1
|
Stafford A, Bender S, Parsons K, Sung B. Evaluating a virtual reality dementia training experience using psychophysiological methods: A randomised controlled study. Australas J Ageing 2024. [PMID: 38406892 DOI: 10.1111/ajag.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training. METHODS Twenty-two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self-reported scales. RESULTS Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean .012 mV vs. video .005 mV, F[1, 20] = 8.70, p = .01; negative emotion fEMG: VR mean .018 mV vs. video .008 mV, F[1, 20] = 18.40, p < .001). Self-ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR .1 t = .07, df = 9, p = .95 vs. video -2.3 t = -2.265, df = 11, p = .045). CONCLUSIONS Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia.
Collapse
Affiliation(s)
- Andrew Stafford
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Stuart Bender
- School of Media, Creative Arts and Social Inquiry, Curtin University, Bentley, Western Australia, Australia
| | - Kiran Parsons
- Curtin Medical School, Curtin University, Bentley, Western Australia, Australia
| | - Billy Sung
- School of Management and Marketing, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
2
|
Chenoweth L, Burley C, Cook J, Cheah SL, Reyes P, Maiden G, McGuire J, McCade D, Brodaty H, Sukhapure M, Harrison F, Williams A. Improving Healthcare Quality and Clinical Outcomes for Persons with Dementia in the Sub-Acute Hospital Through Person-Centered Care Practice. J Alzheimers Dis 2024; 98:619-628. [PMID: 38427481 DOI: 10.3233/jad-231056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Person-centered care is considered beneficial for persons with dementia. Objective To evaluate the impact of a person-centered knowledge translation intervention on the quality of healthcare and outcomes for persons with dementia. Methods Over nine months, sub-acute hospital nursing, allied health, and medical staff (n = 90) participated in online and/or face-to-face person-centered education and were supported by senior nursing, allied health, and medical staff champions (n = 8) to implement person-centered healthcare. The quality of healthcare service, ward climate and care delivery were evaluated pre/post study intervention. In the week following hospital admission (Time 1) and week of discharge (Time 3), agitation incidence (co-primary outcome) was assessed in participants with dementia (n = 80). Participant delirium (co-primary outcome), accidents/injuries, psychotropic medicines, length of stay, readmission and discharge destination (secondary outcomes) were compared with a retrospective group (n = 77) matched on demographics, cognition and function in activities of daily living. Results Improvements occurred post-intervention in service quality by 17.5% (p = 0.369, phi = 0.08), ward climate by 18.1% (p = 0.291, phi = 0.08), and care quality by 50% (p = 0.000, phi = 0.37). Participant agitation did not change from Time 1 to Time 3 (p = 0.223). Relative to the retrospective group, significant reductions occurred in participant delirium (p = 0.000, phi = 0.73), incidents/injuries (p = 0.000, phi = 0.99), psychotropic medicine use (p = 0.030, phi = 0.09), and hospital readmissions within 30 days (p = 0.002, phi = 0.25), but not in discharge to home (p = 0.171). Conclusions When person-centered healthcare knowledge is translated through staff education and practice support, persons with dementia can experience improved healthcare services and clinical outcomes, while healthcare services can benefit through reductions in unplanned service use.
Collapse
Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Claire Burley
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Jacquelene Cook
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
- Department of Aged Health, Chronic Care and Rehabilitation, Concord Hospital, Sydney, Australia
| | - Seong-Leang Cheah
- Research Unit, Justice Health and Forensic Mental Health Network, AGSM (G27), UNSW, Sydney, Australia
| | - Patricia Reyes
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
- Discipline of Medicine, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Genevieve Maiden
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Jane McGuire
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Donna McCade
- War Memorial Hospital, St Vincent's Hospital Health Network, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Mayouri Sukhapure
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Fleur Harrison
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Western Sydney University, NSW, Penrith, Australia
| |
Collapse
|
3
|
Janerka C, Leslie GD, Gill FJ. Development of patient-centred care in acute hospital settings: A meta-narrative review. Int J Nurs Stud 2023; 140:104465. [PMID: 36857979 DOI: 10.1016/j.ijnurstu.2023.104465] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context. AIM To understand the development of patient-centred care in the context of acute hospital settings over the past decade. METHODS A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic. RESULTS One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care. CONCLUSIONS Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions. TWEETABLE ABSTRACT Patient-centred care in acute care settings - we have arrived! Is it sustainable?
