ABSTRACTThe 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.
摘要物理和社会环境被认为是护理患有痴呆症的疗养院居民的重要治疗工具,但人们对农村疗养院的环境却知之甚少。本研究在萨斯喀彻温省的一个农村卫生局(16,000 平方公里)进行。由政府资助的七家小型疗养院(15 至 35 张床位)提供长期机构护理,其中没有一家设有独立的痴呆症特别护理单元 (SCU)。物理环境评估规程(
PEAP)用于从痴呆症护理环境的九个关键方面对这些设施进行评估。评估结果显示,养老院在提供隐私方面的支持度最高,而在最大限度地提高认知度和引导方面的支持度最低。与注册护士、护理助理和活动工作人员进行了焦点小组讨论。护理人员指出了养老院难以满足的六种痴呆症住院患者的特殊需求,其中两种与物理环境有关(安全和平静、安静的环境),四种与社会环境有关(有意义的活动和一对一的接触、发挥余热的机会、灵活的政策以及乐于为痴呆症患者服务的知识丰富的护理人员)。工作人员建议将独立的痴呆症重症监护病房作为管理痴呆症护理的一种方法,但同时也指出了在小型农村设施中创建痴呆症病房所面临的挑战。研究结果为痴呆症护理环境的概念模型提供了支持,该模型强调组织、社会和物理因素之间的相互作用。