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Visser FCW, van Eersel MEA, Hempenius L, Verwey NA, Band C, van der Bol JM, Boudestein K, van Dijk SC, Gobbens R, van der Hooft CS, Kamper AM, Ruiter R, Sipers W, Spoelstra BNA, Stoffels J, Stolwijk-Woudstra DJ, van Stralen KJ, van Strien AM, Wijngaarden MA, Winters M, Strijkert F, van Munster BC. Recognition of cognitive dysfunction in hospitalised older patients: a flash mob study. BMC Geriatr 2024; 24:66. [PMID: 38229025 DOI: 10.1186/s12877-023-04588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND It is important that healthcare professionals recognise cognitive dysfunction in hospitalised older patients in order to address associated care needs, such as enhanced involvement of relatives and extra cognitive and functional support. However, studies analysing medical records suggest that healthcare professionals have low awareness of cognitive dysfunction in hospitalised older patients. In this study, we investigated the prevalence of cognitive dysfunction in hospitalised older patients, the percentage of patients in which cognitive dysfunction was recognised by healthcare professionals, and which variables were associated with recognition. METHODS A multicentre, nationwide, cross-sectional observational study was conducted on a single day using a flash mob study design in thirteen university and general hospitals in the Netherlands. Cognitive function was assessed in hospitalised patients aged ≥ 65 years old, who were admitted to medical and surgical wards. A Mini-Cog score of < 3 out of 5 indicated cognitive dysfunction. The attending nurses and physicians were asked whether they suspected cognitive dysfunction in their patient. Variables associated with recognition of cognitive dysfunction were assessed using multilevel and multivariable logistic regression analyses. RESULTS 347 of 757 enrolled patients (46%) showed cognitive dysfunction. Cognitive dysfunction was recognised by attending nurses in 137 of 323 patients (42%) and by physicians in 156 patients (48%). In 135 patients (42%), cognitive dysfunction was not recognised by either the attending nurse or physician. Recognition of cognitive dysfunction was better at a lower Mini-Cog score, with the best recognition in patients with the lowest scores. Patients with a Mini-Cog score < 3 were best recognised in the geriatric department (69% by nurses and 72% by physicians). CONCLUSION Cognitive dysfunction is common in hospitalised older patients and is poorly recognised by healthcare professionals. This study highlights the need to improve recognition of cognitive dysfunction in hospitalised older patients, particularly in individuals with less apparent cognitive dysfunction. The high proportion of older patients with cognitive dysfunction suggests that it may be beneficial to provide care tailored to cognitive dysfunction for all hospitalised older patients.
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Affiliation(s)
- Fleur C W Visser
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands.
| | - Marlise E A van Eersel
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Liesbeth Hempenius
- Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Nicolaas A Verwey
- Neurology and Geriatric Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Caterina Band
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | | | - Kris Boudestein
- Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis and Vlietland, Schiedam, The Netherlands
| | - Robbert Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Adriaan M Kamper
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Rikje Ruiter
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - Walther Sipers
- Department of Geriatric Medicine, Zuyderland Medical Center Sittard-Geleen, Heerlen-Sittard-Geleen, The Netherlands
| | - Birgit N A Spoelstra
- Department of Geriatric Medicine, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Josephine Stoffels
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Aging & Later Life, Amsterdam, The Netherlands
| | | | | | - Astrid M van Strien
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Marjolein A Wijngaarden
- Leiden University Medical Center, Internal Medicine, Section Geriatrics, Leiden, The Netherlands
| | - Marian Winters
- Departments of Internal Medicine and Geriatrics, Isala Hospital, Zwolle, The Netherlands
| | - Fijanne Strijkert
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine and Alzheimer Center Groningen, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, AA43, The Netherlands
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Noone CE, Franck LS, Staveski SL, Rehm RS. Overcoming patient safety concerns and integrating early mobility into pediatric intensive care unit nursing practice. J Pediatr Nurs 2023; 73:e107-e115. [PMID: 37544857 DOI: 10.1016/j.pedn.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Early Mobilization (EM) in Pediatric Intensive Care Units (PICU) is safe, feasible and improves outcomes for PICU patients, yet patient safety concerns persist among nurses which limits EM adoption. The purpose of this study was to explore how nurses incorporate EM into practice and balance their concerns for patient safety with the benefits of EM. DESIGN & METHODS This focused ethnographic study included 15 in-depth interviews with 10 PICU nurses. Data were analyzed using thematic analysis. RESULTS Two major categories were found which describe the clinical judgement and decision-making of PICU nurses regarding EM. The nurses' concerns for patient safety was the first major category. This included patient-level factors: hemodynamic stability, devices attached, patient's strength, and risk for falls and size. In the second major category, these safety concerns were overcome by applying a multiple step process which resulted in nurses performing EM despite their concerns. That process included: gaining comfort through experience, performing patient safety checks, working with therapists, learning from adverse events, and understanding existing evidence about the benefits of EM. CONCLUSIONS The overarching theme was nurses' determination to preserve patient safety while ensuring patients could receive the benefits of EM. This theme describes the decisions, behaviors and processes that nurses enact to become more comfortable with EM despite their concerns for patient safety and potential adverse events while performing mobility activities. PRACTICE IMPLICATIONS Creating opportunities for nurses to participate in EM may increase their willingness to overcome safety concerns and engage in these activities.
