Supporting autonomy in long-term care: Lessons from nursing assistants

Jacobs, Mary; Snow, A. Lynn; Allen, Rebecca S.; Hartmann, Christine W.; Dautovich, Natalie D.; Parmelee, Patricia A.

doi:10.1016/j.gerinurse.2018.07.004

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Staff members should be trained in patient-centred care strategies. ( 23 ) Communication between staff as to how individualized care is best delivered to specific residents is necessary for consistent care. ( 24 )…”

Section: Resultsmentioning

confidence: 99%

Addressing the Long-Term Care Crisis: Identifying Opportunities for Improvement Using Rapid Reviews

et al. 2022

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Background Long-term care (LTC) facilities require urgent, evidence-based care renewal. During 2020 three medical student-driven research projects aiming to study care satisfaction, patient care team dynamics, and advance care directive effectiveness in a local LTC facility required a marked shift in approach due to COVID-19 regulations. Methods All three projects were re-invented as rapid reviews from their initial designs intended to provide a baseline for quality improvement projects. English-limited PubMed searches for publications within the past 10 years were undertaken. Review articles were prioritized and supplemented by individual studies. Students reviewed the initial abstracts, reviewed them with a supervisor/mentor, assessed the articles for quality, and synthesized major themes. Results A total of 52 publications were evaluated for the final synthesis of all three projects. Relevant information was retrieved for all three areas, suitable for local evaluation/intervention at micro, meso, and macro policy levels. Conclusions Rapid reviews of issue-specific, long-term care literature are low resource avenues towards coordinated care improvement. They may also serve as rapid means for regular policy updates while providing next-generation care providers with improved LTC perspectives.

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Section: Resultsmentioning

confidence: 99%

Addressing the Long-Term Care Crisis: Identifying Opportunities for Improvement Using Rapid Reviews

et al. 2022

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“…Aged care staff often described their work in highly moral terms, as a professional vocation (Andersson Marchesoni et al, 2017;Nordstrom & Wangmo, 2018;Sellevold et al, 2013;Spenceley et al, 2017;Tuckett et al, 2009). An ideal caregiver was seen as someone who is well presented, caring and respectful to others, goes above and beyond the call of duty, and takes personal satisfaction and pride in supporting older people (Adams & Sharp, 2013;Carryer et al, 2010;Lindsey Jacobs et al, 2019;Ludlow et al, 2020;Tuckett et al, 2009;van Der Borg et al, 2017). The ability to provide good quality care stemmed from a combination of personal qualities and professional competencies.…”

Section: Aged Care As a Vocationmentioning

confidence: 99%

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

Garratt

Kosowicz

Gilbert

et al. 2021

Journal of Clinical Nursing

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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.

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“…Person-centered care (PCC) is widely adopted in dementia care all over the world, and supporting autonomy is among the core principles of PCC 12 . Shifting the focus of power to residents is also a primary goal of “Cultural Change” in care facilities.…”

Section: Introductionmentioning

confidence: 99%

Autonomy-supportive environments for people with dementia: an evidence-based review

2023

Interdisciplinary Nursing Research

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Objective: As one of the core principles of person-centered care, supporting the autonomy of residents with dementia has received increasing attention worldwide. Supportive physical environments play an important role in promoting autonomy in the everyday life of residents in care facilities. However, there is no universal definition for autonomy in everyday life nor focused research on autonomy-supportive environments. Thus, this study aims to systematically review the existing evidence of autonomy-supportive design features based on a synthesized concept analysis of autonomy in everyday life. Methods: A synthesized concept analysis on autonomy was conducted based on related definitions of autonomy in design guidelines and environmental assessment tools of elderly care facilities. Using keywords from the concept analysis, multiple databases including PubMed, Web of Science, CINAHL, PsycINFO, and Dementia Design Info were used to carry out a systematic review of autonomy-supportive environmental design features for people with dementia. Additional guidelines and standards were manually searched. The design features supported by empirical studies and studies based on experts’ experience were extracted from the literature. The evidence intensity of each feature was assessed according to the quality and quantity of related studies. Results: Four domains of autonomy, freedom, independence, control, and choice emerged based on the concept analysis. Seventy-eight autonomy-supportive design features were extracted from the literature. Features are summarized into 8 categories: building layout, circulation space, living room, dining space, bathroom, bedroom, outdoor space, and details. Of design features, 60% in the category of building layout have been cross-validated by empirical studies, whereas only 25% of the overall design features have. Conclusions: The results of this review show that numerous design features of the physical environment can support the autonomy of people with dementia in the 4 domains. Features of building layout are well researched and the evidence intensity for the rest of design features still needs to be improved through future empirical studies.

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Supporting autonomy in long-term care: Lessons from nursing assistants

Cited by 10 publications

References 34 publications

Addressing the Long-Term Care Crisis: Identifying Opportunities for Improvement Using Rapid Reviews

Addressing the Long-Term Care Crisis: Identifying Opportunities for Improvement Using Rapid Reviews

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

Autonomy-supportive environments for people with dementia: an evidence-based review

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