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Assessment of patients' needs and resources as a basis in supervision for individualised nursing care in nursing home wards: evaluation of an intervention study
Karolinska institutet.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The study in this thesis was conducted as an intervention project in three nursing home wards in Sweden, in a big city as well as in rural areas, one year in each ward. The intervention consisted of supervision for individualised and documented nursing care with a multidimensional assessment instrument, the Resident Assessment Instrument (RAI/MDS), used as a basis. The main aim was to evaluate the intervention in the wards.

Study I aimed at reviewing nursing documentation in the wards before and after the intervention. Quantitative content analysis was used to review the total number of nursing documentation (n = 58 + 57). The greatest change seen after intervention was the writing of care plans for the individual patients. Daily notes increased in length and number but reflected mostly occasional situations, as before. Computer-triggered Resident Assessment Protocol (RAP) items, obtained from the RAI/MDS assessments and regarded as a means of quality assurance, was used to compare items in the nursing care plans. The aim of study II was to compare patients' life stories and current situations as told by carers (n = 30 + 30). Qualitative content analysis was used to disclose changes and to enable descriptions of patterns in the text. After the intervention the patient was more seen as a unique person with resources and abilities despite limitations, and the nurses' awareness of their own professional approach increased. In study III a phenomenological-hermeneutic approach was used to illuminate nurses' video recorded interactions in morning care sessions involving patients, in one ward, suffering from severe dementia. In order to disclose any changes in the nurses' interactions the video recordings were conducted before, during and after the intervention (n = 24). The meaning in the interactions between the nurse and the patient were communicated through the balancing in actions and reactions, verbal- as well as non- verbal, and was about confirmation and the lack of it. This could fluctuate at times and be present within the whole complex of nursing care situations. The intervention contributed to developing a relationship of intersubjectivity and thus a greater emphasis on confirming nursing care. In study IV stimulated recall interviews were used in connection with the video recordings in order to illuminate the significance of nurses' reflections on their interactions with the patients (n = 12). Another aim was to find out if any changes in their reflections took place across the intervention. A phenomenological-hermeneutic approach revealed that nurses improved their ability to verbalise their reflections and to be aware of their own influence on care quality. The meaning in nurses' reflections was about efforts to maintain a sense of dignity for the patients as well as for themselves. In study V the Cognitive Performance Scale (CPS) included in the RAI/MDS was used to demonstrate the cognitive performance in elderly persons on different levels of care (n = 1276). Cognitive impairments in different stages were found for all levels of care investigated. In nurses' views (n = 50) of using the RAI/MDS (V) a majority thought that the instrument could contribute to improved care quality, even if some of them were hesitant. As the instrument made nurses more aware of the need for information, they thought that information as well as knowledge about the patient increased. They stated in their comments that the assessment covered all areas, and that they sought information they had not paid attention to or bothered about before the intervention, and further, that more of the patients' capacity and interests were considered. The importance of continuing education and supervision was confirmed by the study. It seemed as if the supervision and the use of a comprehensive and detailed assessment tool contributed to increased knowledge about the patients and to efforts to see them as real persons even behind a dementia surface.

Place, publisher, year, edition, pages
Hägersten: Baran Tryck , 2000. , [6], 80, 11, [1] p.
Keyword [en]
Geriatric nursing
Keyword [sv]
Geriatrik, Geriatri
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-182ISBN: 91-628-4531-4 (print)OAI: oai:DiVA.org:esh-182DiVA: diva2:321742
Public defence
2000-12-01, Hörsalen, plan 5, Novum, Blickagången 6, Huddinge sjukhus., Huddinge, 09:00 (English)
Note
Härtill 5 uppsatserAvailable from: 2010-06-02 Created: 2010-06-02 Last updated: 2011-04-04Bibliographically approved
List of papers
1. Carers' reflections about their video-recorded interactions with patients suffering from severe dementia.
Open this publication in new window or tab >>Carers' reflections about their video-recorded interactions with patients suffering from severe dementia.
2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 6, 737-47 p.Article in journal (Refereed) Published
Abstract [en]

Stimulated recall interviews were used in connection with carers' video-recorded interactions with patients suffering from severe dementia before, during and after a 1-year intervention involving supervision for individualized nursing care. The aim was to illuminate carers' reflections on their everyday life with the patients, and to find out if any changes took place across the intervention. A phenomenological-hermeneutic approach was used in the analysis, which revealed that carers' reflections were focused on the carers themselves, on the patients, on context and on the work itself in the shared everyday life. After repeated stimulated recall interviews, together with supervision every month, an improvement in carers' ability to verbalize their reflections and an awareness and knowledge about their own influence on care quality were seen. The interdependence between carers and patients made it necessary for the carers to cope with many complicated here-and-now situations, and in their reflections the carers kept coming back to their efforts to maintain a sense of dignity for the patients as well as for themselves. Reflection through stimulated recall seems to be an important tool for carers in dementia care to facilitate understanding and to help them learn through lived experience, thus developing their skills in nursing care.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-140 (URN)11822845 (PubMedID)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2011-04-04Bibliographically approved
2. Patient life stories and current situation as told by carers in nursing home wards.
Open this publication in new window or tab >>Patient life stories and current situation as told by carers in nursing home wards.
2000 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 9, no 3, 260-79 p.Article in journal (Refereed) Published
Abstract [en]

