Dieneke Smit

The moderating role of decision authority and coworker- and supervisor support on the impact of job demands in nursing homes: A cross-sectional study

BACKGROUND Healthcare workers in nursing homes are faced with high job demands that can have a detrimental impact on job-related outcomes, such as job satisfaction. Job resources may have a buffering role on this relationship. The Demand-Control-Support (DCS) Model offers a theoretical framework to study how specific job resources can buffer the adverse effects of high demands, and can even activate positive consequences of high demands. OBJECTIVES The present study tests the moderating (i.e. buffering and activating) effects of decision authority and coworker- and supervisor support that are assumed by the hypotheses of the DCS Model. DESIGN A national cross-sectional survey was conducted with an anonymous questionnaire. SETTING One hundred and thirty six living arrangements that provide nursing home care for people with dementia in the Netherlands. PARTICIPANTS Fifteen healthcare workers per living arrangement. In total, 1147 people filled out the questionnaires (59% response rate). METHODS Hierarchical multilevel regression analyses were conducted to test the assumption that the effect of job demands on the dependent variables is buffered or activated the most when both decision authority and social support are high. This moderation is statistically represented by three-way interactions (i.e. demands×authority×support), while lower-order effects are taken into account (i.e. two-way interactions). The hypotheses are supported when three-way interaction effects are found in the expected direction. The dependent variables studied are job satisfaction, emotional exhaustion, and personal accomplishment. RESULTS The proposed buffering and activation hypotheses of the DCS Model were not supported in our study. Three-way interaction effects were found for emotional exhaustion and personal accomplishment, though not in the expected direction. In addition, two-way interaction effects were found for job satisfaction and emotional exhaustion. Decision authority was found to buffer the adverse effect of job demands and to activate healthcare staff. Supervisor support was found to buffer the adverse effect of job demands on emotional exhaustion in situations with low decision authority. Finally, coworker support was found to have an adverse effect on personal accomplishment in high strain situations. CONCLUSIONS Findings reveal that decision authority in particular makes healthcare workers in nursing homes less vulnerable to adverse effects of high job demands, and promotes positive consequences of work.

Activity involvement and quality of life of people at different stages of dementia in long term care facilities

Objectives: Involvement in activities is assumed to positively influence the quality of life of people with dementia, yet activity provision in long-term care remains limited. This study aims to provide more insight into the value of activity involvement for domains of the quality of life of long-term dementia care residents, taking resident characteristics and cognitive status into account. Method: Data were derived from 144 long-term care facilities participating in the second measurement (2010/2011) of the living arrangements for dementia study. Amongst 1144 residents, the relationship between time involved in activities (activity pursuit patterns; RAI-MDS) and quality of life (Qualidem) was studied using multilevel linear regression analyses. Analyses were adjusted for residents’ age, gender, neuropsychiatric symptoms, ADL dependency and cognition. To check for effect modification of cognition, interactions terms of the variables activity involvement and cognitive status were added to the analyses. Results: Despite residents cognitive status, their activity involvement was significantly related to better scores on care relationship, positive affect, restless tense behaviour, social relations, and having something to do. A negative relationship existed between the activity involvement and positive self-image. The explained variance in the quality of life between residents caused by the activity involvement was small. Conclusion: Activity involvement seems to be a small yet important contributor to higher well-being in long-term care resident at all stages of dementia. Adjusting activities to individual preferences and capabilities might enlarge this relationship. Further research is needed to confirm this hypothesis, using measurement instruments less sensitive to recall bias and differentiating between the active and passive activity involvement.

The relationship between small-scale nursing home care for people with dementia and staff's perceived job characteristics.

BACKGROUND Over the past few decades, new care models that are more resident-oriented and directed toward small-scale and homelike environments have been developed worldwide. The impact of these care models on the quality of life of residents has been studied. However, little research has been conducted to gain insight into how these new care models influence healthcare staffs work environment. This study focuses on the consequences of small-scale care on staffs perceived job characteristics. METHODS Data were derived from a sample of 136 Dutch living arrangements providing nursing home care for people with dementia (2008/2009), in which 1,327 residents and 1,147 staff participated. The relationship between two indicators of small-scale care (small-scale care characteristics and total number of residents with dementia in facility) and staffs job characteristics (job demands, decision authority, coworker and supervisor support) were studied with multilevel regression analyses. All analyses were adjusted for staff, resident, and living arrangement characteristics when needed. RESULTS Both indicators of small-scale care were associated with job demands; staff perceived less time and work pressure as more characteristics of small-scale care were integrated and the facility had less residents with dementia in total. Only one indicator was associated with decision authority. As more characteristics of small-scale care were integrated, staffs perceived decision authority was higher. No relationship was found with coworker and supervisor social support. CONCLUSIONS Knowing that job demands and decision authority are important predictors of job appraisal and well-being, our findings show that small-scale care could have a beneficial impact on healthcare staffs work environment.

