Residents’ and Relatives’ Experiences of Acute Situations: A Qualitative Study to Inform a Care Model

Abstract

Background and Objectives As new models of care aiming to reduce hospitalizations from nursing homes emerge, their implementers must consider residents’ and relatives’ needs and experiences with acute changes in the residents’ health situations. As part of the larger INTERCARE implementation study, we explored these persons’ experiences of acute situations in Swiss nursing homes. Research Design and Methods Three focus groups were conducted with residents and their relatives and analyzed via reflexive thematic analysis. Results The first theme, the orchestra plays its standards, describes experiences of structured everyday care in nursing homes, which functions well despite limited professional and competency resources. The second theme, the orchestra reaches its limits, illustrates accounts of acute situations in which resources were insufficient to meet residents’ needs. Interestingly, participants’ perceptions of acute situations went well beyond our own professional view, i.e., changes in health situations, and included situations best summarized as “changes that might have negative consequences for residents if not handled adequately by care workers.” Within the third theme, the audience compensates for the orchestra’s limitations, participants’ strategies to cope with resource limitations in acute situations are summarized. Discussion and Implications Our findings suggest differences between care providers’ and participants’ perspectives regarding acute situations and care priority setting. Alongside efforts to promote staff awareness of and responsiveness to acute situations, care staff must commit to learning and meeting individual residents’ and relatives’ needs. Implications for the development and implementation of a new nurse-led model of care are discussed.

Positive effect of the INTERCARE nurse‐led model on reducing nursing home transfers: A nonrandomized stepped‐wedge design

“…The needs and wishes of residents and relatives concerning unplanned transfers to refine the core elements were assessed. 29 …”

Identifying Appropriate Nursing Home Resources to Reduce Fall-Related Emergency Department Transfers

“…In Switzerland, geriatric expertise is lacking in NHs, and caregivers, residents, and relatives need timely geriatric support and advice after a fall or fall-related injury. 40 The presence of APNs in NHs or support from RNs working in extended roles are considered key solutions to re-engineer resources already present in Swiss NHs. 40e42 NH stakeholders are in favor of APNs and RNs with additional training providing that these roles are fully embedded in teams, as opposed to "consulting" APNs or RNs, which visit NHs based on needs.…”

Pathways for older patients in acute situations and involved actors' experiences of decision-making in ambulatory care

“…At times, significant others and healthcare professionals were perceived as steering an older patient's decision in different direction than what the older patient had first decided (150). When support from healthcare professionals at nursing homes lacked in acute situations, older patients and significant felt abandoned (27). Some older patients' also, described a limited opportunity to be included in decision-making during acute situations at nursing homes (10), and others relied on healthcare professionals to make the best decisions for them, thereby taking a passive role (149-151).…”

“…Some older patients' also, described a limited opportunity to be included in decision-making during acute situations at nursing homes (10), and others relied on healthcare professionals to make the best decisions for them, thereby taking a passive role (149-151). Relying on healthcare professionals was described as being connected to their assessments being competent and that they showed respect (27). However, in Sweden, there is limited knowledge about older patients' experiences of decision-making in acute situations in ambulatory care.…”

“…Acute situations reflect undesirable, intense or severe feelings that with the right treatment at the right time will pass, become chronic or lead to death. Acute situations occurs at every level-of-care (25) due to diseases, injuries, or deterioration of chronic diseases (26,27). Diseases refers to pathophysiological description of symptoms and diagnosis, whereas illness refers to the subjective experience of symptoms (28).…”