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Mitike H, Yimam W, Goshiye D, Kumar KP. Knowledge, Attitudes, Practices, and Associated Factors Towards Care of Elderly Patients among Nurses. SAGE Open Nurs 2023; 9:23779608231159631. [PMID: 36865754 PMCID: PMC9972063 DOI: 10.1177/23779608231159631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/10/2023] [Accepted: 02/04/2023] [Indexed: 03/02/2023] Open
Abstract
Background Ethiopia's elderly care service is relatively young and little is known about the practices or readiness of nurses to provide care. Nurses need to have good knowledge, a positive attitude, and experience when it comes to caring for the elderly or patients who are chronically providing quality care. This study aimed to assess the knowledge, attitudes, and practices towards care for elderly patients and associated factors among nurses working in adult care units of public hospitals in Harar, 2021. Methods An institutional-based descriptive cross-sectional study was conducted from February 12 to July 10, 2021. A simple random sampling technique was used to select 478 study participants. Data were collected by trained data collectors using a pretested self-administered questionnaire. From the pretest, Cronbach's alpha for all items was above 0.7 for all items. Data were entered into Epi Data v.4.6 and exported to the Statistical Package for Social Science Version 26 for binary logistic regression analysis. A P-value of 0.05 was used to declare a significant association between variables. Results The study revealed that 311 (69%) had inadequate knowledge. Having a first degree and an unfavorable attitude towards nurses showed a statistically significant association with nurses' inadequate knowledge. A total of 275 (61.0%) nurses were found to have an unfavorable attitude and were significantly associated with having a diploma and first degree, learning in a private organization, 6 to 10 years of experience, lack of training, and inadequate knowledge of nurses. A total of 297 (65.9%) study units had inadequate practice towards the care of elderly patients. Nurses' practices showed a significant association with the type of hospital, work experience, and adherence to guidelines with a response rate of 94.4%. Conclusion The majority of nurses had inadequate knowledge, an unfavorable attitude, and inadequate practice towards the care of elderly patients. Having a first-degree and an unfavorable attitude with inadequate knowledge, lack of training and inadequate knowledge, unfavorable attitudes and less than 11 years of experience, working in non-academic hospitals, and unavailability of guidelines with inadequate practices were significantly associated.
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Affiliation(s)
- Hailye Mitike
- Department of Nursing, College of Medicine and Health Sciences,
Gigjiga University, Gigjiga, Ethiopia
| | - Wondwossen Yimam
- Department of Comprehensive Nursing, College of Medicine and Health
Sciences, Wollo University, Dessie, Ethiopia,Wondwossen Yimam Hussien, Department of
Comprehensive Nursing, College of Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia.
| | - Debrnesh Goshiye
- Department of Pediatrics and Child Health Nursing, College of
Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kumar Prem Kumar
- Department of Adult Health Nursing, College of Medicine and Health
Sciences, Wollo University, Dessie, Ethiopia
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Ijadi Maghsoodi A, Pavlov V, Rouse P, Walker CG, Parsons M. Efficacy of acute care pathways for older patients: a systematic review and meta-analysis. Eur J Ageing 2022; 19:1571-1585. [PMID: 36692788 PMCID: PMC9729482 DOI: 10.1007/s10433-022-00743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/18/2022] Open
Abstract
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow-up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials and acutely admitted patients with an average age of 79, complex conditions and comorbidities to acute geriatric-specific pathways (N = 13,595) were included. Geriatric-specific models were associated with lower costs (weighted mean difference, WMD = - $174.98, 95% CI = -$332.14 to - $17.82; P = 0.03), and shorter LoS (WMD = - 1.11, 95% CI = - 1.39 to - 0.83; P < 0.001). No differences were found in functional decline, ADL, mortality, case fatalities, discharge destination, or readmissions. Geriatric-specific models are valuable for improving patient and system-level outcomes. Although several interventions had positive results, further research is recommended to study hospital-wide geriatric-specific models.
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Affiliation(s)
- Abtin Ijadi Maghsoodi
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand ,Department of Intelligence & Insights, Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
| | - Valery Pavlov
- Department of Information Systems and Operations Management, Faculty of Business and Economics, University of Auckland, Auckland, New Zealand
| | - Paul Rouse
- Department of Accounting and Finance, Faculty of Business and Economics , University of Auckland, Auckland, New Zealand
| | - Cameron G. Walker
- Department of Engineering Science, Faculty of Engineering , University of Auckland, Auckland, New Zealand
| | - Matthew Parsons
- School of Health , University of Waikato, Hamilton, New Zealand ,Te Whatu Ora Health New Zealand Waikato District, Hamilton, New Zealand
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3
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Karapınar M, Kırdı N, Fırat T. Effectiveness of supervised and functional level-based exercise program in elderly inpatients: Randomised controlled trial. Clin Rehabil 2022; 36:1623-1634. [PMID: 35880264 DOI: 10.1177/02692155221116818] [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: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of supervised and unsupervised functional level-based exercises program for elderly inpatients on physical activity, mobility, health-related quality of life and depression status. DESIGN A single-blinded randomised controlled trial. SETTING Internal medicine service. SUBJECTS Patients aged 65 years or older. INTERVENTIONS A supervised functional level-based exercise program was applied to the intervention group by a physiotherapist, for 40 min 5 times a week during their hospitalisation. Patients in the control group were asked to perform an unsupervised functional level-based exercise program which was described by the physiotherapist during the first visit. MAIN MEASURES Mobility, physical activity level and health-related quality of life were assessed at admission and discharge in both groups. Depression status was evaluated at admission and 3 months after discharge. RESULTS Sociodemographic features between intervention group (n = 62) and control group (n = 62) were similar. The intervention group showed a higher increment in mobility, physical activity level and quality of life scores than the control group (d = 0.62, p < 0.05; d = 0.57, p < 0.05; d = 1.12, p < 0.05 respectively). Inpatients in the intervention group, depression scores were lower 3 months after discharge (d = 0.42, p < 0.05). The length of stay in the hospital was not different between the groups. CONCLUSIONS A supervised functional level-based exercise program is more effective than an unsupervised functional level-based exercise program for mobility, physical activity, depression and quality of life in elderly inpatients. These positive contributions are seen within a short period like a 5 to 10 days stay in hospital. TRIAL REGISTRATION ClinicalTrials.gov(NCT03516032).
