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Offermann J, Rohowsky A, Ziefle M. Emotions of scepticism, trust, and security within the acceptance of telemedical applications. Int J Med Inform 2023; 177:105116. [PMID: 37307720 DOI: 10.1016/j.ijmedinf.2023.105116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Addressing demands and shortages in healthcare supply, especially care in nursing homes, applying telemedicine represents a promising approach. However, the patients' acceptance and willingness to use telemedicine are necessary prerequisites for a sustainable integration within the medical supply structure. METHOD Therefore, this online survey study empirically (N = 203) investigates potential patients' attitudes towards telemedicine and their impact on the acceptance and perception of telemedical consultations being applied in nursing homes. Beyond that, using telemedicine in acute situations and for regular consultations is compared. RESULTS The results show three different patterns of attitudes towards telemedicine affecting the evaluation of telemedical consultations in both, acute and regular consultations. CONCLUSION The insights enable concrete recommendations for the integration of telemedicine in healthcare supply adressing the individual needs of potential patients.
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Affiliation(s)
- Julia Offermann
- Human-Computer Interaction Center, Campus-Boulevard 57, Aachen 52074, NRW, Germany
| | - Anna Rohowsky
- Human-Computer Interaction Center, Campus-Boulevard 57, Aachen 52074, NRW, Germany
| | - Martina Ziefle
- Human-Computer Interaction Center, Campus-Boulevard 57, Aachen 52074, NRW, Germany
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Ijadi Maghsoodi A, Pavlov V, Rouse P, Walker CG, Parsons M. Efficacy of acute care pathways for older patients: a systematic review and meta-analysis. Eur J Ageing 2022; 19:1571-1585. [PMID: 36692788 PMCID: PMC9729482 DOI: 10.1007/s10433-022-00743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow-up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials and acutely admitted patients with an average age of 79, complex conditions and comorbidities to acute geriatric-specific pathways (N = 13,595) were included. Geriatric-specific models were associated with lower costs (weighted mean difference, WMD = - $174.98, 95% CI = -$332.14 to - $17.82; P = 0.03), and shorter LoS (WMD = - 1.11, 95% CI = - 1.39 to - 0.83; P < 0.001). No differences were found in functional decline, ADL, mortality, case fatalities, discharge destination, or readmissions. Geriatric-specific models are valuable for improving patient and system-level outcomes. Although several interventions had positive results, further research is recommended to study hospital-wide geriatric-specific models.
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Affiliation(s)
- Abtin Ijadi Maghsoodi
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand ,Department of Intelligence & Insights, Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
| | - Valery Pavlov
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand
| | - Paul Rouse
- Department of Accounting and Finance, Faculty of Business and Economics , University of Auckland, Auckland, New Zealand
| | - Cameron G. Walker
- Department of Engineering Science, Faculty of Engineering , University of Auckland, Auckland, New Zealand
| | - Matthew Parsons
- School of Health , University of Waikato, Hamilton, New Zealand ,Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
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Patient reported outcomes in an elder-friendly surgical environment: Prospective, controlled before-after study. Ann Med Surg (Lond) 2021; 65:102368. [PMID: 34026101 PMCID: PMC8120860 DOI: 10.1016/j.amsu.2021.102368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The Acute Care for the Elderly (ACE) model has demonstrated clinical benefit, but there is little evidence regarding quality of life after discharge. The Elder-friendly Approaches to the Surgical Environment (EASE) study was conducted to assess implementation of an ACE unit on an acute surgical service. Improved clinical and economic outcomes have been demonstrated, but post-discharge patient reported outcomes have not yet been reported. Methods Prospective, concurrently controlled, before-after study at two tertiary care hospitals in Alberta, Canada. The SF-12, EQ-5D, Canadian Malnutrition Screening Tool (CMST) and patient satisfaction were collected from elderly (≥ 65 years old) patients, 6 weeks and 6 months after discharge from an acute care surgical service. A difference-in-difference (DID) method was used to analyze between-site effects. Results At six weeks, patient satisfaction was high at 68%-86%, with significant improvement Pre-to Post-EASE at the control site (p < 0.001), but not the intervention site (p = 0.06). For the intervention site, within-site adjusted pre-post effects were nonsignificant for all patient reported outcomes [EQ-Index Score β coefficient (SE): 0.042 (0.022); EQ-Visual Analog Scale: 0.10 (2.14); SF-12 Physical Component Score: -0.57 (0.84); SF-12 Mental Component Score: 1.17 (0.84); CMST Score: -0.39 (0.34)]. DID analyses were also non significant for all outcomes except for SF-12 Mental Component Score (p < 0.001). Conclusion The clinically and economically beneficial EASE interventions do not appear to compromise quality of life, risk for malnutrition, or patient satisfaction in the post-discharge period. Further research with larger sample size is needed with comparisons to pre-intervention and the early post-discharge period.
