Family members' prioritisation of care in residential aged care facilities: A case for individualised care

Abstract

Objectives To investigate family members' prioritisation of care in residential aged care facilities (RACFs). Introduction and background Family members are often involved in the care of their older relatives even after these relatives transit to a RACF. Understanding family members' priorities regarding care (i.e., what is most important to them) can provide valuable insights into how to better meet residents' needs. Design A multisite mixed‐methods study comprising qualitative methods and Q methodology. The qualitative component of the study was guided by the COREQ checklist. Methods Participants comprised 27 family members of residents living in one of five participating Australian RACFs. Participants rank‐ordered 34 cards, each representing an aspect of care, on a predefined grid from “Least important” (−4) to “Most important” (+4). Participants also engaged in a think‐aloud task, demographic questionnaire, post‐sorting interview and semi‐structured interview. Q data were analysed using inverted factor techniques to identify factors that each represent a portion of shared meaning. Factors were interpreted as viewpoints using data from the think‐aloud task and interviews. These data were further analysed using inductive content analysis to reveal influences on prioritisation decision‐making. Results Three distinct viewpoints were identified through Q methodology: prioritisation of residents' physical needs, maintaining residents' independence, and human connection. Inductive content analysis revealed four influences on prioritisation decision‐making: residents' capabilities and support requirements, unmet needs, family bridging the gaps, and family knowledge of residents. Conclusions The study indicated that to meet residents' needs and family members' priorities, individualised approaches to care are warranted. It also demonstrated the vital role family members play in residents' care when needs are not fully met. Relevance to Clinical Practice Strategies to improve individualised care in clinical practice include flexibility of routines, supporting family members' involvement in care, workforce training focused on family–staff communication, and safer staffing ratios.

Aged care residents’ prioritization of care: A mixed‐methods study

“…Consequently, the sample was biased towards residents who had higher cognitive capacity and physical health. As Q methodology can be a cognitively demanding tasks, we recommend that future studies include residents with cognitive impairment in studies of care prioritization using survey methods, 49,50 interviews 51 or family proxies 18,52 . Despite this limitation, the sample comprised residents with a variety of needs, self‐perceived levels of health, medical conditions and functional abilities.…”

“…Materials for the card-sorting activity comprised a set of 34 cards (Q sort deck), each representing an aspect of care, and a forced distribution sorting grid (Q sort Grid) on which participants ordered the cards (Figure 1). 17 The Q sort deck was taken from our related studies of staff and family members' prioritization of care, 16,18 with slight modifications. For example, 'residents have independence' and 'my family member has independence' were modified to 'I have independence'.…”

“…As Q methodology can be a cognitively demanding tasks, we recommend that future studies include residents with cognitive impairment in studies of care prioritization using survey methods, 49,50 interviews 51 or family proxies. 18,52 Despite this limitation, the sample comprised residents with a variety of needs, self-perceived levels of health, medical conditions and functional abilities. While the sample was limited to a single provider, participants were recruited from five RACFs across two Australian States in an attempt to reduce the influence of environmental context.…”

Decisions and Dilemmas: The Context of Prioritization Dilemmas and Influences on Staff Members’ Prioritization Decisions in Residential Aged Care

“…This study forms part of a larger project on care prioritization in RAC from the perspectives of staff members, family members, and aged care residents (Ludlow, Churruca, Ellis, et al, 2019, 2020; Ludlow, Churruca, Mumford, et al, 2020; Ludlow et al, 2021). Our related study investigated staff members’ priorities and how they prioritize care in RACFs.…”

“…Kalisch et al’s (2009) Missed Nursing Care Model and Schubert et al’s (2007) Conceptual Framework of Implicit Rationing of Nursing Care both situate prioritization decision-making as a precursor to missed care/rationing and consequently, patient outcomes. While both models/frameworks focus on nursing care in acute settings, our related studies on prioritization demonstrate their relevance to the care provided in RAC settings (Ludlow, Churruca, Ellis, et al, 2020; Ludlow, Churruca, Mumford, et al, 2020; Ludlow et al, 2021).…”