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Rojas-Ocaña MJ, Araujo-Hernández M, Romero-Castillo R, García Navarro EB. Educational interventions by nurses in caregivers with their elderly patients at home. Prim Health Care Res Dev 2021; 22:e26. [PMID: 34092277 PMCID: PMC8220347 DOI: 10.1017/s1463423621000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/10/2020] [Accepted: 01/25/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The home is the natural setting for the development of informal care. The work that nurses are required to develop in this context (the carer/the elderly dependent/the home) focuses on training and educational activities to assist these two groups, such as demonstrating care activities to help dependent seniors, instruction in self-care techniques and teaching strategies for the use of human and material resources. AIMS This article analyzes care education interventions performed by nurses, and the factors that facilitate, or limit, health care training. METHODOLOGICAL APPROACH This is a qualitative, descriptive study designed to be flexible and openly analytical in its approach to the research problem and the dynamic nature of the home environment. Triangulation of the methodological techniques and study subjects was applied. RESULTS Nursing interventions related to professional attitudes, such as encouraging communication and facilitating teaching; communication interventions in health education and counseling; and technical interventions aimed at improving access to health information and support for the informal carer. Lack of will, the advanced age of the carer, emotional state and work overload are factors that undermine care instruction, which if reversed, would become learning facilitators. The lack of time and resources in the home are the major limiting factors on care teaching, according to nurses. Evidence from our study suggests that care in the home is considered a key primary health care strategy, one in which nurses play a significant role.
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Baker J, Dickman A, Mason S, Bickerstaff M, Jackson R, McArdle A, Lawrence I, Stephenson F, Paton N, Kirk J, Waters B, Ellershaw J. An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions? BMC Palliat Care 2020; 19:99. [PMID: 32635902 PMCID: PMC7341565 DOI: 10.1186/s12904-020-00611-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI over 48 h may have numerous benefits in both patient care and health service resource utilisation. This service evaluation aims to identify the frequency at which CSCI prescriptions are altered at NHS Acute Hospitals. METHODS Pharmacists or members of palliative care teams at seven acute NHS hospitals recorded anonymised prescription data relating to the drug combination(s), doses, diluent and compatibility of CSCIs containing two or more drugs on a daily basis for a minimum of 2 days, to a maximum of 7 days. RESULTS A total of 1301 prescriptions from 288 patients were recorded across the seven sites, yielding 584 discrete drug combinations. Of the 584 combinations, 91% (n = 533) included an opioid. The 10 most-common CSCI drug combinations represented 37% of the combinations recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days. CONCLUSION Data suggests medication delivered by CSCI over 48 h may be a viable option. Before a clinical feasibility study can be undertaken, a pharmacoeconomic assessment and robust chemical and microbiological stability data will be required, as will the assessment of the perceptions from clinical staff, patients and their families on the acceptability of such a change in practice.
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Affiliation(s)
- J Baker
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. .,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK.
| | - A Dickman
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - S Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - M Bickerstaff
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - R Jackson
- Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - A McArdle
- Pharmacy Department, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - I Lawrence
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - F Stephenson
- Pharmacy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - N Paton
- Pharmacy Department, The Christie NHS Foundation Trust, Manchester, UK
| | - J Kirk
- Pharmacy Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - B Waters
- Pharmacy Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - J Ellershaw
- Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.,Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
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Cortigiani L, Ciampi Q, Lombardo A, Rigo F, Bovenzi F, Picano E. Age- and Gender-Specific Prognostic Cutoff Values of Coronary Flow Velocity Reserve in Vasodilator Stress Echocardiography. J Am Soc Echocardiogr 2019; 32:1307-1317. [DOI: 10.1016/j.echo.2019.05.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/18/2019] [Accepted: 05/25/2019] [Indexed: 01/09/2023]
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Burch P, Blakeman T, Bower P, Sanders C. Understanding the diagnosis of pre-diabetes in patients aged over 85 in English primary care: a qualitative study. BMC FAMILY PRACTICE 2019; 20:90. [PMID: 31255180 PMCID: PMC6599359 DOI: 10.1186/s12875-019-0981-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022]
Abstract
Background The benefit of a “diagnosis” of pre-diabetes in very elderly patients is debated. How clinicians manage pre-diabetic blood results in these patients is unknown. This study aims to understand how clinicians are “diagnosing” older patients with pre-diabetic blood parameters. Methods Semi-structured interviews and focus groups with health care staff (24 total participants) were conducted in the north of England. Interviews and focus groups were recorded, transcribed and analysed thematically. A grounded theory approach was taken with the theory of candidacy being used as a sensitising concept through which questions were framed and results interpreted. Results There is a complex system of competing pressures that influence a clinician in deciding whether, and in what way, to inform a very elderly patient that they have pre-diabetes. The majority of clinicians adjust their management of pre-diabetes to the age and perceived risk/benefit for the patient. Whilst some clinicians choose not to inform certain patients of their blood results, many clinicians maintain, what could be seen as a somewhat paradoxical approach of labeling all older patients with pre-diabetes but downplaying the significance to the patient. The policy, organisational context, workload and professional constraints under which clinicians work, play a significant role in shaping how they deal with pre-diabetic blood results in the very elderly. Conclusion There has been recent acknowledgement of how policy and organisational context frames decision-making, but there is a lack of evidence on how this influences uncertainty and dilemmas in decision-making in practice. These findings add further weight for the argument that treatment burden should be included in clinical guidelines.
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Affiliation(s)
- Patrick Burch
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Thomas Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Hardie D, Smith J. Perceptions and development needs of assistant practitioners supporting individuals with dementia. ACTA ACUST UNITED AC 2017; 26:918-923. [PMID: 28880610 DOI: 10.12968/bjon.2017.26.16.918] [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
In the UK there are an estimated 850 000 people living with dementia. The condition costs the NHS £26 billion each year and it is estimated that this amount will treble over the next 30 years. Thus, there is a need for health and social care staff to be increasingly competent in the delivery of care to those living with dementia. The education of staff will improve knowledge and build capability to support and care for individuals with dementia. This research involved 44 assistant practitioners who shared opinions about their preparation for practice in dementia care. Focus groups and questionnaires were used to collect data that were then thematically analysed. The research also considered the assistant practitioner role in relation to workforce development. Key themes were 'training, awareness and knowledge associated with dementia care' and 'the perceptions of the assistant practitioner regarding confidence to support individuals with dementia'. There was role and responsibility protection from staff, for example, doctors and nurses were reluctant to delegate duties to the assistant practitioner. Participants' commentary indicated, however, that they were competent to support service users with dementia, although there were gaps in their experiences. The case study demonstrated the positive achievement of partnership working between a higher education institution and the workplace, which supported the assistant practitioners' learning and development.
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Affiliation(s)
- Debra Hardie
- Work-based Education Facilitator, University of Bolton
| | - Joanne Smith
- Associate Teaching Professor, University of Bolton
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