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Jafari Pour F, Goudarzi F, Hasanvand S, Ebrahimzadeh F, Kvist T. Psychometric Testing of the Persian Version of the Revised Humane Caring Scale for Patients Admitted to Critical Care Units. J Nurs Meas 2020; 27:508-523. [PMID: 31871288 DOI: 10.1891/1061-3749.27.3.508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To determine the psychometric properties of the Persian version of the Revised Humane Caring Scale (RHCS) for patients admitted to critical care units. METHODS Data were collected from 337 patients admitted to critical care units. A methodological study was carried out to assess content, face and construct validity and reliability. RESULTS The results revealed good content validity. After the elimination of four items in the confirmatory factor analysis, a 42-item model with acceptable fit indices was confirmed. The scale had a high internal consistency. The reliability of each item was satisfactory using the intra-class correlation. Only item 33 was considered unstable and was ultimately eliminated. CONCLUSIONS The Persian version of the 41-item RHCS is an acceptable assessment scale for measuring patient satisfaction with humane caring in critical care units.
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Affiliation(s)
- Fatemeh Jafari Pour
- Student Research Committee, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fateme Goudarzi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Shirin Hasanvand
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Nursing, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics and Epidemiology, Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Khadaroo RG, Warkentin LM, Wagg AS, Padwal RS, Clement F, Wang X, Buie WD, Holroyd-Leduc J. Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery. JAMA Surg 2020; 155:e196021. [PMID: 32049271 DOI: 10.1001/jamasurg.2019.6021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. Objectives To develop and assess the effect of an Elder-Friendly Approaches to the Surgical Environment (EASE) model in an emergency surgical setting. Design, Setting, and Participants This prospective, nonrandomized, controlled before-and-after study included patients 65 years or older who presented to the emergency general surgery service of 2 tertiary care hospitals in Alberta, Canada. Transfers from other medical services, patients undergoing elective surgery or with trauma, and nursing home residents were excluded. Of 6795 patients screened, a total of 684 (544 in the nonintervention group and 140 in the intervention group) were included. Data were collected from April 14, 2014, to March 28, 2017, and analyzed from November 16, 2018, through May 30, 2019. Interventions Integration of a geriatric assessment team, optimization of evidence-based elder-friendly practices, promotion of patient-oriented rehabilitation, and early discharge planning. Main Outcomes and Measures Proportion of participants experiencing a major complication or death (composite) in the hospital, Comprehensive Complication Index, length of hospital stay, and proportion of participants who required an alternative level of care on discharge. Covariate-adjusted, within-site change scores were computed, and the overall between-site, preintervention-postintervention difference-in-differences (DID) were analyzed. Results A total of 684 patients were included in the analysis (mean [SD] age, 76.0 [7.6] years; 327 women [47.8%] and 357 men [52.2%]), of whom 139 (20.3%) were frail. At the intervention site, in-hospital major complications or death decreased by 19% (51 of 153 [33.3%] vs 19 of 140 [13.6%]; P < .001; DID P = .06), and mean (SE) Comprehensive Complication Index decreased by 12.2 (2.5) points (P < .001; DID P < .001). Median length of stay decreased by 3 days (10 [interquartile range (IQR), 6-17] days to 7 [IQR, 5-14] days; P = .001; DID P = .61), and fewer patients required an alternative level of care at discharge (61 of 153 [39.9%] vs 29 of 140 [20.7%]; P < .001; DID P = .11). Conclusions and Relevance To our knowledge, this is the first study to examine clinical outcomes associated with a novel elder-friendly surgical care delivery redesign. The findings suggest the clinical effectiveness of such an approach by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence. Trial Registration ClinicalTrials.gov Identifier: NCT02233153.
