The assessment of the demand for medical care among elderly care
Transkrypt
The assessment of the demand for medical care among elderly care
● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 2/2016 (32-38) ● The assessment of the demand for medical care among elderly care home residents (Ocena zapotrzebowania na opiekę medyczną pacjentów w starszym wieku w warunkach Domu Pomocy Społecznej) M Starczewska 1,A,D, J Tysa 2,B, K Augustyniuk 1,C, J Owsianowska1,B, A Jurczak1,B, E Grochans1,E,F Abstract – Introduction. In the nearest 20 years almost every fourth citizen of our country will cross the threshold of senility. The forms of institutional aid for the elderly include care homes providing nursing and medical services. The aim of this study is to determine the demand for medical care among care home residents. Materials and methods. The study involved 150 residents of the General Mieczysław Boruta-Spiechowicz ‘Veteran’s Home’ in Szczecin. This survey-based study was performed using an original questionnaire. Results. The study group included 48% of women and 52% of men. The most numerous (57%) were residents between the ages of 80 and 89. Nearly one-third of respondents were not visited by their closest relatives, and as many as 83% lived a solitary life. In the study group, views on medical care in the care home were divided: 51% claimed that it was adequate, and 49% held an opposite opinion. According to 41%, the best providers of medical care were physiotherapists and carers, and the worst – physicians. Over two thirds of respondents had a very good opinion both about respect for their intimacy and assistance with personal care activities rendered by nurses. Conclusions. 1. The vast majority of care home residents expect more interest from medical staff (especially physicians and nurses). 2. The demand for medical care increases with age and the length of stay in a care home. It is also more common among residents who are not visited by the closest family members. nariusza ankiety. Wyniki: Badaną grupę stanowiło 48% kobiet i 52% mężczyzn. Największą część (57%) stanowili pensjonariusze w przedziale wiekowym od 80 do 89 lat. Zdecydowana większość badanych tj. 83% była osobami samotnymi. Blisko jedną trzecią badanych pensjonariuszy stanowiły osoby, których nie odwiedzała najbliższa rodzina. Wyniki. badanej grupie opinie dotyczące opieki medycznej na terenie Domu Pomocy Społecznej były podzielone, 51% odpowiedziało, że opieka jest wystarczająca, natomiast 49% było odmiennego zdania. Według 41% pensjonariuszy najlepiej opiekę medyczną sprawowali rehabilitant i opiekun, natomiast najniżej oceniono opiekę świadczoną przez lekarza. Ponad dwie trzecie badanych oceniło świadczoną przez pielęgniarki pomoc w czynnościach pielęgnacyjnych jako bardzo dobrą i dobrą. Większość badanych pensjonariuszy (77%) oceniło poszanowanie intymności podczas zabiegów pielęgnacyjnych bardzo dobrze i dobrze. Wnioski. 1. Zdecydowana większość pensjonariuszy Domu Pomocy Społecznej oczekuje większego zainteresowania ze strony personelu medycznego, przede wszystkim ze strony lekarza i pielęgniarki. 2. Zapotrzebowanie na opiekę medyczną zwiększało się wraz z wiekiem, czasem pobytu, a ponadto występowało częściej u pensjonariuszy, których nie odwiedzali członkowie najbliższej rodziny. Słowa kluczowe – pensjonariusz, Dom Pomocy Społecznej, opieka pielęgnacyjno-medyczna. Key words - resident, care home, nursing and medical care. Author Affiliations: Streszczenie – Wstęp. W ciągu najbliższych 20 lat niemal co czwarty mieszkaniec naszego kraju przekroczy próg starości. Jedną z form pomocy instytucjonalnej dla osób w podeszłym wieku są Domy Pomocy Społecznej, które świadczą opiekę pielęgnacyjno-medyczną. Celem pracy jest określenie zapotrzebowania na opiekę medyczną wśród pensjonariuszy Domu Pomocy Społecznej. Materiał i metody. W badaniu wzięło udział 150 pensjonariuszy Domu Pomocy Społecznej „Dom Kombatanta” im. Gen. Mieczysława Boruty-Spiechowicza w Szczecinie. Zastosowano metodę sondażu diagnostycznego z wykorzystaniem autorskiego kwestio- 1. Nursing Department, Pomeranian Medical University in Szczecin 2.Students’ Research Club at the Nursing Department of the Pomeranian Medical University in Szczecin Authors’ contributions to the article: A. The idea and the planning of the study B. Gathering and listing data C. The data analysis and interpretation D. Writing the article 32 ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● E. Critical