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Adsett JA, McRae PJ, Mudge AM. Staff-Perceived Barriers to Patient Mobilization Vary by Hospital, Discipline, and Experience: A Multisite Cross-Sectional Survey. Arch Phys Med Rehabil 2024:S0003-9993(24)01254-1. [PMID: 39332514 DOI: 10.1016/j.apmr.2024.09.004] [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: 07/22/2024] [Revised: 09/08/2024] [Accepted: 09/11/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVE To describe staff-perceived barriers to progressive patient mobilization. DESIGN Cross-sectional staff survey. SETTING Ten internal medicine wards in 4 hospitals in a large health service. PARTICIPANTS Nursing, medical, and allied health staff (n=208). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Mobilization Attitudes and Beliefs Survey. An overall barriers score and subscale scores for knowledge, attitudes, and behaviors were calculated and compared between hospitals, discipline, and years of clinical experience. RESULTS The survey was completed by 208 participants (123 nurses, 27 medical, 58 allied health), of whom 104 (50%) had <5 years of experience. The greatest perceived barriers included nursing workload, medical orders not being in place, and patient and family resistance to mobilization. Overall barrier scores differed between hospitals, discipline (mean nursing score ± SD 50±7; mean medical score ± SD, 51±7; mean allied health score ± SD, 43±7), and years of clinical experience (<5y mean score ± SD, 50±7; 5-9y mean score ± SD, 47±7; ≥10y mean score ± SD, 46±8); significant differences by hospital and discipline persisted in multivariate analysis. The behavior subscale had the highest barriers score and knowledge the lowest across all subgroups. CONCLUSIONS Staff-perceived nursing workload, lack of medical orders, and patient and family resistance to be the greatest barriers to patient mobilization. Barrier scores differed between disciplines, experience levels, and across hospitals within a single health service. Lower scores on the knowledge subscale highlight the need for multicomponent strategies beyond education that address culture and systems; education may particularly benefit medical staff.
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Affiliation(s)
- Julie A Adsett
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia.
| | - Prue J McRae
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
| | - Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia
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Crowe C, Naughton C, de Foubert M, Cummins H, McCullagh R, Skelton DA, Dahly D, Palmer B, O'Flynn B, Tedesco S. Treatment effect analysis of the Frailty Care Bundle (FCB) in a cohort of patients in acute care settings. Aging Clin Exp Res 2024; 36:187. [PMID: 39254891 PMCID: PMC11387438 DOI: 10.1007/s40520-024-02840-5] [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: 02/11/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE The aim of this study is to explore the feasibility of using machine learning approaches to objectively differentiate the mobilization patterns, measured via accelerometer sensors, of patients pre- and post-intervention. METHODS The intervention tested the implementation of a Frailty Care Bundle to improve mobilization, nutrition and cognition in older orthopedic patients. The study recruited 120 participants, a sub-group analysis was undertaken on 113 patients with accelerometer data (57 pre-intervention and 56 post-intervention), the median age was 78 years and the majority were female. Physical activity data from an ankle-worn accelerometer (StepWatch 4) was collected for each patient during their hospital stay. These data contained daily aggregated gait variables. Data preprocessing included the standardization of step counts and feature computation. Subsequently, a binary classification model was trained. A systematic hyperparameter optimization approach was applied, and feature selection was performed. Two classifier models, logistic regression and Random Forest, were investigated and Shapley values were used to explain model predictions. RESULTS The Random Forest classifier demonstrated an average balanced accuracy of 82.3% (± 1.7%) during training and 74.7% (± 8.2%) for the test set. In comparison, the logistic regression classifier achieved a training accuracy of 79.7% (± 1.9%) and a test accuracy of 77.6% (± 5.5%). The logistic regression model demonstrated less overfitting compared to the Random Forest model and better performance on the hold-out test set. Stride length was consistently chosen as a key feature in all iterations for both models, along with features related to stride velocity, gait speed, and Lyapunov exponent, indicating their significance in the classification. CONCLUSION The best performing classifier was able to distinguish between patients pre- and post-intervention with greater than 75% accuracy. The intervention showed a correlation with higher gait speed and reduced stride length. However, the question of whether these alterations are part of an adaptive process that leads to improved outcomes over time remains.
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Affiliation(s)
- Colum Crowe
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parad, T12R5CP, Cork, Ireland
| | - Corina Naughton
- School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland
| | | | - Helen Cummins
- School of Nursing and Midwifery, University College Cork, Cork, T12 AK54, Ireland
| | - Ruth McCullagh
- School of Clinical Therapies, University College Cork, Cork, T12 AK54, Ireland
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - Darren Dahly
- HRB Clinical Research Facility-UCC, and School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Brendan Palmer
- HRB Clinical Research Facility-UCC, and School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Brendan O'Flynn
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parad, T12R5CP, Cork, Ireland
| | - Salvatore Tedesco
- Tyndall National Institute, University College Cork, Lee Maltings Complex, Dyke Parad, T12R5CP, Cork, Ireland.
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Foley MP, Westby D, Walsh SR. Systematic Review and Meta-analysis of the Impact of Surgeon-Physician Co-management Models on Short Term Outcomes for Vascular Surgery Inpatients. Eur J Vasc Endovasc Surg 2024; 68:336-345. [PMID: 38735522 DOI: 10.1016/j.ejvs.2024.05.005] [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: 08/15/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE As the population ages, vascular surgeons are treating progressively older, multimorbid patients at risk of peri-operative complications. An embedded physician has been shown to improve outcomes in general and orthopaedic surgery. This systematic review and meta-analysis aimed to investigate the impact of surgeon-physician co-management models on morbidity and mortality rates in vascular inpatients. DATA SOURCES PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries. REVIEW METHODS Studies comparing adult vascular surgery inpatients under co-management with standard of care were eligible. The relative risks (RRs) of death, medical complications, and 30 day re-admission between co-management and standard care were calculated. The effect of co-management on the mean length of stay was calculated using weighted means. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies, and certainty assessment with the GRADE analysis tools. RESULTS No randomised controlled trials were identified. Eight single institution studies between 2011 and 2020 with 7 410 patients were included. All studies were observational using before-after methodology. Studies were of high to moderate risk of bias, and outcomes were of very low GRADE certainty of evidence. Co-management was associated with a statistically significant lower relative risk of death (RR 0.64, 95% confidence interval [CI] 0.44 - 0.92; p = .02), cardiac complications (RR 0.47, 95% CI 0.25 - 0.87; p = .02), and infective complications (RR 0.49, 95% CI 0.35 - 0.67; p < .001) in vascular inpatients. No statistically significant differences in length of stay (standard mean difference -0.6 days, 95% CI -1.44 - 0.24 days; p = .16) and 30 day re-admission (RR 0.96, 95% CI 0.84 - 1.08; p = .49) were noted. CONCLUSION Early results of physician and surgeon co-management for vascular surgery inpatients showed promising results from very low certainty data. Further well designed, prospective studies are needed to determine how to maximise the impact of physicians within a vascular service to improve patient outcomes while using hospital resources effectively.
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Affiliation(s)
- Megan Power Foley
- University College Hospital Galway, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
| | | | - Stewart R Walsh
- University College Hospital Galway, Galway, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland; Lambe Institute of Translational Research, University of Galway, Galway, Ireland; National Surgical Research Support Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Young AM, Byrnes A, Mahoney D, Power G, Cahill M, Heaton S, McRae P, Mudge A, Miller E. Exploring hospital mealtime experiences of older inpatients, caregivers and staff using photovoice methods. J Clin Nurs 2024; 33:1906-1920. [PMID: 38284486 DOI: 10.1111/jocn.17009] [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: 10/13/2023] [Revised: 12/05/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIM To gather and understand the experience of hospital mealtimes from the perspectives of those receiving and delivering mealtime care (older inpatients, caregivers and staff) using photovoice methods to identify touchpoints and themes to inform the co-design of new mealtime interventions. METHODS This study was undertaken on acute care wards within a single metropolitan hospital in Brisbane, Australia in 2019. Photovoice methods involved a researcher accompanying 21 participants (10 older patients, 5 caregivers, 4 nurses and 2 food service officers) during a mealtime and documenting meaningful elements using photographs and field notes. Photo-elicitation interviews were then undertaken with participants to gain insight into their experience. Data were analysed using inductive thematic analysis, involving a multidisciplinary research team including a consumer. RESULTS Themes were identified across the three touchpoints: (1) preparing for the meal (the juggle, the anticipation), (2) delivering/receiving the meal (the rush, the clutter and the wait) and (3) experiencing the meal (the ideal, pulled away and acceptance). Despite a shared understanding of the importance of meals and shared vision of 'the ideal' mealtime, generally this was a time of tension, missed cares and dissatisfaction for staff, patients and caregivers. There was stark contrast in some aspects of mealtime experience, with simultaneous experiences of 'the rush' (staff) and 'the wait' (patients and caregivers). There was an overwhelming sense of acceptance and lack of control over change from all. CONCLUSIONS This study identified themes during hospital mealtimes which have largely gone unaddressed in the design of mealtime interventions to date. This research may provide a framework to inform the future co-design of mealtime interventions involving patients, caregivers and multidisciplinary staff, centred around these key touchpoints. PRACTICE IMPLICATIONS Mealtimes are experienced differently by patients, caregivers, nurses and food service officers across three key touchpoints: preparing for, delivering/receiving and experiencing the meal. Improving mealtime experiences therefore necessitates a collaborative approach, with co-designed mealtime improvement programs that include specific interventions focusing each touchpoint. Our data suggest that improvements could focus on reducing clutter, clarifying mealtime roles and workflows and supporting caregiver involvement. IMPACT What problem did the study address? Mealtimes are the central mechanism to meet patients' nutritional needs in hospital; however, research consistently shows that many patients do not eat enough to meet their nutritional requirements and that they often do not receive the mealtime assistance they require. Interventions to improve hospital mealtimes have, at best, shown only modest improvements in nutritional intake and mealtime care practices. Gaining deeper insight into the mealtime experience from multiple perspectives may identify new opportunities for improvement. What were the main findings? Patients, caregivers and staff have shared ideals of comfort, autonomy and conviviality at mealtimes, but challenges of complex teamwork and re-prioritisation of mealtimes in the face of prevailing power hierarchies make it difficult to achieve this ideal. There are three discrete touchpoints (preparing for, delivering/receiving and experiencing the meal) that require different approaches to improvement. Our data suggests a need to focus improvement on reducing clutter, clarifying mealtime roles and workflows and supporting caregivers. Where and on whom will the research have an impact? The research provides a framework for multidisciplinary teams to begin co-designing improvements to mealtime care to benefit patients, caregivers and staff, while also providing a method for researchers to understand other complex care situations in hospital. REPORTING METHOD This manuscript is written in adherence with the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were involved in the conception and design of the study through their membership of the hospital mealtime reference group. A consumer researcher (GP) was involved in the team to advise on study conduct (i.e. recruitment methods and information), data analysis (i.e. coding transcripts), data interpretation (i.e. review and refinement of themes) and manuscript writing (i.e. review and approval of final manuscript).
