Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes.

BACKGROUND: Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches. PURPOSE: This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC. METHODS: Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data. RESULTS: Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.

How do nursing home nurses conceptualize the management of behavioral and psychological symptoms of dementia? A phenomenographic study.

The behavioral and psychological symptoms of dementia (BPSD) present complex challenges for nursing home (NH) nurses, leading to confusion and difficulties in providing effective care. To address these issues, investigating how NH nurses perceive and manage the BPSD is crucial since it can lead to the development of tailored and effective care plans. This study therefore aimed to explore the ways in which NH nurses approach the management of the BPSD by using phenomenography. The study identified five categories of assessment and four categories of intervention in managing the BPSD, with their hierarchical structure represented as an outcome space. Each category's description provides a clear conceptualization of the complex and challenging nature of the BPSD care, offering insights into how NH nurses perceive the BPSD management. The study's findings can enhance NH nurse education and lead to effective care plans for residents with BPSD.

For the interprofessional management of the discomfort of long-term care facility residents with dementia.

Educating interprofessional practitioners in long-term care facilities (LTCFs) is critical for managing discomfort of residents with dementia, which is often unnoticed and undertreated. A framework of education on discomfort management that is applicable in various environments in different facilities is necessary. We developed a preliminary framework to educate interprofessional practitioners on discomfort management of dementia residents in LTCFs. We conducted a three-step research process: a literature review using topic modeling, in-depth interviews, and Delphi surveys. We derived four categories for an interprofessional approach toward discomfort management education in LTCFs: identifying visual and nonvisual signs to communicate among professionals, close observation using comparison and contrast to share information for discomfort care, harmony in interprofessional roles, and applying common and specific professional knowledge for discomfort management. The findings provide the first outline for an educational framework for interprofessional discomfort management in LTCFs for residents with dementia. We recommend interventions across different cultures to verify the framework in future research.

Exploring interprofessional communication during nursing home emergencies using the SBAR framework.

Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.

An e-Problem-Based Learning Program for Infection Control in Nursing Homes: A Quasi-Experimental Study.

Infection is a significant factor adversely affecting the health of nursing home (NH) residents, potentially even leading to death. Therefore, educating NH staff to think critically is necessary to prevent and control infection. In this study, we developed an electronic problem-based learning (e-PBL) program using the Network-Based Instructional System Design model to enhance South Korean NH staff's critical thinking competencies; subsequently, its effectiveness was evaluated. This study utilized a quasi-experimental nonequivalent pretest-post-test design. The participants (n = 54) were randomly allocated into an experimental group (n = 28) and a control group (n = 26). The results indicate that the e-PBL program significantly improved the critical thinking disposition in the experimental group compared with in the control group.

How about an Educational Framework for Nursing Staff in Long-Term Care Facilities to Improve the Care of Behavioral and Psychological Symptoms of Dementia?

Behavioral and psychological symptoms of dementia (BPSD) are common in residents of long-term care facilities (LTCFs). In LTCFs, nursing staff, including nurses and care workers, play a crucial role in managing BPSD as those most in contact with the residents. However, it is ambiguous where their focus should be for effective BPSD care. Thus, this paper aims to reveal BPSD care competencies for nursing staff in LTCFs and to outline an initial frame of education. A multiphase mixed-methods approach, which was conducted through topic modeling, qualitative interviews, and a Delphi survey, was used. From the results, a preliminary educational framework for nursing staff with categories of BPSD care competence was outlined with the four categories of BPSD care competence: using knowledge for assessment and monitoring the status of residents, individualizing approaches on how to understand residents and address BPSD, building relationships for shared decision-making, and securing a safe environment for residents and staff in LTCFs. This preliminary framework illuminates specific domains that need to be developed for competent BPSD care in LTCFs that are centered on nursing staff who directly assess and monitor the changing and deteriorating state of residents in LTCFs.

Nurses' conceptualizations of managing emergencies in nursing homes.

Emergencies can negatively affect the morbidity and mortality of nursing home residents. As nurses employed at nursing homes play a key role in such situations, their conceptualizations of emergency management should be considered to improve care. Accordingly, this study aimed to identify nurses' conceptualizations of managing emergencies in nursing homes. A qualitative research design was conducted using interviews with 20 nurses working in five different nursing homes in the Republic of Korea between September 2019 and August 2020. The data were analyzed using phenomenography. This study identified two main perspectives used by nurses in nursing homes to manage emergencies, depending on the resident's condition: emergency care and daily preventive care. Nurses' conceptualizations of care provided in emergencies were organized under the frames of assessment and intervention, whereas routine care carried out during daily life activities fell under the frame of prevention. This study's findings, which elucidate nurses' complex practical and experiential knowledge, provide insights for the development of emergency management training.

The Development and Effectiveness of a Web-Based Emergency Management Educational Program for Long-Term Care Facility Interprofessional Practitioners.

