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- Beck, Ingela, 1965-, et al.
(author)
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Applying a palliative care approach in residential care : effects on nurse assistants' experiences of care provision and caring climate
- 2014
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In: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 28:4, s. 830-841
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Journal article (peer-reviewed)abstract
- BackgroundA palliative care approach aims to integrate psychosocial and existential as well as relationship aspects in the care and is an approach that can be used in residential care. Nurse assistants are the ones who are closest to the residents but have limited prerequisites for working in accordance with the palliative care approach. We aimed to investigate the effects on nurse assistants' experiences of care provision and the caring climate of an intervention applying a palliative care approach in residential care.MethodsAn intervention involving nurse assistants (n = 75) and their leaders (n = 9), in comparison with controls (n = 110), was evaluated using a questionnaire at three points in time.ResultsIn the intervention group, positive effects were seen concerning the nurse assistants' reports of the care provision in that they focused more on the residents' stories about their lives and on communicating with the residents about what gave meaning to their lives. Also, negative effects were seen when the nurse assistants rated that the residents' needs for medical and nursing care had not been met at the facility directly after the intervention. No effects were seen concerning the caring climate or the prerequisites of providing more person-centred care.ConclusionThe intervention seemed to have encouraged the nurse assistants to focus on relationship aspects with the residents. So as not to jeopardise the NAs' well-being and to support NAs in keeping themselves involved in existential issues, their support most certainly needs to be continuous and ongoing. However, in spite of the leaders' involvement, the intervention was not sufficient for changing the organisational prerequisites for more person-centred care.
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| 2. |
- Beck, Ingela, 1965-
(author)
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Att fokusera på "varandet" i en värld av görande : stöd till personalen i ett palliativt förhållningssätt vid vård- och omsorgsboende för äldre
- 2013
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to study nurse assistants’ experience of palliative care and to investigate how an intervention with a focus on a palliative care approach in residential care facilities influenced the nurse assistants and their work situation. The thesis is based on two qualitative and two quantitative studies, focusing on nurse assistants working at residential care facilities for older people. The qualitative studies were based on focus-group interviews before the intervention (I) and individual interviews after the intervention (IV). The quantitative studies (II, III) were based on a questionnaire, including several measurements, that was answered pre-, and post- intervention. The intervention consisted of study circles with nurse assistants, and workshops together with their leaders, focusing on improvement work. A total of 75 nurse assistants participated in the intervention and answered the questionnaire at baseline and at two follow-ups, in comparison with 110 nurse assistants who served as controls. The results show that the nurse assistants experienced that it was difficult to focus on “being”, i.e. on relationship aspects in their work, since the main discourse in residential care focused on “doing”, i.e. on task oriented aspects. Palliative care was described as something that was only applied during a short and defined phase, namely the very last days of the residents’ life. The results also show that nurse assistants experienced difficulties facing emotional and existential issues with regards to both the residents and their relatives (I). The results of study I were, in turn, used as a basis for the development of the intervention. The evaluation of the intervention showed that the nurse assistants, after the intervention, had increased their focus on the residents’ situation and to a greater extent stated that they focused on the residents’ life stories and on aspects that brought meaning to their lives (III). The nurse assistants also stated that they experienced less criticism from their superiors as well as from the residents after the intervention (II). However, the evaluation also showed that the nurse assistants had a more negative view of the leadership (II), were more critical to the medical and the nursing care (III), and that their job satisfaction had decreased (II) after the intervention. Interviews after the intervention showed that they, as a result of the intervention, had not only gained increased insight into their own significance in their encounter with residents and their relatives, but also an increased awareness of the needs of the residents and their relatives. The intervention also contributed to an increased openness in the workgroup. However, the nurse assistants also expressed frustration over barriers, primarily in the form of a lack of resources and limited leadership (IV), standing in the way of the implementation of changes. The results indicate that the nurse assistants, through discussions and reflections over praxis in their ordinary work group, developed an increased awareness about, and focus on “being”, i.e. on relationship aspects. However, it would seem that essential prerequisites, such as support from the leaders and sufficient resources for working in line with a palliative care approach, were not provided. When implementing a palliative care approach in residential care facilities, more focus on support to the leaders is needed in order to maintain sustainable changes.
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- Orrung Wallin, Anneli, et al.
(author)
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Psychometric properties concerning four instruments measuring job satisfaction, strain, and stress of conscience in a residential care context
- 2013
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In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 57:2, s. 162-171
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Journal article (peer-reviewed)abstract
- There are many instruments assessing the wellbeing of staff, but far from all have been psychometrically investigated. When evaluating supportive interventions directed toward nurse assistants in residential care, valid and reliable instruments are needed in order to detect possible changes. The aim of the study was to investigate validity in terms of data quality, construct validity, convergent and divergent validity and reliability in terms of the internal consistency and stability of the Job Satisfaction Questionnaire, the Psychosocial Aspects of Job Satisfaction, the Strain in Dementia Care Scale (SDCS), and the Stress of Conscience Questionnaire (SCQ) in a residential care context. The psychometric properties of the instruments were investigated in terms of data quality, construct validity, convergent and divergent validity and reliability, including test-retest reliability, in a residential care context with a sample consisting of nurse assistants (n=114). The four instruments responded with different psychometric-related problems such as internal missing data, floor and ceiling effects, problems with construct validity and low test-retest reliability, especially when assessed on the item level. These problems were however reduced or disappeared completely when assessed for total and factor scores. From a psychometric perspective, the SDCS seemed to stand out as the best instrument. However, it should be modified in order to reduce floor effects on item level and thereby gain sensitivity. The Job Satisfaction Questionnaire seemed to have problems both with the construct validity and test-retest reliability. The final choice of instrument must, however, be made dependent on what one intends to measure.
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