1
|
Boyd MC, Burdette JH, Miller ME, Lyday RG, Hugenschmidt CE, Jack Rejeski W, Simpson SL, Baker LD, Tomlinson CE, Kritchevsky SB, Laurienti PJ. Association of physical function with connectivity in the sensorimotor and dorsal attention networks: why examining specific components of physical function matters. GeroScience 2024:10.1007/s11357-024-01251-8. [PMID: 38967698 DOI: 10.1007/s11357-024-01251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
Declining physical function with aging is associated with structural and functional brain network organization. Gaining a greater understanding of network associations may be useful for targeting interventions that are designed to slow or prevent such decline. Our previous work demonstrated that the Short Physical Performance Battery (eSPPB) score and body mass index (BMI) exhibited a statistical interaction in their associations with connectivity in the sensorimotor cortex (SMN) and the dorsal attention network (DAN). The current study examined if components of the eSPPB have unique associations with these brain networks. Functional magnetic resonance imaging was performed on 192 participants in the BNET study, a longitudinal and observational trial of community-dwelling adults aged 70 or older. Functional brain networks were generated for resting state and during a motor imagery task. Regression analyses were performed between eSPPB component scores (gait speed, complex gait speed, static balance, and lower extremity strength) and BMI with SMN and DAN connectivity. Gait speed, complex gait speed, and lower extremity strength significantly interacted with BMI in their association with SMN at rest. Gait speed and complex gait speed were interacted with BMI in the DAN at rest while complex gait speed, static balance, and lower extremity strength interacted with BMI in the DAN during motor imagery. Results demonstrate that different components of physical function, such as balance or gait speed and BMI, are associated with unique aspects of brain network organization. Gaining a greater mechanistic understanding of the associations between low physical function, body mass, and brain physiology may lead to the development of treatments that not only target specific physical function limitations but also specific brain networks.
Collapse
Affiliation(s)
- Madeline C Boyd
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Jonathan H Burdette
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Michael E Miller
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Robert G Lyday
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Christina E Hugenschmidt
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section On Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Sean L Simpson
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Laura D Baker
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section On Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Chal E Tomlinson
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Janssen R&D of Johnson & Johnson, Raritan, NJ, USA
| | - Stephen B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Department of Internal Medicine Section On Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paul J Laurienti
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
2
|
Vera-Salmerón E, Domínguez-Nogueira C, Sáez JA, Romero-Béjar JL, Mota-Romero E. Differentiating Pressure Ulcer Risk Levels through Interpretable Classification Models Based on Readily Measurable Indicators. Healthcare (Basel) 2024; 12:913. [PMID: 38727470 PMCID: PMC11083727 DOI: 10.3390/healthcare12090913] [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] [Received: 03/13/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Pressure ulcers carry a significant risk in clinical practice. This paper proposes a practical and interpretable approach to estimate the risk levels of pressure ulcers using decision tree models. In order to address the common problem of imbalanced learning in nursing classification datasets, various oversampling configurations are analyzed to improve the data quality prior to modeling. The decision trees built are based on three easily identifiable and clinically relevant pressure ulcer risk indicators: mobility, activity, and skin moisture. Additionally, this research introduces a novel tabular visualization method to enhance the usability of the decision trees in clinical practice. Thus, the primary aim of this approach is to provide nursing professionals with valuable insights for assessing the potential risk levels of pressure ulcers, which could support their decision-making and allow, for example, the application of suitable preventive measures tailored to each patient's requirements. The interpretability of the models proposed and their performance, evaluated through stratified cross-validation, make them a helpful tool for nursing care in estimating the pressure ulcer risk level.
Collapse
Affiliation(s)
- Eugenio Vera-Salmerón
- Servicio Andaluz de Salud, Distrito Sanitario Granada-Metropolitano, Centro de Salud Dr. Salvador Caballero de Granada, 18012 Granada, Spain; (E.V.-S.); (E.M.-R.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
| | - Carmen Domínguez-Nogueira
- Inspección Provincial de Servicios Sanitarios, Delegación Territorial de Granada, Consejería de Salud y Familias de la Junta de Andalucía, 41071 Sevilla, Spain;
| | - José A. Sáez
- Department of Statistics and Operations Research, University of Granada, Fuente Nueva s/n, 18071 Granada, Spain;
| | - José L. Romero-Béjar
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, Fuente Nueva s/n, 18071 Granada, Spain;
- Institute of Mathematics, University of Granada (IMAG), Ventanilla 11, 18001 Granada, Spain
| | - Emilio Mota-Romero
- Servicio Andaluz de Salud, Distrito Sanitario Granada-Metropolitano, Centro de Salud Dr. Salvador Caballero de Granada, 18012 Granada, Spain; (E.V.-S.); (E.M.-R.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain
- Department of Nursing, University of Granada, Avda. Ilustración 60, 18071 Granada, Spain
| |
Collapse
|
3
|
Durmuş Sarıkahya S. Investigation of factors associated with pressure ulcer in patients receiving home care services via path analysis. J Tissue Viability 2024:S0965-206X(24)00005-6. [PMID: 38326162 DOI: 10.1016/j.jtv.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/04/2023] [Accepted: 02/01/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting. OBJECTIVE The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services. METHOD This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale." FINDINGS In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale. CONCLUSION The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.
Collapse
Affiliation(s)
- Selma Durmuş Sarıkahya
- Artvin Coruh University, Faculty of Health Sciences, Department of Public Health Nursing, Artvin, Turkey.
| |
Collapse
|
4
|
Sugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud 2023; 148:104605. [PMID: 37801939 DOI: 10.1016/j.ijnurstu.2023.104605] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Pressure injuries are a fundamental safety concern in older people living in nursing homes. Recent studies report a disparate body of evidence on pressure injury prevalence and incidence in this population. OBJECTIVES To systematically quantify the prevalence and incidence of pressure injuries among older people living in nursing homes, and to identify the most frequently occurring PI stage(s) and anatomical location(s). DESIGN Systematic review and meta-analysis. SETTING(S) Nursing homes, aged care, or long-term care facilities. PARTICIPANTS Older people, 60 years and older. METHODS Cross-sectional and cohort studies reporting on either prevalence or incidence of pressure injuries were included. Studies published in English from 2000 onwards were systematically searched in Medline, PubMed, Embase, Cochrane Library, CINAHL and ProQuest. Screening, data extraction and quality appraisal were undertaken independently by two or more authors and adjudicated by another. Outcomes included pressure injury point prevalence, cumulative incidence, and nursing home acquired pressure injury rate. In meta-analyses, Cochrane's Q test and the I2 statistic were used to explore heterogeneity. Random effects models were used in the presence of substantial heterogeneity. Sources of heterogeneity were investigated by subgroup analyses and meta-regression. RESULTS 3384 abstracts were screened, and 47 full-text studies included. In 30 studies with 355,784 older people, the pooled pressure injury prevalence for any stage was 11.6 % (95 % CI 9.6-13.7 %). Fifteen studies with 5,421,798 older people reported the prevalence of pressure injury excluding stage I and the pooled estimate was 7.2 % (95 % CI 6.2-8.3 %). The pooled incidence for pressure injury of any stage in four studies with 10,645 older people was 14.3 % (95 % CI 5.5-26.2 %). Nursing home acquired pressure injury rate was reported in six studies with 79,998 older people and the pooled estimate was 8.5 % (95 % CI 4.4-13.5 %). Stage I and stage II pressure injuries were the most common stages reported. The heel (34.1 %), sacrum (27.2 %) and foot (18.4 %) were the three most reported locations of pressure injuries. Meta-regression results indicated a reduction in pressure injury prevalence over the years of data collection. CONCLUSION The burden of pressure injuries among older people in nursing homes is similar to hospitalised patients and requires a targeted approach to prevention as is undertaken in hospitals. Future studies using robust methodologies focusing on epidemiology of pressure injury development in older people are needed to conduct as the first step of preventing pressure injuries. REGISTRATION NUMBER PROSPERO CRD42022328367. TWEETABLE ABSTRACT Pressure injury rates in nursing homes are comparable to hospital rates indicating the need for targeted programmes similar to those in hospitals.
