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Gormley E, Connolly M, Ryder M. The development of nursing-sensitive indicators: A critical discussion. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100227. [PMID: 39188551 PMCID: PMC11345314 DOI: 10.1016/j.ijnsa.2024.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/17/2024] [Accepted: 07/20/2024] [Indexed: 08/28/2024] Open
Abstract
Discussion arguments In a science-based profession, nurses must continuously monitor and evaluate the effectiveness of their care. However, data on what constitutes nursing care in practice and the delivery process is lacking. Insufficient evidence on how nurses contribute to patient care hampers the evaluation of nursing practice.We discuss nursing-sensitive indicators, their origins, current applications, and challenges related to their use in evaluating the quality of nursing care. We analyse nursing-sensitive indicators in the context of criticisms levelled at the profession related to the lack of evidence to support their value in the larger healthcare environment. Conclusions We have a disjointed approach to evaluating nursing care. Current systems designed to monitor nursing care, such as metrics and data sets, are not adequate or effective for comprehensively evaluating nursing care, considering the fundamentals and values of the nursing profession.
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Affiliation(s)
- Edel Gormley
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Connolly
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Education & Research Centre Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Mary Ryder
- University College Dublin (UCD) School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Cremer S, de Man-van Ginkel JM, Zwakhalen SMG, Willems J, Metzelthin SF, Veenstra MY, Bleijlevens MHC. The struggle is real-A mixed qualitative methods synthesis of challenges in nursing care in activities of daily living. J Nurs Scholarsh 2023; 55:1092-1105. [PMID: 37278376 DOI: 10.1111/jnu.12921] [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] [Received: 02/01/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Supporting care receivers in Activities of Daily Living (ADL), irrespective of diagnosis, setting, or cultural background, lies at the heart of fundamental nursing care. The pursuit of quality ADL care becomes increasingly challenging with the changing complexity of care needs. ADL care delivery is often undervalued and is considered a low-status task despite its crucial importance to care receivers. This study aims to synthesize challenges in ADL care irrespective of the care setting. METHODS In the mixed qualitative methods study, we used expert panel consultations, world café sessions, and a rapid literature review. For data analysis, we simultaneously analyzed the three data sets using inductive and deductive inquiry. RESULTS We identified four challenges and their corresponding subthemes. They are (1) Undervalued common-sense work versus complex, high-skilled care provision; (2) Limitations in professional reflective clinical decision-making; (3) Missed opportunities for shared ADL decisions; and (4) Meeting ADL care needs in a high-throughput system. CONCLUSION These challenges reveal the complexity of ADL care and how its paradoxical narrative relates to the conditions in which nursing professionals struggle to create opportunities, for reflective clinical reasoning and shared ADL decisions, by facing organizational and environmental barriers. CLINICAL RELEVANCE This study is relevant to nursing professionals, care organizations, policymakers, and researchers aiming to improve ADL care and provide insights into challenges in ADL care. This study forms the starting point for a changing narrative on ADL nursing care and subsequent quality improvements in the form of, for example, guidelines for nursing professionals.
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Affiliation(s)
- Svenja Cremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Janneke M de Man-van Ginkel
- Department of Gerontology and Geriatrics, Nursing Science, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sandra M G Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Jules Willems
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Silke F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Marja Y Veenstra
- Department of Psychiatry & Neuropsychology, Alzheimer Center Limburg
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
- Burgerkracht Limburg, Sittard, The Netherlands
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Trundle C, Phillips T. Defining focused ethnography: Disciplinary boundary-work and the imagined divisions between 'focused' and 'traditional' ethnography in health research - A critical review. Soc Sci Med 2023; 332:116108. [PMID: 37531908 DOI: 10.1016/j.socscimed.2023.116108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
This article offers the first critical review of focused ethnography, an increasingly popular research method across health disciplines. Focused ethnographers, we argue, exemplify the practice of methodological boundary work, defining their method in contrast to the 'traditional' ethnographic approach of anthropology and sociology. To examine this boundary work, we collected two samples of health research articles published over the last decade and compared how focused ethnographers and medical anthropologists described, justified, and practised ethnography. We found that the core characteristics most often asserted to differentiate focused ethnography from conventional ethnography were: a more limited study timeframe and scope; a limited subpopulation sample; more concentrated research questions; the inclusion of insider researchers; and more orientation towards applied results. We show, however, that these are imagined binaries that fail to map onto actual differences of practice in the two samples and which obscure many similarities between them. By contrast, we identified four alternative differences between the two methods of ethnography. These centre on understandings of 'research time'; the very meaning of ethnography; the relationship of researchers to 'data'; and the presumed best method of social intervention. We therefore define focused ethnography as a versatile method of ethnography that attends to specific epistemological expectations within the health sciences regarding valid proof and empirical description, the boundaries of research, the nature of research relationships, and the duty to improve biomedicine. Ultimately, our study highlights that methodological boundary-work matters, because assumed differences and unexpressed misunderstandings can prevent productive dialogue and fruitful collaboration between disciplines to address pressing health problems.
