Forming Nursing Home Practices That Support Quality of Care for Residents. A Qualitative Observational Study

Figures & data

Table 1 Characteristics of the Included Nursing Homes

	Nursing Home 1	Nursing Home 2	Nursing Home 3
Finances and organisation	Christian nonprofit organisation	Part of a large private for-profit organisation	Municipality public nonprofit organisation
Residents	Unit 1: 16 residents divided into two groups. Unit 2: 21 residents divided into two groups	Two units, each with 16 residents divided into two groups	Unit 1: 18 residents divided into three groups. Unit 2: 17 residents in a single group
Shared living areas	Unit 1 had 2 semi-attached rooms. Both rooms included a kitchen, dining room and sofas and chairs for relaxation. Unit 2 had a separate living room and kitchen/dining room.	Both units had an open concept with a combined dining and living room in each unit.	Unit 1 had three smaller open-plan kitchen/dining and living rooms. Unit 2 had one large kitchen/dining room and one living room.

Table 2 The Thematic Analysis with Examples from the Different Steps of the Process

The Analysis	Steps Describing the Analysis Process	Examples from the Process
Step 1 Familiarising with the data	Initial ideas from reading and rereading the material	Ex: We found that a lot of time and work was related to preparing and serving the meals
Step 2 Generating codes	Detailed empirical close inductive coding resulting in around 60 codes	Examples of the empirically close codes related to the meals were: Preparing meals Food and drinks Feeding frail residents Kitchen as a social arena Setting the table Timing of the meals
Step 3 Constructing candidate themes	Sorting groups of codes into 9 candidate themes	Analysing and sorting the codes above resulted in the candidate theme: Mealtimes structuring the day.
Step 4 Reviewing potential themes	Discussing the candidate theme within the research group and selecting relevant quotes	Example of a quote relevant to the candidate theme presented above: We would have liked to spend more time with the patients, however, working with the meals is important too. Then we can observe the patients. Then we can see how they eat. We are planning and documenting the care, and it is easier when we have observed how and what they eat and drink.
Step 5 Defining and naming themes	3 Main themes were developed	The further analysis of the candidate theme presented in this table made us include it in the main theme: Working within the given nursing home context.
Step 6 Writing the paper	Through further discussions of the themes, the analysis was strengthened and selected quotes were quality checked	Writing of the result chapter

Table 3 The Main Themes and the Candidate Themes from the Analysis

Main Themes	Candidate Themes Included
Working within the given nursing home context.	Architecture facilitating care.
	Mealtimes structuring the day.
	Residents’ health situations.
	Available care resources.
Creating care practices.	Being alert.
	Utilizing personal resources.
	Engaging in relational work.
Organizing activities.	Planned activities.
	Spontaneous activities.

Table 4 An Example of a Weekly Activity Plan

	Monday	Tuesday	Wednesday	Thursday	Friday
Morning	Exercise with a physiotherapist	Breakfast gathering on the third floor		Breakfast gathering on the fourth floor
Noon	Music therapy singalong	Baking Christmas cookies	Visit from children from the kindergarten	Church service arrangement	Balloon activities with an occupational therapist
Afternoon		Therapy dog from The Red Cross	Sing along in the living room		Reading aloud in the living room
Evening	Bowling in the cafe	Concert with the boys’ chorus	Walking Group	Bingo in the cafe	The movie “Mary Poppins” in the cafe