Public Painted Piano Effect on Cognitively Impaired Long Term Care Residents.

Purpose: The purpose of the study was to examine the effects of music combined with an artistic design of a painted piano on cognitively impaired residents living in a long-term care memory facility. Design: A qualitative descriptive study design was used to elicit responses from the participants. Method: Residents of the facility were invited to attend sessions, during which familiar songs were played. Residents were invited to touch the piano. A series of five interview sessions were performed over several weeks with each resident (N = 10). Findings: Five themes were identified from data analysis: 1. Is it new? 2. A range of piano memories 3. Play it (again) kid 4. I don't have anything to do up there 5. What is there to do now? Some residents expressed joy with the piano, and some had anxiety. However, all residents stayed for the entirety of the sessions and either participated by singing along, playing, or listening. Conclusions: Public painted piano intervention may have positive benefits for people with cognitive impairment and may be considered as part of a viable holistic care plan for this population of residents in a long-term care setting.

Person-centred and efficient care delivery for high-need, high-cost patients: primary care professionals' experiences.

BACKGROUND: High-need, high-cost (HNHC) patients, who typically have complex and long-term care demands, contribute considerably to the high work pressure of primary care professionals (PCPs). To improve patient as well as provider experiences, it is crucial to take into account the PCPs' perspective in designing health care strategies for HNHC patients. Therefore, this study aimed to create insight into PCPs' experienced barriers and possible solutions with regards to person-centred, efficient care delivery to HNHC patients. METHODS: We conducted a qualitative study using focus group interviews with PCPs at a Dutch primary care group. A semi-structured interview guide was developed for the interviews. Qualitative content analysis was employed deductively by means of a categorisation matrix. The matrix was based on the components retrieved from the SELFIE framework for integrated care for multi-morbidity. RESULTS: Forty-two PCPs participated in five focus group interviews. Discussed barriers and solutions were related to the core of the SELFIE framework (i.e. the individual and environment), and particularly four of the six health system components in the framework: service delivery, leadership & governance, workforce, and technologies & medical products. Many discussed barriers revolved around the complex biopsychosocial needs of HNHC patients: PCPs reported a lack of time (service delivery), insufficiently skilled PCPs (workforce), and inefficient patient information retrieval and sharing (technologies & medical products) as barriers to adequately meet the biopsychosocial needs of HNHC patients. CONCLUSIONS: This qualitative study suggests that primary care is currently insufficiently equipped to accommodate the complex biopsychosocial needs of HNHC patients. Therefore, it is firstly important to strengthen primary care internally, taking into account the experienced lack of time, the insufficient number of equipped PCPs and lack of inter-professional information retrieval and sharing. Secondly, PCPs should be supported in cooperating and communicating more efficiently with health services outside primary care to adequately deliver person-centred, efficient care. As a prerequisite, it is crucial to direct policy efforts at the design of a strong system of social and community services. In terms of future research, it is important to assess the feasibility and effects of re-designing primary care based on the provided recommendations.

Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long-term physical condition: A systematic review and meta-ethnography.

BACKGROUND: Children and young people with long-term physical health conditions are at increased risk of experiencing mental health and well-being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well-being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long-term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well-being. METHODS: An information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well-being of children with long-term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta-ethnography was used to synthesize the findings. RESULTS: Screening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting In and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) A Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment. CONCLUSION: These findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well-being of young people living with long-term conditions.

Is the Physical Environment Associated with Spiritual and Religious Coping in Older Age? Evidence from Brazil.

In this cross-sectional Brazilian survey, we examined associations between aspects of physical environment (PE) and spiritual/religious coping (SRC) behaviors. Our studied sample was 77 nursing homes (NH) and 326 community-dwelling residents (CDRs). Aspects of the PE were measured using the environmental domain of the WHOQOL-BREF. SRC was assessed using the BRIEF SRC scale. The PE was significantly associated with positive SRC alone and differed between the two studied samples. "Feeling safe in daily life" and "having access to health services" were positively associated with positive SRC behaviors in NH residents. "Having access to information" and "adequate transport" were significant among CDRs. Positive SRC behaviors are influenced by PE and should be considered in geriatric and gerontology care.

What is known about the spirituality in older adults living in residential care facilities? An Integrative review.

AIM: To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers. DESIGN: Integrative review of literature. DATA SOURCES: Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017. REVIEW METHODS: This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool. RESULTS: Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses', caregivers', and older adults' views on spiritual care differed to some extent. CONCLUSION: The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.

Muscled by the System: Informal Caregivers' Experiences of Transitioning an Older Adult into Long-term Care.

