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Modica A, Bitterman AD. The Impact of Patient Education on Inpatient Fall Risk: A Review. JBJS Rev 2024; 12:01874474-202405000-00005. [PMID: 38748810 DOI: 10.2106/jbjs.rvw.24.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
» Patient falls in the hospital are one of the leading sentinel events identified by the Joint Commission.» Hospital falls affect orthopaedic patients of older age at higher rates, and up to 34% of falls lead to injury such as fractures.» Patients often misperceive their fall risk, and modalities aimed at educating patients to address the incongruence between perceived and actual fall risk significantly reduce fall rate and injurious fall rate.» Adequate communication with patients and their families with the goal of educating them may diminish the physical, psychological, and emotional detriment to orthopaedic patients.
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Affiliation(s)
- Anthony Modica
- Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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2
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Shaw L, Kiegaldie D, Farlie MK. Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC Geriatr 2020; 20:460. [PMID: 33167884 PMCID: PMC7653707 DOI: 10.1186/s12877-020-01819-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023] Open
Abstract
Background Falls in hospitals are a major risk to patient safety. Health professional education has the potential to be an important aspect of falls prevention interventions. This scoping review was designed to investigate the extent of falls prevention education interventions available for health professionals, and to determine the quality of reporting. Method A five stage scoping review process was followed based on Arksey and O’Malley’s framework and refined by the Joanna Briggs Institute Methodology for JBI Scoping Reviews. Five online databases identified papers published from January 2008 until May 2019. Papers were independently screened by two reviewers, and data extracted and analysed using a quality reporting framework. Results Thirty-nine publications were included. Interventions included formal methods of educational delivery (for example, didactic lectures, video presentations), interactive learning activities, experiential learning, supported learning such as coaching, and written learning material. Few studies employed comprehensive education design principles. None used a reporting framework to plan, evaluate, and document the outcomes of educational interventions. Conclusions Although health professional education is recognised as important for falls prevention, no uniform education design principles have been utilised in research published to date, despite commonly reported program objectives. Standardised reporting of education programs has the potential to improve the quality of clinical practice and allow studies to be compared and evaluated for effectiveness across healthcare settings.
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Affiliation(s)
- L Shaw
- Faculty of Health Science, Youth and Community Studies, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia. .,School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3086, Australia.
| | - D Kiegaldie
- Faculty of Health Science, Youth and Community Studies and Healthscope Hospitals, Holmesglen Institute, 488 South Road, Moorabbin, VIC, 3189, Australia.,Eastern Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Australia
| | - M K Farlie
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC, 3199, Australia
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3
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Galiano A, Simonetti M, Quiroga N, Larrain A. Development, implementation and evaluation of an evidence-based practice model in a new hospital in Chile. J Nurs Manag 2020; 28:1748-1757. [PMID: 32799398 DOI: 10.1111/jonm.13134] [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] [Received: 04/30/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To describe an implementation programme for an evidence-based practice (EBP) model in a new Chilean hospital and to analyse the programme evaluation results. BACKGROUND Evidence-based practice is key to professional nursing for improving health care safety and quality. METHODS First, a literature review was performed to develop an institutional EBP model. Second, internal and external analyses contributed to assessing facilitators for and barriers to implementation. Third, a multi-stage implementation plan was conducted. Fourth, process and outcome indicators were evaluated. RESULTS The model considered the basic elements of EBP and outlined different decision-making levels in clinical practice. Several facilitators for implementation were identified. Each implementation stage included activities addressing EBP knowledge, attitude and skills. Outcome indicators showed significant improvement regarding knowledge (p = .038). Providers with formal EBP training, compared with providers without training, showed a significant difference of 8.6% (0.6 points) in the average CPBE-19 score in knowledge, attitude and application in the last evaluation (p < .01). CONCLUSION Having an EBP programme with ongoing implementation strategies improves knowledge over time, and formal training enhances positive results. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can build an institutional research culture to improve the quality of care using an EBP programme that fits organisational needs.
