Nursing students' experiences regarding physical restraint use in long-term care facilities: A qualitative descriptive study.

BACKGROUND: Despite many harmful effects, physical restraints are still used in long-term care facilities. Most existing studies have focused on staff. Nursing students observe staff's use of restraints during gerontological nursing practicums, but there are few studies on nursing students' experiences regarding restraint use in long-term care settings. OBJECTIVE: This study aimed to explore nursing students' experiences with physical restraint use in order to enhance nursing education and improve care quality in long-term care facilities. METHODS: Using convenience sampling method, three nursing schools from three provinces were recruited. Twenty-six senior undergraduate nursing students who had taken a gerontological nursing practicum course participated in this study. A qualitative descriptive method was utilized to provide a clear account of the students' experiences. In-depth interviews were conducted using a semi-structured interview guide. Thematic analysis was used for data analysis. RESULTS: Four themes were identified, which included overuse of restraints, ambivalent response to restraints, becoming accustomed to restraints, and lack of education regarding restraints. Students frequently observed the use of various restraints, which elicited both negative and positive responses, ultimately leading to their desensitization to the overuse of restraints. They expressed a lack of knowledge and educational needs regarding restraint reduction. CONCLUSION: Nursing students encountered the overuse of various restraints, exhibited ambivalent responses, and became desensitized to this practice in long-term care facilities. They perceived a lack of education and educational needs regarding restraint reduction. This study adds important new knowledge to existing literature and provides important insights into restraint use in long-term care facilities. Future studies need to develop and evaluate educational programs for restraint-free and person-centered care targeting nursing students. Long-term care facilities should offer organizational support and implement continuous mandatory training to promote restraint-free care.

Nursing home staff's perceptions of barriers and needs in implementing person-centred care for people living with dementia: A qualitative study.

AIMS AND OBJECTIVES: This study explored nursing home staff's barriers and needs in implementing person-centred care for people with dementia. BACKGROUND: Person-centred care is an imperative international policy and the best-practice standard for dementia care. However, a gap exists between policy and practice. Moreover, there is a lack of qualitative studies that explored nursing home staff's barriers and needs in implementing person-centred care for people living with dementia. DESIGN: A qualitative descriptive approach was adopted. METHODS: Using convenience sampling method, a total of 24 staff members (nurses, nurse's aides, or care workers) were recruited from six nursing homes in Korea. Two in-depth, face-to-face, one-to-one interviews were conducted with all participants (a total of 48 interviews). A semi-structured interview guide was used and field notes were written after each interview. Data were collected until data saturation was reached. Qualitative content analysis was used. This study followed the COREQ guidelines. RESULTS: Four themes emerged from data analysis: insufficient resources, lack of education, negative mindset and poor relationships. This study showed that nursing home staff experienced many barriers and unmet needs in implementing person-centred care for people with dementia. CONCLUSION: The findings indicated that nursing home staff faced many barriers and needs in implementing person-centred care for people with dementia. Nursing home staff need more legitimate, financial, educational and emotional support. RELEVANCE TO CLINICAL PRACTICE: The study indicates more national and organisational support are needed for nursing home staff to successfully implement person-centred care for people living with dementia. Nursing home leaders need to recognise the importance of their role in overcoming the barriers and provide effective support for staff in implementing person-centred dementia care.

Effects of a Web-Based Educational Program Regarding Physical Restraint Reduction in Long-Term Care Settings on Nursing Students: A Cluster Randomized Controlled Trial.

Physical restraint is still frequently used in many countries. However, a lack of education hinders physical restraint reduction in long-term care facilities. No study has yet to examine the effects of physical restraint reduction education on nursing students. This study aimed to evaluate the effects of a web-based educational program of physical restraint reduction on nursing students' knowledge and perceptions. A cluster randomized controlled and single-blind design was used. This study was conducted at four nursing schools in South Korea. A total of 169 undergraduate nursing students completed this study. Using random allocation, two nursing schools (85 students) were allocated as the experimental group and the other two schools (84 students) as the control group. The experimental group received the web-based educational program, and the control group did not receive the educational program. Data were collected immediately before and after the web-based educational program. The experimental group's knowledge and perceptions significantly improved between pre-test and post-test. The analysis of covariance showed statistically significant differences between groups in knowledge (p < 0.001) and perceptions (p < 0.001) over time, revealing positive effects of the web-based educational program. The web-based educational program regarding physical restraint reduction positively affected nursing students' knowledge and perceptions. Future studies are required to examine the educational program's longitudinal effects with more rigorous measurements and research methods.

Understanding Educational Barriers and Needs of North Korean Defector Nursing Students: A Qualitative Descriptive Study.