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Affiliation(s)
- Merve Karapınar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, 52994Suleyman Demirel University, Isparta, Turkey
| | - Nuray Kırdı
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, 37515Hacettepe University, Ankara, Turkey
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Tanyi PL, Pelser A. Towards an “age-friendly-hospital”: Older persons’ perceptions of an age-friendly hospital environment in Nigeria. COGENT MEDICINE 2021. [DOI: 10.1080/2331205x.2020.1853895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Perpetua Lum Tanyi
- Department of Social Work, University of Nigeria Nsukka , Enugu State, Nigeria
- Department of Sociology, University of the Free State , PO Box/Posbus 339, Bloemfontein 9300, South Africa
| | - André Pelser
- Department of Sociology, University of the Free State , PO Box/Posbus 339, Bloemfontein 9300, South Africa
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Busetto L, Stang C, Hoffmann J, Amiri H, Seker F, Purrucker J, Ringleb PA, Nagel S, Bendszus M, Wick W, Gumbinger C. Patient-centredness in acute stroke care - a qualitative study from the perspectives of patients, relatives and staff. Eur J Neurol 2020; 27:1638-1646. [PMID: 32337811 DOI: 10.1111/ene.14283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Although patient-centredness is considered a key component of high-quality neurological care, it is unclear to what extent it can or should be implemented during the acute phase. Using acute stroke as an example, the aim was to identify critical junctures for patient-centredness along the acute care pathway from the perspectives of patients, relatives and staff. METHODS A qualitative multi-method study was conducted including 27 non-participant observations and 37 semi-structured interviews with patients, relatives and staff. Junctures were defined as critical when mentioned (as problematic) in two or three information sources (i.e. observations, staff interviews, or patient and relative interviews), as potentially critical when mentioned in one, and as uncritical when not mentioned. RESULTS Post-procedure communication after thrombectomy, patients' stay at the stroke unit and decision-making around transfer, discharge and rehabilitation were identified as critical junctures for patient-centredness. Arrival at the emergency department and the (thrombectomy) treatment itself were identified as uncritical junctures, whilst history-taking and treatment preparation, the treatment decision and patients' stay at the intensive care unit were identified as potentially critical junctures. CONCLUSIONS In acute stroke care, patients, relatives and staff prioritize fast over patient-centred decision-making in the most time-critical phases, especially before and during treatment. This is reversed after the procedure, when difficulties arise implementing a patient-centred approach in clinical practice. To improve patient-centredness where it is most needed, clear guidelines and accessible resources are recommended. Future research should investigate whether insights from acute phases of stroke care are applicable to other neurological conditions as well.
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Affiliation(s)
- L Busetto
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Stang
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Hoffmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - H Amiri
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Seker
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - P A Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - W Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany
| | - C Gumbinger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Morioka N, Moriwaki M, Tomio J, Kashiwagi M, Fushimi K, Ogata Y. Structure and process of dementia care and patient outcomes after hip surgery in elderly people with dementia: A retrospective observational study in Japan. Int J Nurs Stud 2019; 102:103470. [PMID: 31810019 DOI: 10.1016/j.ijnurstu.2019.103470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Japan introduced the financial incentives for dementia special care at hospitals in the fee schedule in April 2016. OBJECTIVE To investigate whether the financial incentives for dementia special care contributed to better patient outcomes after hip surgery for older adults with dementia. DESIGN Retrospective observational study using the Diagnosis Procedure Combination database and the Reporting on medical functions of hospital beds data. SETTING Acute care hospitals adopting the Diagnosis Procedure Combination system in Japan. PARTICIPANTS A total of 20,393 eligible patients aged 65 years or older with dementia who underwent hip surgeries and discharged from 405 hospitals from April 2016 to March 2017. METHODS There are two levels of dementia care quality categories in the financial incentives for dementia special care as follows: Type 1 requires a multidisciplinary team with geriatric and dementia care expertise and Type 2 requires to assign trained nurses who underwent dementia training at every general ward. The outcomes were in-hospital mortality, readmission within 30 days, and length of hospital stay. We performed generalized estimating equation model or logistic generalized estimating equation models adjusting for individual and hospital characteristics. RESULTS Among the 405 hospitals, the numbers of hospitals without dementia care incentive, those with Type 1, and those with Type 2 were 207, 99, and, 99, respectively. Overall, the prevalence of in-hospital death and readmission within 30 days was 2.01% and 2.70%, respectively. Overall, the mean (standard deviation, SD) length of hospital stay was 32.0 (20.0) days. There were no significant associations between dementia special care and in-hospital mortality in Type 1 (adjusted OR [odds ratio] =0.87, 95% confidence interval [CI] = 0.66-1.16) and Type 2 (adjusted OR = 1.18, 95% CI = 0.92-1.52), and readmission within 30 days in Type 1 (adjusted OR = 1.11, 95% CI = 0.89-1.38) and Type 2 (adjusted OR = 1.03, 95% CI = 0.83-1.29). Length of hospital stay was not significantly different among hospitals with and without incentive, Type 1 (coefficient -0.23, 95% CI = -2.64-2.18.), and Type 2 (coefficient 0.87, 95% CI = -1.54-3.28). An increase in patient-to-nurse ratio was significantly associated with 2.25 days longer length of hospital stay (95% CI 1.00-3.51). CONCLUSION Dementia care incentive was not associated with better outcomes in elderly with dementia who underwent hip surgery in Japan, but the worse nurse workload was associated with longer length of hospital stay. Further long-term assessment is necessary.
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Affiliation(s)
- Noriko Morioka
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masayo Kashiwagi
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kiyohide Fushimi
- Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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Abstract
Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals' differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs' perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.