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Affiliation(s)
- Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Angela Byrnes
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Danielle Mahoney
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Psychology, the University of Queensland, Brisbane, Queensland, Australia
| | - Gary Power
- Consumer Representative Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Margaret Cahill
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sarah Heaton
- Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Centre for Health Services Research, the University of Queensland, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Evonne Miller
- School of Design, Queensland University of Technology, Brisbane, Queensland, Australia
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Treleaven E, Matthews-Rensch K, Garcia D, Mudge A, Banks M, Young AM. Mealtimes matter: Measuring the hospital mealtime environment and care practices to identify opportunities for multidisciplinary improvement. Nutr Diet 2024. [PMID: 38246600 DOI: 10.1111/1747-0080.12863] [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: 07/06/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
AIMS Hospital inpatients often eat poorly and report barriers related to mealtime care. This study aimed to measure and describe the mealtime environment and care practices across 16 acute wards in a tertiary hospital to identify opportunities for improvement. METHODS A prospective cross-sectional audit was undertaken over a two-month period in 2021. A structured audit tool was used at one breakfast, lunch and dinner on each ward to observe the mealtime environment (competing priorities, lighting, tray table clutter) and care practices (positioning, tray within reach, mealtime assistance). Data were analysed descriptively (%, count), with analyses by meal period and ward to identify variation in practices. RESULTS A total of 892 observations were completed. Competing priorities (59%), poor lighting (43%) and cluttered tray tables (41%) were common. Mealtime assistance was required by 300 patients (33.6%; 5.9% eating assistance, 27.7% set-up assistance) and was provided within 10 min for 203 (66.7%) patients. A total of 54 patients (18.0%) did not receive the required assistance. We observed 447 (50.2%) patients lying in bed at meal delivery, with 188 patients (21.1%) sitting in a chair. Competing priorities, poor lighting, poor patient positioning and delayed assistance were worse at breakfast. Mealtime environments and practices varied between wards. CONCLUSION This audit demonstrates opportunities to improve mealtimes in our hospital. Variation between wards and meal periods suggest that improvements need to be tailored to the ward-specific barriers and enablers. Dietitians are ideally placed to lead a collaborative approach alongside the wider multidisciplinary team to improve mealtime care and optimise intake.
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Affiliation(s)
- Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kylie Matthews-Rensch
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dwayne Garcia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Australia
| | - Merrilyn Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
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Valkenet K, McRae P, Reijneveld E, Jans M, Bor P, van Delft L, Young DL, Veenhof C. Inpatient physical activity across a large university city hospital: a behavioral mapping study. Physiother Theory Pract 2024; 40:153-160. [PMID: 36036375 DOI: 10.1080/09593985.2022.2112116] [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: 08/17/2021] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Physical inactivity is common during hospitalization. Physical activity has been described in different inpatient populations but never across a hospital. PURPOSE To describe inpatient movement behavior and associated factors throughout a single university hospital. METHODS A prospective observational study was performed. Patients admitted to clinical wards were included. Behavioral mapping was undertaken for each participant between 9AM and 4PM. The location, physical activity, daily activity, and company of participants were described. Barriers to physical activity were examined using linear regression analyses. RESULTS In total, 345 participants from 19 different wards were included. The mean (SD) age was 61 (16) years and 57% of participants were male. In total, 65% of participants were able to walk independently. On average participants spent 86% of observed time in their room and 10% of their time moving. A physiotherapist or occupational therapist was present during 1% of the time, nursing staff and family were present 11% and 13%, respectively. Multivariate regression analysis showed the presence of an intravenous line (p = .039), urinary catheter (p = .031), being female (p = .034), or being dependent on others for walking (p = .016) to be positively associated with the time spent in bed. Age > 65, undergoing surgery, receiving encouragement by a nurse or physician, reporting a physical complaint or pain were not associated with the time spent in bed (P > .05). CONCLUSION As family members and nursing staff spend more time with patients than physiotherapists or occupational therapists, increasing their involvement might be an important next step in the promotion of physical activity.
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Affiliation(s)
- Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Elja Reijneveld
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
| | - Marielle Jans
- Institute of Mobility Studies, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, NV, USA
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Expertise Center Innovation of Care, Utrecht, Netherlands
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Damanti S, Cilla M, Vitali G, Tiraferri V, Pomaranzi C, De Rubertis G, De Lorenzo R, Di Lucca G, Scotti R, Messina E, Dell’Acqua R, Guffanti M, Cinque P, Castagna A, Rovere-Querini P, Tresoldi M. Exploring the Association between Delirium and Malnutrition in COVID-19 Survivors: A Geriatric Perspective. Nutrients 2023; 15:4727. [PMID: 38004121 PMCID: PMC10674410 DOI: 10.3390/nu15224727] [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: 09/25/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Older individuals face an elevated risk of developing geriatric syndromes when confronted with acute stressors like COVID-19. We assessed the connection between in-hospital delirium, malnutrition, and frailty in a cohort of COVID-19 survivors. Patients aged ≥65, hospitalized in a tertiary hospital in Milan for SARS-CoV-2 pneumonia, were enrolled and screened for in-hospital delirium with the 4 'A's Test (4AT) performed twice daily (morning and evening) during hospital stay. Malnutrition was assessed with the malnutrition universal screening tool (MUST) at hospital admission and with the mini-nutritional assessment short-form (MNA-SF) one month after hospital discharge. Frailty was computed with the frailty index one month after hospital discharge. Fifty patients (median age 78.5, 56% male) were enrolled. At hospital admission, 10% were malnourished. The 13 patients (26%) who developed delirium were frailer (7 vs. 4), experienced a higher in-hospital mortality (5 vs. 3), and were more malnourished one month after discharge (3 of the 4 patients with delirium vs. 6 of the 28 patients without delirium who presented at follow up). The 4AT scores correlated with the MNA-SF scores (r = -0.55, p = 0.006) and frailty (r = 0.35, p = 0.001). Frailty also correlated with MUST (r = 0.3, p = 0.04), MNA-SF (r = -0.42, p = 0.02), and hospitalization length (r = 0.44, p = 0.001). Delirium, malnutrition, and frailty are correlated in COVID-19 survivors. Screening for these geriatric syndromes should be incorporated in routine clinical practice.
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Affiliation(s)
- Sarah Damanti
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Marta Cilla
- Center for Liver Disease, Division of Internal Medicine and Hepatology, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Giordano Vitali
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Valeria Tiraferri
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Chiara Pomaranzi
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giulia De Rubertis
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Rebecca De Lorenzo
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
| | - Emanuela Messina
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Raffaele Dell’Acqua
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Monica Guffanti
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Paola Cinque
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Antonella Castagna
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- Infectious Diseases Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; (E.M.); (M.G.); (P.C.)
| | - Patrizia Rovere-Querini
- Vita Salute University, 20100 Milan, Italy; (V.T.); (C.P.); (G.D.R.); (R.D.L.); (A.C.); (P.R.-Q.)
- General Medicine and Continuity of Care Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
- Division of Immunology, Transplantation & Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; (G.D.L.); (R.S.); (M.T.)
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van Grootel JWM, Bor P, Netjes JA, Veenhof C, Valkenet K. Improving physical activity in hospitalized patients: The preliminary effectiveness of a goal-directed movement intervention. Clin Rehabil 2023; 37:1501-1509. [PMID: 37487188 PMCID: PMC10492426 DOI: 10.1177/02692155231189607] [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: 05/03/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To evaluate the preliminary effectiveness of a goal-directed movement intervention using a movement sensor on physical activity of hospitalized patients. DESIGN Prospective, pre-post study. SETTING A university medical center. PARTICIPANTS Patients admitted to the pulmonology and nephrology/gastro-enterology wards. INTERVENTION The movement intervention consisted of (1) self-monitoring of patients' physical activity, (2) setting daily movement goals and (3) posters with exercises and walking routes. Physical activity was measured with a movement sensor (PAM AM400) which measures active minutes per day. MAIN MEASURES Primary outcome was the mean difference in active minutes per day pre- and post-implementation. Secondary outcomes were length of stay, discharge destination, immobility-related complications, physical functioning, perceived difficulty to move, 30-day readmission, 30-day mortality and the adoption of the intervention. RESULTS A total of 61 patients was included pre-implementation, and a total of 56 patients was included post-implementation. Pre-implementation, patients were active 38 ± 21 minutes (mean ± SD) per day, and post-implementation 50 ± 31 minutes per day (Δ12, P = 0.031). Perceived difficulty to move decreased from 3.4 to 1.7 (0-10) (Δ1.7, P = 0.008). No significant differences were found in other secondary outcomes. CONCLUSIONS The goal-directed movement intervention seems to increase physical activity levels during hospitalization. Therefore, this intervention might be useful for other hospitals to stimulate inpatient physical activity.
