Improving well-being in nursing homes
Residential care facilities and nursing homes are not widely regarded as appealing places to live or work. In both professional practice and research, the emphasis is often on reducing negative aspects such as the heavy workload of nursing staff and the loneliness experienced by residents. In her doctoral thesis, University of Twente Ph.D. candidate Noortje Kloos introduces a positive psychological perspective on working and living in nursing home facilities, focusing specifically on optimizing functioning and enhancing the positive aspects of life.
"Our research shows that three basic psychological needs must be satisfied to maximize the well-being of both residents and staff: autonomy, relatedness and competence," Kloos explains. "The fulfillment of these needs can come under threat, for example as a result of too many rules, time constraints and the complexity of care, but until now little research on this topic has been conducted in the residential care sector."
Kloos asked staff to indicate the degree to which their need for autonomy (the ability to make their own decisions), relatedness (valuable interaction with others) and competence (a sense of being capable) is satisfied in the workplace. They rated feeling competent at work as the aspect that was most important to them, and the study showed that this need is fulfilled more highly than the other two. However, it also showed that all three basic psychological needs at work—competence, autonomy and relatedness—are linked to the work engagement and well-being of staff, even when they seem to find these aspects less important themselves. Given that well-being is generally associated with various positive outcomes, such as the intention to continue working for an organization, the research results could represent an opportunity for residential care facilities to invest more energy in supporting the three basic psychological needs among their staff. "Of course, we should not forget the role that residents can play," Kloos continues, "for example in supporting the relatedness that staff experience in their contact with the people they are caring for."
Autonomy, relatedness and competence for residents
But the need for autonomy, relatedness and competence is also important to the residents of care facilities. "Until now, this group was generally excluded from studies into the satisfaction of basic psychological needs. However, our research shows that, for them, the need for autonomy and the need for relatedness were satisfied more highly than their need for competence," Kloos says. "Our study found that the satisfaction of all three basic needs affected their sense of well-being even 5 to 8 months later. Another important new finding was that a high fulfilment level in autonomy, for example, cannot compensate for a low fulfillment level in competence. Residential care facilities should therefore be focusing on all three."
Nursing staff are also interested in making small adjustments to their behavior to maximize the sense of autonomy, competence and relatedness among residents. Kloos and her team have developed person-centered care innovation for staff, aimed at improving the well-being of residents. "Using video clips and the experiences of staff, we discussed how minor adjustments, such as adapting their work pace and explaining activities, could affect how residents experience their own competence." Her latest study shows it is important for staff to receive enough support in implementing these types of interventions. "An implementation plan should ensure smooth integration into daily care duties and create social support among colleagues."
Monitoring residents' well-being
The research reveals that staff find the well-being of residents difficult to assess: there is a discrepancy between what they report and what residents themselves report. This makes sense, given that well-being is personal and can be difficult for others to evaluate. She believes it is important to find alternative ways of monitoring well-being, for example by looking more closely at autonomy, relatedness and competence. If organizations want staff to report regularly on the well-being of residents, the study shows that a stable organization and detailed instructions would provide much needed support in this task. Kloos also believes it is important to make it easier for residents to report on their own well-being, for example by using more qualitative methods.