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Wells CL, Resnick B, McPherson R, Frampton K. Implementation of the UMove Mobility Program to Promote Safe Patient Mobility and Reduce Falls in the Hospital Setting. Res Gerontol Nurs 2024; 17:19-29. [PMID: 37878599 DOI: 10.3928/19404921-20231013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [Research in Gerontological Nursing, 17(1), 19-29.].
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Resnick B, Boltz M, Galik E, Kuzmik A, Drazich BF, McPherson R, Wells CL. Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia. Am J Crit Care 2023; 32:264-274. [PMID: 37391379 DOI: 10.4037/ajcc2023440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia. OBJECTIVE To explore factors associated with participation in function-focused care in this patient population. METHODS This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing. RESULTS The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14. CONCLUSION For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.
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Affiliation(s)
- Barbara Resnick
- Barbara Resnick is a professor at the University of Maryland School of Nursing, Baltimore
| | - Marie Boltz
- Marie Boltz is a professor at Penn State University, University Park, Pennsylvania
| | - Elizabeth Galik
- Elizabeth Galik is a professor at the University of Maryland School of Nursing, Baltimore
| | - Ashley Kuzmik
- Ashley Kuzmik is a postdoctoral student at Penn State University, University Park, Pennsylvania
| | - Brittany F Drazich
- Brittany F. Drazich is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Rachel McPherson
- Rachel McPherson is a postdoctoral student at the University of Maryland School of Nursing, Baltimore
| | - Chris L Wells
- Chris L. Wells is a physical therapist at the University of Maryland Medical System, Baltimore
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Resnick B, Boltz M, Galik E, Kuzmik A, Ellis J, Wells C, Zhu S. Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description. Res Nurs Health 2022; 45:300-313. [PMID: 35274750 PMCID: PMC9064936 DOI: 10.1002/nur.22223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Ashley Kuzmik
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Jeanette Ellis
- University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Chris Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, Maryland, USA
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Rooijackers T, van Rossum E, Zijlstra GAR, Kempen GIJM, Passos VL, Metzelthin SF. Effectiveness of a reablement training program on self-efficacy and outcome expectations regarding client activation in homecare staff: A cluster randomized controlled trial. Geriatr Nurs 2021; 43:104-112. [PMID: 34861589 DOI: 10.1016/j.gerinurse.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Training and supporting homecare staff in reablement aims to change staff behavior from "doing for" to "doing with" older adults, i.e., supporting client activation. We evaluated the effectiveness of the reablement training program "Stay Active at Home" (SAaH) on staff self-efficacy and outcome expectations regarding client activation in a cluster randomized controlled trial. Ten Dutch homecare nursing teams, comprising 135 nursing team members and 178 domestic workers, were randomized into the intervention group (SAaH) or control group (usual care). Data on self-efficacy and outcome expectations were collected at baseline, 6 and 12 months using scales developed for this study. Mixed-effects regression showed no differences between the study groups on either outcome. Therefore, widespread implementation of SAaH in its current form cannot be recommended. More research is needed on the development and psychometric properties of scales to assess staff behavior and behavioral determinants (e.g., self-efficacy and outcomes expectations) regarding client activation.
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Affiliation(s)
- Teuni Rooijackers
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, Limburg, the Netherlands.