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Affiliation(s)
| | - Marta Simonetti
- Universidad de los Andes Chile Facultad de Enfermería y Obstetricia Escuela de Enfermería
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4
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Cunha LFCD, Baixinho CL, Henriques MA. Preventing falls in hospitalized elderly: design and validation of a team intervention. Rev Esc Enferm USP 2019; 53:e3479. [PMID: 31365730 DOI: 10.1590/s1980-220x2018031803479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/21/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of the present study was the design and validation, by a panel of experts, of a team intervention to manage the risk of falls in the hospitalized elderly. METHOD The method used was a quanti-qualitative approach, using the Delphi method. The study was developed in two phases: in the first, five researchers designed the intervention; in the second, 13 professionals validated it. RESULTS The analysis of the content of the intervention designed by the participants in the first phase of the study allowed assignment of the indicators to the following previously defined categories: team formation; communication; leadership; monitoring; and mutual support. After two rounds, all the indicators obtained a consensus higher than 80%. CONCLUSION The present study allowed validation of a team intervention by a panel of experts, so that teams can manage the risk of falls in hospitalized elderly. The reliability test results ensure that the intervention can be used safely in clinics and for research.
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Affiliation(s)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research and Development Unit, Center for Innovative Care and Health Technology - CiTheCare, Lisbon, Portugal
| | - Maria Adriana Henriques
- Nursing School of Lisbon, Nursing Research and Development Unit, Center for Innovative Care and Health Technology - CiTheCare, Lisbon, Portugal
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5
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Baixinho CL, Dixe MDA, Madeira C, Alves S, Henriques MA. Falls in institutionalized elderly with and without cognitive decline A study of some factors. Dement Neuropsychol 2019; 13:116-121. [PMID: 31073388 PMCID: PMC6497019 DOI: 10.1590/1980-57642018dn13-010014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Falls in long-stay institutions for elderly people have a high prevalence, contributing to the physical and mental deterioration of institutionalized elderly. Objective To determine the prevalence of falls among institutionalized elderly with and without cognitive decline, and to characterize the practices and behaviors of those with and without cognitive decline in managing fall risks, and relate them to some factors. Methods The present correlational study was carried out with a sample of 204 institutionalized elderly, 50% of whom had cognitive decline. Results The elderly with cognitive decline (40.2%) fell less often than those who did not have cognitive decline (42.2%) (p>0.05). Safety practices and behaviors were better in the elderly with cognitive decline (p<0.05). Most of the elderly with cognitive decline who fell took benzodiazepines (65.9%), in contrast with those without cognitive decline (32.2%). It was observed that 81.4% of the elderly without cognitive decline and 43.9% of those with cognitive decline who fell had a performance of over 12 seconds on the Timed Up and Go Test, where differences reached statistical significance in both groups of elderly. Conclusion Data collected in the present study further the knowledge on risk factors in the genesis of falls and on the behavior of elderly with and without cognitive decline in maintaining their safety in self-care and accessibility.