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Abstract
OBJECTIVE To explore hospital-level variation in postoperative delirium using a multi-institutional data source. BACKGROUND Postoperative delirium is closely related to serious morbidity, disability, and death in older adults. Yet, surgeons and hospitals rarely measure delirium rates, which limits quality improvement efforts. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot (2014 to 2015) collects geriatric-specific variables, including postoperative delirium using a standardized definition. Hierarchical logistic regression models, adjusted for case mix [Current Procedural Terminology (CPT) code] and patient risk factors, yielded risk-adjusted and smoothed odds ratios (ORs) for hospital performance. Model performance was assessed with Hosmer-Lemeshow (HL) statistic and c-statistics, and compared across surgical specialties. RESULTS Twenty thousand two hundred twelve older adults (≥65 years) underwent inpatient operations at 30 hospitals. Postoperative delirium occurred in 2427 patients (12.0%) with variation across specialties, from 4.7% in gynecology to 13.7% in cardiothoracic surgery. Hierarchical modeling with 20 risk factors (HL = 9.423, P = 0.31; c-statistic 0.86) identified 13 hospitals as statistical outliers (5 good, 8 poor performers). Per hospital, the median risk-adjusted delirium rate was 10.4% (range 3.2% to 27.5%). Operation-specific risk and preoperative cognitive impairment (OR 2.9, 95% confidence interval 2.5-3.5) were the strongest predictors. The model performed well across surgical specialties (orthopedic, general surgery, and vascular surgery). CONCLUSION Rates of postoperative delirium varied 8.5-fold across hospitals, and can feasibly be measured in surgical quality datasets. The model performed well with 10 to 12 variables and demonstrated applicability across surgical specialties. Such efforts are critical to better tailor quality improvement to older surgical patients.
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Testa L, Seah R, Ludlow K, Braithwaite J, Mitchell RJ. Models of care that avoid or improve transitions to hospital services for residential aged care facility residents: An integrative review. Geriatr Nurs 2019; 41:360-372. [PMID: 30876676 DOI: 10.1016/j.gerinurse.2019.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/18/2019] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
Care transitions for older people moving from residential aged care facilities (RACFs) to hospital services are associated with greater challenges and poorer outcomes. An integrative review was conducted to investigate models of care designed to avoid or improve transitions for older people residing in RACFs to hospital settings. Twenty-one studies were included in the final analysis. Models of care aimed to either improve or avoid transitions of residents through enhanced primary care in RACFs, promoting quality improvement in RACFs, instilling comprehensive hospital care, conducting outreach services, transferring information, or involved a combination of outreach services and comprehensive hospital care. As standalone interventions, standardised communication tools may improve information transfer between RACFs and hospital services. For more complex models, providing quality improvement and outreach to RACFs may prevent some types of hospital admissions.
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Affiliation(s)
- L Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia.
| | - R Seah
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - K Ludlow
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
| | - R J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, Australia
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Dahlke SA, Hunter KF, Negrin K. Nursing practice with hospitalised older people: Safety and harm. Int J Older People Nurs 2019; 14:e12220. [PMID: 30628753 DOI: 10.1111/opn.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nursing teams work with hospitalised older people in institutions, which prioritise a biomedical model of care. This model does not fit the needs of older people because it emphasises efficacy and a narrow definition of patient safety, but does not prioritise functional needs. Nursing care is provided around the clock within the context of fiscal restraints as well as negative societal and nursing perspectives about ageing and old people. Yet, nursing perceptions of managing safety and potential harms to older patients within these hospital institutions are not well understood. METHODS An integrative review was conducted to examine nursing perspectives of safety and harm related to hospitalised older people. RESULTS The majority of included papers focused on restraint use. Findings reveal that nurses are using restraints and limiting mobility as strategies to manage their key priority of keeping older patients safe, reflecting a narrow conceptualisation of safety. Policy, administrative support and individual nurse characteristics influence restraint use. Safety policies that nurses interpret as preventing falls can encourage the use of restraints and limiting mobility, both of which result in functional losses to older people. CONCLUSIONS This complex issue requires attention from clinical nurses, leaders, policy makers and researchers to shift the focus of care to preservation and restoration of function for older people in hospital as a safety priority. IMPLICATIONS FOR PRACTICE Clinical leaders and nursing teams should engage in developing processes of care that incorporate maintaining and restoring older people's function.
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Affiliation(s)
- Sherry Ann Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Negrin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Perry RG, Mitchell JA, Hawkins J, Johnson-Lawrence V. The Role of Age and Multimorbidity in Shaping Older African American Men's Experiences with Patient⁻Provider Communication. Geriatrics (Basel) 2018; 3:E74. [PMID: 31011109 PMCID: PMC6371103 DOI: 10.3390/geriatrics3040074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/06/2018] [Accepted: 10/17/2018] [Indexed: 11/16/2022] Open
Abstract
This study investigated factors associated with older African American men's unmet health communication needs in the context of patient-provider interactions. Responses to a health survey were analyzed for 430 African American men attending a Midwest community health fair. The outcome measure was the extent to which men could get their health-related questions answered during recent medical visits. Men's mean age was 54; 39% had one chronic condition and 22% had two or more comorbidities. The 53% who usually or always had their questions answered were older, had less comorbidity, higher educational attainment, higher annual incomes, were more likely to be married and have any type of insurance, and have a personal physician. Access to care was the primary factor in shaping men's opportunities to ask health-related questions, and older multimorbid and low-income African American men may face increased barriers to healthcare access, and thus barriers to patient-centered care and communication.
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Affiliation(s)
- Ramona G Perry
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
| | - Jamie A Mitchell
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan School of Social Work, Ann Arbor, MI 48103, USA.
