home-dwelling elderly people in Ahvaz, Iran. DESIGN AND METHODS: This clinical trial study conducted on 28 old people living in nursing homes in Ahvaz, who were divided into two groups of intervention and control. The interventions included sensory stimulations of touch, sound, and sight for 4 weeks and 3 sessions weekly and 25 min per each session. FINDINGS: The mean depression and anxiety scores of the intervention group before and after the intervention were 14.5 ± 5.5 and 10.1 ± 5.3 and, 9.6 ± 8.1 and 6.1 ± 6.2, respectively. PRACTICE IMPLICATIONS: MSS could improve the condition of depression and anxiety in the elderly nursing home residents.

Food and Nutrition Care in Long-Term Care Facilities: Examining the Perspectives of Frontline Workers.

Malnutrition in older adults residing in long-term care facilities continues to be a problem in the United States. Existing research has identified a list of possible contributing factors, including staffing problems. Few studies on food and nutrition care have attempted to gain the perspectives of nursing or dietary aides (henceforth, aides), the frontline staff who work most closely with the residents of long-term care facilities. The current study takes a qualitative approach grounded in a theoretical perspective based on Total Quality Management (TQM) to increase understanding of the interpersonal and management practices that affect resident wellbeing, health, and nutrition. Four focus groups (n = 24) were conducted with aides working in long-term care facilities. Aides expressed emotional closeness with residents and provided detailed knowledge about food and nutrition care. They reported both compassion fatigue and satisfaction. An element of dissatisfaction related to aide relationships with management and other employees who did not actively solicit their perspectives and knowledge on resident feeding. The knowledge and experience of aides could be better utilized by shifting management strategies to focus on employee empowerment and training. Principles of TQM could be applied to improve food and nutrition care in long-term care facilities.

Culturally and Linguistically Diverse Older Adults and Mainstream Long-Term Care Facilities: Integrative Review of Views and Experiences.

Older adults from culturally and linguistically diverse (CALD) backgrounds are increasingly identified within mainstream aging populations. However, few studies have focused on CALD older adults' views and experiences in long-term care facilities (LTCFs). The current integrative review aimed to achieve a contemporary understanding through synthesized evidence from studies focusing on CALD older adults in mainstream LTCFs. Two major categories were identified-Views About LTCFs, which included two subcategories: (a) the last stop and no other choice and (b) reasons for admission or transfer; and Experiences of Living in LTCFs, which also included two subcategories: (a) desire to remain connected to personal routines and (b) maintaining identity through native language. CALD older adults have differing perspectives about LTCFs, which are influenced by their cultural backgrounds and values. Future research should evaluate the effectiveness of ethno-specific LTCFs. Establishing culturally appropriate services for CALD older adults in LTCFs, particularly in mainstream facilities, should emphasize cultural accommodation among residents, health care providers, and staff. [Res Gerontol Nurs. 2018; 11(5):265-276.].

Experiences of older people dying in nursing homes: a narrative systematic review of qualitative studies.

OBJECTIVES: To identify and synthesise qualitative research from 2001 investigating older people's (65+ years) experiences of dying in nursing and care homes. METHODS AND OUTCOMES: Eight electronic databases (AMED, ASSIA, CINAHL Plus, Embase, HMIC, Medline, PsychINFO and Scopus) from 2001 to July 2017 were searched. Studies were included if they were qualitative, primary research and described the experiences of dying in nursing or care homes from the perspectives of the older people themselves, their families or staff. Study quality assessment was undertaken to systematically assess methodological quality, but no studies were excluded as a result. RESULTS: 1305 articles were identified. Nine met the inclusion criteria. North American studies dominated. Most used a mixture of observations and interviews. All the included studies highlighted the physical discomfort of dying, with many older people experiencing potentially avoidable symptoms if care were to be improved. Negative psychosocial experiences such as loneliness and depression were also often described in addition to limited support with spiritual needs. CONCLUSIONS: More qualitative research giving a holistic understanding of older people's experiences of dying in residential care homes is needed. Undertaking research on this topic is challenging and requires great sensitivity, but the dearth of qualitative research from the perspectives of those most closely involved in older people's deaths hampers service improvement.

Understanding Pain and Pain Management in Elderly Nursing Home Patients Applying an Interprofessional Learning Activity in Health Care Students: A Norwegian Pilot Study.

BACKGROUND: Pain is common among elderly patients in nursing homes. However, pain assessment and treatment are inadequate. Interprofessional treatment is recommended, and consequently interprofessional education in pain management is necessary. AIMS: This pilot project aimed to describe how two interprofessional groups of students approached pain management in two nursing home patients. DESIGN: We formed two teams comprising one student from the nursing, physical therapy, pharmacy, and medical educations. Each team spent one day examining a patient with chronic pain at a nursing home and they developed pain management plans. METHODS: We collected data through video recordings during teamwork before and after examining the patients and field notes during the patient examination. We analysed the video-recordings applying the seven-step model including 1) viewing the video data, 2) describing the video data, 3) identifying critical events, 4) transcribing, 5) coding, 6) constructing storyline and 7) composing a narrative. Field notes supplied the transcripts. RESULTS: Both teams succeeded in making a pain management plan for their patient. The common examination of the patient was crucial for the students' approaches to pain management and changed their pre-assumptions about the patients' pain. By sharing knowledge and reflecting together, the students reached a common consensus on suggestions for management of the patients' problems. Interprofessional collaboration fostered enthusiasm and a more holistic pain management approach. However, students' lack of knowledge limited their understanding of pain. CONCLUSION: Knowledge of pain management in nursing home patients and the practice of interprofessional cooperation should be included in pain curricula for health care professionals.