A qualitative study of family members' perspectives regarding decision-making for nursing home residents' care.

PURPOSE: We explored how family caregivers perceive decision-making regarding the care of nursing home residents. METHODS: This qualitative study used Flemming's Gadamerian-based research method. In person semi-structured interviews about decision-making concerning residents' care were conducted with 13 family members (nine women, four men) of residents of three Norwegian nursing homes. FINDINGS: The following themes emerged: Excessive focus on autonomy threatens resident wellbeing and safety. Resident wellbeing is the caregiver's responsibility. Resident wellbeing serves as a guiding principle. CONCLUSIONS: The family members of residents and the nursing home caregivers disagreed about the significance of upholding resident autonomy to respect residents' dignity. The family members held that not all instances where residents refused care reflect autonomy situations as care refusal often does not reflect the resident's true values and standards but rather, stems from barriers that render necessary care actions difficult. In situations where residents refuse essential care or when the refusal does not align with the residents second-order values, the family members suggested that caregivers strive to understand the causes of refusal and seek non-coercive ways to navigate it. Hence, the family members seemed to endorse the use of soft paternalism in nursing homes to safeguard residents' wellbeing and dignity.

Implementing and evaluating resources to support good maternity care for parents with learning disabilities: A qualitative feasibility study in England.

PROBLEM: Parents with learning disabilities are often disadvantaged and their needs not well understood in maternity services. BACKGROUND: Despite a global vision to improve maternity care, current evidence confirms poor pre- and post-natal care for parents with learning disabilities and their families. Midwives have expressed a need for support in the delivery of good care to this population of parents. AIM: To test the feasibility of implementing and evaluating two evidence-based and values-based resources - the Together Toolkit and Maternity Passport - to support good maternity care for people with learning disabilities. METHODS: A qualitative feasibility study employing semi-structured interviews with 17 midwives and 6 parents who had used the resources in practice in four NHS Trusts in the south of England. FINDINGS: Midwives and parents described how the resources positively impacted maternity care by enabling midwives, connecting networks and empowering parents. Factors affecting effective implementation of the resources were reported at an individual and setting level. DISCUSSION: Staff training to raise awareness and confidence in supporting parents with learning disabilities, and improved systems for recording parent's individual needs are required to enable the delivery of personalised care. CONCLUSION: Reasonable adjustments need to be prioritised to facilitate implementation of resources to support personalised maternity care and to address inequity for parents with learning disabilities. Aspirations for equity suggested commitment from midwives to challenge and overcome barriers to implementation. Recommendations were made to improve the resources and their implementation. These resources are free and accessible for use [www.surrey.ac.uk/togetherproject].

Involuntary Admission From the Perspective of RNs and Nursing Assistants at a Mental Health Facility.

The current qualitative research study was performed in a psychiatric hospital in São Paulo, Brazil. The study aimed to identify RNs' and nursing assistants' (NAs) (N = 21) knowledge regarding different types of admission to psychiatric hospitals established by Brazilian legislation. Data were collected through semi-structured interviews and analyzed through content analysis resulting in the following theme: Gaps in the Knowledge of RNs and NAs Regarding the Rules for Admission; and five subthemes: voluntary admission and the requirement of having a responsible person during admission; involuntary admission occurring when the family is the one to hospitalize the patient; involuntary admission is the same as compulsory admission; is there involuntary admission?; and the role of the public attorney in involuntary admissions. Results showed deficits in knowledge about the different types of admissions to psychiatric hospitals. Therefore, policies to promote awareness of the legal framework concerning psychiatric treatment should be developed to enable mental health nurses to support patients' autonomy during involuntary admissions. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 42-50.].

Living Out a Life's Meaning.

The literature on aging has grown exponentially in recent years, accompanied by a slew of reports providing data detailing progress, challenges, and opportunities in caring for the aging. Yet such reports too often omit the lived experience of older persons and in-depth discussion of the particular challenges and opportunities that arise within what Janelle S. Taylor calls "moral laboratories." The Evening of Life: The Challenges of Aging and Dying Well, a volume edited by Joseph E. Davis and Paul Scherz and to which Taylor is a contributor, helps fill this gap. With expert analyses from social scientists, philosophers, and health care professionals, the book contains evocative stories that facilitate reflection on the complexity, ambiguity, and diversity of being in later years.

Supporting the delivery of good maternity care for parents with learning disabilities.

BACKGROUND AND OBJECTIVE: Despite directives to improve maternity care in general and to improve care for parents with learning disabilities, the maternity experience of parents with learning disabilities is often poor and lacking reasonable adjustments to care. The objective of this study was to develop resources - in collaboration with key stakeholders - to support the workforce in delivering good maternity care to parents with learning disabilities. DESIGN: A two-phase mixed-methods study. PARTICIPANTS: Phase 1: 16 key stakeholders (health and social care professionals, parents with learning disabilities and their informal supporters/carers) were interviewed to understand views of best practice and inform resource development. Phase 2: 20 healthcare professionals engaged with the resources and gave feedback via online survey or discussion group to further refine them. FINDINGS: Thematic analysis of key stakeholder interviews indicated that good maternity care for parents with learning disabilities requires a positive and proactive approach to identifying need; reasonable adjustments to communication and providing information; and professionals working together to support and enable parents. KEY CONCLUSIONS: Health and social care professionals identified barriers to the delivery of good maternity care for parents with learning disabilities, including how to identify whether a parent has learning disabilities. Professionals in maternity services require additional resources to ensure parents' needs are recognised and they are provided with personalised preparation for parenthood and sufficient support. IMPLICATIONS FOR PRACTICE: The Together Toolkit and Maternity Passport were coproduced to support the workforce to deliver good maternity care to parents with learning disabilities, these resources are free and accessible for use [https://www.surrey.ac.uk/research-projects/together-project-supporting-delivery-good-practice-maternity-services-parents-learning-disabilities]. Further evaluation will explore acceptability and perceived impact of these resources in maternity services.

Reframing dementia: Nursing students' relational learning with rather than about people with dementia. A constructivist grounded theory study.

OBJECTIVES: Developing an informed and effective workforce that provides effective and ethical care to people with dementia and their families is an international priority. Here we explore the impact of a novel approach on students of adult nursing. It involved engagement with people with dementia and their carers over 3 years in the Time for Dementia Programme. This research explored students' perceptions of their professional learning and practice. METHODS: A longitudinal, constructivist grounded theory approach in three phases (3 years) was used. In-depth interviews were conducted with 12 students of adult nursing following visits with older adults with dementia and their carers in their own homes at 12 months, 24 months and at 36 months. A constant comparative analysis of transcribed interviews was completed. RESULTS: A new theory of Whole Sight was identified as representing the impact of the learning that occurred as a consequence of relational learning visits. The core category of New Ways of Seeing dementia represented a broadening of students' views of dementia that encompassed the person's lives and relationships. This led to a person-centred shift in students' practice. The data suggest that Time for Dementia can help students to be active in their contribution to care and serve as change agents in transforming dementia care. CONCLUSIONS: The theory of Whole Sight that emerged is a novel and useful contribution to the evidence on community-based educational initiatives. Visiting people with dementia and their carers at home in training can help develop a workforce that meets their needs.