Nursing contribution to the rehabilitation of older patients: patient and family perspectives

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures

OBJECTIVES

We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures.

DESIGN

Randomized controlled trial.

SETTING

Inpatient rehabilitation hospital.

SUBJECTS

Rib fracture patients treated conservatively were randomized into two groups (experimental and control group).

INTERVENTIONS

Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT).

MAIN MEASURES

At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up.

RESULTS

A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group (P < 0.05). Compared to the TAU group, the RNT group also showed a significant improvement in functional ability and quality of life at six-month follow-up.

CONCLUSIONS

A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up.

TRIAL REGISTRATION

ClinicalTrial.gov Identifier: NCT04168996.

Older people and rural eHealth: perceptions of caring relations and their effects on engagement in digital primary health care

Background

The aim of this article is to describe older people’s perceptions of caring relations in the context of rural eHealth, as well as to explore how such relations can facilitate engagement in digital primary health care. There is an ongoing implementation of eHealth in Western health care, and rural areas and older people are specifically targeted. eHealth is said to be a solution to emergent problems and a technology that will facilitate people’s opportunities to achieve good and equal health. From this perspective, it is crucial that older people engage in eHealth services, but there are barriers for use, and care providers need to adapt to the preferences of older people.

Methods

Semi‐structured interviews with 19 individuals aged 61‐85 were conducted. The participants were using digital services at two primary healthcare centres located in northern Sweden. Qualitative content analysis was used. An important theoretical tenet was that older people’s perceptions of and engagements in eHealth are affected by the specific rural conditions. Ethical approval for the study has been obtained.

Results

The analysis rendered a total of three themes: in‐person interaction was central to people’s perceptions of good caring relations; patient–nurse relations were particularly emphasised; and caring relations in rural eHealth appeared to be multi‐directional and fuelled by a shared sense of rural community. Altogether, this facilitated participants’ engagement in local eHealth initiatives.

Conclusions

eHealth is an opportunity for primary health care and for rural communities. However, the results provide insight into matters that can affect the quality, access, and equality of rural primary health care. Participants’ engagement in eHealth was almost always facilitated by close caring relations with local Registered Nurses. Digital care needs to be approached as a combination of digital and in‐person presence. Separating digital and physical task assignments among different personnel could make older people refrain from seeking health care.

Empathy as an Ethical Imperative

Empathy is an often-discussed topic among nurse scientists, educators, and professional practitioners. There is a small, but growing, body of research with a focus on empathy and its direct impact on clinical patient outcomes. However, nurses continue to place value on behavioral aspects of empathy, such as understanding the thoughts and feelings of others, caring, and perspective taking (Hojat, 2016; Kunyk & Olson, 2001). These empathic behaviors are foundational to establishing the nurse-patient relationship. The nurse-patient relationship is also central to the delivery of ethical patient care (American Nurses Association [ANA], 2015). Ethical care directly reflects elements of professional empathy, such as providing compassionate care, understanding the patient's perspective, and thoughtful consideration of the needs and values of each person (ANA, 2015). Empathy and ethics are connected, and both play a vital role in the decision-making process of nurses, particularly for decisions involving some level of uncertainty that require moral reasoning or values-based judgment (Barlow, Hargreaves, & Gillibrand, 2018).

'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

A purposeful Yet Nonimposing Approach: How Japanese Home Care Nurses Establish Relationships With Older Clients and Their Families

Relationship development is crucial to nursing practice with families. However, little is known about the process of building relationships with multiple family members in home care settings and in various cultures. The objective of this study was to explore the experiences of home care nurses about how they established relationships with older clients and their families in Japan. Grounded theory was used to guide the research. Twenty-three expert home care nurses participated in semistructured interviews concerning their family nursing practice. The establishment of relationships with clients/family members was based on a purposeful yet nonimposing approach composed of four aspects: keeping a mindful distance from the family, not being a threat to family life, being a comfortable neighbor, and gaining trust as a competent nurse. Through a purposeful nonimposing approach, Japanese home care nurses promoted and nurtured nurse-family relationships and became involved in the life of the family. These findings provide a useful foundation to guide practice with families and grow knowledge about the process of establishing relationships with multiple family members in home settings.

Understanding informal carers' experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

PURPOSE

This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice.

METHOD

Meta-ethnography was used to inform the review, and 21 studies were included.

FINDINGS

The analysis identified a core theme of "engaging in care: struggling through", as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown.

CONCLUSIONS

The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.

A day in the life of older people in a rehabilitation setting: an observational study

PURPOSE

Nurses' contribution during inpatient rehabilitation is well documented. However, despite being the largest professional group in this setting, the specialty of rehabilitation nursing is poorly recognised. This article reports on the first of a four-phase study that aimed to clarify and develop the nursing contribution to inpatient rehabilitation for older persons. The aim of this study was to identify activity patterns and time use during daytime and evenings of older adult patients undergoing inpatient rehabilitation.

METHODS

Direct observation using behavioural modelling was undertaken of a convenience sample of 37 older people undergoing inpatient rehabilitation in a specialist unit of a large tertiary hospital in New Zealand. The primary outcome was the observation of meaningful activity. Binomial logistic regression was used to study the association between relevant variables.

FINDINGS

Meaningful activity was most likely to involve walking without assistance and to occur 08:00 to 14:00 h and 16:00 to 21:00 h during weekdays. Patients were more likely to receive treatment during the weekend. Irrespective of time, registered nurses were the health professionals most often present with patients.

CONCLUSIONS

There is likely to be unrealised opportunities for registered nurses to support improved rehabilitation outcomes. Registered nurses' involvement in rehabilitation needs to be actively optimised.

IMPLICATIONS FOR REHABILITATION

Nurses' engagement with older adults in rehabilitation settings is likely to be substantial, placing them as key members of the rehabilitation team. Nurses make a pivotal contribution to inpatient rehabilitation based on specialised knowledge and skills but this contribution is not well understood. Opportunities are likely, at times when allied health professionals are less often present, e.g. evenings and weekends, for registered nurses to more intentionally overlap rehabilitation activities with other care requirements.