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Affiliation(s)
- Rachel G Khadaroo
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey M Warkentin
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Xiaoming Wang
- Aberhart Centre, Research Facilitation, Alberta Health Services, Edmonton, Alberta, Canada
| | - William D Buie
- Department of Surgery, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Hofmeister M, Khadaroo RG, Holroyd-Leduc J, Padwal R, Wagg A, Warkentin L, Clement F. Cost-effectiveness Analysis of the Elder-Friendly Approaches to the Surgical Environment (EASE) Intervention for Emergency Abdominal Surgical Care of Adults Aged 65 Years and Older. JAMA Netw Open 2020; 3:e202034. [PMID: 32242905 PMCID: PMC7125431 DOI: 10.1001/jamanetworkopen.2020.2034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The Elder-Friendly Approaches to the Surgical Environment (EASE) initiative is a novel approach to acute surgical care for elderly patients. OBJECTIVE To determine the cost-effectiveness of EASE. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation from the perspective of the health care system was conducted as part of the controlled before-and-after EASE study at 2 tertiary care centers, the University of Alberta Hospital and Foothills Medical Centre. Participants included elderly adults (aged ≥65 years) admitted for emergency abdominal surgery between 2014 and 2017. Data were analyzed from April 2018 to February 2019. MAIN OUTCOMES AND MEASURES Data were captured at both control and intervention sites before and after implementation of the EASE intervention. Resource use was captured over 6 months of follow-up and was converted to costs. Utility was measured with the EuroQol Five-Dimensions Three-Levels instrument at 6 weeks and 6 months of follow-up. The differences-in-differences method was used to estimate the association of the intervention with cost and quality-adjusted life-years. For a subset of participants, self-reported out-of-pocket health care costs were collected using the Resource Use Inventory at 6 months. RESULTS A total of 675 participants were included (mean [SD] age, 75.3 [7.9] years; 333 women [49.3%]), 289 in the intervention group and 386 in the control group. The mean (SD) cost per control participant was $36 995 ($44 169) before EASE and $35 032 ($43 611) after EASE (all costs are shown in 2018 Canadian dollars). The mean (SD) cost per intervention participant was $56 143 ($74 039) before EASE and $39 001 ($59 854) after EASE. Controlling for age, sex, and Clinical Frailty Score, the EASE intervention was associated with a mean (SE) cost reduction of 23.5% (12.5%) (P = .02). The change in quality-adjusted life-years observed associated with the intervention was not statistically significant (mean [SE], 0.00001 [0.0001] quality-adjusted life-year; P = .72). The Resource Use Inventory was collected for 331 participants. The mean (SE) odds ratio for having 0 out-of-pocket expenses because of the intervention, compared with having expenses greater than 0, was 15.77 (3.37) (P = .02). Among participants with Resource Use Inventory costs greater than 0, EASE was not associated with a change in spending (mean [SE] reduction associated with EASE, 19.1% [45.2%]; P = .57). CONCLUSIONS AND RELEVANCE This study suggests that the EASE intervention was associated with a reduction in costs and no change in quality-adjusted life-years. In locations that lack capacity to implement this intervention, costs to increase capacity should be weighed against the estimated costs avoided.
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Affiliation(s)
- Mark Hofmeister
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey Warkentin
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Sanon M, Hwang U, Abraham G, Goldhirsch S, Richardson LD. ACE Model for Older Adults in ED. Geriatrics (Basel) 2019; 4:E24. [PMID: 31023992 PMCID: PMC6473391 DOI: 10.3390/geriatrics4010024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/16/2022] Open
Abstract
The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.