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Affiliation(s)
- Cristina Lavareda Baixinho
- Escola Superior de Enfermagem de Lisboa, Unidade de Investigação & Desenvolvimento em Enfermagem, Lisboa, Portugal.,Center for Innovative Care and Health Technology - CiTheCare, Portugal
| | - Maria Dos Anjos Dixe
- Center for Innovative Care and Health Technology - CiTheCare, Portugal.,Escola Superior de Saúde, Instituto Politécnico de Leiria, Portugal
| | - Carla Madeira
- Enfermeira Especialista em Enfermagem de Reabilitação, Hospital de Vila Franca de Xira, Portugal
| | - Sílvia Alves
- Enfermeira Especialista em Enfermagem de Reabilitação, Hospital de Vila Franca de Xira, Portugal
| | - Maria Adriana Henriques
- Escola Superior de Enfermagem de Lisboa, Unidade de Investigação & Desenvolvimento em Enfermagem, Lisboa, Portugal
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6
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Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2018; 9:CD005465. [PMID: 30191554 PMCID: PMC6148705 DOI: 10.1002/14651858.cd005465.pub4] [Citation(s) in RCA: 169] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Falls in care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. This is an update of a review first published in 2010 and updated in 2012. OBJECTIVES To assess the effects of interventions designed to reduce the incidence of falls in older people in care facilities and hospitals. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2017); Cochrane Central Register of Controlled Trials (2017, Issue 8); and MEDLINE, Embase, CINAHL and trial registers to August 2017. SELECTION CRITERIA Randomised controlled trials of interventions for preventing falls in older people in residential or nursing care facilities, or hospitals. DATA COLLECTION AND ANALYSIS One review author screened abstracts; two review authors screened full-text articles for inclusion. Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction. We calculated rate ratios (RaR) with 95% confidence intervals (CIs) for rate of falls and risk ratios (RRs) and 95% CIs for outcomes such as risk of falling (number of people falling). We pooled results where appropriate. We used GRADE to assess the quality of evidence. MAIN RESULTS Thirty-five new trials (77,869 participants) were included in this update. Overall, we included 95 trials (138,164 participants), 71 (40,374 participants; mean age 84 years; 75% women) in care facilities and 24 (97,790 participants; mean age 78 years; 52% women) in hospitals. The majority of trials were at high risk of bias in one or more domains, mostly relating to lack of blinding. With few exceptions, the quality of evidence for individual interventions in either setting was generally rated as low or very low. Risk of fracture and adverse events were generally poorly reported and, where reported, the evidence was very low-quality, which means that we are uncertain of the estimates. Only the falls outcomes for the main comparisons are reported here.Care facilitiesSeventeen trials compared exercise with control (typically usual care alone). We are uncertain of the effect of exercise on rate of falls (RaR 0.93, 95% CI 0.72 to 1.20; 2002 participants, 10 studies; I² = 76%; very low-quality evidence). Exercise may make little or no difference to the risk of falling (RR 1.02, 95% CI 0.88 to 1.18; 2090 participants, 10 studies; I² = 23%; low-quality evidence).There is low-quality evidence that general medication review (tested in 12 trials) may make little or no difference to the rate of falls (RaR 0.93, 95% CI 0.64 to 1.35; 2409 participants, 6 studies; I² = 93%) or the risk of falling (RR 0.93, 95% CI 0.80 to 1.09; 5139 participants, 6 studies; I² = 48%).There is moderate-quality evidence that vitamin D supplementation (4512 participants, 4 studies) probably reduces the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; I² = 62%), but probably makes little or no difference to the risk of falling (RR 0.92, 95% CI 0.76 to 1.12; I² = 42%). The population included in these studies had low vitamin D levels.Multifactorial interventions were tested in 13 trials. We are uncertain of the effect of multifactorial interventions on the rate of falls (RaR 0.88, 95% CI 0.66 to 1.18; 3439 participants, 10 studies; I² = 84%; very low-quality evidence). They may make little or no difference to the risk of falling (RR 0.92, 95% CI 0.81 to 1.05; 3153 participants, 9 studies; I² = 42%; low-quality evidence).HospitalsThree trials tested the effect of additional physiotherapy (supervised exercises) in rehabilitation wards (subacute setting). The very low-quality evidence means we are uncertain of the effect of additional physiotherapy on the rate of falls (RaR 0.59, 95% CI 0.26 to 1.34; 215 participants, 2 studies; I² = 0%), or whether it reduces the risk of falling (RR 0.36, 95% CI 0.14 to 0.93; 83 participants, 2 studies; I² = 0%).We are uncertain of the effects of bed and chair sensor alarms in hospitals, tested in two trials (28,649 participants) on rate of falls (RaR 0.60, 95% CI 0.27 to 1.34; I² = 0%; very low-quality evidence) or risk of falling (RR 0.93, 95% CI 0.38 to 2.24; I² = 0%; very low-quality evidence).Multifactorial interventions in hospitals may reduce rate of falls in hospitals (RaR 0.80, 95% CI 0.64 to 1.01; 44,664 participants, 5 studies; I² = 52%). A subgroup analysis by setting suggests the reduction may be more likely in a subacute setting (RaR 0.67, 95% CI 0.54 to 0.83; 3747 participants, 2 studies; I² = 0%; low-quality evidence). We are uncertain of the effect of multifactorial interventions on the risk of falling (RR 0.82, 95% CI 0.62 to 1.09; 39,889 participants; 3 studies; I² = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS In care facilities: we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling. General medication review may make little or no difference to the rate of falls or risk of falling. Vitamin D supplementation probably reduces the rate of falls but not risk of falling. We are uncertain of the effect of multifactorial interventions on the rate of falls; they may make little or no difference to the risk of falling.In hospitals: we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling. We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling. Multifactorial interventions may reduce rate of falls, although subgroup analysis suggests this may apply mostly to a subacute setting; we are uncertain of the effect of these interventions on risk of falling.