review of the article F. Final approval of the article Correspondence to: Małgorzata Starczewska MD, Nursing Department, Pomeranian Medical University in Szczecin Żołnierska 48 Str., PL-71-210 Szczecin, Poland, e-mail: [email protected] The calculations and statistical analysis have been conducted using the STATISTICA 10 PL package. For qualitative variables, percentage values have been calculated. The correlation between qualitative variables has been assessed using the Chi-square test (χ2). In all the analyses, held to be significant were those effects for which significance level p amounted to 0.05 (p ≤ 0.05). Accepted for publication: March 18, 2016. III. I. INTRODUCTION n the nearest 20 years almost every fourth citizen of our country will cross the threshold of senility. Such a rapid grow in the population of Polish seniors in the nearest future results from the fact that the ‘baby boom’ generation born in the 1950s will be entering the age of senility [1]. The increase in senior population is the effect of, among others, the development of medical sciences, easier access to medical services and an improvement in living conditions [2-5]. The transformation brought about mainly by demographic processes requires preparing actions and new forms of support and assistance for the growing group of the elderly who are often viewed as disabled and inactive. The forms of institutional aid for the elderly include care homes providing residential, nursing and support services [6]. The aim of this study is to determine the demand for medical care among care home residents. I II. MATERIAL AND METHODS The study was conducted in 2012 and involved 150 residents of the General Mieczysław Boruta-Spiechowicz ‘Veteran’s Home’ in Szczecin. The research programme has obtained a positive opinion from the Bioethical Committee at the Pomeranian Medical University. This survey-based study was performed using an original questionnaire. The questionnaire included 21 questions and was composed of two parts. Part one concerned demographic data, i.e. sex, age, education, civil status, children, visits by relatives and family and the duration of stay at the care home. Part two included questions concerning the subject of the study, i.e. the assessment of medical care provided at the care home in terms of kindness and understanding of the medical personnel, assistance in personal care activities and respect for intimacy. RESULTS The study group of care home residents comprised 48% of women (72 people) and 52% of men (78 people) aged from 60 to over 90. The largest group of 57% (86) consisted of seniors aged 80 to 89, then 27 % (40) were in the age from 70 to 79. The least numerous group were residents 60-69 years old - 1%. One-third of the respondents had a secondary education, whereas 31% had an elementary education. A higher education was declared by 13% (20) of respondents. The vast majority of respondents - 83% (124) lived a solitary life. Nearly two-thirds (98) of the respondents had children. The largest group of the residents surveyed - 32%, were people not visited by their closest family members. The remaining ones - 31% (46) of respondents had visitors several times a week, whereas 23% (35) saw guests several times a month. The groups of respondents visited several times a year and fewer were represented by 7% of the respondents each. The average duration of stay among the care home residents surveyed ranged from 1 year to over 5 years. Most respondents stayed there 4-5 years or more. In the study group, views on medical care in the care home were divided; 51% (77) claimed that it was adequate, and 49% (73) held an opposite view. The vast majority of care home residents 76% (114) expected more interest from medical staff. They had the greatest expectations in relation to the physician - 102 residents, and in relation to the nurse - 73 people. According to the respondents, medical care was provided the best by the physiotherapist and carer – such was the opinion of 41% (61) of respondents. According to over one-third of seniors, the nurse administered care very well. Also one-third believed that she did it well. Evaluated the lowest was the care provided by the physician, since 29% found that it was average and 22% viewed it as poor or very poor. The greatest politeness, understanding and interest assessed as very good and good were shown, according to 33 ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● 