| | - Erik van Rossum
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, Limburg, the Netherlands; Zuyd University of Applied Sciences, Research Center for Community Care, Academy of Nursing, P.O. Box 550, 6400 AN, Heerlen, Limburg, the Netherlands
| | - G A Rixt Zijlstra
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands
| | - Gertrudis I J M Kempen
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, Limburg, the Netherlands
| | - Valéria Lima Passos
- Maastricht University, Care and Public Health Research Institute, Department of Methodology, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands
| | - Silke F Metzelthin
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, P.O. Box 616, 6200 MD, Maastricht, Limburg, the Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, Limburg, the Netherlands
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Squires A, Murali KP, Greenberg SA, Herrmann LL, D'amico CO. A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program. THE GERONTOLOGIST 2021; 61:e75-e84. [PMID: 31681955 DOI: 10.1093/geront/gnz150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Nurses Improving Care for Healthsystem Elders (NICHE) is a nurse-led education and consultation program designed to help health care organizations improve the quality of care for older adults. To conduct a scoping review of the evidence associated with the NICHE program to (a) understand how it influences patient outcomes through specialized care of the older adult and (b) provide an overview of implementation of the NICHE program across organizations as well as its impact on nursing professionals and the work environment. RESEARCH DESIGN AND METHODS Six databases were searched to identify NICHE-related articles between January 1992 and April 2019. After critical appraisal, 43 articles were included. RESULTS Four thematic categories were identified including specialized older adult care, geriatric resource nurse (GRN) model, work environment, and NICHE program adoption and refinement. Specialized older adult care, a key feature of NICHE programs, resulted in improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation. Improvements in the geriatric nurse work environment as measured by perceptions of the practice environment, quality of care, and aging-sensitive care delivery have been reported. NICHE program adoption and refinement focuses on the methods used to improve care, implementation and adoption of the NICHE program, and measuring its impact. DISCUSSION AND IMPLICATIONS The evidence about the NICHE program in caring for older adults is promising but more studies examining patient outcomes and the impact on health care professionals are needed.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, New York, New York.,Division of General Internal Medicine, Langone School of Medicine, New York University, New York, New York
| | | | | | - Linda L Herrmann
- Hartford Institute for Geriatric Nursing, New York University, New York, New York
| | - Catherine O D'amico
- Nurses Improving Care for Healthsystem Elders Program (NICHE), Rory Meyers College of Nursing, New York, New York
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Affiliation(s)
- Barbara Resnick
- School of Nursing, University of Maryland, 655 West Lombard Street, Baltimore, MD 21201, USA.
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Moermans VRA, Capezuti E, Hamers JPH. Prevention and reduction of involuntary treatment at home: A feasibility study of the PRITAH intervention. Geriatr Nurs 2020; 41:536-543. [PMID: 32139030 DOI: 10.1016/j.gerinurse.2020.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Sometimes care is provided to a cognitively impaired person against the person's will, referred to as involuntary treatment. We developed the PRITAH intervention, aimed at prevention and reduction of involuntary treatment at home. PRITAH consists of a policy discouraging involuntary treatment, workshops, coaching by a specialized nurse and alternative interventions. A feasibility study was conducted including 30 professional caregivers. Feasibility was assessed by attendance lists (reach), a logbook (dose delivered and fidelity), evaluation questionnaires and focus group interviews (dose received, satisfaction & barriers). The workshops and coach were positively evaluated and the average attendance rate was 73%. Participants gained more awareness and knowledge and received practical tips and advice to prevent involuntary treatment. Implementation of the intervention was feasible with minor deviations from protocol. Recommendations for improvement included more emphasis on involvement of family caregivers and general practitioners and development of an extensive guideline to comply with the policy.
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Affiliation(s)
- Angela M H J Mengelers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Michel H C Bleijlevens
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Vincent R A Moermans
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands; Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City University of New York, New York, United States.
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI, Maastricht University, Maastricht, the Netherlands.
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Resnick B, Boltz M. Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls. Clin Geriatr Med 2019; 35:237-251. [PMID: 30929885 DOI: 10.1016/j.cger.2019.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Physical activity, defined as bodily movement that expends energy including such things as bed mobility, transfers, bathing, dressing, and walking, has a positive impact on physical and psychosocial outcomes among older adults during their hospitalization and the post hospitalization recovery period. Despite benefits, physical activity is not the focus of care in the acute care setting. Further there are many barriers to engaging patients in physical activity and fall prevention activities including patient, family and provider beliefs, environmental challenges and limitations, hospital policies, and medical and nursing interventions. This paper provides an overview of falls and physical activity prevalence among acute care patients, challenges to engaging patients in physical activity and falls prevention activities and innovative approaches to increase physical activity and prevent falls among older hospitalized patients.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
| | - Marie Boltz
- Pennsylvania State University, College of Nursing, 201 Nursing Sciences Building, University Park, PA 16802, USA
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Older patients’ participation in physical activity during hospitalization: A qualitative study of ward nurses’ perceptions in an Asian context. Geriatr Nurs 2019; 40:91-98. [DOI: 10.1016/j.gerinurse.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/08/2018] [Indexed: 01/23/2023]
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Abstract
To overcome challenges associated with optimizing function and physical activity among hospitalized older adults, we developed function-focused care for acute care (FFC-AC). The purpose of this study was to test the feasibility and preliminary effectiveness of this intervention. We hypothesized that hospitalized trauma patients exposed to FFC-AC would (1) maintain or improve function, spend more time in physical activity, and have fewer adverse events between admission and discharge; and (2) maintain or improve function, have less fear of falling, fewer depressive symptoms, less pain, be more physically resilient, and be less likely to experience adverse events at 1 month postdischarge compared with those exposed to FFC-education only (EO). FFC-AC was implemented by a research function-focused care nurse who worked on the participating units for 20 hr a week for 16 months to implement the three components of FFC-AC. The sample included 89 older orthopedic trauma patients the majority of whom were female (N = 59, 66%), white (N = 82, 92%), and not married (N = 53, 59%). At discharge and/or 30 days postdischarge, participants in the treatment site showed greater improvement in function, less fear of falling, and better physical resilience when compared with those in the FFC-EO site. Future research is needed to continue to work on engaging staff in function-focused care approaches and optimizing the hospital environment and policies to support nurses in this type of care approach.