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Singh I, Aithal S. Selecting best-suited "patient-related outcomes" in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care. Patient Relat Outcome Meas 2018; 9:309-320. [PMID: 30288133 PMCID: PMC6163022 DOI: 10.2147/prom.s160519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The population is aging worldwide, and hospitals are admitting a higher proportion of acutely unwell older people. Population-specific factors such as multimorbidity and frailty in older people compounded by deficient expertise contribute to longer lengths of stay, higher readmission rates, and increased rates of institutionalization. A wide range of acute geriatric care models are currently providing acute care to frail older people and these have been shown to provide a cost-effective high-quality service. In this review, population-specific factors, service models, and a wide range of patient-related outcomes of "at risk" older people admitted to an acute geriatric care unit are explored. In addition, we also discuss data measurements and a quality improvement methodology to improve the delivery of care based on the patient outcome data. We hope, in addition to ensuring effectiveness and sustainability of our current services, this may also enhance academic research. Regular monitoring and evaluation of patient-related clinical outcomes not only improve the patient care and reduce the caregiver burden but also help in implementing quality initiatives to develop existing services.
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Affiliation(s)
- Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Ystrad Mynach, UK,
| | - Shridhar Aithal
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Ystrad Mynach, UK,
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Bail K, Draper B, Berry H, Karmel R, Goss J. Predicting excess cost for older inpatients with clinical complexity: A retrospective cohort study examining cognition, comorbidities and complications. PLoS One 2018; 13:e0193319. [PMID: 29474407 PMCID: PMC5825075 DOI: 10.1371/journal.pone.0193319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 02/08/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established. METHOD To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data. RESULTS For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p<0.0001). DISCUSSION Hospital-acquired complications and dementia cost more than other kinds of inpatient complexity, but admission severity is a better predictor of excess cost. Because complications are potentially preventable and dementia care in hospitals can be improved, risk-reduction strategies for common complications, particularly for patients with dementia could be cost effective. CONCLUSIONS Complications and dementia were found to cost more than other kinds of inpatient complexity.
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Affiliation(s)
- Kasia Bail
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Brian Draper
- School of Psychiatry University of New South Wales, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Sydney, Australia
| | - Helen Berry
- Professor of Climate Change and Mental Health, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rosemary Karmel
- Australian Institute of Health and Welfare, Canberra, Australia
| | - John Goss
- Health Research Institute, University of Canberra, Canberra, Australia
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Malik M, Moore Z, Patton D, O'Connor T, Nugent LE. The impact of geriatric focused nurse assessment and intervention in the emergency department: A systematic review. Int Emerg Nurs 2018; 37:52-60. [PMID: 29429847 DOI: 10.1016/j.ienj.2018.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/04/2017] [Accepted: 01/31/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Nursing assessment of elderly patients is imperative in Emergency Departments (ED) while providing interventions that increase independence facilitating discharge to primary healthcare. AIMS To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS). METHODS Search strategy used following databases; Cochrane, Medline, CINAHL, Embase, Scopus and Web of Knowledge; And terms; geriatric nurse assessment, nurse discharge planning, geriatric nurse specialist, nurse intervention, emergency department, accident and emergency, patient outcomes, discharge, admissions, readmissions, hospital utilization, hospitalization, length of stay/hospital stay. RESULTS Nine studies were included: seven RCTs and two prospective pre/post-intervention designed studies. Geriatric focused nursing assessment and interventions did not have a statistical impact on hospitalization, readmissions, LOHS and ED revisits. Risk screening and comprehensive geriatric assessment extending into primary care may reduce readmission rates but not affect hospitalization. An increase in ED visits in the intervention group at 30 days post-intervention was noted. CONCLUSION Inconsistencies in assessment and interventions for the older person in ED are apparent. Further research evaluating a standardised risk assessment tool and innovative interventions extending into primary healthcare is required.
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Affiliation(s)
- M Malik
- Emergency Department, St. James's Hospital, James's Street, Dublin 8, Ireland.
| | - Z Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; University of Ghent, Belgium.
| | - D Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland.
| | - T O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland.
| | - L E Nugent
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland.
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Patient Participation in Hospital Care: How Equal is the Voice of the Client Council? HEALTH CARE ANALYSIS 2016; 23:238-52. [PMID: 24398556 DOI: 10.1007/s10728-014-0271-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patient participation in healthcare is highly promoted for democratic reasons. Older patients make up a large part of the hospital population but their voices are less easily heard by most patient participation instruments. The client council can be seen as an important medium to represent the interests of this increasing group of patients. Every Dutch healthcare institution is obliged to have a client council and its rights are legally established. This paper reports on a case study of a client council in a hospital and shows how equality as the core democratic value manifests itself in practice and marginalizes the voices of older patients. Based on the work of Joan Tronto we show that sameness is the driving force behind the functioning of the client council which leads the council to operate as part of the hospital system. Consequently, important aspects of the hospital practice remain out of sight. To be of greater value for all patients we argue that successful patient participation requires not only equal opportunities but also 'the condition of equal voice'.
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Fry M, Fitzpatrick L, Considine J, Shaban RZ, Curtis K. Emergency department utilisation among older people with acute and/or chronic conditions: A multi-centre retrospective study. Int Emerg Nurs 2016; 37:39-43. [PMID: 27743877 DOI: 10.1016/j.ienj.2016.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/11/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Older persons aged over 65years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. METHODS A 12-month retrospective medical record audit of persons over 65years presenting to four EDs. RESULTS Data from 44,774 (26.6%) patients aged 65years and over were analysed. Patients with acute conditions presented more frequently (n=30,373; 67.8%), received more urgent triage categories (n=13,471; 30.1%) and had higher admission rates (n=18,332; 61%). Chronic conditions presented less frequently (n=14,396; 32.1%) and had higher discharge rates (n=9302; 65%). Patients over 80years were allocated more urgent triage categories and commonly presented with falls (n=3814; 8.5%). Patients between 65 and79years had a higher discharge rate (n=10,397; 46.1%). CONCLUSION Older persons with acute illnesses were more likely to be admitted than those with chronic conditions and who were more likely to be discharged home. There is scope for further investigation of new models of care to better manage older persons with chronic conditions and ED discharge practices.
