Nurses' perceptions of quality and the factors that affect quality care for older people living in long-term care settings in Ireland

Abstract

Aim: The aim of this research was to determine the factors that facilitate or hinder high quality nursing care for older people in long-term care settings in Ireland.

Background: The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors which have an impact on care have been identified, it is difficult to determine key factors from current research.

Method: This was a mixed method study, which involved qualitative and quantitative approaches. A self-response questionnaire was generated from data gathered by interview and analysis of literature. Information was collected from 498 nurses working in long-term care settings within a Health Board. A 68% response rate was achieved. Factor analysis was used to identify facilitating and hindering factors of quality care for older people.

Results: Nine factors where identified six facilitating factors of quality and three hindering factors of quality care. The six factors, which facilitate quality, were: an ethos of promoting independence and autonomy; a homelike social environment; person centred, holistic care; knowledgeable, skilled staff; knowing the person and adequate multidisciplinary resources. The three factors which hindered quality care; these were: a lack of time and patient choice, resistance to change and bound by routine.

Conclusions: The findings of this research provide nurses with a clear set of facilitating and hindering factors of quality care for older people and reveal some of the complexities and challenges of providing this care.

Relevance to clinical practice: Long-term care is the home of many older people and attention within these environments to the facilitating and hindering factors of quality is required. It is hoped that the factors generated in this study add to understanding in relation to quality care and the factors that influence this.