Collapse
Affiliation(s)
- Carrie Janerka
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Western Australia, Australia; Fiona Stanley Hospital, South Metropolitan Health Service, Western Australia, Australia
| | - Fenella J Gill
- School of Nursing, Curtin University, Western Australia, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Western Australia, Australia
| |
Collapse
|
4
|
Soun S, Hunter KF, Dahlke S. Nursing Care Management of Responsive Behaviors for Persons Living With Dementia in Acute Care Settings: An Integrative Review. J Gerontol Nurs 2023; 49:19-25. [PMID: 36719660 DOI: 10.3928/00989134-20230106-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The current integrative review was performed to understand how acute care nurses manage responsive behaviors among persons living with dementia (PLWD) in acute care settings. Eight studies were included, and three themes were developed: Person-Centered Approach, Non-Person-Centered Approach, and Facilitators and Barriers to Care Approaches. Nurses expressed difficulties in caring for hospitalized PLWD due to lack of knowledge of dementia care, pressure to work more efficiently, and prioritization of acute medical concerns. Nurses frequently used nonpharmacological approaches that required less time spent with patients. Results suggest that nurses in acute care settings require further education regarding dementia and person-centered care approaches for PLWD. Nursing management can support nurses' learning needs through education and policies to improve patient outcomes. [Journal of Gerontological Nursing, 49(2), 19-25.].
Collapse
|
5
|
Chenoweth L, Williams A, McGuire J, Reyes P, Maiden G, Brodaty H, Liu Z, Cook J, McCade D, Taylor-Rubin C, Freeman M, Burley C. Evaluating Implementation and Outcomes of a Person-Centered Care Model for People with Dementia in the Rehabilitation In-Patient Setting: Project Protocol. J Alzheimers Dis 2023; 91:1409-1421. [PMID: 36641672 DOI: 10.3233/jad-220882] [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: 01/15/2023]
Abstract
BACKGROUND While Australian guidelines promote person-centered healthcare (PCC) for persons with dementia, healthcare systems, routines, rules, and workplace cultures can pose challenges in the provision of PCC. OBJECTIVE To present a knowledge translation protocol of the PCC model in a sub-acute rehabilitation hospital. METHODS The two-year pre/post/follow-up translation project will include (n = 80) persons with dementia, (n = 80) adult family/carers of patient participants, (n = 60) healthcare staff (medical, nursing, allied health), and (n = 8) PCC staff champions. Champions will complete six half-days' training in PCC. Medical, nursing, and allied health staff will be provided with PCC learning manuals, complete six hours of online PCC education and attend six face-to-face PCC education sessions. Champions will provide ongoing support to staff in PCC practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework will be used to evaluate: i) outcomes for prospective patients provided with PCC, compared with a matched sample of retrospective patients (primary outcomes agitation incidence and severity); 2) champion and staff PCC knowledge, confidence, engagement, and practice quality; 3) person, family/carer, champion, and staff satisfaction with PCC; 4) PCC costs and benefits; and 5) organizational structures, systems and policies required to implement and maintain PCC in sub-acute healthcare. RESULTS We will identify if PCC benefits persons with dementia, staff, and healthcare services, and we will generate evidence on the educational and organizational resources required to embed PCC in practice. CONCLUSION Project findings will inform tailored PCC education applications for dissemination in healthcare and produce evidence-based PCC practice guidelines to improve healthcare for persons with dementia.
