Train Georgina, Nurock Shirley, Kitchen Ginnette, Manela Monica, Livingston Gill
Royal Free and University College Medical School, Department of Mental Health Sciences, University College London, Archway Campus, Holborn Union Building, Highgate Hill, London N19 5NL, UK.
Int Psychogeriatr. 2005 Jun;17(2):237-51. doi: 10.1017/s1041610205001729.
Most people living in 24-hour care settings have dementia, and little is known about what makes long-term care a positive experience for them.
This carer-led qualitative study examined working practices in 24-hour long-term care-settings, including hospitals, nursing and residential homes, with the aim of finding out and making recommendations about such settings. Using semi-structured interviews, managers, nurses and care assistants were asked about work practices, such as how they coped with difficult behavior, about shifts, staffing levels, staff retention and training. Relatives of residents with dementia were asked about their role and perceptions of the care provided, and residents were asked for their opinions of their care.
Staff reported that residents presented with increasingly challenging behavior compared to the past, and that sometimes staffing levels and skills were inadequate. Of all the settings, hospitals had the most problems with staffing levels and retention, staff-relative relationships and staff support systems. Relatives saw their own role as positive. People with dementia of varying severity could usefully evaluate some of the services they received.
Dementia-specific training and education of staff in all long-term care-settings, including induction, should address the management of problem behavior in dementia and thereby improve staff fulfilment and relatives' satisfaction. The long-stay hospital may not be appropriate as a "home for life" for those with dementia, and we recommend that long-stay care settings should be able to cater flexibly for a range of resident needs.
大多数住在24小时护理机构的人患有痴呆症，对于如何让长期护理成为他们的积极体验，我们知之甚少。
这项由护理人员主导的定性研究调查了24小时长期护理机构的工作实践，包括医院、疗养院和养老院，旨在了解这些机构的情况并提出建议。通过半结构化访谈，询问了管理人员、护士和护理助理关于工作实践的问题，比如他们如何应对困难行为、轮班情况、人员配备水平、员工留用和培训。询问了痴呆症患者的亲属关于他们的角色以及对所提供护理的看法，还询问了患者对其护理的意见。
工作人员报告称，与过去相比，患者的行为挑战越来越大，而且有时人员配备水平和技能不足。在所有机构中，医院在人员配备水平和留用、员工与亲属关系以及员工支持系统方面存在的问题最多。亲属认为自己的角色是积极的。不同严重程度的痴呆症患者能够有效地评估他们所接受的一些服务。
在所有长期护理机构中，包括入职培训在内，针对痴呆症的工作人员培训和教育应涉及痴呆症问题行为的管理，从而提高员工的成就感和亲属的满意度。长期住院医院可能不适宜作为痴呆症患者的“终身之家”，我们建议长期护理机构应能够灵活满足一系列患者的需求。