Collapse
Affiliation(s)
- R D Udeshika Priyadarshani Sugathapala
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Department of Nursing and Midwifery, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Aindralal Balasuriya
- Department of Para Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Sri Lanka.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia.
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey.
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Institute of Health Queensland, Griffith University, Brisbane, QLD, Australia; Gold Coast University Hospital and Health Service, Gold Coast, QLD, Australia.
| |
Collapse
|
5
|
Avsar P, Budri A, Patton D, Walsh S, Moore Z. Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2021; 19:112-120. [PMID: 34751500 DOI: 10.1111/wvn.12545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND A pressure ulcer (PU) is a localized injury to the skin or underlying tissue usually over a bony prominence. The prevention PU per patient per day is costly; therefore, the detection of a PU at its earliest stage is imperative to afford timely interventions. Currently, there are very few clinically useful tools to assist with early PU detection and prevention. AIM There were two primary aims of this study: (1) to investigate the relationship between activity, mobility, and PU development; and (2) to ascertain the next steps for delineating an algorithm based on activity and mobility for detecting PU risk among older adult residents in long-term care. METHOD This quantitative, prospective, descriptive, non-experimental study was conducted between July 2019 and March 2020 among 53 older adult residents who were followed for 4 consecutive days. Participants' Braden score, Elderly Mobility Scale (EMS) score, Movement Level, and 6-item Cognitive Impairment Test score were assessed. Further, the sacrum and heels were assessed daily using a non-invasive subepidermal moisture (SEM) scanner and visual skin assessment (VSA). SEM values > 0.5 were considered as indicative of the presence of an SEM-PU. RESULTS The incidence rate of VSA-PU was 15.1% (N = 8). There was an incidence of 87.5% (N = 42) of SEM-PU damage. According to the Braden subscale, Mobility Braden, most of the participants (62.2%, N = 33) were assessed as having no limitations/slightly limited mobility, while the EMS indicated that most of the participants (67.9%, N = 36) were classed in an independent category. From the 42 SEM-PUs observed, 62% (N = 26) occurred among the low movers, and 38% (N = 16) occurred among the high movers. LINKING EVIDENCE TO ACTION Using traditional methods for the assessment of movement does not provide insight into the protective nature of the movement. Given that both low- and high-moving patients can develop tissue damage, it is important to focus on the assessment of movement using more objective measures and algorithms, which enable real-time assessment of the protective nature of the movement. This would enable development of person-centered PU prevention strategies to reduce the burden of this significant healthcare problem.
Collapse
Affiliation(s)
- Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Aglecia Budri
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Griffith University, Brisbane, Qld, Australia
| | - Simone Walsh
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Griffith University, Brisbane, Qld, Australia.,The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Lida Institute, Shanghai, China.,University of Wales, Cardiff, UK
| |
Collapse
|
6
|
Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Flüssigkeits‐assoziierte Hautschäden (FAH): Eine
Best Practice
Empfehlung von Wund‐D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-827. [PMID: 34139095 DOI: 10.1111/ddg.14388_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim Dissemond
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Essen, Deutschland
| | - Bernd Assenheimer
- Schule für Pflegeberufe, Universitätsklinikum, Tübingen, Deutschland
| | - Veronika Gerber
- Schulung und Beratung im Wundmanagement, Spelle, Deutschland
| | | | | | - Norbert Kolbig
- Stabstelle Wundmanagement, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | | | - Peter Kurz
- WPM Wund Pflege Management, Bad Pirawarth, Österreich
| | | | | | - Kerstin Protz
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, CWC - Comprehensive Wound Center, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | | | - Robert Strohal
- Abteilung für Dermatologie und Venerologie, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Jürg Traber
- Chirurgie/Gefässchirurgie FEBVS, Phlebologie SGP, Venenklinik Bellevue, Kreuzlingen, Schweiz
| | - Jan Kottner
- CharitéCentrum 1 für Human- und Gesundheitswissenschaften, Charité -Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
7
|
Dissemond J, Assenheimer B, Gerber V, Hintner M, Puntigam MJ, Kolbig N, Koller S, Kurz P, Läuchli S, Probst S, Protz K, Steiniger A, Strohal R, Traber J, Kottner J. Moisture-associated skin damage (MASD): A best practice recommendation from Wund-D.A.CH. J Dtsch Dermatol Ges 2021; 19:815-825. [PMID: 33942514 DOI: 10.1111/ddg.14388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Wund-D.A.CH., as the umbrella organization of German-speaking wound treatment societies, has currently developed a best practice recommendation for skin damage caused by body fluids, which is known as moisture-associated skin damage (MASD) in English-speaking countries. In this expert consensus, the diseases incontinence-associated dermatitis (IAD), intertriginous dermatitis, including intertrigo, gram-negative bacterial toe web infection and toxic contact dermatitis, including periwound and peristomal dermatitis are presented in a differentiated manner. A common feature of these clinical diseases is a deterioration of skin integrity due to prolonged exposure to body fluids such as urine, stool, sweat or wound exudate with associated physical-irritative and/or chemical irritation. In addition, other comorbidities and cofactors play an important role. The diagnosis of these interdisciplinary and interprofessionally relevant MASD is difficult in everyday clinical practice because there are currently no uniform definitions and many relevant differential diagnoses. Effective strategies for the prevention and therapy of these skin diseases are, for example, continence management, use of efficient, absorbent aids with good retention as well as consistent skin protection and adequate skin care. Another important aspect is the education of patients and relatives about the origin, treatment and prevention of MASD.
Collapse
Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Germany
| | | | - Veronika Gerber
- Training and Consulting for Wound Management, Spelle, Germany
| | | | | | - Norbert Kolbig
- Office for Wound Management, University Hospital Düsseldorf, Germany
| | | | - Peter Kurz
- WPM Wound Care Management, Bad Pirawarth, Austria
| | - Severin Läuchli
- Dermatology Department, University Hospital, Zurich, Switzerland
| | | | - Kerstin Protz
- Institute for Health Services Research in Dermatology and Nursing, CWC - Comprehensive Wound Center, University Hospital Hamburg, Germany
| | | | - Robert Strohal
- Department of Dermatology and Venereology, State Hospital Feldkirch, Austria
| | - Jürg Traber
- Surgery/Vascular Surgery FEBVS, Phlebology SGP, Vein Hospital Bellevue, Kreuzlingen, Switzerland
| | - Jan Kottner
- Charité Centrum 1 for Human and Health Sciences, Charité -University Hospital Berlin, Germany
| |
Collapse
|
8
|
Strube-Lahmann S, Müller-Werdan U, Norman K, Skarabis H, Lahmann NA. Underweight in Nursing Homes: Differences between Men and Women. Gerontology 2021; 67:211-219. [PMID: 33472200 DOI: 10.1159/000512459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. MATERIAL AND METHODS A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in "R." RESULTS Average prevalence of underweight in nursing home residents was 13.7% (13.2-14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0-16.2) and the prevalence of underweight among men was 7.5% (6.7-8.2). The CRT-based modeling indicated that "loss of appetite" as the most important indicator for low BMI. If "loss of appetite" was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were "very large institutions" and the "resident/nurse ratio." The random forest analysis confirmed the importance of the CRT approach. DISCUSSION/CONCLUSION The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.
Collapse
Affiliation(s)
- Sandra Strube-Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ursula Müller-Werdan
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristina Norman
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, Potsdam, Germany
| | - Horst Skarabis
- Emeritus Professor for Statistics at the Freie Universität Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| |
Collapse
|
9
|
Maurer C, Gattinger H, Mayer H. Die Problematik der Implementierung von Kinästhetik in Einrichtungen der stationären Langzeitpflege - Eine Multiple Case-Study. Pflege 2020; 34:13-21. [PMID: 33349061 DOI: 10.1024/1012-5302/a000780] [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: 11/19/2022]
Abstract
Difficulty of implementing kinaesthetics in long-term care institutions - A multiple case-study Abstract. Background: Resources have been invested from long-term care institutions for the development of nursing staffs' kinaesthetics competence for years. Recent studies have shown that implementing or sustainably promoting the kinaesthetics competence is problematic, but in-depth knowledge of the causes thereof is lacking. Aim: Which barriers impede a sustainable implementation of kinaesthetics in long-term care institutions? Method: A "multiple case-study" was carried out in three institutions located in the German-speaking part of Switzerland. The data from guide-based interviews and (case-related) literature on the external context was inductively condensed in the within-case analysis. The results were then compared in the cross-case synthesis and summarized in an abstract way. Results: The synthesis showed that the implementation of kinaesthetics can be influenced negatively at three different institutional levels - management, nursing team and individual nursing staff - as well as by external factors. Conclusions: In nursing practice and nursing science, as well as in the health care sector, a basic understanding of kinaesthetics in the context of professional nursing care is required. Especially those responsible for management and implementation must be aware of possible barriers in order to develop appropriate strategies.