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Affiliation(s)
- JWM van Grootel
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
| | - P Bor
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - JA Netjes
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
| | - K Valkenet
- Department of Rehabilitation, Physiotherapy Science & Sport, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Utrecht, The Netherlands
- Research Center of Healthy and Sustainable Living, Research group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Utrecht, Utrecht, The Netherlands
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9
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Harvey G, Collyer S, McRae P, Barrimore SE, Demmitt C, Lee-Steere K, Nolan B, Mudge AM. Navigating the facilitation journey: a qualitative, longitudinal evaluation of 'Eat Walk Engage' novice and experienced facilitators. BMC Health Serv Res 2023; 23:1132. [PMID: 37864161 PMCID: PMC10588033 DOI: 10.1186/s12913-023-10116-3] [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: 06/08/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) and integrated-PARIHS (i-PARIHS) frameworks position facilitation as an overarching strategy to enable implementation. In the revised i-PARIHS framework, facilitation is operationalised through a multi-level model with novice, experienced and expert facilitators working together in a network structure to build facilitation knowledge and skills along a continuum. To date, there has been limited evaluation of this facilitation model in practice, which is the aim of the study reported here. METHODS A descriptive, qualitative longitudinal study was undertaken to track a team of four novice and two experienced facilitators involved in facilitating the implementation of an intervention known as 'Eat Walk Engage' to improve multidisciplinary team delivery of age-friendly care principles in hospital. Over an 18-month period, repeat interviews were conducted to explore the learning, development, and evolving roles of novice facilitators and the roles of the experienced facilitators in providing support and mentoring. Interview data were analysed using a descriptive qualitative approach and findings were interpreted in collaboration with the participating facilitators. RESULTS The findings demonstrated experiential learning in both the novice and experienced facilitator groups as they enacted their roles in practice. The novice facilitators progressively transitioned to becoming more experienced facilitators and the experienced facilitators became increasingly expert, in line with the i-PARIHS concept of a facilitation journey from novice to expert. Strategies to support this development included a staggered approach to learning, regular meetings between the experienced and novice facilitators, reflective writing and informal peer support and networking. However, the roles were not without challenge and these challenges changed over time, from a more specific focus on the demands of the facilitator role to concerns about embedding and sustaining improvements in practice. CONCLUSIONS Within a network of peers and a mentored relationship with more experienced facilitators, individuals who are new to an implementation facilitator role can transition along a continuum to become experienced facilitators. Building implementation facilitation capability in this way takes time and requires tailored support and mentorship using a mix of structured and flexible approaches incorporating opportunities for reflection to support individual and group learning.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, Australia.
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Sarah Collyer
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Brisbane, Australia
| | | | - Camey Demmitt
- Caboolture Hospital, Caboolture, Queensland, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Medicine, Brisbane, Australia
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10
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Olufson HT, Ottrey E, Green TL, Young AM. Enhancing or impeding? The influence of digital systems on interprofessional practice and person-centred care in nutrition care systems across rehabilitation units. Nutr Diet 2023. [PMID: 37850243 DOI: 10.1111/1747-0080.12846] [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: 05/22/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
AIMS Digital health transformation may enhance or impede person-centred care and interprofessional practice, and thus the provision of high-quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person-centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. METHODS Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. RESULTS We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. CONCLUSIONS While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition-related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person-centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential.
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Affiliation(s)
- Hannah T Olufson
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Theresa L Green
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, Queensland, Australia
| | - Adrienne M Young
- Dietetics & Food Services, Royal Brisbane & Women's Hospital, Metro North Health, Herston, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
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11
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Olufson HT, Ottrey E, Young AM, Green TL. An ethnographic study exploring person-centred nutrition care in rehabilitation units. Disabil Rehabil 2023:1-9. [PMID: 37776895 DOI: 10.1080/09638288.2023.2254230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored. MATERIALS AND METHODS An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory. RESULTS Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals. CONCLUSIONS PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings.
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Affiliation(s)
- Hannah T Olufson
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- Dietetics & Food Services, Surgical, Treatment & Rehabilitation Service (STARS), Metro North Health, Herston, QLD, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, QLD, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, VIC, Australia
| | - Adrienne M Young
- Dietetics & Food Services, Royal Brisbane & Women's Hospital, Metro North Health, Herston, QLD, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
| | - Theresa L Green
- School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- STARS Education & Research Alliance, STARS, University of Queensland & Metro North Health, Herston, QLD, Australia
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12
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Young A, Kozica-Olenski S, Mallan K, McRae P, Treleaven E, Walsh Z, Mudge A. Developing and validating a novel staff questionnaire to identify barriers and enablers to nutrition and mealtime care on hospital wards. Nutr Diet 2023; 80:389-398. [PMID: 37169361 DOI: 10.1111/1747-0080.12815] [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: 11/20/2022] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
AIMS Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. METHODS Literature review, multidisciplinary focus groups and end-user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha. RESULTS The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub-scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub-scale demonstrated good reliability with Cronbach's alpha values all >0.70. CONCLUSION This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused.
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Affiliation(s)
- Adrienne Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Kimberley Mallan
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zoe Walsh
- Nutrition and Dietetics, Community and Oral Health Metro North Health, Melbourne, Victoria, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Queensland, Australia
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13
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Crick JP, Juckett L, Salsberry M, Quatman C, Quatman-Yates CC. Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study. J Healthc Qual 2023; 45:191-199. [PMID: 37010318 DOI: 10.1097/jhq.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Falls in and following hospitalization are common and problematic. Little is understood about the factors that impede or promote effective implementation of fall prevention practices. PURPOSE AND RELEVANCE Physical therapists are commonly consulted for acute care patients at risk for falling. The purpose of this study is to understand therapist perceptions of their effectiveness in fall prevention and to explore the impact of contextual factors on practice patterns to prevent falls surrounding hospitalization. METHODS Survey questions were tailored to the constructs of hospital culture, structural characteristics, networks and communications, and implementation climate, in addition to inquiries regarding practice patterns and attitudes/beliefs. RESULTS Overall, 179 surveys were analyzed. Most therapists (n = 135, 75.4%) affirmed their hospital prioritizes best practices for fall prevention, although fewer agreed that therapists other than themselves provide optimal fall prevention intervention (n = 105, 58.7%). Less practice experience was associated with greater odds of affirming that contextual factors influence fall prevention practice (odds ratio 3.90, p < .001). Respondents who agreed that their hospital system prioritizes best practices for fall prevention had 14 times the odds of believing that their system prioritizes making improvements ( p = .002). CONCLUSIONS/IMPLICATIONS As experience influences fall prevention practice, quality assurance and improvement initiatives should be used to ensure minimum specifications of practice.
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14
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Byrnes A, McRae P, Mudge AM. 'Life is about movement-everything that is alive moves': a mixed methods study to understand barriers and enablers to inpatient mobility from the older patient's perspective. Age Ageing 2023; 52:afad111. [PMID: 37463284 PMCID: PMC10353760 DOI: 10.1093/ageing/afad111] [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: 12/14/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Mobility in hospital is important to maintain independence and prevent complications. Our multi-centre study aimed to measure mobility and identify barriers and enablers to mobility participation from the older patient's perspective. METHODS Mixed methods study including direct observation of adult inpatients on 20 acute care wards in 12 hospitals and semi-structured interviews with adults aged 65 years or older on each of these wards. Interviews were undertaken by trained staff during the inpatient stay. Quantitative data were analysed descriptively. Qualitative data were initially coded deductively using the theoretical domains framework (TDF), with an inductive approach then used to frame belief statements. RESULTS Of 10,178 daytime observations of 503 adult inpatients only 7% of time was spent walking or standing. Two hundred older patient interviews were analysed. Most (85%) patients agreed that mobilising in hospital was very important. Twenty-three belief statements were created across the eight most common TDF domains. Older inpatients recognised mobility benefits and were self-motivated to mobilise in hospital, driven by goals of maintaining or recovering strength and health and returning home. However, they struggled with managing pain, other symptoms and new or pre-existing disability in a rushed, cluttered environment where they did not wish to trouble busy staff. Mobility equipment, meaningful walking destinations and individualised programmes and goals made mobilising easier, but patients also needed permission, encouragement and timely assistance. CONCLUSION Inpatient mobility was low. Older acute care inpatients frequently faced a physical and/or social environment which did not support their individual capabilities.
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Affiliation(s)
- Angela Byrnes
- Eat Walk Engage Program, Metro North Health, Herston, QLD, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Prue McRae
- Eat Walk Engage Program, Metro North Health, Herston, QLD, Australia
- Internal Medicine Research Unit, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Alison M Mudge
- Address correspondence to: Alison M. Mudge, Eat Walk Engage Program, 6th floor block 7, Royal Brisbane and Women’s Hospital, Butterfield St, Herston, 4029 QLD, Australia. Tel: 61736460854.
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15
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Mudge AM, McRae P, Young A, Blackberry I, Lee-Steere K, Barrimore S, Quirke T, Harvey G. Implementing a ward-based programme to improve care for older inpatients: process evaluation of the cluster randomised CHERISH trial. BMC Health Serv Res 2023; 23:668. [PMID: 37344776 DOI: 10.1186/s12913-023-09659-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Older inpatients are at high risk of hospital-associated complications, particularly delirium and functional decline. These can be mitigated by consistent attention to age-friendly care practices such as early mobility, adequate nutrition and hydration, and meaningful cognitive and social activities. Eat Walk Engage is a ward-based improvement programme theoretically informed by the i-PARIHS framework which significantly reduced delirium in a four-hospital cluster trial. The objective of this process evaluation was to understand how Eat Walk Engage worked across trial sites. METHODS Prospective multi-method implementation evaluation on medical and surgical wards in four hospitals implementing Eat Walk Engage January 2016-May 2017. Using UK Medical Research Council guidance, this process evaluation assessed context, implementation (core components, implementation strategies and improvements) and mechanisms of impact (practice changes measured through older person interviews, structured mealtime observations and activity mapping) at each site. RESULTS The four wards had varied contextual barriers which altered dynamically with time. One ward with complex outer organisational barriers showed poorer implementation and fewer practice changes. Two experienced facilitators supported four novice site facilitators through interactive training and structured reflection as well as data management, networking and organisational influence. Novice site facilitators used many implementation strategies to facilitate 45 discrete improvements at individual, team and system level. Patient interviews (42 before and 38 after implementation) showed better communication about program goals in three sites. Observations of 283 meals before and 297 after implementation showed improvements in mealtime positioning and assistance in all sites. Activity mapping in 85 patients before and 111 patients after implementation showed improvements in cognitive and social engagement in three sites, but inconsistent changes in mobility. The improvements in mealtime care and cognitive and social engagement are plausible mediators of reduced delirium observed in the trial. The lack of consistent mobility improvements may explain why the trial did not show reduction in functional decline. CONCLUSIONS A multi-level enabling facilitation approach supported adaptive implementation to varied contexts to support mechanisms of impact which partly achieved the programme goals. Contexts changed over time, suggesting the need for adequate time and continued facilitation to embed, enhance and sustain age-friendly practices on acute care wards and optimise outcomes. TRIAL REGISTRATION The CHERISH trial was prospectively registered with the ANZCTR ( http://www.anzctr.org.au ): ACTRN12615000879561.