Collapse
Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, NSW, Australia
| | - Anna Williams
- School of Nursing and Midwifery, Parramatta South Campus, Western Sydney University, Penrith, NSW, Australia
| | - Jane McGuire
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Patricia Reyes
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Genevieve Maiden
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, NSW, Australia
| | - Zhixin Liu
- Health direct Australia, Haymarket, NSW, Australia
| | - Jacquelene Cook
- UNSW Medicine and Health, Department of Aged Health, Chronic Care and Rehabilitation Concord Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Donna McCade
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Cathleen Taylor-Rubin
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Matilda Freeman
- War Memorial Hospital, Uniting, South Eastern Sydney Local Health District (SESLHD), Waverley, NSW, Australia
| | - Claire Burley
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, UNSW Medicine and Health, UNSW, Sydney, NSW, Australia
| |
Collapse
|
6
|
Chenoweth L, Williams A, Fry M, Endean E, Liu Z. Outcomes of Person-centered Care for Persons with Dementia in the Acute Care Setting: A Pilot Study. Clin Gerontol 2022; 45:983-997. [PMID: 34229578 DOI: 10.1080/07317115.2021.1946233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This pilot study assessed clinical outcomes and quality care for persons with dementia in an acute hospital with PCC, compared with usual care. METHODS Forty-seven consented persons 60 years and over with dementia were assigned to PCC (n = 26) or usual care (control) (n = 21). Hospital nurses and allied health staff received 3 h of face-to-face education in PCC, and practice support by four PCC-trained nurse champions. Control group staff received 3 h of face-to-face education on dementia and delirium care clinical guidelines. Primary outcomes behavioral/neuropsychiatric symptoms and care quality were analyzed based on repeated measures at baseline (Time 1), 4-5 days after baseline (Time 2) and day 8-10 after baseline (Time 3) where available. RESULTS Compared with controls, at Time 2 PCC produced statistically significant improvements in behavioral/neuropsychiatric symptoms (adjusted p = .036) and care quality (adjusted p = .044). Where length of stay exceeded 8 days after baseline (Time 3), there was a sustained improvement in quality care (p = .007), but not in behavioral/neuropsychiatric symptoms (p = .27). CONCLUSIONS PCC can improve care quality for persons with dementia; nursing; agitation; paid caregivers with dementia and reduce behavioral/neuropsychiatric symptoms during short hospital stays. CLINICAL IMPLICATIONS Hospital systems need to support PCC to reduce behavioral/neuropsychiatric symptoms in dementia during long hospital stays.
Collapse
Affiliation(s)
- Lynn Chenoweth
- Centre for Healthy Brain Ageing, Faculty of Medicine, University of New South Wales (Sydney), Sydney, NSW, Australia
| | - Anna Williams
- School of Nursing (Sydney), The University of Notre Dame Australia, Fremantle, NSW, Australia
| | - Margaret Fry
- Northern Sydney Local Health District, Sydney; Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Zhixin Liu
- Stats Central, University of New South Wales (Sydney), Sydney, NSW, Australia
| |
Collapse
|
7
|
Cheong CY, Tay FHE, Yap PLK. Adaptation and Validation of the Person-Centred Assessment Tool for the Acute Care Setting. Dement Geriatr Cogn Disord 2022; 51:73-79. [PMID: 35287126 DOI: 10.1159/000522325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Person-centred care (PCC) is synonymous with best practice in the care of persons with dementia. Despite this, PCC is not routinely assessed, and there is no validated tool for in the acute care setting. We aimed to validate the Person-Centred Assessment Tool (P-CAT) in an acute setting. METHODS P-CAT was administered independently to a total of 161 nurses (n = 16, from a specialized dementia unit with PCC training; n = 116, geriatric wards; n = 30, medical/surgical wards). The word "residents" was replaced with "patients" in P-CAT. We employed confirmatory factor analysis with principal component extraction to verify the previously reported three- and two-factor solutions. A one-way between-groups ANOVA was then used to investigate group differences in the P-CAT score (total scale and subscale). RESULTS Factor analysis revealed a two-factor solution (explained variance 42.28%): (i) extent of personalizing care and (ii) amount of organizational and environmental support. Out of the 13 items, only 2 items did not load as expected. The internal consistency reliability of the scale was satisfactory (Cronbach's α = 0.77). Nurses' P-CAT scores were significantly different across ward settings [Welch's F(2,37.20) = 13.01, p < 0.001, ω2 = 0.09], with the highest among those PCC trained. Post hoc analyses revealed a significant difference in mean subscale scores between PCC-trained nurses and nurses from the other two ward settings. P-CAT scores were not significantly correlated with age, r(159) = 0.01, p = 0.861, or with nursing experience, r(159) = 0.04, p = 0.615. DISCUSSION/CONCLUSION P-CAT possesses adequate validity and reliability as a quantitative assessment tool of PCC in the acute care setting.
