Older patients’ participation in physical activity during hospitalization: A qualitative study of ward nurses’ perceptions in an Asian context

Motivating factors for physical activity participation among individuals with chronic obstructive pulmonary disease: A qualitative study applying the motivation, opportunity, and ability model

OBJECTIVE

The study aims to explore the driving forces behind physical activity engagement among patients with chronic obstructive pulmonary disease, focusing on motivation, opportunity, and capability.

DESIGN

A phenomenological qualitative study applied the motivation, opportunity, and capability model, conducted in two respiratory units of a Chinese university hospital.

METHODS

Participants, selected by age, gender, and illness duration, included inpatients during the interview sessions and those recently discharged within six months. One-on-one semi-structured interviews were recorded, transcribed, and analyzed by the Colaizzi seven-step method.

RESULTS

Seventeen participants diagnosed with chronic obstructive pulmonary disease for over one year aged between 66 (range: 42-96) participated. Three major themes were identified: Inspiring participation motivation-transitioning from recognizing significance to habit formation; Offering participation opportunities-reiterating demand for personalized strategies and ideal environmental settings; Enhancing participation capability-addressing strategies for overcoming fears, setting goals, ensuring safety, and adjusting activity levels.

CONCLUSIONS

This research underscores the vital role of inspiring participation motivation, offering opportunities, and enhancing the capability for participation in effective engagement. Advocating increased attention from healthcare departments, fostering interdisciplinary collaboration, improving activity guidance and counseling effectiveness, and considering individual preferences can significantly benefit those patients with chronic obstructive pulmonary disease who hesitate or are unable to participate in physical activities, thereby increasing the dose of non-leisure time physical activity.

Improving nutrition care and diet intake for hospitalised older people at risk of malnutrition through a nurse-driven mealtime assistance bundle

BACKGROUND

Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition.

OBJECTIVES

This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition.

METHODS

This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation.

RESULTS

There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire.

CONCLUSIONS

Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care.

IMPLICATIONS FOR PRACTICE

Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.

Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: A systematic review and thematic synthesis

OBJECTIVE

To explore health professionals' perspectives on physical activity and sedentary behaviour of hospitalised adults to understand factors that contribute to these behaviours in this environment.

DATA SOURCES

Five databases (PubMed, MEDLINE, Embase, PsycINFO and CINAHL) were searched in March 2023.

REVIEW METHODS

Thematic synthesis. Included studies explored perspectives of health professionals on the physical activity and/or sedentary behaviour of hospitalised adults using qualitative methods. Study eligibility was assessed independently by two reviewers and results thematically analysed. Quality was assessed using the McMaster Critical Review Form and confidence in findings assessed using GRADE-CERQual.

RESULTS

Findings from 40 studies explored perspectives of over 1408 health professionals from 12 health disciplines. The central theme identified was that physical activity is not a priority in this setting due to the complex interplay of multilevel influences present in the interdisciplinary inpatient landscape. Subthemes, the hospital is a place for rest, there are not enough resources to make movement a priority, everyone's job is no one's job and policy and leadership drives priorities, supported the central theme. Quality of included studies was variable; critical appraisal scores ranged from 36% to 95% on a modified scoring system. Confidence in findings was moderate to high.

CONCLUSION

Physical activity in the inpatient setting is not a priority, even in rehabilitation units where optimising function is the key. A shift in focus towards functional recovery and returning home may promote a positive movement culture that is supported by appropriate resources, leadership, policy, and the interdisciplinary team.

Perspectives of patients and clinicians on older patient mobility on acute medical wards: a qualitative study

BACKGROUND

Low mobility during an acute care medical hospitalization is frequent and associated with adverse outcomes, particularly among older patients. Better understanding barriers and facilitators to improve mobility during hospitalization could help develop effective interventions. The goal of this study was to assess barriers and facilitators to older medical patients' hospital mobility, from the point of view of patients and clinicians, to develop a framework applicable in clinical practice.

METHODS

We conducted a qualitative study in one university and two non-university hospitals of two different language and cultural regions of Switzerland, including 13 focus groups (FGs; five with patients, eight with clinicians). We included 24 adults aged 60 years or older hospitalized on an acute general internal medicine ward of one of the three participating hospitals during the previous years, and 34 clinicians (15 physicians, nine nurses/nursing assistants, 10 physiotherapists) working on those wards. The FG guides included open-ended questions exploring mobility experiences, expectations, barriers and facilitators to mobility, consequences of low mobility and knowledge on mobility. We applied an inductive thematic analysis.