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Affiliation(s)
- Martine Sanon
- Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine 1, New York, NY 10029, USA; (U.H.); (S.G.)
| | - Ula Hwang
- Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine 1, New York, NY 10029, USA; (U.H.); (S.G.)
- Icahn School of Medicine at Mount Sinai Department of Emergency Medicine2, New York, NY 10029, USA; (G.A.); (L.D.R.)
| | - Gallane Abraham
- Icahn School of Medicine at Mount Sinai Department of Emergency Medicine2, New York, NY 10029, USA; (G.A.); (L.D.R.)
| | - Suzanne Goldhirsch
- Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine 1, New York, NY 10029, USA; (U.H.); (S.G.)
| | - Lynne D. Richardson
- Icahn School of Medicine at Mount Sinai Department of Emergency Medicine2, New York, NY 10029, USA; (G.A.); (L.D.R.)
| | - GEDI WISE Investigators
- Icahn School of Medicine at Mount Sinai Department of Emergency Medicine2, New York, NY 10029, USA; (G.A.); (L.D.R.)
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Rosenfeld P, Kwok G, Glassman K. Assessing the perceptions and attitudes among geriatric resource nurses: Evaluating the NICHE program at a large academic medical center. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:268-282. [PMID: 29412068 DOI: 10.1080/02701960.2018.1428577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The national Nurses Improving Care for Healthsystem Elders (NICHE) program and the geriatric resource nurse (GRN) model promote training a geriatric nursing workforce to serve in hospitals and elsewhere. Literature exists on the NICHE program but this is the first to study the opinions, attitudes, and perceptions of GRNs in practice. Our organization's hybrid GRN model, first adopted in 1999, combines materials from national NICHE program with homegrown resources and has GRNs practicing in a wide range of clinical specialties. This descriptive study, using survey design and administrative data, examined GRNs trained prior to 2017 to assess their (i) demographic, employment, and other characteristics; (ii) satisfaction with components of training program; (iii) ability to apply new knowledge and skills in practice; (iv) perceived support from leadership; and (v) perceived barriers encountered. Program outcomes, such as completion rates and workplace satisfaction, as well as areas for improvement and recommendation for future research, are also discussed.
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Affiliation(s)
- Peri Rosenfeld
- a Director, Center for Innovations in the Advancement of Care and Outcomes Research & Program Evaluation , NYU Langone Health , NY , NY , USA
| | - Gary Kwok
- b Data Analyst, Center for Innovations in the Advancement of Care , NYU Langone Health , NY , NY , USA
| | - Kimberly Glassman
- c Senior Vice President of Patient Care Services and Chief Nursing Officer , NYU Langone Health , New York , NY , USA
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D'Onofrio A, Büla C, Rubli E, Butrogno F, Morin D. Functional trajectories of older patients admitted to an Acute Care Unit for Elders. Int J Older People Nurs 2017; 13. [PMID: 28791772 DOI: 10.1111/opn.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 07/12/2017] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To describe the functional trajectories of older medical inpatients and to identify factors associated with overall and in-hospital functional decline. BACKGROUND Functional decline during a hospital stay is an important clinical outcome because independence remains a major determinant of older persons' quality of life and health care demands. DESIGN AND METHODS Participants (n = 189) were admitted to the Acute Care Unit for Elders of a Swiss academic hospital and were aged 65 years and older. Performance in basic activities of daily living at home (self-reported), at hospital admission (observed) and at discharge (observed) was collected. Differences in scores for basic activities daily living between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline. Predictors of in-hospital and overall decline were identified using bivariate and multivariate logistic regression analyses. RESULTS Pre-admission, in-hospital and overall functional decline occurred in 56.1%, 17.5% and 43.4% of the participants, respectively. In contrast, in-hospital functional improvement occurred in 40.2% of the participants. No predictors of pre-admission decline were identified, whereas pre-admission performance in instrumental activities of daily living was associated with in-hospital decline. Male gender and in-hospital delirium were associated with overall functional decline. CONCLUSIONS Most older inpatients experienced functional decline before their hospital admission, but only a minority experienced decline during their stay. Importantly, delirium was a strong predictor of overall functional decline. IMPLICATIONS FOR PRACTICE Low performance in instrumental activities of daily living prior to admission and delirium occurrence identified older patients at higher risk for in-hospital and overall functional decline. Gerontological nurses should play a key role in identifying these patients to provide preventative interventions and recovery care to preserve or restore their functional independence.