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Affiliation(s)
- Chelsea E Noone
- University of California at San Francisco School of Nursing, Lucile Packard Children's Hospital at Stanford, USA.
| | - Linda S Franck
- Department of Family Health Care Nursing, University of California at San Francisco, USA.
| | - Sandra L Staveski
- Department of Family Health Care Nursing, University of California at San Francisco, USA.
| | - Roberta S Rehm
- Department of Family Health Care Nursing, University of California at San Francisco, USA.
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Dufour I, Vedel I, Quesnel-Vallée A. Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec. J Alzheimers Dis 2022; 89:1091-1101. [PMID: 35964188 DOI: 10.3233/jad-220327] [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: 11/15/2022]
Abstract
BACKGROUND The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls. OBJECTIVE To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data. METHODS This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA. RESULTS The study cohort was composed of 25,125 older adults, of which 784 (3.12%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information. CONCLUSION To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.
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Affiliation(s)
- Isabelle Dufour
- Department of Epidemiology, Biostatistics, andOccupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Isabelle Vedel
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Faculty of Medicine, McGill University, Montréal, Canada
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Systematic Review of Dementia Support Programs with Multicultural and Multilingual Populations. Geriatrics (Basel) 2021; 7:geriatrics7010008. [PMID: 35076511 PMCID: PMC8788268 DOI: 10.3390/geriatrics7010008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Dementia care programs have become more common due to a growing number of persons living with dementia and lack of substantial benefit from pharmacologic therapies. Cultural and language differences may present barriers to access and efficacy of these programs. In this article, we aimed to systematically review the current literature regarding outcomes of dementia care programs that included multicultural and non-English speaking populations. Methods: A systematic review was conducted using four scientific search engines. All studies included in the review are English language, randomized control trials evaluating various care coordination models. The initial search strategy focusing on studies specifically targeting multicultural and non-English speaking populations resulted in too few articles. We expanded our search to articles that included these populations although these populations may not have been the focus of the study. Results: Seven articles met inclusion criteria for final review. Measured outcomes included emergency room use, hospitalizations, provider visits, quality of life indicators, depression scores, and caregiver burden. Conclusions: Dementia care programs demonstrate significant ability to provide support and improve outcomes for those living with dementia and their caregivers. There is limited research in this field and thus opportunity for further study in underserved and safety net populations including more high-quality randomized controlled trials with larger sample sizes.
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Annear MJ, Tierney LT, Vickers JC, Palmer AJ. Counting the cost of dementia-related hospital admissions: A regional investigation. Australas J Ageing 2016; 35:E32-5. [DOI: 10.1111/ajag.12318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Annear
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tasmania Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tasmania Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tasmania Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
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Bass DM, Judge KS, Maslow K, Wilson NL, Morgan RO, McCarthy CA, Looman WJ, Snow AL, Kunik ME. Impact of the care coordination program "Partners in Dementia Care" on veterans' hospital admissions and emergency department visits. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2015; 1:13-22. [PMID: 29854922 PMCID: PMC5975051 DOI: 10.1016/j.trci.2015.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
INTRODUCTION "Partners in Dementia Care" (PDC) tested a care-coordination program based on partnerships between Veterans Affairs (VA) medical centers and Alzheimer's Association chapters. The hypothesis posited PDC would reduce the likelihood and number of veterans' hospital admissions and emergency department (ED) visits, particularly for those with more cognitive impairment or behavioral symptoms. METHODS The sample included 328 veterans with dementia and their primary family or friend caregivers from five matched sites (two randomly selected treatment sites). Data came from VA records; supplemented by caregiver research interviews. Regression analyses using the likelihood and number of hospital and ED visits as outcomes tested for overall treatment-comparison group differences and statistical interactions with cognitive impairment and behavioral symptoms. RESULTS Consistent with the hypothesis, three significant interactions showed treatment-group veterans, with more cognitive impairment and behavioral symptoms, had fewer hospital admissions and ED visits than comparison-group veterans. There were no differences in the likelihood of hospital or ED use. DISCUSSION PDC, a low-cost program for veterans and caregivers, was effective in reducing the number, but not the likelihood, of hospital admissions and ED visits. Reductions in service use were greater when caregivers reported more difficulties with veterans' symptoms, which in the absence of PDC would place veterans at risk of being high-volume, high-cost service users.Clinical Trial Registration: ClinicalTrials.gov: NCT00291161.
