Dementia-related work activities of home care nurses and aides: Frequency,perceived competence,and continuing education priorities

ABSTRACT

An understanding of the specific dementia learning needs of home care staff is needed to plan relevant continuing education (CE) programs and supports. The study’s objective was to examine frequency and perceived competence in performing 20 dementia-related work activities, and identify CE priorities among home care staff. A cross-sectional survey of all home care staff in a primarily rural health region was used to gather data. Of 111 eligible staff, 82 participated (41 nursing aides, 41 nurses/case managers). To explore the relationship between activity frequency (F) and competence (C), the proportion of nurses and aides in four quadrants for each activity was examined: (1) low F-low C, (2) low F-high C, (3) high F-low C, and (4) high F-high C. Nurses/case managers were significantly more likely than aides to regularly perform 11 activities and to report high competence in 9 activities (p < .05); aides were more likely to assist with two activities (personal care and daily living activities). Thus, nurses/case managers performed a broader range of activities and reported higher competence overall. The top CE topic for both groups was recognizing differences between dementia subtypes, but rankings for most activities varied by group. Aides’ CE priorities indicated a desire to develop competence in low frequency-low competence activities, suggesting an expanded role in supporting dementia patients and their families. Nurses’ CE priority topics were in the high F-high C quadrant, indicating a need to further develop competence in these activities. Findings have implications for planning CE programming for home care providers.     

THE ROLE OF EDUCATION AND HEALTH CARE DELIVERY STRUCTURE IN QUALITY OF NURSING CARE FOR MENTALLY ILL PATIENTS IN NURSING HOMES

A study of nursing home staff found that nurses generally are not knowledgeable about psychiatric symptoms and do not seek out psychiatric intervention for their patients who need it. Even when nurses are knowledgeable about psychiatric symptoms and have had special training in mental health care it is found that they nonetheless rarely seek psychiatric intervention for their patients. The problem to be redressed lies not merely in increased education alone. It also resides in the organizational character of health care delivery in nursing homes, which makes adequate nursing response to mental illnesses impossible.     

Development of a Curriculum for Long-Term Care Nurses to Improve Recognition of Depression in Dementia

There is increasing recognition of the severe consequences of depression in long-term care residents with dementia. Most health care providers are unprepared to recognize and to manage the complexity of depression in dementia. Targeted educational initiatives in nursing homes are needed to address this growing problem. This paper describes the development of competencies, learning objectives, and learning outcomes for a curriculum on depression in dementia for nurses working in nursing home settings. This work provides the foundation for a curriculum to improve learning for nurses and, ultimately, to advance health care outcomes for residents with cooccurring depression and dementia.     

Nursing Students’ Perceptions of a Silent Mentor Program in an Anatomy Course

Anatomy is a core course in undergraduate nursing curriculum. In today’s nursing profession, the integration of biosciences and humanities is increasingly emphasized. Anatomy is considered one of the most essential bioscience subjects for nursing practice. Thus, integrating a silent mentor program into the anatomy course can enrich the knowledge of undergraduate nursing students regarding biosciences and humanities and enhance their future patient-centered care competencies. This article aimed to understand the students’ perceptions of integrating a silent mentor program into the anatomy course. Qualitative approach included four focus group interviews. Themes were developed using the analytic induction technique. Twenty-five second-year undergraduate nursing students from a university were recruited. Semi-structured interviews were used to guide four focus group interviews. Focus group interviews were digitally recorded, transcribed, and analyzed. According to the preliminary findings, nursing students regarded silent mentors not only as teaching tools but also as tools to learn more than anatomy. Students greatly respected the silent mentors and were highly engaged in the anatomy course. They expected to become better students or future nurses. Four themes were identified from the interviews: emotional transformation, caring spirit, course engagement, and self-expectation. The findings suggest that the silent mentor program offered students a beneficial learning experience and stimulated their developing competency in nursing humanities. How the silent mentor program can help students achieve optimum academic performance and how their positive experience of the program and humanistic spirit translates into clinical practice in future should be studied further.     

