Abstract The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.
Dutch society faces major challenges in caring for nursing home residents, particularly due to a growing shortage of staff. Politicians are striving to strengthen family involvement. However, family involvement brings uncertainties and tensions, with moral dimensions often underexposed. This thesis examines these moral aspects from the perspective of family and develops strategies to strengthen family involvement.Family members face challenges in caring for their loved one in a nursing home, especially in their relationship with the nursing home staff. They often find it difficult to communicate their wishes and concerns because of their sense of vulnerability. After admitting their loved one, they hand over many caregiving tasks to nursing home staff, but they are often unsure of what to expect and what is expected of them, which often goes unspoken. Family members also experience psychosocial challenges such as guilt, loneliness, and coping with their loved one's deteriorating health.Interventions that can help strengthen the relationship of trust between family and nursing home staff include: prioritizing informal conversations, discussing mutual expectations, and making nursing home staff more aware of family emotions. Striving for reciprocity, familiarity, transparency, empathy, and setting realistic goals are essential.To enhance family involvement, the implicit division of care responsibilities must be addressed. Therefore, fostering an ongoing dialogue between nursing home staff and family is recommended, aimed at building moral consensus on the division of care responsibilities. A good relationship of trust is essential to ensure open and transparent communication.
Abstract Aim To explore the moral dimension of family experiences with being involved in the care of their loved one with dementia in the nursing home, using the care ethical framework of Tronto. Design This qualitative study used a care ethical approach in which empirical data and care ethical theory were dialectically related and mutually informing. Methods Fifteen close family members of nursing home residents with dementia were interviewed between February 2020 and October 2020. Forty‐two interviews were conducted, based on a semi‐structured open‐ended design. A thematic narrative approach combined with the five phases of care as defined by Tronto was used to analyse the empirical data. Subsequently, Tronto's identified ethical qualities were used to identify the moral dimension of these empirical findings. Results We found that in the care process (1) family can find it difficult to recognize their loved one's care needs; (2) both family and staff are reluctant to discuss the allocation of responsibilities with each other; (3) family sometimes feels insecure when it comes to connecting with their loved one; (4) family is often reluctant to provide feedback to staff when they are critical about the care that has been given; and (5) family is generally mild in judging staff, due to staff shortages. The care ethical interpretation of these findings showed that the moral qualities of attentiveness, responsibility, competence, responsiveness, and solidarity are under pressure to a certain extent. Conclusion Family experiences moral distress during the care process, which hinders family involvement in nursing homes for people with dementia. Impact Nursing home staff can look for and pilot strategies focused on supporting families to act more in accordance with the moral qualities that are under pressure. This can improve family involvement in practice. Patient or Public Contribution No Patient/Public Contribution. Implications for Practice/Policy Nursing home staff paying more attention to families' emotional struggles related to the decline of their loved one, could help families to be more attentive to noticing true care needs of the resident. Both family and nursing home staff should take more often initiatives to evaluate the division of care responsibilities with each other. Nursing home staff should help family connect with their loved one during their visits if they experience difficulties in doing so. Nursing home staff taking more often initiatives to contact family and ask them how they perceive the care for their loved one, can positively affect the responsiveness of both family and staff. It would be helpful if nursing home management could ensure the presence of sufficient and qualified staff so that the first four phases of the care process are not hindered by the lack of staff.