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Affiliation(s)
- Margaret Fry
- Northern Sydney Local Health District, Faculty of Health, University of Technology Sydney, Australia.
| | - Lesley Fitzpatrick
- Emergency Department, Royal North Shore Hospital, Northern Sydney Local Health District, Honorary Associate, Faculty of Health, University of Technology Sydney, Australia.
| | - Julie Considine
- Deakin University, School of Nursing, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research, 221 Burwood Highway, Burwood, Victoria 3125, Australia; Eastern Health - Deakin University Nursing & Midwifery Research Centre, Level 2, 5 Arnold St, Box Hill, Victoria 3138, Australia.
| | - Ramon Z Shaban
- Menzies Health Institute Queensland, School of Nursing and Midwifery Griffith University, Nathan Campus, N48 Health Sciences Building, 170 Kessels Rd, Nathan, Qld 4111, Australia; Department of Infection Control and Infectious Diseases, Gold Coast University Hospital, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, Qld 4215, Australia.
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, 88 Mallet St, Camperdown, NSW, Australia; Trauma Service, St George Hospital, Gray St, Kogarah, NSW, Australia; St George Clinical School, Faculty of Medicine, University of NSW, NSW, Australia.
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Baumbusch J, Leblanc ME, Shaw M, Kjorven M. Factors influencing nurses' readiness to care for hospitalised older people. Int J Older People Nurs 2015; 11:149-59. [PMID: 26710941 DOI: 10.1111/opn.12109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 11/05/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To gain a better understanding of nurses' perspectives on factors that influence their readiness to provide appropriate care for hospitalised older people. BACKGROUND Hospitals have consistently been criticised for failing to address the unique, complex needs of older people. Research suggests that multiple issues have led to this situation, including a lack of educational preparation for nurses, limited attention to environmental factors, and an absence of organisational preparedness that ensures hospitals are adapted to meet the needs of older people. DESIGN An exploratory, qualitative approach was used. METHODS Forty-one Registered Nurses participated (24 point-of-care nurses; 17 organisational leaders). Six focus groups and one individual interview were conducted. Thematic data analysis was employed to generate the main study findings. RESULTS An overarching theme of 'Poor Fit' emerged. While participants identified the shifting needs of patients towards more complex and relational care, the broader organisational and societal contexts were, largely, unchanging. This resulted in nurses recognising the factors needed to be ready to care for older patients and their families, but working in hospitals that were not suited to these needs. CONCLUSIONS The findings identify factors at the point-of-care, the organisational level, and in broader societal attitudes that shape nurses' readiness to care for hospitalised older people. However, many of these factors are modifiable and care for older people could be improved through quality improvement initiatives and nursing leadership. This study offers insight into ways to re-imagine nursing care that can be responsive to older people's complex needs in hospitals. IMPLICATIONS FOR PRACTICE With a growing contingent of hospitalised older people, it is imperative that nurses, who comprise the largest workforce in this setting, be included in the planning and delivery of healthcare services to ensure readiness to meet the needs of this population.
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Affiliation(s)
- Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Marie-Eve Leblanc
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Maureen Shaw
- Vancouver Acute, Vancouver General Hospital Site, Vancouver, BC, Canada
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18
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Karam G, Radden Z, Berall LE, Cheng C, Gruneir A. Efficacy of emergency department-based interventions designed to reduce repeat visits and other adverse outcomes for older patients after discharge: A systematic review. Geriatr Gerontol Int 2015; 15:1107-17. [PMID: 26171554 PMCID: PMC5008161 DOI: 10.1111/ggi.12538] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
AIM There is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within emergency departments (ED) targeted towards reducing ED re-visits, hospitalizations, nursing home admissions and deaths in older patients after initial ED discharge. METHODS Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the ED, included a comparison group, and reported quantitative results in four primary outcomes: ED re-visits, hospitalizations, nursing home admissions and death after initial ED discharge. RESULTS Of the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral-based interventions, studies that used a validated prediction tool to identify high-risk patients more frequently reported improved outcomes than those that did not use such a tool. CONCLUSION Of the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations.
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Affiliation(s)
- Grace Karam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Zoe Radden
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Laura E Berall
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Catherine Cheng
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Karki S, Bhatta DN, Aryal UR. Older people's perspectives on an elderly-friendly hospital environment: an exploratory study. Risk Manag Healthc Policy 2015; 8:81-9. [PMID: 26028980 PMCID: PMC4440357 DOI: 10.2147/rmhp.s83008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Many older people are vulnerable with multiple health problems and need of extensive care and support for quality of life. The main objective of this study was to explore the older people's perspectives on an "elderly-friendly" hospital. METHODS Hospital was stratified by four domains including government, semi-government, community, and private. We interviewed 33 hospitalized older patients and four hospital managers between June and December 2014 in Kathmandu, Nepal, using purposive sampling technique. We executed a qualitative content analysis step with extensive review of the interviews. Final name of the theme was given after the agreement between the research team and experts to improve trustworthiness. Elderly-friendly services, expectation from government and hospital, and health policy related to senior citizen were developed as main themes. RESULTS Most of the participants were satisfied with the behavior of health personnel. However, none of the health personnel were trained with geriatric health care. Elderly-friendly hospital guidelines and policy were not developed by any hospitals. Older people health card, advocacy for older people's health and benefit, and hospital environment were the common expectations of older patients. Government policy and budget constraint were the main obstacles to promote elderly-friendly health care services. CONCLUSION Elderly-related health policies, physical environments of hospital, elderly-friendly health manpower, advocacy, and other facilities and benefits should be improved and developed. There are urgent needs to develop elderly-friendly hospital policies and guidelines that focus on older people's health benefits and friendly services.