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Affiliation(s)
- David M. Bass
- Benjamin Rose Institute on Aging, Cleveland, OH, USA
| | - Katherine S. Judge
- Benjamin Rose Institute on Aging, Cleveland, OH, USA
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
| | | | - Nancy L. Wilson
- Houston VA Health Services Research & Development Center of Excellence, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Robert O. Morgan
- The University of Texas School of Public Health, Houston, TX, USA
| | | | | | - A. Lynn Snow
- Center for Mental Health and Aging and Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
- Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | - Mark E. Kunik
- Houston VA Health Services Research & Development Center of Excellence, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- South Central Veterans Affairs Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Demir Akça AS, Saraçli Ö, Emre U, Atasoy N, Güdül S, Özen Barut B, Şenormanci Ö, Büyükuysal MÇ, Atik L, Atasoy HT. Relationship of Cognitive Functions with Daily Living Activities, Depression, Anxiety and Clinical Variables in Hospitalized Elderly Patients. Noro Psikiyatr Ars 2014; 51:267-274. [PMID: 28360637 DOI: 10.4274/npa.y7053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Cognitive impairment in elderly patients, which may be a sign of dementia, depression, anxiety or medical diseases, has been determined as a risk factor for functional loss. In this study, we aimed to investigate the frequency of cognitive impairment and to investigate the relationship of cognitive status with sociodemographic variables, daily living activities, anxiety and depression in elderly inpatients. METHOD The sample of this cross-sectional and descriptive study consists of 243 patients aged 65 years and older who were hospitalized in Bülent Ecevit University Hospital. A sociodemographic questionnaire,, the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale, Lawton-Brody Instrumental Daily Activities Scale, Geriatric Depression Scale (GDS) and the Beck Anxiety Inventory were used for data collection. RESULTS One hundred and six (43.6%) patients were female and 137 (56.4%) were male. The patients were divided into two groups according to the Mini-Mental State Examination (MMSE) 23/24 cut-off score. The cognitive decline was statistically significantly more frequent in patients who were older, female, less educated, low socioeconomic status, and living in rural areas. There were more problems in the basic and instrumental activities of daily living and nutrition in patients with cognitive decline. Anxiety and depression scores were higher in this group. In our study, although the frequency of cognitive decline and depression according to GDS were 56% and 48%, respectively; we found that only 10.5% of patients applied to the psychiatrist, and 9.3% of patients received psychiatric treatment. CONCLUSION Cognitive decline may cause deterioration in the daily living activities, nutrition and capacity for independent functioning. Older age, female, low education, low socioeconomic status and living in rural area are important risk factors for cognitive impairment. Cognitive decline in older age may be associated with depression and anxiety. We assume that when cognitive decline, depression and other psychiatric problems are unidentified, it may contribute to deterioration of mental health in medically ill elderly.
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Affiliation(s)
- Ayşe Semra Demir Akça
- Department of Family Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Özge Saraçli
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ufuk Emre
- Department of Neurology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Nuray Atasoy
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Serdar Güdül
- Clinic of Neurology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey
| | - Banu Özen Barut
- Department of Neurology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Ömer Şenormanci
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - M Çağatay Büyükuysal
- Department of Biostatistics, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Levent Atik
- Department of Psychiatry, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - H Tuğrul Atasoy
- Department of Neurology, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
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Nilsson A, Rasmussen BH, Edvardsson D. Falling behind: a substantive theory of care for older people with cognitive impairment in acute settings. J Clin Nurs 2013; 22:1682-91. [PMID: 23452009 DOI: 10.1111/jocn.12177] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To develop a theoretical understanding of the processes hindering person-centred care of older people with cognitive impairment in acute care settings. BACKGROUND Although person-centred care with its holistic focus on the biopsychosocial needs of patients is commonly considered the gold standard care for older people with cognitive impairment, the extent to which care is person-centred can increase in acute care settings generally. DESIGN Grounded theory inspired by Strauss and Corbin. METHOD The study used a grounded theory approach to generate and analyse data from a Swedish sample of acute care staff, patients and family members. RESULTS The substantive theory postulates that staff risks 'falling behind' in meeting the needs of older patients with cognitive impairment if working without consensus about the care of these patients, if the organisation is disease-oriented and efficiency-driven, and if the environment is busy and inflexible. This facilitated 'falling behind' in relation to meeting the multifaceted needs of older patients with cognitive impairment and contributed to patient suffering, family exclusion and staff frustration. CONCLUSIONS The theory highlights aspects of importance in the provision of person-centred care of older people with cognitive impairment in acute settings and suggests areas to consider in the development of caring environments in which the place, pace and space can meet the needs of the older person. RELEVANCE TO CLINICAL PRACTICE The proposed substantive theory can be used to critically examine current ward practices and routines, and the extent to which these support or inhibit high-quality person-centred care for older patients with known or unknown cognitive impairments.