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Rixon L, Baron J, McGale N, Lorencatto F, Francis J, Davies A. Methods used to address fidelity of receipt in health intervention research: a citation analysis and systematic review. BMC Health Serv Res 2016; 16:663. [PMID: 27863484 PMCID: PMC5116196 DOI: 10.1186/s12913-016-1904-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The American Behaviour Change Consortium (BCC) framework acknowledges patients as active participants and supports the need to investigate the fidelity with which they receive interventions, i.e. receipt. According to this framework, addressing receipt consists in using strategies to assess or enhance participants' understanding and/or performance of intervention skills. This systematic review aims to establish the frequency with which receipt is addressed as defined in the BCC framework in health research, and to describe the methods used in papers informed by the BCC framework and in the wider literature. METHODS A forward citation search on papers presenting the BCC framework was performed to determine the frequency with which receipt as defined in this framework was addressed. A second electronic database search, including search terms pertaining to fidelity, receipt, health and process evaluations was performed to identify papers reporting on receipt in the wider literature and irrespective of the framework used. These results were combined with forward citation search results to review methods to assess receipt. Eligibility criteria and data extraction forms were developed and applied to papers. Results are described in a narrative synthesis. RESULTS 19.6% of 33 studies identified from the forward citation search to report on fidelity were found to address receipt. In 60.6% of these, receipt was assessed in relation to understanding and in 42.4% in relation to performance of skill. Strategies to enhance these were present in 12.1% and 21.1% of studies, respectively. Fifty-five studies were included in the review of the wider literature. Several frameworks and operationalisations of receipt were reported, but the latter were not always consistent with the guiding framework. Receipt was most frequently operationalised in relation to intervention content (16.4%), satisfaction (14.5%), engagement (14.5%), and attendance (14.5%). The majority of studies (90.0%) included subjective assessments of receipt. These relied on quantitative (76.0%) rather than qualitative (42.0%) methods and studies collected data on intervention recipients (50.0%), intervention deliverers (28.0%), or both (22.0%). Few studies (26.0%) reported on the reliability or validity of methods used. CONCLUSIONS Receipt is infrequently addressed in health research and improvements to methods of assessment and reporting are required.
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Affiliation(s)
- Lorna Rixon
- Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | | | - Nadine McGale
- Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Fabiana Lorencatto
- Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Jill Francis
- Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Anna Davies
- Centre for Health Services Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
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Resnick B. In geriatrics … Maybe less and basic is better? Geriatr Nurs 2015; 37:7-8. [PMID: 26708141 DOI: 10.1016/j.gerinurse.2015.11.006] [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]
Affiliation(s)
- Barbara Resnick
- University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
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Resnick B, Galik E, Wells PT CL, Boltz M, Holtzman L. Optimizing physical activity among older adults post trauma: Overcoming system and patient challenges. Int J Orthop Trauma Nurs 2015; 19:194-206. [PMID: 26547682 PMCID: PMC4637820 DOI: 10.1016/j.ijotn.2015.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/24/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND By 2050 it is anticipated that close to half (40%) of all trauma patients will be over the age of 65. Recovery for these individuals is more complicated than among younger individuals. Early mobilization has been shown to improve outcomes. Unfortunately, there are many challenges to early mobilization. The Function Focused Care Intervention was developed to overcome these challenges. PURPOSE The purpose of this paper was to describe the initial recruitment of the first 25 participants and delineate the challenges and successes associated with implementation of this intervention. RESULTS Overall recruitment rates were consistent with other studies and the intervention was implemented as intended. Most patients were female, white and on average 79 years of age. Optimizing physical activity of patients was a low priority for the nurses with patient safety taking precedence. Patients spent most of the time in bed. Age, depression and tethering were the only factors that were associated with physical activity and functional outcomes of patients. CONCLUSION Ongoing work is needed to keep patients physically active in the immediate post trauma recovery period.
