An examination of family caregiver experiences during care transitions of older adults

Community-Based Hip Fracture Rehabilitation Interventions for Older Adults With Cognitive Impairment: A Systematic Review

BACKGROUND

A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post hospital discharge are currently unknown.

OBJECTIVE

The aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies.

METHODS

The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy included a combination of text words and subject headings relating to the concepts of CI, dementia, delirium, cognitive reserve, and hip fractures. For a study to be included in the review, it had to involve participants with CI who underwent hip fracture surgery, and consisted of an outpatient intervention that occurred in the participant's home or community. Peer-reviewed journal articles were identified by searching various databases. Two independent reviewers screened the titles and abstracts to determine which articles comprising of a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist were used during the full article data analysis and synthesis. A meta-analysis was not conducted due to heterogeneity of measures and outcomes.

RESULTS

The original search resulted in over 3000 articles. Of those, three studies satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment.

CONCLUSIONS

The findings from this review suggest that community-based rehabilitation post hospital discharge interventions show promising results towards improving various physical function outcomes, mobility, and activities of daily living for older adults with CI following a hip fracture. This review also demonstrates and discusses the current lack of outpatient rehabilitation interventions targeted towards older adults with CI post-hip fracture. Additionally, several substantive gaps that require attention to move this field forward are highlighted.

Ways of understanding being a healthcare professional in the role of family member of a patient admitted to hospital. A phenomenographic study

Healthcare professionals' experience of being family member of a patient can contribute to knowledge development and organizational learning in further ways than the experiences of general family members. However, there is little research on healthcare professionals' experience being on 'the other side of the bed'.

OBJECTIVE

To describe how healthcare professionals understand the role of being a healthcare professional and a family member of a patient admitted to hospital.

DESIGN

Qualitative with a phenomenographic approach.

SETTING

Three Swedish hospitals.

PARTICIPANTS

All healthcare professionals in three hospitals were invited. Twenty-one volunteered for the study and 18 met the inclusion criteria; to have one year of professional experience and to have visited the family member in hospital daily during hospitalization. Family members in maternity or psychiatric care were excluded.

METHODS

Semi-structured interviews were used for data collection. Transcripts were analyzed with a phenomenographic method to describe variation and commonality in the ways of understanding the phenomenon under study.

RESULTS

Four dominant ways of understanding the phenomenon were identified; the informed bystander, the supervisor, the advocate and the carer. The four ways of understanding were hierarchically related with "The informed bystander" being least involved in the care of the family member and "The carer" more or less taking over the patient's care because of inappropriate, unsafe or omitted care. Common for all ways of understanding the phenomenon, except "The informed bystander", was the difficult balance between their loyalty toward the family member and their colleagues among the staff. "The informed bystander" and "The supervisor" are ways of understanding the phenomenon under study that, to our knowledge, has not been described before.

CONCLUSIONS

This study describes how being a family member of a patient can be understood in four different ways when the family member is a healthcare professional. The findings show similarities to previous studies on general family members as well as nurse-family members of patients in critical care. The need for professional communication, support and coordination will be substantially different if the family member understands his/her role as an informed bystander compared to if they perceive themselves as a carer. The role conflict and ambivalence toward building relationships described are aspects that need further exploration, as does the experience of being forced to care for a family member. Our findings contribute with new knowledge developing patient- and family-centered care.

The Competency Model for Professional Rehabilitation Nursing

BACKGROUND

Rehabilitation nursing is practiced in various settings along the healthcare continuum. No framework is noted in the literature that defines the necessary competencies of the rehabilitation nurse.

PURPOSE

To develop a Competency Model for Professional Rehabilitation Nursing and its application to clinical and educational practice.

METHOD/DESIGN

A seven-member Association of Rehabilitation Nurses (ARN) task force was convened; conducted a literature review, reviewed current and historical ARN documents, including the Strategic Plan, and developed a Competency Model for Professional Rehabilitation Nursing practice.

FINDINGS

The Competency Model for Professional Rehabilitation Nursing delineates four domains of rehabilitation nursing practice and essential role competencies.

CONCLUSION

The Competency Model for Professional Rehabilitation Nursing addresses this diverse specialty practice in the current healthcare arena. This framework can be used to guide nurses practicing at different levels of proficiency in various settings.

CLINICAL RELEVANCE

The Competency Model can be used as a structure for staff orientation, evaluation tools, clinical ladder components, role descriptions and rehabilitation nursing courses.