Hearing loss in older critical care patients: participation in decision making

Does the Synergy Model Implementation Improve the Transition from In-Hospital to Primary Care? The Experience from an Italian Cardiac Surgery Unit, Perspectives, and Future Implications

The demand for care services in the healthcare system has changed and is triggering a smooth transition from in-hospital to primary care. In this regard, patient-centered-care models of care delivery might provide a framework to follow patients' journeys throughout their transition between different levels of care. Accordingly, an Italian research group at a cardiac hospital in Northern Italy implemented the Synergy Model in a Cardiac Surgery Unit, a patient-centered-care model, and is using the framework of the model to guide a smooth transition of patients towards rehabilitation and primary care after their hospitalization. This discursive paper is focused on the experience, perspectives, and future implications of adopting the Synergy Model to facilitate the transition from in-hospital to primary care. The presented experience and discussion might be helpful to the international debate regarding the strategies to boost a smooth transition from in-hospital to primary care.

Evidence-Based Communication with Critically Ill Older Adults

Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.

Audiovestibular Symptoms at the Intensive Care Unit: A Narrative Review

Vertigo, tinnitus and hearing loss are the most common audiovestibular symptoms detected in the emergency departments and outpatients settings. However, little is known about these on patients at the intensive care unit. Although these symptoms may be common in this scenario, few studies have documented their onset, triggers and other factors associated to their presentation. The evaluation of these symptoms is a challenge for intensive care unit physicians, neurologists and otolaryngologists due to several factors as consciousness, systemic comorbidities, prolonged immobility and antibiotic therapy. The frequency of audiovestibular symptoms at the intensive care unit and the related events and factors associated to their presentation will be explored in this review.

Evidence-Based Communication with Critically Ill Older Adults

Communication is a critical component of patient-centered care. Critically ill, mechanically ventilated patients are unable to speak and this condition is frightening, frustrating, and stressful. Impaired communication in the intensive care unit (ICU) contributes to poor symptom identification and restricts effective patient engagement. Older adults are at higher risk for communication impairments in the ICU because of pre-illness communication disorders and cognitive dysfunction that often accompanies or precedes critical illness. Assessing communication disorders and developing patient-centered strategies to enhance communication can lessen communication difficulty and increase patient satisfaction.

The state of the evidence about the Synergy Model for patient care

AIM

To systematically and critically summarize the state of the evidence about the Synergy Model and its utilization in nursing practice.

BACKGROUND

The Synergy Model emphasizes the importance of alignment between patient needs and nurse competencies in achieving adequate patient- and nurse-related outcomes. It is a relatively new patient-centred care model developed at the end of the 1990s.

INTRODUCTION

Despite the Synergy Model's potential to support patient-centred care, its practical application is still mainly limited. Thus far, literature about the Synergy Model has not yet been synthesized, undermining its broader utilization globally.

METHODS

A systematic search was performed on the following databases: PubMed, CINAHL and Scopus. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and checklist to guide the systematic search; 26 papers were included in this study. A critical interpretative synthesis was adopted to summarize the data extracted from the included papers.

RESULTS

Five interpretative themes emerged: conceptualization, experiences from the field, nursing education, patient-related outcomes and system-related outcomes. Synergy Model shows a precise theoretical definition, and it was implemented in multiple clinical settings, mainly in critical care contexts. It seems to have a positive influence on patient-related, nurse-related and system-related outcomes.

DISCUSSION

Synergy Model seems to be positively associated with specific susceptible outcomes, such as patient satisfaction, reduction of patient's complications, staff satisfaction, empowerment, and engagement of patients and healthcare providers. However, the level of evidence is still limited.

CONCLUSION

Future international research should demonstrate the feasibility of implementing the Synergy Model at an international level. More empirical research is needed to demonstrate the effectiveness of the model on susceptible outcomes.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This systematic review could support further development of international programmes based on the Synergy Model. The Synergy Model's implementation has the potential to optimize nursing competencies, patient- and nurse-related outcomes.

Hearing and Health Outcomes: Recognizing and Addressing Hearing Loss in Hospitalized Older Adults

As age increases, the prevalence of hearing loss significantly increases, reaching up to 89% of those 80 years and older. Hearing loss in older patients is often unrecognized and its consequences are often underappreciated. Hearing loss can interfere with the ability to exchange important health information and to participate in health care decision-making. Hearing loss during hospitalization increases the risk of misdiagnosis. There is a lack of empirical data regarding prevalence and recognition of hearing loss in hospitalized older adults. In this article, we describe a variety of negative outcomes that may result when older inpatients are functioning with unrecognized hearing loss.

Screening for hearing, visual and dual sensory impairment in older adults using behavioural cues: a validation study

OBJECTIVE

This study investigated the psychometric properties of the Severe Dual Sensory Loss screening tool, a tool designed to help nurses and care assistants to identify hearing, visual and dual sensory impairment in older adults.

DESIGN

Construct validity of the Severe Dual Sensory Loss screening tool was evaluated using Crohnbach's alpha and factor analysis. Interrater reliability was calculated using Kappa statistics. To evaluate the predictive validity, sensitivity and specificity were calculated by comparison with the criterion standard assessment for hearing and vision. The criterion used for hearing impairment was a hearing loss of ≥40 decibel measured by pure-tone audiometry, and the criterion for visual impairment was a visual acuity of ≤0.3 diopter or a visual field of ≤0.3°. Feasibility was evaluated by the time needed to fill in the screening tool and the clarity of the instruction and items. Prevalence of dual sensory impairment was calculated.

RESULTS

A total of 56 older adults receiving aged care and 12 of their nurses and care assistants participated in the study. Crohnbach's alpha was 0.81 for the hearing subscale and 0.84 for the visual subscale. Factor analysis showed two constructs for hearing and two for vision. Kappa was 0.71 for the hearing subscale and 0.74 for the visual subscale. The predictive validity showed a sensitivity of 0.71 and a specificity of 0.72 for the hearing subscale; and a sensitivity of 0.69 and a specificity of 0.78 for the visual subscale. The optimum cut-off point for each subscale was score 1. The nurses and care assistants reported that the Severe Dual Sensory Loss screening tool was easy to use. The prevalence of hearing and vision impairment was 55% and 29%, respectively, and that of dual sensory impairment was 20%.

CONCLUSIONS

The Severe Dual Sensory Loss screening tool was compared with the criterion standards for hearing and visual impairment and was found a valid and reliable tool, enabling nurses and care assistants to identify hearing, visual and dual sensory impairment among older adults.