National registry-based data of adverse events in Finnish long-term professional homecare in 2009-2019.

AIMS AND OBJECTIVES: The aim of this study was to discover the nature of the adverse events in Finnish long-term professional homecare reported by professionals, and to identify the circumstances in which adverse events occur and their consequences. BACKGROUND: Adverse events are incidents causing unintended and unnecessary harm to older people at home. Safety is a basic human right and a fundamental prerequisite for independent living among older people at home. Few studies have focused on both long-term professional homecare environment and the safety of older people. DESIGN: The research was a descriptive registry-based study. METHODS: This study consisted of adverse events (N = 61248) in Finnish public long-term professional homecare (2009-2019). Data were described using frequencies and percentages. STROBE statement checklist was chosen for reporting the study process. RESULTS: By profession, practical nurses and registered nurses reported the most of adverse events (89.8%). These were either critical incidents (78.3%) or near misses (20.0%) and concerned medicine, injuries and accidents, information flow or management. Consequences for older people were usually rated from no-harm to moderate harm. For long-term professional homecare, image harm, extra financial costs, no-harm and prolonged care for older people were among the consequences. Personnel frequently observed the older people afterwards and informed older people of adverse events, yet some of actions were unknown. CONCLUSIONS: Many harmful adverse events are considered harmless for older people. Sometimes this can lead to unmet care needs or missed care. The degree of harm needs to be assessed in terms of physical, mental and social health with the HaiPro reporting system for homecare. RELEVANCE TO CLINICAL PRACTICE: An understanding and a comprehensive view of the situation and holistic assessment of care needs includes safety and safety risks to increase safety and feeling of safety for older people at home.

A caring and living environment that supports the spirituality of older people with dementia: A hermeneutic phenomenological study.

INTRODUCTION: Meeting spiritual needs is an important part of the quality of nursing for older people living with dementia. The spirituality-supportive caring and living environment has rarely been studied, even though the environment plays an important role in supporting the well-being of older people with dementia. AIM: To further understanding about the spirituality-supportive elements of a caring and living environment from the perspective of older people with dementia and their family members. DESIGN, SETTING AND PARTICIPANTS: We adapted hermeneutic phenomenology as a philosophical background and methodological approach in this study. After receiving the approval of the researcher's University Ethics Committee, a purposive sample of ten older people with dementia and their nine family members, in home care and long-term care settings in Southern Finland were recruited for interviews. METHODS: An interview-based study was conducted using photography to collect the data. The in-depth interviews were conducted in dyads between September 2017 and March 2020 and transcribed verbatim. Thematic analysis was used to interpret the data. RESULTS: Spirituality was seen as a continuum within human life, manifested through the environment even if older people with dementia were unable to express themselves. The spirituality experiences of the participants within the caring and living environment were summarized into three themes: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" The older people, their family members and other people involved in their care provided a caring and living environment that supported spirituality with opportunities to seek answers to these questions through to the meaning of their life. DISCUSSION AND CONCLUSIONS: This hermeneutic phenomenological study provides a new insight into the environment that supports the spirituality of older people with dementia. The elements of caring and living environment can remind older people with dementia of what supports their own way of thinking about spirituality and brings meaning to their life. Therefore, spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia. TWEETABLE ABSTRACT: Spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia.

Supporting the spirituality of older people living with dementia in nursing care: A hermeneutic phenomenological inquiry into older people's and their family members' experiences.

BACKGROUND: Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion. OBJECTIVE: To understand how older people living with dementia and their family members experience spirituality and its support in nursing care. DESIGN: A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology. SETTINGS: We conducted the study in home care and long-term care settings in Southern Finland. PARTICIPANTS: We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19). METHODS: We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis. RESULTS: The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience. CONCLUSIONS: Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals.

Nursing support for older people's autonomy in residential care: An integrative review.

BACKGROUND: Nurses play a crucial role in enabling older people's autonomy in residential care. However, there is a lack of synthesised knowledge about how nurses can support older people. OBJECTIVE: The aim of this study was to identify and synthesise nursing support for older people's autonomy in residential care. METHODS: An integrative review was carried out by searching the CINAHL, Philosopher's index, PubMed, SocINDEX, Scopus and Web of Science databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research papers published in English, without date limitations. The constant comparison method was used for the analysis. RESULTS: The review identified 24 papers, and these showed that older people's autonomy was based on dignity. Nurses protected older people's autonomy in eight different ways. They protected their right to make their own decisions, acted as advocates, respected their wishes, provided opportunities for autonomy, fostered independence, gave information to residents and relatives, provided individualised care practices and protected older people's safety. However, there were also barriers that needed to be overcome. CONCLUSIONS: Nurses used multiple, individually tailored activities to support older people's autonomy, but they also had different reasons for supporting or hindering it. Work and leadership structures are needed to ensure that older people's autonomy is driven by ethical practices. IMPLICATIONS FOR PRACTICE: The results of this review can help nurses who provide residential care for older people to recognise the different nursing activities that can be used to support older people's autonomy and to develop strategies to apply them in different daily care situations. However, further research is needed to determine how these activities can be realised in daily care and how they cover different aspects of older people's lives in residential care.

Older people's perceived autonomy in residential care: An integrative review.

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people's perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher's Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people's individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples' autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people's choices. Professionals' characteristics, such as education and attitudes, and the older people's living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people's perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved.

Supporting spirituality in the care of older people living with dementia: a hermeneutic phenomenological inquiry into nurses' experiences.

BACKGROUND: Spirituality is defined as a search for answers to existential questions about the meaning of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve affiliation with a specific religion. Studies on spirituality have focused on palliative care, and there are limited studies into the spirituality in the care of older people with dementia. AIM: To describe the experiences of nurses supporting spirituality in the care of older people living with dementia. METHOD: This study, informed by Heideggerian hermeneutic phenomenology, was conducted in 2014/15. Data were collected by interviewing a purposive sample of 17 nurses. RESULTS: Supporting the spirituality of older people with dementia was seen as understanding their spirituality within a framework of person-centeredness and individuality. The participants came to understand the spiritual needs of older people with dementia through both verbal and nonverbal expression and by learning about older people's individual spiritual backgrounds. Meeting spiritual needs meant approaching the person with dementia as a valuable human as well as paying attention, to and supporting, his/her personal philosophy of life within nursing care. CONCLUSION: Learning and developing an understanding of the spiritual needs of older people with dementia is challenging. The nurses offered person-centred, spiritual care, to people with dementia from a variety of perspectives, which is important in the provision of comprehensive care. There is a need to find usable tools to help nurses to learn and understand the individual spiritual needs of older people with dementia and to explore how these older adults experience having their spirituality supported within their nursing care.

Nursing Support of the Spiritual Needs of Older Adults Living With Dementia: A Narrative Literature Review.

Across this literature review (n = 10), supporting spirituality in the nursing care of older adults with dementia is concerned with supporting religious activity, enabling connections, nurses' reflections on their own spirituality, and nonverbal communication. The benefits from the support of spirituality were seen to be reciprocal and to occur in everyday nursing.