Students' experiences with a hybrid learning environment in nursing homes: A qualitative study.

AIM: The aim of this study is to explore how students experience learning in a hybrid learning environment in a nursing home setting and their perceptions of relationship-centred care. BACKGROUND: Nursing homes are undergoing a culture shift from task-centred care to person- and relationship-centred care, requiring a different approach to how nursing home staff work and are educated. Hybrid learning environments aim to educate professionals who continuously work on their professional development by integrating and merging learning and working to facilitate the culture shift. DESIGN: An exploratory qualitative study design was used. The setting were nursing home wards organised according to a hybrid learning environment located in the Netherlands. Participants were students in two-year training for nurse assistants, three-year training for certified nurse assistants, or four-year training for vocationally trained registered nurses. Data were collected through semi-structured interviews and focus groups. Data were analysed using direct content analysis. RESULTS: Analysis revealed three themes regarding how students experienced learning in the hybrid learning environment: 1) design of the learning process, 2) disconnection between working and learning and 3) learning resources. Regarding how learning in the hybrid learning environment influences students' perceptions of relationship-centred care analyses revealed two themes: 1) recognising the essence of relationship-centred care and 2) overstaffing and student-resident interaction. CONCLUSIONS: The hybrid learning environment in a nursing home setting remains underdeveloped. By considering some improvement points (e.g., clarity of the role of work supervisor and students' awareness of learning while executing daily tasks), the hybrid learning environment can promote a shift from working task-centred to working relationship-centred. Additionally, students must grasp the essence of the concept of relationship-centred care and need support in developing reflection skills to provide it.

How Stories Can Contribute Toward Quality Improvement in Long-Term Care.

It is important to evaluate how residents, their significant others, and professional caregivers experience life in a nursing home to improve quality of care based on their needs and wishes. Narratives are a promising method to assess this experienced quality of care as they enable a rich understanding, reflection, and learning. In the Netherlands, narratives are becoming a more substantial element within the quality improvement cycle of nursing homes. The added value of using narrative methods is that they provide space to share experiences, identify dilemmas in care provision, and provide rich information for quality improvements. The use of narratives in practice, however, can also be challenging as this requires effective guidance on how to learn from this data, incorporation of the narrative method in the organizational structure, and national recognition that narrative data can also be used for accountability. In this article, 5 Dutch research institutes reflect on the importance, value, and challenges of using narratives in nursing homes.

Comparing text mining and manual coding methods: Analysing interview data on quality of care in long-term care for older adults.

OBJECTIVES: In long-term care for older adults, large amounts of text are collected relating to the quality of care, such as transcribed interviews. Researchers currently analyze textual data manually to gain insights, which is a time-consuming process. Text mining could provide a solution, as this methodology can be used to analyze large amounts of text automatically. This study aims to compare text mining to manual coding with regard to sentiment analysis and thematic content analysis. METHODS: Data were collected from interviews with residents (n = 21), family members (n = 20), and care professionals (n = 20). Text mining models were developed and compared to the manual approach. The results of the manual and text mining approaches were evaluated based on three criteria: accuracy, consistency, and expert feedback. Accuracy assessed the similarity between the two approaches, while consistency determined whether each individual approach found the same themes in similar text segments. Expert feedback served as a representation of the perceived correctness of the text mining approach. RESULTS: An accuracy analysis revealed that more than 80% of the text segments were assigned the same themes and sentiment using both text mining and manual approaches. Interviews coded with text mining demonstrated higher consistency compared to those coded manually. Expert feedback identified certain limitations in both the text mining and manual approaches. CONCLUSIONS AND IMPLICATIONS: While these analyses highlighted the current limitations of text mining, they also exposed certain inconsistencies in manual analysis. This information suggests that text mining has the potential to be an effective and efficient tool for analysing large volumes of textual data in the context of long-term care for older adults.

District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study.

BACKGROUND: Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS: A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS: District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS: Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.

Systematic development of a set of implementation strategies for transitional care innovations in long-term care.

BACKGROUND: Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS: As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS: Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS: This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.

Professional caregivers' perceived barriers hindering the prevention and reduction of involuntary treatment among older persons receiving long-term care: A mixed methods study.

