Psychosocial needs within nursing homes: perspectives of family members, staff, and residents
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Growth in the number of older Canadians (i.e., those age 65 and older) has brought nursing home (NH) care into sharper focus. Although the physical health needs of NH residents are well described, less is known about which psychological and social needs are important to this population. The objectives of this dissertation are to: (a) develop and content validate a list of psychosocial needs relevant to NH residents that is informed by theory and their experiences, (b) use the developed list of needs and the perspectives of family members to determine which psychosocial needs are most important to residents with dementia and to a preliminary extent, residents without dementia, and (c) begin to understand how NH staff are enabled or hindered in meeting NH residents’ psychosocial needs. A comprehensive literature review and focus group with NH residents (n = 5) informed the development of the initial list of psychosocial needs. A Delphi survey administered through both a mailing and an online format with family members (n = 34) was used to establish consensus about which of these psychosocial needs were essential for NH residents with dementia. From the initial list of 25 psychosocial needs, family members of residents identified 16 needs that are highly important for residents with dementia. These needs can be grouped into the categories of choice and control, personal effectiveness, social connection, fun and pleasure, and self-acceptance. Six of these needs were identified by family members as being essential for resident well-being, which were grouped into the categories of choice and control (choice to accept or decline help from others), personal effectiveness (perceiving that staff are responsive to requests, access to devices that increase independence, and opportunities to talk with staff about care), and social connection (opportunities to maintain relationships with friends and family outside the nursing home, and warm and caring exchanges with staff). There was considerable overlap between the essential psychosocial needs for residents with dementia and a small sample of residents without dementia. Further, these needs are closely aligned with Self Determination Theory (Ryan & Deci, 2000). The results of the Delphi survey informed a follow-up focus group with NH staff (n = 10) to better understand the strategies they use to help residents meet their psychosocial needs, as well as the challenges they encounter when trying to do so. Staff perceived that providing person-centred and individualized care, as well as engaging in their own self-care, facilitates residents’ psychosocial well-being. Staff perceived that residents’ psychosocial needs are met though exercising choice and control wherever possible. Safety concerns, lack of time, and conflict with family members were some of the challenges identified by staff in helping residents to meet their needs. NH facilities are encouraged to explore how to support staff members’ efforts to meet these needs and minimize the barriers identified in this research. Smaller staff–resident ratios and additional staff training and education are two of several possible strategies to support staff in meeting residents’ psychosocial needs. The results of this study can help advance our knowledge of NH residents’ psychosocial needs and the role that staff members play in meeting these needs. Collectively, these findings are consistent with a person-centred philosophy of NH care. They also underscore the importance of future research examining effective interventions to address nursing home residents’ psychological and social needs, especially those related to choice and control, personal effectiveness, and social connection. This information will be helpful for optimizing nursing home residents’ mental health, well-being, and quality of life.