RESULTS

We identified four themes of barriers and facilitators to mobility: 1) patient-related factors; 2) clinician-related factors; 3) social interactions; and 4) non-human factors. Clinician-related factors were only mentioned in clinician FGs. Otherwise, subthemes identified from patient and clinician FGs were similar and codes broadly overlapped. Subthemes included motivation, knowledge, expectations, mental and physical state (theme 1); process, knowledge - skills, mental state - motivation (theme 2); interpersonal relationships, support (theme 3); hospital setting - organization (theme 4).

CONCLUSIONS

From patients' and clinicians' perspectives, a broad spectrum of human and structural factors influences mobility of older patients hospitalized on an acute general internal medicine ward. New factors included privacy issues and role perception. Many of those factors are potentially actionable without additional staff resources. This study is a first step in participatory research to improve mobility of older medical inpatients.

Sensitivity and specificity of three screening tools for frailty in hospitalized older adults

AIM

To determine the test accuracy, including sensitivity, specificity, positive predictive value, negative predictive value and area under curve, of three frailty screening tools in identifying the risk of frail outcomes among hospitalized older patients.

DESIGN

Prospective longitudinal study.

METHODS

The screening tools [Frail-PPS (Frail-Physical, Psychological and Social), Frailty Assessment Measure (FAM), and Identification of seniors at-risk hospitalized patients (ISAR-HP)] were administered by ward nurses to patients aged 65 years and older within 24 h of admission to an acute hospital. Sensitivity, specificity, positive predictive value, negative predictive value and area under curve analysis of the three tools in the context of three frail outcomes, (a) functional decline at three months after discharge-defined as a decline of at least one point on the Katz Index, (ii) requiring a full-time caregiver upon discharge, and (iii) death by three months after discharge, was assessed.

RESULTS

Of 366 patients enrolled in the study, 78 (21.3%) experienced one or more frail outcomes, with 65 (17.76%) experiencing functional decline, 61 (16.67%) requiring a full-time caregiver upon discharge and 8 (2.19%) dying by three months. Frail-PPS had sensitivity 12.5% to 31.4% and specificity 91.2% to 94.8%, varying by the considered frail outcome. Similarly, FAM had sensitivity 12.5% to 29.4% and specificity 90.9% to 94.1%, and ISAR-HP had sensitivity 2.9% to 19.2% and specificity 92.2% to 99.1%. positive predictive value of the FAM, Frail-PPS and ISAR-HP ranged from 3.0 to 45.5%, 3.1 to 50.0% and 3.9 to 23.6% respectively, while their negative predictive value ranged from 87.1% to 97.9%, 87.7% to 97.9% and 92.2% to 99.4% respectively. The area under curve values were moderate for the Frail-PPS (0.56 to 0.75), FAM (0.58 to 0.70) and ISAR-HP (0.71 to 0.77) for the three outcomes.

CONCLUSIONS

With high specificity and negative predictive values, as well as low sensitivity, FAM and Frail-PPS may be beneficial in identifying older individuals who are not frail, minimizing unnecessary further assessment and intervention.

Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review

BACKGROUND

To improve older patients' physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs).

METHODS

In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000-May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels.

RESULTS

The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients' fear, and HCPs' safety concerns; interpersonal level: patient-HCP relation and HCPs' unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients' unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators.

CONCLUSION

The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.

Healthcare professionals feel empowered by implementing a hospital-based multifaceted intervention: a qualitative study using inductive thematic analysis

Background

Most patients are insufficiently physically active during their hospital stay, and this is associated with poor health and delayed recovery. Hospital-based multifaceted interventions aim to encourage patients to engage in physical activity. Ban Bedcentricity is one such intervention. Its value – and that of others similar to it – for healthcare professionals has not been studied yet. Whether an intervention looks and feels right, and whether it does the job well, is important for healthcare professionals and thus its use. Understanding value for healthcare professionals seems crucial for the long-term adoption and implementation of interventions. Therefore, we studied healthcare professionals’ perceptions of value in terms of the implementation of a multifaceted intervention that aimed at improving physically active behaviour in patients during their hospital stay.

