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The Physical and Social Environments of Small Rural Nursing Homes: Assessing Supportiveness for Residents with Dementia*

Published online by Cambridge University Press:  31 March 2010

Debra G. Morgan ,
Karen M. Semchuk ,
Norma J. Stewart  and
Carl D'Arcy
Debra G. Morgan*
Affiliation:
University of Saskatchewan
Karen M. Semchuk
Affiliation:
University of Saskatchewan
Norma J. Stewart
Affiliation:
University of Saskatchewan
Carl D'Arcy
Affiliation:
University of Saskatchewan
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Debra G. Morgan, Ph.D., R.N., Institute of Agricultural Rural & Environmental Health, Wing 3E, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatchewan, SK S7N 0W8. ([email protected])
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Abstract

The physical and social environments are recognized as important therapeutic tools in the care of nursing home residents with dementia, yet little is known about the environments of rural nursing homes. This study was conducted in one rural health authority (16,000 km 2) in the province of Saskatchewan. Long-term institutional care was provided in seven small (15 to 35 beds), publicly funded nursing homes, none of which had separate dementia special care units (SCUs). The Physical Environmental Assessment Protocol (PEAP) was used to evaluate the facilities on nine key dimensions of dementia care environments. Facilities were most supportive in provision of privacy and least supportive on maximizing awareness and orientation. Focus groups were conducted with registered nurses, nursing aides, and activity workers. Staff caregivers identified six special needs of residents with dementia that were difficult to meet in the nursing homes, two of which were related to the physical environment (safety and a calm, quiet environment) and four of which were related to the social environment (meaningful activity and one-to-one contact, opportunity to use remaining abilities, flexible policy, and knowledgeable caregivers who enjoy working with persons with dementia). Staff suggested separate dementia SCUs as one approach to managing dementia care but also identified challenges in creating dementia units in small rural facilities. Results provide support for conceptual models of dementia care settings that emphasize the interaction of organizational, social, and physical factors.

Résumé

Quoiqu'il existe peu de renseignements sur les milieux des maisons de soins infirmiers ruraux, il est reconnu que ces milieux physiques et sociaux sont des outils thérapeutiques importants face aux soins des résidents de ces maisons qui souffrent de démence. La présente étude a été effectuée dans une région rurale de services d'hygiène (16 000 km2) en Saskatchewan, au Canada. Des soins institutionnels à long terme ont été dispensés dans sept petites maisons de soins infirmiers (de 15 à 35 lits) recevant l'assistance de l'État ; les installations n'étaient pas munies d'unités de soins de démence spéciaux. Nous avons eu recours au Protocole d'évaluation du milieu physique (Physical Environmental Assessment Protocol [PEAP]) pour l'évaluation des installations à l'aide de neuf dimensions clés de soins en milieu de démence. Les installations appuyaient surtout la provision de la vie privée ; la maximalisation de la prise de conscience et l'orientation étaient dimensions recevant le moins d'appui. Il y a eu discussion parmi des groupes témoins d'infirmiers autorisés, de préposés aux soins et de préposés aux activités. Le personnel a identifié six besoins spéciaux de résidents souffrant de démence. Ces besoins sont très difficiles à combler dans le présent milieu : deux besoins sont liés au milieu physique (soit la sécurité et un milieu calme et tranquille) et quatre besoins sont liés au milieu social (soit des activités significatives et un contact un à un, la chance d'utiliser les capacités non affectées, une politique flexible, des soignants qui possèdent des connaissances et qui prennent plaisir à travailler avec des personnes souffrant de démence). Le personnel a suggéré des unités séparées de soins spéciaux afin de rencontrer les besoins des soins de la démence. Toutefois, les participants ont identifié les défis propices aux petites installations rurales. Les résultats appuient les modèles théoriques des cadres de soins de démence. Ces modèles peuvent accentuer l'intéraction des facteurs organisationnels, sociaux et physiques.

