Responding to Poor-Quality Care During Research in Nursing Homes

Krause, Melanie R.; Palmer, Janice L.; Bowers, Barbara J.; Buckwalter, Kathleen C.

doi:10.3928/19404921-20100504-04

Cited by 3 publications

(5 citation statements)

References 13 publications

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“…Nowadays, inability to manage activities of daily living independently is a common excuse for admission of older people to a nursing home. 2 This bears significant new considerations of delivery of health care systems to the country and increases demand for medical care and nursing homes.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study exploring issues related to medication management in residential aged care facilities

Nizaruddin¹,

Omar²,

Mhd-Ali³

et al. 2017

PPA

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BackgroundGlobally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs).Participants and methodsA total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner.Results and discussionThree themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes.ConclusionThere are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

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Section: Introductionmentioning

confidence: 99%

A qualitative study exploring issues related to medication management in residential aged care facilities

Nizaruddin¹,

Omar²,

Mhd-Ali³

et al. 2017

PPA

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“…It is generally accepted that should participants disclose dangerous practices which suggest the potential for harm to others researchers should consider divulging this information to an appropriate authority or professional (Johnson & Long, 2015). However, responding to care that is of poor quality, where care practices are problematic, but do not meet the definition of reportable abuse, is not so straightforward (Krause et al, 2011). In this study, anecdotes of poor nursing practice around the use of PRN medication were recounted by participants however they were recounted about other individuals and were not an account of their own practice.…”

Section: Discussionmentioning

confidence: 86%

“…This study has identified some poor practices around the use of PRN medication that require discussion from an ethical perspective. When undertaking research within the healthcare setting, there is the potential for researchers to observe poor or unsafe practices or to hear about them (Krause, Palmer, Bowers, & Buckwalter, 2011). It is generally accepted that should participants disclose dangerous practices which suggest the potential for harm to others researchers should consider divulging this information to an appropriate authority or professional (Johnson & Long, 2015).…”

Section: Discussionmentioning

confidence: 99%

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

Jimu¹,

Doyle

2019

Issues in Mental Health Nursing

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Pro re nata (PRN) medication is medication administered by nurses as required commonly in response to a patient's symptoms or behaviour including insomnia, agitation or anxiety. There is a paucity of research around the process of PRN administration in mental health settings in Ireland and international evidence suggests inconsistencies in practices. This study aimed to explore the process of PRN medication administration by mental health nurses. Using a qualitative descriptive design, semi-structured interviews were undertaken with 19 mental health nurses in three acute inpatient units in one mental health service in Ireland. Most participants reported undertaking an assessment of the patient before administering PRN medication however many also reported having observed incidents of poor practice. There was evidence of some interdisciplinary sensitivities around instructions regarding the use of PRN medications between doctors who prescribed them and nurses who dispensed them. A need for service improvements were also identified including the use of alternative strategies to PRN use such as de-escalation techniques and education around psychopharmacology. PRN medication is commonly used in mental health settings however this study suggests that there is potential for improvement in relation to how it is prescribed and administered. Overuse of PRN medication has been associated with increased morbidity. Mental health nurses are required to carefully consider whether PRN medication is warranted in the first instance and how its use might impact on patients.

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“…Neglect maybe understood as an omission by somebody to provide care which they had a duty to provide (Mandelstam, 2014), whereas an error is defined as a "failure of a planned action to be completed as intended or use of a wrong plan to achieve an aim" (Kohn et al, 1999); it does not always result in harm (Chamberlain et al, 2012). Responding to poor quality-of-care which does not reach the definition of reportable neglect or abuse is noted to be problematic (Krause et al, 2011). The UK prevalence survey of the abuse of older people utilises the term mistreatment to refer to all forms of abuse (psychological, physical, sexual and financial) and neglect (O'Keeffe et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…In the USA, Krause et al (2011) established that there are varying definitions of reportable abuse in different states. The Welsh Neglect Project found evidence that there is a lack of a coherent and shared view about what constitutes neglect (Stevens and Laing, 2015).…”

Section: Discussionmentioning

confidence: 99%

A concept analysis of poor care using Rodgers’ evolutionary cycle

Shanahan

2019

JAP

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Purpose The purpose of this paper is to examine and explicate the concept of poor care by exploring what it is and what contributes to its occurrence in practice with a particular focus on the care of older people. Design/methodology/approach The results of systematically searched published literature were analysed using an inductive, descriptive, thematic approach as part of Rodgers’ evolutionary concept analysis method. Findings The concept of poor care is understood in the context of the antecedents of vulnerability, use of healthcare services and interaction with healthcare personnel. Its defining characteristics involve individual’s personal traits, interpersonal dynamics, an endangered self, misconceptions or organisational constraints. Research limitations/implications Further research is needed to explore the recognition of poor care and reporting thresholds. In addition, the role of the “zone of tolerance” of expectations in the delivery and receipt of interpersonal care and attention for older people needs to be better understood. Originality/value Understanding the continuum and mapping the structures of poor care in contemporary UK healthcare practice can help sensitise practitioners to the widespread range and potential for instances of poor care. This concept analysis uniquely demonstrates consequences not only for the patient but also for healthcare staff and other individuals.

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Responding to Poor-Quality Care During Research in Nursing Homes

Cited by 3 publications

References 13 publications

A qualitative study exploring issues related to medication management in residential aged care facilities

A qualitative study exploring issues related to medication management in residential aged care facilities

The Administration of Pro re nata Medication by Mental Health Nurses: A Thematic Analysis

A concept analysis of poor care using Rodgers’ evolutionary cycle

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