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Affiliation(s)
- Barbara Resnick
- Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Elizabeth Galik
- Associate Professor, University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
| | - Chris L. Wells PT
- Clinical Associate Professor, Physical Therapy and Rehabilitation Science 655 W. Baltimore Street, Baltimore MD 21201, Tel: 410 706 6663
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, 140 Commonwealth Ave, Chestnut Hill, MA 02467, Tel: 617-552-6379
| | - Lauren Holtzman
- Project Manager, University of Maryland, School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, Tel: 410 706 5178
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Wojtusiak J, Levy CR, Williams AE, Alemi F. Predicting Functional Decline and Recovery for Residents in Veterans Affairs Nursing Homes. THE GERONTOLOGIST 2015; 56:42-51. [PMID: 26185151 DOI: 10.1093/geront/gnv065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/08/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This article describes methods and accuracy of predicting change in activities of daily living (ADLs) for nursing home patients following hospitalization. DESIGN AND METHODS Electronic Health Record data for 5,595 residents of Veterans Affairs' (VAs') Community Living Centers (CLCs) aged 70 years and older were analyzed within the VA Informatics and Computing Infrastructure. Data included diagnoses from 7,106 inpatient records, 21,318 functional status evaluations, and 69,140 inpatient diagnoses. The Barthel Index extracted from CLC's Minimum Data Set was used to assess ADLs loss and recovery. Patients' diagnoses on hospital admission, ADL status prior to hospitalization, age, and gender were used alone or in combination to predict ADL loss/gain following hospitalization. Area under the Receiver-Operator Curve (AUC) was used to report accuracy of predictions in short (14 days) and long-term (15-365 days) follow-up post-hospitalization. RESULTS Admissions fell into 7 distinct patterns of recovery and loss: early recovery 19%, delayed recovery 9%, delayed recovery after temporary decline 9%, early decline 29%, delayed decline 10%, delayed decline after temporary recovery 6%, and no change 18%. Models accurately predicted ADL's 14-day post-hospitalization (AUC for bathing 0.917, bladder 0.842, bowels 0.875, dressing 0.871, eating 0.867, grooming 0.902, toileting 0.882, transfer 0.852, and walking deficits was 0.882). Accuracy declined but remained relatively high when predicting 14-365 days post-hospitalization (AUC ranging from 0.798 to 0.875). IMPLICATIONS Predictive modeling may allow development of more personalized predictions of functional loss and recovery after hospitalization among nursing home patients.
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Affiliation(s)
- Janusz Wojtusiak
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Cari R Levy
- Department of Internal Medicine, Palliative Care, Veterans Affairs Medical Center Eastern Colorado Health Care System, Denver
| | - Allison E Williams
- Department of Research, Bay Pines Veterans Affairs Healthcare System, Bay Pines, Florida.