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Affiliation(s)
- Ian D Cameron
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Suzanne M Dyer
- DHATR Consulting120 Robsart StreetParksideSouth AustraliaAustralia5063
| | - Claire E Panagoda
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health DistrictSt LeonardsNSWAustralia2065
| | - Geoffrey R Murray
- Illawarra Shoalhaven Local Health DistrictAged Care, Rehabilitation and Palliative CareWarrawongAustralia
| | - Keith D Hill
- Curtin UniversitySchool of Physiotherapy and Exercise Science, Faculty of Health SciencesGPO Box U1987PerthWestern AustraliaAustralia6845
| | - Robert G Cumming
- Sydney Medical School, University of SydneySchool of Public HealthRoom 306, Edward Ford Building (A27)Fisher RoadSydneyNSWAustralia2006
| | - Ngaire Kerse
- University of AucklandDepartment of General Practice and Primary Health CarePrivate Bag 92019AucklandNew Zealand
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7
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Witt S, Englander E, Kumlien C, Axelsson M. Mismatch between risk factors and preventive interventions? A register study of fall prevention among older people in one Swedish county. Int J Older People Nurs 2018; 13:e12209. [PMID: 30187674 DOI: 10.1111/opn.12209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/06/2018] [Accepted: 07/22/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Falls are a common and often a devastating health hazard for older people, causing suffering, morbidity and mortality. Falls are costly for society in terms of both resources and direct medical costs. Although knowledge about falls and fall prevention is well known, falls among older people are still a major problem. AIM AND OBJECTIVES The aim was to estimate the prevalence of the risk of falls among older people receiving municipal health care. A further aim was to investigate the consistency between fall risk factors and preventive nursing interventions. DESIGN A cross-sectional register study. METHODS Data containing risk assessments based on the Downton Fall Risk Index (DFRI) and planned interventions by the municipal health care were collected from the Swedish national quality registry, Senior Alert. Data were analysed using descriptive and analytic statistics. RESULTS In the sample of 5,427 older people, the prevalence of the risk of falling was 79%. There was a difference in prevalence between the different types of municipal health care, sex and age. The most common preventive intervention was environment adjustments, and the least planned intervention was information/education about falls. Physical activity as an intervention was planned among 13.2% of the participants. Approximately 27% of the older people did not have any planned interventions despite being at risk of falling. Planned interventions did not always correspond with the risk factors; for instance, only 35.4% of those at risk of falling due to medication obtained pharmaceutical reviews as a preventive measure to decrease the risk. CONCLUSION The risk of falling is common among older people, and the preventive interventions do not sufficiently follow current evidence. This implies that systematic implementation of fall-prevention guidelines is needed in municipal care. IMPLICATION FOR PRACTICE A better match between identified risk factors and preventive interventions is warranted.
