Family functioning evaluated by family members of older patients and nurses in emergency departments.

The functioning of families in emergency departments (EDs) encompasses the level at which the families of older patients perform as a whole during the ED stay. Currently, little is known about how the families of older patients function in EDs. In this study, family functioning included the subareas of family strengths, structural factors and relationships both inside and outside the family. The study aimed to describe family functioning in EDs as evaluated by both the family members (n = 111) of older patients and nurses (n = 93). The data were collected from four Estonian hospitals, and the scale used was the Family Functioning, Health and Social Support scale. The results showed that both the family members and nurses evaluated family functioning and all its subareas as being moderate. Family structural factors were found to be associated with the family members' social status. The scores in the subareas were higher when older patients had received help from family members before the ED visit. The family members and nurses differed significantly in the scores they gave for family functioning in general and for all the subareas. No association was found between family functioning as rated by nurses and the families' demographic characteristics. These results suggest that nurses should pay more attention to family functioning in general and to the structural factors within the family, including internal relationships, while older patients are in the ED. Comprehensive knowledge about how families function during an ED stay may help nurses to better meet the needs of older patients and their families and help them to prepare families to provide aftercare at home. Our findings support the idea that healthcare organisation and delivery should be more family centred.

Hospital nurses' work motivation.

BACKGROUND: The knowledge surrounding nurses' work motivation is currently insufficient, and previous studies have rarely taken into account the role of many influential background factors. AIM: This study investigates the motivation of Estonian nurses in hospitals, and how individual and organisational background factors influence their motivation to work. METHODS: The study is quantitative and cross-sectional. An electronically self-reported questionnaire was used for data collection. The sample comprised of 201 Registered Nurses working in various hospital settings in Estonia. Data were analysed using descriptive statistics, two-sample Wilcoxon rank-sum (Mann-Whitney) test, Kruskal-Wallis equality-of-populations rank test and Spearman's correlation. RESULTS: Both extrinsic and intrinsic motivations were noted among hospital nurses. Nurses were moderately externally motivated (M = 3.63, SD = 0.89) and intrinsically strongly motivated (M = 4.98, SD = 1.03). A nurses' age and the duration of service were positively correlated with one particular area of extrinsic work motivation, namely introjected regulation (p < 0.001). Nurses who had professional training over 7 days per year had both a higher extrinsic motivation (p = 0.016) and intrinsic work motivation (p = 0.004). CONCLUSIONS: The findings expand current knowledge of nurses' work motivation by describing the amount and orientation of work motivation among hospital nurses and highlighting background factors which should be taken into account in order to sustain and increase their intrinsic work motivation. The instrument used in the study can be an effective tool for nurse managers to determine a nurse's reasons to work and to choose a proper motivational strategy. Further research and testing of the instrument in different countries and in different contexts of nursing is however required.

Hospital nurses' working conditions in relation to motivation and patient safety.

There is a lack of empirical knowledge about nurses' perceptions of their workplace characteristics and conditions, such as level of autonomy and decision authority, work climate, teamwork, skill exploitation and learning opportunities, and their work motivation in relation to practice outputs such as patient safety. Such knowledge is needed particularly in countries, such as Estonia, where hospital systems for preventing errors and improving patient safety are in the early stages of development. This article reports the findings from a cross-sectional survey of hospital nurses in Estonia that was aimed at determining their perceptions of workplace characteristics, working conditions, work motivation and patient safety, and at exploring the relationship between these. Results suggest that perceptions of personal control over their work can affect nurses' motivation, and that perceptions of work satisfaction might be relevant to patient safety improvement work.

Resources of residents for potential transition from long-term care to community.

BACKGROUND AND OBJECTIVE: Transition from long-term care to the community can have positive effects on residents' health and quality of life and promote the feelings of happiness, safety, and independence. The aim of this study was to examine residents' resources for potential transition to the community after residing in long-term care facilities. MATERIAL AND METHODS: The study was conducted in 8 long-term care institutions for older persons of Kaunas county. The study population comprised 252 residents. The items contained in the interRAI Long-Term Care Facility assessment instrument were used to evaluate a consistent positive outlook, social activities, and discharge potential. Cognitive impairment was measured using the Cognitive Performance Scale. Activities of daily living were measured using the Activities of Daily Living Hierarchy Scale. RESULTS: More than 10% of the residents exhibited no cognitive impairment. One-third of the residents preferred to transition back to the community from their long-term care facility. Two-thirds expressed that they had familiar surroundings, which could be assumed to increase their feeling of safety at home. Social activities prevalent among residents included taking care of plants and walking outdoors. About 40% of the residents were physically independent in the activities of daily living. In spite of these resources, no residents were involved in a discharge process due to the lack of established nursing and social care services and transitional care plans. CONCLUSIONS: With well-organized community services, some residents in long-term care facilities may have enough resources to live in the community.