NASTY,BRUTISH AND LONG: ADVENTURES IN OLD AGE AND THE WORLD OF ELDERCARE By Ira Rosofsky

Nurses play a significant role in geriatric care. However, as the aging population and demand for geriatric nurses increase worldwide, shortages of nurses seem to arise. This creates the need to assess and address the motivation and attitudes of nurses toward geriatric care. The intent of this qualitative study is to surface the essence or the “lebenswelt” that describe the motivation and attitudes of a selected group of Filipino nurses toward geriatric care. A total of six registered nurses who had experienced taking care of elderly patients voluntarily participated as respondents of this study. A two-part instrument developed by the researchers was made to elicit necessary data and information. The first part comprised of the robotfoto intended to establish the baseline characteristics of nurses under study. The second part consisted of a semistructured individual in-depth interview using “aide memoire” to probe into the motivation and attitudes of the nurse respondents. Field texts were phenomenologically reduced via repertory grid. Two distinct and interesting themes, namely Geriatric Service Motivation Typology and the Yin-Yang of Geriatric Attitudes emerged. The first theme includes the Single Loop and Double Loop type of motivation The former involves a transactional and unidirectional process, while the latter constitutes a two-way relational and transformational process. The second theme consists of a harmonious combination of the two sides of the nurses' attitudes toward geriatric care. Through this study, the human side of nursing is seen and captured, thus increasing the awareness and knowledge of nurses, improving provision of optimum geriatric care, and inspiring nurses to pursue geriatric nursing with a yearning to serve the elderly with and from the heart.     

The Job Performance of Nursing Graduates: A Program Evaluation

Abstract

The study was designed to assess the strengths and weaknesses of the nursing education preparation of associate degree nursing graduates as reflected in their job performance. The predictive relationships of measures of scholastic success such as G.P.A. and State Board Examination Scores with graduate job performance were also investigated. A rating scale of 62 items was designed to measure the following dimensions of nursing performance: (a) planning for nursing care, (b) implementing nursing care, (c) interpersonal relationships and communication, (d) leadership and group procedures, (e) evaluating and reporting nursing care, (f) professional involvement, and (g) other. Sources for the rating scale included curriculum objectives and a field survey of performance criteria. Graduates were rated by a nurse and a physician who function in close supervision of their job. Graduates completed a similar rating scale in which they were asked to rate the adequacy of their educational preparation for various job requirements. Ratings were obtained from a sample of 153 graduates of the associate degree nursing program at Delta College, University Center, Michigan. Results indicated a stated need for additional clinical experience requiring total involvement of nursing students, advanced course work in pharmacology, anatomy, physiology, and nutrition, and planned leadership preparation. Findings demonstrated no significant relationship between various indices of G.P.A. and State Board Examination Scores with job rated performance. It is projected that rated job performance is influenced by a number of personality variables. Physicians perceive the performance of nurses from different perspectives than do supervising nurses.     

English as a second language nurses in the United States: culture,communication, and needs for continuing education

The purpose of the study was to understand the role of culture in English as a Second Language (ESL) nurses’ clinical communication experiences in the United States, and how these experiences demonstrate the need for continuing education for ESL nurses. Five Taiwanese nurses who worked in U.S. health care contexts were recruited in the study. Data were collected through focus group and individual interviews, and data were analyzed using narrative and thematic analyses. Findings indicate that cultural differences in clinical settings complicated ESL nurses’ communication experiences, including linguistic and cultural diversity, the independent role of nurses, patient-centered care, and choice of speech registers. Findings further show that comprehensive on-the-job, vocational training in English for Nursing Purposes (ENP) is essential in order to assist ESL nurses’ transit between home and host country cultures. In other words, familiarising nurses with patient-centered care and different discourse patterns, developing critical thinking skills, and enhancing cultural competence should be emphasised in ESL nurses’ continuing education.     

The Meaning-Based Adult Day Care Program Managed by Nurses for Filipino Older Persons

The study aimed to develop a meaning-based adult day care program managed by nurses for Filipino older persons. Meaning-based nursing care is intended to serve as a guide in creating meaningful, focused, and structured activities for nurses in adult day care.

A mixed methods research design was used in the study. This method involved the development of a training module, meaning-based nursing care, training of registered nurses, training evaluation of nurses, and referral for interdisciplinary team meetings and consultations. Meaning-based care was approaches that address the meaning of experiences for older persons in the process of conducting adult day care services.