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Affiliation(s)
- Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia.
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia.
- University of Queensland Faculty of Medicine, Brisbane, Australia.
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
| | - Adrienne Young
- University of Queensland Faculty of Medicine, Brisbane, Australia
- Royal Brisbane and Women's Hospital Department of Nutrition and Dietetics, Herston, Australia
| | - Irene Blackberry
- LaTrobe University John Richards Centre for Rural Ageing Research, Wodonga, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Herston, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Tara Quirke
- Consumer Advocate Dementia Training Australia, Brisbane, Australia
| | - Gillian Harvey
- Queensland University of Technology Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
- Flinders University College of Nursing and Health Sciences, Bedford Park, Australia
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16
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Cahill M, Neill S, Treleaven E, Lee-Steere K, Carter A, McCormack L, Mudge A. Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people. J Adv Nurs 2023; 79:961-969. [PMID: 35864082 DOI: 10.1111/jan.15363] [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: 09/29/2021] [Revised: 05/29/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
AIMS Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital-associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi-level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. DESIGN Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. DATA SOURCES We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity-based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. IMPLICATIONS FOR NURSING This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. CONCLUSION The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. IMPACT Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.
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Affiliation(s)
- Margaret Cahill
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Sharne Neill
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Medicine Service Line, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Elise Treleaven
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Karen Lee-Steere
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Andy Carter
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Linda McCormack
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Alison Mudge
- Eat Walk Engage program, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia
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17
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Feo R, Urry K, Conroy T, Kitson AL. Why reducing avoidable hospital readmissions is a 'wicked' problem for leaders: A qualitative exploration of nursing and allied health perceptions. J Adv Nurs 2023; 79:1031-1043. [PMID: 35332579 DOI: 10.1111/jan.15220] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. DESIGN A qualitative, exploratory study using a critical realist approach. METHOD One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. RESULTS Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. CONCLUSION Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies. IMPACT Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kristi Urry
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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18
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Grealish L, Ranse K, Todd JA, Armit L, Billett S, Collier L, Bail K, Moyle W. Barriers and enablers to embedding fundamental nursing care for older patients-Implications of a mixed methods study for nursing leadership. J Adv Nurs 2023; 79:1162-1173. [PMID: 35285976 DOI: 10.1111/jan.15194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/04/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022]
Abstract
AIMS To understand the enablers and barriers for delivering fundamental care to hospitalized older patients. DESIGN Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results. METHODS Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations. RESULTS There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs. CONCLUSION The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions. IMPACT Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.
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Affiliation(s)
- Laurie Grealish
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia.,Gold Coast Health, Australia
| | - Kristen Ranse
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
| | | | | | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Australia
| | | | | | - Wendy Moyle
- Menzies Health Institute Queensland, Australia.,School of Nursing & Midwifery, Griffith University, Australia
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19
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Frederiksen KO, Nørgaard B, Bruun IH. How to Improve Hospitalized Older Adults’ Activity Level: A Mixed Methods Study. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2121884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
| | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Inge Hansen Bruun
- Department of Physical and Occupational Therapy, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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20
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Bruun IH, Frederiksen KO, Nørgaard B. Attendance of Physical and Occupational Therapists Improves Older Hospitalized Adults’ Activity Levels. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2116523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Inge Hansen Bruun
- Department of Physical and Occupational Therapy, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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21
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Dijkstra F, van der Sluis G, Jager-Wittenaar H, Hempenius L, Hobbelen JSM, Finnema E. Facilitators and barriers to enhancing physical activity in older patients during acute hospital stay: a systematic review. Int J Behav Nutr Phys Act 2022; 19:99. [PMID: 35908056 PMCID: PMC9338465 DOI: 10.1186/s12966-022-01330-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To improve older patients' physical activity (PA) behavior, it is important to identify facilitators and barriers to enhancing PA in older patients (≥ 65 years) during hospitalization from the perspectives of patients, caregivers, and healthcare professionals (HCPs). METHODS In this systematic review, a search of PubMed, CINAHL, PsycINFO, EMBASE, and Web of Science (January 2000-May 2021) was performed, and quantitative, qualitative, and mixed-methods studies were included. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Identified facilitators and barriers were categorized using the social ecological model at the intrapersonal, interpersonal, and institutional levels. RESULTS The 48 included articles identified 230 facilitators and 342 barriers. The main facilitators at the intrapersonal level included: knowledge, awareness, and attitudes; interpersonal level: social support, including encouragement and interdisciplinary collaboration; and institutional level: stimulating physical environment, patient activities and schedules, and PA protocols. The main barriers at the intrapersonal level included: physical health status, having lines or drains, patients' fear, and HCPs' safety concerns; interpersonal level: patient-HCP relation and HCPs' unclear roles; and institutional level: lack of space and resources, including time and equipment. Best evidence synthesis provided moderate level of evidence for three barriers: patients' unwillingness or refusal to move, patients having symptoms, and patients having lines or drains. No moderate level of evidence was found for facilitators. CONCLUSION The PA behavior of older adults during hospitalization is multidimensional. Our overview highlights facilitators and barriers on multilevel scale (intrapersonal, interpersonal, and institutional levels) that guides patients, caregivers, HCPs, and researchers in future clinical practice, and intervention development and implementation.
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Affiliation(s)
- F Dijkstra
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, P.O. Box 1080, 8900, CB, Leeuwarden, The Netherlands.
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
- Department of Health Science, Section of Nursing Research & Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- FAITH research, Groningen/Leeuwarden, The Netherlands.
| | - G van der Sluis
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Health Strategy and Innovation, Nij Smellinghe Hospital Drachten, Drachten, The Netherlands
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - J S M Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Finnema
- Research Group Living, Wellbeing and Care for Older People, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, P.O. Box 1080, 8900, CB, Leeuwarden, The Netherlands
- Department of Health Science, Section of Nursing Research & Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- FAITH research, Groningen/Leeuwarden, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences, Groningen, The Netherlands
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22
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Geelen SJ, Giele BM, Veenhof C, Nollet F, Engelbert RH, van der Schaaf M. The Better By Moving study: A multifaceted intervention to improve physical activity in adults during hospital stay. Clin Rehabil 2022; 36:1342-1368. [PMID: 35702004 PMCID: PMC9420894 DOI: 10.1177/02692155221105337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective ‘Better By Moving’ is a multifaceted intervention developed and implemented in collaboration with patients and healthcare professionals to improve physical activity in hospitalized adults. This study aimed to understand if, how and why ‘Better By Moving’ resulted in higher levels of physical activity by evaluating both outcomes and implementation process. Design Mixed-methods study informed by the Medical Research Council guidance. Setting Tertiary hospital. Participants Adult patients admitted to surgery, haematology, infectious diseases and cardiology wards, and healthcare professionals. Measures Physical activity was evaluated before and after implementation using the Physical Activity Monitor AM400 on one random day during hospital stay between 8 am and 8 pm. Furthermore, the time spent lying on bed, length of stay and discharge destination was investigated. The implementation process was evaluated using an audit trail, surveys and interviews. Results There was no significant difference observed in physical activity (median [IQR] 23 [12–51] vs 27 [17–55] minutes, P = 0.107) and secondary outcomes before-after implementation. The intervention components’ reach was moderate and adoption was low among patients and healthcare professionals. Patients indicated they perceived more encouragement from the environment and performed exercises more frequently, and healthcare professionals signalled increased awareness and confidence among colleagues. Support (priority, resources and involvement) was perceived a key contextual factor influencing the implementation and outcomes. Conclusion Although implementing ‘Better By Moving’ did not result in significant improvements in outcomes at our centre, the process evaluation yielded important insights that may improve the effectiveness of implementing multifaceted interventions aiming to improve physical activity during hospital stay.
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Affiliation(s)
- Sven Jg Geelen
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands
| | - Boukje M Giele
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, 8124University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, 8119University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Frans Nollet
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Raoul Hh Engelbert
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- 26066Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Amsterdam, Netherlands.,522567Amsterdam Movement Sciences, Ageing & Vitality, Amsterdam, Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, 10191Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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23
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Wallis M, Craswell A, Marsden E, Taylor A. Establishing the Geriatric Emergency Department Intervention in Queensland emergency departments: a qualitative implementation study using the i-PARIHS model. BMC Health Serv Res 2022; 22:692. [PMID: 35606808 PMCID: PMC9128293 DOI: 10.1186/s12913-022-08081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/13/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Frail older adults require specific, targeted care and expedited shared decision making in the emergency department (ED) to prevent poor outcomes and minimise time spent in this chaotic environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to help limit these undesirable consequences. This qualitative study aimed to explore the ways in which two hospital implementation sites implemented the structures and processes of the GEDI model and to examine the ways in which the i-PARIHS (innovation-Promoting Action on Research Implementation in Health Services) framework influenced the implementation. METHODS Using the i-PARIHS approach to implementation, the GEDI model was disseminated into two hospitals using a detailed implementation toolkit, external and internal facilitators and a structured program of support. Following implementation, interviews were conducted with a range of staff involved in the implementation at both sites to explore the implementation process used. Transcribed interviews were analysed for themes and sub-themes. RESULTS There were 31 interviews with clinicians involved in the implementation, conducted across two hospitals, including interviews with the two external facilitators. Major themes identified included: (i) elements of the GEDI model adopted or (ii) adapted by implementation sites and (iii) factors that affected the implementation of the GEDI model. Both sites adopted the model of care and there was general support for the GEDI approach to the management of frail older people in the ED. Both sites adapted the structure of the GEDI team and the expertise of the team members to suit their needs and resources. Elements such as service focus, funding, staff development and service evaluation were initially adopted but adaptation occurred over time. Resourcing and cost shifting issues at the implementation sites and at the site providing the external facilitators negatively impacted the facilitation process. CONCLUSIONS The i-PARIHS framework provided a pragmatic approach to the implementation of the evidenced-based GEDI model. Passionate, driven clinicians ensured that successful implementation occurred despite unanticipated changes in context at both the implementation and host facilitator sites as well as the absence of sustained facilitation support.