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Affiliation(s)
- Sofia Witt
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Health Center Fågelbacken, Malmö, Sweden
| | - Emma Englander
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Christine Kumlien
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Cardio-Thoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden
| | - Malin Axelsson
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
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Teresi JA, Ramírez M, Fulmer T, Ellis J, Silver S, Kong J, Eimicke JP, Boratgis G, Meador R, Lachs MS, Pillemer K. Resident-to-Resident Mistreatment: Evaluation of a Staff Training Program in the Reduction of Falls and Injuries. J Gerontol Nurs 2018; 44:15-23. [PMID: 29677382 PMCID: PMC6668910 DOI: 10.3928/00989134-20180326-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022]
Abstract
Resident-to-resident elder mistreatment (R-REM) occurs frequently in long-term services and support settings. The purpose of the current study was to evaluate the effect of a R-REM training program for nursing and other frontline staff on resident falls and injuries in a cluster randomized trial of units within four nursing homes. Interview and observational data from a sample of 1,201 residents (n = 600 and n = 601 in the usual care and intervention groups, respectively) and staff were collected at baseline and 6 and 12 months. A generalized linear model was used to model the falls/injuries outcome. The net reduction in falls and injuries was 5%, translating to 10 saved events per year in an averagesized facility. Although the result did not reach statistical significance due to low power, the findings of fall prevention associated with implementing the intervention in long-term care facilities is clinically important. [Journal of Gerontological Nursing, 44(6), 15-23.].
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9
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Sterke CS, Panneman MJ, Erasmus V, Polinder S, Beeck EF. Increased care demand and medical costs after falls in nursing homes: A Delphi study. J Clin Nurs 2018; 27:2896-2903. [DOI: 10.1111/jocn.14488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Carolyn Shanty Sterke
- Department of Physiotherapy Aafje Nursing Homes Rotterdam The Netherlands
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | | | - Vicki Erasmus
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Suzanne Polinder
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Ed F Beeck
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
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10
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Hendry A, Snowden A, Brown M. When holistic care is not holistic enough: The role of sexual health in mental health settings. J Clin Nurs 2017; 27:1015-1027. [DOI: 10.1111/jocn.14085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Avril Hendry
- Mental Health; School of Health and Social care; Edinburgh Napier University; Edinburgh UK
| | - Austyn Snowden
- Mental Health; School of Health and Social care; Edinburgh Napier University; Edinburgh UK
| | - Michael Brown
- Health & Social Care Research; School of Health & Social Care; Edinburgh Napier University; Edinburgh UK
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11
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Loytved CAL, Hasenberg G, Brendel K, Bothe-Moser C, Eggenschwiler R, Eigenmann D, Graf P, Hammer K, Hauser R, Oberndörfer K, Pfister-Stoppa A, Spiegel-Hefel E, Stiefel A. Implementation in nursing and midwifery. A scoping review / Implementationsprojekte in der Pflege und Hebammenarbeit. Scoping review. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2017. [DOI: 10.1515/ijhp-2017-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Evidence-based expertise in nursing and midwifery is growing but is not automatically turned into practice. The importance of implementation research is therefore increasing. International research results on factors facilitating implementation have not yet been sufficiently presented.
Objective
This scoping review will explore the findings on successful preparation, realisation and maintenance of interventions in nursing and midwifery.
Method
Based on an existing systematic approach, relevant data bases were accessed to identify original studies relating to implementation research in nursing and midwifery. The process of study selection and the characteristics of the included studies were charted.
Findings
In the four reviews and 38 studies which met the inclusion criteria, various factors leading to successful implementation are identified. Based on the included studies, four facilitating factors can be pinpointed: (1) workplace culture (16 entries), (2) leadership culture (28 entries), (3) resources (4 entries), and (4) training (22 entries). Depending on the specific phase of the implementation process (preparation, realisation, or maintenance), these factors will vary in importance.
Conclusion
This scoping review provides an orientation for the field of implementation research and it maps the design, themes and results of the studies included. It should be noted that few studies take into consideration the relevant theories, as well as the influence that the researchers and the target group may have on the implementation process, or provide an exact description of the setting in which the implementation takes place.
