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Armstrong L, Moir C, Taylor P. How, and under what contexts, do academic-practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol. BMJ Open 2023; 13:e077784. [PMID: 37879689 PMCID: PMC10603429 DOI: 10.1136/bmjopen-2023-077784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Internationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped with the skills and knowledge required to improve practice. Now, New Zealand and Australia are beginning to implement QI education into their nursing curricula. However, QI education is complex; comprising multiple components, each influenced by the contexts under which they are developed and implemented. Evaluation studies of QI education unanimously acknowledge that academic and practice partnerships (APPs) are essential to optimally embed QI into preregistration curricula, yet it is not understood how, and under what contexts, APPs collaborate to achieve this. METHODS AND ANALYSIS A realist review to determine how, and under what contexts, APPs collaborate to implement QI education in pre-registration nursing will be conducted using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards Guidelines. International stakeholders will be consulted at each stage which includes (1) clarifying the scope of the review through empirical literature and tacit expert knowledge, (2) searching for evidence in healthcare and social science databases/grey literature, (3) appraising studies using the Evidence for Policy and Practice Information and Co-ordinating Centre weight of evidence framework and extracting data using Standards for QUality Improvement Reporting Excellence in Education Publication Guidelines, (4) synthesising evidence and drawing conclusions through the creation of context, mechanism and outcome configurations and (5) disseminating findings through conferences and peer-reviewed publications. ETHICS AND DISSEMINATION Ethical approval was not required for this study. Findings will be disseminated to international nurse educators, leaders and front-line staff implementing QI education within their own academic and practice contexts through conferences and peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021282424.
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Affiliation(s)
| | - Chris Moir
- Centre for Post Graduate Nursing Studies, University of Otago, Dunedin, New Zealand
| | - Peta Taylor
- Department of Health Practice, Ara Institute of Canterbury Ltd, Christchurch, New Zealand
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da Silva RC, Cavalcante AMRZ, de Sá ES, Gondim MC, Santana AB, de Matos MA, Bachion MM, de Barros ALBL, Lopez KD, Swanson EA, Moorhead S. Evaluation of the effectiveness of nursing interventions in research from Brazilian postgraduation programs. Int J Nurs Knowl 2023; 34:325-339. [PMID: 36366820 DOI: 10.1111/2047-3095.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/07/2022] [Indexed: 10/12/2023]
Abstract
PURPOSE The purpose of this study was to evaluate research from Brazilian postgraduate students who provide evidence of effectiveness for Nursing Interventions Classification (NIC). METHODS We conducted a literature review study of thesis and dissertations available in the Brazilian Digital Library of Dissertations and Theses (D/T) in May 2021 regardless of the year they were conducted. In those studies that did not utilize the NIC in the effectiveness evaluation, the cross-mapping methodology was employed between NIC and the interventions used by the authors of the studies. RESULTS Using a systematic process, we identified 91 studies. Twenty-seven met a priori inclusion and exclusion criteria. We found an increase in studies that focused on nursing interventions in the last 10 years (n = 19), a large proportion of clinical trials (n = 16), and the majority of articles from the Southeast region of Brazil (n = 20). The areas of focus were adult and elderly care, and with a special interest in the behavioral domain (n = 11). Two sensitivity criteria were identified in all D/T (n = 27), and each study presented evidence of effectiveness of a minimum of three criteria simultaneously. CONCLUSIONS Based on the effectiveness criteria, the Brazilian scientific production in postgraduate programs carried out by nurses provides evidence of the effectiveness for NIC nursing interventions. IMPLICATIONS FOR NURSING PRACTICE It is recommended to conduct further research that uses the NIC in the planning, conduct, and evaluation of interventions, based on effectiveness criteria of nursing sensitivity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karen Dunn Lopez
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | | | - Sue Moorhead
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Martini D, Noordegraaf M, Schoonhoven L, Lalleman P. Leadership moments: Understanding nurse clinician-scientists' leadership as embedded sociohistorical practices. Nurs Inq 2023; 30:e12580. [PMID: 37420320 DOI: 10.1111/nin.12580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/09/2023]
Abstract
Nurse clinician-scientists are increasingly expected to show leadership aimed at transforming healthcare. However, research on nurse clinician-scientists' leadership (integrating researcher and practitioner roles) is scarce and hardly embedded in sociohistorical contexts. This study introduces leadership moments, that is, concrete events in practices that are perceived as acts of empowerment, in order to understand leadership in the daily work of newly appointed nurse clinician-scientists. Following the learning history method we gathered data using multiple (qualitative) methods to get close to their daily practices. A document analysis provided us with insight into the history of nursing science to illustrate how leadership moments in the everyday work of nurse clinician-scientists in the "here and now" can be related to the particular histories from which they emerged. A qualitative analysis led to three acts of empowerment: (1) becoming visible, (2) building networks, and (3) getting wired in. These acts are illustrated with three series of events in which nurse clinician-scientists' leadership becomes visible. This study contributes to a more socially embedded understanding of nursing leadership, enables us to get a grip on crucial leadership moments, and provides academic and practical starting points for strengthening nurse clinician-scientists' leadership practices. Transformations in healthcare call for transformed notions of leadership.