Long-term care facility (LTCF) interprofessional practitioners who care for residents at high risk of emergencies due to old age, frailty, and complex diseases must be able to manage such emergencies collaboratively. A shared mental model (SMM) enhances performance toward a common goal by allowing effective collaboration through promoting the sharing of knowledge and skills among interprofessional team members. Therefore, this study developed a web-based educational program for LTCF interprofessional practitioners based on an SMM. We followed a network-based instructional system design that consists of analysis, design, development, implementation, and evaluation for developing the program. A total of 54 participants completed the educational program in four LTCFs in South Korea. A significant improvement was identified in communication knowledge, communication confidence, role recognition, transactive memory system, and team effectiveness in the experimental group. The results show that the program improved the emergency management process and reliability among interprofessional practitioners, positively impacting interprofessional collaboration and ensuring the safety of patients during emergencies in LTCFs.

Exploring a Nursing Home-Specific, Interdisciplinary, Function-Focused, Communicative Framework Based on Situation, Background, Assessment, and Recommendation.

BACKGROUND: Improved methods of communication are needed among professionals in related fields to address the increasing complexity of clinical situations and various levels of functioning experienced by older adults who live in nursing homes. PURPOSE: The purpose of this study was to explore function-focused clinical communication among nurses and providers based on the Situation, Background, Assessment, Recommendation (SBAR) approach toward interdisciplinary collaboration to maintain function among nursing home residents and to identify the characteristics of SBAR flows in nursing homes. METHODS: Detailed interviews with 28 interdisciplinary professionals working in four nursing homes were conducted. Directed qualitative content analysis was used to identify the internal attributes of SBAR-based communication. Case analysis was conducted to identify SBAR flows. RESULTS: Four themes emerged as key factors for function-focused interdisciplinary staff communication in nursing homes. Effective nursing care to maintain function among nursing home residents requires accurate awareness of abnormal circumstances. Knowledge of assessment and resident background are needed to address situations requiring intervention and identify the problems underlying a resident's current state. The optimal therapeutic environment is created by sharing roles and tasks among practitioners through referrals.Twelve generalized situations requiring function-focused communication (i.e., dislocation of body line because of joint contracture, change in walking, difficulty of moving because of pain, difficulty in eating, fever, change in sleep pattern, change in excretion pattern, change in weight, change in condition, change in problematic behavior, decrease in cognitive function, and change in relationships) and the related nurse-centered SBAR pathways were identified. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: These results represent a first prototype for developing practical communication guidelines for nursing-home-specific function-focused care and provide new insights into the interdisciplinary approach.

Concept Development of Identification of Discomfort for Nursing Home Patients With Advanced Dementia.

PURPOSE: The aim of this study is to clarify the concept of discomfort identification by concept development in the nursing home. METHODS: The Schwartz-Barcott and Kim's hybrid model was used. FINDINGS: The identification of discomfort can be explained as an interactive and confirmative process of sympathetically responding to patients with dementia's problem behavior expressions that communicate unmet needs. CONCLUSIONS: The identification of discomfort has the potential to improve the detection of multidimensional discomfort related to nursing diagnosis as a holistic and patient-centered approach. IMPLICATION FOR NURSING PRACTICE: The findings could help nursing home nurses have a better understanding of identification of discomfort and can improve nurses and interdisciplinary caregivers' knowledge for developing appropriate comfort caring activities.

Suicide from carbon monoxide poisoning in South Korea: 2006-2012.

BACKGROUNDS: Suicide from carbon monoxide poisoning by burning coal briquette or barbecue charcoal increased rapidly in some East Asian countries in the recent decade. The purpose of this study was to examine trends in suicides from carbon monoxide poisoning in South Korea and their epidemiologic characteristics. METHODS: We presented age-standardized mortality rates of carbon monoxide suicide and compared them with those of suicide by other methods using registered death data from Statistics Korea (South Korea) from 2006 to 2012. Logistic regression analysis was conducted to estimate odds ratios of carbon monoxide suicide by socio-demographic characteristics before and after the marked increase in carbon monoxide suicide in September 2008. RESULTS: The number of carbon monoxide suicides in South Korea was only 34 in 2006 but rapidly increased to 267 in 2008 and was 1125 in 2012, with the age-standardized rates of 0.06 (2006), 0.48 (2008), and 1.97 (2012) per 100,000 population respectively (a striking 3,183% increase in 2006-2012). Suicide by carbon monoxide poisoning showed greater odds ratios among men, younger age groups, single or the divorced, and those with high education and non-manual jobs compared with suicides by other methods. LIMITATIONS: This study only used data for fatal self-poisoning by carbon monoxide (non-fatal cases not included) and had no information on the sources of carbon monoxide. CONCLUSIONS: Carbon monoxide suicides substantially increased in South Korea over the relatively short study period and showed some distinct socio-demographic characteristics compared with suicides by other methods.