Effects of socially stimulating group intervention on lonely, older people's cognition: a randomized, controlled trial.

OBJECTIVE: Loneliness may predict impaired cognition among older people. The aim of this study was to determine the effects of socially stimulating group intervention on cognition among older individuals suffering from loneliness. DESIGN: A randomized controlled trial. SETTING AND PARTICIPANTS: Two hundred thirty-five participants (≥75 years) in seven day care centers in Finland. INTERVENTION: Group intervention was based on the effects of closed-group dynamics and peer support. The three-month intervention was aimed to enhance interaction and friendships between participants and to socially stimulate them. Each group was facilitated by two specifically trained professionals. In addition to active discussions, the groups included three types of activities depending on the participants' interests: 1) therapeutic writing; 2) group exercise; and 3) art experiences. MEASUREMENTS: Cognition was measured by the Alzheimer's Disease Assessment Scale (ADAS-Cog), and mental function was measured by the 15D measure. RESULTS: The intervention and control groups were similar at baseline with respect to their demographics, disease burden, depression, and cognition. The ADAS-Cog scale improved more in the intervention group than in the control group within the three-month period, with mean changes being -2.6 points (95% confidence interval [CI]: -3.4 to -1.8) and -1.6 points (95% CI: -2.2 to -1.0), respectively. The dimension of mental function in the 15D showed significant improvement at 12 months in the intervention group (+0.048, 95% CI: +0.013 to +0.085) compared with the control group (-0.027, 95% CI: -0.063 to +0.010). CONCLUSION: Psychosocial group intervention improved lonely older people's cognition.

Pharmaceutical care as described by home-dwelling older people in Finland.

BACKGROUND AND OBJECTIVE: Pharmaceutical care is one of the most important therapeutic tools in older people care. The aim of this study was to describe the knowledge and attitudes of older home-dwelling people's about their perceptions of pharmaceutical care and use of medication. MATERIAL AND METHODS: The data were collected using theme interviews with 16 older Finnish people (born 1920). Inductive content analysis was used in analyzing the data. RESULTS: Older people's knowledge about their pharmaceutical care varied widely: some had precise knowledge whereas others had none. Guidance in pharmaceutical care was not readily available. The interviewees took a positive attitude toward their pharmaceutical care and favored a minimum use of medication. Being able to cope independently with their pharmaceutical care strengthened the older people's sense of control over their lives. CONCLUSIONS: The study offers new knowledge about the significance of older people's individual pharmaceutical care at home. By listening to and utilizing older people's experiences, we can recognize the factors that promote the independent coping and inclusion of older people in their pharmaceutical care. This enables health care providers to increase the safety and quality of pharmaceutical care for older people.

Perceptions of the psychological well-being and care of older home care clients: clients and their carers.

AIM: To explore and compare older home care clients' (65+) and their professionals' perceptions of the clients' psychological well-being and care and to identify possible differences in these perceptions. BACKGROUND: Psychological well-being is considered an important dimension of quality of life. With advancing age, older people require home care support to be able to remain in their own home. The main goal of care is to maximise their independence and quality of life. DESIGN: Descriptive, survey design with questionnaire. METHODS: A postal questionnaire was distributed to 200 older home care clients and 570 social and health care professionals in 2007. The total response rate was 63%. The questionnaire consisted of questions about clients' psychological well-being and the provision of care by home care professionals. The differences in responses between clients and professionals were analysed using cross-tabulations, the Pearson Chi-Square Test and Fisher's Exact Tests. RESULTS: The professional group believed that their clients did not have plans for the future. They believed that their clients felt themselves depressed and suffering from loneliness significantly more often than the client group did. The client group were also significantly more critical of the care (motivating independent actions, physical, psychological and social care) they got from the professional group than how the professionals evaluated the care they gave. CONCLUSIONS: To be able to support older clients to continue living at home, professionals need to provide a service that meets client's own perceptions and complex social and health care needs as well as personal sense of well-being. RELEVANCE TO CLINICAL PRACTICE: The findings offer useful insights for the professional in planning and delivering appropriate home care services. A better understanding of differences between clients' and professionals' perceptions could lead to a better individualised care outcome.

Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: randomized controlled trial.

AIM: This paper is a report of a study to explore the effects of psychosocial group nursing intervention on older people's feelings of loneliness, social activity and psychological well-being. BACKGROUND: Older people's loneliness is associated with low quality of life, and impaired health, increased use of health and social services and increased mortality. Previous intervention studies have achieved quite modest results. METHOD: A randomized controlled trial was conducted between 2003 and 2006 using a group intervention aimed at empowering older people, and promoting peer support and social integration. A total of 235 people (>74 years) suffering from loneliness met 12 times with professional leaders in groups. The UCLA Loneliness Scale and Lubben's Social Network Scale were used at entry, after 3 and 6 months. Psychological well-being was charted using a six-dimensional questionnaire at baseline and 12 months later. FINDINGS: A statistically significantly larger proportion of intervention group participants had found new friends during the follow-up year (45% vs. 32%, P = 0.048), and 40% of intervention group participants continued their group meetings for 1 year. However, no differences were found in loneliness or social networks between the groups. Psychological well-being score improved statistically significantly in the intervention groups [+0.11, 95% confidence interval (CI): +0.04 to +0.13], compared with the controls (+0.01, 95% CI: -0.05 to +0.07, P = 0.045). Feeling needed was statistically significantly more common in the intervention groups (66%) than in controls (49%, P = 0.019). CONCLUSION: New sensitive measurements of loneliness and social isolation are needed to measure fluctuations in feelings of loneliness and in social isolation.

[Supporting a patient's self-management]. / Potilaan omahoidon tukeminen.

Regardless of favorable results of health care, citizens still face with health risks which are associated with the life style. Shift from professional-centered care to patient-centered care sets challenging tasks and roles to professionals as well as patients. Professional's authority is transformed into a role of a patient's partner and trainer, with whom the patient negotiates the best treatment for him or her. Professional taking the role of a partner and a trainer strengthens the patient's self-management skills by supporting patient's empowerment, autonomy, motivation and self-efficacy when the patient is solving his or her health problems and making decisions. From the patient's point of view, self-management demands knowledge of objectives and means of treatment as well as willingness to take responsibility for one's own treatment and ways of living, as well as confidence to one's own resources and capabilities.

Personal resources supporting living at home as described by older home care clients.

This study describes the personal resources of older (> or = 75 years) home care clients in Finland and their perceptions of factors that enhance and constrain their ability to live independently at home. The data were collected by unstructured interviews with 21 older home care clients. Inductive content analysis were used to analyse the data. The resources of older people consisted of a sense of control over one's life and a determination to remain active. Factors enhancing older people's resources were their involvement in leisure activities and social networks, factors undermining their resources were conditions on living imposed by outsiders, declining health and loneliness. The results show that home care professionals do not yet have sufficient skills and abilities to identify and support older people's existing resources. As well as having access to necessary resources, it is also crucial that older people know how to use them.

Images of loneliness: using art as an educational method in professional training.

BACKGROUND: An educational program using art was created to prepare healthcare professionals to work with older adults by deepening their knowledge of loneliness and promoting self-reflection. METHOD: Participants viewed art exploring themes of loneliness and discussed their perceptions. Semi-structured feedback questionnaires were used to evaluate evidence of learning. RESULTS: Training enhanced ethical knowing, aesthetic knowing, and empathy. Healthcare professionals also reported increased self-knowledge and skills to use art in group interventions. They gained deeper understanding of loneliness through viewing works of art. CONCLUSION: Viewing art and discussing perceptions of loneliness or suffering was an effective method to help healthcare professionals develop empathy.

Nutrition in patients receiving home care in Finland: tackling the multifactorial problem.