Collapse
Affiliation(s)
- Carola Maurer
- Institut für Pflegewissenschaft, Universität Wien.,Institut für Angewandte Pflegewissenschaft IPW-OST, OST - Ostschweizer Fachhochschule, St. Gallen
| | - Heidrun Gattinger
- Institut für Angewandte Pflegewissenschaft IPW-OST, OST - Ostschweizer Fachhochschule, St. Gallen
| | - Hanna Mayer
- Institut für Pflegewissenschaft, Universität Wien
| |
Collapse
|
10
|
Raeder K, Jachan DE, Müller-Werdan U, Lahmann NA. Prevalence and risk factors of chronic wounds in nursing homes in Germany: A Cross-Sectional Study. Int Wound J 2020; 17:1128-1134. [PMID: 32815303 PMCID: PMC7949346 DOI: 10.1111/iwj.13486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022] Open
Abstract
The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures.
Collapse
Affiliation(s)
- Kathrin Raeder
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Deborah Elisabeth Jachan
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Nils Axel Lahmann
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| |
Collapse
|
11
|
Moda Vitoriano Budri A, Moore Z, Patton D, O’Connor T, Nugent L, Mc Cann A, Avsar P. Impaired mobility and pressure ulcer development in older adults: Excess movement and too little movement—Two sides of the one coin? J Clin Nurs 2020; 29:2927-2944. [DOI: 10.1111/jocn.15316] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Aglecia Moda Vitoriano Budri
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Zena Moore
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Cardiff University Cardiff UK
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Monash University Melbourne Vic. Australia
- UGent Ghent University Ghent Belgium
| | - Declan Patton
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- University of Wollongong Wollongong NSW Australia
| | - Tom O’Connor
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
- Fakeeh College for Medical Sciences Jeddah Saudi Arabia
- Lida Institute Shanghai China
| | - Linda Nugent
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Aisling Mc Cann
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| | - Pinar Avsar
- School of Nursing and Midwifery Skin Wounds and Trauma – SWaT Research Centre Royal College of Surgeons in Ireland Dublin Ireland
| |
Collapse
|
12
|
Impaired Mobility and Urinary Incontinence in Nursing Home Residents: A Multicenter Study. J Wound Ostomy Continence Nurs 2020; 46:524-529. [PMID: 31478987 DOI: 10.1097/won.0000000000000580] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study was to evaluate associations among use of walking aids, mobility status, and occurrence of urinary incontinence (UI) in geriatric patients residing in nursing homes, and to examine associations between UI severity (frequency and amount) and its impact on health-related quality of life (QoL). DESIGN Multicenter descriptive cross-sectional prevalence study. SUBJECTS AND SETTING A total of 2044 patients from nursing homes were included in the study. A majority were female (72.0%), the mean age of participants was 82.1 years (SD 11.2), their mean body mass index was 26.1 (SD 5.4), and their mean Care Dependency Scale score was 46.0 (SD 18.2), indicating a medium to high care dependency. The study setting was 30 nursing homes throughout Germany from 2014 to 2015. METHODS Data were collected by trained nurses using a standardized data collection form to collect information about demographic characteristics, health conditions, mobility status measured according to the Elderly Mobility Scale (EMS), UI, and QoL measured using the International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF). RESULTS The prevalence of UI was 69.7% (n = 1804). Analysis of variance showed that, in 1659 nursing home residents with information on UI, 572 reported a medium amount of leakage with a mean impact on health-related QoL of 2.2 (SD 2.2, P < .001) on a scale from 0 (no impact) to 10 (very high impact). The mean of the impact on QoL in 235 residents who reported a large amount of leakage was 2.4 (SD 3.0, P < .001). In 1741 residents with information on the frequency of UI, 637 reported being urinary incontinent more than once a day with a mean impact on QoL of 2.2 (SD 2.1, P < .001) and 359 residents with permanent UI stated a mean impact on QoL of 2.1 (SD 2.8, P < .001). According to the bivariate association of UI with use of walking aids, the highest prevalence of UI (61.2%) was in patients who did not use any walking aids. The Chi-square Automatic Interaction Detector (CHAID) of the relationship between mobility according to the EMS and UI indicated that 71.1% of all patients with UI did not use any walking aids, although their mobility status had been reduced. CONCLUSIONS Findings indicate a significant association between impaired mobility and UI in nursing home residents. Chronic, severe urinary incontinence exerted the greatest impact on health-related QoL. Therefore, we recommend measures to preserve or regain mobility to minimize or prevent UI in geriatric residents and patients and, thus, increase their health-related QoL.
Collapse
|
13
|
Parker CN, Finlayson KJ, Edwards HE, MacAndrew M. Exploring the prevalence and management of wounds for people with dementia in long-term care. Int Wound J 2020; 17:650-659. [PMID: 32056378 DOI: 10.1111/iwj.13325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022] Open
Abstract
The prevalence of wounds and comorbidities such as dementia increase with age. With an ageing population, the likelihood of overlap of these conditions is strong. This study aimed to determine the prevalence of wound types and current management strategies of wound care for people with dementia in long-term care (LTC). A scoping literature review, a cross-sectional observational and chart audit study of residents in dementia specific facilities in LTC were conducted. The scoping review indicated that people with dementia/cognitive impairment are often excluded from wound related studies andof the nine studies included in this review, none looked at the prevalence of types of wounds other then pressure injuries. In the skin audit, skin tears were noted as the most common wound type with some evidence-based practice strategies in place for residents. However, documentation of current wound occurred in less than a third of residents with wounds. This is the first study to note the prevalence of different wound types in people with dementia and current management strategies being used across two dementia-specific facilities and a lack of research in this area limits evidence in guiding practice.
Collapse
Affiliation(s)
- Christina N Parker
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kathleen J Finlayson
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Helen E Edwards
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Margaret MacAndrew
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| |
Collapse
|
14
|
Nasiri S, Zahedi G, Kuntz S, Fathi M. Knowledge representation and management based on an ontological CBR system for dementia caregiving. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2019.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
15
|
Implementing a patient-centered walking program for residents in long-term care: A quality improvement project. J Am Assoc Nurse Pract 2019; 30:383-391. [PMID: 29979297 DOI: 10.1097/jxx.0000000000000037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE This quality improvement (QI) project was designed to increase walking activity for eligible residents in long-term care (LTC). Walking programs have positive benefits; however, they are underused in LTC. METHODS The Model for Improvement and Plan-Do-Study-Act cycles were used to implement the key components including building a guiding coalition, environment and policy assessment, development of a patient-centered walking program protocol, staff education, mobility huddle to motivate and mentor staff, and ongoing evaluation and feedback. RESULTS Of the 78 residents screened for walking activity, 13 (17%) were eligible. Data were collected weekly. After 20 weeks, 69% (n = 9) of the enrolled residents were still in the program. The majority of residents were provided walking activity between 60% and 90% of the time. None of the residents experienced a fall during the activity. Average adherence to documenting the activity was 79%. CONCLUSIONS The QI project provided the implementation and evaluation of a consistent walking program in a LTC setting. IMPLICATIONS FOR PRACTICE The project findings may assist nurse practitioners in implementing QI initiatives in LTC to increase walking activity of eligible residents and aid in evaluating those programs. However, leadership commitment and ongoing support are essential to sustain the effectiveness of a program.