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Affiliation(s)
- Sushmita Karki
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal
| | - Dharma Nand Bhatta
- Department of Public Health, Nobel College, Pokhara University, Kathmandu, Nepal ; Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand
| | - Umesh Raj Aryal
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
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Day J, Higgins I. Adult family member experiences during an older loved one's delirium: a narrative literature review. J Clin Nurs 2015; 24:1447-56. [DOI: 10.1111/jocn.12771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Jenny Day
- School of Nursing and Midwifery; Faculty of Health and Medicine; University of Newcastle; University Drive; Callaghan NSW Australia
| | - Isabel Higgins
- School of Nursing and Midwifery; Faculty of Health and Medicine; University of Newcastle; University Drive; Callaghan NSW Australia
- Older Person Care; Nursing and Midwifery Research Centre; Hunter New England Local Health District; Callaghan NSW Australia
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Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centred practice. Int J Orthop Trauma Nurs 2015; 19:24-35. [DOI: 10.1016/j.ijotn.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022]
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Drabsch T. Rural collaborative guideline implementation: Evaluation of a hub and spoke multidisciplinary team model of care for orthogeriatric inpatients - A before and after study of adherence to clinical practice guidelines. Aust J Rural Health 2015; 23:80-6. [DOI: 10.1111/ajr.12139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tracey Drabsch
- Western New South Wales Local Health District; Orange New South Wales Australia
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23
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Dahlke SA, Phinney A, Hall WA, Rodney P, Baumbusch J. Orchestrating care: nursing practice with hospitalised older adults. Int J Older People Nurs 2014; 10:252-62. [DOI: 10.1111/opn.12075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 09/29/2014] [Indexed: 02/05/2023]
Affiliation(s)
| | - Alison Phinney
- Nursing; University of British Columbia; Vancouver British Columbia Canada
| | - Wendy Ann Hall
- School of Nursing; UBC; Vancouver British Columbia Canada
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24
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Fan L, Lukin W, Zhao J, Sun J, Hou XY. Interventions targeting the elderly population to reduce emergency department utilisation: a literature review. Emerg Med J 2014; 32:738-43. [DOI: 10.1136/emermed-2014-203770] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 11/27/2014] [Indexed: 11/03/2022]
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Van der Elst E, Deschodt M, Welsch M, Milisen K, Dierckx de Casterlé B. Internal consistency and construct validity assessment of a revised Facts on Aging Quiz for Flemish nursing students: an exploratory study. BMC Geriatr 2014; 14:128. [PMID: 25468447 PMCID: PMC4267412 DOI: 10.1186/1471-2318-14-128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since more people are reaching older and older ages, healthcare systems are becoming in need of more and more knowledgeable nurses to meet the specific health care needs of older persons. Several instruments exist to measure and evaluate students' knowledge of older persons, ageing, and gerontological care; however, unequivocal evidence on their use and psychometric properties is scarce. The aim of the study was to validate a revised version of Palmore's Facts on Aging Quiz (FAQ). METHODS A cross-sectional, exploratory study was conducted. Palmore's FAQ version 1 and Facts on Aging Mental Health Quiz were used as bases for the development of a revised FAQ instrument. Three researchers translated these instruments into Dutch. A panel of nine experts in geriatric research and gerontological care evaluated the translation and the face and content validity of the instrument. We used a cross-sectional, exploratory design to assess its internal consistency and construct validity. Cronbach's alpha coefficients, exploratory factor analysis, and the known-groups technique were used for these analyses. RESULTS Based on the experts' consensus, a revised version of the FAQ, consisting of 36 items, was produced. Exploratory factor analysis did not reveal underlying constructs suggesting that the revised version encloses a more general concept of knowledge (e.g. about older persons, aging, gerontological care). Using the known-groups technique, we validated the instrument, showing that it discriminates between the knowledge of first- and third-year nursing students. The overall Cronbach's coefficient of 0.723 was acceptable and changed minimally (from 0.708 to 0.724) when items were removed. CONCLUSION We conclude that the revised version of the FAQ can be used to properly evaluate nursing students' knowledge about older persons and gerontological care, as reasonable reliability and validity were established for this revised version of the FAQ.
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Affiliation(s)
| | | | | | | | - Bernadette Dierckx de Casterlé
- Centre for Health Services and Nursing Research, Department of Public Health & Primary Care, KU Leuven, Kapucijnenvoer 35/4, 3000 Leuven, Belgium.
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LaMantia MA, Boustani MA, Jhanji S, Maina M, Nazir A, Messina FC, Frame A, Alder C, Chodosh J. Redesigning acute care for cognitively impaired older adults: Optimizing health care services. DEMENTIA 2014; 15:913-30. [PMID: 25128821 DOI: 10.1177/1471301214547089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI. DESIGN AND METHODS Focus group sessions were conducted with providers to identify their approach to caring for cognitively impaired hospitalized adults; obstacles and facilitators to providing this care; and suggestions for improving the care process. Using a thematic analysis, two reviewers analyzed these transcripts to develop codes and themes. RESULTS Seven themes emerged from the focus group transcripts. These were: (1) reflections on serving the cognitively impaired population; (2) descriptions of perceived barriers to care; (3) strategies that improve or facilitate caring for hospitalized older adults; (4) the importance of fostering a hospital friendly to the needs of older adults; (5) the need for educating staff, patients, and caregivers; (6) the central role of good communication; and (7) steps needed to provide more effective care. IMPLICATIONS Providing effective acute care services to older adults with CI is an important challenge in health care reform. An understanding derived from the perspective of multiple professional disciplines is an important first step. Future research will build on this preliminary study in developing new acute care models for patients with CI.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shola Jhanji
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Mungai Maina
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Arif Nazir
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frank C Messina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amie Frame
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Joshua Chodosh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Clinical instructors' knowledge and perceptions about nursing care of older people: A pilot study. Nurse Educ Pract 2014; 14:434-40. [DOI: 10.1016/j.nepr.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/28/2013] [Accepted: 03/03/2014] [Indexed: 11/22/2022]
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de Almeida Tavares JP, da Silva AL, Sá-Couto P, Boltz M, Capezuti E. Portuguese nurses' knowledge of and attitudes toward hospitalized older adults. Scand J Caring Sci 2014; 29:51-61. [PMID: 24628017 DOI: 10.1111/scs.12124] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Abstract
Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses' education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross-sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence-based guidelines in their practice.