AIMS: To gain insights into the barriers towards the prevention and/or reduction of involuntary treatment in long-term geriatric care. DESIGN: Mixed methods. BACKGROUND: Measures to which a person resists and/or does not provide consent for are defined as involuntary treatment. The use of involuntary treatment violates the autonomy of (older) persons and causes more harm than benefit. Moreover, it contradicts the values of person-centred care. Nevertheless, its use among people living with dementia (PLWD) is still common practice. METHODS: We conducted a cross-sectional, mixed methods study, including an online survey for professional caregivers and a semistructured focus group interview with professional caregivers. RESULTS: A total of 218 participants completed the questionnaire. The percentage of participants who perceived barriers in one of the 22 survey items ranged from 15% to 42%. Lack of time, the experienced need to use involuntary treatment, uncertainty about responsibilities of stakeholders and a lack of knowledge on methods to prevent and/or reduce the use of involuntary treatment were most seen as barriers. Nursing staff perceived a lack of time hindering them in the prevention or reduction of involuntary treatment more often than other professional caregivers. Working in home care and having no former experience with involuntary treatment usage increased perceived barriers. Participants of the focus group interview confirmed these findings and added that professional caregivers in general lack awareness on the concept of involuntary treatment. CONCLUSIONS: One out of four professional caregivers experiences barriers hindering prevention and/or reduction of involuntary treatment. More research is needed to gain a better understanding of how professional caregivers can be supported to remove barriers and, consequently, prevent and/or reduce the use of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE: Professional caregivers experience many barriers towards the prevention and reduction of involuntary treatment. Future initiatives should aim to remove the perceived barriers.

After COVID-19 vaccinations: what does living and working in nursing homes look like?

BACKGROUND: Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS: The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS: Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS: The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS: Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.

The perspectives of older people living with dementia regarding a possible move to a nursing home.

BACKGROUND/OBJECTIVES: Moving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes. MATERIALS AND METHODS: This study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed. RESULTS: The majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home. DISCUSSION/IMPLICATIONS: This study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home.

The development of an automatic speech recognition model using interview data from long-term care for older adults.

OBJECTIVE: In long-term care (LTC) for older adults, interviews are used to collect client perspectives that are often recorded and transcribed verbatim, which is a time-consuming, tedious task. Automatic speech recognition (ASR) could provide a solution; however, current ASR systems are not effective for certain demographic groups. This study aims to show how data from specific groups, such as older adults or people with accents, can be used to develop an effective ASR. MATERIALS AND METHODS: An initial ASR model was developed using the Mozilla Common Voice dataset. Audio and transcript data (34 h) from interviews with residents, family, and care professionals on quality of care were used. Interview data were continuously processed to reduce the word error rate (WER). RESULTS: Due to background noise and mispronunciations, an initial ASR model had a WER of 48.3% on interview data. After finetuning using interview data, the average WER was reduced to 24.3%. When tested on speech data from the interviews, a median WER of 22.1% was achieved, with residents displaying the highest WER (22.7%). The resulting ASR model was at least 6 times faster than manual transcription. DISCUSSION: The current method decreased the WER substantially, verifying its efficacy. Moreover, using local transcription of audio can be beneficial to the privacy of participants. CONCLUSIONS: The current study shows that interview data from LTC for older adults can be effectively used to improve an ASR model. While the model output does still contain some errors, researchers reported that it saved much time during transcription.

Implementing Four Transitional Care Interventions for Older Adults: A Retrospective Collective Case Study.

BACKGROUND AND OBJECTIVES: Four interventions to improve care transitions between hospital and home or community settings for older adults were implemented in Leuven, Belgium over the past 4 years. These complex interventions consist of multiple components that challenge their implementation in practice. This study examines the influencing factors, strategies used to address challenges in implementing these interventions, and implementation outcomes from the perspectives of health care professionals involved. RESEARCH DESIGN AND METHODS: This was a qualitative, collective case study that was part of the TRANS-SENIOR research network. Authors conducted semistructured interviews with health care professionals about their perceptions regarding the implementation. Thematic analysis was used, and the Consolidated Framework for Implementation Research guided the final data interpretation. RESULTS: Thirteen participants were interviewed. Participants reported major implementation bottlenecks at the organizational level (resources, structure, and information continuity), while facilitators were at the individual level (personal attributes and champions). They identified engagement as the primary strategy used, and suggested other important strategies for the future sustainability of the interventions (building strategic partnerships and lobbying for policies to support transitional care). They perceived the overall implementation favorably, with high uptake as a key outcome. DISCUSSION AND IMPLICATIONS: This study highlights the strong role of health care providers, being motivated and self-driven, to foster the implementation of interventions in transitional care in a bottom-up way. It is important to use implementation strategies targeting both the individual-level factors as well as the organizational barriers for transitional care interventions in the future.

Text mining in long-term care: Exploring the usefulness of artificial intelligence in a nursing home setting.