Collapse
|
16
|
Maurer C, Draganescu S, Mayer H, Gattinger H. Attitudes and needs of residents in long-term care facilities regarding physical activity-A systematic review and synthesis of qualitative studies. J Clin Nurs 2019; 28:2386-2400. [PMID: 30589972 DOI: 10.1111/jocn.14761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the attitudes and needs of nursing home residents regarding physical activity. BACKGROUND Nursing home residents often have mobility problems and are at high risk for further mobility impairment. From their point of view, being physically active is an important part of their perceived quality of life. However, no study has synthesised existing qualitative literature on residents' attitudes and needs regarding physical activity. DESIGN Synthesis of qualitative studies. METHODS A systematic review and synthesis of qualitative studies was performed, using ENTREQ statement for reporting. Three databases (PubMed, CINAHL and PsycINFO) were searched, supplemented by a hand search. Qualitative studies published in English or German were included if they addressed the attitudes and needs of residents concerning the promotion of physical activities. Finally, 12 studies were critically reviewed, and a thematic synthesis was conducted. RESULTS Four analytical themes relating to residents' attitudes were identified: "promoting physical activity increases the quality of life," "accepting the conditions," "personal initiative is significant" and "promoting physical activity is not helpful." Relating to residents' needs, the analyses yielded five themes: "living autonomously," "continuing life as before," "competent care," "individually adapted programme and support," and "barrier-free accessibility." CONCLUSION Nursing home residents have different attitudes and needs regarding being physically active. It is important to perceive these attitudes and needs of each resident and to offer an individually adapted programme and support. Further research should consider motivational strategies for residents who are not very much familiar with being physically active and offer exercise programmes with individual parts to address residents' preferences. RELEVANCE TO CLINICAL PRACTICE To motivate and activate residents, institutions should be aware of residents' individual attitudes and needs regarding physical activity. Further development of interventions concerning mobility promotion activities and their implementation in long-term care settings should consider the outlined factors.
Collapse
Affiliation(s)
- Carola Maurer
- Institute for Applied Nursing Science, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Sever Draganescu
- University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Heidrun Gattinger
- Institute for Applied Nursing Science, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| |
Collapse
|
17
|
Older patients’ participation in physical activity during hospitalization: A qualitative study of ward nurses’ perceptions in an Asian context. Geriatr Nurs 2019; 40:91-98. [DOI: 10.1016/j.gerinurse.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/08/2018] [Indexed: 01/23/2023]
|
18
|
Lechner A, Lahmann N, Lichterfeld‐Kottner A, Müller‐Werdan U, Blume‐Peytavi U, Kottner J. Dry skin and the use of leave-on products in nursing care: A prevalence study in nursing homes and hospitals. Nurs Open 2019; 6:189-196. [PMID: 30534408 PMCID: PMC6279727 DOI: 10.1002/nop2.204] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the prevalence of dry skin in nursing homes and hospitals and to describe relationships between topical skincare interventions and dry skin. DESIGN Two multicentre descriptive cross-sectional prevalence studies. METHODS The studies were performed in German nursing homes and hospitals in 2015 and 2016. Data were collected by trained nurses based on a standardized data collection form. The severity of dry skin was measured using the Overall Dry Skin Score. RESULTS In total, 1,662 nursing home residents and 1,486 hospital patients participated. The prevalence of dry skin was 41.2% in nursing homes and 55.2% in hospitals. In case of skincare dependency, the proportions of participants with dry skin were higher, particularly in hospitals (70.2%). In both institutions, the application of leave-on products increased when dry skin was present but remained lower in hospitals. Considering the high amount of skin dryness in skincare-dependent participants, interventions seem not to be successful. Results indicate a need for skincare improvement in future.
Collapse
Affiliation(s)
- Anna Lechner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Nils Lahmann
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Andrea Lichterfeld‐Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ursula Müller‐Werdan
- Department of Geriatrics, Nursing Research Group in GeriatricsCharité – Universitätsmedizin BerlinBerlinGermany
| | - Ulrike Blume‐Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin ScienceCharité – Universitätsmedizin BerlinBerlinGermany
- University Centre for Nursing and MidwiferyGent UniversityGentBelgium
| |
Collapse
|
19
|
Kennedy KJ, Price K, Rando TL, Boylan J, Dyer AR. Ensuring healthy skin as part of wound prevention: an integrative review of health professionals' actions. J Wound Care 2018; 27:707-715. [PMID: 30398943 DOI: 10.12968/jowc.2018.27.11.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To provide a synthesis of the best available, recent primary or secondary research evidence on early preventative activities taken to increase skin health, and reduce the incidence of facility-acquired skin tears and pressure ulcers (PUs) in community, residential and health-care institutions. METHOD An integrative review focusing on a 10-year period, 2007-2017. A literature search of health databases was carried out, as well as a search of grey literature in relevant skin, wound care and nursing association journals. A second search was also conducted focused on literature from policy and guideline development organisations. Primary outcomes of interest were reduction in dry skin (xerosis), friable skin, or increases in healthy skin maintenance activities. Secondary outcomes of interest were reductions in PU or skin tear occurrences. Opinion, non-systematic literature reviews and discussion papers were excluded. RESULTS Of the 4932 references obtained from the searches, a total of 33 articles were included in the review: 27 peer-reviewed journal articles and six articles from the grey literature search. No guideline was found that focused on maintaining skin health as a person ages. Studies identified the main factors for maintaining skin health as nutrition, hydration and skin care regimen. CONCLUSION Skin care regimens, including a focus on good nutrition and pH balance, should start immediately on arrival in institutions such as hospitals or residential aged care, and continue throughout the stay.
Collapse
Affiliation(s)
- Kate J Kennedy
- University of South Australia, School of Nursing and Midwifery, City East, Adelaide, Australia
| | - Kay Price
- University of South Australia, School of Nursing and Midwifery, City East, Adelaide, Australia
| | - Tabatha L Rando
- Wound Management Innovation Cooperative Research Centre, Healthy Ageing Node, Flinders at Tonsley, Clovelly Park, Australia
| | - Jo Boylan
- Southern Cross Care (SA & NT), Peter Taylor House, Parkside, Australia
| | - Anthony R Dyer
- Wound Management Innovation Cooperative Research Centre, Healthy Ageing Node, Flinders at Tonsley, Clovelly Park, Australia
| |
Collapse
|
20
|
den Ouden M, Zwakhalen SMG, Meijers JMM, Bleijlevens MHC, Hamers JPH. Feasibility of DAIly NURSE: A nursing intervention to change nursing staff behaviour towards encouraging residents' daily activities and independence in the nursing home. J Clin Nurs 2018; 28:801-813. [PMID: 30230069 PMCID: PMC7380124 DOI: 10.1111/jocn.14677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 09/02/2018] [Accepted: 09/13/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the feasibility of DAIly NURSE and a nursing intervention to encourage nursing home residents' daily activities and independence. BACKGROUND Nursing home residents are mainly inactive during the day. DAIly NURSE was developed to change nursing behaviour towards encouraging nursing home residents' activities and independence by creating awareness. It consists of three components: education, coaching-on-the-job and policy. DESIGN A mixed-method study. METHODS The feasibility of DAIly NURSE in practice was tested in six psychogeriatric nursing home wards, using attendance lists (reach), evaluation questionnaires (fidelity, dose received and barriers), notes made by the researcher (dose delivered and fidelity) and a focus group interview (dose received and barriers) with nursing home staff (n = 8) at the end of the study. RESULTS The feasibility study showed that all three components (education, coaching-on-the-job and policy) were implemented in practice. The attendance rate in the workshops was high (average: 82%). Nursing home staff were satisfied with the workshops (mean score 9 out of 10 points) and agreed that DAIly NURSE was feasible in daily nursing care practice. Recommendations to optimise the feasibility of DAIly NURSE included the following: Add video observations of a specific moment of the day to create awareness of nursing behaviour; educate all nursing staff of the ward during the workshops; and organise information meetings for family members before the start of the intervention. Nursing staff were satisfied with the intervention and provided recommendations for adjustments to the content of the three components. The most important adjustment is the use of video observations to create awareness of nursing staff behaviour. CONCLUSIONS DAIly NURSE, consisting of education, coaching-on-the-job and policy, is feasible in nursing home practice. RELEVANCE TO CLINICAL PRACTICE DAIly NURSE might help to change nursing behaviour towards encouraging residents' daily activities and independence.