86% (129) of those surveyed, by the nurses and carers; somewhat lower were assessed therapists - 84% (126) and physiotherapists - 80% (120). The worst were assessed doctors, who obtained very good and good marks from 65% of the residents. Over two-thirds of the respondents - 69% (103) evaluated the assistance in personal care provided by nurses as very good and good. None found it to be very bad. In the eyes of 51% (77) of the respondents, the nurses reacted to calls very fast or fast. Yet, a similar number, 49%, found that the nurses reacted in an average, bad or even very bad manner. The vast majority of residents - 72% (109) were of the opinion that the nurses reacted very well or well to requests. Barely 12% (17) of seniors believed that the nurse reacted in a bad or very bad manner. Most of the respondents - 77% (115 people) assessed the respect for intimacy during nursing activities as very good and good. Few people, i.e. 13% (19) considered it as average, and merely 10% as bad or very bad. In terms of providing information on the type and manner of treatment planned, the best were assessed in the opinion of 86% (129) of the respondents their carers, and in the opinion of 85% (128) their therapists; whereas 78% (116) of the respondents pointed to the physiotherapists and 71% (106) to nurses. The smallest percentage of 59% (89) gave doctors the mark of very good and good. This professional group obtained the most negative opinions in the scope of providing information. The vast majority of residents, as many as 93% (140) evaluated the ability to perform nursing activities such as drawing blood, making injections or dressings as very good and good and barely 1% (1) found it to be poor. Almost three-fourths of the respondents - 73% (109) found that a beneficial influence may be exerted on health by sport, physical exercise, dancing, and Nordic walking. 59% (88) of the respondents mentioned going for a walk, whereas 50% of the seniors mentioned entertainment in the form of playing chess, cards, draughts, solving crosswords, going to the cinema or theatre and watching television. Analysed was the influence of selected factors such as sex, age, education, civil status, having children, visits by the closest family and duration of stay in the care home on opinions concerning: nurses’ assistance in personal care activities and the rapidity of their reaction to calls; information furnished by the medical personnel on the type and manner of treatment planned; respect for intimacy, politeness, understanding and interest shown by the medical personnel. The analysis of the research material has shown a statistically significant correlation between the assessment of nursing assistance and the age of the residents studied (p≤0.05) (Table 1). In the scope of rapidity of reaction to calls or respect for intimacy, no statistically relevant correlations have been found (p>0.05). Table 1. Analysis of the assessment of assistance in nursing activities, rapidity of reaction to calls and respect for intimacy in relation to selected variables Assistance in nursing activities χ2 p Rapidity of reaction to calls χ2 p Sex 2.40 >0.05 8.10 Age 17.00 ≤0.05 Education 3.28 Civil status Number of children Visits by close family Duration of stay Respect for intimacy χ2 P >0.05 2.58 >0.05 18.66 >0.05 11.55 >0.05 >0.05 14.93 >0.05 10.03 >0.05 1.39 >0.05 1.41 >0.05 2.20 >0.05 2.06 >0.05 1.34 >0.05 6.22 >0.05 8.90 >0.05 11.29 >0.05 24.86 >0.05 3.10 >0.05 12.35 >0.05 19.93 >0.05 χ2 – Chi-square test; p – significance level calculated for χ2 The analysis of the assessment of politeness, showing understanding and interest by the medical personnel has demonstrated a statistically significant correlation between the assessment of the physician and the respondents’ sex (p≤0.05) and duration of stay (p≤0.01). There is also a correlation between the assessment of the nurse and the duration of stay (p≤0.05) as well as the assessment of the physical therapist and the frequency of visits by the closest family (p≤0.05) and duration of stay (p≤0.05) (Table 2) The assessment of the carer’s politeness depended significantly on the frequency of visits by the closest family (p≤0.05). In turn, the assessment of the therapist’s politeness depended significantly on the education of the residents surveyed (p≤0.05), on the fact of having children (p≤0.01), the frequency of visits by the closest family (p≤0.05) and the duration of stay in the care home (p≤0,05) (Table 2). 