Methods

Using Ban Bedcentricity as a case study to focus on healthcare professionals’ perceptions about multifaceted interventions, we conducted a qualitative study between November 2019 and September 2020. Semi-structured interviews were conducted with purposefully selected physicians, physiotherapists, and nurses (assistants) until theoretical data saturation was reached. Inductive thematic analysis was used to identify key themes and develop a conceptual model.

Results

We interviewed 15 healthcare professionals and formulated six key themes from these interviews. The participants said that Ban Bedcentricity empowered them in their beliefs about the importance of physical activity for hospitalized patients (theme 1). They also indicated that it made them more aware of the value of physical activity (theme 2) and skilled to promote physical activity as part of their professional role (theme 3). Similarly, they noted that it enabled them to shift from providing hands-on support to verbal coaching (theme 4). Other aspects that the participants valued were the increased possibilities for teamwork (theme 5) and the routinized physical activity promotion in usual care (theme 6). The challenges discussed by the participants were prioritizing activities that promoted physical activity, especially because of a high workload, and avoiding relapses of new routinized work practices related to physical activity promotion if insufficient long-term support and training were provided.

Conclusions

Our conceptual model shows that the implementation of a hospital-based multifaceted intervention by healthcare professionals empowers their beliefs, and improves their awareness, skills, professional roles, teamwork, and work routinization. These values are typically overlooked, despite potentially being important facilitators for long-term implementation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08310-w.

Barriers and facilitators to mobility of patients hospitalised on an acute medical ward: a systematic review

BACKGROUND

low patient mobility is common during hospitalisation and is associated with adverse outcomes. To change practice, interventions should address barriers and facilitators to mobility. Our aim was to systematically review the literature to provide a synthesised overview of patient-, health care professional (HCP)- and environment-/system-related barriers and facilitators to mobility of patients hospitalised on an acute care medical ward.

METHODS

we searched Medline, Embase, PsycInfo, Web of Science Core Collection, Cochrane CENTRAL, CINHAHL and Google Scholar (inception to 18 October 2021) to identify studies reporting barriers and/or facilitators to mobility of adults hospitalised on an acute medical ward. We applied a deductive and inductive thematic analysis to classify barriers and facilitators into themes and subthemes relevant for clinical practice.

RESULTS

among 26 studies (16 qualitative, 7 quantitative and 3 mixed methods), barriers and facilitators were categorised into 10 themes: patient situation, knowledge, beliefs, experiences, intentions, emotions, social influences, role/identity, implementation/organisation and environment/resources. Barriers included patient characteristics (e.g. impaired cognitive/physical status) and symptoms, HCPs prioritising other tasks over mobility, HCPs labelling patients as 'too sick', fear of injury, lack of time, lack of clarity about responsibility, patient medical devices and non-encouraging environment. Facilitators included knowledge of mobility importance, HCP skills, interdisciplinarity, documentation and unit expectations, encouraging staff, goal individualisation, activity programme, family/visitor/volunteer support and availability of equipment.

CONCLUSION

this synthesised overview of patient-, HCP- and environment-/system-related barriers and facilitators to mobility of adults hospitalised on an acute medical ward can help researchers and clinicians focus on what can realistically be influenced to improve mobility.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42021285954.

Physical Activity, Quality of Life, and Nursing Workload in Colorectal Surgery

Postoperative recovery depends on a complex interplay of patient-related factors of which mobility is an essential part. The aim of this study is to evaluate correlations between perioperative physical activity, quality of life, and postoperative nursing workload in colorectal surgery. A prospective study was used to assess footsteps, quality of life, and nursing workload. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Patients with reduced and good mobilization were compared, and the cut-off defined by the median daily preoperative footsteps. Quality of life was assessed by the Cleveland Global Quality of Life (CGQL). Nursing workload was calculated using the Project Research in Nursing (PRN) score. Statistical correlation was measured by use of the Pearson coefficient. Fifty patients were included. Mean age was 59 years, mean body mass index was 25 kg/m2, and 68% of them were males. Demographics, surgical details, and clinical outcomes were comparable between the group of patients with poor mobilization compared to those with good mobilization. No correlation was found between pre- or post-operative footsteps and CGQL (r =  − 0.072, p = 0.640 and r =  − 0.127, p = 0.407), as well as between the number of pre- or post-operative footsteps and PRN (r = 0.060, p = 0.687 and r =  − 0.095, p = 0531). In conclusion, no correlation was found between the number of perioperative footsteps, quality of life, and nursing workload after colorectal surgery.

