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Amin R, Völzer B, El Genedy-Kalyoncu M, Blume-Peytavi U, Kottner J. Skin care types, frequencies and products: A cross-sectional study in German institutional long-term care. J Tissue Viability 2024; 33:318-323. [PMID: 38360494 DOI: 10.1016/j.jtv.2024.02.005] [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: 08/03/2023] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
AIM The aim of the study was to describe types and frequencies of skin care interventions and products provided in institutional long-term care. MATERIALS AND METHODS Baseline data from a cluster randomized controlled trial conducted in nursing homes in Berlin, Germany was collected before randomization. Numbers, proportions and frequencies of washing, showering and bathing, and the application of leave-on products were calculated. Product labels were iteratively and inductively categorized into overarching terms and concepts. RESULTS A total of n = 314 residents participated in the study. In the majority, washing of the whole body was done once daily, and showering was performed once per week or more rarely. The majority received leave-on products daily on the face and once per week on the whole body. Most of the skin care interventions were delivered by nurses. There was marked heterogeneity in terms of product names, whereas the product names reveal little about the ingredients or composition. CONCLUSION Personal hygiene and cleansing interventions are major parts of clinical practice in long-term care. Daily washing is a standard practice at the moment. In contrast, leave-on products are used infrequently. To what extent the provided care promotes skin integrity is unclear. Due to the heterogeneity and partly misleading labels of skin care products, informed decision making is difficult to implement at present. CLINICALTRIALS GOV IDENTIFIER NCT03824886.
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Affiliation(s)
- Ruhul Amin
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117, Berlin, Germany; BCSIR Laboratories Dhaka, Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Bettina Völzer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Monira El Genedy-Kalyoncu
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Clinical Research Center for Hair and Skin Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117, Berlin, Germany.
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Kottner J. Nurses as skin care experts: Do we have the evidence to support practice? Int J Nurs Stud 2023; 145:104534. [PMID: 37348391 DOI: 10.1016/j.ijnurstu.2023.104534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Jan Kottner
- Charité-Universitätsmedizin Berlin, Institute of Clinical Nursing Science, Charitéplatz 1, 10117 Berlin, Germany.
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Skin care in nursing: A critical discussion of nursing practice and research. Int J Nurs Stud 2016; 61:20-8. [PMID: 27267180 DOI: 10.1016/j.ijnurstu.2016.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 11/20/2022]
Abstract
Skin (self-)care is part of human life from birth until death. Today many different skin care practices, preferences, traditions and routines exist in parallel. In addition, preventive and therapeutic skin care is delivered in nursing and healthcare by formal and informal caregivers. The aim of this contribution is a critical discussion about skin care in the context of professional nursing practice. An explicit skin assessment using accurate diagnostic statements is needed for clinical decision making. Special attention should be paid on high risk skin areas, which may be either too dry or too moist. From a safety perspective the protection and maintenance of skin integrity should have the highest priority. Skin cleansing is the removal of unwanted substances from the skin surface. Despite cleansing efficacy soap, other surfactants and water will inevitably always result in the destruction of the skin barrier. Thousands of products are available to hydrate, moisturize, protect and restore skin properties dependent upon their formulation and the concentration of ingredients. These products intended to left in contact with skin exhibit several actions on and in the skin interfering with skin biology. Unwanted side effects include hyper-hydration and disorganization of lipid bilayers in the stratum corneum, a dysfunctional barrier, increased susceptibility to irritants and allergies, and increases of skin surface pH. Where the skin barrier is impaired appropriate interventions, e.g. apply lipophilic products in sufficient quantity to treat dry skin or protect the skin from exposure to irritants should be provided. A key statement of this contribution is: every skin care activity matters. Every time something is placed on the skin, a functional and structural response is provoked. This response can be either desired or undesired, beneficial or harmful. The choice of all skin care interventions in nursing and healthcare practice must be based on an accurate assessment of the skin and concomitant health conditions and on a clearly defined outcome. A standardized skin care and skin care product language is needed for researchers planning and conducting clinical trials, for reviewers doing systematic reviews and evidence-base summaries, for nurses and other healthcare workers to deliver evidence-based and safe skin care.