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. Office of Chief of Staff, District of Columbia Veterans Affairs Medical Center, Washington, DC
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Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J 2015; 6:e0017. [PMID: 25973269 PMCID: PMC4422456 DOI: 10.5041/rmmj.10201] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This review examines ways to decrease preventable effects of hospitalization on older adults in acute care medical (non-geriatric) units, with a focus on the Israeli experience at the Rambam Health Care Campus, a large tertiary care hospital in northern Israel. Hospitalization of older adults is often followed by an irreversible decline in functional status affecting their quality of life and well-being after discharge. Functional decline is often related to avoidable effects of in-hospital procedures not caused by the patient's acute disease. In this article we review the literature relating to the recognized effects of hospitalization on older adults, pre-hospitalization risk factors, and intervention models for hospitalized older adults. In addition, this article describes an Israeli comprehensive research study, the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR), and outlines the design of a combined intervention model being implemented at the Rambam Health Care Campus. The majority of the reviewed studies identified preadmission personal risk factors and psychosocial risk factors. In-hospital restricted mobility, under-nutrition care, over-use of continence devices, polypharmacy, and environmental factors were also identified as avoidable processes. Israeli research supported the findings that preadmission risk factors together with in-hospital processes account for functional decline. Different models of care have been developed to maintain functional status. Much can be achieved by interdisciplinary teams oriented to the needs of hospitalized elderly in making an impact on hospital processes and continuity of care. It is the responsibility of health care policy-makers, managers, clinicians, and researchers to pursue effective interventions to reduce preventable hospitalization-associated disability.
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Affiliation(s)
- Hanna Admi
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - Hagar Baruch
- Nursing Directorate, Rambam Health Care Campus, Haifa, Israel
| | - Anna Zisberg
- Cheryl Spencer Department of Nursing and Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
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Kneafsey R, Clifford C, Greenfield S. Perceptions of hospital manual handling policy and impact on nursing team involvement in promoting patients’ mobility. J Clin Nurs 2014; 24:289-99. [DOI: 10.1111/jocn.12659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - Collette Clifford
- School of Health and Population Science; College of Medical and Dental Science; University of Birmingham; Birmingham UK
| | - Sheila Greenfield
- School of Health and Population Science; College of Medical and Dental Science; University of Birmingham; Birmingham UK
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Parke B, Hunter KF. The care of older adults in hospital: if it's common sense why isn't it common practice? J Clin Nurs 2014; 23:1573-82. [PMID: 24444372 DOI: 10.1111/jocn.12529] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2013] [Indexed: 01/07/2023]
Abstract
AIMS AND OBJECTIVES To present three converging myths that underlie the perception that nursing care for older persons in hospital is simple in comparison with its actual complexity. BACKGROUND Literature provides strong evidence indicating that the myths we discuss inherently arise from ageism, the social value of older patients and the economic burden of being an older patient in hospital. These powerful social discourses promote harm to older patients. Harm emerges from both the omission of gerontological nursing knowledge and skill and the commission of acts that unintentionally harm. A corresponding ethical challenge results for acute care nurses. DESIGN A discursive paper. METHODS We illuminate gerontological issues by discussing three myths. In myth one, we detail four clusters of distinguishing characteristics in older hospitalised people. In the second myth, we challenge the idea that the role of the acute care hospital is to attend only to acute medical concerns. Finally, in the third myth, we address the issue of incorporating functional assessment into the acute care nursing assessment. We argue that functional assessment is poorly integrated and becomes acceptable only as long as the medical regimen is managed appropriately. CONCLUSION Safe quality care in hospital for older adults requires a hybrid practice that integrates acute care specialty knowledge with gerontological nursing knowledge and skill. Clinical reasoning that integrates this type of nursing knowledge can prevent harm. RELEVANCE TO CLINICAL PRACTICE Integrating key elements of acute care nursing specialty knowledge with gerontological nursing principles aids to prevent the omission of care that is known to be harmful to older people. Conversely, the commission of gerontologically sensitive acute care can enhance safety and promote quality care in hospital.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
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Kneafsey R, Clifford C, Greenfield S. What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study. Int J Nurs Stud 2013; 50:1617-29. [DOI: 10.1016/j.ijnurstu.2013.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 02/14/2013] [Accepted: 04/13/2013] [Indexed: 11/25/2022]
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Taraldsen K, Sletvold O, Thingstad P, Saltvedt I, Granat MH, Lydersen S, Helbostad JL. Physical behavior and function early after hip fracture surgery in patients receiving comprehensive geriatric care or orthopedic care--a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2013; 69:338-45. [PMID: 23902933 DOI: 10.1093/gerona/glt097] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This study is a part of the randomized controlled trial, the Trondheim Hip Fracture Trial, and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care (CGC) with those managed with orthopedic care (OC). METHODS Treatment comprised CGC with particular focus on mobilization, or OC. A total of 397 hip fracture patients, age 70 years or older, home dwelling, and able to walk 10 m before the fracture, were included. Primary outcome was measurement of upright time (standing and walking) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor. Secondary outcomes were number of upright events on Day 4, need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1-3, and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery. RESULTS A total of 317 (CGC n = 175, OC n = 142) participants wore the activity monitor for a 24-hour period. CGC participants had significantly more upright time (mean 57.6 vs 45.1 min, p = .016), higher number of upright events (p = .005) and better Short Physical Performance Battery scores (p = .002), than the OC participants. Cumulated Ambulation score did not differ between groups (p = .234). CONCLUSIONS When treated with CGC, compared with OC, older persons suffering a hip fracture spent more time in upright, had more upright events, and had better lower limb function early after surgery despite no difference in their need for assistance during ambulation.