Collapse
Affiliation(s)
- Chin Yee Cheong
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Felicia Hui En Tay
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Philip Lin Kiat Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| |
Collapse
|
8
|
Feasibility of a two-part person-centred care initiative for people living with dementia in acute hospitals: A mixed methods study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
9
|
Keuning-Plantinga A, Finnema EJ, Krijnen W, Edvardsson D, Roodbol PF. Validation and psychometric evaluation of the Dutch person-centred care of older people with cognitive impairment in acute care (POPAC) scale. BMC Health Serv Res 2021; 21:59. [PMID: 33435963 PMCID: PMC7805135 DOI: 10.1186/s12913-020-06048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022] Open
Abstract
Background Person-centred care is the preferred model for caring for people with dementia. Knowledge of the level of person-centred care is essential for improving the quality of care for patients with dementia. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale is a tool to determine the level of person-centred care. This study aimed to translate and validate the Dutch POPAC scale and evaluate its psychometric properties to enable international comparison of data and outcomes. Methods After double-blinded forward and backward translations, a total of 159 nurses recruited from six hospitals (n=114) and via social media (n=45) completed the POPAC scale. By performing confirmatory factor analysis, construct validity was tested. Cronbach’s alpha scale was utilized to establish internal consistency. Results The confirmatory factor analysis showed that the comparative fit index (0.89) was slightly lower than 0.9. The root mean square error of approximation (0.075, p=0.012, CI 0.057–0.092) and the standardized root mean square residual (0.063) were acceptable, with values less than 0.08. The findings revealed a three-dimensional structure. The factor loadings (0.69–0.77) indicated the items to be strongly associated with their respective factors. The results also indicated that deleting Item 5 improved the Cronbach’s alpha of the instrument as well as of the subscale ‘using cognitive assessments and care interventions’. Instead of deleting this item, we suggest rephrasing it into a positively worded item. Conclusions Our findings suggest that the Dutch POPAC scale is sufficiently valid and reliable and can be utilized for assessing person-centred care in acute care hospitals. The study enables nurses to interpret and compare person-centred care levels in wards and hospital levels nationally and internationally. The results form an important basis for improving the quality of care and nurse-sensitive outcomes, such as preventing complications and hospital stay length. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06048-x.
Collapse
Affiliation(s)
- Annette Keuning-Plantinga
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands. .,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands. .,University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelyn J Finnema
- NHL Stenden University of Applied Sciences, Rengerslaan 8-10, Postbox 1298, 8900, CG, Leeuwarden, The Netherlands.,Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands.,Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - Wim Krijnen
- Hanze University of Applied Sciences, Eyssoniusplein 18, 9714, CE, Groningen, The Netherlands
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Level 4, Austin Tower, PO BOX 55555, Heidelberg, Victoria, 3084, Australia.,Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Petrie F Roodbol
- Health Sciences-Nursing Science & Education University of Groningen & University Medical Center Groningen, Hanzeplein 1, Postbox 30.001, 9700, RB, Groningen, The Netherlands.,University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
Werner P, AboJabel H, Cohen Saban H, Kermel Schiffman I, Idilbi N, Engel A, Malka-Zeevi H, Dwolatzky T, Dudkiewicz M. Validating the Hebrew version of the Person-Centered Care of Older People with Cognitive Impairment in Acute Care scale. J Nurs Manag 2020; 29:584-590. [PMID: 33051924 DOI: 10.1111/jonm.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Abstract
AIM To validate the Hebrew version of the Person-Centered Care of Older People with Cognitive Impairment in the Acute Care scale. BACKGROUND The Person-Centered Care of Older People with Cognitive Impairment in Acute Care scale is a reliable and valid measure to assess the extent to which person-centred care among people with dementia is adopted in the acute care setting. METHODS A cross-sectional study using a self-reporting structured questionnaire was conducted with 678 professionals (69% nurses, 26% physicians, 5% other health care professionals) in five hospitals across Israel. RESULTS Similar to other languages, best results were obtained using 14 of the 15 items included in the original scale. Confirmatory factor analysis indicated the appropriateness of a three-factor structure for the Hebrew version of the scale. Cronbach's alpha scores for these factors were moderate to good. CONCLUSIONS The Hebrew version of the scale is a reliable and valid tool for assessing hospital professionals' perceptions of person-centred care. IMPLICATIONS FOR NURSING MANAGEMENT A new language validated version of the scale will allow nurse managers to learn from multiple countries' experience while conducting international comparisons. Such developments will improve and expand the implementation of the person-centred care among people with dementia in hospital settings.
