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Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Ebadi A, Gobbens RJJ. Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study. BMC Geriatr 2021; 21:555. [PMID: 34649518 PMCID: PMC8515677 DOI: 10.1186/s12877-021-02524-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. METHODS This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. RESULTS In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as "age-unfriendly structure," "inefficient care," and "frailty of older adults" could increase the risk of MNC. In addition, factors such as "support capabilities" and "ethical and legal requirements" will moderate MNC. CONCLUSIONS Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
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Affiliation(s)
- Zahra Rezaei-Shahsavarloo
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing & Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Anjara SG, Ní Shé É, O'Shea M, O'Donoghue G, Donnelly S, Brennan J, Whitty H, Maloney P, Claffey A, Quinn S, McMahon N, Bourke N, Lang D, Reilly P, McGuigan C, Cosgrave S, Lawlor L, O'Shea D, McAuliffe E, O'Donnell D. Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol. HRB Open Res 2020; 3:8. [PMID: 32789287 PMCID: PMC7359747 DOI: 10.12688/hrbopenres.13004.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.
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Affiliation(s)
- Sabrina G Anjara
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin, 4, Ireland
| | - John Brennan
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | - Hellen Whitty
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | | | - Anne Claffey
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland
| | | | - Niamh McMahon
- St. James's University Hospital, Dublin, 8, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, 2, Ireland
| | - Noeleen Bourke
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland.,Health Service Executive CHO 8 (Longford and Westmeath), Mullingar, Ireland
| | | | - Patrice Reilly
- Health Service Executive CHO 9 (Dublin North City and County), Dublin, Ireland
| | | | | | | | | | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
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