ABSTRACTThis study explored informal caregivers' experiences of transitioning an older adult into long-term care (LTC). Qualitative description guided our analysis of semi-structured interviews with 13 informal caregivers of older adults from three LTC homes in southern Ontario. Our findings illustrate that caregivers experience chronic worry and burden before deciding on, or requiring to apply for, LTC. A sense of lack of control was a prominent theme, especially when caregivers were applying for LTC beds. Participants perceived pushing, pressure, and punishment from the health care system and felt relieved and fortunate after they accepted a bed offer. This tumultuous experience stimulated caregivers to anticipate future transitions. It is recommended that caregivers receive preparation and targeted support to manage transition experiences. Improved communication among health professionals is essential. Penalties for declining an offer for a bed in LTC should be re-examined in relation to its negative influence on caregivers' experiences.

Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model: A qualitative study on embrace.

BACKGROUND: Due to the rise in the number of older adults within the population, healthcare demands are changing drastically, all while healthcare expenditure continues to grow. Person-centered and integrated-care models are used to support the redesigning the provision of care and support. Little is known, however, about how redesigning healthcare delivery affects the professionals involved. OBJECTIVES: To explore how district nurses and social workers experience their new professional roles as case managers within Embrace, a person-centered and integrated-care service for community-living older adults. METHODS: We performed a qualitative study consisting of in-depth interviews with case managers (district nurses, n = 6; social workers, n = 5), using a topic-based interview guide. Audiotaped interviews were transcribed verbatim and analyzed using qualitative content analysis. RESULTS: The experiences of the case managers involved four major themes: 1) the changing relationship with older adults, 2) establishing the case-manager role, 3) the case manager's toolkit, and 4) the benefits of case management. Within these four themes, subthemes addressed the shift to a person-centered approach, building a relationship of trust, the process of case management, knowledge and experience, competencies of and requirements for case managers, and the differences in professional background. DISCUSSION: We found that this major change in role was experienced as a learning process, one that provided opportunities for personal and professional growth. Case managers felt that they were able to make a difference, and found their new roles satisfying and challenging, although stressful at times. Ongoing training and support were found to be a prerequisite in helping to shift the focus towards person-centered and integrated care.

Sleep Among Long-Term Care Residents in China: A Narrative Review of Literature.

The objective of this study is to synthesize and evaluate the current body of sleep research among long-term care (LTC) residents in China and provide insights for future research. Systematic searches identified 15 studies that examined sleep in LTC residents in China. Sleep disturbances and poor sleep quality were prevalent in Chinese LTC residents. Eight cross-sectional studies reported that demographics, comorbidities, lifestyle, and environment were associated with sleep quality in Chinese LTC residents. Seven intervention studies, including exercise, traditional Chinese medicine, light therapy, and behavioral interventions resulted in improved sleep quality. Only subjective sleep measures were used in all 15 studies. Some methodological issues were identified in studies, especially those conducted in Mainland China. Sleep research in LTC residents in China is still at the beginning stages. Future studies should consider more rigorous designs and objective sleep measures, and develop target interventions based on factors associated with sleep disturbances.

Nursing Work in Long-Term Care: An Integrative Review.

Evidence suggests that delivery of good nursing care in long-term care (LTC) facilities is reflected in nurses' descriptions of the factors and structures that affect their work. Understanding the contemporary nature of nursing work in aged care will influence policies for improving current work structures in this practice setting. The current review aims to present a contemporary perspective of RNs' work in LTC facilities. A comprehensive search and purposeful selection of the literature was conducted using CINAHL, PubMed, Medline, Scopus, and Google Scholar databases. Nine studies were eligible for review. Common themes revealed that nursing work in aged care settings is characterized by RNs providing indirect care tasks-primarily care coordination, engaging in non-nursing activities, and having an expanded and overlapping role. As care providers, aged care RNs do not always provide direct care as part of their nursing work. The scope of RN work beyond its clinical nature or performance of non-nursing tasks adds complexity in clarifying RN work roles in aged care. [Journal of Gerontological Nursing, 43(11), 41-49.].

Preferences of residents with dementia for end of life care.

Aim To explore the preferences of residents with dementia for their end of life care, and nurses' perceptions of these preferences. Method Residents' preferences were compared with nurses' perceptions of their preferences in a qualitatively designed study in which the nominal group technique was adopted for data collection. Findings Some of the residents' preferences for their end of life care matched nurses' perceptions of their preferences, but differences were identified. Residents emphasised comfort, family presence, familiar staff and surroundings; nurses thought that residents would want good communication, pain management, advance care planning, being cared for by knowledgeable staff and the inclusion of their families. Conclusion End of life care needs are individual and a generic approach is not a sufficient standard of care for people with dementia. Patients should be included in studies about their needs and preferences for future care to provide a holistic approach to end of life care, and to develop evidence-based standards.