Keywords

agingruralnursing homelong-term caredementiaenvironmentspecial care unitvieillissementruralmaison de soins infirmierssoins de longue duréedémencemilieuunité de soins spéciaux
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 22 , Issue 3 , Fall/Automne 2003 , pp. 283 - 296
Copyright
Copyright © Canadian Association on Gerontology 2003

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Footnotes

*

The authors would like to acknowledge the financial support of the Health Services Utilization and Research Commission (Socio-Health Development Grant) and the participating health region. We would also like to thank the participants for their contribution to this research. Dr. Morgan's work was supported by Post-Doctoral Fellowships from the Institute of Agricultural Rural and Environmental Health and the Alzheimer Society of Canada. This research was also supported, in part, by the National Health Research Development Program, Health Canada through a National Health Research Scholar Award to Dr. Semchuk. Dr. Stewart had investigator support from the Canadian Institutes of Health Research. Dr. D'Arcy's work was supported by a grant from Saskatchewan Health.

References

Algase, D., Beck, C., Kolanowski, A., Whall, A., Berent, S., Richards, K., et al. (1996). Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. American Journal of Alzheimer's Disease, 11(6), 10–19.CrossRefGoogle Scholar
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Aronson, M. (1994). Reshaping dementia care: Practice and policy in long-term care. London: Sage.Google Scholar
Calkins, M. (1988). Planning environments for the elderly and confused. Owings Mills, MD: National Health.Google Scholar
Canada Mortgage and Housing Corporation. (1991). Maintaining seniors' independence in rural areas: A guide to planning housing and support services. Ottawa, ON: Author.Google Scholar
Canadian Study of Health and Aging Working Group. (1994a). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Canadian Study of Health and Aging Working Group. (1994b). Patterns of caring for people with dementia in Canada. Canadian Journal on Aging, 13(4), 470–487.CrossRefGoogle Scholar
Coward, R., Duncan, P., & Freudenberger, K. (1994). Residential differences in the use of formal services prior to entering a nursing home. The Gerontologist, 34, 44–49.CrossRefGoogle ScholarPubMed
Coward, R., Duncan, P., & Uttaro, R. (1996). The rural nursing home industry: A national perspective. Journal of Applied Gerontology, 15(2), 153–171.CrossRefGoogle Scholar
Coward, R., Horne, C., Duncan, P., & Dwyer, J. (1992). Job satisfaction among hospital nurses: Facility size and location comparisons. The Journal of Rural Health, 8(4), 255–267.CrossRefGoogle ScholarPubMed
Dawson, P., Kline, K., Wiancko, D., & Wells, D. (1986). Preventing excess disability in patients with Alzheimer's Disease. Geriatric Nursing, 7(6), 298–330.CrossRefGoogle ScholarPubMed
Day, K., Carreon, D., & Stump, C. (2000). The therapeutic design of environments for people with dementia: A review of empirical research. The Gerontologist, 40, 397–416.CrossRefGoogle ScholarPubMed
Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine.Google Scholar
Government of Saskatchewan. (2001). Saskatchewan facts and figures. Retrieved 20 Dec. 2001 from http://www.gov.sk.ca/aboutsask/factsGoogle Scholar
Grant, L., & Ory, M. (2000). Alzheimer special care units in the United States. Research and Practice in Alzheimer's disease, 4, 19–44.Google Scholar
Gunderson, W., Marshall, K., Stewart, N., & Morgan, D. (1995, May). Needs assessment for dementia care: Midwest Health District. Report printed at the University of Saskatchewan, Saskatoon, SK.Google Scholar
Hall, G., & Buckwalter, K. (1987). Progressively lowered stress threshold: A conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1(6), 399–406.Google ScholarPubMed
Harrington, C., Kovner, C., Mezey, M., Kayser-Jones, J., Burger, S., Mohler, M., Burke, R., & Zimmerman, D. (2000). Experts recommend minimum nurse staffing standards for nursing facilities in the United States. The Gerontologist, 40(1), 5–15.Google ScholarPubMed
Health Canada. (1991). Designing facilities for people with dementia. Ottawa, ON: Health Facilities Design Unit, Health Services Directorate, Dept. of National Health & Welfare.Google Scholar
Kayser-Jones, J. (1991). The impact of the environment on the quality of care in nursing homes: A social-psychological perspective. Holistic Nursing Practice, 5(3), 29–38.CrossRefGoogle ScholarPubMed