Knowing a patient's life story is important for good nursing care of frail and vulnerable elderly people with cognitive impairments. The aim of the study was to compare patients' life stories and current situations as told by carers before and after 1 year of supervision, in which the Resident Assessment Instrument was used as a basis for individualized nursing care. Qualitative content analysis was used to disclose changes and to enable descriptions of patterns. After the intervention, two overall perspectives emerged from the analysis: the patient as a unique person with resources and abilities, despite limitations, and the carers' awareness of their own professional approach. It seemed as if the supervision and the use of a comprehensive and detailed assessment tool contributed to increased knowledge about the patients and to efforts to see them as real persons behind the dementia surface.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-141 (URN)11276619 (PubMedID)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2011-04-04Bibliographically approved
3. Review of nursing documentation in nursing home wards - changes after intervention for individualized care.
Open this publication in new window or tab >>Review of nursing documentation in nursing home wards - changes after intervention for individualized care.
1999 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 29, no 6, 1462-73 p.Article in journal (Refereed) Published
Abstract [en]

Using standardized assessment instruments may help staff identify needs, problems and resources which could be a basis for nursing care, and facilitate and improve the quality of documentation. The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) especially developed for the care of elderly people, was used as a basis for individualized and documented nursing care. This study was carried out to compare nursing documentation in three nursing home wards in Sweden, before and after a one-year period of supervised intervention. The review of documentation focused on structure and content in both nursing care plans and daily notes. The greatest change seen after intervention was the writing of care plans for the individual patients. Daily notes increased both in total and within parts of the nursing process used, but reflected mostly temporary situations. Even though the documentation of nursing care increased the most, it was the theme medical treatment which was the most extensive overall. A difference was seen between computer-triggered Resident Assessment Protocol (RAP) items, obtained from the RAI/MDS assessments, and items in the nursing care plans; the former could be regarded as a means of quality assurance and of making staff aware of the need for further discussions. The RAI/MDS instrument seems to be a useful tool for the dynamic process in nursing care delivered and as a basis for documentation. The documentation should communicate a patient's situation and progress, and if staff are to be able to use it in their everyday nursing care activity, it must be well-structured and freely available. The importance of continuing education and supervision in nursing documentation for development of a reliable source of information was confirmed by the present study.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-142 (URN)10354242 (PubMedID)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2011-04-04Bibliographically approved
4. Staff views on the Resident Assessment Instrument, RAI/MDS, in nursing homes, and the use of the Cognitive Performance Scale, CPS, in different levels of care in Stockholm, Sweden.
Open this publication in new window or tab >>Staff views on the Resident Assessment Instrument, RAI/MDS, in nursing homes, and the use of the Cognitive Performance Scale, CPS, in different levels of care in Stockholm, Sweden.
1998 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 28, no 3, 642-53 p.Article in journal (Refereed) Published
Abstract [en]

Multidimensional functional assessment is the basis of individualized care. It is especially important in the care of elderly, with the complexity of symptomatology and often with cognitive impairment present. An assessment instrument for elderly persons, used in this study, is the Resident Assessment Instrument/Minimum Data Set (RAI/MDS) and its incorporated MDS Cognitive Performance Scale (CPS). The purposes of the study were to demonstrate the cognitive performance in elderly persons in different levels of care by using the CPS and to elicit the views of staff on use of the RAI/MDS. Cognitive impairment was found in 1276 elderly persons in six levels of care studied, an important factor to consider when organizing care of elderly. An intervention study was carried out for 1 year in three nursing home wards, with training and supervision in implementation of the RAI/MDS including individualized and documented care. Part of a questionnaire was used to evaluate staff (n = 50) views on using the instrument. A majority of the staff thought that the RAI/MDS could contribute to the improvement of quality of care, documentation in nursing records, and in co-operation and engagement. Further research is necessary to elicit more knowledge on the usefulness and benefits of the instrument.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-143 (URN)9756234 (PubMedID)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2011-04-04Bibliographically approved
5. Carers' interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness.
Open this publication in new window or tab >>Carers' interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness.
2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 2, 225-36 p.Article in journal (Refereed) Published
Abstract [en]

1. A phenomenological-hermeneutic approach was used to illuminate carers' video-recorded interactions in connection with supervision for individualized nursing care. 2. In order to disclose any changes in the carers' interactions with patients suffering from severe dementia the video recordings were conducted before, during and after the intervention. 3. The content of the videos was transcribed as a text, mainly verbal communication. Due to the rich data the videos and text were kept together as a whole in every step of the analysis. 4. After an initial naïve understanding, different subthemes emerged in the structural analyses: promoting competence, struggling for co-operation, deep communication for communion, showing respect for the unique person, skills in balancing power, distance in a negative point of view, and fragmentary nursing situations. 5. The overall theme was 'Carers' balancing in their interactions, verbal as well as non-verbal, to promote a sense of mutual togetherness with the patient'. 6. The supervision intervention contributed to an improvement in carers' skills in balancing in their interactions. In the caring process carers' and patients' shared experiences and, due to patients' disabilities, interactions depended mainly on carers' qualities and capabilities for this confirming nursing care.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-139 (URN)11903722 (PubMedID)
Available from: 2010-05-19 Created: 2010-05-19 Last updated: 2011-04-04Bibliographically approved

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