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Cabañas Cob A, Apellaniz Aparicio B, Santa Palao G, Pardo Chacón C, Larena Grijalba P, Fabado Martínez P. [Health and social care in an urban nursing home providing healthcare services and primary care's role: A qualitative study with residents, relatives and professionals]. Aten Primaria 2023; 55:102529. [PMID: 36565598 PMCID: PMC9798115 DOI: 10.1016/j.aprim.2022.102529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/26/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
AIM To identify the elements involved in adequate health and social care for old people living in nursing homes, determine their possible barriers and enablers and define primary care's role in it. DESIGN Qualitative study with phenomenological approach. SETTING State funded private nursing home and its corresponding primary care center in the southeastern urban area of Madrid. PARTICIPANTS Elderly residents, their relatives, and professionals from the nursing home and the primary care center. METHOD Five focus groups were conducted between November 2019 and January 2020, with semi-structured interviews based on the variables of analysis and themes related to the objectives. The sessions were recorded and transcribed. An open and axial coding was performed to identify categories after a triangulation of the data. RESULTS The elements of adequate care identified are individualized care, promotion of autonomy, adequate information to residents and relatives, quality of services, coordination between professionals, and a continuous end of life care. The main barriers are the deficit of professionals, the differences in expectations between users and workers, and the organizational gap between the healthcare system and nursing homes providing healthcare services. The role identified for primary care is mostly bureaucratic. CONCLUSIONS It is necessary to continue exploring these elements and to outline the role of primary care in nursing homes with different characteristics.
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Coman R, Caponecchia C. Optimizing aged care environments to promote resident functional mobility and reduce staff injury risk. FRONTIERS IN AGING 2023; 4:1157829. [PMID: 37090486 PMCID: PMC10117947 DOI: 10.3389/fragi.2023.1157829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023]
Abstract
Introduction: This study aimed to evaluate the suitability and usability of the Pro-Mobility patient/person handling assessment tool (ProMob) within residential aged care. Physiological changes associated with ageing influence an older person's ability to perform functional mobility tasks such as transferring from furniture and walking. Strategies that improve capability and/or reduce the physical demands of the task have the potential to promote an older person's mobility, independence and wellbeing. Environment-related strategies in Manual Handling of People (MHP), such as optimum seated heights, in part address this challenge, as they can promote resident functional mobility while also protecting staff from injury. The ProMob tool was developed to address this issue through systematic evaluation of these environmental factors. Methods: The participants in this study were seven (7) residential aged care facilities (RACFs) operated by a not-for-profit aged care organization. A qualified assessor evaluated MHP risk management with the ProMob tool at each RACF through collection of data for a random sample of residents (n = 67) regarding their living environments and available mobility information. Data was transferred to an SPSS-22 statistical software database for analysis which involved descriptive statistics and cross tabulations. Results: Application of the ProMob tool provided effective quantification of the nature and extent of environment-related MHP interventions that may influence resident mobility. Areas for improvement with MHP risk management were identified, with variation evident across RACF's within the same organisation, which was not consistent with levels of care (e.g., lack of clear space to facilitate mobility). Low level care facilities were observed to have fewer adaptive environmental features that could potentially slow decline in independence. Discussion: Features of the aged care environment can be used to facilitate the functional mobility of aged care residents, and simultaneously reduce injury risk for staff in MHP interactions. The ProMob tool can be used for auditing care facilities, planning re-development, and continual improvement in provision of care and management of staff injury risk exposure.