The study gave evidences to the ability of nurses to manage a program for older persons. Thus, the study recommends the use of the nursing model developed to prescribe guidelines in the conduct of meaning-based adult day care programs and services.     

The effects of a short-term death training program on nursing home nursing staff

This study examines the effects on nursing home nurses of a two-day training program concerned with nurses and their response to the dying patient. Utilizing the Solomon four-group design, the study investigates whether exposure to information on death and dying (a) results in the acquisition of greater knowledge about death and dying, (b) is accompanied by a more positive attitude toward the elderly, and (c) is accompanied by a change in anxiety about death. Based on t tests and one-way analyses of covariance, the results point up the mixed nature of short-term training programs. It was found that there was a significant increase in the nurses' knowledge about death and dying, there was no change in their attitudes toward the elderly, and there was a significant increase among the nurses in the death anxiety experienced. This is not to suggest that training programs of this sort should not be conducted with nursing home staff. On the one hand such programs provide information useful for job performance. On the other hand they create some sensitization to death, which at the very least could give nurses greater insights into the concerns of the patients and perhaps stimulate empathetic responses.     

Learning from Errors at Work: A Replication Study in Elder Care Nursing

Learning from errors is an important way of learning at work. In this article, we analyse conditions under which elder care nurses use errors as a starting point for the engagement in social learning activities (ESLA) in the form of joint reflection with colleagues on potential causes of errors and ways to prevent them in future. The goal of our study was to investigate whether exploratory findings from an earlier study on hospital nurses’ ESLA (Bauer and Mulder Learning in Health and Social Care 6:121–133, 2011) replicate and generalise to the domain of elder care nursing. For this purpose, we surveyed a sample of N?=?180 elder care nurses using vignette-based questionnaires. With these data, we tested a mediation model of nurses’ ESLA suggested by the earlier study. We firstly found a statistically significant indirect effect of error strain on ESLA that is completely mediated by the estimation of an error as relevant for learning (β?=?.16). Secondly, the perception of a safe social team climate at work has a statistically significant indirect effect on ESLA that is completely mediated by nurses’ tendency to cover up errors (β?=?.31). These results entirely cross-validate the exploratory findings of Bauer and Mulder (Learning in Health and Social Care 6:121–133, 2011) on hospital nurses’ ESLA and show that they generalise to the domain of elder care nursing.     

The real ‘cost’ of study in Australia and the ramifications for China,Australia, and the Chinese nursing students: what do these three players want? A narrative review

Australia attracts international nursing students from China to maintain its economic advantage and to alleviate the projected nursing shortage; conversely, China needs its best and brightest citizens who have trained abroad in nursing to return to cope with current challenges within its healthcare system and nursing education. This paper explores whether China can lure its foreign-trained nurses home to achieve its goals; whether China or Australia will win the nursing talent war; and do Chinese nursing students want to remain abroad or return home. The insight gained can support the development of successful human capital investment for all parties involved.     

Factors associated with nurses' intention to report child abuse: a national survey of Taiwanese nurses

OBJECTIVE: The objectives were to determine the experiences of Taiwanese nurses with a new child abuse reporting law and to assess attitudinal correlates of nurses' intention to report. METHOD: A stratified quota sampling technique was used to select registered nurses working in pediatric, psychiatric and emergency care units in Taiwan. A total of 1400 (return rate 88%) questionnaires from 1617 nurses were used. The questionnaire includes demographic information, attitudes toward and knowledge of child abuse and reporting laws, and eight vignettes of child abuse. RESULTS:Most nurses (86%) said they had never reported a child abuse case; 21% said they had failed to report a suspected case of child abuse. Most (80%) had never had any child abuse education. About 75% felt their nursing education and in-service training was inadequate or absent. Most had an inadequate knowledge of the reporting law (mean score: 60% correct). Nurses only answered 17-43% of the law-related questions correctly. The majority accepted the professional responsibility to report. There were some differences among pediatric, psychiatric and emergency care nurses. In general, these Taiwanese nurses had negative attitudes toward corporal punishment and toward parents who abuse their children. The study also identified a variety of attitudes related to intention to report relevant to the Theory of Planned Behavior. CONCLUSIONS:Nurses accept responsibility for reporting but they believe their professional preparation for reporting is inadequate. There is a strong need for in-service and pre-service education about child abuse among nurses in Taiwan.     