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Affiliation(s)
- Marianne Wallis
- Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Queensland Australia
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Elizabeth Marsden
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
| | - Andrea Taylor
- Sunshine Coast Health Institute, Birtinya, Queensland Australia
- School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Sippy Downs, Queensland Australia
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24
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Mudge AM, McRae P, Banks M, Blackberry I, Barrimore S, Endacott J, Graves N, Green T, Harvey G, Hubbard R, Kurrle S, Lim WK, Lee-Steere K, Masel P, Pandy S, Young A, Barnett A, Inouye SK. Effect of a Ward-Based Program on Hospital-Associated Complications and Length of Stay for Older Inpatients: The Cluster Randomized CHERISH Trial. JAMA Intern Med 2022; 182:274-282. [PMID: 35006265 PMCID: PMC8749692 DOI: 10.1001/jamainternmed.2021.7556] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Hospital-associated complications of older people (HAC-OPs) include delirium, hospital-associated disability, incontinence, pressure injuries, and falls. These complications may be preventable by age-friendly principles of care, including early mobility, good nutrition and hydration, and meaningful cognitive engagement; however, implementation is challenging. OBJECTIVES To implement and evaluate a ward-based improvement program ("Eat Walk Engage") to more consistently deliver age-friendly principles of care to older individuals in acute inpatient wards. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized CHERISH (Collaboration for Hospitalised Elders Reducing the Impact of Stays in Hospital) trial enrolled 539 consecutive inpatients aged 65 years or older, admitted for 3 days or more to study wards, from October 2, 2016, to April 3, 2017, with a 6-month follow-up. The study wards comprised 8 acute medical and surgical wards in 4 Australian public hospitals. Randomization was stratified by hospital, providing 4 clusters in intervention and in control groups. Statistical analysis was performed from August 28, 2018, to October 17, 2021, on an intention-to-treat basis. INTERVENTION A trained facilitator supported a multidisciplinary work group on each intervention ward to improve the care practices, environment, and culture to support key age-friendly principles. MAIN OUTCOMES AND MEASURES Primary outcomes were incidence of any HAC-OP and length of stay. Secondary outcomes were incidence of individual HAC-OPs, facility discharge, 6-month mortality, and all-cause readmission. Outcomes were analyzed at the individual level, adjusted for confounders and clustering. RESULTS A total of 265 participants on 4 intervention wards (124 women [46.8%]; mean [SD] age, 75.9 [7.3] years) and 274 participants on 4 control wards (145 women [52.9%]; mean [SD] age, 78.0 [8.2] years) were enrolled. The composite primary outcome of any HAC-OP occurred for 115 of 248 intervention participants (46.4%) and 129 of 249 control participants (51.8%) (intervention group: adjusted odds ratio, 1.07; 95% CI, 0.71-1.61). The median length of stay was 6 days (IQR, 4-9 days) for the intervention group and 7 days (IQR, 5-10 days) for the control group (adjusted hazard ratio, 0.96; 95% credible interval, 0.80-1.15). The incidence of delirium was significantly lower for intervention participants (adjusted odds ratio, 0.53; 95% CI, 0.31-0.90). There were no significant differences in other individual HAC-OPs, facility discharge, mortality, or readmissions. CONCLUSIONS AND RELEVANCE The Eat Walk Engage program did not reduce the composite primary outcome of any HAC-OP or length of stay, but there was a significant reduction in the incidence of delirium. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12615000879561.
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Affiliation(s)
- Alison M Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Prue McRae
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Eat Walk Engage Program, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Merrilyn Banks
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Melbourne, Victoria, Australia
| | - Sally Barrimore
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - John Endacott
- Geriatrics Department, Nambour Hospital, Nambour, Queensland, Australia
| | - Nicholas Graves
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Theresa Green
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.,STARS Research and Education Alliance, Metro North Health Surgical Treatment and Rehabilitation Service, Brisbane, Queensland, Australia
| | - Gill Harvey
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ruth Hubbard
- Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sue Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wen Kwang Lim
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Aged Care Services, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karen Lee-Steere
- Eat Walk Engage Program, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Phil Masel
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Shaun Pandy
- Department of Internal Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Adrian Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon K Inouye
- Marcus Institute for Ageing Research, Hebrew SeniorLife, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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25
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Bor P, van Delft L, Valkenet K, Veenhof C. Perceived Factors of Influence on the Implementation of a Multidimensional Project to Improve Patients' Movement Behavior During Hospitalization: A Qualitative Study. Phys Ther 2022; 102:6423599. [PMID: 34751782 DOI: 10.1093/ptj/pzab260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/29/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to explore perceived factors of influence on the implementation of Hospital in Motion, a multidimensional and multidisciplinary implementation project to improve inpatients' movement behavior. METHODS This qualitative study was conducted on 4 wards. Per ward, a tailored action plan was implemented consisting of multiple tools and interventions to stimulate the integration of inpatient physical activity in usual care processes. After implementation, semi-structured interviews were performed with health care professionals and patients to explore perceived factors of influence on the implementation of the Hospital in Motion project. A content analysis was performed using the framework of the Medical Research Council for complex interventions as guidance for the identification of categories and themes. RESULTS In total, 16 interviews were conducted with health care professionals and 12 with patients. The results were categorized into the 3 key components of the Medical Research Council framework: implementation, mechanisms of impact, and context. An important factor of influence within the theme "implementation" was the iterative and multidisciplinary approach. Within the theme "mechanisms of impact," continuous attention and the interaction of multiple interventions, tailored to the target group and targeting multiple dimensions (individual, inter-professional, community and society), were perceived as important. Within the theme "context," the intrinsic motivation and inter-professional, community and societal culture towards physical activity was perceived to be of influence. CONCLUSION Impact can be achieved and maintained by creating continuous attention to inpatient physical activity and by the interaction between different interventions and dimensions during implementation. To maintain enough focus, the amount of activities at one time should be limited. IMPACT To improve inpatients' movement behavior, implementation project teams should be multidisciplinary and should implement a small set of tailored interventions that target multiple dimensions. Intermediate evaluation of the implementation process, strategies, and interventions is recommended.
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Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lotte van Delft
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Expertise Center Healthy Urban Living, Utrecht, the Netherlands
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26
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Naughton C, Cummins H, de Foubert M, Barry F, McCullagh R, Wills T, Skelton DA, Dahly D, Palmer B, Murphy A, McHugh S, O'Mahony D, Tedesco S, O Sullivan B. Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13473.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD). Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes. The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.
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27
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Ley L, Khaw D, Duke M, Botti M. Low dose mobility and functional status outcomes in hospitalized older general medicine patients. Geriatr Nurs 2021; 43:7-14. [PMID: 34798311 DOI: 10.1016/j.gerinurse.2021.10.020] [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: 08/24/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022]
Abstract
Emerging evidence suggests hospitalized older adults should walk at least 20-minutes daily to minimize functional decline. A single-institution case study conducted in a tertiary-referral centre in Melbourne, Australia, aimed to examine functional change and describe characteristics of older patients' in-hospital mobility. From 526 older patients vulnerable to functional decline, a sample of 41 patients (Mean age = 83.6, SD = 6.1 years) participated in 6-hour naturalistic observations. Functional change was measured at 2-weeks preadmission, admission and discharge with the revised Measurement System of Functional Autonomy (SMAF). Nearly 25% (n = 10) of observed patients functionally declined between preadmission and discharge and five patients died (12.2%). Thirty-two patients (78%) mobilized in 133 episodes accounting for 3.1% of the 246-hours observed. A daily walking-exercise dose equivalent to 20-min was associated with less functional decline in older adults with moderate to high walking capability supporting the effectiveness of this daily walking-exercise dose in minimizing functional decline.
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Affiliation(s)
- Lenore Ley
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research - Alfred Health, Deakin University, Locked Bag 22000, Geelong, Australia.
| | - Damien Khaw
- Centre for Quality and Patient Safety Research - Epworth Health, Deakin University, Locked Bag 22000, Geelong, Australia
| | - Maxine Duke
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
| | - Mari Botti
- Deakin University, School of Nursing & Midwifery, 1 Gheringhap St., Geelong, Victoria 3220, Australia
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28
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Geelen SJG, van Dijk-Huisman HC, de Bie RA, Veenhof C, Engelbert R, van der Schaaf M, Lenssen AF. Barriers and enablers to physical activity in patients during hospital stay: a scoping review. Syst Rev 2021; 10:293. [PMID: 34736531 PMCID: PMC8569983 DOI: 10.1186/s13643-021-01843-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low levels of physical activity are common during the hospital stay and have been associated with negative health outcomes. Understanding barriers and enablers to physical activity during a hospital stay can improve the development and implementation of tailored interventions aimed at improving physical activity. Previous studies have identified many barriers and enablers, but a comprehensive overview is lacking. This study aimed to identify and categorize all published patient- and healthcare professional-reported barriers and enablers to physical activity during a hospital stay for acute care, using the Theoretical Domains Framework (TDF). METHODS We conducted a scoping review of Dutch and English articles using MEDLINE, CINAHL Plus, EMBASE, PsycINFO, and Cochrane Library (inception to September 2020), which included quantitative, qualitative, and mixed-methods studies reporting barriers and enablers to physical activity during a hospital stay for acute care, as perceived by patients or healthcare professionals. Two reviewers systematically extracted, coded, and categorized all barriers and enablers into TDF domains. RESULTS Fifty-six articles were included in this review (32 qualitative, 7 quantitative, and 17 mixed-methods). In total, 264 barriers and 228 enablers were reported by patients, and 415 barriers and 409 enablers by healthcare professionals. Patient-reported barriers were most frequently assigned to the TDF domains Environmental Context & Resources (ECR, n = 148), Social Influences (n = 32), and Beliefs about Consequences (n = 25), while most enablers were assigned to ECR (n = 67), Social Influences (n = 54), and Goals (n = 32). Barriers reported by healthcare professionals were most frequently assigned to ECR (n = 210), Memory, Attention and Decision Process (n = 45), and Social/Professional Role & Identity (n = 31), while most healthcare professional-reported enablers were assigned to the TDF domains ECR (n = 143), Social Influences (n = 76), and Behavioural Regulation (n = 54). CONCLUSIONS Our scoping review presents a comprehensive overview of all barriers and enablers to physical activity during a hospital stay and highlights the prominent role of the TDF domains ECR and Social Influences in hospitalized patients' physical activity behavior. This TDF-based overview provides a theoretical foundation to guide clinicians and researchers in future intervention development and implementation. SCOPING REVIEW REGISTRATION No protocol was registered for this review.
