Work environment and person‐centred dementia care in nursing homes—A cross‐sectional study

Rutten, Johanna E R; Backhaus, Ramona; Tan, Frans E. S.; Prins, Marleen; Roest, Henriëtte van der; Heijkants, Ceciel; Hamers, Jan P.H.; Verbeek, Hilde

doi:10.1111/jonm.13386

Cited by 9 publications

(13 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Addressing divergent care values, processes, priorities, staff turnover and low foundational knowledge has the potential to create and sustain functional teams and support teamwork critical to person-centred practices, (cf. Kong et al, 2022;Oppert et al, 2018;Rutten et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…It was stressed that education and/or in‐house training possibilities are of great importance in addressing this gap. Previous research has shown that when staff share the same care philosophy, continuing education on dementia and regular supervision is associated with a higher degree of person‐centredness (Rutten et al., 2021; Sjögren et al., 2017). However, having low foundational knowledge may also imply that staff are set to provide care beyond their competence and expertise, hindering all efforts to promote PCC.…”

Section: Discussionmentioning

confidence: 99%

“…It was also reported that leadership involvement was the most important factor for implementing PCC (Jacobsen et al., 2017). Previous research has shown that it is of outmost importance that the leaders can communicate the goals and visions of PCC to reach a high quality of care (Rutten et al., 2021) and promote and maintain PCC in nursing homes (Backman et al., 2020). Although nursing home leadership has been shown to be of importance regarding translating the policy of PCC into practice (Backman et al., 2016, 2020; 2021) and overcoming barriers to the implementation PCC (Jacobsen et al., 2017; Quasdorf & Bartholomeyczik, 2019; Rokstad et al., 2015), no study has been found that explores nursing home managers own descriptions of barriers to lead PCC in nursing homes.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

Backman,

Ahnlund,

Lövheim

et al. 2023

Int J Older People Nursing

View full text Add to dashboard Cite

BackgroundResearch suggests that person‐centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person‐centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person‐centred care.ObjectivesTo explore barriers to leading person‐centred care as narrated by nursing home managers.MethodsA descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person‐centred nursing homes. Data were analysed using content analysis.ResultsMulti‐level barriers to leading person‐centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers.ConclusionMulti‐level barriers influence nursing home managers' ability to lead and promote person‐centred care. Promoting the development of person‐centred practices requires efforts to eliminate barriers on person, team and organisational level.Implications for PracticeIdentifying and overcoming barriers at various levels in nursing home care has the potential to promote person‐centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person‐centred practices. Multi‐level strategies are needed to target challenges at person‐, team‐ and organisational level when striving to develop person‐centred care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

Backman,

Ahnlund,

Lövheim

et al. 2023

Int J Older People Nursing

View full text Add to dashboard Cite

show abstract

“…Notable is that several of the positive factors attributed to the influence of the expert coaches pertained to behavioural qualities, such as employees’ sense of urgency, commitment, and open communication. Although such behavioural factors are known to have a large impact on the effectiveness of QI [ 30 ], they are also elusive and notoriously difficult to change. According to interviewees, the frequent and long-term presence of the expert coaches, in combination with their independent position, helped to create a climate of openness and trust in which new routines could be shaped and practised [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Improving the quality of care in nursing home organizations with urgent quality issues: design and effectiveness of a Dutch government-funded support programme

Vermunt,

Reijmer,

van Biessum

et al. 2023

BMC Health Serv Res

View full text Add to dashboard Cite

Background Various societal developments are currently challenging the ability of European nursing home organizations to meet quality standards. To support nursing home organizations throughout the Netherlands in quality improvement (QI), the Dutch government launched a nationwide programme in 2016 entitled ‘Dignity and pride’ (D&p). As part of this programme, participating nursing home organizations followed a tailored trajectory centred around intensive, on-site support from external expert coaches. For this study, we evaluated to what extent quality improvements were realized in the programme, paying particular attention to the role of the expert coaches. Methods Thirty-six nursing home organizations were included. At the start of D&p, the majority of these organizations (78%) had major quality issues as determined by the Health Care Inspectorate. Information on quality of care at the start versus end of the programme was obtained from improvement plans and final evaluation reports. Quality of person-centred care (PCC) and resident safety were quantified using a standardized assessment tool based on national guidelines, with improvements analysed using two-sided paired-sample T-tests. In addition, semi-structured interviews were conducted with 14 coaches and 29 healthcare professionals, focusing on the greatest benefits of programme participation and on the added value of the expert coaches. Results After completion of the programme, 60% of the organizations scored a 4 (= good) on PCC and resident safety, and none scored a 2 or less (average improvement on a 5-point scale for both themes: 1.9 points, p < 0.001). Interviewees confirmed that the quality of care had both improved and become more person-centred. The expert coaches were credited with substantially contributing to the QI process by offering an outsider’s perspective, bringing in experience and expertise, and helping the organization stay committed and focused. Conclusions Our study results suggest that the D&p programme was associated with improved quality of care in nursing home organizations with urgent quality issues. However, offering on-site tailored support through a nationally coordinated, government-funded programme is both time- and labour-intensive, and therefore not feasible in every healthcare setting. Nevertheless, the findings provide valuable insights for future QI support strategies.

show abstract

“…RCC facilitates a holistic view of the resident, recognising residents’ preferences and values, promotes autonomy, and right to self-determination. RCC emphasises partnerships between the health- carer and resident, in addition to care flexibility in attempt to contribute to meaningful lives and promote well-being for the residents [ 37 – 39 ].…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Work environment and person‐centred dementia care in nursing homes—A cross‐sectional study

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 9 publications

References 58 publications

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

Nursing home managers' descriptions of multi‐level barriers to leading person‐centred care: A content analysis

Improving the quality of care in nursing home organizations with urgent quality issues: design and effectiveness of a Dutch government-funded support programme

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

Contact Info

Product

Resources

About