Nach einem Beschluss der KMK (Gesamtstrategie zum Bildungsmonitoring) sollen Bildungsprozesse in Deutschland durch vier miteinander verbundene Bereiche beobachtet und weiterentwickelt werden: regelmasige Teilnahme an internationalen Schulleistungsuntersuchungen, zentrale Uberprufung der Bildungsstandards im Landervergleich, Vergleichsarbeiten und gemeinsame Bildungsberichterstattung. Systemmonitoring ist ein Teil des Bildungsmonitorings. Im Studienbrief wird erlautert, warum Studien des Systemmonitorings durchgefuhrt werden und welche Ziele sie im Einzelnen verfolgen. Zudem werden die bekanntesten Studien im Rahmen des Systemmonitorings vorgestellt: TIMSS, PISA, IGLU und DESI. (DIPF)
ABSTRACT Aim To explore experiences of nursing home staff in implementing self‐designed interventions to foster trusting relationships with family in practice. Design This qualitative study used a Participatory Action Research approach. Methods Data collection included focus groups ( n = 15), interviews ( n = 28) and observations ( n = 5). A holistic narrative approach was used for data analysis, resulting in co‐constructed narratives representing experiences of nursing home staff in implementing four different interventions in five Dutch dementia special care units in nursing homes. The data collection period began in August 2021 and ended in April 2022. Results Nursing home staff implemented self‐designed interventions to foster trusting relationships with family, including initiating informal conversations, sharing residents’ ‘happy’ moments, discussing mutual expectations, and being more aware of families’ emotional burdens. Identified facilitators emphasise the importance of reciprocity, familiarity, transparency, realistic goal setting and empathy. Identified barriers are related to moral uncertainty in balancing competing demands, conflicting social norms, prioritising hands‐on care tasks over family contact and lack of courage to act. Conclusion Nursing home staff conclude that their interventions contribute positively to building and maintaining a trusting relationship with families. Implications for the Profession and/or Patient Care Sharing the narratives of nursing home staff with peers would support them in implementing interventions to foster trust. Regular Moral Case Deliberations can be used to address moral uncertainty. Collective dialogue among nursing home staff can be useful in establishing new social norms that prioritise family involvement. Conversation skills training can empower nursing home staff. Impact Trust between nursing home staff and families can be improved by implementing the conducted interventions. Reporting Method This report adheres to the standards for reporting qualitative research (COREQ). Patient or Public Contribution No patient or public contribution.
During the COVID-19 outbreak in 2020, national governments took restrictive measures, such as a visitors ban, prohibition of group activities and quarantine, to protect nursing home residents against infections. As 'safety' prevailed, residents and close relatives had no choice but to accept the restrictions. Their perspectives are relevant because the policies had a major impact on them, but they were excluded from the policy decisions. In this study we looked into the moral attitudes of residents, close relatives and volunteers regarding the restrictions in retrospect, and what moral lessons they considered important.We conducted 30 semi-structured interviews with residents and close relatives and one focus group meeting with volunteers working in nursing homes. Data were transcribed verbatim and analyzed inductively. Subsequently, three Socratic dialogue meetings with residents, close relatives and volunteers were organized in which first analysis outcomes were discussed and dialogues were fostered into moral lessons for future pandemics. Outcomes were combined with moral theory following an empirical bioethics design.Critical perspectives regarding the COVID-19 restrictions grew in time. Various moral values were compromised and steered moral lessons for our future. The participants recognized three moral lessons as most important. First, constructing tailored (well-balanced) solutions in practice is desirable. Second, proper recognition is needed for the caring role that close relatives fulfill in practice. Third, a responsive power distribution should be in place that includes all stakeholder perspectives who are affected by the restrictions.Comparing the results with moral theory strengthens the plea for inclusion of all stakeholder groups in decision-making processes. To further concretize the moral lessons, tailored solutions can be realized with the use of moral case deliberations. Proper recognition includes actions addressing moral repair and including counter-stories in the debate. Responsive power distribution starts with providing clear and trustworthy information and including all perspectives.
Background Family involvement in nursing homes is generally recognized as highly valuable for residents, staff and family members. However, family involvement continues to be challenging in practice. Aim To contribute to the dialogue about family involvement and develop strategies to improve family involvement in the nursing home. Methods This interpretative synthesis consists of a thematic analysis and care ethical interpretation of issues regarding family involvement from the perspective of families in nursing homes reported in literature. Findings This study reveals the complexities of family involvement in the nursing home by drawing attention to the moral dimension of the issues experienced by families, as seen through the theoretical lens of Baier’s care ethical concept of trust as a theoretical lens. The synthesis of literature resulted in a thematic categorization of issues reported by families, namely, family–staff relationship, psychosocial factors and organizational circumstances. The care ethical interpretation of the synthesis of literature showed that the concept of trust resonates with all reported issues. Trust evolves over time. Early issues are mostly related to getting to know each other. Secondly, families want to experience that staff are competent and of good will. Difficult feelings families may have, such as guilt or loneliness, and dealing with the deterioration of the loved one puts families in a vulnerable position. This power imbalance between family and staff impedes a trusting relationship. Issues related to organizational circumstances, such as understaffing, also undermine families' trust in staff and the nursing home. Discussion and conclusion Baier’s theoretical concept of trust provides a deeper insight into the moral dimension of family involvement from the perspective of families in the nursing home. To improve family involvement in practice, we propose to aim future interventions at reinforcing trust in the relationship between family and staff as well as in the organizational context in which these care relationships occur.