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Affiliation(s)
| | - Gabriele Hasenberg
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Karin Brendel
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Cornelia Bothe-Moser
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Ruth Eggenschwiler
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Denise Eigenmann
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Petra Graf
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Kristin Hammer
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Regula Hauser
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Katrin Oberndörfer
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Anja Pfister-Stoppa
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Elisabeth Spiegel-Hefel
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
| | - Andrea Stiefel
- Zurich University of Applied Sciences , School of Health Professions , Winterthur , Switzerland
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12
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Baixinho CRSL, Dixe MDACR, Henriques MAP. Falls in long-term care institutions for elderly people: protocol validation. Rev Bras Enferm 2017; 70:740-746. [DOI: 10.1590/0034-7167-2017-0109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/02/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: To validate the content of a fall management risk protocol in long-term institutions for elderly people. Methods: Methodological, quanti-qualitative study using the Delphi technique. The tool, based on the literature, was sent electronically to obtain consensus among the 14 experts that meet the defined inclusion criteria. Results: The 27 indicators of the protocol are organized in three dimensions: prepare for the institutionalization (IRA=.88); manage the risk of falls throughout the institutionalization (IRA=.9); and lead the communication and formation (IRA=1), with a CVI=.91. Two rounds were performed to get a consensus superior to 80% in every item. Conclusion: The values obtained in the reliability test (>0.8) show that the protocol can be used to meet the intended goal. The next step is the clinic validation of the protocol with residents of long-term care institutions for elderly people.
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Easton T, Milte R, Crotty M, Ratcliffe J. Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2016; 14:12. [PMID: 27999476 PMCID: PMC5153687 DOI: 10.1186/s12962-016-0061-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents’ quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, Flinders University, Adelaide, Australia ; NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Rachel Milte
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia ; Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Flinders Health Economics Group, Flinders University, Adelaide, Australia ; NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, Australia
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Briones-Peralta MÁ, Rodríguez-Martín B. [Effectiveness of training interventions aimed at reducing physical restraints in institutionalised older people: A systematic review]. Rev Esp Geriatr Gerontol 2016; 52:93-101. [PMID: 27166508 DOI: 10.1016/j.regg.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/19/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
There is some controversy about the use of physical restraints in institutionalised elderly people. The aim of this review is to analyse studies that evaluated the effectiveness of training interventions targeting interdisciplinary teams aimed at preventing, reducing or eliminating the use of physical restraints in nursing homes. A systematic search was performed in the Cochrane Library, PubMed, PsycINFO, EMBASE, and Web of Science to find clinical trials, published in English or in Spanish, that examined training sessions for interdisciplinary teams aimed at preventing, minimising or eliminating the use of physical restrains in institutionalised people over 65 years. Ten papers fulfilled the inclusion criteria. The findings show conflicting results on the effectiveness of training sessions. Furthermore, they lack sufficient empirical evidence to be able to assert that training sessions brought about a reduction in the use of physical restraints. More studies are needed that analyse the effectiveness of these interventions to prevent or eliminate the use of physical restraints in these institutions.
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Affiliation(s)
- María Ángeles Briones-Peralta
- Área Psicosocial, Servicios Sociales, Diputación de Cuenca, Cuenca, España; Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España
| | - Beatriz Rodríguez-Martín
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España; The School of Nursing and Midwifery, The University of Sheffield, Sheffield, Reino Unido.
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A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS One 2015; 10:e0140711. [PMID: 26559675 PMCID: PMC4641718 DOI: 10.1371/journal.pone.0140711] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. METHODS Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. RESULTS Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). CONCLUSION Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.