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Kottner J, Hahnel E, Trojahn C, Stroux A, Dobos G, Lichterfeld A, Richter C, Blume-Peytavi U. A multi-center prevalence study and randomized controlled parallel-group pragmatic trial to compare the effectiveness of standardized skin care regimens on skin health in nursing home residents: A study protocol. Int J Nurs Stud 2015; 52:598-604. [DOI: 10.1016/j.ijnurstu.2014.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 01/28/2023]
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Kottner J, Boronat X, Blume-Peytavi U, Lahmann N, Suhr R. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study. J Adv Nurs 2014; 71:570-80. [DOI: 10.1111/jan.12517] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jan Kottner
- Clinical Research Center for Hair and Skin Science; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Germany
| | - Xavier Boronat
- Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Germany
| | - Ulrike Blume-Peytavi
- Clinical Research Center for Hair and Skin Science; Department of Dermatology and Allergy; Charité-Universitätsmedizin Berlin; Germany
| | - Nils Lahmann
- Institute of Health and Nursing Science; Charité-Universitätsmedizin Berlin; Germany
| | - Ralf Suhr
- Centre for Quality in Care; Berlin Germany
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Geraghty J. Introducing a new skin-care regimen for the incontinent patient. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2011; 20:409-415. [PMID: 21537257 DOI: 10.12968/bjon.2011.20.7.409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Maintaining skin integrity and preventing skin breakdown and moisture lesions in the incontinent patient is an everyday challenge for nurses in the acute setting. The management of incontinence is often a socially or culturally prohibited topic Fletcher (2008); it is frequently attributed to ill health, the aging process or hospitalization, and often overlooked. The concept of cleansing should be commonplace, but it is complicated by the ritualism that underpins this ordinary yet fundamental aspect of patient care (Voegeli, 2010). The use of traditional methods of cleansing with soap and water in the management of skin integrity consumes significant amounts of nursing time. However, this procedure conflicts with infection control measures and predisposes the patient to further skin breakdown. This article looks at the use of an evaluation of a skin-cleansing emollient product in an elderly-care setting to provide evidence enabling an innovation that would lead to a change in practice. It highlights the importance of the implementation of a skin-care regimen as part of basic nursing care for the incontinent patient within the acute setting, and challenges ritualistic practice with evidence-based care.
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Melis RJF, van Eijken MIJ, Boon ME, Olde Rikkert MGM, van Achterberg T. Process evaluation of a trial evaluating a multidisciplinary nurse-led home visiting programme for vulnerable older people. Disabil Rehabil 2010; 32:937-46. [PMID: 19860600 DOI: 10.3109/09638280903381006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This article describes the content of and adherence with a nurse-led home visiting programme (Dutch Geriatric Intervention Programme; DGIP) for vulnerable older people. The randomised Dutch EASYcare Study showed positive patient endpoints for DGIP. Describing content and adherence is rarely performed, but highly important for understanding the results of trials. METHOD DGIP is a complex multicomponent intervention tailored to the patients' needs. This process evaluation describes these components and patient characteristics and creates meaningful clusters of these specific components using hierarchical cluster analysis. Both patient/caregiver and physician adherence rates and possible predictors were investigated. RESULTS In line with the heterogeneity among the subjects, the individual treatment plans turned out to be highly tailored. Cluster analysis identified five clusters of intervention components. DGIP turned out to be largely unsuitable for one group of very vulnerable older participants in urgent need of more care. Overall, physician adherence was 75% and was better than patient adherence (51% complete/partial adherence). Adherence levels increased when both patients, caregivers and physicians received recommendations. CONCLUSIONS The content of a multicomponent tailored home-visiting programme was very diverse, matching the heterogeneity among frail elderly subjects. Detailed process and cluster analysis helped to understand the content of the intervention, sharpen target criteria and identify possibilities to improve adherence.
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Affiliation(s)
- René J F Melis
- Department of Geriatric Medicine, Radboud University Nijmegen, The Netherlands.
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THOMAS VALERIE, LAMBERT SUSAN. An ethnographic study of intermediate care services in Wales: the hidden work. J Nurs Manag 2008; 16:181-7. [DOI: 10.1111/j.1365-2834.2008.00846.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nariculam J, Murphy DG, Jenner C. Urology ward attenders: auditing a nurse-led service. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2007. [DOI: 10.1111/j.1749-771x.2007.00023.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walsh B, Yardley L, Donovan-Hall M, Smith H. Implementation of nurse-delivered vestibular rehabilitation in primary care: a qualitative study of nurses? views on involvement in an innovative service. J Clin Nurs 2007; 16:1072-81. [PMID: 17459139 DOI: 10.1111/j.1365-2702.2005.01511.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore practice nurses' perceptions of vestibular rehabilitation and its place in relation to their general role development. BACKGROUND Vestibular rehabilitation has been known for a long time to be effective for chronically dizzy patients in secondary care, but its use in primary care has been limited. A recent pragmatic trial of vestibular rehabilitation delivered by practice nurses in primary care has confirmed its utility in a community setting. This type of role is increasingly common for practice nurses, but few studies explore the nurses' perspective. METHODS A qualitative study was undertaken; 19 nurses took part in focus group sessions. Participants discussed their views on vestibular rehabilitation and its potential for integration with their existing role. A thematic analysis of the data was undertaken. FINDINGS Four main themes were identified: creating a unique nursing role; the therapeutic role; responsibility and role boundaries; and time. Nurses were positive about developing extended roles, but sought ways to achieve this without eroding fundamental nursing skills. Vestibular rehabilitation was seen as fulfilling both the need for a distinct nursing identity and professional development. Concerns over responsibility for patient assessment and time management constraints are potential obstacles to overcome in the wider development of this therapy in primary care. CONCLUSIONS Understanding the perspective of nurses will be vital in future development of chronic disease management within primary care. Whilst nurses may be positive about such role expansion, the implementation of services of this type will require clarity about nurses' responsibilities and flexibility in managing workload. RELEVANCE TO CLINICAL PRACTICE Vestibular rehabilitation is simple, low-tech and appropriate for widespread development in primary care. Nurses wishing to provide vestibular rehabilitation or similar chronic disease management activities will need to work with medical colleagues to define role boundaries.