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Affiliation(s)
- Andreina D'Onofrio
- Geriatric Medicine and Geriatric Rehabilitation Division, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
| | - Christophe Büla
- Geriatric Medicine and Geriatric Rehabilitation Division, Faculty of Biology and Medicine, University of Lausanne Hospital Center (CHUV), Lausanne University, Lausanne, Switzerland
| | - Eve Rubli
- Geriatric Medicine and Geriatric Rehabilitation Division, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
| | - Fabiana Butrogno
- Geriatric Medicine and Geriatric Rehabilitation Division, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
| | - Diane Morin
- Faculty of Biology and Medicine, Institut universitaire de formation et de recherche en soins, Lausanne University, Lausanne, Switzerland.,University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland.,Faculty of Nursing Sciences, Universite Laval, Quebec City, QC, Canada
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Abstract
The literature suggests that by 2050, about 40% of all trauma patients will be over age 65 years. We already exceeded this prediction at Lehigh Valley Health Network in 2013, with 46.6% of the Pennsylvania trauma registry qualifiers being age 65 or greater, and 17.7% age 85 and greater. Currently, only 8.8% of trauma centers incorporate Geriatric Resource Programs into trauma care. Our trauma team has incorporated geriatric education for nurses by incorporating an educational nursing program called Nurses Improving Care for Healthsystem Elders, to improve outcomes, reduce hospital complications, and reduce health care costs for this high-risk population. The older adult population is on the rise and trauma nurses must be provided the tools to care for this high-risk patient group.
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Abstract
OBJECTIVE The aim of this study was to investigate the relationship between nurse caring behavior scores and the use of the "Get to Know Me" poster in hospitalized older adults. BACKGROUND Hospitalization can be an isolating experience for the patient and his/her family. Within the high-tech healthcare arena, the focus of the "patient/person" can be lost. The art of caring and basic communication between the nurse and person is essential to nursing. METHODS This was a 2-group quasi-experimental pretest-posttest design using the intervention of the Get to Know Me poster and measurement of nurse caring behaviors with the Caring Assessment of Care Givers (CACG) instrument. RESULTS Nurse caring behavior scores of the nurses in the experimental group who utilized the Get to Know Me poster were significantly higher on the total CACG scores as well on the subscale dimensions of maintaining belief, being with, and doing for than those of the nurses forming the control group. CONCLUSIONS The results of this research indicated that interventions that focus the attention on the person and emphasize patient-focused care can enhance nurse caring behaviors and strengthen the patient-nurse relationship.
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Lees MC, Merani S, Tauh K, Khadaroo RG. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis. Can J Surg 2015. [PMID: 26204143 DOI: 10.1503/cjs.011614] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. METHODS We conducted a retrospective cohort study of patients aged 65-80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. RESULTS Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43-10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32-2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85-0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27-0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53-0.90, p = 0.007). CONCLUSION American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home.