Collapse
Affiliation(s)
- Mirre den Ouden
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
21
|
Gattinger H, Senn B, Hantikainen V, Köpke S, Ott S, Leino-Kilpi H. The self-reported and observed competence of nursing staff in mobility care based on Kinaesthetics in nursing homes - A cross-sectional study. Pflege 2018; 31:319-329. [PMID: 30117373 DOI: 10.1024/1012-5302/a000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The majority of care-dependent persons living in nursing homes have mobility impairment affecting the physical, psychological, and social aspects of the persons' lives. Therefore, nursing staff needs competence to provide good mobility enhancing care. AIM This study assesses the self-reported and observed competence of nursing home staff in mobility care based on Kinaesthetics in order to increase attention about nursing staff's impact on nursing home residents' mobility. METHODS A cross-sectional study design involving a survey and an observational study was employed. Survey data were collected using the Kinaesthetics Competence Self-Evaluation (KCSE) scale. For the observational study, data were collected with a video camera and rated using the Kinaesthetics Competence Observation (KCO) instrument. Data were analysed using descriptive statistics, correlation methods and a generalised linear model. RESULTS The majority of survey participants (n = 180) indicated their competence in mobility care based on Kinaesthetics as very good (mean score 13, SD 1.44, on a scale from 4 to 16). The observed competence of nursing staff (n = 40) was good (mean score 10.8, SD 2.44, out of a possible score from 4 to 16). Positive correlations were found between self-reported or observed competence in mobility care based on Kinaesthetics and employment rate, work experience in nursing home care and Kinaesthetics training. CONCLUSION A combined assessment of self-evaluation and observation is recommended in order to get a comprehensive picture of knowledge, skills, attitude and dynamic state of nursing staffs' competence in mobility care based on Kinaesthetics.
Collapse
Affiliation(s)
- Heidrun Gattinger
- 1 Institute of Applied Nursing Science, University of Applied Science FHS St. Gallen, Switzerland
| | - Beate Senn
- 1 Institute of Applied Nursing Science, University of Applied Science FHS St. Gallen, Switzerland
| | | | - Sascha Köpke
- 3 Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
| | - Stefan Ott
- 1 Institute of Applied Nursing Science, University of Applied Science FHS St. Gallen, Switzerland
| | - Helena Leino-Kilpi
- 2 Department of Nursing Science, University of Turku, Finland.,4 Turku University Hospital, Finland
| |
Collapse
|
22
|
Kuntz S, Dassen T, Lahmann NA. Specific item patterns in comparison to generalized sum score-the Care Dependency Scale (CDS) as a screening tool for specific care problems. J Eval Clin Pract 2018; 24:731-739. [PMID: 29882621 DOI: 10.1111/jep.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study is to identify items of the Care Dependency Scale (CDS) with overriding importance for the specific nursing care problems of pressure ulcers, falls, and malnutrition. METHOD Secondary data analysis of 5 multicentre consecutive annual cross-sectional surveys from 2008 to 2012. For the study, data were analysed from 19 787 individuals in 262 long-term care facilities throughout Germany. Based on a standardized study protocol and international definitions, data regarding care dependency and care problems were gathered by direct examination. To identify the most relevant items of the CDS regarding pressure ulcers, falls, and malnutrition, classification trees (Classification and Regression Trees) were calculated. The validity of the identified items was then confirmed by applying "area under the receiver operating characteristic curve (AUC)" statistics. RESULTS The Classification and Regression Tree analysis showed a total of 6 nodes for pressure ulcer prevalence on 2 levels. Both levels provided the CDS item mobility as the most important predictor for the prevalence of pressure ulcers with a prevalence of 9.0% for these being completely dependent. The most important CDS item to determine malnutrition is completely dependent on eat and drink with a malnutrition prevalence of 25.2%. Of all CDS items that have been entered into the model, the item mobility showed the strongest association with falls. For pressure ulcers, the CDS items mobility (0.72) and body posture (0.71) provided a higher AUC than the total CDS sum score. Furthermore, for malnutrition, we measured an AUC of 0.63 for item eat and drink while the total CDS provided an AUC of 0.62. CONCLUSIONS The results of our study suggest that the CDS may be a useful tool for screening patients regarding the risk of pressure ulcers and/or malnutrition. According to our study, the CDS can be used as an assessment for many different care problems.
Collapse
Affiliation(s)
- Simone Kuntz
- Department of Geriatrics, Geriatrics Research Group, Working Group-Nursing Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Theo Dassen
- Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nils A Lahmann
- Department of Geriatrics, Geriatrics Research Group, Working Group-Nursing Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
23
|
Galik E, Holmes S, Resnick B. Differences Between Moderate to Severely Cognitively Impaired Fallers Versus Nonfallers in Nursing Homes. Am J Alzheimers Dis Other Demen 2018; 33:247-252. [PMID: 29490466 PMCID: PMC6200320 DOI: 10.1177/1533317518761856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The purpose of this study was to test differences in psychotropic medication, function, physical activity, agitation, resistiveness to care, comorbidities, and depression among moderate to severely cognitively impaired nursing home residents who were fallers versus nonfallers. METHODS This was a secondary data analysis using baseline data from a randomized controlled trial testing the Function and Behavior Focused Care intervention across 12 nursing homes. The sample included 336 older adults, the majority of whom were female and white. RESULTS There was a significant difference in the total number of comorbidities, agitation, the total number of psychotropic medications, depressive symptoms, and physical activity between those who fell and those who did not fall (Pillai-Bartlett trace = 4.91; P < .001). DISCUSSION Findings support prior work except with regard to medication use, cognition, and function. Due to inconsistent findings, additional research is recommended particularly with regard to the use of specific drug groups and medications.
Collapse
Affiliation(s)
- Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sarah Holmes
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| |
Collapse
|
24
|
Sanson G, Bertocchi L, Dal Bo E, Di Pasquale CL, Zanetti M. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud 2018; 82:40-48. [DOI: 10.1016/j.ijnurstu.2018.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 01/10/2023]
|
25
|
Bolano D, Berchtold A, Bürge E. The Heterogeneity of Disability Trajectories in Later Life: Dynamics of Activities of Daily Living Performance Among Nursing Home Residents. J Aging Health 2018; 31:1315-1336. [DOI: 10.1177/0898264318776071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices.
Collapse
Affiliation(s)
| | | | - Elisabeth Bürge
- University of Applied Sciences, Western Switzerland, Geneva, Switzerland
- Deceased on June 8, 2015
| |
Collapse
|
26
|
Pressure ulcer incidence and Braden subscales: Retrospective cohort analysis in general wards of a Portuguese hospital. J Tissue Viability 2018; 27:95-100. [DOI: 10.1016/j.jtv.2018.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/19/2022]
|
27
|
Zwakhalen SM, Hamers JP, Metzelthin SF, Ettema R, Heinen M, de Man-Van Ginkel JM, Vermeulen H, Huisman-de Waal G, Schuurmans MJ. Basic nursing care: The most provided, the least evidence based - A discussion paper. J Clin Nurs 2018; 27:2496-2505. [DOI: 10.1111/jocn.14296] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sandra M.G. Zwakhalen
- Department of Health Services Research; Research School CAPHRI; Maastricht University; Maastricht The Netherlands
| | - Jan P.H. Hamers
- Department of Health Services Research; Research School CAPHRI; Maastricht University; Maastricht The Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research; Research School CAPHRI; Maastricht University; Maastricht The Netherlands
| | - Roelof Ettema
- University of Professional Education Utrecht; Utrecht The Netherlands
| | - Maud Heinen
- Radboud University Medical Center; Radboud Institute for Health Sciences; IQ Healthcare; Nijmegen The Netherlands
| | - Janneke M. de Man-Van Ginkel
- Department of Rehabilitation, Nursing Science and Sport; Nursing Science; University Medical Center Utrecht; Brain Center Rudolf Magnus; Utrecht The Netherlands
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; Utrecht The Netherlands
| | - Hester Vermeulen
- Radboud University Medical Center; Radboud Institute for Health Sciences; IQ Healthcare; Nijmegen The Netherlands
| | - Getty Huisman-de Waal
- Radboud University Medical Center; Radboud Institute for Health Sciences; IQ Healthcare; Nijmegen The Netherlands
| | - Marieke J. Schuurmans
- Department of Rehabilitation, Nursing Science and Sport; Nursing Science; University Medical Center Utrecht; Brain Center Rudolf Magnus; Utrecht The Netherlands
- Nursing Science; Program in Clinical Health Sciences; University Medical Center Utrecht; Utrecht The Netherlands
| |
Collapse
|
28
|
Gattinger H, Senn B, Hantikainen V, Köpke S, Ott S, Leino-Kilpi H. Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale. BMC Nurs 2017; 16:67. [PMID: 29200963 PMCID: PMC5697076 DOI: 10.1186/s12912-017-0257-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care. METHODS The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015. RESULTS The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted. CONCLUSION The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.