34 ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● p >0.05 χ2 1.47 p >0.05 χ2 3.73 P >0.05 3.07 >0.05 χ2 Therapist 21.05 >0.05 25.39 >0.05 29.16 ≤0.05 28.82 ≤0.05 30.04 ≤0.05 Duration of stay ≤0.01 21.23 ≤0.05 22.32 ≤0.05 18.74 >0.05 20.99 ≤0.05 χ2 – Chi-square test; p – significance level calculated for χ2 The analysis of the assessment of information provided by the medical personnel on the type and manner of treatment planned has revealed a statistically significant correlation between the assessment of the physical therapist and education (p=0.05) as well as between the assessment of the carer and the frequency of visits by the closes family (p=0.05) as well as between the assessment of the therapist and education (p≤0.05) and duration of stay (p≤0.001) (Table 3). >0.05 ≤0.05 >0.05 >0.05 ≤0.001 >0.05 5.20 12.10 1.69 5.85 22.71 1.32 >0.05 >0.05 >0.05 =0.05 >0.05 >0.05 10.91 14.16 8.06 26.28 10.81 0.75 >0.05 =0.05 >0.05 >0.05 >0.05 >0.05 12.46 20.55 5.68 25.43 1.33 >0.05 3.48 15.38 >0.05 >0.05 >0.05 12.55 >0.05 >0.05 >0.05 15.74 Duration of stay >0.05 Visits by the closest family 17.20 ≤0.05 >0.05 ≤0.01 17.76 1.23 8.23 >0.05 >0.05 >0.05 16.36 5.84 3.99 >0.05 >0.05 >0.05 16.99 6.15 4.48 >0.05 >0.05 >0.05 13.29 7.57 3.29 >0.05 >0.05 >0.05 Number of children χ2 – Chi-square test; p – significance level calculated for χ2 IV. Visits by closest family 28.83 Number of children 3.09 Civil status 5.36 Education 9.44 Civil status 7.03 Education 2.13 >0.05 14.35 >0.05 8.13 >0.05 16.12 >0.05 10.22 >0.05 9.39 Age Age p Carer >0.05 3.73 >0.05 5.90 >0.05 5.65 >0.05 4.22 ≤0.05 Sex 10.46 Sex χ2 1.38 p 22.84 χ2 Physical therapist Nurse 15.55 p >0.05 χ2 >0.05 p >0.05 χ2 >0.05 p >0.05 2 Physician χ p 2 Therapist 6.63 χ Carer 9.46 p Physical therapist 3.15 χ2 Nurse 2.98 Physician Table 3. Analysis of the assessment of information provided by the medical personnel on the type and manner of treatment planned in relation to selected variables 2.34 Table 2. Analysis of the assessment of politeness, showing understanding and interest by the personnel in relation to selected variables DISCUSSION In 2011, according to the Central Statistical Office of Poland, there were over 5 million people aged 65 and more in Poland, who constituted approx. 14% of the entire population. It is estimated that within the nearest 20 years almost every fourth inhabitant of Poland will cross the threshold of senility, thus joining the group of 8.5 million senior Polish citizens [1]. The ageing of society brings about social, economic, and political consequences. The ageing generation become the main clients of medical and social care, and they constitute a population with a particularly high risk of old-age diseases and geriatric syndromes [1, 7]. According to Kryszkiewicz, education is one of the factors influencing the condition of health and extending life expectancy [8]. Well-educated people evince a greater awareness of a healthy lifestyle and more often engage in positive health-oriented behaviours. They are equally eager to engage in activities demanding mental effort, which slows down dementia and enhances their mental capacity [9]. 35 ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● The authors’ own study demonstrated that one-third of the respondents had a secondary education - 34%, whereas 31% of the respondents had an elementary education and higher education was declared by 13% of the care home residents. The results of research conducted by Nowak et al. considerably differ from the authors’ own study in terms of secondary education – 21.4% of respondents and higher education, which did not exceed 1% [10]. In the own study, it has been demonstrated that the vast majority of residents surveyed - 83% were single people without a wife or husband. At the same time, the largest group of respondents - 32%, i.e. nearly one-third, was made up of people who were not visited by any member of the close family. Similar results have been presented by Kurowska, who indicated that most care home residents were solitary people – widows and widowers comprised 57.4% of the respondents, whereas single people accounted for 20.4%. Furthermore, 70.4% of the respondents did not have children. According to the same author, the activity of care home residents always increased following contacts with family and friends [11], which demonstrates how contact with the closest ones positively leads to a considerable increase in the physical