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van Oppen JD, Coats T, Conroy S, Hayden S, Heeren P, Hullick C, Liu S, Lucke J, Lukin B, McNamara R, Melady D, Mooijaart SP, Rosen T, Banerjee J. Person-centred decisions in emergency care for older people living with frailty: principles and practice. Emerg Med J 2024:emermed-2024-213898. [PMID: 39060102 DOI: 10.1136/emermed-2024-213898] [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: 01/09/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Older people living with frailty are frequent users of emergency care and have multiple and complex problems. Typical evidence-based guidelines and protocols provide guidance for the management of single and simple acute issues. Meanwhile, person-centred care orientates interventions around the perspectives of the individual. Using a case vignette, we illustrate the potential pitfalls of applying exclusively either evidence-based or person-centred care in isolation, as this may trigger inappropriate clinical processes or place undue onus on patients and families. We instead advocate for delivering a combined evidence-based, person-centred approach to healthcare which considers the person's situation and values, apparent problem and available options.
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Affiliation(s)
- James David van Oppen
- Centre for Urgent and Emergency Care Research, The University of Sheffield, Sheffield, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Tim Coats
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Sarah Hayden
- Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pieter Heeren
- Faculty of Medicine and Life Sciences, Healthcare & Ethics Research Group, UHasselt, Hasselt, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Flanders, Belgium
| | - Carolyn Hullick
- Australian Commission on Safety and Quality in Healthcare, Sydney, New South Wales, Australia
- The University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Shan Liu
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jacinta Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, Netherlands
| | - Bill Lukin
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Rosa McNamara
- Emergency Department, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Don Melady
- Department of Family and Community Medicine, Schwartz Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Simon P Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands
| | - Tony Rosen
- Department of Emergency Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Jay Banerjee
- College of Life Sciences, University of Leicester, Leicester, UK
- Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Boak J, Rasekaba T, Baxter P, Blackberry I. How is complexity measured and detected among community dwelling older people aged 65 years and over? A scoping review. J Adv Nurs 2024; 80:84-95. [PMID: 37574775 DOI: 10.1111/jan.15824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/22/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
AIM To identify and explore tools that measured and detected complexity of care among community dwelling people aged 65 years and older. DATA SOURCES Databases were searched for articles published up to 23 September 2022 including CINAHL, EMBASE and MEDLINE, Cochrane database for trials and grey literature. METHODS A scoping review was conducted and reported in accordance with the PRISMA guidelines. Eligible articles included those with participants aged over 65 years, living in the community and studies that included care complexity detection or assessment and how this related to care delivered. Covidence was used to screen titles, abstracts and full-text articles. RESULTS Eighteen full texts were reviewed; four studies were included in the final review. All selected studies included people aged over 65 years living in the community. A high level of reliability for the items included in the interventions was found. The selected studies included tools for assessing older person's needs with nurses involved in the assessment. CONCLUSION The review identified four tools for measuring complexity in community dwelling older people. Two tools have the capacity to objectively measure complexity due to the holistic nature of items included and appear easy to use to support clinical judgement decisions. IMPACT The review places a spotlight on the concept of complexity and highlights the lack of definition of care complexity. The synthesized result highlights the need to explore detection of care complexity of older people further and consider ways of supporting clinical judgement and decision making of community nurses. The use of a validated tool may enhance clinical judgement regarding care complexity and may lead to a more consistent and timely approach to care. PATIENT OR PUBLIC CONTRIBUTION During the development phase, the study was presented to a consumer group from the researcher's workplace. PROSPERO REGISTRATION CRD42022299336.