Collapse
Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Hanan AboJabel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Hagar Cohen Saban
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Nasra Idilbi
- The Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - Anat Engel
- Edith Wolfson Medical Center, Holon, Israel
| | | | - Tzvi Dwolatzky
- Technion - Israel Institute of Technology, Haifa, Israel.,Rambam Health Care Campus, Haifa, Israel
| | | |
Collapse
|
11
|
Fridberg H, Wallin L, Wallengren C, Kottorp A, Forsman H, Tistad M. Development and evaluation of the measurement properties of a generic questionnaire measuring patient perceptions of person-centred care. BMC Health Serv Res 2020; 20:960. [PMID: 33081770 PMCID: PMC7574493 DOI: 10.1186/s12913-020-05770-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation of person-centred care (PCC) is a challenging undertaking. Thus, a call has been issued for a robust and generic instrument to measure and enable evaluation of PCC across settings and patient groups. This study aimed to develop a generic questionnaire measuring patients' perceptions of PCC. Further aims were to evaluate its content and measurement properties using a mixed-methods approach entailing Rasch and qualitative content analyses. METHODS The study was conducted in three iterative phases. Phase one included six key informants to gain a broad view of the concept. Phase two entailed a Delphi study involving two rounds with eight experts who generated ratings on relevance, readability, comprehensiveness and suggestions for revision. Data were analysed using the Item Content Validity Index in conjunction with qualitative comments to improve the questionnaire. Phase three was performed using a mixed-methods design. Quantitative data were collected from patients (n = 553) responding to the questionnaire who were recruited from six in- and outpatient care units in a health care region in Sweden. Data was analysed using the Rasch measurement model. Qualitative data were based on the respondents' free-text comments, cognitive interviews (n = 10) and field notes, and then analysed with deductive content analysis. RESULTS A questionnaire was developed and operationalised based on the information given by key informants in phase one and then validated for its content by experts in phase two. In phase three Rasch analyses revealed problems with targeting, thresholds and two misfitting items. These problems were corroborated by data from the qualitative analyses, which also revealed some issues of wording and interpretation of items. When thresholds were resolved and two items removed, the questionnaire met the assumptions of the Rasch model. CONCLUSIONS Experts gave the questionnaire content high ratings and it met measurement requirements assumed by the Rasch model after revisions. Those problems on targeting that remain need to be addressed in future studies. Meanwhile, we regard the questionnaire as of sufficient quality to be useful in benchmarking PCC.
Collapse
Affiliation(s)
- Helena Fridberg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Catarina Wallengren
- Institute of Health and Care Sciences and University of Gothenburg Centre for Person-Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
12
|
Toye C, Slatyer S, Kitchen S, Ingram K, Bronson M, Edwards D, van Schalkwyk W, Pienaar C, Wharton P, Bharat C, Hill KD. Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study. Clin Interv Aging 2019; 14:2223-2237. [PMID: 31908433 PMCID: PMC6927259 DOI: 10.2147/cia.s211424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/19/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of inter-professional collaboration. METHODS Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves. RESULTS From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time. CONCLUSION Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.