Focus on dementia care: Continuing education preferences,challenges, and catalysts among rural home care providers

ABSTRACT

Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery formats of dementia-specific continuing education (CE) programs, and challenges and catalysts to attending CE on any topic. From January through March, 2014, 82 of 111 eligible home care staff in one Saskatchewan health region completed a cross-sectional postal survey (73.9% response rate). The survey included 41 nurses/case managers (client care coordinators, assessors, and team managers) and 41 continuing care aides (home health aides). Nurses/case managers and aides were equally likely to report moderate to high interest in locally delivered CE and low interest in Internet-based and computer-based CE. Compared with nurses/case managers, aides were more likely to report challenges to CE attendance due to CE not being a requirement of their position or relevant to their work. Low staffing levels were the top challenge regardless of professional role. Nurses/case managers and aides were equally likely to identify locally offered programs and paid time off as the top two catalysts of CE attendance. Given the growing number of individuals with dementia receiving home care services, the current study suggests that continuing education should be offered locally and included in rural staff’s paid time in order to encourage attendance.     

提高优质护理病房护士综合素质的实践与体会

目的：探讨提高优质护理病房护士综合素质的方法。方法：选取我院2010年9月至2011年2月及2011年3月到2011年8月期间两种不同床位包干护理模式下的护士及患者做研究对象,采用我院自行设计的优质护理服务质量评价表和出院患者满意度调查问卷收集资料,就护士业务能力等进行对比分析。结果：新法护理模式护理质量（P=0.478）与病人对包床责任护士服务的满意度（P=0.979）与旧法差异均无统计学意义,新法包床护理病人满意度高于旧法（P=0.022）,新法包床护士护理技术操作（P=0.042）及理论考核成绩（P〈0.001）均优于旧法。结论：新法床位包干、小组负责的护理模式,有利于提高护士的综合素质,提升优质护理服务的内涵,值得临床推广。     

Quality of life of nursing home residents before and after reminiscence therapy

This study was conducted to determine the effects of reminiscence therapy as a nursing intervention on the quality of life (QOL) of nursing home residents. This was a quasi-experimental study with a single-group pretest and posttest design. Sampling inclusion criteria were being 65 years of age or older, ability to communicate, lack of hearing impairment, lack of dementia or any given psychiatric disorder, and volunteering to participate in the study. Participants included 32 nursing home residents, who were divided into groups of 2–5 and received a total of 12 sessions of group reminiscence therapy. After the intervention, a decrease was noticed in the total score and subdomain test scores of a QOL scale. Although the study design did not allow confirmation of the effect of reminiscence, analysis showed some useful indications for further research. Additionally, participants stated that the reminiscence program might be a meaningful activity for nursing home residents.     

Factors Influencing Nursing Students’ Intention to Practice Sexuality Education in their Professional Work

Abstract

Sexuality has an essential part in human lives and can be affected by changes in one’s health status. Since the nursing profession delivers holistic care for patients, nurses must have the knowledge and skills to deliver care concerning sexuality. Evidence from the professional literature demonstrates that nurses do not address sexuality care consistently, mainly due to different factors such as lack of knowledge, skills, and cultural attitudes. This study’s purpose was to learn about the factors that affect nursing students’ willingness to grasp the nurse’s role as a sexuality educator in practice prior to establishing a specified course in sexual education for BSN students. A quantitative study was conducted in a college at the center of Israel, with a convenience sample of nursing students in a BSN program (n?=?214). The research tool was a questionnaire designed to assess the knowledge, attitudes, and willingness of nursing students to practice sexuality education in the future. The study’s approach was based on Ajzen’s Theory of Planned Behavior. Results indicated that self-efficacy is the main mediator between attitudes and intentions. There is a need to reinforce nursing student’s self-efficacy on the subject to increase their intention to practice it in the future.     

Experiences with home hospice care: determinants of place of death

During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.