Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study

BACKGROUND

Despite the critical need, interventions aimed at frailty in sub-Saharan Africa are scarce, attributed to factors such as insufficient healthcare infrastructure, the pressing need to address infectious diseases, maternal and child health issues, and a general lack of awareness. Hence, the aim of this research was to develop, implement, and evaluate the effect of a nurse-led program on frailty and associated health outcomes in community-dwelling older individuals in Ethiopia.

METHODS

This study utilised a pre-test, post-test, and follow-up single-group quasi-experimental design. The main outcome measure was to determine changes in the frailty levels of older individuals living in communities at three different intervals: initially (T0), immediately after the intervention (T1), and 12 weeks following the intervention (T2). Secondary outcomes were the observed changes in daily living activities, nutritional status, depression levels, and quality of life (QOL), evaluated at each of these data collection points. To analyse changes in frailty and response variables over these periods, Friedman's ANOVA and Cochran's Q test were employed, setting the threshold for statistical significance at P < 0.05.

RESULTS

Sixty-six older people with a high adherence rate of 97% completed the intervention and the follow-up measurements. Participants had an average age of 66.7 ± 7.9 years, with females comprising 79.4% of the group. Notably, 12 weeks post-intervention, there was a marked decrease in frailty (χ2(2) = 101.05, p < 0.001) and depression scores (χ2(2) = 9.55, p = 0.008) compared to the baseline. However, the changes in depression, physical, mental, and environmental domains of QOL were not sustained for 12 weeks post-intervention. Study participants showed an improvement in nutritional status (χ2(2) = 25.68, p < 0.001), activity of daily living (χ2(2) = 6.00, p = 0.05), and global quality of life (χ2(2) = 20.64, p < 0.001).

CONCLUSIONS

The nurse-led intervention notably, 12 weeks post-intervention reduced frailty and depression. The intervention improved the nutritional status and some components of the quality of life of the participants. There is a need for further studies, especially with larger participant groups and stronger research designs such as randomized controlled trials (RCTs).

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05754398 (03/03/2023).

Comparing the delirium objective structured clinical examination (OSCE) education package to standard education for post-registration nurses: A randomised controlled trial

BACKGROUND

A recent pilot study demonstrated that an interactive delirium educational intervention, The Delirium OSCE Education Package, had a positive impact on self-perceptions of confidence and competence in the use of delirium assessment tools and delirium knowledge; delirium knowledge scores; clinical practice; and planned practice change for participants. However, it is not known if The Delirium OSCE Education Package is superior to standard methods of professional development education.

OBJECTIVE

To determine if The Delirium OSCE Education Package is superior to standard methods of professional development education on observations of delirium care in practice scores for post-registration nurses.

DESIGN

Clustered randomised, controlled, and observer-blinded, multisite superiority trial with two parallel groups at each site.

SETTINGS

Three private hospitals across New South Wales, Australia.

PARTICIPANTS

Registered nurses (RNs) (n = 153) or enrolled nurses (ENs) (n = 37) working in the eligible inpatient medical or surgical wards at each site.

METHODS

Within each hospital site wards were clusters, with wards rather than individuals being randomised for The Delirium OSCE Education Package or standard professional development education at a ratio of 1:1. The primary outcome was observations of delirium care in practice, 6-weeks post (T1) allocated intervention. Secondary outcomes were self-perceived confidence and competence (self-efficacy) in delirium assessment tools and delirium knowledge; and delirium knowledge scores.

RESULTS

A total of 51.3 % (n = 20) in the intervention group obtained a satisfactory observation of delirium care in practice score, compared to 34.9 % (n = 15) in the control group (p = 0.134, χ2). The odds of a satisfactory observation of delirium care in practice score for the intervention group was 10.1 times higher than the control (p = 0.009). The mean MCQ score and perceptions of confidence and competence in the intervention and control group increased from baseline to six-weeks post-intervention, however, there was no significant difference between the groups.