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Grealish L, Chaboyer W. Older, in hospital and confused - the value of nursing care in preventing falls in older people with cognitive impairment. Int J Nurs Stud 2015; 52:1285-7. [PMID: 25726429 DOI: 10.1016/j.ijnurstu.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/23/2015] [Accepted: 02/05/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Laurie Grealish
- Associate Professor Subacute and Aged Nursing, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University and Gold Coast Health, Gold Coast, Australia
| | - Wendy Chaboyer
- Professor of Nursing and Director, NHMRC Centre of Research Excellence in Nursing, Research Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Gold Coast, Australia
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Murphy K, Cooney A, Casey D. Improving the quality of life for older people in long-term care settings. J Comp Eff Res 2015; 3:301-15. [PMID: 24969156 DOI: 10.2217/cer.14.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Many governments across Europe and America set maintaining the quality of life (QoL) of older people living in long-term care as a key policy objective; however, much of the evidence reveals that life in many care environments is still routinized and institutionalized. QoL is a term that is widely used but poorly defined and understood. The focus of this Review is on identifying the components of QoL and reviewing strategies for improving QoL in long-term care. Six components of QoL were consistently identified across studies: autonomy, environment, connectedness, meaningful activity, independence and sense of self. A review of strategies for improving QoL revealed that the evidence of effectiveness across studies remains inconclusive. The judgment of quality was often hampered by inadequate details on the study design and the use of nonspecific and wide-ranging QoL tools. Furthermore, high-quality studies are required to determine effectiveness.
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Affiliation(s)
- Kathy Murphy
- School of Nursing & Midwifery, Aras Moyola, NUI Galway, Galway, Ireland
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Costa-Dias MJ, Oliveira AS, Martins T, Araújo F, Santos AS, Moreira CN, José H. Medication fall risk in old hospitalized patients: a retrospective study. NURSE EDUCATION TODAY 2014; 34:171-176. [PMID: 23769987 DOI: 10.1016/j.nedt.2013.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 04/08/2013] [Accepted: 05/15/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND While the causes of falls in old hospitalized patients are multifactorial, medication has been considered as one of the most significant factors. Given the large impact that this phenomenon has on the lives of the elderly and organizations, it is important to explore such phenomenon in greater depth. OBJECTIVE The objective of this study was to explore the association between medication and falls and the recurrent falls (n≥2), and identify medication related risk for fall in hospitalized patients, in a large acute hospital. DESIGN Retrospective and quantitative study from June 2008 to December 2010. SETTING The study was conducted in a private hospital for acute patients in Lisbon, Portugal. PARTICIPANTS The study included a sample of 214 episodes of fall event notifications which occurred in 193 patients. METHODS The current study was conducted through the "face to face consensus" technique which emerged the treatment groups to investigate. Regarding the data analysis we used Student's t test, ANOVA and Odds Ratio. In the violation of the premises for the use of parametric statistics we used the Kruskal-Wallis test. To assess the fall risk, and the medication-related fall risk, we used the Morse Fall Risk Scale, and the Medication Fall Risk Score. RESULTS Patients who received drugs from the therapy group of "Central Nervous System", are 10 times more likely to have fall risk (OR 9. 90, 95% CI 1.6-60.63). Association was found between falls (OR 6.09, 95% CI 1.30-28.54) and its recurrence (OR 3.32, 95% CI 1.61-6.85), among patients receiving haloperidol and receiving tramadol for recurrent falls (OR 3.10, 95% CI 1.59-6.07). In 34% of the patients the medication fall risk score was 6 or higher. CONCLUSIONS This current study allowed identifying medication-related risk factors for falls, that nurses should consider when prescribing interventions to prevent falls and its recurrence, when patients are admitted to acute care hospitals.
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Affiliation(s)
| | | | | | | | - Ana Sofia Santos
- Unit of Continuing and Palliative Care, Hospital da Luz, S.A., Lisbon, Portugal
| | | | - Helena José
- Catholic University of Portugal, Lisbon, Portugal; European Academy of Nursing Science, United Kingdom.
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Thorsteinsson HS, Sveinsdóttir H. Readiness for and predictors of evidence-based practice of acute-care nurses: a cross-sectional postal survey. Scand J Caring Sci 2013; 28:572-81. [DOI: 10.1111/scs.12083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Hrund S. Thorsteinsson
- Faculty of Nursing; University of Iceland; Eirberg Iceland
- Department of Nursing Professional Practice Development; Landspitali University Hospital; Reykjavík Iceland
| | - Herdís Sveinsdóttir
- Faculty of Nursing; University of Iceland; Eirberg Iceland
- Division of Surgical Services; Faculty Chair Surgical Nursing; Landspitali University Hospital; Reykjavík Iceland
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