This study describes the nutritional status of Finnish home care patients (n=178), their problems related to eating, digestion, and diet; their use of Meals on Wheels services; and informal caregivers' role in nutritional support. Half of the patients were at risk for malnutrition and 3% were malnourished according to Mini Nutritional Assessment (MNA) results. Most patients had problems with food intake, which were related to lower MNA scores. One-third of the participants had an unbalanced diet, and approximately half received assistance with shopping and food preparation from an informal caregiver. Home care patients' nutritional status, including all related aspects, such as shopping, food preparation, eating, and digestion, must be evaluated regularly and comprehensively.

Achieving Prudent Dementia Care (Palliare): An International Policy and Practice Imperative.

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.

Older people in the emergency department: a literature review.

BACKGROUND: Emergency departments (EDs) play a unique role in healthcare systems throughout the world by providing acute interventions for older patients with acute/emergency and multiple health problems. The aim of this review was to identify studies that focused on older patients admitted to EDs and to determine the reasons for the visits. DESIGN AND METHODS: The literature review was based on a comprehensive search of electronic databases. Inclusion criteria were original research written in English; published 2002-2012; focused on older people; reasons for ED visit; and factors that affect the discharge process and those associated with a repeat ED visit. Other literature reviews and studies unrelated to the ED context, and studies examining patients aged ≥65 years, were excluded. Content analysis was performed. Twenty-five studies were identified and critically evaluated. RESULTS: The highest proportion of older people visited the ED because of multiple health conditions. The reasons for the visits were cardiovascular, mental health, musculoskeletal and abdominal conditions; adverse drug reactions; dermatological, neurological and respiratory conditions; poor health status; accidents; and the influence of time factors such as time of day, week or season. Factors that affected the discharge process were unresolved problems, health risk identification, aftercare instructions, medication prescribed at discharge and patient's residence before ED admission. Factors associated with repeat ED visits were sociodemographic characteristics, social problems, health problems, need for systematic health assessment, healthcare service use and inadequacy of care provided. CONCLUSIONS: The current review showed that older people are the main population visiting EDs; important factors required for planning and providing nursing care for older people in EDs were identified. More research is needed to determine how EDs support older people and their families. IMPLICATIONS FOR PRACTICE: The findings of the current review identified that older people visit ED quite often because of different reasons. Discharge process and repeat visits may be influenced by various factors. To ensure quality nursing care in ED nurses need to be aware why do older people visit the ED, what factors may influence discharge and what factors are associated with repeat ED visits.

Oral and nutritional status in frail elderly.

This article describes associations between oral health and nutritional status among chronically ill older adults who were living at home and receiving regular professional home care services. A structured questionnaire, oral examination, and Mini-Nutritional Assessment were completed for 51 subjects (mean age 83.7 years). Two-thirds of the sample were edentulous, and one-third had between 2 and 23 teeth (mean 10.59, SD +/- 6.92). Sixty percent of subjects complained of xerostomia, while dentists found only 48% to have clinical signs of dry mouth. More than half of the subjects had stimulated saliva rates of < 0.8 ml/min. Stimulated saliva secretion rates were lower for persons with no functional natural dentition or prostheses (p = 0.012). Subjects assessed their dentures to be more functional than did the dentist (Kappa 0.338). No one was considered malnourished. 47% were at risk of malnutrition, and 52% were well nourished. The dentist's estimation of dry mouth and eating problems were significantly associated to lower MNA scores (p = 0.049 and p = 0.015, respectively). Subjects with a natural functioning dentition had higher BMI scores (p = 0.0485).

Client-centeredness of Finnish and Estonian nursing students and the support from nursing education to develop it. Students' self-evaluation.

PURPOSE: The purpose of this comparative study is to describe the differences between Finnish and Estonian students evaluations about their client-centeredness and educational support they received to develop it. BACKGROUND: Client-centeredness has many positive effects on the quality and effectiveness of care. However, some deficiencies have been identified in the client-centeredness of nursing staff. Research on the subject has been limited, and we lack knowledge of graduating students' competence in client-centeredness and the support of their education to develop it. METHODS: The sample consisted of 390 undergraduate nursing students, 195 from Finland and 195 from Estonia. The data were collected in 2009 using the structured five-point scale questionnaire. The questionnaire was designed to measure students' client-centeredness and the educational support they received from nursing education. The data were analyzed by the PASW Statistics 18-programme using descriptive statistics, Kolmogorov-Smirnov test and Mann-Whitney U-test. RESULTS: Predominantly, students in both countries evaluated their level of client-centeredness high. The Estonian students generally evaluated their client-centeredness higher compared to the Finnish students. The same applied to support provided by nursing education. The greatest differences were related to education and particularly theoretical teaching. In Estonia, students' client-centeredness manifested itself more in politeness and willingness to serve clients, whereas respecting the clients' values was emphasized in Finland. Students' requisites, referred here as knowledge, skills and abilities to implement client-centered nursing, for client-centeredness had deficiencies, and the support from education was also the weakest regarding these aspects. CONCLUSION: In future, education on development of nursing activities, acquisition of knowledge and services provided by health care as well as legislation should be enhanced, since these areas proved the most difficult for the students.