CONCLUSION

The Delirium OSCE Education Package provides the foundation for facilitating change in delirium care. It is recommended that The Delirium OSCE Education Package is implemented as part of a multicomponent strategy involving a validation delirium screening and assessment tool, hospital-specific policy, interprofessional education, and delirium champions. Future studies are needed to evaluate the sustainability of the intervention and if there is a positive impact on patient-level outcomes.

'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid

BACKGROUND

Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom.

METHODS

This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid.

RESULTS

Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options.

CONCLUSIONS

Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics.

PATIENT AND PUBLIC INVOLVEMENT

Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.

Perioperative knowledge, self-efficacy and clinical practices related to postoperative delirium care in older people across geographical regions in Australia

INTRODUCTION

In older people undergoing surgery, there is a lower tolerance for complications. This highlights the need for documented clinical practices on proper prevention, pre-screening and management of complications such as postoperative delirium (POD). Evidence-based clinical practice guidelines exist for delirium management; however, the management of delirium in clinical settings differs widely.

OBJECTIVE

This study aims to develop an understanding of the knowledge, components of self-efficacy (confidence/competence), and clinical practice related to POD care among preoperative and recovery nurses across different types of geographical locations in Australia.

DESIGN

A 27-item online survey was sent out to professional associations focused on perioperative care across Australia. The participants included practicing registered nurses specialising in perioperative care. The main outcome measures were Knowledge, confidence/competence and clinical practice relating to POD care in older patients.

FINDINGS

Respondents were categorised into two groups-major cities and rural and remote. Mean age was 46.3 years for respondents in Australian major cities and 49.5 for the comparison group. There was a statistically significant difference between Australian major cities and 'rural and remote' in confidence in detecting hyperactive delirium, 25.2% versus 11.7% respectively as well as managing hyperactive delirium, 13.8% versus 1.7%, respectively. Similar results were also observed on hypoactive delirium. Respondents from both groups did not mirror the ideal situation in managing a hyperactive delirium.

DISCUSSION

Results from this study are inconclusive and there is no clear-cut observation in clinical practice or knowledge between the two geographical categories in this study.

CONCLUSION

The absence of a distinct strategy with POD prevention highlights the need for a uniform approach and consensus on POD prevention and management in older people. This can be achieved by creating more awareness and education through professional development related to POD.

Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study

BACKGROUND

The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty.

OBJECTIVES

This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia.

METHODS

The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05.

DISCUSSION

The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries.

TRIAL REGISTRATION

The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.

In their own words: An exploration of primary children's participation in a dementia education program

ISSUE ADDRESSED

As the population ages the prevalence of dementia increases and children are increasingly experiencing family members and older friends living with dementia. Unfortunately, stigma about living with dementia is common. Increasing understanding about dementia among children has the potential to reduce this stigma. This paper reports on the qualitative findings of Project DARE (dementia knowledge, art, research and education), a school-based, multi-modal, arts program designed to increase understanding about dementia among children aged 8-10 years.

METHODS

A constructivist grounded theory approach was used to understand students' experience of the intervention. Thematic analysis was used to identify key themes emerging from interviews with randomly selected students (n = 40) who had taken part in the program.

RESULTS

The data analysis generated three themes related to students' awareness of dementia and experiences of the program: (1) nurturing empathy, (2) memory loss is complex, (3) learning about dementia through the arts to promote resilience. These themes show that the intervention increased students' awareness of dementia, and empathy towards people who are both directly and indirectly affected by dementia.

CONCLUSIONS

Although dementia education can be viewed as too sensitive for primary aged students, the current study demonstrates that such initiatives are feasible and can be effectively implemented with this age group. SO WHAT?: Changing student's beliefs about dementia can positively impact their relationships with people living with dementia.

Effects of simulation-based education module on delirium care in undergraduate nursing students: A quasi-experimental study

AIM

To examine the effects of a delirium education module on undergraduate nursing students' knowledge of and perceived confidence and competence in delirium care.