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Affiliation(s)
- Dieke Martini
- Research Group for Person-Centeredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mirko Noordegraaf
- Utrecht School of Governance, Utrecht University, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pieterbas Lalleman
- Research Group for Person-Centeredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands
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Nilsen P, Thor J, Bender M, Leeman J, Andersson-Gäre B, Sevdalis N. Bridging the Silos: A Comparative Analysis of Implementation Science and Improvement Science. FRONTIERS IN HEALTH SERVICES 2022; 1:817750. [PMID: 36926490 PMCID: PMC10012801 DOI: 10.3389/frhs.2021.817750] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Background Implementation science and improvement science have similar goals of improving health care services for better patient and population outcomes, yet historically there has been limited exchange between the two fields. Implementation science was born out of the recognition that research findings and effective practices should be more systematically disseminated and applied in various settings to achieve improved health and welfare of populations. Improvement science has grown out of the wider quality improvement movement, but a fundamental difference between quality improvement and improvement science is that the former generates knowledge for local improvement, whereas the latter is aimed at producing generalizable scientific knowledge. Objectives The first objective of this paper is to characterise and contrast implementation science and improvement science. The second objective, building on the first, is to highlight aspects of improvement science that potentially could inform implementation science and vice versa. Methods We used a critical literature review approach. Search methods included systematic literature searches in PubMed, CINAHL, and PsycINFO until October 2021; reviewing references in identified articles and books; and the authors' own cross-disciplinary knowledge of key literature. Findings The comparative analysis of the fields of implementation science and improvement science centred on six categories: (1) influences; (2) ontology, epistemology and methodology; (3) identified problem; (4) potential solutions; (5) analytical tools; and (6) knowledge production and use. The two fields have different origins and draw mostly on different sources of knowledge, but they have a shared goal of using scientific methods to understand and explain how health care services can be improved for their users. Both describe problems in terms of a gap or chasm between current and optimal care delivery and consider similar strategies to address the problems. Both apply a range of analytical tools to analyse problems and facilitate appropriate solutions. Conclusions Implementation science and improvement science have similar endpoints but different starting points and academic perspectives. To bridge the silos between the fields, increased collaboration between implementation and improvement scholars will help to clarify the differences and connections between the science and practice of improvement, to expand scientific application of quality improvement tools, to further address contextual influences on implementation and improvement efforts, and to share and use theory to support strategy development, delivery and evaluation.
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Affiliation(s)
- Per Nilsen
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Thor
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Miriam Bender
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Boel Andersson-Gäre
- Jönköping University, Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden
| | - Nick Sevdalis
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, United Kingdom
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da Silva RC, Gondim MC, Cavalcante AMRZ, Bachion MM, da Silva VM, de Oliveira Lopes MV. Ineffective health management: A systematic review and meta-analysis of related factors. J Nurs Scholarsh 2021; 54:376-387. [PMID: 34811891 DOI: 10.1111/jnu.12747] [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: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A standardized language system can support the elaboration of clinical guidelines by matching information from similar patterns of response to people. To identify the factors that are related to a higher likelihood of an ineffective health management nursing diagnosis. METHODS We conduct a systematic review and meta-analysis. An electronic search was conducted in MEDLINE databases via PubMed, Web of Science, SciELO, CINAHL, SCOPUS, and Embase between October and November 2020. Descriptive data were extracted from each article. The odds ratios for each etiological factor related to ineffective health management were directly extracted from the articles or calculated from the data described in the articles. The analysis of the measurements of exposure and the magnitude of the effect was performed using the statistical software R, and a forest plot was constructed for each etiological factor. FINDINGS Ten studies were included, and 15 related factors were recovered from the primary studies. The factors that significantly increased the likelihood of an ineffective health management nursing diagnosis were insufficient knowledge of the therapeutic regimen, perceived barriers, powerlessness, economic disadvantage, and difficulty managing complex treatment regimens. No effect was verified with the following factors: decision conflict, family pattern of healthcare, and inadequate number of cues to action. CONCLUSION Factors related to a higher likelihood of ineffective health management may be the focus of early and targeted nursing interventions, contributing to an improved quality of care. CLINICAL RELEVANCE Understanding exposure to these factors can improve diagnostic reasoning at different population levels.
