The practice of care in long-term care facilities for the elderly: a challenge for the training of professionals

Damaceno, Daniela Garcia; Chirelli, Mara Quaglio; Lazarini, Carlos Alberto

doi:10.1590/1981-22562019022.180197

Daniela Garcia Damaceno

Faculdade de Medicina de Botucatu da Universidade Estadual Paulista “Júlio de Mesquita Filho”, Programa de Pós-graduação em Enfermagem, Botucatu, SP, Brasil

https://orcid.org/0000-0001-8656-009X

Mara Quaglio Chirelli

Faculdade de Medicina de Marília, Programa de Pós-graduação em “Saúde e Envelhecimento”, Marília, São Paulo, Brasil.

https://orcid.org/0000-0002-7417-4439

Carlos Alberto Lazarini

Faculdade de Medicina de Marília, Programa de Pós-graduação em “Saúde e Envelhecimento”, Marília, São Paulo, Brasil.

https://orcid.org/0000-0003-3010-4436

Correspondence
Mara Quaglio Chirelli marachirelli@gmail.com

CI*	DCS**
Timed and systematic care	It is very busy, the day goes very quickly, it’s hard. So, you have to work with a timetable in here, because otherwise you won’t manage it, if you don’t establish times for things, you won’t be able to provide care. It isn’t like a private facility, here there’s bath time, coffee time, everything has a schedule. We follow the pattern of the institution. During the day it means it’s quite systematic, because it has to be, I've worked during the day and when you go into one room someone in the other room is already calling you. (P1, P4, P6 to P8, P14, P15, P17 to P23, P25 to P29)
Team care	It’s gratifying, you have to pay attention to everything, every detail, and we’re a team here, when someone needs extra help, we’re a partnership. Every shift does their job so they don’t leave a mess for the next one. (P19, P24)
Longitudinal Care	I try to carry out longitudinal follow-up care more slowly, there is no established routine for re-assessment, but as often as I can I do [...] a longitudinal follow-up. (P5)
Quality basic care	You have to pay attention to everything, every detail. For example, it’s very important to talk when they’re having a shower, not just put them in there and leave. You have to have a different way of looking at things. It’s care for hygiene. We take care so they don’t run away, or hurt themselves, or fight among themselves. (P1, P4, P19, P21)

CI*	DCS**
Doesn’t believe change is required	I haven’t noticed, I think I'm doing my job. I feel fulfilled, I love what I do. And things are great the way they are. At least in my area I don’t think they’re needed. There was a time we even thought they were, but today everything is ok and I'm content where I am. (P2, P6, P7, P8, P9, P10, P11, P12, P13, P14, P15, P16, P17, P19, P26)
Greater availability of time	I need more time actually, I can’t perform all the activities I have to organize and the monitoring I do ends up being segmented at various times. I would like to have more time to talk to them, give them a little more attention, which they like, give them affection and they end up feeling it, the lack of that part of care. [...] because they’re the most needy, to talk, to give them a hug. [...] because during the day the work is very mechanical, there’s a lot to do [...]. (P1, P3, P5, P18, P20, P21, P22, P23 P24, P28)
More care professionals	To meet people's needs, you would need more care professionals for specific tasks. [...] I could do everything and I would have more time to sit down and talk, cut their nails, do their nails and talk to them, have fun. And it gets hard, a lot of them are bedridden. (P1, P2, P5, P7, P18, P21, P22, P23, P24, P25, P29)
Need for more training	I need to know more and I'm even looking to take other courses to see if they bring anything new, to add to our knowledge. [...] However, we have already tried to have more training, but it is not easy to understand the thinking of the paid staff. If there is no financial benefit, they don’t look kindly on it. (P4, P5)
Greater participation of family of elderly person	I’d request more care from the family. It’s the lack of a family that makes the work difficult. (P4, P25)
Better interprofessional communication and communication with management	Communication with both colleagues and upper management. It would improve working together. More dialogue for the betterment of the elderly themselves. (P15, P26)
New ways to stimulate the cognitive process of the elderly	I would change how we manage care, the ways of interacting, there should be other ways to stimulate the cognitive process of the inner self. But we can’t do it, due to a lack of training, a lack of space, a lack of creativity, because they want to establish other routines, due to a lack of knowledgeable personnel in this area ... I would bring in someone to read, tell a story, perform theater, something, people who can get their attention, because they can’t just sleep all the time. (P5, P19, P28)

CI*	DCS**
Doesn’t believe change is required	I don’t think so, they addressed everything. First we learned through theory, then in practice, then back for more theory, I think it has to be like this anyway. (P2, P19, P29)
More time allocated to practical activities	I didn’t have much of this training in internships. In theory you should see the role of the professional, but in practice you don’t. So, I think there should be a bigger practical part. If the course had more of this, we would graduate having learnt more. It focuses a lot on theory and there’s a difference between what you read in a book and what you get in practice at the hospital, which is so busy. (P1, P18, P21 to P24, P27)
Specific gerontological care related content	There was nothing about the elderly on my nursing course. And if you had geriatrics, there was no follow-up care, no specific elderly person to care for or to let you understand how it is. There isn’t much time allocated to the subject, they do it because they have to teach that content, but it’s basic care, a little psychiatry [...]. The care is described in general terms and they describe the patient as a single thing, child, adult, elderly person, but they aren’t as specific as the care here. [...] There the focus isn’t on the patient and here it is on the elderly person, it’s different. (P1, P4, P18, P20, P22, P23, P25, P26)
Content specific to care in the LTCF	It’s rare to find a university which has contact with an LTCF, because it is a different management structure from the outpatient clinic, or hospitalization, or home visits. Because you deal with the psychological aspect, with the issue of abandonment. The aspect of social fragility, at times, is preponderant in the care of the person. So you have to know how to focus on that person's needs, you control your urge to treat everything at all costs, because it’s impossible. You have to manage your anxiety better [...]. So, I think if the students had longitudinal contact with this, I think it would add something [...]. Of course, the number of people who work with LTCFs is very small, so this might not be of interest to the academic director, but on the other hand, when you need it, it's a shock. You end up having to figure out what you're going to do alone. ” (P3 and P5)
Availability of refresher courses and exchanges between professionals	There should always be refresher courses and updates [...] everybody could pass on a new experience. (P28)

[1] Correspondence
Mara Quaglio Chirelli marachirelli@gmail.com

CI*	DCS**
Humanized care	The most important quality is humanization. Here they treat the elderly in a way that makes them feel like they’re at home. After all, you aren’t fiddling with a plant, so if you don’t like it, if you have no patience, look for another job. (M1 and M3)
Physical conditions of the elderly and the environment	Everything is always clean [...]. It's always clean, they don’t smell, they're always clean. The rooms are clean, they smell of someone who’s had a bath, the general area is clean, the kitchen is always spotless, the quality of the food is good and also we always follow the guidelines of the doctor responsible for the treatment of the elderly. (M2; M3 and M4)
Preparation of care professionals	The elderly are very well looked after [...] and they don’t want to leave because they must like it. The staff are very attentive, they bring both problems and solutions. There are some excellent employees who wear the uniform of the institution, in return, we try to give all the staff the best working conditions to provide the best care. (M4)

Brasil

Brasil

The practice of care in long-term care facilities for the elderly: a challenge for the training of professionals

Abstract

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