THE STRUCTURE
4.3 CASE TWO
4.3.4 FINDINGS FROM ELDERLY RESIDENTS
Findings from five elderly residents of Case Two comprising socio-demographic data and data from interview are presented. A summary of the qualitative fmdings are presented in
Table 4.5. Five themes emerged from the data, namely: reasons for admission, interactive relationship, experiences of the elderly, psychosocial support and satisfaction with care.
4.3.4.1 Demographic data
The following findings were obtained from five elderly residents of Case Two. The findings followed the "outcome" of the study's conceptual framework. Data sources were demographic information and interview. The demographic variables of interest were age, gender, cultural group and marital status. The ages of the participants ranged from 69 to 80 years. In relation to gender, two were females and three were males. Regarding cultural group, they were all Indians, who were never married and widowed.
4.3.4.2 Findings from Interview with elderly residents and observation
Table 4.5: Interview with elderly residents and observation
Concepts from the Emerging Themes Data Source Conceptual Framework
OUTCOME Reasons for admission Interview Experiences of the Elderly Interactive Relationship Observation
Experiences of the elderly Psychosocial Support Satisfaction with care
4.3.4.3 Reasons for admission
The reason for admission into the RCF was varied among participants. One participant said he was admitted after the death of his older brother, who had been his only source of support. He discloses:
I was staying with my brother and his wife, but after he died, his wife told me to come to this facility.
Other participants reported that they previously stayed in assisted homes for younger people, but when they became senior citizens, they were asked to relocate to the current RCF. Multiple health-related problems were reported by many participants as a major reason for their admission such as poor eyesight, heart condition, shortness of breath, chronic fatigue, diabetes and arthritis. One participant reported that she was admitted due to lack of a family caregiver because her children live overseas; as indicated below:
I have been alone all the time; I decided to come live here because my children are overseas, four of them; I only got one daughter here and the family is getting too small now; so I don't have anyone to care for me.
One male elderly resident wanted to stay away from his adult children because staying away from them gives him a sense of independence. Another participant reported that he decided to become a resident due to perceived lack of future caregivers because he thinks his children will not be able to look after him in the future when he will need people to care for him:
I decided to come here myself because nowadays children do not look after their parents. So I came here because my children are grown and they got to live their lives and I do not want to be a burden to anyone.
Findings of the reasons for admission to the ReF were death of a brother, lack of support, growing beyond age limit, multiple and chronic health-related conditions, lack of family caregivers and the desire to gain independence from family.
4.3.4.4 Interactive relationship
Interacting with other residents was reported to be therapeutic for the elderly. One participant disclosed that such relationships can help residents to overcome their past experiences in order to embrace their current circumstances. She further explained that interacting with others can help residents learn from others' experiences with the view of overcoming personal shortcomings.
We join everyone; it keeps us going and we can forget the past; when you keep to yourself, you do not learn anything; that is why we are living here for. By getting together in groups, we joke, talk and we learn so much of things from each other.
4.3.4.5 Experiences of the elderly
The participants reported good experiences of living in the ReF because they were well looked after by the staff. The researcher also observed that most of the residents looked happy and willing to participate in this study. However, some of them had some unique experiences. For example, one participant reported that sometimes the food is a bit too strong for old people probably due to a toothache or missing teeth. Another participant reported that he sometimes feels like going away from the current ReF because his roommate always mistreats him as illustrated by the following quotations:
I'm pleased to be here, but my roommate, you know, he is annoying. He is a little cheeky; he makes me feel like leaving and going somewhere else, you know.
4.3.4.6 Psychosocial support
The participants reported several means of psychosocial support which they considered crucial to their well-being. For example, love and care by family was reported by one male participant, whose daughter is married with children, but stay in another province.
According to him, his married daughter and her family love and care for him; always providing him emotional, financial and material support. Contact with people seemed important even if a resident does not have a family of origin. According to one resident:
I actually contacted a couple, a family, a husband and a wife and their two little kids; they came here to visit me, talk to me,· the same couple invited me recently to their home when they were having a family reunion and they said I was a part of their family.
Cell phones were also significant since residents use them to keep in touch with family and friends. A relationship with God gives some people a sense of spiritual support. One participant reported his desire to get closer to God as a means of spiritual support. "I only look for the good in life and I want to get close to God".
Another participant reported that he was once blind, but his sight was restored through spiritual healing which he described as "God's miracle". He further reported that the Hindu priest asked his parents to give him a new name and the name change effected the restoration of his sight.