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Affiliation(s)
- Kristin Taraldsen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Burket TL, Hippensteel D, Penrod J, Resnick B. Pilot testing of the function focused care intervention on an acute care trauma unit. Geriatr Nurs 2013; 34:241-6. [DOI: 10.1016/j.gerinurse.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/16/2022]
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Kolanowski AM, Resnick B, Beck C, Grady PA. Advances in nonpharmacological interventions, 2011-2012. Res Gerontol Nurs 2013; 6:5-8. [PMID: 23327595 DOI: 10.3928/19404921-20121204-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ann M Kolanowski
- Hartford Center of Geriatric Nursing Excellence, School of Nursing, The Pennsylvania State University, University Park, Pennsylvania 16802, USA.
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Lorenz RA. Commentary on Physical Capability Scale: psychometric testing. Clin Nurs Res 2013; 22:30-5. [PMID: 23427345 DOI: 10.1177/1054773812459632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Function focused care approaches: literature review of progress and future possibilities. J Am Med Dir Assoc 2012; 14:313-8. [PMID: 23246237 DOI: 10.1016/j.jamda.2012.10.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 10/30/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Consistent with a care approach that optimizes the underlying ability of the patient/resident, the Omnibus Budget Reconciliation Act of 1987 mandated that residents attain and maintain their highest level of function. Restorative Care, which more recently has been referred to as Function Focused Care 4, is a philosophy of care that focuses on evaluating the older adult's underlying capability with regard to function and physical activity and helping him or her optimize and maintain functional abilities and increase time spent in physical activity. The purpose of this review was to consider the work that has been done in testing function focused care and to provide guidance on the best ways in which to integrate this philosophy within any setting. METHODS A systematic review of the available literature studying the impact of function focused care approaches was performed using MEDLINE and CINAHL search engines. The studies included were evaluated based on such things as design, specifically whether or not they were experimental designs (which included randomized trials or quasi experimental studies) or single group studies intended to pilot an intervention or for purposes of feasibility; randomization approaches; sample size/number of residents or patients included; descriptions of the intervention such as if there was a champion utilized (research supported or staff); or if motivation of older adults or caregivers was addressed. RESULTS Out of 41 articles identified by CINAHL and 148 via MEDLINE, 20 articles met our inclusion and exclusion criteria. Overall the results provided support for the safety and efficacy of function focused care approaches. Continued research is particularly needed to consider best approaches for dissemination and implementation of function focused care and to test function focused care in acute care settings.
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Functional Decline in Hospitalized Older Adults: Can Nursing Make a Difference? Geriatr Nurs 2012; 33:272-9. [DOI: 10.1016/j.gerinurse.2012.01.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 11/22/2022]
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Abstract
The purpose of this study was to characterize physical activity (PA) based on survey and ActiGraphy data from older adults at 2 mo post-hip fracture and consider the factors that influence PA among these individuals. The sample included participants from a current Baltimore hip study, the BHS-7. Measurement of PA was based on the Yale PA Survey (YPAS) and 48 hr of ActiGraphy. The sample included the first 200 individuals enrolled in the study, with analyses including 117 individuals (59%) who completed the YPAS and wore the ActiGraph for 48 hr. Half the participants were male, with an overall mean age of 81.3 yr (SD = 7.9). Findings indicate that at 2 mo post-hip fracture participants were engaged in very limited levels of PA. Age and comorbidities were the only variables to be significantly associated with PA outcomes.
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