Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item Stakeholder’s experiences of living and caring in technology-rich supported living environments for tenants living with dementia(BioMed Central, 2023-02-01) Daly-Lynn, Jean; Ryan, Assumpta; McCormack, Brendan; Martin, SuzanneBackground: Technology innovation provides an opportunity to support the rising number of people living with dementia globally. The present study examines experiences of people who have dementia and live in technology enriched supported care models. Additionally, it explores caregiver’s attitudes towards technology use with the housing scheme. Methods: A qualitative research design was adopted, and eight housing schemes consented to take part in the study. A technology audit was undertaken in addition to participant interviews and caregiver survey. Seven peer researchers conducted semi-structured interviews with 22 people living with dementia. Interviews were analysed using thematic analysis. Informal and formal caregivers were invited to complete a survey to capture their attitudes towards technology use. A total of 20 informal and 31 formal caregiver surveys were returned. All surveys were input into Survey Monkey and downloaded into excel for analysis. Closed questions were analysed using descriptive statistics and open-ended questions were organised into themes and described descriptively. Results: The technology audit identified that technologies were in place from as early as 2002. Technology heterogeneity of, both passive and active devices, was found within the housing schemes. Technologies such as wearable devices were reportedly used according to need, and mobile phone use was widely adopted. The themes that developed out of the tenant interviews were: Attitudes and Engagement with Technology; Technology Enhancing Tenants Sense of Security; Seeking Support and Digital Literacy; and Technology Enabled Connection. A lack of awareness about living alongside technology was a major finding. Technologies enabled a sense of reassurance and facilitated connections with the wider community. The interaction with technology presented challenges, for example, remembering passwords, access to Wi-Fi and the identification of its use in an emergency. The caregiver survey reported a range of facilitators and barriers for the use of technology within care. Both types of caregivers held relatively similar views around the benefits of technology, however their views on issues such as privacy and consent varied. Safety was considered more important than right to privacy by family caregivers. Conclusions: The present study provides new insight into stakeholder’s experiences of living, working and caregiving alongside technology in supported living environments. As the generation of people living with dementia become more tech savvy, harnessing everyday technologies to support care could enable holistic care and support the transition through the care continuum. Advance care planning and technology assessments are at the very core of future technology provision. It is evident that a paternalistic attitudes towards technology use could impact the multitude of benefits technology can play in both health and leisure for people living with dementia and their caregivers.Item A narrative review of staff views about dementia care in hospital through the lens of a systems framework(SAGE Publications, 2022-12-29) Duah-Owusu White, Mary; Kelly, FionaBackground: Significant numbers of people with dementia are admitted into acute settings. They are likely to face poor health outcomes during hospitalisation. There is the need to fully understand the care provided to people with dementia through novel methods such a systems approach (i.e. human interactions, policy, environment and equipment). Aim: The aim of this literature review is to explore hospital practitioners’ views on dementia care and to analyse findings using a systems approach. Methods: We conducted a narrative review of primary studies that examined dementia care in acute settings. We analysed a total of 33 papers using Thomas and Harden’s thematic synthesis guidelines. Results: Thirty-three papers met the inclusion criteria for the review. The findings were as follows: (1) staff-patient relationships (e.g. coping with difficult behaviour), (2) staff–family relationships (e.g. the benefits of involving families in patient care), (3) staff–staff relationships (e.g. building a robust multidisciplinary team), (4) staff–patient care decisions (e.g. decisions directly related to the patient), (5) the environment (e.g. difficulty in adjusting to the hospital environment), (6) policies (e.g. hospital bureaucratic processes) and (7) equipment (e.g. pain assessment tools). Conclusion: The paper revealed multidimensional challenges in the provision of dementia care within hospitals. We conclude that training programmes, hospital policies and processes aimed at improving outcomes for patients with dementia should adopt a systems approach which focuses on the relational, environmental, procedural and instrumental aspects of the hospital system.Item How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review(BMC, 2022-04-22) Marulappa, Nidhi; Anderson, Natalie N.; Bethell, Jennifer; Bourbonnais, Anne; Kelly, Fiona; McMurray, Josephine; Rogers, Heather L.; Vedel, Isabelle; Gagliardi, Anna R.Background: Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods: We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results: We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion: Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.Item A qualitative study of family members' experiences of their loved one developing dementia and their subsequent placement in a nursing home(Wiley, 2021-02-07) Fekonja, Zvonka; Kmetec, Sergej; Novak, Barbara; McCormack, Brendan; Mlinar Reljić, NatašaAim: To investigate the family members' experiences with receiving help and support while their loved one develops dementia and their subsequent placement in nursing homes.Item Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)(BMJ Publishing Group, 2020-12-13) Sampson, Elizabeth L.; Feast, Alexandra; Blighe, Alan; Froggatt, Katherine; Hunter, Rachael; Marston, Louise; McCormack, Brendan; Nurock, Shirley; Panca, Monica; Powell, Catherine; Rait, Greta; Robinson, Louise; Woodward-Carlton, Barbara; Young, John; Downs, MurnaObjectives: To pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents. Design: