Legitimizing neglect - a qualitative study among nursing home staff in Norway

Lund, Stine; Skolbekken, John-Arne; Mosqueda, Laura; Malmedal, Wenche

doi:10.1186/s12913-023-09185-1

Cited by 7 publications

(13 citation statements)

References 52 publications

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“…The pattern of the included papers suggested that the scientific literature describing fundamental nursing (Q1), the experience and descriptions of fundamental nursing (Q2), interventions or activities targeting fundamental nursing and continuity of care (Q3) were in most cases focusing on individual physical needs. In many papers, fundamental nursing was described to point towards fragmented and suboptimal fundamental nursing in home- and facility-based care, in line with previous literature reviews [ 10 , 114 – 116 ] and primary research studies [ 117 , 118 ]. The pattern of fragmented care could also be put in relation to one of the recurring descriptions from the analysis, that is, the lack of both sufficient and adequately trained nursing personnel and relationship to less-than-optimal fundamental nursing within home- and facility-based care [ 68 *, 69 *, 71 *, 72 *, 73 *, 75 *, 79 *, 80 *, 83 *, 89 *, 90 *, 93 *, 94 *, 97 *, 98 *, 107 *].…”

Section: Discussionmentioning

confidence: 73%

What about the fundamentals of nursing—its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

Nordaunet,

Gjevjon,

Olsson

et al. 2024

BMC Nurs

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Aim This scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people’s fundamentals of care needs in home- or facility-based care. Methods This scoping review was carried out following the steps of Arksey and O’Malley’s methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023. Results Forty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition—or rather nutritional care activities targeting eating and drinking—was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care. Conclusion Fundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing. Trial registration Open Science Framework https://doi.org/10.17605/OSF.IO/XJ39E Protocol: http://dx.doi.org/10.1136/bmjopen-2022-069798

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Section: Discussionmentioning

confidence: 73%

What about the fundamentals of nursing—its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

Nordaunet,

Gjevjon,

Olsson

et al. 2024

BMC Nurs

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“…Intentional or not, this handling of cognitive dissonance and moral distress, depicts neglectful behaviour as less severe, and thus easier for the staff to face in their everyday work. This is also indicated by previous research showing that nursing staff regularly fail to recognise their own practices as neglectful, normalising missed care as a way of legitimising neglect [ 45 ]. Tolerating neglect may be a way of enabling existing and insufficient care practices.…”

Section: Discussionmentioning

confidence: 88%

“…The sample included 13 registered nurses (RN), 12 licensed practical nurses (LNP), one social worker (SW), one social educator (SE) and three nurse assistants (A). A more detailed overview of participants has been given elsewhere [ 45 ].…”

Section: Methodsmentioning

confidence: 99%

“Just pee in the diaper” - a constructivist grounded theory study of moral distress enabling neglect in nursing homes

Lund,

Malmedal,

Mosqueda

et al. 2024

BMC Geriatr

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Background A growing body of evidence shows that many nursing home residents’ basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: “How do nursing home staff manage their moral distress related to neglectful care practices?” Methods A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. Results Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. Conclusions Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

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“…The recent theoretical academic literature shows that healthcare professionals are particularly susceptible to burnout due to risky decision-making involving people, empathy, and responsibility (Lluch et al 2022). The literature addressing burnout among nurses in retirement homes, where specialised services are tailored to individuals typically aged 80 and above (Friganović et al 2019;Lund et al 2023), is noticeably sparse, especially when juxtaposed with the extensive research conducted on various aspects of nursing practice (De Diego-Cordero et al 2022) and investigations into COVID-19 prevalence rates (Mary Pappiya et al 2023), but not on demographic issues (Sherman and Touhy 2017). Consequently, there is an imperative to establish conducive conditions for nursing staff to flourish and grow, ensuring their capacity to provide high-quality care.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Burnout Experienced by Nurses in Retirement Homes on Human Resources Economics

Leskovic,

Gričar,

Folgieri

et al. 2024

Economies

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The human resources economic implications of nursing burnout amongst nurses working in retirement homes have become a critical concern within the healthcare industry. As the backbone of care provision in these settings, it is crucial to understand the consequences of burnout on the workforce’s well-being and organisational sustainability. This study aims to investigate burnout among nurses working in retirement homes in Slovenia. The reasons for burnout vary across countries and regions, so gathering data specific to this population is essential. Through surveys conducted among 253 nurses and medical technicians, factor analysis revealed three factors for burnout: emotional exhaustion, reduced personal fulfilment, and impersonality. This research aims to pave the way for reducing workplace stress by creating new opportunities for better working conditions. To achieve these goals, executive management in retirement homes should gain proficiency in the four elements of the quality management cycle: planning, execution, evaluation, and continuous improvement. Furthermore, a comparative analysis was conducted to collate the empirical findings with those from Croatia.

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Legitimizing neglect - a qualitative study among nursing home staff in Norway

Cited by 7 publications

References 52 publications

What about the fundamentals of nursing—its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

What about the fundamentals of nursing—its interventions and its continuity among older people in need of home- or facility-based care: a scoping review

“Just pee in the diaper” - a constructivist grounded theory study of moral distress enabling neglect in nursing homes

The Effect of Burnout Experienced by Nurses in Retirement Homes on Human Resources Economics

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