Elder-friendly emergency services in Brazil: necessary conditions for care

Conception of a Recognized Accreditation for a Senior-Friendly Hospital: The Accreditation "Hospital Attentive to the Elder"

OBJECTIVES

Consideration of the need to strengthen the commitment of professionals to the good care of the older population in hospitals has been emerging over the last several years. The steering committee of the geriatric sector of the hospitals of our Hospital Consortium (HC) has structured an accreditation project to promote the commitment of professionals to the good care of older adult patients in hospitals: the "Hospital Attentive to the Elder" (HAE) accreditation. This global approach aims to better adapt care to the needs of this population in the hospital and promote positive values (eg, kindness, attentive support).

DESIGN

The creation of the HAE accreditation required the creation of an accreditation board, a referential framework, and an accreditation procedure.

SETTING AND PARTICIPANTS

The whole process was coordinated by the accreditation board, a multidisciplinary entity, representative of the hospitals of our HC.

METHODS

The 5-step approach of the accreditation procedure includes a commitment to the HAE, with the support of the institutional board, and an internal self-assessment phase to guide the creation of action plans, followed by an accreditation cross-evaluation visit. The HAE accreditation is awarded to departments that meet the described criteria. This accreditation process was initially initiated by our HC.

RESULTS

In June 2021, 6 of 10 hospitals of our HC and 11 departments, which mobilized 28 medical, paramedical, and quality referents, initiated the process. All 11 departments fulfilled the criteria for the accreditation, and a ceremony to hand out the certificates was organized in December 2023.

CONCLUSIONS AND IMPLICATIONS

We envisage that this accreditation process could be offered at the regional and national level to any hospital or group of hospitals with departments that receive patients aged >75 years, regardless of their specialty.

Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review

BACKGROUND

Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging.

METHODS

A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode.

RESULTS

Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services.

CONCLUSION

To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.

Barriers to Trauma Care in South and Central America: a systematic review

INTRODUCTION

Trauma is widespread in Central and South America and is a significant cause of morbidity and mortality. Providing high quality emergency trauma care is of great importance. Understanding the barriers to care is challenging; this systematic review aims to establish current the current challenges and barriers in providing high-quality trauma care within the 21 countries in the region.

METHODS

OVID Medline, Embase, EBM reviews and Global Health databases were systematically searched in October 2020. Records were screened by two independent researchers. Data were extracted according to a predetermined proforma. Studies of any type, published in the preceding decade were included, excluding grey literature and non-English records. Trauma was defined as blunt or penetrating injury from an external force. Studies were individually critically appraised and assessed for bias using the RTI item bank.

RESULTS

57 records met the inclusion criteria. 20 countries were covered at least once. Nine key barriers were identified: training (37/57), resources and equipment (33/57), protocols (29/57), staffing (17/57), transport and logistics (16/57), finance (15/57), socio-cultural (13/57), capacity (9/57), public education (4/57).

CONCLUSION

Nine key barriers negatively impact on the provision of high-quality trauma care and highlight potential areas for improving care in Central & South America. Many countries in the region, along with rural areas, are under-represented by the current literature and future research is urgently required to assess barriers to trauma management in these countries. No funding was received.

CLINICAL TRIAL REGISTRATION

PROSPERO CRD42020220380.

Age-Friendly Health Care: A Systematic Review

Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.

Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review

AIM

To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice.

BACKGROUND

Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined.

DESIGN

Systematic literature review.

DATABASES AND DATA TREATMENT

A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review.

RESULTS

Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied.

CONCLUSION

Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.

Evaluation of elderly care dynamics in an emergency care unit

OBJECTIVE

understand elderly care dynamics of an emergency care unit.

METHOD

this is a case study evaluation, using a qualitative approach and the theoretical-methodological reference of a fourth generation evaluation. Data collection was conducted between February and September 2017, through 460 hours of participant observation, interviews with 33 social actors among health professionals, elderly people and their relatives of an emergency care unit located in a municipality in the northwest of Paraná, as well as negotiation meetings with participants.

RESULTS

the evaluation showed the elderly care dynamics is mainly influenced by nursing actions that articulate care practices based on priority, frailty, autonomy, independence and family context of the elderly patients.

FINAL CONSIDERATIONS

an evaluation of how the emergency care unit operates helps improve elderly care in urgent and emergency services.

Management of elderly people with Stroke: strategies based on action research

OBJECTIVE

To elaborate and implement, through an educational intervention with the nursing team of the Emergency Unit, strategies that contribute to the management of elderly people suspected/affected by Stroke.

METHOD

Action research with eighteen nursing professionals working in the Emergency Unit of a reference hospital. The data were collected through five pedagogical workshops and systematized through the thematic analysis.

RESULTS

After a situational analysis and identification of the difficulties in the management of these elderly, a synthesis chart was prepared with strategic actions, responsible professionals and perspectives for implementation in the short, medium and long term. Short-term strategies had, for the most part, immediate implementation; the others were agreed on the need for further implementation.

FINAL CONSIDERATIONS

The educational intervention allowed the construction of strategies that were implemented or agreed with the management for later applicability, sensitizing the group regarding the importance of the qualification and prompt care in the management of the elderly suspected/affected by Stroke.

Elderly care in the emergency department: an integrative review

Abstract Objective: To identify the care practices of nurses for the elderly in emergency departments. Method: An integrative review was carried out in the CAPES database, selecting publications in English, Portuguese and Spanish published between January 2011 and October 2016. The descriptors used were: "Emergency nursing"; "Geriatric nursing"; "Health services for the elderly"; "Elderly person"; "Nursing care". Results: Sixteen articles were analyzed in English, the majority of which had a qualitative approach (56.2%). Australia had the largest number of publications (31.2%). After reading the studies in full, the common themes were organized and classified into three categories: Challenges/difficulties in the care of the elderly in the emergency department, Positive experiences of elderly care in the emergency department and The emergency department as a space of death and dying. Conclusion: The care practices of nurses are focused on identifying the main problems regarding elderly care, adaptation and the planning of their work routine. Another strategy is the implementation of instruments of evaluation specific to elderly patients and the involvement of the family in all stages of care.