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Affiliation(s)
- Sven Jacobus Gertruda Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
| | - Hanneke Corine van Dijk-Huisman
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
| | - Robert Adriaan de Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Antoine François Lenssen
- Department of Physical Therapy, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6229HX, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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29
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de Foubert M, Cummins H, McCullagh R, Brueton V, Naughton C. Systematic review of interventions targeting fundamental care to reduce hospital-associated decline in older patients. J Adv Nurs 2021; 77:4661-4678. [PMID: 34240755 DOI: 10.1111/jan.14954] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023]
Abstract
AIMS To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital-associated decline (HAD) in older patients. DESIGN Systematic review of experimental studies using randomized and quasi-experimental designs. DATA SOURCES We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020. REVIEW METHODS We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi-Experimental Studies. RESULTS From 1729 papers, 18 studies using quasi-experimental and pre-post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n = 14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium. CONCLUSION Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence-translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher-quality pragmatic trial designs, standardized outcomes, staff co-designed interventions, evidence-translation frameworks and patient engagement to make more confident inference about effectiveness. IMPACT Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse-led quality improvement.
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Affiliation(s)
- Marguerite de Foubert
- South Infirmary Victoria University Hospital, Cork, Ireland.,Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Valerie Brueton
- Formerly Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom
| | - Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Hall K, Maxwell L, Cobb R, Steele M, Chambers R, Roll M, Bell SC, Kuys S. Physiotherapy service provision in a specialist adult cystic fibrosis service: A pre-post design study with the inclusion of an allied health assistant. Chron Respir Dis 2021; 18:14799731211017895. [PMID: 34142582 PMCID: PMC8216416 DOI: 10.1177/14799731211017895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.
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Affiliation(s)
- Kathleen Hall
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Lyndal Maxwell
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
| | - Robyn Cobb
- Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Michael Steele
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia.,Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Rebecca Chambers
- Physiotherapy, The Prince Charles Hospital, Chermside, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Mark Roll
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Scott Cameron Bell
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Chermside, Queensland, Australia.,Translational Research Institute, Woolloongabba, Queensland, Australia.,Children's Health Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Suzanne Kuys
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, Queensland, Australia
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31
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Naughton C, Simon R, White TJ, de Foubert M, Cummins H, Dahly D. Mealtime and patient factors associated with meal completion in hospitalised older patients: An exploratory observation study. J Clin Nurs 2021; 30:2935-2947. [PMID: 33945183 DOI: 10.1111/jocn.15800] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine mealtime and patient factors associated with meal completion among hospitalised older patients. We also considered contextual factors such as staffing levels and ward communication. BACKGROUND Sub-optimum nutrition is a modifiable risk factor for hospital associated decline (HAD) in older patients. Yet, the quality of mealtime experiences can be overlooked within ward routinised practice. DESIGN Cross sectional, descriptive observation study. METHODS We undertook structured observation of mealtimes examining patient positioning, mealtime set-up and feeding assistance. The outcome was meal completion categorised as 0, 25%, 50%, 75% or 100%. Data were collected on patient characteristics and ward context. We used mixed-effects ordinal regression models to examine patient and mealtime factors associated with higher meal completion producing odds ratios (OR) and 95% confidence intervals (CI). The study was reported as per STROBE guidelines. RESULTS We included 60 patients with a median age of 82 years (IQR 76-87) and clinical frailty score of 5 IQR (4-6). Of the 279 meals, 51% were eaten completely, 6% three quarters, 15% half, 18% a quarter and 10% were not eaten at all. Mealtime predictors with a weak association with less-meal completion were requiring assistance, special diets, lying in bed, and red tray (indicator of nutrition risk), but were not statistically significant. Significant patient-level factors were higher values for frailty (OR 0.34 [0.11-1.04]) and Malnutrition Universal Screening Tool (OR 0.22 [0.08-0.62]). The average nurse-to-patient ratio was 1:5.5. CONCLUSION Patient factors were the strongest predictors for meal completion, but mealtime factors had a subtle influence. The nursing teams' capacity to prioritise mealtimes above competing demands is important as part of a comprehensive nutrition strategy. RELEVANCE TO CLINICAL PRACTISE Nurses are central to optimising nutrition for frail older patients. It requires ward leadership to instil a culture of prioritising assisted mealtimes, improved communication, greater autonomy to tailor nutrition strategies and safe staffing levels.
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Affiliation(s)
- Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, Brookfield, University College Cork, Cork, Ireland
| | - Rachel Simon
- South Tipperary General Hospital, Clonmel, Ireland
| | - T J White
- South Tipperary General Hospital, Clonmel, Ireland
| | - Marguerite de Foubert
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Darren Dahly
- HRB Clinical Research Facility Cork, School of Public Health, University College Cork, Cork, Ireland
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32
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Mudge AM, McRae P, Donovan PJ, Reade MC. Multidisciplinary quality improvement programme for older patients admitted to a vascular surgery ward .. Intern Med J 2021; 50:741-748. [PMID: 32537917 DOI: 10.1111/imj.14400] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older vascular surgical patients are at high risk of hospital-associated complications and prolonged stays. AIMS To implement a multidisciplinary co-management model for older vascular patients and evaluate impact on length of stay (LOS), delirium incidence, functional decline, medical complications and discharge destination. METHODS Prospective pre-post evaluation of a quality improvement intervention, enrolling pre-intervention (August 2012-January 2013) and post-intervention cohort (September 2013-March 2014). Participants were consenting patients aged 65 years and over admitted to the vascular surgical ward of a metropolitan teaching hospital for at least 3 days. Intervention was physician-led co-management plus a multidisciplinary improvement programme targeting delirium and functional decline. Primary outcomes were LOS, delirium and functional decline. Secondary outcomes were medical complications and discharge destination. Process measures included documented consultation patterns. Administrative data were also compared for all patients aged 65 and older for 12 months pre- and post-intervention. RESULTS We enrolled 112 participants pre-intervention and 123 participants post-intervention. LOS was reduced post-intervention (geometric mean 7.6 days vs 9.3 days; ratio of geometric means 0.82 (95% confidence interval CI0.68-1.00), P = 0.04). There was a trend to less delirium (18 (14.6%) vs 24 (21.4%), P = 0.17) and functional decline (18 (14.6%) vs 27 (24.3%), P = 0.06), with greatest reductions in the urgently admitted subgroup. Administrative data showed reduced median LOS (5.2 days vs 6 days, P = 0.03) and greater discharge home (72% vs 50%, P < 0.01). CONCLUSIONS Physician-led co-management plus a multidisciplinary improvement programme may reduce LOS and improve functional outcomes in older vascular surgical patients.
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Affiliation(s)
- Alison M Mudge
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Prue McRae
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter J Donovan
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael C Reade
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Johnson AM, Kuperstein J, Graham RH, Talari P, Kelly A, Dupont-Versteegden EE. BOOSTing patient mobility and function on a general medical unit by enhancing interprofessional care. Sci Rep 2021; 11:4307. [PMID: 33619329 PMCID: PMC7900133 DOI: 10.1038/s41598-021-83444-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 02/02/2021] [Indexed: 11/09/2022] Open
Abstract
Low mobility during hospitalization remains prevalent despite associated negative consequences. The goal of this quality improvement (QI) project was to increase patient mobility and function by adding a physical therapist (PT) to an existing interprofessional care team. A mobility technician assisted treatment group patients with mobility during hospitalization based on physical therapist recommendations. Change in functional status and highest level of mobility achieved by treatment group patients was measured from admission to discharge. Observed hospital length of stay (LOS), LOS index, and 30-day all cause hospital readmission comparisons between treatment group and a comparison group on the same unit, and between cross-sectional comparison groups one year prior were used for Difference in Difference analysis. Bivariate comparisons between the treatment and a cross-sectional comparison group from one year prior showed a statistically significant change in LOS Index. No other bivariate comparisons were statistically significant. Difference in Difference methods showed no statistically significant change in observed LOS, LOS Index, or 30-day readmission. Patients in the treatment group had statistically significant improvements in functional status and highest level of mobility achieved. Physical function and mobility improved for patients who participated in mobility sessions. Mobility technicians may contribute to improved care quality and patient safety in the hospital.
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Affiliation(s)
- A M Johnson
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA.
| | - J Kuperstein
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA
| | - R Hogg Graham
- Department of Health and Clinical Sciences, College of Health Sciences, University of Kentucky, Lexington, USA
| | - P Talari
- Division of Hospital Medicine, University of Kentucky HealthCare, Lexington, USA
| | - A Kelly
- Department of Medicine, Center for Health Services Research, University of Kentucky, Lexington, USA
| | - E E Dupont-Versteegden
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, 900 S. Limestone Street, Lexington, KY 40536, USA
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Yinusa G, Scammell J, Murphy J, Ford G, Baron S. Multidisciplinary Provision of Food and Nutritional Care to Hospitalized Adult In-Patients: A Scoping Review. J Multidiscip Healthc 2021; 14:459-491. [PMID: 33654405 PMCID: PMC7910096 DOI: 10.2147/jmdh.s255256] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Multidisciplinary approaches to nutritional care are increasingly emphasized and recommended. However, there is little evidence of how different disciplines work together collaboratively to deliver optimum quality care to adult in-patients. This scoping review aimed to describe the existing literature on multidisciplinary collaboration to identify the various disciplines involved and the features that influence collaborative working in implementing multidisciplinary food and nutritional care with adult in-patients. METHODS Multiple databases were searched, including MEDLINE Complete, Embase, CINAHL Complete, HMIC, and Scopus, from their inception to December 2019. Data were retrieved from eligible studies. A narrative description of findings is reported with respect to the disciplines involved, the aspects of nutritional care explored, and the collaborative processes categorized using the input, process, and outcome framework. RESULTS Thirty-one studies with heterogeneous study designs met the eligibility criteria. Studies were undertaken in six countries. Findings show a wide diversity of multidisciplinary collaborations in various aspects of nutritional care in all studies. Multidisciplinary nutritional care provision was facilitated by several processes, including training and development, communication and information sharing, and clinical leadership and management support. Outcomes were reported at the patient, team, and organizational levels. CONCLUSION This review reveals the significance of the interrelationship between different disciplines and their complementary contributions towards the delivery of optimal food and nutritional care. Key aspects include the involvement of different disciplines, the clarification of roles and multidisciplinary interrelationships, communication, information sharing, clinical leadership, and management support, all of which facilitated collaborative working. Our review uncovered that these features can significantly influence multidisciplinary working. This review is the first to present literature concerning the attributes that affect collaborative working. Further research is recommended specifically around multidisciplinary nutritional care processes and conditions that allow for better collaborative working.