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Affiliation(s)
- Anita Nilsson
- Department of Nursing, Umeå University, Umeå, Sweden.
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Krall E, Close J, Parker J, Sudak M, Lampert S, Colonnelli K. Innovation pilot study: acute care for elderly unit--promoting patient-centric care. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2012; 5:90-6. [PMID: 23002571 DOI: 10.1177/193758671200500309] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Older patients, defined as age 65 years or older, comprise more than 40% of admissions to the acute care environment. These patients' needs are different; cognitive impairment, chronic health issues, caregiver burden, and maintenance of functional level present challenges to healthcare organizations when caring for this population on a general medical-surgical unit. BACKGROUND A pilot project, the creation of a six-bed Acute Care for Elderly (ACE) unit situated within a 33-bed medical-surgical unit, was established to meet the unique needs of this older patient population. CONCLUSIONS Outcomes including falls, pressure ulcers, functional level (the latter as measured by the KATZ), and length of stay were examined and demonstrated marked improvement compared to similar patients outside the ACE unit. Older patients need individualized care planning by staff competent in elder care and a specialty unit to address their specific needs.
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Affiliation(s)
- Eva Krall
- Pomerado Hospital, 15615 Pomerado Road, Poway, CA 92064, USA.
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Conley DM, Burket TL, Schumacher S, Lyons D, DeRosa SE, Schirm V. Implementing Geriatric Models of Care: A Role of the Gerontological Clinical Nurse Specialist-Part II. Geriatr Nurs 2012. [DOI: 10.1016/j.gerinurse.2012.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tabrizi JS, Gharibi F, Wilson AJ. Advantages and Disadvantages of Health Care Accreditation Mod-els. Health Promot Perspect 2011; 1:1-31. [PMID: 24688896 PMCID: PMC3963612 DOI: 10.5681/hpp.2011.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 07/10/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This systematic review seeks to define the general advantages and disadvan-tages of accreditation programs to assist in choosing the most appropriate approach. METHOD Systematic search of SID, Ovid Medline & PubMed databases was conducted by the keywords of accreditation, hospital, medical practice, clinic, accreditation models, health care and Persian meanings. From 2379 initial articles, 83 articles met the full inclusion criteria. From initial analysis, 23 attributes were identified which appeared to define advantages and disadvantages of different accreditation approaches and the available systems were compared on these. RESULTS Six systems were identified in the international literature including the JCAHO from USA, the Canadian program of CCHSA, and the accreditation programs of UK, Australia, New Zealand and France. The main distinguishing attributes among them were: quality improve-ment, patient and staff safety, improving health services integration, public's confi-dence, effectiveness and efficiency of health services, innovation, influence global standards, information management, breadth of activity, history, effective relationship with stakeholders, agreement with AGIL attributes and independence from government. CONCLUSION Based on 23 attributes of comprehensive accreditation systems we have defined from a systematic review, the JCAHO accreditation program of USA and then CCHSA of Can-ada offered the most comprehensive systems with the least disadvantages. Other programs such as the ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accredita-tion programs were fairly comparable according to these criteria. However the decision for any country or health system should be based on an assessment weighing up their specific objec-tives and needs.
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Affiliation(s)
- Jafar S. Tabrizi
- Public Health and Management Department, Faculty of Health and Nutrition, b) National Public health Management Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farid Gharibi
- Dept. of Health Services Management, Faculty of Health and Nutrition, Tabriz University of Medical
Sciences, Tabriz- Iran
| | - Andrew J. Wilson
- Faculty of Health, Queensland University of Technology, Brisbane-Australia
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Moyle W, Borbasi S, Wallis M, Olorenshaw R, Gracia N. Acute care management of older people with dementia: a qualitative perspective. J Clin Nurs 2010; 20:420-8. [PMID: 21029231 DOI: 10.1111/j.1365-2702.2010.03521.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVES This Australian study explored management for older people with dementia in an acute hospital setting. BACKGROUND As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. DESIGN A descriptive qualitative approach was used. METHOD Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. RESULTS Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. CONCLUSION Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. RELEVANCE TO CLINICAL PRACTICE Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy.
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Affiliation(s)
- Wendy Moyle
- Authors: Griffith Health Institute, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
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Ganzer CA, Crogan NL. Diabetes in African Americans: The Critical Importance of Cognitive Assessment. Geriatr Nurs 2010. [DOI: 10.1016/j.gerinurse.2010.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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