Barriers and enablers to physical activity in patients during hospital stay: a scoping review

BACKGROUND

Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF).

METHODS

We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains.

RESULTS

Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54).

CONCLUSIONS

Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients' physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation.

SCOPING REVIEW REGISTRATION

No protocol was registered for this review.

Nursing care related to fall prevention among hospitalized elderly people: an integrative review

OBJECTIVE

to identify scientific productions on nursing care related to fall risk prevention among hospitalized elderly people.

METHODS

an integrative literature review from 2015 to 2019 in the PubMed/MEDLINE, Scopus, Web of Science, LILACS, BDENF, SciELO and CINAHL databases, in Portuguese, English and Spanish. The keywords were elderly, hospitalization, accidents due to falls, nursing care.

RESULTS

thirty-three publications were analyzed. The synthesis of the studies resulted in the categories: Clinical nursing assessments to prevent falls among hospitalized elderly people; Fall risk factors for elderly people; Fall risk prevention strategies for elderly people.

FINAL CONSIDERATIONS

it was found that the scientific knowledge produced on nursing care related to fall risk prevention for hospitalized elderly people evidences the clinical assessment, risk factors and strategies such as nursing care, contributing to foster self-care behavior and promotion security for elderly people.

Nurses' perceptions of their role with respect to promoting physical activity in adult patients: a systematic review

AIMS AND OBJECTIVES

To identify the nurses' perceptions of their role with respect to promoting physical activity in adult patients and factors related to this role perceptions.

BACKGROUND

Ageing and chronic diseases are often accompanied by a decrease in physical activity. Nurses are in an excellent position to promote physical activity, because of their close and frequent interactions with patients. However, they often fail to actively stimulate patients to physical activity due to a lack of time, competing priorities and their focus on acute problems. Unclear was how nurses view their professional role in the promotion of physical activity.

DESIGN

Systematic literature review.

METHODS

PubMed, COCHRANE and CINAHL EBSCO were searched for papers published from 2006 to September 2019. Two reviewers independently assessed the methodological quality, using MMAT criteria. Thematic synthesis was used to analyse the data. The PRISMA statement was followed for reporting.

RESULTS

Overall, 10 quantitative, eight qualitative and one mixed methods study were included in the review. Analyses of these studies resulted in six themes: (1) active and professional role; (2) the recognised importance; (3) fear of patient falling; (4) patient's present health and need; (5) interdisciplinary context and responsibility; and (6) nurses' knowledge.

CONCLUSIONS

Nurses perceive they have an active role in the promotion of physical activity and consider it as important and part of their professional role. Clear guidance increased education and stronger awareness of guidelines might enable nurses to translate their perceived role into daily practice. This will enhance professional fulfilment as well as patients' physical activity.

RELEVANCE TO CLINICAL PRACTICE

The findings guide the development of interventions that aim to improve nursing care with respect to the promotion of physical activity and help managers and educators to provide appropriate resources and education.

Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research

QUESTION

What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care?

METHODS

A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach.

RESULTS

Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence).

CONCLUSIONS

Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay.

Patient Activation and its Predictors in Hospitalized Older Adults in Singapore

BACKGROUND

Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients.

AIMS

To explore patient activation and its predictors in hospitalized older adults in Singapore.

METHODS

Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation.

RESULTS

300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (β=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care.

CONCLUSION

Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.

My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults

BACKGROUND

Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management.

OBJECTIVES

To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore.

METHODS

A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed.

RESULTS

Three salient themes emerged from the data. Firstly, 'Regaining self-control, avoiding complications' describes the participants' journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, 'Preserving social identities and roles' illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, 'Accessing proximal support systems' highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed.

CONCLUSIONS

Findings can prompt primary healthcare providers to leverage on the patients' life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

Enrolled nurses' perceptions of providing nutritional care to hospitalised older people in Singapore's acute care setting: A qualitative descriptive study

BACKGROUND

Malnutrition is a growing challenge in health care as its prevalence among hospitalised older people is expected to intensify alongside the rapidly ageing world's population. Singapore's nursing framework adopts enrolled nurses as the main providers to nutritional care, where nutritional care is a process of screening, assessment, intervention, continuous monitoring and documentation. This is the first Asian study conducted on enrolled nurses' perceptions of nutritional care.