INTRODUCTION: A growing number of North Korean defector students enter nursing schools in South Korea. Many of them, however, quit nursing school and fail to obtain a nurse license. The purpose of this study was to describe the educational barriers and needs of North Korean defector nursing students. METHOD: A qualitative descriptive approach was employed. Convenience sampling was used, and 14 students participated. Qualitative content analysis was employed. RESULTS: Five themes emerged: lack of preparation for higher education, multiple language barriers, differences in education and culture, lack of support and resources, and lack of information and understanding. DISCUSSION: South Korean government needs to provide North Korean defector students with more practical supportive programs. South Korean nursing schools need to provide more transcultural education for South Korean students and supportive adaptation programs for North Korean defector students to produce culturally competent nurses who provide culturally congruent health care.

Men's experiences after prostatectomy: A meta-synthesis.

OBJECTIVE: The purpose of this review was to critically analyze, interpret, and synthesize the literature on men's experiences after prostatectomy. DESIGN: A meta-synthesis was conducted. DATA SOURCES: Six databases (PubMed, EMBASE, CINAHL, PsycINFO, AgeLine, and Sociological Abstract) were searched from the earliest year to 2016. From initial searches with main keywords (prostatectomy and qualitative study), 642 abstracts were retrieved. Based on inclusion criteria (English-language published qualitative study focusing on the experience of men after prostatectomy), this meta-synthesis included 15 studies. REVIEW METHODS: Components of meta-study (meta-data-analysis, meta-method, and meta-theory) were employed to analyze, interpret, and synthesize the results of included studies. Three authors independently appraised the methodological quality of the included studies using a combined appraisal tool (The Critical Appraisal Skills Programme Qualitative Research Checklist and Paterson et al.'s Primary Research Appraisal Tool). The Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement was used to strengthen the completeness of reporting. RESULTS: Fifteen studies met inclusion criteria and quality appraisal guidelines, however, most did not identify or relate their findings to theory. Through meta-synthesis, five themes emerged: facing a life-changing situation, experiencing changes and their impact, striving to manage and adjust to changes, coping with masculinity, and anticipating the future. CONCLUSIONS: After prostatectomy, men experienced physical, psychological, and social changes. Many men are physically and psychologically ill-prepared and suffer from lack of information and support. Health care providers need to be sensitive to men's needs including perceptions of masculinity, realize the importance of support as an essential component of men's adaptation post-prostatectomy, and provide comprehensive and individualized patient-centered interventions. Future studies need to use rigorous research methods, clearly identify methodological approaches, and consider employing or developing theory.

What Is the Status Quo of Evidence-Based Community Health Nursing?

BACKGROUND AND PURPOSE: With an increasing emphasis on evidence-based nursing in general, evidence-based practice has become a buzzword among community health nurses in many countries. Despite the global interests, evidence-based community health nursing is not even clearly defined in the literature and very little is known about the current status of evidence-based community health nursing. Therefore, the purpose of this article is to identify the status quo of evidence-based nursing in community health nursing through an integrative literature review. METHODS: Four electronic databases were searched from the earliest year to 2016 with combinations of keywords. Twenty-six eligible articles were reviewed, and the characteristics reflecting the current status of evidence-based community health nursing were extracted. RESULTS: Through the content analysis process, 6 characteristics were identified. First, in evidence-based community health nursing, the needs of clients, families, caregivers, and health care professionals were identified and assessed. Second, interventions were planned based on systematic reviews on various relevant sources. Third, various types of research methods were used. Fourth, available resources were assessed and used, and the findings of cost estimation, cost/effectiveness, or cost/benefit analyses were reported. Fifth, training, support, monitoring, and coordination were included as major components. Finally, the evidence used and/ or found in the studies was evaluated, disseminated, and updated as the last step. IMPLICATIONS FOR PRACTICE: Community health nurses are required to continuously integrate, implement, evaluate, disseminate, and update their evidence for future evidence-based community health nursing.

Effects of a Multicomponent Restraint Reduction Program for Korean Nursing Home Staff.

PURPOSE: Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. DESIGN: A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). METHODS: Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. FINDINGS: Repeated measures analysis of variance showed significant differences between groups in knowledge (p < .001), perceptions (p < .001), and attitudes (p = .011) over time. These significant improvements in the MRRP group (EG) were sustained over the 3-month period. CONCLUSIONS: The MRRP effectively improved the knowledge, perceptions, and attitudes of nursing home staff about restraint use with older adults. Additional studies are recommended to evaluate effects of its components while using larger samples and rigorous research methods and measurements, and the inclusion of boosters or other supports to sustain change. CLINICAL RELEVANCE: These results provide valuable knowledge regarding a multicomponent intervention for changing nursing home staff attributes that likely influence clinical practice. Elements of the educational content and methods found useful for nursing home staff may also be effective in vocational and continuing education as well as for families of older nursing home residents.