and mental activity of care home residents. According to Chmiel-Perzyńska et al., the politeness of nursing personnel was assessed the highest by pensioners – 84.9% of good and very good marks, and the assessment rose with the frequency of using nursing care [12]. The authors’ own study shows that the greatest kindness, understanding and interest assessed as very good and good were expressed by nurses according to 86% of the respondents. The analysis of the authors’ own study concerning the assessment of politeness, showing understanding and interest by the medical personnel has demonstrated a statistically significant correlation between the assessment of the physician and the sex of the residents surveyed (p≤0.05). Moreover, a statistically significant correlation has been observed between the assessment of the physician and the duration of stay at the care home (p≤0.01). Worth paying attention to is the research by Nowak [10], which has demonstrated that people who were helped in making a decision on moving into a care home expected the medical personnel to show understanding much more than those who made the decision themselves. In the research by Marcinowicz et al. it has been noticed that both the characteristics of the physician, i.e. age or sex, and the sociodemographic characteristics of the patient: age, sex, education and economic status are broadly considered in quantitative research as variables influencing the satisfaction with medical care and its evaluation [13]. It results from the authors’ own study that the majority of residents, i.e. 93%, assessed the skill at performing nursing activities as very good and good. According to ChmielPerzyńska et al., people who took advantage of a nurse’s services more often assessed better not only her kindness but also her skills and competence. This probably results from the creation of a bond between patients and medical personnel and the increase in trust concerning their competence [12]. In the authors’ own study, a correlation exists between the assessment of the nurse and the duration of stay among the respondents (p≤0.05). According to the research by Nowak et al., in the case of people staying one month at the care home, the need for help in everyday activities was the smallest because those people did not know who to ask for assistance and what kind of assistance they may use. Similarly, the least help was needed by residents staying 10 months at the care home. It was caused by the fact that they had already settled in the new place and made friends with other residents. People who have made such friendships had significantly smaller expectations in relation to the medical personnel than those who remained solitary, which may be the result of peer assistance [10]. According to Kurowska, the purpose of care of the elderly is not so much attempting to restore their former vitality and health, even though such a result is undoubtedly desirable, as improving the quality of the residents’ life, providing them with the necessary assistance and care without leading to their incapacitation at the same time [11]. The results of the authors’ own study have shown that the respondents expected, above all, the physician to take greater interest in them - 102 people, and then the nurses 73 people. In turn, in the results of the research by Nowak et al., the respondents consider the nurse to be the most helpful person in care home conditions and they have the greatest expectations in relation to her [10]. Based on the research by Grywalska et al., it has been found that the availability of medical help is one of the most essential measures of quality in healthcare, which is why it should be continuously improved [14]. According to Kurowska, the task of carers is especially to educate and promote actions leading to self-sufficiency, stimulating understanding and acceptance of the situation in which the patients found themselves and convincing them that in spite of illness and disability they can and ought to lead a wholesome lifestyle [11]. The research conducted by Głowacka et al. among seniors from the Tuchola County proves that the elderly adopt a negative attitude towards senility, which results mainly from somatic ailments causing mobility and functional re36 ● JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No.2/2016 ● strictions. It has been found that senior citizens spend too little time on physical activity [15]. Research by Drobnik et al. has