Collapse
Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia 6102, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Susan Slatyer
- Discipline of Nursing, College of Science, Health, Engineering & Education, Murdoch University, Perth, Western Australia 6150, Australia, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Su Kitchen
- Clinical Lead and Clinical Nurse Consultant in Falls Management, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Katharine Ingram
- Consultant Geriatrician, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Mary Bronson
- Deputy Nurse Co Director, Medical Division, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Deborah Edwards
- Occupational Therapy Coordinator, Acute Services Emergency Department, Sir Charles Gardiner Hospital, Perth, Western Australia6009, Australia
| | - Welma van Schalkwyk
- Registered Nurse, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Catherine Pienaar
- Project Officer, Nursing Research, Perth Children’s Hospital and Murdoch University, Perth, Western Australia6009, Australia
| | - Philippa Wharton
- Project Officer, Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia6009, Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales2006, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Victoria3199, Australia
| |
Collapse
|
13
|
Grealish L, Simpson T, Soltau D, Edvardsson D. Assessing and providing person-centred care of older people with cognitive impairment in acute settings: threats, variability, and challenges. Collegian 2019. [DOI: 10.1016/j.colegn.2018.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
14
|
Lee YM, Song JE, Park C, Son YJ. Psychometric Evaluation of the Korean Version of Patient-Centered Care Scale for Hospital Nurses. Eval Health Prof 2018; 42:344-365. [PMID: 30336687 DOI: 10.1177/0163278718805244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patient-centered care (PCC) encourages active collaboration and effective communication among patients, their family caregivers, and health-care providers to achieve high-quality care. Despite its importance, there is no validated and reliable Korean instrument for assessing PCC among health-care providers yet. This study aimed to establish a Korean version of the PCC (K-PCC) Scale using international translation guidelines and systematically evaluating its psychometric properties. The participants in this study were 424 nurses with a mean age of 28.07 years (±4.56) from two university hospitals in South Korea. Confirmatory factor analysis identified that the revised model, which included three factors (holistic, collaborative, and responsive care), had a satisfactory goodness of fit. The testing of item convergent and item-discriminant validity revealed a 100% scaling success. Criterion validity showed that nurses who had positive perceptions of K-PCC were more likely to practice PCC (r = .692, p < .001). The internal consistency for 23 items as a whole was good, at .935. From these results, K-PCC is considered a valid and reliable instrument for measuring health-care providers' perceptions of PCC among Korean populations. Scale brevity and simplicity, together with rigorous testing, indicate that validation of the PCC Scale may be helpful for ensuring quality improvement in hospital settings.
Collapse
Affiliation(s)
- Yun Mi Lee
- 1 Department of Nursing, College of Medicine, Inje University, Busan, South Korea
| | - Ju-Eun Song
- 2 College of Nursing, Ajou University, Suwon, South Korea.,3 Research Institute of Nursing Science, Ajou University, Suwon, South Korea
| | - Chanhee Park
- 4 Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Youn-Jung Son
- 4 Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| |
Collapse
|
15
|
Fogg C, Griffiths P, Meredith P, Bridges J. Hospital outcomes of older people with cognitive impairment: An integrative review. Int J Geriatr Psychiatry 2018; 33:1177-1197. [PMID: 29947150 PMCID: PMC6099229 DOI: 10.1002/gps.4919] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. METHODS Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. RESULTS One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. CONCLUSIONS Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
Collapse
Affiliation(s)
- Carole Fogg
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- School of Health Sciences and Social Work, Faculty of ScienceUniversity of PortsmouthPortsmouthUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter Griffiths
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Paul Meredith
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
| | - Jackie Bridges
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| |
Collapse
|
16
|
Ikegami C, Ota K. Development of a Self-Report Checklist to Assess Dementia Care by Nurses in Hospital Settings. Res Gerontol Nurs 2018; 11:91-102. [PMID: 29451934 DOI: 10.3928/19404921-20180131-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022]
Abstract
Nurses working at general hospitals face difficulties in providing dementia care. The current study examined aged care nurses' dementia care practices in the hospital setting and developed a dementia care checklist that nurses can use to review their own care practice. A self-administered questionnaire was given to 676 participants; responses were collected from 595 participants. Exploratory factor analysis identified six factors (e.g., patient understanding prompted by concern and interest for the patient, respect for patients' voluntary behavior, early detection of abnormalities) among the questionnaire's 28 items. This analysis provided a framework for the checklist and verified that it had satisfactory internal consistency and construct validity. The frequency of care practices varied with participants' knowledge of dementia care requirements, satisfaction with their own dementia care practice, confidence in their ability to judge patients' physical condition, and cooperation with colleagues. This checklist might improve dementia care in hospital settings. [Res Gerontol Nurs. 2018; 11(2):91-102.].