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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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Boltz M, Capezuti E, Shuluk J, Brouwer J, Carolan D, Conway S, DeRosa S, LaReau R, Lyons D, Nickoley S, Smith T, Galvin JE. Implementation of geriatric acute care best practices: initial results of the NICHE SITE self-evaluation. Nurs Health Sci 2013; 15:518-24. [PMID: 23656606 PMCID: PMC3949432 DOI: 10.1111/nhs.12067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/30/2022]
Abstract
Nurses Improving Care of Healthsystem Elders (NICHE) provides hospitals with tools and resources to implement an initiative to improve health outcomes in older adults and their families. Beginning in 2011, members have engaged in a process of program self-evaluation, designed to evaluate internal progress toward developing, sustaining, and disseminating NICHE. This manuscript describes the NICHE Site Self-evaluation and reports the inaugural self-evaluation data in 180 North American hospitals. NICHE members evaluate their program utilizing the following dimensions of a geriatric acute care program: guiding principles, organizational structures, leadership, geriatric staff competence, interdisciplinary resources and processes, patient- and family-centered approaches, environment of care, and quality metrics. The majority of NICHE sites were at the progressive implementation level (n = 100, 55.6%), having implemented interdisciplinary geriatric education and the geriatric resource nurse (GRN) model on at least one unit; 29% have implemented the GRN model on multiple units, including specialty areas. Bed size, teaching status, and Magnet status were not associated with level of implementation, suggesting that NICHE implementation can be successful in a variety of settings and communities.
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Affiliation(s)
| | | | - Joseph Shuluk
- New York University College of Nursing, New York, NY
| | | | | | | | | | | | | | | | | | - James E. Galvin
- New York University Langone School of Medicine, New York, NY
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Boltz M, Parke B, Shuluk J, Capezuti E, Galvin JE. Care of the older adult in the emergency department: nurses views of the pressing issues. THE GERONTOLOGIST 2013; 53:441-53. [PMID: 23442380 DOI: 10.1093/geront/gnt004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of the study was to describe nurses' views of the issues to be addressed to improve care of the older adult in the emergency department (ED). DESIGN AND METHODS An exploratory content analysis examined the qualitative responses of 527 registered nurses from 49 U.S. hospitals who completed the Geriatric Institutional Profile. RESULTS 5 central themes emerged from the analysis, representing a lack of older person hospital environment fit in the ED: (a) respect for the older adult and carers, (b) correct and best procedures and treatment, (c) time and staff to do things right, (d) transitions, and (e) a safe and enabling environment. The nurses offered solutions to address lack of fit, including modifications to the social climate, policies and procedures, care systems and processes, and physical design. IMPLICATIONS The nurses' descriptions of the pressing issues surrounding care of older adults in the ED provide useful information to consider when developing a senior-friendly ED. Results also illuminate solutions that can be taken to address issues. These solutions give direction for future intervention research.
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Affiliation(s)
- Marie Boltz
- New York University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003-6677, USA.
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Kent F, Keating J. Patient outcomes from a student-led interprofessional clinic in primary care. J Interprof Care 2013; 27:336-8. [DOI: 10.3109/13561820.2013.767226] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee S, Staffileno BA, Fogg L. Influence of staff education on the function of hospitalized elders. Nurs Outlook 2013; 61:e2-8. [DOI: 10.1016/j.outlook.2012.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 04/24/2012] [Accepted: 05/29/2012] [Indexed: 01/17/2023]
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M Doody C, Markey K, Doody O. The experiences of registered intellectual disability nurses caring for the older person with intellectual disability. J Clin Nurs 2012; 22:1112-23. [PMID: 23134212 DOI: 10.1111/jocn.12020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2012] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To explore the experiences of registered intellectual disability nurses caring for the older person with intellectual disability. BACKGROUND Increased longevity for the older person with intellectual disability is relatively a new phenomenon with social and medical factors having significantly increased the lifespan. The ageing population of people with intellectual disability is growing in Ireland, and they are outliving or expected to outlive their family carers. DESIGN A qualitative Heideggerigan phenomenological approach allowed the researcher become immersed in the essence of meaning and analyse how registered intellectual disability nurses working with the older person perceive, experience and express their experience of caring. METHODS After ethical approval was granted, data were collected through semi-structured interviews from seven participants and were transcribed and analysed thematically using Burnard's framework for data analysis. RESULTS Three key themes were identified: 'care delivery', 'inclusiveness' and 'client-focused care'. The study highlights the need for effective planning, an integrated approach to services and that the registered intellectual disability nurse needs to be integrated into the care delivery system within the health service to support client and family carers in the home environment. CONCLUSIONS Overall, the study shows the importance of teamwork, proactive planning, inclusion, attitudes, individualised care, knowing the person and best practice in providing care for older people with intellectual disability. RELEVANCE TO CLINICAL PRACTICE This paper reports on the findings of a study which explored the experiences of caring for the older person with intellectual disability. Teamwork, proactive planning, client-centred approach and supporting clients living at home are important as ageing is inevitable.
