Objectivity in needs assessment practice: admission to a residential home.

In 1997, the Dutch government installed independent agencies to assess the long-term care needs of individual clients and to give advice on the allocation of appropriate services. Needs assessors assess, among other things, the eligibility of clients requesting admission to a residential home. According to guidelines, needs assessors should do this objectively and independently from care providers and health care insurers. The present paper examines how needs assessors explore the clients' expressed needs, determine their normative needs and advise on allocation. Needs assessors perform these tasks in a situation where a clear professional framework is absent, and moreover, residential home capacity is limited. A qualitative study was undertaken, observing 13 house calls of clients requesting admission to a residential home. Furthermore, interviews were held with all needs assessors and a document analysis was made. It was found that needs assessors use comparable methods in exploring the clients' motivation and assessing their needs in the relevant areas, apparently using a professional framework. However, when transforming the needs of clients into an adequate allocation, needs assessors struggled with interpretation of criteria and included their personal ideas of services into the allocation decision. The paper concludes with the suggestion that further professionalisation may lead to a greater uniformity in needs assessment practice, and will assist needs assessors in the difficult task of transforming clients' needs into long-term care allocation advice.

Home care by and for relatives of MS patients.

Relatives and family members are the core of the care provided in the home. This also applies to relatives of multiple sclerosis (MS), patients who are dependent on assistance by others. If we want to keep the system of home care going, nurses must keep these care-providing relatives on their feet. We can only do this if we give timely support to these relatives in carrying out their care task and the problems that may arise from it. Once the relatives are overburdened, help is too late. Thus, prevention is an important task for home care nurses. It is crucial that the support the nurses offer fits the specific chemistry of MS patients and their relatives; their efforts will therefore be substantial.

Coping strategies of enrolled nurses in nursing homes: shifting between organizational imperatives and residents' needs.

In today's nursing homes, which can be considered modern versions of "total institutions", enrolled nurses expend much energy coping with problems which arise from the day-to-day care of seriously impaired patients. The problems they encounter include the burden of never ending work, having to cope with deviant and problematic behaviour, handling emotional disturbance and, on a more abstract level, balancing self-interest and power with love and affection. The grounded theory approach was used to discover the coping strategies employed by enrolled nurses. On the criterium of favouring either organizational imperatives or residents' needs, six strategies were differentiated, and placed into one of two categories. The discovery during research of two distinct nursing teams, each inclining towards the strategies available within one of these two categories, not only has important theoretical implications, but also practical consequences for the training of student nurses, the labour market and the quality of care.