Collapse
|
17
|
Waters RA, Buchanan A. An exploration of person-centred concepts in human services: A thematic analysis of the literature. Health Policy 2017; 121:1031-1039. [DOI: 10.1016/j.healthpol.2017.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 06/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
|
18
|
Grealish L, Chaboyer W, Harbeck E, Edvardsson D. The person-centred care of older people with cognitive impairment in acute care (POPAC) scale - psychometric evaluation. J Nurs Manag 2016; 25:139-147. [PMID: 27873377 DOI: 10.1111/jonm.12451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2016] [Indexed: 11/29/2022]
Abstract
AIM To test the reliability and validity of the Person-centred care of Older People with cognitive impairment in Acute Care scale to determine nurses' perceptions of person-centred care. BACKGROUND One-third of older adults admitted to hospital are at risk of serious hospital-acquired complications such as falls, infections and pressure injuries because of cognitive impairment. These risks can be reduced through person-centred practices. The Person-centred care of Older People with cognitive impairment in Acute Care scale is a self-report staff instrument to explore the extent to which person-centred practices are undertaken; however psychometric testing is limited. METHODS A cross-sectional sample of acute care nurses (n = 240) in Queensland, Australia completing self-report questionnaires. Psychometric analyses of item performance, reliability and validity were conducted. RESULTS Item analysis revealed independent items. One item was removed due to negatively associating with the scale, improving total Cronbach's alpha from 0.76 to 0.84. The three original factors were maintained with regrouping of items. Confirmatory factor analysis confirmed the revised model. CONCLUSIONS The revised Person-centred care of Older People with cognitive impairment in Acute Care scale had satisfactory psychometric properties when used as a total scale. IMPLICATIONS FOR NURSING MANAGEMENT Scale brevity and simplicity together with rigorous development and testing indicates that the revised Person-centred care of Older People with cognitive impairment in Acute Care may be useful for quality improvement programmes into the care of older people in hospitals.
Collapse
Affiliation(s)
- Laurie Grealish
- Subacute and Aged Nursing, Menzies Health Institute Queensland, Griffith University & Gold Coast Health, Southport, Queensland, Australia
| | - Wendy Chaboyer
- NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Emma Harbeck
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - David Edvardsson
- La Trobe University/Austin Health/Northern Health Clinical Schools of Nursing, Melbourne, Victoria, Australia.,Department of Nursing, Umeå University, Sweden
| |
Collapse
|
19
|
Hafskjold L, Sundler AJ, Holmström IK, Sundling V, van Dulmen S, Eide H. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol. BMJ Open 2015; 5:e007864. [PMID: 25877282 PMCID: PMC4401848 DOI: 10.1136/bmjopen-2015-007864] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. METHODS AND ANALYSIS This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. ETHICS AND DISSEMINATION Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people.
Collapse
Affiliation(s)
- Linda Hafskjold
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Annelie J Sundler
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Vibeke Sundling
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - Sandra van Dulmen
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Eide
- Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| |
Collapse
|
20
|
Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Characteristics and Needs of Psychiatric Patients With Prolonged Hospital Stay. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:181-8. [PMID: 26174218 PMCID: PMC4459245 DOI: 10.1177/070674371506000405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds. METHODS This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed. RESULTS A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). CONCLUSIONS Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients.