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Affiliation(s)
- Bronagh Walsh
- School of Nursing & Midwifery, University of Southampton, Southampton, UK.
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Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev 2007; 2007:CD002214. [PMID: 17443516 PMCID: PMC7017859 DOI: 10.1002/14651858.cd002214.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. This is an update of an earlier review published in The Cochrane Library in Issue 3, 2004. OBJECTIVES To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH STRATEGY We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. The initial search was done in January 2001. The register search was updated in October 2006, the other database searches were updated in November 2006 and the citation search was run in January 2007. SELECTION CRITERIA Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality (OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher quality studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. AUTHORS' CONCLUSIONS There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
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Affiliation(s)
- P D Griffiths
- King's College London, School of Nursing and Midwifery, Room 3.29b JCMB, Waterloo Road, London, UK, SE1 8WA.
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Melis RJF, van Eijken MIJ, Borm GF, Wensing M, Adang E, van de Lisdonk EH, van Achterberg T, Olde Rikkert MGM. The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]. BMC Health Serv Res 2005; 5:65. [PMID: 16207382 PMCID: PMC1298295 DOI: 10.1186/1472-6963-5-65] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Accepted: 10/05/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications. Several inpatient geriatric health services have proven effectiveness in frail persons. However, the wish to live independently and policies that promote independent living as an answer to population aging call for community intervention models for frail elderly people. Maybe models such as preventive home visits, comprehensive geriatric assessment, and intermediate care qualify, but their efficacy is controversial, especially in frail elderly persons living in the community. With the Dutch EASYcare Study Geriatric Intervention Programme (DGIP) we developed a model to study effectiveness of problem based community intervention models in frail elderly people. METHODS/DESIGN DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition, mood, behaviour, mobility, and nutrition. A geriatric specialist nurse applies a guideline-based intervention with a limited number of follow up visits. The intervention starts with the application of the EASYcare instrument for geriatric screening. The EASYcare instrument assesses (instrumental) activities of daily life, cognition, mood, and includes a goal setting item. During the intervention the nurse regularly consults the referring GP and a geriatrician. Effects on functional performance (Groningen Activity Restriction Scale), health related quality of life (MOS-20), and carer burden (Zarit Burden Interview) are studied in an observer blinded randomised controlled trial. 151 participants were randomised over two treatment arms--DGIP and regular care--using pseudo cluster randomisation. We are currently performing the follow up visits. These visits are planned three and six months after inclusion. Process measures and cost measures will be recorded. Intention to treat analyses will focus on post intervention differences between treatment groups. DISCUSSION The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented. The problem-based participant selection procedure satisfied; few patients that the GP referred did not meet our eligibility criteria. The use of standard terminology makes detailed insight into the contents of our intervention possible using terminology others can understand well.
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Affiliation(s)
- René JF Melis
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, internal postal code 318, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Monique IJ van Eijken
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, internal postal code 229, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - George F Borm
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, internal postal code 252, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Michel Wensing
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, internal postal code 229, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eddy Adang
- Department of Medical Technology Assessment, Radboud University Nijmegen Medical Centre, internal postal code 253, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eloy H van de Lisdonk
- Department of General Practice, Radboud University Nijmegen Medical Centre, internal postal code 229, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Theo van Achterberg
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, internal postal code 229, PO box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marcel GM Olde Rikkert
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, internal postal code 318, PO box 9101, 6500 HB Nijmegen, The Netherlands
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Plochg T, Delnoij DMJ, van der Kruk TF, Janmaat TACM, Klazinga NS. Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home. BMC Health Serv Res 2005; 5:38. [PMID: 15910689 PMCID: PMC1168893 DOI: 10.1186/1472-6963-5-38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 05/24/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model. METHODS A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches. RESULTS Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model. CONCLUSION We concluded that setting up a low intensity early discharge model of intermediate care between a university hospital and a residential home is less straightforward than was originally perceived by management, and that quality of care needs careful monitoring to ensure the change is for the better.
