What is and what ought to be: A meta‐synthesis of residential aged care staffs’ perspectives on quality care

Abstract

Background: As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives.Objective: A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care." Methods: Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers.Results: Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. Conclusion:Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity.Relevance to clinical practice: This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment. K E Y W O R D Smeta-synthesis, nursing practice, qualitative research, quality care, residential care | 3125 GARRATT eT Al.

Measuring person-centred care in German nursing homes – exploring the construct validity of the Dementia Policy Questionnaire: a cross-sectional study of a secondary data set

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“…Echoing the findings in this article, it can be epitomised by ‘being seen and respected as a person and … being informed and involved in one's own care and treatment’ (Nilsen et al, 2022, p. 573). Second, person‐centred care can be difficult to realise, largely due to limited resources, including time and competencies (Garratt et al, 2021; Watson & Hatcher, 2021). Extending previous research, this study demonstrates that despite the oft‐cited challenges that hinder quality aged care, brilliance happens.…”

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“…Yet LTRC facilities remain highly structured work environments where the relational aspects of work that are key to person-centeredness can be perceived as not meeting the standard of "real work," which is bound up with instrumental values of linearity, abstraction, and rationality (Banerjee et al, 2021). The historically low station of LTRC in society has depended on the moral complexities and relational skills found beneath the surface and on the margins of "real work" failing to be accounted for (Garratt et al, 2021). Dissonance between tenets of person-centered philosophy and delivery of LTRC is reflected in the policy landscape which does not emphasize social care guidelines for building relationships (Hande, Keefe, & Taylor, 2021;Lowndes & Struthers, 2017).…”

“…This finding is supported by work from Lightman (2021), who reported on interviews with immigrant women HCAs from Alberta and found that participants wished for their voices to be better understood and taken as integral to public conversations about reform and improvement of the LTRC sector. Similarly, Garratt et al's (2021) metasynthesis of LTRC staff perspectives on quality care found that staff positioned broader institutional and political contexts, government funding, regulation, and minimum staffing/training levels as occupying the space between "what is and what ought to be" in quality care (Garratt et al, 2021). Ideals of what workers know to be possible supply a promising source of engagement towards greater congruence between care realities, organizational cultures, and policy.…”