Mindfulness-based cognitive therapy for anxiety symptoms in older adults in residential care.

OBJECTIVES: Anxiety in older people is under-diagnosed and poorly treated despite significant impairments that arise from anxiety. Mindfulness-based cognitive therapy (MBCT) has been shown to be a promising treatment for anxiety. The aim of this study was to determine the effect of an MBCT program on anxiety symptoms in older people living in residential care. METHOD: Fifty-two participants (34 females) were randomly allocated into therapy and control groups using a 2 × 3 mixed design. The average age of participants was 83 years. RESULTS: The group effect showed significant improvements on all measures at the end of the seven-week program in the therapy group, while the control group did not show significant changes. CONCLUSION: This study represents one of the first studies of the effectiveness of an MBCT program on anxiety symptoms for older people using a randomized controlled trial. The study has implications for future research that include the effectiveness of MBCT for the treatment of anxiety symptoms in older people, the utility of group therapy programs in residential care and the benefits of using specialized instruments for older populations.

Childhood long-term conditions in primary care: a qualitative study of practitioners' views.

BACKGROUND: Improving child health and wellbeing in England was the key focus of the Chief Medical Officer's Annual Report 2012, which recommended that all children with long-term conditions (LTCs) have a named GP responsible for their care. Little is known, however, about practitioners' views and experiences of supporting children with LTCs in primary care. AIM: To explore practitioners' views of supporting children with LTCs and their families in primary care. DESIGN AND SETTING: Qualitative interview study in primary care settings in South Yorkshire, England. METHOD: Interviews explored practitioners' views and experiences of supporting children with asthma, cystic fibrosis, type 1 diabetes, and epilepsy. Interviews were audiotaped, transcribed verbatim, and analysed using the framework approach. RESULTS: Nineteen practitioners were interviewed: 10 GPs, five practice nurses, and four nurse practitioners. The GPs' clinical roles included prescribing and concurrent illness management; nurse practitioners held minor illness clinics; and practice nurses conduct asthma clinics and administer immunisations. GPs were coordinators of care and provided a holistic service to the family. GPs were often unsure of their role with children with LTCs, and did not feel they had overall responsibility for these patients. Confidence was dependent on experience; however, knowledge of GPs' own limits and accessing help were felt to be more important than knowledge of the condition. CONCLUSION: Primary care has a valuable role in the care of children with LTCs and their families. This study suggests that improving communication between services would clarify roles and help improve the confidence of primary care practitioners.

Changing the Culture of Long-Term Care: Combating Heterosexism.

The purpose of this article is to describe how heterosexism impedes the provision of culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) residents in long-term care (LTC) facilities. LTC facilities continue to employ staff members who lack an understanding of sexuality and sexual diversity in the elderly. In this article, we identify the heterosexual assumption, namely heterosexism, as the primary issue surrounding the holistic care of the LGBTQ elder in LTC. We first review the literature related to LGBTQ elders in LTC facilities, identifying the themes that emerged from the review, specifically the definitions of homophobia and heterosexism; perceptions of LGBTQ elders as they consider placement in LTC facilities; and staff knowledge of and biases toward sexuality and sexual diversity in LTC settings. Then, we suggest approaches for changing the culture of LTC to one in which LGBTQ elders feel safe and valued, and conclude by considering how facility leaders are in a unique position to enable LGBTQ elders to flourish in what may be their last home.

The role of children's support in elders' decisions to live in a yanglaoyuan (residential long-term care) : children's support and decision to live in a yanglaoyuan.

The purpose of this study is to investigate the role of children's support in elders' decisions to live in a yanglaoyuan (residential long-term care) in Shanghai based on their intentions and actual experiences, drawing on both quantitative and qualitative data. The 2005 Shanghai Elderly Citizen Longitudinal Tracking Study (SECLTS) examines a stratified sample of community-dwelling elders and their intention to live in a yanglaoyuan (N = 1,512). Eleven semi-structured, retrospective interviews described how children participated in residents' decision-making to live in a yanglaoyuan. Logistic regression analyses reveal that satisfaction with children's support-financial, instrumental, and emotional-is negatively associated with respondents' intention to live in a yanglaoyuan. Higher levels of respondents' satisfaction with their children's support are associated with lower levels of intention to live in a yanglaoyuan. Such support, however, does not necessarily determine elders' decision to live in a yanglaoyuan. Qualitative analyses suggest that children participated throughout residents' actual process of deciding to live in a yanglaoyuan. Children helped residents to make the decision to live in a yanglaoyuan. Residents reported how their children contributed to instrumental support to face family caregiving challenges and how they experienced and shared the emotional process in the decision-making. Quantitative and qualitative findings complement each other to provide a holistic understanding of the role of children's support in elders' intention to live in a yanglaoyuan, as well as in their actual decision-making experiences. These findings also suggest the evolving nature of children's support in family caregiving in contemporary Chinese society.

