Evidence and Practice

Clinical

Care homes

Defining, monitoring and improving quality in Welsh care homes

Why you should read this article • To understand the different definitions of quality • To enhance your awareness of how quality in care homes is monitored • To familiarise yourself with the methods that can be used to improve quality in care homes Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals – including nurses – should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.

Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia

Knowledge, attitudes and learning needs of formal carers of people with dementia

Policymakers should be aware of the need for investment in specialist dementia units

Role of nursing associates in addressing the needs of people with dementia in hospital

Role of nursing associates in addressing the needs of people with dementia in hospital

Nursing associates are well placed to address the needs of this patient population

Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals

ANPs can lead comprehensive geriatric assessment in acute hospitals

Exploring the role of the ANP in identifying frailty and leading CGA for older people

Older lady hydration

Strategies to prevent dehydration in older people with dementia: a literature review

There is a significant evidence base supporting a range of strategies to improve hydration

What is an older husband’s experience of caring for his wife who has dementia?

What is an older husband’s experience of caring for his wife who has dementia?

In this review, nursing implications are addressed and guidance proposed to offer support

CPD articles

Extending the Newcastle Model: how therapeutic communication can reduce distress in people with dementia

How therapeutic communication can reduce distress in people with dementia

Newcastle Model’s biopsychosocial framework is revisited to understand the caregiving context

Osteoporosis and fragility fractures: risk assessment, management and prevention

Osteoporosis and fragility fractures: risk assessment, management and prevention

Nurses need to be aware of the risk factors and identify at-risk patients

Understanding and managing depression in older people

Understanding and managing depression in older people

Clinicians do not always recognise depression in older people as they attribute symptoms to the ageing process and the effects of failing health. Similarly, older people do not always appreciate that their symptoms relate to their mood. Understanding how depression affects older people can improve access to support, thereby improving overall health and quality of life. To ensure these outcomes we need a workforce with excellent communication skills that supports therapeutic relationships, promotes recognition of symptoms, and enhances assessment, diagnosis, treatment and management.

COPD

Helping people live with chronic obstructive pulmonary disease

How nurses can have a positive effect on the lives of people with COPD

Communication

Effective communication with older people

Nurses can overcome communication barriers through thoughtful interventions

Approaches to managing older people using opiates and their risk of dependence

Approaches to managing older people using opiates and their risk of dependence

There is little doubt that opiates have transformed healthcare, particularly in relation to pain management. However, many patients prescribed this type of drug develop problems such as dependency. Although we do not know how many older people have developed such problems due to opiate use we know that some will. It is important for nurses to understand the context in which opiates are used, as well as the specific needs of older people and how to respond to them.

How to

Hearing loss

How to address the communication needs of older patients with hearing loss

Hearing loss is a common problem in older people and may have a negative effect on their care while in hospital, as well as resulting in significant cost to the NHS. This article outlines the findings of a two-year project in an NHS trust to improve the care of older people with hearing loss. An important outcome of the project was the development of a hearing loss toolkit containing good practice recommendations and tools to help staff in all NHS trusts, and other care settings, implement practical and cost-effective improvements.

Planning

How to use advance care planning in a care home

Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.

Practice question

Many older people use multiple medicines, medicines optimisation helps to ensure safe and appropriate polypharmacy

Why is medicines optimisation important for older people living with frailty?

Medicines optimisation can help ensure appropriate polypharmacy

www.resus.org.uk/faqs/faqs-dnacp

How should I discuss not attempting CPR with people who have dementia?

Discuss the wishes of people with dementia proactively due to its progression

Picture shows a care home supervisor talking to a resident. Healthcare professionals can help meet the needs of older people approaching the end of life by asking the right questions.

Surprise questions that can improve end of life care

Older people approaching the end of life can be helped by asking the right questions

Push-on mower

Care home residents can benefit from carrying out everyday activities

Safety concerns prevent care home residents doing everyday tasks that benefit them

What is ageism, how can I recognise it and how can I deal with it in my workplace?

Discrimination against older people can mean inferior standards in services that affect them

How do I recognise and treat pain appropriately in a person with dementia?

A tool to help staff manage pain in dementia care uses four simple steps

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