BACKGROUND

Delirium is common in intensive care units (ICUs) and leads to poor clinical outcomes. The under recognition of delirium is a major problem in ICU medicine. Nurses, as first-line health care providers, can address this by recognizing patients who are experiencing delirium. Since undergraduate nursing students will be the future ICU nurses, it is important to deliver the knowledge regarding delirium care. However, education about assessing delirium in ICUs among undergraduate nursing students is lacking.

DESIGN

Quasi-experimental study.

METHODS

A total of 74 undergraduate students were divided into an intervention group (n=34) and a comparison group (n=40). A 2-hour simulation-based delirium education module integrated into a critical care curriculum was delivered to the intervention group only. The classroom-based intervention was administered at a medical university in northern Taiwan. Study outcomes were measured using a structured survey including (1) a 16-item delirium care knowledge quiz, (2) confidence in delirium care scale and (3) competence in delirium care scale. The survey was distributed to students before and after the module in December 2020. The Mann-Whitney U test, chi-square test and Fisher's exact test were adopted to test the differences of all variables between groups. A generalized estimating equation model was used to investigate the adjusted treatment effects.

RESULTS

The participants had a median age of 22 years and 81% were female. The delirium education module yielded greater knowledge (B = 3.04, 95% confidence interval = 2.20-3.88), confidence (B = 4.20, 95% confidence interval = 2.67-5.73) and competence (B = 4.82, 95% confidence interval = 3.33-6.30) in delirium care when the treatment and control groups were compared.

CONCLUSIONS

For undergraduate nursing students, simulation-based education module is effective in improving the knowledge of and confidence and competence in delirium care. It is recommended that this be included in critical care nursing curricula.

Determinants of the intention to work in aged care: a cross-sectional study to assess gerontological nursing competencies among undergraduate nursing students

BACKGROUND

There are huge demands for aged-care workers, and undergraduate gerontological nursing education plays a critical role in providing academic and professional training.

PURPOSE

To examine relationships of characteristics, aged-care education, and gerontological nursing competencies with the intention to work in aged care.

METHODS

An online survey was distributed to undergraduate nursing students between April and June 2022 to gather characteristics, relevant aged-care education, gerontological nursing competencies, and intentions to work in aged care data. Multivariate regression analyses were conducted to identify determinants of the intention to work in aged care.

RESULTS

Students (n = 358) who were older (p < 0.001) and who were married (p < 0.001) had higher intentions to work in aged care. "Promoting mental health and psychological well-being", "Providing evidence-based dementia care", and "Enabling access to technology", were also associated with positive intentions.

CONCLUSIONS

This study provides evidence on determinants of the intention to work in aged care, particularly gerontological nursing competencies.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review

BACKGROUND

The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people.

METHODS

The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention.

RESULTS

Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression.

CONCLUSIONS

Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID of CRD42022348064.

Delirium assessment tools among hospitalized older adults: A systematic review and metaanalysis of diagnostic accuracy

Delirium is a common neuropsychiatric syndrome that is often overlooked in clinical settings. The most accurate instrument for screening delirium has not been established. This study aimed to compare the diagnostic accuracy of the 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) in detecting delirium among older adults in clinical settings. These assessment tools feature concise item sets and straightforward administration procedures. Five electronic databases were systematically searched from their inception to September 7, 2022. Studies evaluating the sensitivity and specificity of the 4AT, Nu-DESC, and CAM against the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases as the reference standard were included. Bivariate random effects model was used to summarize the sensitivity and specificity results. A total of 38 studies involving 7378 patients were included. The 4AT, Nu-DESC, and CAM had comparable sensitivity in detecting delirium (0.76, 0.78, and 0.80, respectively). However, the specificity of the CAM was higher than that of the 4AT (0.98 vs 0.89, P = .01) and Nu-DESC 0.99 vs 0.90, P = .003). Diagnostic accuracy was moderated by the percentage of women, acute care setting, sample size, and assessors. The three tools exhibit comparable sensitivity, and the CAM has the highest specificity. Based on the feasibility of the tools, nurses and clinical staffs could employ the Nu-DESC and the 4AT on screening out positive delirium cases and integrate these tools into daily practice. Further investigations are warranted to verify our findings.

Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People

BACKGROUND

Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia.

METHODS

This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined.

RESULTS

The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91.

CONCLUSION

The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.

Measuring gerontological nursing competencies among aged care nurses: Cultural adaptation and psychometric validation

BACKGROUND

Existing gerontological nursing competencies include the requisite knowledge and skills required for aged care nursing. What were not previously considered were legal and ethical aspects and access to technology, e-health and social media.

OBJECTIVES

This study aimed to validate an Australian gerontological nursing competencies scale and assess the factors associated with for aged care nurses in Taiwan.

METHODS

A methodological study design was used to validate the scale with a sample of 369 aged care nurses from aged care settings including nursing homes, long-term care facilities and aged care wards in Taiwan. The cultural adaptation and psychometric validation were evaluated. The content validity, construct validity through exploratory factor analysis and the internal consistency of the scale were assessed.

RESULTS

The exploratory factor analysis extracted two levels of gerontological nursing practice, 'essential' and 'enhanced', which accounted for 80.8% of the total variance. The internal consistency, split-half reliability and test-retest reliability were excellent. Aged care nurses with higher levels of education, aged care education as their highest degree and continued education within 6 months, and certified long-term care education had higher gerontological nursing competencies scores than those who did not.

CONCLUSIONS

This validated gerontological nursing competencies scale is a reliable and valid tool that can be implemented in future workforce planning, research and postgraduate and undergraduate curriculum and education in Taiwan and other Mandarin-speaking locales.

IMPLICATIONS FOR PRACTICE

Using validated gerontological nursing competencies scales to explain different levels of specialist practice is crucial for addressing negative views about aged nursing and explicitly demonstrate the possibilities for career pathways in gerontological nursing.

The impact of montessori-based programmes on individuals with dementia living in residential aged care: A systematic review

OBJECTIVES

This systematic review examined the effectiveness of Montessori-based programmes for individuals with dementia living in residential aged care.

METHODS

Nine databases were searched between January 2010 to October 2021, including Scopus, CINAHL, MEDLINE, Web of Science, SocINDEX with Full Text, PubMed, PsycINFO, Cochrane library and Cochrane Registry. Publications were included if they used Montessori-based programmes as interventions for individuals with dementia living in residential aged care and were qualitative, quantitative, mixed-method, or pilot studies. The quality of eligible studies was assessed using Joanna Briggs Institute critical appraisal instruments and the Mixed Method Critical Appraisal Tool. The findings were tabulated and narratively synthesised.

RESULTS

Fifteen studies were included in this review. The quality scores of the 15 studies ranged from 62 to 100 out of 100. Four key categories of outcomes were observed: (1) significantly improved engagement; (2) significantly improved mental health outcomes, including affect, depression, agitation, excessive eating and psychotropic medication prescriptions; (3) significantly improved feeding difficulty but mixed results regarding nutritional status; and (4) no significant changes in the activities of daily living and quality of life of individuals with dementia.

CONCLUSION

Cognitive capacity, personal preferences, individual care needs and the design of Montessori-based activities are pivotal to tailoring personalised Montessori-based activities for individuals with dementia in residential aged care and to maximise intervention outcomes. The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed. The study summarised evidence about the effectiveness of Montessori-based programmes for individuals with dementia and informed healthcare professionals about how to implement individualised Montessori-based programmes.

Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis

BACKGROUND

With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over.

METHODS

Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed.

RESULTS

A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted.

LINKING EVIDENCE TO ACTION

This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.

Delirium education and post-anaesthetics care unit nurses' knowledge on recognising and managing delirium in older patients

BACKGROUND

Postoperative delirium (POD) is a major complication following a surgical procedure. There is evidence that improving knowledge about POD could enhance POD care and patient outcomes.

