Effects of the implementation of the Resident Assessment Instrument on gaps between perceived needs and nursing care supply for nursing home residents in the Netherlands.

This study evaluated the effects of the implementation of the Resident Assessment Instrument (RAI) on gaps perceived between residents' needs and nursing care received in Dutch nursing homes. In a controlled group design residents were interviewed before and after the implementation. Most gaps were perceived in the psycho-social area rather than physical or needs with aids and facilities. In general, perceived gaps decreased more strongly in the experimental group. The results give an indication that assessment using RAI leads to a better meeting of the residents' perceived needs. More research is needed to investigate the quality of the assessment using RAI in more detail.

Improvements in the quality of co-ordination of nursing care following implementation of the Resident Assessment Instrument in Dutch nursing homes.

AIM: To study the effect of implementation of the Resident Assessment Instrument (RAI) on the quality of co-ordination of nursing care in Dutch nursing homes. BACKGROUND: The Resident Assessment Instrument (RAI) was designed to improve the quality of care and quality of life in nursing homes. Until now, only noncontrolled studies on the effects of implementation of the RAI have been carried out. DESIGN/METHODS: Quasi-experimental; intervention wards with RAI compared with wards with no intervention. We used the co-ordination of nursing care instrument, which includes measures for case history, care plan, end of shift report, communication, patient allocation and patient report. The scores on these scales represent the quality of nursing procedures on a ward. The measurements were done 1 month before and 8 months after RAI-implementation in 18 wards in 10 nursing homes in the Netherlands. RESULTS: Out of 348 somatic patients on the participating wards who met the inclusion criteria and signed an informed consent, 278 could be measured at the first and 218 at the second data collection. 175 residents could participate twice. We used a meta-analysis technique to study the mean differences between eight couples of RAI/control wards before and after the intervention. The mean difference scores showed significant positive improvement in the RAI group for case history, there were minor (not statistically significant) improvements for all other scores and the total score. These results are encouraging especially in light of the fact that RAI-implementation in all the experimental wards did not proceed according to plan, owing to staffing and software problems. CONCLUSIONS: We conclude that the RAI has the potential to improve the quality of co-ordination of care in nursing homes.

The relation between quality of co-ordination of nursing care and quality of life in Dutch nursing homes.

Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client-tailored and effective nursing care for this population. Because of the permanency of their stay, the care received affects the quality of daily life. This study investigated the quality of co-ordination of care and the way it is related to gaps between needs and care supply, the quality of life and health status of residents living in Dutch nursing homes. To assess the perceived quality of life and experienced discrepancies between needs and care supply, 337 residents of 10 different nursing homes were interviewed. The quality of co-ordination of nursing care was assessed by judgements of the residents and nurses and by analysing the care documents. The results showed a relation between the co-ordination of care and care discrepancies; the higher the quality of co-ordination of care, the fewer the gaps between residents' needs and the care they received. The psycho-social aspects in particular showed a gap between the needs and care supply. As regards the relation between co-ordination of care and quality of life, the strongest positive relations were found between taking case histories, patient allocation and dimensions of quality of life. No direct relations were found between the co-ordination of care and care discrepancies on the one hand and the health status of the residents on the other. In conclusion, this study showed that the quality of co-ordination of care can affect the perceived quality of life of nursing home residents. To meet the residents' needs it is important to assess their physical and psycho-social needs accurately. More research focusing on this assessment is needed in order to improve the quality of life of nursing home residents.

[Effect of snoezelen on the behaviour of demented elderly]. / Effecten van snoezelen op het gedrag van demente ouderen.

A randomised cross-over trial was carried out at nursing home Bernardus in Amsterdam to investigate the effect of 'snoezelen' in a specially furnished room on the well-being of demented elderly people. The behaviour during the experimental intervention 'snoezelen' was compared with the behaviour during the control intervention, consisting of standard activities in the livingroom. Sixteen elderly persons participated in the study. They were all in a very advanced stage of dementia, requiring a high level of care and nursing. The occurrence of behavioural problems was registered, using video cameras and assessed with four subscales of the Gedragsobservatieschaal voor de Intramurale Psychogeriatrie (GIP) (behavioural observation scale for intramural psychogeriatrics). During the experimental intervention a relatively low level of behavioural problems was observed. This could indicate that snoezelen increases the wellbeing of demented elderly. The outcome of this study indicates the need of a larger-scale study in which additional outcome parameters should be included.

[The effect of sensory stimulation in the sensory stimulation room on the well-being of demented elderly. A cross-over trial in residents of the R.C. Care Center Bernardus in Amsterdam]. / Het effect van snoezelen in de snoezelruimte op het welbevinden van demente ouderen. Een cross-over trial bij bewoners van R.K. Zorgcentrum Bernardus te Amsterdam.

A controlled cross-over experiment was carried out to investigate the effect of snoezelen in the snoezelenroom on the well-being of elderly people with dementia. Seventeen elderly residents from the Bernardus Nursing Home in Amsterdam participated. All were in a very advanced stage of dementia requiring a high level of care and nursing. In this study, the presence of behavioural problems was used as a basis for the measurement of well-being. The behaviour was registered by video cameras and analysed by means of certain subscales of a Dutch behavioural observation scale for intramural psychogeriatrics, the Gedragsobservatieschaal voor Intramurale Psychogeriatrie (GIP). The results showed that less behavioural problems were seen with the experimental intervention. This indicates a higher degree of well-being during the snoezelen activity in the snoezelen room than when the residents remained in the living room. The results of this study indicate the need for a large-scale study in which additional outcome parameters are measured.