Collapse
Affiliation(s)
- Heidrun Gattinger
- Finnish Doctoral Programme in Nursing Science, Department of Nursing Science, University of Turku, Turku, Finland
- Institute of Applied Nursing Sciences, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, Postfach, 9001 St. Gallen, Switzerland
| | - Beate Senn
- Institute of Applied Nursing Sciences, University of Applied Sciences FHS St.Gallen, St. Gallen, Switzerland
- Research Affiliate Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Virpi Hantikainen
- Adjunct Professor Department of Nursing Science, University of Turku, Turku, Finland
- Research Affiliate Institute of Applied Nursing Sciences, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Stefan Ott
- University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| |
Collapse
|
29
|
Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J. Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study. BMC Geriatr 2017; 17:263. [PMID: 29132305 PMCID: PMC5683462 DOI: 10.1186/s12877-017-0655-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/01/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Geriatric patients are affected by a range of skin conditions and dermatological diseases, functional limitations and chronic diseases. Skin problems are highly prevalent in elderly populations. Aim of this study was to investigate possible associations between health, functional and cutaneous variables in aged long-term care residents. METHODS This observational, cross-sectional, descriptive prevalence study was conducted in a random sample of 10 institutional long-term care facilities in Berlin. In total, n = 223 residents were included. Demographic and functional characteristics, xerosis cutis, incontinence associated dermatitis, pressure ulcers and skin tears were assessed. Stratum corneum hydration, transepidermal water loss, skin surface pH and skin temperature were measured. Data analysis was descriptive and explorative. To explore possible bivariate associations, a correlation matrix was created. The correlation matrix was also used to detect possible collinearity in the subsequent regression analyses. RESULTS Mean age (n = 223) was 83.6 years, 67.7% were female. Most residents were affected by xerosis cutis (99.1%; 95% CI: 97.7% - 100.0%). The prevalence of pressure ulcers was 9.0% (95% CI: 5.0% - 13.0%), of incontinence associated dermatitis 35.4% (95% CI: 29.9% - 42.2%) and of skin tears 6.3% (95% CI: 3.2% - 9.5%). Biophysical skin parameters were not associated with overall care dependency, but with age and skin dryness. In general, skin dryness and measured skin barrier parameters were associated between arms and legs indicating similar overall skin characteristics of the residents. CONCLUSION Prevalence of xerosis cutis, pressure ulcers and skin tears were high, indicating the load of these adverse skin conditions in this population. Only few associations of demographic characteristics, skin barrier impairments and the occurrence of dry skin, pressure ulcers, skin tears and incontinence-associated dermatitis have been detected, that might limit the diagnostic value of skin barrier parameters in this population. Overall, the measured skin barrier parameters seem to have limited diagnostic value for the reported skin conditions except xerosis cutis. TRIAL REGISTRATION This study is registered at https://clinicaltrials.gov/ct2/show/NCT02216526 . Registration date: 8th November 2014.
Collapse
Affiliation(s)
- Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carina Trojahn
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| |
Collapse
|
30
|
Abstract
To overcome challenges associated with optimizing function and physical activity among hospitalized older adults, we developed function-focused care for acute care (FFC-AC). The purpose of this study was to test the feasibility and preliminary effectiveness of this intervention. We hypothesized that hospitalized trauma patients exposed to FFC-AC would (1) maintain or improve function, spend more time in physical activity, and have fewer adverse events between admission and discharge; and (2) maintain or improve function, have less fear of falling, fewer depressive symptoms, less pain, be more physically resilient, and be less likely to experience adverse events at 1 month postdischarge compared with those exposed to FFC-education only (EO). FFC-AC was implemented by a research function-focused care nurse who worked on the participating units for 20 hr a week for 16 months to implement the three components of FFC-AC. The sample included 89 older orthopedic trauma patients the majority of whom were female (N = 59, 66%), white (N = 82, 92%), and not married (N = 53, 59%). At discharge and/or 30 days postdischarge, participants in the treatment site showed greater improvement in function, less fear of falling, and better physical resilience when compared with those in the FFC-EO site. Future research is needed to continue to work on engaging staff in function-focused care approaches and optimizing the hospital environment and policies to support nurses in this type of care approach.
Collapse
|
31
|
Lechner A, Lahmann N, Neumann K, Blume-Peytavi U, Kottner J. Dry skin and pressure ulcer risk: A multi-center cross-sectional prevalence study in German hospitals and nursing homes. Int J Nurs Stud 2017; 73:63-69. [DOI: 10.1016/j.ijnurstu.2017.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 12/23/2022]
|
32
|
den Ouden M, Kuk NO, Zwakhalen SM, Bleijlevens MH, Meijers JM, Hamers JP. The role of nursing staff in the activities of daily living of nursing home residents. Geriatr Nurs 2017; 38:225-230. [DOI: 10.1016/j.gerinurse.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/28/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
|
33
|
Rommel A, Kottner J, Suhr R, Lahmann N. [Frequency of falls among clients of home care services : The importance of care-related and social risk factors]. Z Gerontol Geriatr 2017; 52:3-9. [PMID: 28332012 DOI: 10.1007/s00391-017-1215-5] [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: 07/24/2016] [Revised: 12/21/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Among the elderly falls frequently result in injuries, increase the need for long-term care and pose a challenge for the quality assurance in nursing care. We describe the frequency and risk factors of falls among care-dependent persons using home care services in Germany. METHODS The participants of the study "Nursing-related health problems in home care" (n = 880) were recruited based on a list of the officially accredited nursing services. Data collection followed a standardized study protocol. Proportions were calculated and adjusted odds ratios and predicted probabilities were estimated using binary logistic regression. RESULTS Falls are a frequent occurrence among care-dependent persons who are cared for by home care services: Almost every tenth care-dependent person suffers from a fall within a period of 2 weeks. Falls are mainly associated with social and care-related factors. Besides a low educational status this comprises certain living and care arrangements: People living alone or having infrequent contact to their nursing service as well as clients that, according to their carers, should receive more support have a significantly higher chance of falling. Multimorbidity is a medical risk factor while neurological diseases as well as polypharmacy present increased risks only in interaction with living and care arrangements. CONCLUSION Nursing staff and physicians should maintain an overview of the social and health conditions of people in need of long-term care. If care-dependent persons live alone or are infrequently cared for, additional medical problems considerably increase the risk for falling; therefore, preventive interventions and follow-up assessments of actual need levels should be promptly considered if health conditions or living arrangements change.
Collapse
Affiliation(s)
- A Rommel
- Abteilung 2: Epidemiologie und Gesundheitsmonitoring, Robert-Koch-Institut, Postfach 65 02 61, 13302, Berlin, Deutschland.
| | - J Kottner
- Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - R Suhr
- Stiftung ZQP, Zentrum für Qualität in der Pflege, Berlin, Deutschland
| | - N Lahmann
- Forschungsgruppe Geriatrie, AG Pflegeforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
34
|
Moon M, Lee SK. Applying of Decision Tree Analysis to Risk Factors Associated with Pressure Ulcers in Long-Term Care Facilities. Healthc Inform Res 2017; 23:43-52. [PMID: 28261530 PMCID: PMC5334131 DOI: 10.4258/hir.2017.23.1.43] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was to use decision tree analysis to explore the factors associated with pressure ulcers (PUs) among elderly people admitted to Korean long-term care facilities. METHODS The data were extracted from the 2014 National Inpatient Sample (NIS)-data of Health Insurance Review and Assessment Service (HIRA). A MapReduce-based program was implemented to join and filter 5 tables of the NIS. The outcome predicted by the decision tree model was the prevalence of PUs as defined by the Korean Standard Classification of Disease-7 (KCD-7; code L89*). Using R 3.3.1, a decision tree was generated with the finalized 15,856 cases and 830 variables. RESULTS The decision tree displayed 15 subgroups with 8 variables showing 0.804 accuracy, 0.820 sensitivity, and 0.787 specificity. The most significant primary predictor of PUs was length of stay less than 0.5 day. Other predictors were the presence of an infectious wound dressing, followed by having diagnoses numbering less than 3.5 and the presence of a simple dressing. Among diagnoses, "injuries to the hip and thigh" was the top predictor ranking 5th overall. Total hospital cost exceeding 2,200,000 Korean won (US $2,000) rounded out the top 7. CONCLUSIONS These results support previous studies that showed length of stay, comorbidity, and total hospital cost were associated with PUs. Moreover, wound dressings were commonly used to treat PUs. They also show that machine learning, such as a decision tree, could effectively predict PUs using big data.