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Kranz C, Macali J, Phengphoo S, Schvaneveldt N, Patterson B, Guo JW. Game-Based Quality Improvement Teaching: Using Taters in Nursing Education. J Nurs Educ 2021; 60:590-593. [PMID: 34605680 DOI: 10.3928/01484834-20210730-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Quality improvement (QI) is difficult to teach in the classroom; therefore, nursing students are often under-prepared to participate in such projects after graduation. The Plan-Do-Study-Act method is commonplace in QI instruction and is often used in nursing. This study proposed and evaluated a gameful learning approach to improve understanding and engagement of a QI process using Potato Head figures. METHOD An observational design was utilized. Following classroom activity, students self-selected to join focus groups to discuss gameful learning experiences in learning QI techniques. Transcripts were analyzed using thematic analysis. RESULTS Overall, learners found the activity was effective in teaching QI. Positive and negative themes were identified, including fun and competitive, interactive and communication, and teamwork; disconnection between QI topic and game, and unclear instruction, respectively. CONCLUSION Using gameful learning helped students understand and engage with QI projects that may translate to clinical practice for new graduate nurses. [J Nurs Educ. 2021;60(10):590-593.].
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Cassidy CE, Flynn R, Shuman CJ. Preparing Nursing Contexts for Evidence-Based Practice Implementation: Where Should We Go From Here? Worldviews Evid Based Nurs 2021; 18:102-110. [PMID: 33493388 DOI: 10.1111/wvn.12487] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Context is important to the adoption and sustainability of evidence-based practices (EBPs). Currently, most published implementation efforts address context in relation to one specific EBP or a bundle of related EBPs. Since EBP and implementation are ongoing and dynamic, more discussion is needed on preparing nursing contexts to be more conducive to implementation generally. AIM To discuss the need to create contexts that are more adaptable to ongoing change due to the dynamic nature of EBPs and the ever-changing healthcare environment. METHODS This paper builds on a collection of our previous work, as nursing implementation scientists representing the Canadian and American healthcare contexts, and a literature review of the implementation science, knowledge translation, and sustainability literatures from 2006 to 2019. RESULTS We argue for a different way of thinking about the influence of context and implementation of EBPs. We contend that nursing contexts must be prepared to be more flexible and conducive to ongoing EBP implementation more generally. Contexts that embrace, facilitate, and have the capacity for change may be more likely to effectively de-implement ineffective interventions or implement and sustain new EBPs. We outline future directions to build a program of research on preparing the soil for implementation of EBPs, including building capacity among nurses, supporting organizations to embrace change, co-producing research evidence, and contributing to implementation science. LINKING EVIDENCE TO ACTION Supporting contexts to adopt and sustain evidence in nursing practice is essential for bridging the evidence to practice gap and improving outcomes for patients, clinicians, and the health system. Moving forward, we need to develop a better understanding of how to create contexts that embrace change prior to the implementation of EBPs in order sustain improvements to patient and health system outcomes.