Staff perceptions of barriers to physical restraint-reduction in long-term care: a meta-synthesis.

AIMS AND OBJECTIVES: To critically review the existing qualitative studies to identify, from the perspective of staff, the barriers to physical restraint reduction in long-term geriatric care facilities. BACKGROUND: Despite the adverse physical and psychosocial effects, physical restraints are still used frequently in many geriatric long-term care facilities around the world. There is, however, no study that synthesises the existing qualitative literature regarding the barriers to the restraint reduction from the perspective of facility staff. DESIGN/METHODS: The metastudy research process guided this qualitative synthesis. Five electronic databases were searched, and ten studies were included in this metastudy. RESULTS: Five themes were identified through metasynthesis of the findings: concern about and responsibility for safety, unclear and inconsistent definitions of restraint and restraint-free care, difficulties in the transition from acceptance to removal, noninvolvement in decision-making to remove restraint and insufficient resources and education. CONCLUSION: A concept analysis of physical restraint is sorely needed, and future studies should explore the prevalence of restraint, the effects of education for staff and family on restraint reduction, and success stories related to restraint-free care. More research is needed regarding the restraint reduction effectiveness and cost issues. RELEVANCE TO CLINICAL PRACTICE: Physical restraints, commonly used in many geriatric long-term care facilities, result in many negative effects and ethical issues. To achieve success in reducing physical restraint use, governmental policies and long-term care institutions should underpin staff efforts with legal, educational and practical support.

Older adults' definitions of health: A metasynthesis.

BACKGROUND: Despite many gerontological studies focusing on the health of older adults, little attention has been paid to their perceptions of health. Understanding older adults' health perceptions is important because their self-perceptions are important predictors of and strongly related to survival and mortality. Older adults have different perceptions of health compared with younger adults because of their age-related changes, diseases, and limitations. There are also differences between older adults' and health professionals' perceptions of health. OBJECTIVES: The purpose of this systematic review was to analyze and synthesize qualitative studies that have explored older adults' perceptions of health. METHODS: Four electronic databases were searched for qualitative studies published from the earliest year to 2013, revealing 12 studies for inclusion. The systematic review employed three components of the meta-study including meta-data-analysis, meta-method, and meta-theory. RESULTS: Five health themes are identified from the included studies: ability to do something independently, absence or management of symptoms, acceptance and adjustment with optimism, connectedness with others, and feeling enough energy. CONCLUSION: Future gerontological research should use appropriate existing health theories and develop new health theories specific to older adults. Healthcare providers should evaluate and revise their health definitions according to older adults' health perceptions and provide appropriate health interventions. Policymakers should have an in-depth understanding of older adults' health perceptions to establish effective older-adult-centered health policies.

Nursing staff views of barriers to physical restraint reduction in nursing homes.

PURPOSE: There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. METHODS: Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. RESULTS: Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. CONCLUSION: The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care.

The experiences of Korean immigrant caregivers of non-English-speaking older relatives with dementia in American nursing homes.

The purpose of this article is to describe Korean immigrant caregivers' experiences regarding American nursing home placement of their non-English-speaking older relatives with dementia. Qualitative descriptive methods and qualitative content analysis were used. A total of 17 semistructured interviews were conducted with 10 Korean immigrant family caregivers. The "Korean way of thinking" emerged as a fundamental cultural belief about caregiving. Six major themes were identified: (a) I never thought about a nursing home; (b) If I think in a Korean way, I feel . . . ; (c) Nursing home staff cannot communicate with . . . ; (d) My care recipient maintains Korean culture; (e) Nursing home services are better than expected but . . . ; and (f) My care recipient is more vulnerable because of dementia. This study provides valuable insights for health care providers about communication and cultural issues of immigrant caregivers for non-English-speaking older relatives with dementia.

Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was to systematically review the literature regarding the effectiveness of nonpharmacological interventions for agitation in older adults with dementia. METHODS: Seven electronic databases (to 2004) were searched, and randomized clinical trials employing nonpharmacologic interventions for agitation in dementia published in English or Korean were selected. In addition, the reference lists from relevant review articles and all eligible studies were searched to identify other trials. Interventions were categorized into seven types: sensory intervention, social contact, activities, environmental modification, caregiver training, combination therapy, and behavioral therapy. Studies were abstracted, and data were pooled by intervention category. RESULTS: Fourteen studies (n = 586) were included. Sensory interventions were statistically significantly effective in reducing agitation (standardized mean difference: SMD -1.07; 95% confidence interval (CI) -1.76 to -0.38, p = 0.002), while social contact (SMD -0.19; CI -0.71 to 0.33), activities (SMD -0.20; CI -0.71 to 0.31), environmental modification (weighted mean difference: WMD 1.90; CI -2.82 to 6.62), caregiver training (SMD 0.21; CI -0.15 to 0.57), combination therapy (WMD 1.85; CI -1.78 to 5.48), and behavioral therapy interventions (SMD -0.27; CI -0.72 to 0.19) were not significantly effective in reducing agitation. These results were consistent among higher quality studies. CONCLUSION: This systematic review indicated that among the seven types of nonpharmacological interventions available for agitation in older adults with dementia, only sensory interventions had efficacy in reducing agitation. More trials are needed to confirm this finding and future research should use more rigorous methods.