AIM

The study aimed to evaluate whether the amount of delirium education among registered nurses working in post-anaesthetics care units (PACU) impacts on their self-reported confidence and competence in recognising and managing delirium as well as prior knowledge on factors that influence the risk of delirium onset for older people.

METHOD

The current study utilised an online survey on delirium care practice among registered nurses in PACUs. The survey consisted of 27 items. There were questions about confidence and competence in delirium care, knowledge about delirium risk factors, and ranked responses to two case scenario questions to evaluate the application of POD care. There were also demographic questions, including previous experience with delirium care education.

RESULTS

A total of 336 responses were generated from registered nurses working in PACU. Our findings found substantial variability among the respondents about their delirium care education. The amount of delirium education did not influence the PACU registered nurses' confidence or competence in delirium care. In addition, previous education did not have an impact on their knowledge about delirium risk factors.

DISCUSSION AND CONCLUSION

These findings suggested that the quantity of prior education about delirium did not improve the confidence, competence, knowledge, or case scenario questions of PACU registered nurses. Thus, delirium care education needs to be transformed to ensure it has a positive effect on delirium care clinical practice by registered nurses in PACU.

"The Challenge is Not to Make Her Feel Old and Bad": Exploring Australian Family Member Experiences of Conversations About Driving With Older Adults Using an Online Survey

This study explored the experiences of Australian family members having conversations about driving with older adults. An exploratory cross-sectional design using an online survey was carried out with Australian family members of current or retired (former) older drivers. One hundred and fifty-six intergenerational family members across Australia completed the survey. Qualitative content analysis of free-text responses identified that the outcomes of conversations were impacted by a range of environmental and individual factors. The essence of conversations centered around two opposing (positive and negative) discourses. The findings highlighted that an individualized approach to the content of conversations is required due to; driver attributes and actions, variations in the level of support experienced by family members, differences in physical and cognitive declines with age, negative perceptions on the impact of driving retirement, and absence of acceptable alternatives to driving. We recommend using positive discourse and reappraisal techniques when initiating driving conversations with older adults.

"I don't trust it, so I don't read it": How do older Australians navigate and search for information about their health and driving?

OBJECTIVES

Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the "DRIVING AND STAYING INDEPENDENT" resource assisting older drivers to make informed decisions about timely changes to their driving.

METHODS

Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data.

RESULTS

Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly.

CONCLUSIONS

This study provides important insights for an evidence-based social marketing campaign promoting the "DRIVING AND STAYING INDEPENDENT" resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Association between Malnutrition and Delirium in Older Chronic Kidney Disease Patients Admitted to Intensive Care Units: A Data Linkage Study

BACKGROUND

Independently, malnutrition and delirium in older hospitalised adults is prevalent. However, there is limited evidence on the association between these two conditions in older hospitalised adults with chronic kidney disease (CKD).

OBJECTIVES

To determine the association between malnutrition and delirium in older CKD patients admitted to intensive care units (ICU).

METHODS

This data linkage study utilised administrative data from New South Wales (NSW) hospitals in Australia between 2017 and 2020.Admitted patient data was linked with Cause of Death Unit Record File, and NSW Registry of Deaths (RBD). The study population comprised all CKD patients aged 65 and over admitted to ICUs. Descriptive statistics were used to summarise patient characteristics. Binary logistic tested for association between malnutrition and delirium.

RESULTS

The study population included 748 CKD patients with a total 948 admissions in the study period. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to code for all outcomes and comorbidities. The incidence of delirium was 15.5% (n=141) and malnutrition was recorded in 11.3% (n=103) across all admissions. The adjusted odds ratio (OR) of a delirium diagnosis was 2.07 (95% CI: 1.27-3.39) for CKD patients that were malnourished compared to non-malnourished CKD patients.

CONCLUSIONS

This study showed a significant association between delirium and malnutrition in older CKD patients admitted to ICU. Management of malnutrition could be critical in reducing the risk of delirium in older hospitalized patients with CKD. Additionally, more education and awareness around delirium and its association with malnutrition are needed in clinical practice.