Collapse
Affiliation(s)
- Mikyung Moon
- College of Nursing, the Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea
| | | |
Collapse
|
35
|
Rushton PW, Mortenson BW, Viswanathan P, Wang RH, Miller WC, Hurd Clarke L. Intelligent power wheelchair use in long-term care: potential users' experiences and perceptions. Disabil Rehabil Assist Technol 2016; 12:740-746. [PMID: 27982717 DOI: 10.1080/17483107.2016.1260653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Long-term care (LTC) residents with cognitive impairments frequently experience limited mobility and participation in preferred activities. Although a power wheelchair could mitigate some of these mobility and participation challenges, this technology is often not prescribed for this population due to safety concerns. An intelligent power wheelchair (IPW) system represents a potential intervention that could help to overcome these concerns. The purpose of this study was to explore a) how residents experienced an IPW that used three different modes of control and b) what perceived effect the IPW would have on their daily lives. MATERIALS AND METHODS We interviewed 10 LTC residents with mild or moderate cognitive impairment twice, once before and once after testing the IPW. Interviews were conducted using a semi-structured interview guide, audio recorded and transcribed verbatim for thematic analyses. RESULTS Our analyses identified three overarching themes: (1) the difference an IPW would make, (2) the potential impact of the IPW on others and (3) IPW-related concerns. CONCLUSIONS Findings from this study confirm the need for and potential benefits of IPW use in LTC. Future studies will involve testing IPW improvements based on feedback and insights from this study. Implications for rehabilitation Intelligent power wheelchairs may enhance participation and improve safety and feelings of well-being for long-term care residents with cognitive impairments. Intelligent power wheelchairs could potentially have an equally positive impact on facility staff, other residents, and family and friends by decreasing workload and increasing safety.
Collapse
Affiliation(s)
- Paula W Rushton
- a School of Rehabilitation , Université de Montréal , Montréal , Québec , Canada.,b CHU Sainte-Justine Research Center , Montréal , Québec , Canada
| | - Ben W Mortenson
- c Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada.,d International Collaboration on Repair Discoveries , Vancouver , British Columbia , Canada.,e Rehabilitation Research Program, GF Strong Rehabilitation Research Lab , Vancouver , British Columbia , Canada
| | - Pooja Viswanathan
- f Department of Occupational Science and Occupational Therapy , Intelligent Assistive Technology and Systems Lab, University of Toronto , Toronto , Ontario , Canada.,g Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - Rosalie H Wang
- f Department of Occupational Science and Occupational Therapy , Intelligent Assistive Technology and Systems Lab, University of Toronto , Toronto , Ontario , Canada.,g Toronto Rehabilitation Institute , Toronto , Ontario , Canada
| | - William C Miller
- c Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , British Columbia , Canada.,d International Collaboration on Repair Discoveries , Vancouver , British Columbia , Canada.,e Rehabilitation Research Program, GF Strong Rehabilitation Research Lab , Vancouver , British Columbia , Canada.,h Vancouver Coastal Health Research Institute , Vancouver , British Columbia , Canada
| | - Laura Hurd Clarke
- h Vancouver Coastal Health Research Institute , Vancouver , British Columbia , Canada.,i School of Kinesiology , University of British Columbia , Vancouver , British Columbia , Canada
| | | |
Collapse
|
36
|
Gattinger H, Leino-Kilpi H, Hantikainen V, Köpke S, Ott S, Senn B. Assessing nursing staff's competences in mobility support in nursing-home care: development and psychometric testing of the Kinaesthetics Competence (KC) observation instrument. BMC Nurs 2016; 15:65. [PMID: 27895529 PMCID: PMC5120435 DOI: 10.1186/s12912-016-0185-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022] Open
Abstract
Background Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff’s interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff’s competences in kinaesthetics. Methods The Kinaesthetics Competence (KC) observation instrument was developed between January and June 2015 based on a literature review, a concept analysis and expert meetings (18). The pilot instrument was evaluated with two expert panels (n = 5, n = 4) regarding content validity, usability and inter-rater agreement. Content validity was assessed by determining the content validity index (CVI). The final instrument was tested in a cross-sectional study in three nursing homes in the German-speaking part of Switzerland between July 2015 and February 2016. In this study nursing staff (n = 48) was filmed during mobilization situations. Based on this video data two observers independently assessed nursing staff’s competences in kinaesthetics with the KC observation instrument. Inter-rater reliability and inter-rater agreement was evaluated using the intra-class correlation coefficient (ICC) and percentage of agreement. Construct validity was assessed by a discriminating power analysis. Internal consistency was evaluated using Cronbach’s alpha coefficient and item analysis. Results The final version of the KC observation instrument comprised of four domains (interaction, movement support of the person, nurses’ movement, environment) and 12 items. The final instrument showed an excellent content validity index of 1.0. Video sequences from 40 persons were analysed. Inter-rater reliability for the whole scale was good (ICC 0.73) and the percentage of inter-rater agreement was 53.6% on average. Cronbach’s alpha coefficient for the whole instrument was 0.97 and item-total correlations ranged from 0.76 to 0.90. The construct validity of the instrument was supported by a significant discrimination of the instrument between nursing staff with no or basic and with advanced kinaesthetics training for the total score and 3 of 4 subscales. Conclusions The KC observation instrument showed good preliminary psychometric properties and can be used to assess nursing staff’s competences in mobility care based on the principles of kinaesthetics.
Collapse
Affiliation(s)
- Heidrun Gattinger
- Department of Nursing Science, University of Turku, Turku, Finland ; Institute of Applied Nursing Science, FHS St. Gallen University of Applied Sciences, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland ; Turku University Hospital, Turku, Finland
| | - Virpi Hantikainen
- Department of Nursing Science, University of Turku, Turku, Finland ; Institute of Applied Nursing Science, FHS St. Gallen University of Applied Sciences, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Stefan Ott
- FHS St. Gallen University of Applied Sciences, St. Gallen, Switzerland
| | - Beate Senn
- Institute of Applied Nursing Science, FHS St. Gallen University of Applied Sciences, Rosenbergstrasse 59, 9001 St. Gallen, Switzerland ; Research Affiliate Sydney Nursing School, University of Sydney, Sydney, Australia
| |
Collapse
|
37
|
Gattinger H, Leino-Kilpi H, Köpke S, Marty-Teuber S, Senn B, Hantikainen V. Nurses' competence in kinaesthetics : A concept development. Z Gerontol Geriatr 2016; 50:506-515. [PMID: 27619218 DOI: 10.1007/s00391-016-1126-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 07/19/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Abstract
AIM This study was carried out to systematically describe nurses' competence in kinaesthetics. BACKGROUND In elderly care the kinaesthetics program for nurses has been taught for over 25 years; however, the competence that nurses should gain through kinaesthetics training from a theoretical perspective has not yet been systematically described. MATERIAL AND METHODS The method was modelled after the three phases of the hybrid model of concept development by Schwartz-Barcott and Kim (2000). In the theoretical phase a working definition was established and a literature review conducted. We searched the online databases PubMed and CINAHL and the reference lists up to February 2016. In the empirical phase experts defined the attributes during a workshop in October 2013. In the analytical phase the results from the theoretical and empirical phase were combined in order to define antecedents, attributes and consequences of the concept. RESULTS The concept of nurses' competence in kinaesthetics includes two antecedents: (1) nurses' kinaesthetics training and (2) care recipients' need for mobility support in activities of daily living. This concept includes a set of attributes in the areas of knowledge, skills, attitudes and dynamic state. It contributes towards (1) movement competence and (2) physical and psychological well-being of both care recipients and nurses. CONCLUSION The concept of nurses' competence in kinaesthetics might support awareness and communication about mobility-enhancing gerontological care. Based on the attributes of nurse' competence in kinaesthetics an assessment instrument will be developed that can be used to evaluate nurses' competence in kinaesthetics in clinical practice. Further research is needed to evaluate the consequences of the developed concept.