demonstrated that the consequence of reduced physical activity is the reduction in the quality of seniors’ life, and therefore the rehabilitation of a senior citizen should be multi-faceted, and thus effective in raising the quality of life in that period [16]. Grzegorczyk et al. provide that conducting a rehabilitation programme for seniors depends on multiple factors. First of all, it is necessary to win the patient’s trust by constantly caring for his or her health and to convince that person that it is purposeful to systematically exercise and engage in physical activity – this is best achieved by showing an example from that person’s environment [17]. The results obtained in the present study demonstrate that care was administered the best by the physiotherapist, as 41% of the respondents believe. Consequently, we may assume that a properly conducted rehabilitation programme, apart from having a positive influence on the resident, also leads to a better assessment of the physical therapist. Based on the own research, assessed the best by the residents in terms of providing information about the type and manner of planned therapy have been carers – 86% and therapists – 85 %. Then, very good and good marks have been obtained by physiotherapists – 78 % and nurses – 71%. The smallest percentage of respondents, i.e. 59%, evaluated physicians as very good and good. Patients ought to be informed about the course of treatment as well as all activities performed in relation to them by the entire medical personnel. According to Kamińska et al., it is the obligation of the medical personnel to inform the patient about his or her rights. It is a reason for concern that in the research of the above authors, only 44% of the respondents were familiar with patients’ rights. Most respondents - 83% replied that it was the doctor that had a conversation with them concerning treatment; in turn, half of the patients admitted that nurses talked to them about personal care. Research has shown that doctors talk to patients more often about treatment than nurses about personal care [18], which is a considerable difference in relation to the own study. The study conducted has shown that the vast majority of respondents, i.e. 73% believed that active rest could have a positive influence on health: sport, physical exercise, dancing, Nordic walking, whereas 59% pointed to going for a walk, and 50% of residents mentioned entertainment, i.e. chess, playing cards, draughts, crosswords, going to the cinema or theatre and watching TV. In research by Kurowska et al., it has been demonstrated that 16.7% of the respondents participated in the proposed occupational thera- py such as handicraft and painting, then 14.8% took part in walking trips, coach trips, outings to the theatre, philharmonic or cinema, whereas further 11.1% of the respondents took part in events organized in the care home such as dancing parties, and finally 55.5% visited their family and friends [11]. The conclusion is that care home residents know what has a positive influence on their health, but they do not make use of their knowledge in practice. The own study and research by other authors have shown the importance of a proper attitude of the medical personnel, i.e. understanding, respect for dignity, maintaining intimacy during care and therapeutic activities as well as politeness and interest expressed in relation to care home residents, and what benefit it brings. The residents expect acceptance and assistance in everyday activities, and when they receive it, they show gratitude and satisfaction with the care provided. It is necessary to become familiar with their expectations and wishes, which is an individual issue shaped by multiple factors. The provision of top-quality nursing and medical services to seniors ought to spring from not only the progress of medical sciences and civilizational development, but also from a moral obligation to that effect. V. CONCLUSIONS The vast majority of care home residents expected greater interest from the medical personnel, especially from the physician and nurse. The need for medical care increased with age and duration of stay. Furthermore, it concerned more often those residents who were not visited by the closest family VI. REFERENCES [1] Bień B. Opieka geriatryczna w perspektywie starzenia się ludności Polski. W: O sytuacji ludzi starych. Hrynkiewicz J (red.). 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