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Parke B, Hunter KF, Bostrom AM, Chambers T, Manraj C. Identifying modifiable factors to improve quality for older adults in hospital: a scoping review. Int J Older People Nurs 2012; 9:8-24. [PMID: 23067226 DOI: 10.1111/opn.12007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/26/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified. DESIGN Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology. METHOD We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria. RESULTS A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes. CONCLUSION The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care. IMPLICATIONS FOR PRACTICE Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Holm SE, Mu K. Discharge Planning for the Elderly in Acute Care: The Perceptions of Experienced Occupational Therapists. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.719601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Edvardsson D, Nilsson A, Fetherstonhaugh D, Nay R, Crowe S. The person-centred care of older people with cognitive impairment in acute care scale (POPAC). J Nurs Manag 2012; 21:79-86. [PMID: 23339497 DOI: 10.1111/j.1365-2834.2012.01422.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To construct and evaluate psychometric properties of the person-centred care of older people with cognitive impairment in acute care settings (POPAC) scale. BACKGROUND Older people with cognitive impairment are admitted frequently to acute care, with needs not always met through standard practice. Best practice models have been suggested, but few assessment scales exist. METHODS Psychometric evaluation using statistical estimates of validity and reliability based on an Australian sample of acute care nursing staff (n = 212). RESULTS The final 15-item questionnaire consists of three subscales, 'using cognitive assessments and care interventions', 'using evidence and cognitive expertise' and 'individualizing care'. Estimates of validity and reliability were highly satisfactory. CONCLUSION The POPAC scale makes a valuable contribution by providing valid and reliable measures of the extent to which acute nursing staff report using best practice care processes to identify and consider cognitive impairment and to employ nursing interventions to meet the needs associated with old age and cognitive impairment. IMPLICATIONS FOR NURSING MANAGEMENT The POPAC scale is short, easy to administer and not time consuming to complete, but still provides clinically relevant information. It can be used as a conceptual fundament in developing best practice nursing care in the acute clinical setting, as well as for nursing research.
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Affiliation(s)
- David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
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NILSSON ANITA, LINDKVIST MARIE, RASMUSSEN BIRGITH, EDVARDSSON DAVID. Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care. J Nurs Manag 2012; 20:640-7. [DOI: 10.1111/j.1365-2834.2012.01406.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Baumbusch J, Dahlke S, Phinney A. Nursing students’ knowledge and beliefs about care of older adults in a shifting context of nursing education. J Adv Nurs 2012; 68:2550-8. [DOI: 10.1111/j.1365-2648.2012.05958.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kergoat MJ, Latour J, Lebel P, Leclerc BS, Leduc N, Béland F, Berg K, Presse N, Tanon A, Bolduc A. Quality-of-care processes in geriatric assessment units: principles, practice, and outcomes. J Am Med Dir Assoc 2012; 13:459-63. [PMID: 22236611 DOI: 10.1016/j.jamda.2011.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To assess quality-of-care processes and to examine whether care processes are associated with short-term postdischarge outcomes in older vulnerable hospitalized patients. DESIGN Retrospective study. SETTING Forty-nine Geriatric Assessment Units. PARTICIPANTS Patients aged 65 and older who were admitted to a Geriatric Assessment Unit for a fall with trauma. MEASUREMENTS Three care processes (comprehensiveness, informational continuity, patient-centered care) assessed through chart audit; three-month postdischarge outcomes (emergency department visit, hospital readmission, and death) obtained from national databases. RESULTS A total of 934 hospitalization records were included. Mean comprehensiveness and informational continuity scores were 55% ± 12% and 42% ± 16%, respectively. Items related to geriatric global assessment (eg, functional autonomy) were particularly overlooked. Patient-centered care was poorly provided, with only 24% of hospitalization records showing evidence of advance care directives and at least one patient/family meeting with the physician to discuss clinical evolution. For the three care processes, a large variability among Geriatric Assessment Units was observed. Better comprehensiveness of care was associated with lowered short-term mortality (OR = 0.73, 95% CI = 0.55-0.96, P = .023), whereas higher scores on informational continuity was associated with fewer emergency department visits (OR = 0.91, 95% CI = 0.82-1.00, P = .046), hospital readmissions (OR = 0.84, 95% CI = 0.74-0.94, P = .003), and mortality (OR = 0.72, 95% CI = 0.59-0.88, P = .002). Patient-centered care was not associated with any of the postdischarge outcomes. CONCLUSION A large gap between geriatric care principles and practice in Geriatric Assessment Units has been observed. Our results show that improvement in care processes may be translated to decreased short-term health services use and mortality.
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Affiliation(s)
- Marie-Jeanne Kergoat
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal (QC), Canada.
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Davidson PM, DiGiacomo M, McGrath SJ. The Feminization of Aging: How Will This Impact on Health Outcomes and Services? Health Care Women Int 2011; 32:1031-45. [DOI: 10.1080/07399332.2011.610539] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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D'Aavolio DA, Heike ME, Burke D, Gallivan T. The plus of 65+. Nurs Manag (Harrow) 2011; 42:32-37. [PMID: 22037370 DOI: 10.1097/01.numa.0000403277.19626.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Manias E, Gibson SJ, Finch S. Testing an Educational Nursing Intervention for Pain Assessment and Management in Older People. PAIN MEDICINE 2011; 12:1199-215. [DOI: 10.1111/j.1526-4637.2011.01181.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schnitker L, Martin-Khan M, Beattie E, Gray L. Negative health outcomes and adverse events in older people attending emergency departments: A systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.aenj.2011.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Systematic Review and Qualitative Analysis to Inform the Development of a New Emergency Department-Based Geriatric Case Management Model. Ann Emerg Med 2011; 57:672-82. [DOI: 10.1016/j.annemergmed.2011.01.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 01/23/2011] [Accepted: 01/28/2011] [Indexed: 11/19/2022]
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Dahlke S. Examining Nursing Practice with Older Adults Through a Historical Lens. J Gerontol Nurs 2011; 37:41-8. [DOI: 10.3928/00989134-20110106-06] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/30/2010] [Indexed: 11/20/2022]
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Elo S, Saarnio R, Routasalo P, Isola A. Gerontological rehabilitation nursing of older patients in acute health centre hospitals: nursing views. Int J Older People Nurs 2011; 7:46-56. [DOI: 10.1111/j.1748-3743.2011.00277.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Andersson L, Burman M, Skär L. Experiences of caretime during hospitalization in a medical ward: older patients’ perspective. Scand J Caring Sci 2011; 25:646-52. [DOI: 10.1111/j.1471-6712.2011.00874.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Steele JS. Current Evidence Regarding Models of Acute Care for Hospitalized Geriatric Patients. Geriatr Nurs 2010; 31:331-47. [DOI: 10.1016/j.gerinurse.2010.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/09/2010] [Accepted: 03/14/2010] [Indexed: 10/19/2022]
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