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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. (morgand@sask.usask.ca)
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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.

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