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Affiliation(s)
- Jennifer Boak
- Bendigo Health, Community Nursing Service, East Bendigo, Victoria, Australia
| | - Tshepo Rasekaba
- John Richards Centre for Ageing Research, La Trobe University, Wodonga, Victoria, Australia
| | - Pamela Baxter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Irene Blackberry
- John Richards Centre for Ageing Research, La Trobe University, Wodonga, Victoria, Australia
- Care Economy Research Institute, La Trobe University, Wodonga, Victoria, Australia
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2023; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [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: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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Santos C, Fernandes CS, Bastos C, Cruz MA, Costa S, Lima L. Older person's experience of PT4Ageing-A programme on self-management «support» in chronic illness. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:346-352. [PMID: 37714461 DOI: 10.1016/j.enfcle.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/30/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE This study sought to describe the experience of a group of older adults who participated in a chronic illness self-management program. METHODS The study employed a qualitative phenomenological approach. Participants were eight elders and data collected using semi-structured interviews Data was analysed using thematic analysis. RESULTS Five themes emerged from the analysis: (1) Tips to improve our daily lives, (2) I was always motivated, (3) Sharing and mutual help, (4) They made us believe we were capable (5). It would be great if it did not end here. Globally, the participants of the program described their experience as very positive. They identified gains from participating in the program, such as learning strategies to help them cope with their health problems, improving their ability to manage their illnesses more autonomously and building social support, that even persisted after the conclusion of the intervention. CONCLUSION The findings of this study provide insight into how older adults experience a program for the self-management of chronic illness. For the development of future programs, support building must be considered. Older adults who participate in self-management programmes exhibit improved self-efficacy in relation to the management their chronic illnesses and greater autonomy in self-care.
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Affiliation(s)
- Célia Santos
- Escuela de Enfermería de Oporto, Porto, Portugal; lCINTESIS@RISE Research, Porto, Portugal
| | - Carla Silvia Fernandes
- Escuela de Enfermería de Oporto, Porto, Portugal; lCINTESIS@RISE Research, Porto, Portugal.
| | - Celeste Bastos
- Escuela de Enfermería de Oporto, Porto, Portugal; lCINTESIS@RISE Research, Porto, Portugal
| | | | - Sandra Costa
- lCINTESIS@RISE Research, Porto, Portugal; Instituto de Ciencias Biomédicas Abel Salazar, Universidad de Oporto, Porto, Portugal; ACES Grande Porto I - Santo Tirso/Trofa, ARS Norte Administración Sanitaria del Norte, I.P., Porto, Portugal
| | - Lígia Lima
- Escuela de Enfermería de Oporto, Porto, Portugal; lCINTESIS@RISE Research, Porto, Portugal
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Zadvinskis IM, Tucker S, Hoying J. Evidence, expertise, and patient/family preferences to maximize health for older adults with implications for evidence-based practice. Worldviews Evid Based Nurs 2022; 19:344-351. [PMID: 36102340 PMCID: PMC9826038 DOI: 10.1111/wvn.12605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND As Americans live longer and with chronic conditions, the healthcare system, researchers, faculty, practicing providers, patients, and families must adapt to changing societal needs and goals. AIMS The aim of this commentary was to offer recommendations that align with the six vital directions to improve the health care and quality of life for older Americans. METHODS This article expands upon the six vital directions from an evidence-based practice (EBP) perspective that values the three legs of the EBP stool: (1) research evidence, (2) clinician expertise, and (3) patient preferences, values, and circumstances. RESULTS The recommendations reflect the scientific literature, our expertise in EBP and research, our nursing roles and expertise, and our experiences in the care of our older parents. By sharing our experiences as nurse scientists and daughters, we offer insight to raise the healthcare bar for older adults through EBP and meaningful, person-centered care. LINKING ACTION TO EVIDENCE Vital directions for improving the health care and quality of life for older Americans include promoting interprofessional education to create an adequately prepared workforce; researching and implementing pathways to minimize the social determinants of health for older adults; disseminating findings that remediate older adult health disparities; innovating approaches for managing chronic health conditions at home; and studying and implementing approaches for allocating resources for end-of-life care that are satisfying for the patients, their family, and clinicians.
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Affiliation(s)
- Inga M. Zadvinskis
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA
| | - Sharon Tucker
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA,The Ohio State University College of NursingColumbusOhioUSA
| | - Jacqueline Hoying
- Helene Fuld Health Trust National Institute for Evidence‐based Practice in Nursing and HealthcareColumbusOhioUSA,The Ohio State University College of NursingColumbusOhioUSA
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