The competence of certified nurse assistants caring for persons with dementia diseases in residential facilities.

In Sweden, a majority of elderly persons living in residential facilities have some form of dementia, and caring for them is a demanding and complex task. The formal education level of personnel in residential facilities is low. The aim of this paper is to describe certified nurse assistants' (CNAs) content of competence caring for persons with dementia diseases in residential facilities. Information from 22 diary notes was obtained and 12 CNAs in four residential facilities were interviewed. The diary notes and interviews were transcribed and analysed using conventional content analysis. Three main categories were generated from the diaries: Social and Health Care, Health Care Targeted towards Medicine and, finally, Organization. The same categories were generated from the interviews but with the addition of Knowledge - its use, growth and deficiencies. The results show that competence is mainly based on personal, experienced-based knowledge and 'standard routines'. In general, the nurse assistants' interest in developing knowledge is weak. Furthermore, CNAs lack competence in essential theoretical knowledge about dementia diseases. It is notable that CNAs, caring for people with serious dementia, know little about the reasons for the residents' divergent behaviour. Consequently, knowledge related to dementia and mental diseases must be highlighted. Therefore, formal education focused on these diseases is crucial.

Quality of care in relation to a critical pathway from the staff's perspective.

UNLABELLED: Specific groups with complex nursing requirements, such as patients suffering from stroke, are in greatest need of a critical pathway. AIM: To study how the critical pathway is reflected in caring work from the staff's perspective. METHOD: Personnel (n = 16): physicians, care developers, speech therapists, physiotherapists, occupational therapists, nurses, assistant nurses. Content analysis has been used. Two main categories were formed: function of the critical pathway and effects of the critical pathway. FINDINGS: The nurse in the stroke ward is seen as the "spider in the web". There is a need for more collaboration, both in and between hospitals and primary health care. Many of the staff members feel that they are working in a learning organization. Others say that they have low job satisfaction caused by low manning and, consequently, less time to spend with the patients. CONCLUSION: The critical care chain has not been fully developed in accordance with the care model. It emerges that patients spend a lot of time waiting while the staff have too little time to spend with patients.

Quality of care and development of a critical pathway.

BACKGROUND: The current study reports on the first step towards developing quality of care for stroke patients at a hospital in western Sweden. A general critical pathway from the patient's perspective was developed by a multidisciplinary group. AIM: The aim was to investigate quality of care and the effectiveness of a critical pathway. METHOD: The study should be classified as a case study. Patients (n = 22), next of kin (n = 63) and staff (n = 91) make up the research group. Data collection was carried out through questionnaires on quality of care before testing the critical pathway. Data on the critical pathway were collected during the testing period. FINDINGS: The respondents valued some aspects of care as good, but there were some deficiencies as regards patient information and the patient's participation in his/her own care. Next of kin were less positive than the patients. The analyses of the critical pathway showed that the key events need to be more specific and that the number of key events should be reduced. CONCLUSION: By additionally developing the critical pathway, it should be possible to further improve the quality of care for stroke patients.

Nurses' skills in managing ethically difficult care situations: interpretation of nurses' narratives.

A total of 18 good nurses experienced in the care of cancer patients were asked to describe care situations where it had been difficult to know what was 'the right and good' thing to do for the patient. The purpose of the study was to throw light on how they disclosed themselves in managing ethically difficult care situations; to elucidate the nurse as a part of the concrete care situation. A phenomenological hermeneutic interpretation disclosed the use of paradigm cases, placing in opposition to each other negative and positive outcomes, limiting and liberating maxims, and reserved and open approaches, on the part of nurses with limited versus extensive skills in managing ethically difficult care situations. These patterns were interpreted as revealing psychological defences. The study stresses the importance of recurrent education in nursing and nursing ethics, and of individual support.

Application of primary nursing within a team setting in the hospice care of cancer patients.

A qualitative study was conducted to obtain a deeper understanding of the hospice care of terminally ill cancer patients, where care was delivered via a primary nursing system combined with a team setting. Relatives of terminally ill cancer patients (n = 20) and the personnel (n = 8) participated in open-ended interviews. Phenomena relating to the philosophy of primary nursing and the hospice movement (continuity; closeness; accountability 24 h/day; individualized care; satisfied physical, psychological, social, and spiritual needs; and support to relatives) were experienced by the relatives, nurses, and physician as "good care." Most of the phenomena defined as important needs by the relatives and personnel were met when the primary nurse was on duty and the team was intact. Needs that were unmet were mainly a result of lack of continuity. Caring for the terminally ill via primary nursing in a team setting was regarded as two-sided by the nurses. It was seen as stimulating and rewarding, as well as demanding and burdensome. Therefore, the need for support to the nurses involved was deeply stressed.