Collapse
Affiliation(s)
- Marc Afilalo
- Associate Professor, Department of Medicine, McGill University, Montreal, Quebec; Director, Emergency Department, Jewish General Hospital, Montreal, Quebec
| | - Nathalie Soucy
- Clinical Research Associate, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Xiaoqing Xue
- Statistician, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Antoinette Colacone
- Research Coordinator, Emergency Department—Research Division, Jewish General Hospital, Montreal, Quebec
| | - Emmanuelle Jourdenais
- Director, Emergency Department, Centre Hospitalier de L’Université de Montréal, Notre-Dame Hospital, Montreal, Quebec
| | - Jean-François Boivin
- Professor, Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec
| |
Collapse
|
21
|
Afilalo M, Soucy N, Xue X, Colacone A, Jourdenais E, Boivin JF. Hospital stay on acute care units for non-acute reasons: Effects of patient pre-hospitalization and admission factors. Healthc Manage Forum 2015; 28:34-39. [PMID: 25838569 DOI: 10.1177/0840470414551906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identifies patient risk factors present prior to an acute hospitalization that are associated with occupying acute care beds for non-acute reasons on the 30th day of a hospitalization. Data from 952 adult patients were obtained, among which 333 (35%) were evaluated as non-acute on their 30th day. Inability to move in and out of the bed, cognitive impairment, receiving home or community healthcare services prior to hospitalization, unavailable family resources, a secondary diagnosis within the mental and behavioural category, and age ≥75 years were found to increase the risk of occupying acute care beds for non-acute reasons, while patients with a feeding tube were less likely to be non-acute at day 30.
Collapse
Affiliation(s)
- Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nathalie Soucy
- Emergency Department, Jewish General Hospital, Montreal, Quebec, Canada
| | - Xiaoqing Xue
- Emergency Department, Jewish General Hospital, Montreal, Quebec, Canada.
| | | | - Emmanuelle Jourdenais
- Emergency Department, CHUM Notre-Dame Hospital, University of Montreal, Montreal, Quebec, Canada
| | - Jean-François Boivin
- Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
22
|
Nilsson A, Lindkvist M, Rasmussen BH, Edvardsson D. Measuring levels of person-centeredness in acute care of older people with cognitive impairment: evaluation of the POPAC scale. BMC Health Serv Res 2013; 13:327. [PMID: 23958295 PMCID: PMC3751919 DOI: 10.1186/1472-6963-13-327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/13/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Person-centeredness is increasingly advocated in the literature as a gold-standard, best practice concept in health services for older people. This concept describes care that incorporates individual and multidimensional needs, personal biography, subjectivity and interpersonal relationships. However, acute in-patient hospital services have a long-standing biomedical tradition that may contrast with person-centred care. Since few tools exist that enable measurements of the extent to which acute in-patient hospital services are perceived as being person-centred, this study aimed to translate the English version of the Person-centred care of older people with cognitive impairment in acute care scale (POPAC) to Swedish, and evaluate its psychometric properties in a sample of acute hospital staff. METHODS The 15-item POPAC was translated, back-translated and culturally adjusted, and distributed to a cross-sectional sample of Swedish acute care staff (n = 293). Item performance was evaluated through assessment of item means, internal consistency by Cronbach's alpha on total and on subscale levels; temporal stability was assessed through Pearson's product correlation and intra-class correlation between test and retest scores. Confirmatory factor analysis was used to explore model fit. RESULTS The results indicate that the Swedish version POPAC provides a tentatively construct-valid and reliable contribution to measuring the extent to which acute in-patient hospital services have processes and procedures that can facilitate person-centred care of older patients with cognitive impairment. However, some questions remain regarding the dimensionality of POPAC. CONCLUSIONS POPAC provides a valuable contribution to the quest of improving acute care for older patients with cognitive impairment by enabling measures and subsequent accumulation of internationally comparable data for research and practice development purposes. POPAC can be used to highlight strengths and areas for improvements in care practice for older patients, and to illuminate aspects that risk being overlooked in busy acute hospital settings.
Collapse
Affiliation(s)
- Anita Nilsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | | | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| |
Collapse
|