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Affiliation(s)
| | - Rachel Flynn
- WCHRI, University of Alberta, Edmonton, AB, Canada.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Child Health Evaluative Sciences and Centre for Nursing Research, The Hospital for Sick Children, Toronto, ON, Canada
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Managerial Strategies for Long-Term Care Organization Professionals: COVID-19 Pandemic Impacts. SUSTAINABILITY 2020. [DOI: 10.3390/su12229682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper aims to analyze the strategies that healthcare professionals have adopted during the coronavirus pandemic (COVID-19) in long-term care organizations in Rio de Janeiro city, Brazil, by investigating their competencies—mainly managerial ones. To reach its goals, this paper performs empirical research and theoretical research. For the empirical research, the plans of professionals during COVID-19 pandemic in long-term care organizations are observed, and a questionnaire is applied to analyze observed data integrity. The data are analyzed through the Python and IBM SPSS Statistic programming languages, and descriptive analyses use descriptive statistic proportions, rates, minimum, maximum, mean, median, standard deviation, and coefficient of variation (CV). A non-parametric approach performs repeated measure comparisons using Wilcoxon’s test, while the McNemmar test is used to repeat the categorical variables. Statistical significance is assumed at the 5% level. For the theoretical research, a literature review is developed using scientific databases. The results show that for the searched period, the number of deaths and the number of people infected by COVID-19 in these organizations are low when compared to general statistics of Rio de Janeiro city. This paper concludes that these strategical adoptions have brought significant benefits to long-term care organizations, and it might motivate researchers to develop future studies related to long-term care organizations, helping to fill the literature gap on the subject.
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Jean E, Sevilla Guerra S, Contandriopoulos D, Perroux M, Kilpatrick K, Zabalegui A. Context and implementation of advanced nursing practice in two countries: An exploratory qualitative comparative study. Nurs Outlook 2019; 67:365-380. [DOI: 10.1016/j.outlook.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 01/09/2019] [Accepted: 02/02/2019] [Indexed: 11/15/2022]
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10
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Reducing RN Vacancy Rate. J Nurs Adm 2018; 48:316-322. [DOI: 10.1097/nna.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Granero-Molina J, Fernández-Sola C, Mateo-Aguilar E, Aranda-Torres C, Román-López P, Hernández-Padilla JM. Fundamental care and knowledge interests: Implications for nursing science. J Clin Nurs 2018; 27:2489-2495. [PMID: 29119685 DOI: 10.1111/jocn.14159] [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] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To characterise the intratheoretical interests of knowledge in nursing science as an epistemological framework for fundamental care. BACKGROUND For Jürgen Habermas, theory does not separate knowledge interests from life. All knowledge, understanding and human research is always interested. Habermas formulated the knowledge interests in empirical-analytical, historical-hermeneutic and critical social sciences; but said nothing about health sciences and nursing science. DESIGN Discursive paper. RESULTS The article is organised into five sections that develop our argument about the implications of the Habermasian intratheoretical interests in nursing science and fundamental care: the persistence of a technical interest, the predominance of a practical interest, the importance of an emancipatory interest, "being there" to understand individuals' experience and an "existential crisis" that uncovers the individual's subjectivity. CONCLUSIONS The nursing discipline can take on practical and emancipatory interests (together with a technical interest) as its fundamental knowledge interests. Nurses' privileged position in the delivery of fundamental care gives them the opportunity to gain a deep understanding of the patient's experience and illness process through physical contact and empathic communication. RELEVANCE TO CLINICAL PRACTICE AND NURSING RESEARCH In clinical, academic and research environments, nurses should highlight the importance of fundamental care, showcasing the value of practical and emancipatory knowledge. This process could help to improve nursing science's leadership, social visibility and idiosyncrasy.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Ester Mateo-Aguilar
- Escuela Superior de Ciencias de la Salud Tecnocampus. Centro adscrito a la Universidad Pompeu Fabra, Barcelona, Spain
| | | | - Pablo Román-López
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
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Casey M, O'Connor L, Nicholson E, Smith R, O'Brien D, O'Leary D, Fealy GM, Mcnamara MS, Stokes D, Egan C. The perceptions of key stakeholders of the roles of specialist and advanced nursing and midwifery practitioners. J Adv Nurs 2017; 73:3007-3016. [DOI: 10.1111/jan.13359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mary Casey
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Laserina O'Connor
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Emma Nicholson
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Rita Smith
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Denise O'Brien
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Denise O'Leary
- School of Hospitality Management and Tourism; Dublin Institute of Technology; Dublin Ireland
| | - Gerard M Fealy
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | - Martin S Mcnamara
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
| | | | - Claire Egan
- School of Nursing, Midwifery & Health Systems; University College Dublin; Belfield Dublin Ireland
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Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment. Arch Orthop Trauma Surg 2017; 137:507-515. [PMID: 28233062 DOI: 10.1007/s00402-017-2646-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course. METHODS We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course. RESULTS The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001). CONCLUSIONS After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.
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