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Affiliation(s)
- Gladys Yinusa
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Janet Scammell
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Jane Murphy
- Ageing and Dementia Research Centre, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
| | - Gráinne Ford
- Dietetic Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, Dorset, UK
| | - Sue Baron
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
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Geelen SJG, Giele BM, Engelbert RHH, de Moree S, Veenhof C, Nollet F, van Nes F, van der Schaaf M. Barriers to and solutions for improving physical activity in adults during hospital stay: a mixed-methods study among healthcare professionals. Disabil Rehabil 2021; 44:4004-4013. [PMID: 33605171 DOI: 10.1080/09638288.2021.1879946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify healthcare professionals' perspectives on key barriers to improving physical activity in hospitalized adult patients, and to identify solutions to overcome these barriers. Methods: We used an explanatory sequential mixed-methods study design in a Dutch university hospital. A survey exploring 39 potential barriers was completed by 15 physicians/physician assistants, 106 nurses, four nursing assistants, and four physical therapists working on surgery, internal medicine, and cardiology wards. Next, three in-depth semi-structured focus groups - comprising 30 healthcare professionals - discussed the survey findings to identify key barriers and solutions. Focus group discussions were analyzed using thematic analysis. Results: Five themes were identified that described both the key barriers and the solutions to overcome these barriers. Healthcare professionals proposed several solutions, including clarifying the definition of physical activity, empowering patients to take responsibility for physical activity, giving physical therapists or physicians a prominent role in encouraging physical activity, and changing the hospital ward to entice patients to become physically active. Conclusions: Healthcare professionals need clear guidelines, roles, and responsibilities when it comes to physical activity. They also need personalized interventions that empower patients in physical activity. Finally, hospital wards should be designed and furnished so that patients are encouraged to be active.IMPLICATIONS FOR REHABILITATIONMany healthcare professionals want to sustainably improve physical activity in hospitalized adults.For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team.Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay.Hospital wards should be designed and furnished so that patients are encouraged to be physically active.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Sandra de Moree
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Fenna van Nes
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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Kozica-Olenski S, Treleaven E, Hewitt M, McRae P, Young A, Walsh Z, Mudge A. Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey. J Hum Nutr Diet 2021; 34:687-694. [PMID: 33491875 DOI: 10.1111/jhn.12854] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. METHODS A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. RESULTS Responses from 143 participants (mean age 67 years, 57% male, 28% rehabilitation, median 6 days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P = 0.01). CONCLUSIONS This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.
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Affiliation(s)
- S Kozica-Olenski
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - E Treleaven
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - M Hewitt
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Mater Health, Brisbane, QLD, Australia
| | - P McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - A Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Z Walsh
- Nutrition and Dietetics, Brighton Health Campus, Brighton, QLD, Australia
| | - A Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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McLaren-Hedwards T, D'cunha K, Elder-Robinson E, Smith C, Jennings C, Marsh A, Young A. Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub-acute hospital, rehabilitation and aged-care settings: A systematic review. Nutr Diet 2021; 79:140-168. [PMID: 33416215 DOI: 10.1111/1747-0080.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged-care facility settings. METHODS Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. RESULTS Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non-communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. CONCLUSIONS Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large-scale, well-designed experimental studies to assess the potential impacts of these interventions.
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Affiliation(s)
- Taya McLaren-Hedwards
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Kelly D'cunha
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Elaina Elder-Robinson
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Claire Smith
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Cindy Jennings
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Abigail Marsh
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Adrienne Young
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Wu Y, Smits EJ, Window P, Beningfield A, Johnston V, McRae P. Mobility levels of acute medical patients: Is behavioural mapping comparable to accelerometry? Clin Rehabil 2020; 35:595-605. [PMID: 33203223 DOI: 10.1177/0269215520970341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To (1) determine agreement between behavioural mapping and accelerometry for measuring mobility levels in an acute medical inpatient setting and to (2) explore and compare the required resources and costs for both methods. DESIGN Observational cross-sectional study. SETTING Tertiary referral teaching hospital in Brisbane, Australia. SUBJECTS Adult patients admitted to two acute medical wards. MAIN MEASURES Mobility levels were recorded by behavioural mapping, and thigh and chest-worn accelerometers (ActivPAL). The level of agreement between the two methods was evaluated using the Intraclass Correlation Coefficients for each mobility level (i.e. lying, sitting, upright, standing and walking). RESULTS Nineteen patients (10 male (53%); mean(SD) age of 72(14) years) were included in the agreement analysis. The Intraclass Correlation Coefficients were high for 'lying' (ICC = 0.87), 'sitting' (ICC = 0.84) and 'upright' (ICC = 0.93), indicating good to excellent agreement between the two methods. For these mobility levels, mean differences between the two methods were small (<2%), with large standard deviations (up to 18%). Agreement was poor for 'standing' (ICC = 0.00) and 'walking' (ICC = 0.35). Both methods were labour-intensive, with labour costs of A$1,285/€798 (34 hours) for behavioural mapping and A$1,055/€655 (28 hours) for accelerometry. No further costs were involved in behavioural mapping, but clinical backfill was required. Accelerometry involved a financial investment for accelerometers (A$11,100/€6,894 for 22 ActivPAL devices). CONCLUSION Agreement between behavioural mapping and accelerometry was good for measuring 'lying', 'sitting' and 'upright', but poor for 'standing' and 'walking' in an acute inpatient setting. Both behavioural mapping and accelerometry were labour-intensive, with high costs for the accelerometry equipment.
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Affiliation(s)
- Yizhou Wu
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Esther J Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alice Beningfield
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Venerina Johnston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Prue McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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39
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Effects of a nursing care program focused on basic self-care in older acute medical in-patients: a randomized controlled trial. Porto Biomed J 2020; 5:e086. [PMID: 33532653 PMCID: PMC7846415 DOI: 10.1097/j.pbj.0000000000000086] [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: 05/23/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Acute illness and hospitalization are often associated with decreased independence in basic activities of daily living. The aim of this study was to test the hypothesis that a nursing care program focused on basic self-care (N_BSC) improves functional outcomes in older patients admitted to an acute medical unit. Methods This was a 2-group randomized controlled trial with repeated measures: 182 older patients admitted to an acute medical unit were randomly allocated to the usual care group (n = 91) and intervention group (n = 91). The intervention consisted of nursing care centered on basic self-care that includes promotion of daily walking and all daytime meals seated, out of bed. The main outcome was changes in the number of independent basic activities of daily living (BADL) from 2 weeks before admission (baseline) to discharge. Results There was significant effect of the N_BSC on the outcomes. Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, whereas usual care patients performed independently 1.90 BADL (P < .001). Conclusions N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.
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van Delft LMM, Bor P, Valkenet K, Slooter AJC, Veenhof C. The Effectiveness of Hospital in Motion, a Multidimensional Implementation Project to Improve Patients' Movement Behavior During Hospitalization. Phys Ther 2020; 100:2090-2098. [PMID: 32915985 PMCID: PMC7720640 DOI: 10.1093/ptj/pzaa160] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Hospital in Motion is a multidimensional implementation project aiming to improve movement behavior during hospitalization. The purpose of this study was to investigate the effectiveness of Hospital in Motion on movement behavior. METHODS This prospective study used a pre-implementation and post-implementation design. Hospital in Motion was conducted at 4 wards of an academic hospital in the Netherlands. In each ward, multidisciplinary teams followed a 10-month step-by-step approach, including the development and implementation of a ward-specific action plan with multiple interventions to improve movement behavior. Inpatient movement behavior was assessed before the start of the project and 1 year later using a behavioral mapping method in which patients were observed between 9:00 am and 4:00 pm. The primary outcome was the percentage of time spent lying down. In addition, sitting and moving, immobility-related complications, length of stay, discharge destination home, discharge destination rehabilitation setting, mortality, and 30-day readmissions were investigated. Differences between pre-implementation and post-implementation conditions were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test for non-normal distributed data, or independent samples t test for normally distributed data. RESULTS Patient observations demonstrated that the primary outcome, the time spent lying down, changed from 60.1% to 52.2%. For secondary outcomes, the time spent sitting increased from 31.6% to 38.3%, and discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%). No statistical differences were found in the other secondary outcome measures. CONCLUSION The implementation of the multidimensional project Hospital in Motion was associated with patients who were hospitalized spending less time lying in bed and with a reduced number of discharges to a rehabilitation setting. IMPACT Inpatient movement behavior can be influenced by multidimensional interventions. Programs implementing interventions that specifically focus on improving time spent moving, in addition to decreasing time spent lying, are recommended.
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Affiliation(s)
| | - Petra Bor
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University; and UMC Utrecht Brain Center, Utrecht University
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University; and UMC Utrecht Brain Center, Utrecht University
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Centre Utrecht, Utrecht University; and Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
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Hunter SC, Kim B, Mudge A, Hall L, Young A, McRae P, Kitson AL. Experiences of using the i-PARIHS framework: a co-designed case study of four multi-site implementation projects. BMC Health Serv Res 2020; 20:573. [PMID: 32576197 PMCID: PMC7310499 DOI: 10.1186/s12913-020-05354-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework is an implementation framework that has been developed and refined over the last 20 years. Its underlying philosophy is that implementing research into healthcare practice is complex, unpredictable and non-linear which therefore requires a flexible and responsive approach to implementation. Facilitation is recognized as the central ingredient of this approach, and i-PARIHS now provides a Facilitation Guide with associated tools. This multiple case study of four implementation projects explored how the i-PARIHS framework has been practically operationalized by diverse implementation project teams. METHODS A co-design approach was used to elicit the experiences of four implementation project teams who used the i-PARIHS framework to guide their implementation approach. We conducted the established co-design steps of (i) setting up for success, (ii) gathering the experience, and (iii) understanding the experience. In particular we explored teams' approaches to setting up their projects; why and how they used the i-PARIHS framework and what they learnt from the experience. RESULTS We found both commonalities and differences in the use of i-PARIHS across the four implementation projects: (i) all the projects used the Facilitation Checklist that accompanies i-PARIHS as a starting point, (ii) the projects differed in how facilitation was carried out, (iii) existing tools were adapted for distinct phases: pre-implementation, during implementation, and post-implementation stages; and (iv) project-specific tools were often developed for monitoring implementation activities and fidelity. CONCLUSIONS We have provided a detailed overview of how current users of i-PARIHS are operationalising the framework, which existing tools they are using or adapting to use, and where they have needed to develop new tools to best utilise the framework. Importantly, this study highlights the value of existing tools from the published i-PARIHS Facilitation Guide and provides a starting point to further refine and add to these tools within a future Mobilising Implementation of i-PARIHS (or "Mi-PARIHS") suite of resources. Specifically, Mi-PARIHS might include more explicit guidance and/or tools for developing a structured implementation plan and monitoring fidelity to the implementation plan, including recording how strategies are tailored to an evolving context.