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Affiliation(s)
- Mackenzie C Lees
- From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta
| | - Shaheed Merani
- From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta
| | - Keerit Tauh
- From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta
| | - Rachel G Khadaroo
- From the Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lees, Merani, Khadaroo); and the Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta (Khadaroo), Edmonton, Alta
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Khadaroo RG, Padwal RS, Wagg AS, Clement F, Warkentin LM, Holroyd-Leduc J. Optimizing senior's surgical care - Elder-friendly Approaches to the Surgical Environment (EASE) study: rationale and objectives. BMC Health Serv Res 2015; 15:338. [PMID: 26293153 PMCID: PMC4546177 DOI: 10.1186/s12913-015-1001-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023] Open
Abstract
Background It is estimated that seniors (≥65 years old) account for >50 % of acute inpatient hospital days and are presenting for surgical evaluation of acute illness in increasing numbers. Unfortunately, conventional acute care models rarely take into account needs of the elderly population. The failure to consider these special needs have resulted in poor outcomes, longer lengths of hospital stay and have likely increased the need for institutional care. Acute Care for the Elderly models on medical wards have demonstrated decreased cost, length of hospital stay, readmissions and improved cognition, function and patient/staff satisfaction. We hypothesize that specific Elder-friendly Approaches to the Surgical Environment (EASE) interventions will similarly improve health outcomes in a cost-effective manner. Methods/design Prospective, before-after study with a concurrent control group. Four cohorts of 140 consecutively-screened older patients (≥65 years old) will be enrolled (560 patients in total). The EASE interventions involves co-locating all older surgical patients on a single unit, involving an interdisciplinary care team (including a geriatric specialist) in the development of individual care plans, implementing evidence-informed elder-friendly practices, use of a reconditioning program, and optimizing discharge planning. Subjects will be followed via chart review for their hospital stay, and will then complete in-person or telephone interviews at 6 weeks and 6 months after discharge. Measured outcomes include clinical (postoperative major in-hospital complication or death [primary composite outcome]; death or readmission within 30-days of initial discharge; length of hospital stay), humanistic (quality of life; functional, cognitive, and nutritional status) and economic (health care resource utilization and costs) endpoints. Within-site mean change scores will be computed for the composite primary outcome and the overall covariate-adjusted between-site pre-post difference will be the dependent variable analyzed using generalized linear mixed model procedures including adjustment for clustering. Discussion Our findings will generate new knowledge on outcomes from acute surgical care in older patients and validate a novel elder-friendly surgical model including assessment of both clinical and economic benefits. If effective, we expect the EASE initiatives to be generalizable to other surgical centres. Trial registration Clinicaltrials.govidentifier:NCT02233153
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Affiliation(s)
- Rachel G Khadaroo
- Department of Surgery, University of Alberta, Edmonton, AB, Canada. .,2D3.77 Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton, T6G 2B7, AB, Canada.
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Alberta Diabetes Institute, Edmonton, AB, Canada.
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada. .,Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada.
| | - Fiona Clement
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | | | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada. .,Alberta Seniors Health Strategic Clinical Network, Calgary, AB, Canada.
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Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J 2015; 6:e0017. [PMID: 25973269 PMCID: PMC4422456 DOI: 10.5041/rmmj.10201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.
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Affiliation(s)
- Hanna Admi
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - Hagar Baruch
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
| | - Anna Zisberg
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
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Griffiths P, Bridges J, Sheldon H, Thompson R. The role of the dementia specialist nurse in acute care: a scoping review. J Clin Nurs 2014; 24:1394-405. [DOI: 10.1111/jocn.12717] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Griffiths
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | - Jackie Bridges
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | | | - Rachel Thompson
- Royal College of Nursing and Admiral Nurse; Dementia UK
- Royal College of Nursing; London UK
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Babine RL, Honess C, Wierman HR, Hallen S. The role of clinical nurse specialists in the implementation and sustainability of a practice change. J Nurs Manag 2014; 24:39-49. [DOI: 10.1111/jonm.12269] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Rhonda L. Babine
- Center for Clinical and Professional Development; Maine Medical Center; Portland Maine USA
| | - Cindy Honess
- Center for Clinical and Professional Development; Maine Medical Center; Portland Maine USA
| | - Heidi R. Wierman
- Division of Geriatrics; Maine Medical Center; Portland Maine USA
| | - Sarah Hallen
- Geriatrics; Maine Medical Center; Portland Maine USA
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Wong KS, Ryan DP, Liu BA. A system-wide analysis using a senior-friendly hospital framework identifies current practices and opportunities for improvement in the care of hospitalized older adults. J Am Geriatr Soc 2014; 62:2163-70. [PMID: 25355067 DOI: 10.1111/jgs.13097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital's practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. This article describes the application of one such framework-the Senior-Friendly Hospital (SFH) framework adopted in Ontario, Canada-which comprises five interrelated domains: organizational support, processes of care, emotional and behavioral environment, ethics in clinical care and research, and physical environment. This framework provided the blueprint for a self-assessment of all 155 adult hospitals across the province of Ontario. The system-wide analysis identified practice gaps and promising practices within each domain of the SFH framework. Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care.