Gerontological rehabilitation nursing of older patients in acute health centre hospitals: nursing views.

AIM: The aim was to describe gerontological rehabilitation nursing in an acute hospital setting from nursing staff's points of view. BACKGROUND: In the model of gerontological rehabilitation nursing, older people are active operators in their own rehabilitation process. It is the task of nursing staff, together with the patient, their relatives and a multiprofessional team, to support the patient's commitment to the rehabilitation goal. METHODS: In this study, a cross-sectional design was used. Registered nurses (RNs) and practical nurses (PNs) (n = 367) from four different hospitals responded to the questionnaire. Data analysis was carried out with spss using descriptive statistics. RESULTS: The majority of nursing staff (66%) considered that older rehabilitation patients thought that rehabilitation was activity undertaken by physiotherapists aimed at improving patients' functional abilities. The wards in question have well-functioning rehabilitation teams. The rehabilitation of older patients is a goal-oriented activity. Despite this, not everyone was aware of the goals. Essential patient care and promotion of rehabilitation were well attended to by nurses. Emotional support was emphasised in maintaining the motivation of older people. CONCLUSIONS: Because RNs and PNs, unlike other professionals, see older rehabilitation patients 24 hours a day and are able to assess their possibilities of coping independently with essential tasks, nursing staff could have an active role in the rehabilitation team. The education of nursing staff must focus on boosting self-esteem and teaching independent decision-making in promoting the rehabilitation of older persons and the assessment of their progress. IMPLICATIONS FOR PRACTICE: Nurse managers must arrange further education for nurses in promoting the rehabilitation of older persons. Nurse managers must also arrange time for the multiprofessional team to discuss and agree joint rehabilitation goals.

Positive life orientation predicts good survival prognosis in old age.

The purpose of this study is to investigate the value of life orientation as a screening tool and survival indicator in old age. A postal questionnaire answered by 2490 random older people (>75 years) included six questions concerning satisfaction with life, feeling needed, plans for future, zest for life, lack of feelings of depression and loneliness. The vital status was followed for 57 months. All-cause mortality rate was 19.1% and 30.3% among elderly with (22%) and without (78%) positive life orientation, respectively (p<0.001). The difference in mortality increased over time. After controlling for age, gender, and subjective health, the protective value of positive life orientation remained significant (hazard ratio, HR=0.78, 95%CI=0.63-0.98, p<0.03). Feeling needed was the strongest independent predictor (HR=0.72, p<0.001). A six-question life orientation identifies old people at risk. Positive life orientation predicts good survival prognosis independently of subjective health.

Patient-centeredness in long-term care of older patients - a structured interview.

AIM: The aim of this study was to describe assessments of older people about patient-centeredness in the long-term care of Estonian hospitals, and to determine correlations between patients' assessments and their socio-demographic characters. BACKGROUND: Patient-centeredness increases patients' satisfaction and enhances their recovery. Still, patients' opinions are not always taken into account. METHOD: A cross-sectional study included 111 older people in long-term care of 14 Estonian hospitals. Data were collected in 2008 by means of structured interviews. RESULTS: What patients agreed most was that they were given enough opportunity to carry out activities they were capable of performing themselves. Two thirds of participants had not been sufficiently consulted on who would be providing their care. Half of the participants were not given sufficient opportunity to decide what kind of care was needed and how they would receive it. The more assistance patients needed in daily living activities, the less they considered the care as patient-centred. CONCLUSIONS: From the perspective of older people, the patient-centeredness in Estonian long-term care is above average. Providing patient-centred long-term care in Estonian hospitals deserves more attention. RELEVANCE TO CLINICAL PRACTICE: Older people should be more involved in decision-making, especially those who need more assistance in daily living activities.