Pilot cluster randomised controlled trial. Setting: 14 NHs (7 intervention, 7 control) in London and West Yorkshire. Participants: NH residents, their family carers and staff. Intervention: Complex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) ‘Stop and Watch (S&W)’ early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators. Outcome measures: Data on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted. Results: We recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm. Conclusions: Recruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted. Trial registration number: ISRCTN74109734 (https://doi.org/10.1186/ISRCTN74109734). Original protocol: BMJ Open. 2019;9(5):e026510. doi:10.1136/bmjopen-2018-026510.Item Acceptability and use of a patient-held communication tool for people living with dementia: A longitudinal qualitative study(BMJ, 2020-05-05) Leavey, Gerard; Corry, Dagmar; Waterhouse-Bradley, Bethany; Curran, Emma; Todd, Stephen; McIlfatrick, Sonja; Coates, Vivien; Watson, Max; Abbott, Aine; McCrory, Bernadine; McCormack, BrendanObjectives: To assess the acceptability and use of a low-cost patient-held communication tool.Item Facilitation of a workplace learning intervention in a fluctuating context: An ethnographic, participatory research project in a nursing home in Norway(Foundation of Nursing Studies (FoNS), 2018-10-14) Dahl, Hellen; Dewing, Jan; Mekki, Tone Elin; Håland, Astrid; Øye, ChristineBackground: This single-site nursing home study is part of a larger cluster-randomised controlled trial that aimed to reduce staff use of restraint. The cluster-RCT study involved 24 nursing homes, and investigated the effect of a standardised education intervention to reduce restraint in dementia care with a person-centred care approach. This article draws on empirical data from one of the nursing homes in the control group of the trial, at which the education intervention was tailored to better account for contextual circumstances. Aim: To explore how a tailored education intervention can reduce the use of restraint in a nursing home. The study aims to investigate what local contextual circumstances influenced the process of facilitation of the intervention. Methods: The study was theoretically informed by the Promoting Action Research Implementation in Health Services (PARiHS) framework, with practice development principles to address local learning needs and contextual issues. External facilitators tailored the education intervention in collaboration with the nursing home leader and staff. A participatory design with data collection based on principles of critical ethnography was used to evaluate the intervention. Results: Fluctuation emerged as the core theme from the evaluation: fluctuating enthusiasm among staff, fluctuating nursing home culture and fluctuating responses by care home residents. Conclusion: The study offers insights into the interplay between a tailored facilitation intervention and fluctuating contextual circumstances in a nursing home. Implications for practice: A successful education intervention requires facilitators who can take into consideration and adapt to fluctuations in the context Facilitation skills must include the ability to value team experiences, recognise learning needs, provide feedback and participate in finding solutions in the moment Flexibility is important in terms of how new knowledge can be used in person-centred ways, notably in attempts to reduce the use of restraint in dementia careItem Developing facilitation skills amongst undergraduate nursing students to promote dementia awareness with children in a higher education institution (innovative practice)(Sage, 2018-11-17) Gibson, Caroline; Rennie, Karen; Dewing, Jan; McKinlay, LesleyFinal year students on a BSc Hons Nursing programme in Scotland were supported to become Dementia Friends facilitators and develop interactive dementia awareness sessions for children from local schools. The children were invited to indicate phrases and images they associated with ‘dementia’ at the outset and end of the session. Analysis of the responses suggested that there were positive changes in the children’s values and beliefs when thinking about a person living with dementia during the sessions. We suggest that peer learning is a valuable strategy to increase public and professional awareness about dementia and supports the development of graduate attributes.Item Haven: Sharing receptive music listening to foster connections and wellbeing for people with dementia who are nearing the end of life, and those who care for them(Sage, 2018-10-11) Garabedian, Claire E.; Kelly, FionaThis paper reports on research exploring the effects of music played for 12 dyads: a care home resident (‘resident’) with dementia and someone closely connected to him/her (‘carer’). Six individualised music interventions (3 live and 3 pre-recorded) were played by the first author on solo cello within five Scottish non-NHS care homes. All interventions were video-recorded. Semi-structured interviews with carer participants, key staff, and managers explored their responses to interventions. Thick descriptions of video recordings and interview transcripts were thematically coded using Nvivo. A key finding was that structural elements of the interventions combined with characteristics of the music played facilitated an internalised experience of ‘haven’; sonically transporting listeners away from their present reality and fulfilling the basic human needs for inclusion, comfort, identity, occupation and attachment.Item Research and education to understand fire risks associated with dementia: A collaborative case study (innovative practice)(SAGE, 2018-08-01) Heward, Michelle; Kelly, FionaThis article reports on outcomes from the evaluation of a collaborative project between a University and a Fire and Rescue Service where research and education were developed to inform understanding of fire risks associated with dementia. Project outcomes were determined using a mixed-methods approach (survey, reports, statistics, case studies, course evaluation forms). Main outputs were a research report that identified dementia-specific fire risks and safety strategies, and an education package for Fire and Rescue Service staff and volunteers. The evaluation demonstrates the value of collaborative partnerships to develop understanding of risks pertinent to particular vulnerable groups and research-informed education.