Kezia Scales

Ingroup identity as an obstacle to effective multiprofessional and interprofessional teamwork: findings from an ethnographic study of healthcare assistants in dementia care

Rising dementia incidence is likely to increase pressures on healthcare services, making effective well coordinated care imperative. Yet, barriers to this care approach exist which, we argue, might be understood by focussing on identity dynamics at the frontlines of care. In this article, we draw upon findings from an ethnographic study of healthcare assistants (HCAs) from three dementia wards across one National Health Service mental health trust. Data revealed that the HCAs are a close-knit ‘in-group’ who share low group status and norms and, often highlight their own expertise in order to promote self worth. HCAs’ social identity is considered as a barrier to effective teamwork with strong ingroup behaviour suggested as a consequence of their marginalisation. We explore these findings with reference to social identity theory (Tajfel, ; Turner, ) and discuss implications for delivering multiprofessional and interprofessional care.

The emotional labour of healthcare assistants in inpatient dementia care

ABSTRACT Although there is much written on the emotional labour of nursing, there is little research grounded in the experience of so-called ‘unqualified’ care assistants. This paper is drawn from an ethnographic study conducted with care assistants on three dementia care wards in one mental health trust within the United Kingdom National Health Service (NHS). We describe the emotional labour carried out by care assistants in their attempts to provide personalised care for people whose cognitive degeneration renders conventional relationship-building very difficult, produces unpredictable ‘challenging behaviour’ and calls into question the notion of ‘feeling rules’. This context requires the ability to strike a balance between emotional engagement and detachment, and it is the complexities of this relationship that are the focus of this paper, arguing that a degree of detachment is a prerequisite to engagement in this context. In conclusion, we argue that the contribution of care assistants in this context needs to be better acknowledged, supported and remunerated.

The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents

Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship.

Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes

To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs).

Ward features and stigma experiences of mental health service users in Belgium and England: A replication study:

Background: Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others? Aims: This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users’ expectations and experiences of stigma. Methods: The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible. Results: Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations. Conclusions: This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.

Evidence-Based Nonpharmacological Practices to Address Behavioral and Psychological Symptoms of Dementia

Background and Objectives To draw from systematic and other literature reviews to identify, describe, and critique nonpharmacological practices to address behavioral and psychological symptoms of dementia (BPSDs) and provide evidence-based recommendations for dementia care especially useful for potential adopters. Research Design and Methods A search of systematic and other literature reviews published from January 2010 through January 2017. Nonpharmacological practices were summarized to describe the overall conceptual basis related to effectiveness, the practice itself, and the size and main conclusions of the evidence base. Each practice was also critically reviewed to determine acceptability, harmful effects, elements of effectiveness, and level of investment required, based on time needed for training/implementation, specialized care provider requirements, and equipment/capital requirements. Results Nonpharmacological practices to address BPSDs include sensory practices (aromatherapy, massage, multi-sensory stimulation, bright light therapy), psychosocial practices (validation therapy, reminiscence therapy, music therapy, pet therapy, meaningful activities), and structured care protocols (bathing, mouth care). Most practices are acceptable, have no harmful effects, and require minimal to moderate investment. Discussion and Implications Nonpharmacological practices are person-centered, and their selection can be informed by considering the cause and meaning of the individuals behavioral and psychological symptoms. Family caregivers and paid care providers can implement evidence-based practices in home or residential care settings, although some practices require the development of more specific protocols if they are to become widely used in an efficacious manner.

Pneumonia Identification Using Nursing Home Records.

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research. [Res Gerontol Nurs. 2016; 9(3):109-114.].

Person-directed care planning in nursing homes: A scoping review: XXXX

Abstract Aim Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person‐directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person‐directed care planning (PDCP). Methods A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis. Results Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end‐of‐life care. Essential elements of PDCP include knowing the person, integrating the persons goals in care planning and updating care plans as individuals’ needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies. Conclusion This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP. Implications for practice These findings can be used to guide implementation of PDCP.

The Dementia Experience: Sociological Observations on the Construction of Cognition in Care Homes

Dementia is a pressing mental health problem with particular prevalence in care homes and other long-term care settings for older persons. Although biomedical knowledge about dementia is advancing rapidly, a cure remains beyond reach, and existing pharmacological treatment options are limited in efficacy and acceptability. Alternative, person-centred care strategies are therefore critically needed to support the quality of life of those living with dementia. Drawing on ethnographic case studies of care homes in the United Kingdom and United States, this chapter describes how the “institutional logics” underpinning care practices in different settings produced divergent “dementia experiences”, regardless of clinical diagnosis. Considering dementia as intersubjective and situated—not just pathological—highlights the potential for certain care strategies to ameliorate or even prevent the distress that is otherwise considered “symptomatic” of disease. The chapter concludes by discussing the significance of institutional logics theory for understanding mental health settings and services more broadly.

Person-Directed Care Planning in Nursing Homes: Resident, Family, and Staff Perspectives:

Empowering individuals to direct their own care is central to person-centered care and health care policy. However, there is limited knowledge of how “person-directed care planning” (PDCP) can be achieved in particular settings. This study identifies key structures and processes for operationalizing and implementing PDCP in nursing homes. Using participatory inquiry, we convened “stakeholder engagement sessions” with residents, families, nursing staff, and managers/administrators in two North Carolina nursing homes (N = 24 sessions; N = 67 unique participants). Stakeholders discussed current care-planning processes and provided feedback on an emergent conceptual framework of PDCP. Three themes emerged through directed-content analysis: strategies included providing formal and informal opportunities to engage in care planning and ensuring effective follow-through; different roles were required among leadership, staff, residents, and families to accomplish PDCP; and limits on achieving PDCP included competing priorities and perceived regulatory and resource constraints. Results are discussed in terms of the specific competencies required for accomplishing PDCP.