OBJECTIVES: In nursing homes, narrative data are collected to evaluate quality of care as perceived by residents or their family members. This results in a large amount of textual data. However, as the volume of data increases, it becomes beyond the capability of humans to analyze it. This study aims to explore the usefulness of text mining approaches regarding narrative data gathered in a nursing home setting. DESIGN: Exploratory study showing a variety of text mining approaches. SETTING AND PARTICIPANTS: Data has been collected as part of the project 'Connecting Conversations': assessing experienced quality of care by conducting individual interviews with residents of nursing homes (n = 39), family members (n = 37) and care professionals (n = 49). METHODS: Several pre-processing steps were applied. A variety of text mining analyses were conducted: individual word frequencies, bigram frequencies, a correlation analysis and a sentiment analysis. A survey was conducted to establish a sentiment analysis model tailored to text collected in long-term care for older adults. RESULTS: Residents, family members and care professionals uttered respectively 285, 362 and 549 words per interview. Word frequency analysis showed that words that occurred most frequently in the interviews are often positive. Despite some differences in word usage, correlation analysis displayed that similar words are used by all three groups to describe quality of care. Most interviews displayed a neutral sentiment. Care professionals expressed a more diverse sentiment compared to residents and family members. A topic clustering analysis showed a total of 12 topics including 'relations' and 'care environment'. CONCLUSIONS AND IMPLICATIONS: This study demonstrates the usefulness of text mining to extend our knowledge regarding quality of care in a nursing home setting. With the rise of textual (narrative) data, text mining can lead to valuable new insights for long-term care for older adults.

Factors contributing to innovation readiness in health care organizations: a scoping review.

BACKGROUND: Increasing innovation readiness of healthcare organizations is necessary to meet upcoming challenges, including population aging, staff shortages and reduced funding. Health care organizations differ in the extent to which they are innovation ready. This review aims to clarify the concept of innovation readiness and identify which factors contribute to innovation readiness in health care organizations. METHODS: A scoping review was conducted based on the framework from Arksey and O'Malley. PubMed/MEDLINE, CINAHL and Web of Science were searched for studies that (a) aimed to contribute to scientific knowledge about innovation readiness of health care organizations, (b) were peer-reviewed, (c) reported empirical data and (d) were written in English, Dutch or German. Factors researched in the included studies were bundled into 4 overarching main factors and 10 sub-factors. RESULTS: Of the 6,208 studies identified, 44 were included. The majority (n = 36) of the studies had been conducted since 2011 and almost half of the studies (n = 19) were performed in hospitals. Of the 44 studies, 21 researched factors contributing to innovation readiness in the implementation stage of the innovation process. The authors used a variety of words and descriptions addressing innovation readiness, with hardly any theoretical frameworks for innovation readiness presented. Four main factors and 10 sub-factors contributing to the innovation readiness of health care organizations were summarized: strategic course for innovation, climate for innovation, leadership for innovation and commitment to innovation. Climate for innovation (n = 16) was studied the most and individual commitment to innovation (n = 6) was the least studied. CONCLUSION: Our study identified four main factors contributing to the innovation readiness of health care organizations. Research into innovation readiness of health care organizations is a rather new field. Future research could be directed towards defining the concept of innovation readiness and the development of a framework for innovation readiness. More understanding of the interplay of factors contributing to innovation readiness in all stages of the innovation process and in diverse health care settings can support health care managers to structurally embed innovation. This review contributes to the first stage of theory building on factors contributing to innovation readiness of health care organizations.

District nurses' attitudes towards involuntary treatment in dementia care at home: A cross-sectional study.

One in two persons living with dementia (PLWD) at home receive care which they resist to and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in the use of involuntary treatment. However, little is known how their attitudes and opinions influence the use of involuntary treatment. This cross-sectional study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants and their opinion about its restrictiveness and discomfort. Results show that district nurses perceive involuntary treatment as regular part of nursing care, having neither positive nor negative attitude towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD at home.

Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique.

BACKGROUND: Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions. METHODS: A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors': i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis. RESULTS: Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors. CONCLUSIONS: Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs.

Caregiver decision-making concerning involuntary treatment in dementia care at home.

BACKGROUND: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. OBJECTIVE: To identify and describe family caregivers' experiences regarding care decisions for situations that can lead to involuntary treatment use in persons living with dementia at home. RESEARCH DESIGN: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. ETHICAL CONSIDERATION: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. FINDINGS: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. DISCUSSION AND CONCLUSION: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations.

Involuntary treatment in dementia care at home: Results from the Netherlands and Belgium.