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Affiliation(s)
- Ken S Wong
- Regional Geriatric Program of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Parke B, Hunter KF. The care of older adults in hospital: if it's common sense why isn't it common practice? J Clin Nurs 2014; 23:1573-82. [PMID: 24444372 DOI: 10.1111/jocn.12529] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 01/07/2023]
Abstract
AIMS AND OBJECTIVES To present three converging myths that underlie the perception that nursing care for older persons in hospital is simple in comparison with its actual complexity. BACKGROUND Literature provides strong evidence indicating that the myths we discuss inherently arise from ageism, the social value of older patients and the economic burden of being an older patient in hospital. These powerful social discourses promote harm to older patients. Harm emerges from both the omission of gerontological nursing knowledge and skill and the commission of acts that unintentionally harm. A corresponding ethical challenge results for acute care nurses. DESIGN A discursive paper. METHODS We illuminate gerontological issues by discussing three myths. In myth one, we detail four clusters of distinguishing characteristics in older hospitalised people. In the second myth, we challenge the idea that the role of the acute care hospital is to attend only to acute medical concerns. Finally, in the third myth, we address the issue of incorporating functional assessment into the acute care nursing assessment. We argue that functional assessment is poorly integrated and becomes acceptable only as long as the medical regimen is managed appropriately. CONCLUSION Safe quality care in hospital for older adults requires a hybrid practice that integrates acute care specialty knowledge with gerontological nursing knowledge and skill. Clinical reasoning that integrates this type of nursing knowledge can prevent harm. RELEVANCE TO CLINICAL PRACTICE Integrating key elements of acute care nursing specialty knowledge with gerontological nursing principles aids to prevent the omission of care that is known to be harmful to older people. Conversely, the commission of gerontologically sensitive acute care can enhance safety and promote quality care in hospital.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
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de Almeida Tavares JP, Silva ALD, Sá-Couto P, Boltz M, Capezuti EA. Validation of the Professional Issues Scales with Portuguese Nurses. Res Gerontol Nurs 2013; 6:264-74. [DOI: 10.3928/19404921-20130729-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/08/2013] [Indexed: 11/20/2022]
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de Almeida Tavares JP, da Silva AL. Use of the Geriatric Institutional Assessment Profile: An Integrative Review. Res Gerontol Nurs 2013; 6:209-20. [DOI: 10.3928/19404921-20130304-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/20/2013] [Indexed: 11/20/2022]
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Capezuti E, Boltz M, Cline D, Dickson VV, Rosenberg MC, Wagner L, Shuluk J, Nigolian C. Nurses Improving Care for Healthsystem Elders - a model for optimising the geriatric nursing practice environment. J Clin Nurs 2012; 21:3117-25. [PMID: 23083387 PMCID: PMC3532620 DOI: 10.1111/j.1365-2702.2012.04259.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. BACKGROUND The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses' perception of their practice and its' relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. DESIGNS Discursive paper. METHOD In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals' systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. RESULTS Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. CONCLUSIONS Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff's perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. RELEVANCE TO CLINICAL PRACTICE The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.
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Conley DM, Burket TL, Schumacher S, Lyons D, DeRosa SE, Schirm V. Implementing Geriatric Models of Care: A Role of the Gerontological Clinical Nurse Specialist—Part I. Geriatr Nurs 2012; 33:229-34. [PMID: 22838028 DOI: 10.1016/j.gerinurse.2012.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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