OBJECTIVE

To explore enrolled nurses' perceptions of providing nutritional care to hospitalised older people in Singapore's acute care setting.

METHODS

This is a qualitative descriptive study. Individual face-to-face semi-structured interviews using an interview guide were conducted with 15 enrolled nurses from September 2017 to January 2018. The collected data were analysed using content analysis.

RESULTS

Four main categories were identified as follows: (1) The role of enrolled nurses in the provision of nutritional care, (2) Perceived enablers in nutritional care, (3) Perceived challenges in nutritional care and (4) Proposed strategies to improve nutritional care.

CONCLUSION

This study provided insights to the perceived roles of enrolled nurses in nutritional care. It also outlined the enablers and challenges faced by the enrolled nurses and their suggestions to improve nutritional care provision. One critical finding was the need to better engage families and domestic helpers in nutritional care of older people.

IMPLICATIONS FOR PRACTICE

To optimise nutritional care delivery, healthcare institutions should explore ways to engage and involve families and domestic helpers during older patients' mealtimes. Nurses could also educate older people, their families and domestic helpers on the importance of nutritional care during hospitalisation.

Systems Approach Is Needed for In-Hospital Mobility: A Qualitative Metasynthesis of Patient and Clinician Perspectives

OBJECTIVE

To describe how different key stakeholders (ie, interprofessional clinical care team and patients) perceive their role in promoting in-hospital mobility by systematically synthesizing qualitative literature.

DATA SOURCES

PubMed, Ovid MEDLINE, Ovid PsychInfo, and Cumulative Index to Nursing and Allied Health were searched using terms relevant to mobility, hospitalization, and qualitative research. A total of 510 unique articles were retrieved and screened for eligibility.

STUDY SELECTION

Eligible qualitative studies included stakeholder perspectives on in-hospital mobility, including patients, nursing staff, rehabilitation staff, and physicians. Eleven articles remained after inclusion/exclusion criteria were applied.

DATA EXTRACTION

At least 2 authors independently read, coded, and derived themes from each study. We used a team-based inductive approach to thematic synthesis informed by critical realism and the socioecological model. Reciprocal translation unified convergent and divergent constructs across primary studies. Investigator triangulation enhanced interpretation.

DATA SYNTHESIS

Three primary themes emerged: (1) patient, family, and clinician expectations shape roles in in-hospital mobility; (2) stakeholders' role in mobility depends on hospital environment, infrastructure, culture, and resources; and (3) teamwork creates successful in-hospital mobility, but lack of coordination and cooperation leads to delay in mobilizing. Studies suggested that while mobility is an essential construct in the professional role of clinicians and in the personal identity of patients, the ability of stakeholders to realize their role in mobility is highly dependent on the hospital physical and cultural environment, administrative support, clarity in professional roles, and teamwork.

CONCLUSIONS

Interventions designed to address the problem of low hospital mobility should take a systems approach and consider allocation of resources, clarity around professional responsibilities, and elevation of patient and clinician expectations surrounding mobility.

Tasks and responsibilities in physical activity promotion of older patients during hospitalization: A nurse perspective

Aim

To investigate how nurses perceive tasks and responsibilities in physical activity promotion of hospitalized older patients and which factors are of influence.

Design

Mixed methods sequential explanatory design.

Methods

One hundred and eight nurses participated in a questionnaire survey and 51 nurses in a subsequent in‐depth interview. Data were collected on tasks and responsibilities in physical activity promotion and their influencing factors as perceived by nurses. Quantitative data were analysed using descriptive statistics and a deductive approach with directed content analysis was used for the data from the interviews.

Results

Nurses perceived to have a dominant role in physical activity promotion of older patients during hospitalization. Ninety per cent of the nurses stated to be responsible for physical activity promotion and 32% stated to be satisfied with the actual level of physical activity of their patients. Nurses have specified to be responsible for signalling and performing physical activity promotion tasks and had final responsibility for transfers from bed to chair and promotion of daily activities. Influencing factors were low patient motivation, high workload causing priority shifts of tasks and the role of physicians.

Nurses' perceptions of their role in functional focused care in hospitalised older people: An integrated review

AIM

The aim of this integrative review was to identify nurses' perspectives of their role in influencing the functional status of hospitalised older people.

