Symposium 10 Health promoting nursing homes. Care quality and working environment in Norwegian nursing homes. C2: Quality of care in nursing homes from the nursing home residents' perspectives

Background Defining care quality for long-term residents has several challenges. Institute of Medicine’s definition of quality of care is: ”Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Further, six domains of care quality are outlined: Safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The health care services rely on the best available information; both about the patient and about the effectiveness of a particular kind of treatment for patients with similar health problems. However, patients may do well despite poor quality because humans are resilient and tend to adapt to the situation. Determining what is good or bad care quality requires knowledge of the values that individuals place on various health outcomes and how these may differ among individuals. This study contributes to the development of care quality in NHs. The aim of the study was to explore how quality of care in NHs could be understood from the perspective of NH residents. Methods In-depth interviews of fifteen mentally lucid residents aged 65 and over were performed. Analyses were done by meaning condensation and coding. By comparing and contrasting the content, meaning categorization was achieved. Results Two main categories of what residents viewed as important for high quality of care and considered as having met their needs and expectations emerged: “The nursing home as my home” and “Interpersonal care quality”. The category “The nursing home as my home” encompassed four subcategories of quality of care experience: ‘Being at home in a nursing home’, ‘Paying the price for 24-hour care’, ‘Personal habits and institutional routines’, and ‘Meaningful activities for a meaningful day’. The main category “Interpersonal care quality” comprised three subcategories: ‘Care for and alleviation of medical, physical and psychological needs’, ‘Protecting the resident’s integrity’, and ‘Psychosocial well-being’. Conclusion Ambiguities concerning the NH as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. Furthermore, care quality in NHs implies a balanced, individual approach to medical, physical and psychosocial care, including interpersonal aspects of care. The findings added together, suggest, from the residents’ perspective, that nurses are in a key position to optimize value in NH care by enhancing factors associated with quality.