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Affiliation(s)
- S C Hunter
- College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia.
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia.
| | - B Kim
- Centre for Healthcare Organization and Implementation Research, U.S. Department of Veterans Affairs, Boston, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - A Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, QLD, Australia
| | - L Hall
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - A Young
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, QLD, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - P McRae
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - A L Kitson
- College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5042, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Crafting age friendly cancer care: A model for improvement utilizing the 4Ms framework across the continuum of an NCI-designated Cancer Center. J Geriatr Oncol 2020; 12:152-156. [PMID: 32546367 DOI: 10.1016/j.jgo.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
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Lee-Steere K, Liddle J, Mudge A, Bennett S, McRae P, Barrimore SE. "You've got to keep moving, keep going": Understanding older patients' experiences and perceptions of delirium and nonpharmacological delirium prevention strategies in the acute hospital setting. J Clin Nurs 2020; 29:2363-2377. [PMID: 32220101 DOI: 10.1111/jocn.15248] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore older inpatients' experiences and perceptions of delirium and nonpharmacological delirium prevention strategies (NDPS). BACKGROUND Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients' perspectives of these strategies. This information may assist staff to better support patient participation in NDPS. DESIGN Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient's experience of delirium and NDPS. METHODS Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients' experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ. RESULTS Twenty-three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, whilst enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks. CONCLUSION A more patient-centred approach to delirium prevention requires consideration of older people's values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients' engagement in NPDS to prevent delirium in hospital. RELEVANCE TO CLINICAL PRACTICE Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.
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Affiliation(s)
- Karen Lee-Steere
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jacki Liddle
- ARC Centre of Excellence for the Dynamics of Language, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, QLD, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Prue McRae
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Sally E Barrimore
- Nutrition and Dietetics Department, The Prince Charles Hospital, Brisbane, QLD, Australia
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Belostotsky V, Laing C, White DE. The sustainability of a quality improvement initiative. Healthc Manage Forum 2020; 33:195-199. [PMID: 32249605 DOI: 10.1177/0840470420913055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional decline in seniors admitted to hospital is due in part to lack of mobilization. Many Quality Improvement (QI) initiatives targeting mobilization of the elderly population in acute care exist; however, their long-term effectiveness is not well-documented. Mobilization of Vulnerable Elders (MOVE) was a grant-funded initiative that started in Ontario and spread to Alberta. The primary objective of this project was to ascertain the sustainability of the MOVE project 1 year post implementation at two hospital sites in Alberta, Canada. Qualitative and quantitative cross-sectional data were gathered from multidisciplinary healthcare professionals. Our findings suggest MOVE was not well-sustained one year post implementation. Examination of specific survey questions provided an indication of strengths and weaknesses of the MOVE QI. Sustainable and cost-effective QI targeted at this elderly patient demographic could alleviate some of the demand on the healthcare system. Modifications to improve the sustainability of MOVE are summarized.
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Roberts NA, Alexander K, Wyld D, Janda M. Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review. JMIR Res Protoc 2019; 8:e14579. [PMID: 31769763 PMCID: PMC6904897 DOI: 10.2196/14579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. Objective The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. Results This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. Conclusions Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs. International Registered Report Identifier (IRRID) PRR1-10.2196/14579
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Affiliation(s)
- Natasha Anne Roberts
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia.,Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kimberly Alexander
- School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,School of Medicine, University of Queensland, St Lucia, Australia
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Woolloongabba, Australia.,Queensland University of Technology, Kelvin Grove, Australia
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Grealish L, Chaboyer W, Mudge A, Simpson T, Cahill M, Todd JA, Ownsworth T, Krug M, Teodorczuk A, Marshall AP. Using a general theory of implementation to plan the introduction of delirium prevention for older people in hospital. J Nurs Manag 2019; 27:1631-1639. [PMID: 31444812 DOI: 10.1111/jonm.12849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
AIM To develop an implementation plan for delirium prevention. BACKGROUND The use of non-pharmacological interventions to prevent hospital-acquired delirium is well established but their implementation has been notoriously difficult to achieve. Systematic analysis of context as part of implementation planning is critical. METHODS Ethnographic study was conducted in a 24-bed general medical ward. Eleven patients and family members and 15 health service staff participated through observations, individual interviews and document review. Inductive analysis was used to generate themes that described enablers and barriers. RESULTS Enablers included a ward culture that embraced safety and placing the person at the centre of care. Barriers were in tension with the enablers and included limited staff knowledge, specialist forms exclusive to the nursing discipline, inflexible ward routines and frequent disruptions. CONCLUSIONS In addition to standard implementation strategies such as individual education and leadership, implementing delirium prevention requires consideration of team practices, review of policy document design and identification of outcomes data than can support collaborative reflexive practice. IMPLICATIONS FOR NURSING MANAGEMENT The use of a theory-informed ethnographic approach exposed tensions that may be otherwise invisible. Understanding the tensions increases the likelihood of implementation success. Using a systematic assessment approach can create a comprehensive implementation plan.
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Affiliation(s)
- Laurie Grealish
- Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia.,School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Wendy Chaboyer
- School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Qld, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Toni Simpson
- Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - Margaret Cahill
- Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Herston, Qld, Australia
| | - Jo-Anne Todd
- School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Mt Gravatt, Qld, Australia
| | - Maree Krug
- Specialist Medical Unit, Robina Hospital, Robina, Qld, Australia
| | - Andrew Teodorczuk
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia.,School of Nursing & Midwifery and Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia
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Johnson AM, Howell DM. Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care. J Clin Nurs 2019; 28:4044-4052. [PMID: 31264747 DOI: 10.1111/jocn.14986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To qualitatively evaluate an early mobilisation quality improvement project implemented on a general medicine unit. BACKGROUND Early mobility quality improvement projects show promising quantitative results yet have failed to collect data from patient and staff experience associated with physical activity during illness and the impact of this change in clinical practice. DESIGN A mixed methods case study was used to evaluate a mobility quality improvement project. Quantitative results will be published separately. The qualitative evaluation used a phenomenological lens to explore the patient and staff experience. METHODS Semi-structured interviews with twelve participants (four patients and eight staff) were performed during the project. Data were analysed using open coding, direct interpretation and then categorised into an overarching and four supporting themes. Findings are reported per the Standards for Reporting Qualitative Research. RESULTS Participants reported that early mobilisation bridged a gap in care. Staff understood the benefits of early mobility. Patients expressed how mobility aligned with personal preferences and their need to prepare for hospital discharge. Greater functional independence and higher mobility levels in patients on the unit reduced staff level of care. When patients were consistently presented with opportunities to be mobile and active, they expected mobility to be a part of their daily care plan. CONCLUSIONS Findings suggest that early mobility quality improvement projects have the potential to transform clinical practice and improve the quality of care for patients in acute care. RELEVANCE TO CLINICAL PRACTICE All members of the healthcare team, including the patient, recognise the importance of maintaining mobility and function during hospitalisation yet focus on these needs are often delayed or missed. Early mobility quality improvement projects help to set patient expectations and build a culture that promotes patient mobility and function during acute illness.
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Affiliation(s)
- Audrey M Johnson
- Department of Rehabilitation Science, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Dana M Howell
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, Kentucky
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van Delft LMM, Bor P, Valkenet K, Veenhof C. Hospital in Motion, a Multidimensional Implementation Project to Improve Patients' Physical Behavior During Hospitalization: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e11341. [PMID: 30964442 PMCID: PMC6477568 DOI: 10.2196/11341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/03/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
Background Despite the evidence of the adverse consequences of immobility during hospitalization, patients spend most of the time in bed. Although physical activity is a modifiable factor that can prevent in-hospital functional decline, bed rest is deeply rooted in the hospital culture. To attack this, a multidimensional approach is needed. Therefore, Hospital in Motion, a multidimensional implementation project, was designed to improve physical behavior during hospitalization. Objective The primary objective of this study is to investigate the effectiveness of Hospital in Motion on inpatient physical behavior. Secondary objectives are to investigate the effectiveness on length of hospital stay and immobility-related complications of patients during hospitalization and to monitor the implementation process. Methods For this study, Hospital in Motion will be implemented within 4 wards (cardiology, cardiothoracic surgery, medical oncology, and hematology) in a Dutch University Medical Center. Per ward, multidisciplinary teams will be composed who follow a step-by-step multidimensional implementation approach including the development and implementation of tailored action plans with multiple interventions to stimulate physical activity in daily care. A prepost observational study design will be used to evaluate the difference in physical behavior before and 1 year after the start of the project, including 40 patients per time point per ward (160 patients in total). The primary outcome measure is the percentage of time spent lying, measured with the behavioral mapping method. In addition, a process evaluation will be performed per ward using caregivers’ and patient surveys and semistructured interviews with patients and caregivers. Results This study is ongoing. The first participant was enrolled in October 2017 for the premeasurement. The postmeasurements are planned for the end of 2018. The first results are expected to be submitted for publication in autumn 2019. Conclusions This study will provide information about the effectiveness of the Hospital in Motion project on physical behavior and about the procedures of the followed implementation process aimed to incorporate physical activity in usual care. These insights will be useful for others interested in changing physical behavior during hospitalization. Trial Registration Netherlands Trial Register NTR7109; https://www.trialregister.nl/trial/6914 (Archived by WebCite at http://www.webcitation.org/76dyhdjdd) International Registered Report Identifier (IRRID) DERR1-10.2196/11341
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Affiliation(s)
- Lotte Martine Maria van Delft
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Petra Bor
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Conchin S, Carey S. The expert's guide to mealtime interventions – A Delphi method survey. Clin Nutr 2018; 37:1992-2000. [DOI: 10.1016/j.clnu.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/27/2017] [Accepted: 09/11/2017] [Indexed: 11/27/2022]
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