METHODS

An integrative review using Whittemore and Knafls' method was conducted using EBSCOhost CINAHL, Ovid MEDLINE(R), EBSCOhost, Social Gerontology, Cochrane Database of Systematic Reviews and ProQuest Dissertations & Theses data bases. Only studies with nurses' perspectives, or beliefs about their role in function-focused care were included. Content analysis was used to develop the themes nurses' role in function-focused care and barriers to functional care.

RESULTS

The review found 12 relevant articles. Nurses believed that they were responsible for function-focused care, yet functional care tasks were often missed. Organisational contexts created many barriers to providing function-focused care for patients. Nurses felt powerless to address these overarching problems in their organisations.

CONCLUSION

Nurses understand the importance of functional care yet often fail to carry out functional care interventions. Lack of organisational support creates a workplace that is short on staff, time and equipment and does not prioritise functional care needs. Nurse leaders and healthcare organisations need to reprioritise function-focused care for the good of patients, families and healthcare budgets.

Promotion of mobility among hospitalised older adults: An exploratory study on perceptions of patients, carers and nurses

BACKGROUND

Hospitalisation of an older adult due to acute medical illness can result in adverse events and accelerate loss of independence despite recovery from the illness. Promoting mobility during hospitalisation can help to mitigate the risks of functional decline. Understanding the perspectives on the barriers and the maintenance of mobility is essential in the development of effective strategies.

AIMS

To explore the perceptions of patients and their carers, as well as the nurses on promotion of mobility among hospitalised adult older patients.

METHODS

A qualitative descriptive study design with purposive and convenience sampling approach was undertaken. A total of fourteen patients, six carers and ten nurses from a general medical ward of an acute care tertiary public hospital in Singapore were recruited over the period of November 2017 to February 2018. Face to face semi-structured interviews were conducted and audio-recorded. The interview transcripts were coded and an inductive content analysis approach was adopted to generate categories of sub-themes and themes through the open coding process.

RESULTS

Four main themes were generated: (1) perceived and induced fear of falling; (2) challenges in initiation of mobility; (3) influence of premorbid status and physical condition on activity level; and (4) strategies to promote mobility.

CONCLUSION

Recognition of the importance of mobility as well as the detrimental effects of prolonged bed rest during hospitalization is an essential first step toward developing successful interventions to promote mobility in the Asian context. Improvements need to be made to help overcome the various barriers and challenges in the mobilization of the older patients in the acute care settings. Nurses and other members of the care team can help to increase the confidence of patients and among family carers (in providing assistance during mobility) by role modelling and provision of walking aids as well as risk-based education.

In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity

Aims

To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward.

Design

A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity.

Methods

Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted.

Results

Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.

Development of a longlist of healthcare quality indicators for physical activity of patients during hospital stay: a modified RAND Delphi study

OBJECTIVE

To develop a longlist of healthcare quality indicators for the care of hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay.

DESIGN

A modified RAND/UCLA Appropriateness Method Delphi study.

SETTING AND PARTICIPANTS

Participants were physical therapists, nurses and managers working in Dutch university medical centres.

METHODS

The current study consisted of three phases. Phase I was a systematic literature search for quality indicators and relevant domains. Phase II was a survey among healthcare professionals to collect additional data. Phase III consisted of three consensus rounds. In round 1, experts rated the relevance of the potential indicators online (Delphi). The second round was a face-to-face expert panel meeting managed by an experienced moderator. Acceptability, feasibility and validity of the quality indicators were discussed by the panel members. In round 3, the panel members rated the relevance of the potential indicators that were still under discussion.

RESULTS

The search retrieved 1556 studies of which 53 studies were assessed full text. Data from 17 studies were included in a first draft longlist of indicators. Eighteen nurses and one physical therapist responded to the survey and added data for a second draft of the longlist. Experts constructed the final longlist of 23 indicators in three consensus rounds. Seven domains were identified: 'Policy', 'Attitude and education', 'Equipment and support', 'Evaluation', 'Information', 'Patient-tailored physical activity plan' and 'Outcome measure'.

CONCLUSION AND IMPLICATIONS

The healthcare quality indicators developed in this study could help to grade, monitor and improve healthcare for hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay. Future research will focus on the psychometric quality of the indicators and selection of key performance indicators.