4.3.4.7 Satisfaction with care
Four of the research participants reported that they were satisfied with the RCF, giving many reasons for their satisfaction. For example, one participant described her
Another participant said he was satisfied with the ReF because it was more affordable compared to other places.
Today the cost of living out in the open place, I tried once and I failed; I am very thanliful I have been accepted in this place and I like staying here; I will stay here until I die.
Four participants did not see the need for any changes to be implemented because in their view, they were satisfied with the place as it was. However, one participant said he wished there were additional wheelchairs for those who had physical disabilities. Another participant wished there would be more outings for the residents.
They must take us more on outings, beaches, open picnics, and whatever; that is what I would like to have more.
The above findings were obtained of the experiences of the elderly under four themes,
"interactive relationship", "experiences of living in ReF", "psychosocial support", and
"satisfaction with care". In the next section, the researcher presents findings on the 10 nursing staff who participated in the quantitative aspect of ease Two.
4.3.5 FINDINGS FROM NURSING STAFF
The following findings were obtained from 10 nursing staff (three RNs & seven ENs) who participated in the quantitative aspect of Case Two. Data was elicited using semi- structured questionnaires, composed of closed and opened-ended questions. The presentation includes demographic data, caring for the elderly, professional knowledge about elder care, and nursing experiences of caring for the elderly. Because the sample size was small, the researcher used descriptive statistics to present some of the findings in this section.
4.3.5.1 Demographic data of nursing staff
The demographic variables of the participants were age, gender, marital status and level of education. Their ages ranged from 30 to 50 years and above. Five participants were between ages 30 and 39 years; Four were between 40 and 49 years; and one was in the category of 50 years and above. All of them were females. Regarding marital status, five were married; two were never married and three were divorced. All of them completed grade 12, and three also had tertiary education in nursing.
4.3.5.2 Caring for the elderly
Six questions were used in Case Two to determine what nursing staff do to manage challenging behavior and confusion among the elderly. They reported supervision and assisting with ADLs as the focus of care. The strategies reported to manage aggression in the elderly were listening and speaking to them clearly, while reassuring and calming them down. Staff managed elderly residents suffering from confusion by repeating instructions and reassuring the elderly. One of the RNs summed up this approach as follows: " ... making clarifications, orientation and family involvement and trying to understand them ".
The staff were asked to determine whether they had professional skills in counseling and problem-solving and how such skills could help them in caring for the elderly with challenging behavior. Summary of [mdings from the close-ended questions are displayed in Table 4.8. Having problem-solving skills helped nursing staff members to gain patients' confidence and trust. It also helped them to deal with the residents' problem and
not the behavior, thereby enabling them to understand the patients' needs and intervene properly.
4.3.6 Nursing staff self-reported knowledge about elder care
Sixteen objective questions were used to determine from the nursing staff of Case Two whether they had different levels of professional knowledge on elder care over concerns such as medication management, infection control, universal precautions, wound care, etc. Summary of findings from the close-ended questions are also presented in Table 4.6 below.
Table 4.6: Nursing Staff Self-reported Knowledge About Elder Care
Questionnaire items Yes No Total
1. Do you have skills in counselling 5 5 10 2. Do you have problem-solving skills 10 0 10 Indicate vour Knowledge about the followinI!
3. Medication management 10 0 10
4. Infection Control 10 0 10
5. Universal Precaution 10 0 10
6. Wound Care 10 0 10
7. Management of Incontinence 10 0 10
8. Prevention and management of pressure sores 10 0 10 9. Patient safety and protecting the residents from 10 0 10
hazards
10. Preventing the residents from falls in RCFs 10 0 10 11. Nutritional needs of the elderly 10 0 10 12. How to connect residents to services 10 0 10 13. Rehabilitation needs of the elderly 10 0 10 14. The need for exercise for the elderly 10 0 10 15. Recreational need for the elderly 10 0 10 16. The need for respite care for elderly care givers 10 0 10
17. Palliative care and dying 10 0 10
18. Spiritual needs of the elderly 10 0 10
The above data presents evidence that the nursing staff in this ReF have very good nursing knowledge of the various aspects of elder care. Ten out of 10 nurses reported that they have the above skills required for the care of the elderly.
The participants were again asked the following two subjective questions: 1). How did you acquire this knowledge? 2). How does the knowledge affect your care to the elderly?
In response to the first question, the nursing staff reported that they acquired the above knowledge through experience, as well as during their professional training, and through doctors and nurses. In response to the second question, the nursing staff reported that their professional knowledge had equipped them not only on the needs and beliefs of the elderly, but also on the ability to understand and respond to the changes that take place in the elderly resident's behavior.