AIMS AND OBJECTIVES: To gain insight into the request, use and associated factors of involuntary treatment in people with dementia (PwD) receiving professional home care in the Netherlands and Belgium. BACKGROUND: Most of the PwD remain living at home as long as possible. Due to complex care needs, this can result in an increased risk for care provided against the wishes of the client and/or to which the client resists, referred to as involuntary treatment. DESIGN: Secondary data analyses of two cross-sectional surveys. METHODS: Dementia case managers and district nurses filled in a questionnaire for each PwD in their caseload. This study included data of 627 PwD receiving professional home care in the Netherlands and 217 in Belgium. The same methodology (questionnaire and variables) was used in both samples. Descriptive statistics and multi-level logistic regression analyses were used to analyse the data. The study adhered to the STROBE checklist. RESULTS: More than half of the PwD (50.7%) living at home received involuntary treatment (Belgium 68.2% and the Netherlands 44.7%). Nonconsensual care (82.7%) was the most common, followed by psychotropic medication (40.7%) and physical restraints (18.5%). Involuntary treatment use was associated with living alone, greater ADL dependency, lower cognitive ability, higher family caregiver burden and receiving home care in Belgium versus the Netherlands. Involuntary treatment was most often requested by family caregivers. CONCLUSIONS: Involuntary treatment is often used in PwD, which is in line with previous findings indicating dementia as a risk factor for involuntary treatment use. More research is needed to gain insight into variations in prevalence across other countries, which factors influence these differences and what countries can learn from each other regarding prevention of involuntary treatment. RELEVANCE TO CLINICAL PRACTICE: To provide person-centred care, it is important to study ways to prevent involuntary treatment in PwD and to stimulate dialogue between professional and family caregivers for alternative interventions.

Interventions to Improve the Transition From Home to a Nursing Home: A Scoping Review.

BACKGROUND AND OBJECTIVES: The transition from home to a nursing home is a stressful event for both older persons and informal caregivers. Currently, this transition process is often fragmented, which can create a vicious cycle of health care-related events. Knowledge of existing care interventions can prevent or break this cycle. This project aims to summarize existing interventions for improving transitional care, identifying their effectiveness and key components. RESEARCH DESIGN AND METHODS: A scoping review was performed within the European TRANS-SENIOR consortium. The databases PubMed, EMBASE (Excerpta Medica Database), PsycINFO, Medline, and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they described interventions designed to improve the transition from home to a nursing home. RESULTS: 17 studies were identified, describing 13 interventions. The majority of these interventions focused on nursing home adjustment with 1 study including the entire transition pathway. The study identified 8 multicomponent and 5 single-component interventions. From the multicomponent interventions, 7 main components were identified: education, relationships/communication, improving emotional well-being, personalized care, continuity of care, support provision, and ad hoc counseling. The study outcomes were heterogeneous, making them difficult to compare. The study outcomes varied, with studies often reporting nonsignificant changes for the main outcome measures. DISCUSSION AND IMPLICATIONS: There is a mismatch between the theory on optimal transitional care and current transitional care interventions, as they often lack a comprehensive approach. This research is the first step toward a uniform definition of optimal transitional care and a tool to improve/develop (future) transitional care initiatives on the pathway from home to a nursing home.

Reopening the doors of Dutch nursing homes during the COVID-19 crisis: results of an in-depth monitoring.

OBJECTIVES: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. DESIGN: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. PARTICIPANTS: Visitors and healthcare professionals. INTERVENTION: Allowing visitors using local regulations based on national guidelines. MEASUREMENTS: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. RESULTS: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. CONCLUSION: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are sometimes still struggling to find the right balance between infection control and well-being.

Working in a Dutch nursing home during the COVID-19 pandemic: Experiences and lessons learned.

AIMS: To gain insight into how direct care staff in Dutch nursing homes experienced work during the COVID-19 pandemic. DESIGN: A qualitative study consisting of semi-structured, face-to-face focus groups was conducted using "the active dialogue approach". METHODS: Participants (n = 29) were care staff from four care teams at Dutch nursing homes. Teams were selected based on the number of COVID-19 infections amongst residents. Data were analysed with conventional content analysis. RESULTS: Themes emerging from the data were the loss of (daily) working structure, interference between work and private life for direct care staff, the importance of social support by the team and a leader, and the effects on relationship-centred care of the measures. Results offer concrete implications for similar situations in the future: psychological support on-site; autonomy in daily work of care staff; an active role of a manger on the work floor and the importance of relationship-centred care.