Staff–resident interactions in long-term care for people with dementia: the role of meeting psychological needs in achieving residents’ well-being

Objectives: The aim of this study is to explore the extent to which staff–resident interactions address or undermine residents’ psychological needs and how such interactions are associated with residents’ well-being. Method: Data on staff–resident interactions and residents’ well-being were collected for 51 residents from nine long-term care settings using dementia care mapping (DCM). DCM yields a count and detailed description of staff–resident interactions that either address (personal enhancers – PEs) or undermine (personal detractions – PDs) residents’ psychological needs, and every 5-minute scores for each residents mood and engagement (ME-value). The relationship between PEs and PDs and well-being was analysed by studying residents’ ME-values before and three time frames after a PE or PD occurred. Results: A total of 76 PEs and 33 PDs were observed. The most common PEs were those addressing psychological needs for comfort and occupation. However residents’ well-being increased most often after PEs that addressed residents’ need for identity, attachment and inclusion. The most common PDs were those which undermined the need for comfort, inclusion and occupation. Residents’ well-being decreased most often after PDs that undermined the need for comfort. Conclusion: Increasing interactions which address residents’ need for attachment, identity and inclusion and eliminating interactions which undermine residents’ need for comfort may be particularly important in achieving residents’ well-being. In the long run, residents’ well-being could be achieved by staff availing of the opportunities to empower and facilitate residents, thus meeting their needs for occupation. These findings provide directions for training in person-centred care.

The long-term effect of group living homes versus regular nursing homes for people with dementia on psychological distress of informal caregivers.

Objective: In this follow-up study, the long-term influence of group living homes (GLHs) on informal caregiver distress was compared with modern yet regular nursing homes (NHs). Method: Informal caregivers of GLH (N = 37) and NH residents (N = 49) were studied at the time of admission, 6 months thereafter, and approximately 24 months after admission. Repeated measures of ANOVA were performed to study group-by-time effects on psychopathology, role overload, and feelings of competence. Result: All outcomes of psychological distress in GLH caregivers showed significantly greater decline compared with NH caregivers during the first six months after admission. The course of psychological distress stabilized in both caregiver groups after six months. Conclusion: GLHs may have played a role in reducing caregiver burden during the first six months after the nursing home admission of the care recipient. The stabilization of caregivers’ psychological distress between T1 and T2 may indicate that there is no further room for improvement in the GLH and NH groups after six months. The implication would be that both GLHs and NHs succeeded in keeping caregivers’ distress relatively low over the long term. More knowledge is needed on whether and how caregivers’ psychological distress after institutionalization of the care recipient can be reduced to a greater extent.

Predictors of activity involvement in dementia care homes : A cross-sectional study

BackgroundDespite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement.MethodsData were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed.ResultsThe most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement.ConclusionsTo increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff’s experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means.

Het geheim van de succesvolle woonvoorziening

Tussen woonvoorzieningen voor mensen met dementie blijken grote kwaliteitsverschillen te bestaan. Dat werd duidelijk uit de eerste meetronde van de Monitor Woonvormen Dementie, een tweejaarlijks landelijk onderzoek naar de intramurale zorg voor mensen met dementie. De verschillen hadden betrekking op de kwaliteit van leven van bewoners, de kwaliteit van zorg, de personeelsinzet en het welbevinden van de medewerkers. Dat roept natuurlijk de vraag op hoe het komt dat sommige woonvoorzieningen op deze gebieden succesvoller zijn dan andere. Wat is het geheim van de succesvolle huizen?

Is de zorg persoonsgericht

In Nederland gebruiken we in de zorg voor mensen met dementie veelvuldig termen als ‘persoonsgericht’ of ‘belevingsgericht’. Maar waarom is het van belang persoonsgerichte zorg te bieden? Wat houdt deze benadering precies in? Hoe persoonsgericht is de verpleeghuiszorg voor mensen met dementie in Nederland eigenlijk? En wat is er nodig voor deze vorm van zorg? Het eerste van drie artikelen over de uitkomsten van de Monitor Woonvormen Dementie.

Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints

BACKGROUND Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints. METHODS Data were derived from the first wave (2008-2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ). RESULTS Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints. CONCLUSIONS Staffs job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making - especially role of physician, staffs knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.

Partners in de zorg? De Monitor Woonvormen Dementie (2).

De roep om betrokkenheid van familieleden bij de verpleeghuiszorg voor mensen met dementie neemt toe. Maar met welk doel precies? En mag je eigenlijk wel van familieleden verwachten dat zij – na een vaak intensieve periode van mantelzorg – ook in het verpleeghuis zorg blijven bieden? En: heb je als zorgmedewerker in dat geval nog wel controle over je eigen werk? Deze en andere vragen borrelen vaak op als het gaat over de inzet van familieleden in de verpleeghuiszorg voor mensen met dementie. Reden voor het Trimbos-instituut om in de recente uitgave van de Monitor Woonvormen Dementie de betrokkenheid van familieleden nader te onderzoeken.