Collapse
Affiliation(s)
- Heidrun Gattinger
- Department of Nursing Science, University of Turku, Turku, Finland. .,Institute for Applied Nursing Science, University of Applied Science St. Gallen, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
| | | | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | | | - Beate Senn
- Institute for Applied Nursing Science, University of Applied Science St. Gallen, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.,Research Affiliate Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Virpi Hantikainen
- Institute for Applied Nursing Science, University of Applied Science St. Gallen, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland
| |
Collapse
|
38
|
Lichterfeld A, Lahmann N, Blume-Peytavi U, Kottner J. Dry skin in nursing care receivers: A multi-centre cross-sectional prevalence study in hospitals and nursing homes. Int J Nurs Stud 2016; 56:37-44. [DOI: 10.1016/j.ijnurstu.2016.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 01/24/2023]
|
39
|
Hignett S, Wolf L. Reducing inpatient falls: Human Factors & Ergonomics offers a novel solution by designing safety from the patients' perspective. Int J Nurs Stud 2016; 59:A1-3. [PMID: 26924377 DOI: 10.1016/j.ijnurstu.2016.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Sue Hignett
- Loughborough Design School, Loughborough University, Loughborough, Leics. LE11 3TU, UK.
| | - Laurie Wolf
- Barnes Jewish Hospital, St Louis, MO 63110, USA.
| |
Collapse
|
40
|
Development and usability of the MAINtAIN, an inventory assessing nursing staff behavior to optimize and maintain functional activity among nursing home residents: a mixed-methods approach. BMC Health Serv Res 2016; 16:38. [PMID: 26837812 PMCID: PMC4736173 DOI: 10.1186/s12913-016-1288-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022] Open
Abstract
Background Functional decline is common in nursing home residents. Nursing staff can help prevent this decline, by encouraging residents to be more active in functional activities. Questionnaires measuring the extent to which nursing staff encourage functional activity among residents are lacking. In addition, there are no measurement instruments to gain insight into nursing staff perceived barriers and facilitators to this behavior. The aim of this study was to develop, and study the usability, of the MAastrIcht Nurses Activities INventory (MAINtAIN), an inventory assessing a) the extent to which nursing staff perceive to perform behaviors that optimize and maintain functional activity among nursing home residents and b) the perceived barriers and facilitators related to this behavior. Methods Using a mixed-methods approach the MAINtAIN was developed and its usability was studied. Development was based on literature, expert opinions, focus group (N = 3) and individual interviews (N = 14) with residents and staff from nine nursing homes in the Netherlands. Usability was studied in a cross-sectional study with 37 nurses and certified nurse assistants; data were analyzed using descriptive statistics. Results Development of the MAINtAIN resulted in two distinctive parts: MAINtAIN-behaviors and MAINtAIN-barriers. MAINtAIN-behaviors, targeting nursing staff behavior to optimize and maintain functional activity, includes 19 items covering activities of daily living, household activities, and miscellaneous activities. MAINtAIN-barriers addresses the perceived barriers and facilitators related to this behavior and comprises 33 items covering barriers and facilitators related to the residents, the professionals, the social context, and the organizational and economic context. The usability study showed that the inventory was not difficult to complete, that items and response options were clear, and that the number of missing values was low. Few items showed a floor or ceiling effect. Conclusions The newly developed inventory MAINtAIN provides a usable method for researchers and nursing homes to obtain insight into nursing staff perceived behavior in optimizing functional activity among residents and their perceived barriers and facilitators related to this behavior. Outcomes of the MAINtAIN may contribute to change in nursing staff behavior and may improve nursing care. Further research with regard to the psychometric properties of the MAINtAIN is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1288-7) contains supplementary material, which is available to authorized users.
Collapse
|
41
|
Lannering C, Ernsth Bravell M, Midlöv P, Östgren CJ, Mölstad S. Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents. J Clin Nurs 2016; 25:940-50. [DOI: 10.1111/jocn.13154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | - Marie Ernsth Bravell
- Institute of Gerontology; School of Health Sciences; Jönköping University; Jönköping Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, General Practice/Family Medicine; Lund University; Malmö Sweden
| | - Carl-Johan Östgren
- Department of Medical and Health Sciences, General Practice; Linköping University; Linköping Sweden
| | - Sigvard Mölstad
- Department of Clinical Sciences in Malmö, General Practice/Family Medicine; Lund University; Malmö Sweden
| |
Collapse
|
42
|
Hignett S, Wolf L, Taylor E, Griffiths P. Firefighting to Innovation: Using Human Factors and Ergonomics to Tackle Slip, Trip, and Fall Risks in Hospitals. HUMAN FACTORS 2015; 57:1195-1207. [PMID: 26138215 DOI: 10.1177/0018720815593642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/01/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). BACKGROUND Risk factors for patient STFs have been identified and reported since the 1950s and are mostly unchanged in the 2010s. The prevailing clinical view has been that STF events indicate underlying frailty or illness, and so many of the interventions over the past 60 years have focused on assessing and treating physiological factors (dizziness, illness, vision/hearing, medicines) rather than designing interventions to reduce risk factors at the time of the STF. METHOD Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management as (a) a design-based (building) approach to embed safety into the built environment, (b) a staff- (and organization-) based approach, and (c) a patient behavior-based approach to explore and understand patient perspectives of STF events. RESULTS AND CONCLUSION The results from the case studies suggest taking a similar HFE integration approach to other industries, that is, a sustainable design intervention for the person who experiences the STF event-the patient. APPLICATION This paper offers a proactive problem-solving approach to reduce STFs by patients in acute hospitals. Authors of the three case studies use HFE principles (bench/book) to understand the complex systems for facility and equipment design and include the perspective of all stakeholders (bedside).
Collapse
Affiliation(s)
- Sue Hignett
- Loughborough University, Loughborough, United Kingdom
| | | | | | | |
Collapse
|
43
|
Johansen E, Bakken LN, Moore Z. Pressure Ulcer in Norway-A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care. Healthcare (Basel) 2015; 3:417-28. [PMID: 27417771 PMCID: PMC4939547 DOI: 10.3390/healthcare3020417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/24/2015] [Accepted: 05/25/2015] [Indexed: 12/05/2022] Open
Abstract
Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.
Collapse
Affiliation(s)
- Edda Johansen
- Department of Nursing Science, Faculty of Health Sciences, Buskerud and Vestfold University College, Grønland 58, Drammen 3045, Norway.
| | - Linda N Bakken
- Department of Nursing Science, Faculty of Health Sciences, Buskerud and Vestfold University College, Grønland 58, Drammen 3045, Norway.
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland.
| |
Collapse
|
44
|
Hatzopoulos K, Jahn P, Knorr D, Wittrich A. [For discussion: Quality assurance in medical care - is PKMS the right way to go?]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2015; 109:736-738. [PMID: 26699262 DOI: 10.1016/j.zefq.2015.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 06/05/2023]
Abstract
Hospitals are legally obliged to take part in external comparative quality assurance programs. Quality indicators for pressure ulcer prevention are among the most widely used for geriatric clinical institutions. To enable more precise risk adjustment established risk factors are employed in conjunction with the OPS 9-200. Using a PKMS case to produce an OPS 9-200 is far too heterogeneous, sketchy and vague to create an accurate and satisfactory pressure ulcer risk assessment for patients with varied and individual case factors. Therefore we propose to include risk factors which, according to experts, are clearly and specifically related to pressure ulcers (e.g. immobility and incontinence) and matched by unique ICD codes.
Collapse
Affiliation(s)
| | - Patrick Jahn
- Leiter Pflegeforschung, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Dana Knorr
- Bundesverband Geriatrie e.V., Berlin, Deutschland
| | | |
Collapse
|