Challenges and care strategies associated with the admission to nursing homes in Germany: a scoping review

Abstract

Background The admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany. Methods We conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model. Results Twelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people. Conclusion Although the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers.

Transitional care decision‐making through the eyes of older people and informal caregivers: An in‐depth interview‐based study

“…Yet this finding was also reflected in two studies and in one systematic review, in which results indicated informal caregivers' worries about whether or not they were making the right decisions for their loved ones, as well as feelings of ambivalence, such as guilt versus relief after a nursing home admission. [33][34][35] According to our findings, experiences in transitional care decision-making and involvement preferences and engagement, in particular, might be explained by the transition's urgency. Older people (and their informal caregivers) who faced an acute transition were often less active or were even totally uninvolved in the decision-making prosses.…”

“…The fact that 11 of the 15 informal caregivers in this study were the children of the older person may imply a high level of direct responsibility and commitment and thus burden. Yet this finding was also reflected in two studies and in one systematic review, in which results indicated informal caregivers’ worries about whether or not they were making the right decisions for their loved ones, as well as feelings of ambivalence, such as guilt versus relief after a nursing home admission 33–35 …”

“…Yet this finding was also reflected in two studies and in one systematic review, in which results indicated informal caregivers’ worries about whether or not they were making the right decisions for their loved ones, as well as feelings of ambivalence, such as guilt versus relief after a nursing home admission. 33 , 34 , 35 …”

Perceptions of Saudi psychiatric mental health nurses’ roles in the inpatient mental health care setting

“…However, Son et al .’s (2019) research concluded that PMHNs do provide various therapies, such as relaxation, aromatherapy and counseling. However, while PMHNs might value psychosocial interventions (Skudlik et al ., 2023), they are often incapable of implementing these practices due to a lack of time or training.…”

“…However, this preference for a medical model may not allow PMHNs to fulfill their caring role because it might assign them to being therapeutic assistants for psychiatrists (Skudlik et al ., 2023) or attendants for medical staff (Hayes, 2022).…”