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Health and quality of care from older peoples' and formal caregivers' perspective
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karlstads universitet, Fakulteten för samhälls- och livsvetenskaper.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective.

Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II).

The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV).

Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II).

Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV).

Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet , 2011. , 78 p.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2011:63
Keyword [en]
Older people, community care, dependency, health, adaptation, compensation, phenomenology, quality of care, organizational climate, stress of conscience, competence, health, sense of coherence, formal caregivers
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
URN: urn:nbn:se:du-15765ISBN: 978-91-7063-402-4 (print)OAI: oai:DiVA.org:du-15765DiVA: diva2:747422
Public defence
2012-01-20, 1B306 Fryxellsalen, Karlstads universitet, Karlstad, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2014-09-16Bibliographically approved
List of papers
1. Experiences of health and well-being, a question of adjustment and compensation - views of older people dependent on community care.
Open this publication in new window or tab >>Experiences of health and well-being, a question of adjustment and compensation - views of older people dependent on community care.
2007 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 2, no 4, 278-87 p.Article in journal (Refereed) Published
Abstract [en]

Most studies concerning older people's health and well-being have focused on their ill health, disease and complaints and have mainly been conducted with a quantitative design. Hence, there is still a need for qualitative studies in which these peoples' own views on health and well-being are shown, especially when they are dependent on health care in a community setting. A qualitative approach was used in the study reported here and aimed at obtaining a deeper understanding of older peoples' own views about their health and well-being. Interviews were carried out on two occasions with 19 older people living in their own homes and in sheltered accommodation. The data were analysed using content analysis. The findings suggested that the possibility to feel healthy was dependent both on the older person's own ability to adjust or compensate to their situation, and on how their caregivers, relatives and friends could compensate for the obstacles the older person faced. The subcategories that captured the informants' experiences of health and ill health were described as positive and negative poles of autonomy, togetherness, tranquillity and security in daily life. The significance of the caregivers was clearly evident. Their competence, commitment and treatment were prerequisites for the older person's ability to experience health in spite of being dependent on care.

National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-15763 (URN)10.1111/j.1748-3743.2007.00089.x (DOI)20925842 (PubMedID)
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2014-09-16Bibliographically approved
2. The meaning of good and bad care in the community care: older people's lived experiences
Open this publication in new window or tab >>The meaning of good and bad care in the community care: older people's lived experiences
2009 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 4, no 3, 156-65 p.Article in journal (Refereed) Published
Abstract [en]

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological-hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data. The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.

National Category
Nursing
Identifiers
urn:nbn:se:du-15761 (URN)10.1111/j.1748-3743.2008.00156.x (DOI)20925772 (PubMedID)
Available from: 2014-09-16 Created: 2014-09-16 Last updated: 2015-08-14Bibliographically approved
3. Caregivers in older peoples’ care: perception of quality of care, working conditions, competence and personal health
Open this publication in new window or tab >>Caregivers in older peoples’ care: perception of quality of care, working conditions, competence and personal health
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, 704-714 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to describe and compare nursing assistants’, enrolled nurses’ and registered nurses’ perceptions of quality of care, working conditions, competence and personal health in older peoples’ care. Altogether 70 nursing assistants, 163 enrolled nurses and 198 registered nurses completed a questionnaire comprising Quality from the Patient’s Perspective modified for caregivers, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items on education and competence and Health Index. The caregivers reported higher perceived reality of quality of care in medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere. In subjective importance, the highest rating was assessed in one of the physical-technical items. The organisational climate was for three of the dimensions rather close/reached the value for a creative climate, for seven dimensions close to a stagnant climate. In perceived stress of conscience, there were low values. Nursing assistants had lower values than enrolled nurses and registered nurses. The caregivers reported highest values regarding previous education making them feel safe at work and lowest value on the item about education increasing the ability for a scientific attitude. Registered nurses could use knowledge in practice and to a higher degree than nursing assistants/enrolled nurses reported a need to gain knowledge, but the latter more often received education during working hours. The health index among caregivers was high, but registered nurses scored lower on emotional well-being than nursing assistants/enrolled nurses. The caregivers’ different perceptions of quality of care and work climate need further attention. Although stress of conscience was low, it is important to acknowledge what affected the caregivers work in a negative way. Attention should be paid to the greater need for competence development among registered nurses during working hours. © 2012 Nordic College of Caring Science.

Keyword
caregivers; competence; health; older people's care; organisational climate; quality of care; stress of conscience; working conditions
National Category
Nursing
Research subject
Hälsa och välfärd
Identifiers
urn:nbn:se:du-12472 (URN)10.1111/j.1471-6712.2012.01083.x (DOI)000321625800025 ()
Available from: 2013-05-23 Created: 2013-05-23 Last updated: 2015-06-26Bibliographically approved
4. Formal caregivers' perceptions of quality of care for older people: associating factors
Open this publication in new window or tab >>Formal caregivers' perceptions of quality of care for older people: associating factors
2015 (English)In: BMC Research Notes, ISSN 1756-0500, E-ISSN 1756-0500, Vol. 8, no 1, 623Article in journal (Refereed) Published
Abstract [en]

Background:

Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431).

Results:

In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience.

Conculsions:

The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.

National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-15764 (URN)10.1186/s13104-015-1597-7 (DOI)26517989 (PubMedID)
Available from: 2011-12-15 Created: 2014-09-16 Last updated: 2017-04-03Bibliographically approved

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