Family caregivers of older people in nursing homes.

PURPOSE: This paper aims to review literature related to the experiences of family caregivers after institutionalization of their older relatives. METHODS: Thirty-one research-based articles were reviewed for information on the following six dimensions: caregivers' involvement in care; the effects of institutionalization on mental health of caregivers; predictors of caregivers' mental health; caregivers' feelings; caregivers' difficulties and needs; and interventions for caregivers. RESULTS: Family caregivers continued their caregiver roles after institutionalization. There was a significant decrease in the caregivers' burden after institutionalization. Depression in caregivers, however, was not significantly reduced. The predictors of caregivers' mental health included characteristics of care recipients, caregivers, and institutions as well as interactions. After institutionalization, caregivers experienced positive feelings, negative feelings, and mixed feelings. Caregivers encountered many difficulties related to care recipients' decreasing cognitive functions, care recipients' behavioral problems, and institutional problems. Interventions improved caregivers' outcomes, care recipients' outcomes, staff members' outcomes, and the communication/relationships among the three groups. CONCLUSION: This review expands existing knowledge and provides valuable information. Nurses and researchers need to conduct more research related to family caregivers' difficulties and needs. Future studies should develop more effective interventions and test the effects of interventions on family caregivers as well as care recipients and staff members.

The influence of culture on the experiences of Korean, Korean American, and Caucasian-American family caregivers of frail older adults: a literature review.

PURPOSE: The purpose of this review is to explore cultural influences on the experiences of Korean, Korean American, and Caucasian American family caregivers caring for frail older adults in terms of the selection of a primary caregiver, caregiving motivation, support/help-seeking, and negative emotional responses(depression and burden). METHODS: Seven electronic databases were searched to retrieve studies from 1966 to 2005. Thirty-two studies were identified. RESULTS: This review supported cultural influences on the selection of primary caregiver, caregiving motivation, and support/help-seeking among the three caregiver groups. In Korean caregivers, the major primary caregivers were daughters-in-law while among Korean American and Caucasian American caregivers, the major primary caregivers were daughters or spouses. As a major caregiving motivation, Caucasian American caregivers reported filial affection while Korean caregivers and Korean American caregivers reported filial obligation. Korean caregivers reported higher extended family support, while Caucasian American caregivers reported higher utilization of formal support. Korean caregivers showed the highest levels of depression followed by Korean American caregivers and Caucasian American caregivers. CONCLUSION: In order to develop culturally appropriate interventions and policies, more research is needed to further explain these differences among the three groups, especially regarding support/help-seeking and negative emotional responses.

Agitation in dementia: concept clarification.

AIM: The aim of this paper is to clarify the concept of agitation in dementia through analysing definitions, critical attributes, components, boundaries, antecedents and consequences of agitation. BACKGROUND: The concept of agitation is not well defined. In addition, there exists much confusion about the characteristics and boundaries of agitation, as well as the distinction between agitation and related concepts. Recently developed theoretical models for agitation in dementia require new interpretation and conceptualization of agitation. METHODS: Morse's method of critical appraisal of the literature was used. In addition, some parts of Rodgers' evolutionary method were employed. Data were selected using six electronic databases and the key words 'agitation', 'agitated', 'dementia', 'demented' and 'Alzheimer'. The analysis included 86 empirical or theoretical papers and one book. RESULTS: A transition from the observer's perspective to the patient's perspective in the interpretation of agitation was found. Five critical attributes of agitation in dementia were identified: excessive, inappropriate, repetitive, non-specific and observable. Patient factors, interpersonal factors, environmental factors and restraint were identified as precipitating antecedents. Mediating antecedents included discomfort, unmet need and misinterpretation. Consequences of agitation were identified at the levels of patient, caregiver and others. CONCLUSIONS: This transition in perspectives has important implications as it can change health providers' attitudes and responses to agitation and lead to patient-focused and individualized care. Researchers and clinicians are encouraged to avoid labelling agitated behaviour as 'disturbing behaviour'.