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Affiliation(s)
- Robyn Coman
- Occupational Health and Safety (OHS) Academic Program, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
- *Correspondence: Robyn Coman,
| | - Carlo Caponecchia
- School of Aviation, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
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Cranley LA, Yeung L, Tu W, McGillis Hall L. Healthcare aide involvement in team decision‐making in long‐term care: A narrative review of the literature. J Clin Nurs 2022. [DOI: 10.1111/jocn.16573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Lisa A. Cranley
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
| | - Lily Yeung
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
| | - Wendy Tu
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
- Home and Community Care Support Services Newmarket Ontario Canada
| | - Linda McGillis Hall
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto Ontario Canada
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Narsakka N, Suhonen R, Stolt M. Environment in institutional care settings as a promoting factor for older individuals' mobility: A systematic review. Scand J Caring Sci 2021; 36:382-392. [PMID: 34893995 PMCID: PMC9300114 DOI: 10.1111/scs.13053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/05/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Background Mobility is important for health and well‐being; however, older individuals in institutional care settings are relatively sedentary. The environment has an increased influence on mobility in older age due to changes in individual functioning; thus, environmental mobility support solutions for this population are needed. Objectives The aim of this systematic review was to identify elements of the environment that have been used in the content and delivery of interventions to promote mobility and to assess the effects of these interventions on mobility outcomes. Design A systematic literature search was conducted using CINAHL and MEDLINE from the earliest date through 30 September 2020 for randomised controlled trials, quasi‐experimental and pre‐post design studies. Inclusion and critical appraisal of articles were conducted by two independent researchers. Data were extracted and synthesised. Setting and participants Studies were included if they had employed some element of the environment in the content and/or delivery of the intervention and had assessed mobility‐related outcomes of older individuals in institutional long‐term care settings providing full‐time care. Measures Studies were included if they reported data on mobility‐related outcomes including aspects of physical activity, physical function, life space and functional autonomy. Results Eight studies were included. Physical, social and symbolic elements of the environment were utilised in the interventions. Positive effects on mobility outcomes were reported in exercise interventions utilising environmental elements mostly as supportive components. Conclusions and implications Empirical evidence about effective mobility interventions employing elements of the environment as main intervention components is lacking. A serious dilemma exists about the need for older individuals’ independence and mobile/active late life and the lack of support for such initiatives in long‐term care. Given the emphasised relationship of the environment and mobility with age due to changes in functioning, environmental solutions require further examination.
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Affiliation(s)
- Noora Narsakka
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital and City of Turku Welfare Division, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
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Pentecost C, Frost J, Sugg HVR, Hilli A, Goodwin VA, Richards DA. Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis. J Clin Nurs 2019; 29:1858-1882. [PMID: 31661591 PMCID: PMC7319357 DOI: 10.1111/jocn.15082] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/07/2019] [Accepted: 08/24/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene. BACKGROUND The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention. METHODS Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2). RESULTS We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. CONCLUSIONS To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. RELEVANCE TO CLINICAL PRACTICE More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's experience. Nursing interventions should include effective nurse leadership and nurse-patient collaboration and a focus on fundamental care by the host organisation.
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Affiliation(s)
- Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Holly V R Sugg
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Angelique Hilli
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - David A Richards
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Nurses and nursing assistants decision-making regarding use of safe patient handling and mobility technology: A qualitative study. Appl Nurs Res 2018; 39:141-147. [DOI: 10.1016/j.apnr.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/19/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022]
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Gattinger H, Senn B, Hantikainen V, Köpke S, Ott S, Leino-Kilpi H. Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale. BMC Nurs 2017; 16:67. [PMID: 29200963 PMCID: PMC5697076 DOI: 10.1186/s12912-017-0257-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care. METHODS The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015. RESULTS The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted. CONCLUSION The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.
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Affiliation(s)
- Heidrun Gattinger
- Finnish Doctoral Programme in Nursing Science, Department of Nursing Science, University of Turku, Turku, Finland
- Institute of Applied Nursing Sciences, University of Applied Sciences FHS St. Gallen, Rosenbergstrasse 59, Postfach, 9001 St. Gallen, Switzerland
| | - Beate Senn
- Institute of Applied Nursing Sciences, University of Applied Sciences FHS St.Gallen, St. Gallen, Switzerland
- Research Affiliate Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Virpi Hantikainen
- Adjunct Professor Department of Nursing Science, University of Turku, Turku, Finland
- Research Affiliate Institute of Applied Nursing Sciences, University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Stefan Ott
- University of Applied Sciences FHS St. Gallen, St. Gallen, Switzerland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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Hang JA, Francis-Coad J, Burro B, Nobre D, Hill AM. Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting. Geriatr Nurs 2016; 37:464-469. [DOI: 10.1016/j.gerinurse.2016.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 06/21/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022]
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Patterson C, Procter N, Toffoli L. Situation awareness: when nurses decide to admit or not admit a person with mental illness as an involuntary patient. J Adv Nurs 2016; 72:2042-53. [DOI: 10.1111/jan.13024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 12/19/2022]
Affiliation(s)
| | - Nicholas Procter
- University of South Australia; Adelaide South Australia Australia
| | - Luisa Toffoli
- University of South Australia; Adelaide South Australia Australia
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Taylor J, Barker A, Hill H, Haines TP. Improving person-centered mobility care in nursing homes: A feasibility study. Geriatr Nurs 2015; 36:98-105. [DOI: 10.1016/j.gerinurse.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 11/16/2022]
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