Krueger, R. (1994). Focus groups: A practical guide for applied research (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
Lawton, M. (1980). Psychosocial and environmental approaches to the care of senile dementia patients. In Cole, J. & Barrett, J. (Eds.), Psychopathology in the aged (pp. 265–278). New York: Raven Press.Google Scholar
Lawton, M., Weisman, G., Sloane, P., Norris-Baker, C., Calkins, M., & Zimmerman, S. (2000). Professional Environmental Assessment Procedure for Special Care Units for elders with dementing illness and its relationship to the Therapeutic Environment Screening Schedule. Alzheimer Disease and Associated Disorders, 14(1), 28–38.CrossRefGoogle Scholar
Leon, J., Cheng, C., & Alvarez, R. (1997). Trends in special care: Changes in SCU from 1991 to 1995 ('95/96 TSC). Journal of Mental Health and Aging, 3(2), 149–168.Google Scholar
Mendelson, R., & Bollman, R. (1998). Rural and small town population is growing in the 1990s. Rural and Small Town Analysis Bulletin, 1(1). (Statistics Canada Cat. no. 21-006-XPB)Google Scholar
Morgan, D., & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19(6), 740–761.CrossRefGoogle Scholar
Morgan, D., Semchuk, K., Stewart, N., & D'Arcy, C. (2002a). Job strain among staff of rural nursing homes: A comparison of nurses, aides, and activity workers. Journal of Nursing Administration, 32(3), 152–161.CrossRefGoogle Scholar
Morgan, D., Semchuk, K., Stewart, N., & D'Arcy, C. (2002b). Rural families caring for a relative with dementia: Barriers to use of formal services. Social Science & Medicine, 55, 1129–1142.CrossRefGoogle ScholarPubMed
Norris-Baker, C., Weisman, G., Lawton, M., Sloane, P., & Kaup, M. (1999). Assessing special care units for dementia: The Professional Environmental Assessment Protocol. In Steinfeld, E. & Danford, G. (Eds.), Enabling environments: Measuring the impact of environment and disability and rehabilitation (pp. 165–181). New York: Kluwer / Academic Plenum.CrossRefGoogle Scholar
Ory, M. (1994). Dementia special care: The development of a national research initiative. Alzheimer Disease and Associated Disorders, 8(Suppl. 1), S389–S394.Google ScholarPubMed
Reisberg, B., Ferris, S., DeLeon, M. & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Reisberg, B., Franssen, E., Sclan, S. Kluger, A., & Ferris, S. (1989). Stage specific incidence of potentially remediable behavioral symptoms in aging and Alzheimer Disease. Bulletin of Clinical Neurosciences, 54, 95–111.Google Scholar
Rowles, G. (1996). Nursing homes in the rural long-term care continuum. In Rowles, D., Beaulieu, J., & Meyers, W. (Eds.), Long-term care for the rural elderly (pp. 109–131). New York: Springer.Google Scholar
Sarchuk, C., & Wiebe, P. (1992). Organization and coordination of services to individuals with dementia living in rural settings. In Gutman, G. (Ed.), Shelter and care of persons with dementia (pp. 183–192). Vancouver, BC: The Gerontology Research Centre, Simon Fraser University.Google Scholar
Saskatchewan Bureau of Statistics. (1997). Saskatchewan 1991–1996 census population. Regina, SK: Author.Google Scholar
Saskatchewan Health. (2000). Saskatchewan health facilities. Regina, SK: Saskatchewan Health District Management Services.Google Scholar
Sloane, P., Lindeman, D., Phillips, C., Moritz, D., & Koch, G. (1995). Evaluating Alzheimer's special care units: Reviewing the evidence and identifying potential sources of study bias. The Gerontologist, 35(1), 103–111.CrossRefGoogle ScholarPubMed
Statistics Canada. (1999). A portrait of seniors in Canada (catalogue no. 89-519-XPE). Ottawa, ON: Ministry of Industry, Science, & Technology.Google Scholar
Statistics Canada, Health Statistics Division. (2003). Distribution of rated bed capacity of residential care facilities for the aged offering level II or higher care, by urban/rural geography by province, 1999. Data extracted from Residential Care Facilities Survey, 1 April 1999. Ottawa, ON: Ministry of Industry, Science, & Technology.Google Scholar
Weisman, G., Cohen, U., Day, K., & Meyer, G. (1990). Programming and design for dementia: Development of a 50-person residential environment. Milwaukee, WI: Centre for Architecture and Urban Planning Research.Google Scholar
Weisman, G., Lawton, M., Sloane, P., Calkins, M., & Norris-Baker, L. (1996). The Professional Environmental Assessment Protocol. Milwaukee, WI: School of Architecture, University of Wisconsin at Milwaukee.Google Scholar