Experiences of attendance at a neuromuscular centre: perceptions of adults with neuromuscular disorders.

PURPOSE: The aim of this research is to gain an insight into adults with neuromuscular disorders' experiences of attendance at a specialised, voluntary sector, Neuromuscular Centre and explore its value to these adults who attend for treatment, education or employment. METHOD: This study was qualitative in design. In-depth interviews were conducted with nine self-selected participants, recruited from the population of adults with neuromuscular disorders who attended the Neuromuscular Centre. Interviews were transcribed verbatim and thematically analysed. Thematic networks were utilised to aid interpretation. RESULTS: Participants saw the benefit of specialist input to remain mobile and independent for longer. The Centre created a culture of understanding and empathy which facilitated mutual support and self-acceptance. Opportunities for employment and education offered a sense of purpose. Sharing experiences developed self-knowledge and the ability to self-manage their condition. CONCLUSION: Attendance at this voluntary sector Neuromuscular Centre provided physical, psychosocial and economic benefits. The Neuromuscular Centre through its holistic approach offers a unique model for rehabilitation of adults with neuromuscular disorders. As an enterprise, satellite centres adopting the ethos of the Centre could be created, which could potentially help to redress the inequalities in health care for adults with neuromuscular disorders.

A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong.

BACKGROUND: Primary care based management of long-term conditions (LTCs) is high on the international healthcare agenda, including the Asia-Pacific region. Hong Kong has a 'mixed economy' healthcare system with both public and private sectors with a range of types of primary care doctors. Recent Hong Kong Government policy aims to enhance the management of LTCs in primary care possibly based on a 'family doctor' model. Patients' views on this are not well documented and the aim of the present study was to explore the views of patients with LTCs on family doctors in Hong Kong. METHODS: The views of patients (with a variety of LTCs) on family doctors in Hong Kong were explored. Two groups of participants were interviewed; a) those who considered themselves as having a family doctor, b) those who considered themselves as not having a family doctor (either with a regular primary care doctor but not a family doctor or with no regular primary care doctor). In-depth individual semi-structured interviews were carried out with 28 participants (10 with a family doctor, 10 with a regular doctor, and 8 with no regular doctor) and analysed using the constant comparative method. RESULTS: Participants who did not have a family doctor were familiar with the concept but regarded it as a 'luxury item' for the rich within the private healthcare system. Those with a regular family doctor (all private) regarded having one as important to their and their family's health. Participants in both groups felt that as well as the more usual family medicine specialist or general practitioner, traditional Chinese medicine practitioners also had the potential to be family doctors. However most participants attended the public healthcare system for management of their LTCs whether they had a family doctor or not. Cost, perceived need, quality, trust, and choice were all barriers to the use of family doctors for the management of their LTCs. CONCLUSIONS: Important barriers to the adoption of a 'family doctor' model of management of LTCs exist in Hong Kong. Effective policy implementation seems unlikely unless these complex barriers are addressed.

Know thy residents: an exploration of long-term care nursing staff's knowledge.

Nursing staff's knowledge of residents' lives in long-term care is critical to the provision of quality care, the formation of strong relationships between staff and residents, and the promotion of psychosocial well-being for residents. This study examines the degree to which nursing staff in assisted living facilities and nursing homes know residents in terms of their lives and occupations, family members, tastes and interests, and medical conditions. Quantitative surveys were administered to nursing staff-resident dyads (N = 199) as part of a larger study on quality of life in long-term care. Results indicated that while nursing staff generally knew residents fairly well, a significant percentage of nursing staff reported knowing nothing at all in each of the categorical areas of residents' lives. Implications center on eliminating barriers to knowledge attainment and implementing educational interventions that may augment nursing staff's knowledge of residents.

The changing face of long-term care: looking at the past decade.

Baby boomers on the verge of retirement who are considering future long-term care needs are searching for options that will promote comfort and quality of life in an environment comparable to the home left behind. Culture change is taking on different faces throughout long-term care, moving from a traditional medical model towards a holistic approach. New models of care address individual needs of the aging population. This article has three aims: (1) to evaluate the current state of culture change throughout long-term care, (2) to describe models of change seen among the long-term care industry, and (3) to report on existing work comparing the Green House Model of Care to two traditional nursing homes in Tupelo, Mississippi.