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Affiliation(s)
- Thomas Plochg
- Department of Social Medicine, Academic Medical Centre / University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Diana MJ Delnoij
- Nivel Netherlands Institute for Health Services Research, Drieharingstraat 6, Utrecht, The Netherlands
| | - Tineke F van der Kruk
- Department of Geriatrics, Academic Medical Centre / University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tonnie ACM Janmaat
- Medical Board, Academic Medical Centre / University of Amsterdam, Meibergdreef 9, Amsterdam The Netherlands
| | - Niek S Klazinga
- Department of Social Medicine, Academic Medical Centre / University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Walsh B, Steiner A, Pickering RM, Ward-Basu J. Economic evaluation of nurse led intermediate care versus standard care for post-acute medical patients: cost minimisation analysis of data from a randomised controlled trial. BMJ 2005; 330:699. [PMID: 15757959 PMCID: PMC555630 DOI: 10.1136/bmj.38397.633588.8f] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To undertake an economic evaluation of nurse led intermediate care compared with standard hospital care for post-acute medical patients. DESIGN Cost minimisation analysis from an NHS perspective, comprising secondary care, primary care, and community care, using data from a pragmatic randomised controlled trial. SETTING Nurse led unit and acute general medical wards in large, urban, UK teaching hospital. PARTICIPANTS 238 patients. OUTCOME MEASURE Costs to acute hospital trusts and to the NHS over six months. RESULTS On an intention to treat basis, nurse led care was associated with higher costs during the initial admission period (nurse led care 7892 pounds sterling (14,970 dollars; 11,503 euros), standard care 4810 pounds sterling, difference 3082 pounds sterling (95% confidence interval 1161 pounds sterling to 5002 pounds sterling)). During the readmission period, costs were similar (nurse led care 1444 pounds sterling, standard care 1879 pounds sterling, difference -435 pounds sterling, -1406 pounds sterling to 536 pounds sterling). Total costs at six months were significantly higher (nurse led care 10,529 pounds sterling , standard care 7819 pounds sterling, difference 2710 pounds sterling, 518 pounds sterling to 4903 pounds sterling). Sensitivity analyses suggested that the trend for nurse led care to be more expensive was maintained even with substantial cost reductions, although differences were no longer significant. CONCLUSION Acute hospitals may not be cost effective settings for nurse led intermediate care. Both inpatient and total costs were significantly higher for nurse led care than for standard care of post-acute medical patients, suggesting that this model of care should not be pursued unless clinical or organisational benefits justify the increased investment.
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Affiliation(s)
- Bronagh Walsh
- School of Nursing and Midwifery, University of Southampton, Southampton SO17 1BJ.
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Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev 2004:CD002214. [PMID: 15495030 DOI: 10.1002/14651858.cd002214.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. OBJECTIVES To determine whether nursing-led inpatient units are effective in preparing patients for discharge from hospital compared to usual inpatient care. SEARCH STRATEGY We searched The Cochrane Library, the Specialized Register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, MEDLINE, CINAHL, EMBASE, BNI and HMIC databases. Citation searches were undertaken on the science and social science citation indices. Authors were contacted to identify additional data. SELECTION CRITERIA Controlled trials and interrupted time series designs that compared the NLU to usual inpatient care managed by doctors. Patients over 18 years of age following an acute hospital admission for a physical health condition. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. MAIN RESULTS Ten random or quasi-random controlled trials reported on a total of 1896 patients. There was no statistically significant effect on inpatient mortality ( OR 1.10, 95% CI 0.56 to 2.16) or mortality to longest follow up (OR 0.92, 95% CI 0.65 to 1.29) but higher qaulity studies showed a larger non-significant increase in inpatient mortality (OR 1.52, 95% CI 0.86 to 2.68). Discharge to institutional care was reduced for the NLU (OR 0.44 95% CI 0.22 to 0.89) and functional status at discharge increased (SMD 0.37, 95% CI 0.20 to 0.54) but there was a near significant increase in inpatient stay (WMD 5.13 days 95% CI -0.5 days to 10.76 days). Early readmissions were reduced (OR 0.52 95% CI 0.34 to 0.80). One study compared a NLU for the chronically critically ill with ICU care. Mortality (OR 0.62 95% CI 0.35 to 1.10) and length of inpatient stay differ did not differ (WMD 2 days, 95% CI 10.96 to -6.96 days). Early readmissions were reduced (OR 0.33 95% CI 0.12 to 0.94). Costs of care on the NLU were higher for UK studies but lower for US based studies. REVIEWERS' CONCLUSIONS There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
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Affiliation(s)
- P D Griffiths
- Florence Nightingale School of Nursing and Midwifery, King's College London, Waterloo Road, London, UK, SE1 8WA.
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