Teaching delirium to undergraduate medical students: Exploring the effects of a cross‐professional group objective structured clinical examination compared to standard education

OBJECTIVES

To compare a cross-professional facilitated delirium group objective structured clinical examination (GOSCE) educational intervention with standard delirium education for medical students during clinical placement, and explore the differences in the examiner's written feedback between the two groups.

METHODS

A non-randomised clustered controlled designed study at a single metropolitan university across several campuses in Sydney, Australia. A convenience sample of third-year medical students was recruited. Students' knowledge, communication, and clinical reasoning skills were assessed using a delirium case mock OSCE at the end of the academic year. The OSCE marks and the examiner's feedback for the intervention and control group were compared.

RESULTS

The intervention group (n = 41) had a higher total mean OSCE mark compared to the control group (n = 29) (36.5, SD 2.9 vs. 33.7, SD 2.9, p < 0.001). Content analysis of the examiner's feedback showed the intervention group had a greater understanding of the need for forward planning and future cognitive assessments, and the roles of the interdisciplinary team in delirium care.

CONCLUSIONS

The innovative cross-professional facilitated delirium GOSCE education was effective in increasing delirium knowledge, communication, and clinical reasoning skills compared to conventional education for medical students during clinical placement. Further studies are needed to investigate how this is translated into practice.

Perceived barriers and facilitators to the provision of physiotherapy in residential aged care facilities: A national survey of Australian physiotherapists

OBJECTIVE

To identify and explore physiotherapists' perceived barriers and facilitators to the provision of physiotherapy in Australian residential aged care facilities (RACFs).

METHODS

A national cross-sectional survey was conducted with physiotherapists who worked in Australian RACFs for at least 50% of their working week. A variety of methods, such as social media, direct contact with aged care providers, and the Australian Physiotherapy Association, were used to advertise the survey. A rigorous design was used to develop the online survey to collect views on barriers and facilitators to provision of physiotherapy in Australian RACFs. Descriptive analysis was conducted using SPSS to analyse participant characteristics. Inductive framework analysis was conducted using NVivo 12 to identify key themes.

RESULTS

One hundred and sixty-five qualified and registered physiotherapists (mean age 39.5 years, 74% female) who worked predominantly in Australian RACFs participated in this study. Five themes were identified: individual physiotherapist, collaborations, organisational, RACF community, and public policy. Each had associated barriers and facilitators to provision of physiotherapy as perceived by physiotherapists. Individual, collaborative, and RACF community factors were the main facilitators of physiotherapy in Australian RACFs. Organisational and public policy factors were identified as the main barriers of physiotherapy.

CONCLUSIONS

This study highlighted what factors are perceived by RACF physiotherapists to facilitate provision of physiotherapy, and what areas of improvement should be considered to potentially provide more effective care in Australian RACFs. Due to the varied responses in this study, further research is warranted to determine the degree of impact of the identified factors.

The impact of ageing simulation education on qualified acute care nurses' empathy towards older people: A mixed-methods study

AIMS AND OBJECTIVES

To evaluate the influence of an ageing simulation intervention on qualified acute care nurses' empathy towards older people.

BACKGROUND

Life expectancy is increasing globally with an increased incidence of older people accessing healthcare services. As such, it is essential for qualified nurses within hospital settings to connect with older people by establishing healthful relationships. Empathy is an essential component of healthful nurse-patient relationships. Fortunately, empathy can be taught through education.

DESIGN

A convergent mixed-methods design was utilised.

METHODS

Nurses (N = 95) undertook an 8-hour ageing simulation intervention. Data were collected from April 2019 to May 2020 across three time points: before the intervention (T0); immediately after (T1) and at three months follow-up (T2). A mix of convenience (intervention) and purposeful (follow-up) sampling techniques were utilised. Quantitative data were collected via the Interpersonal Reactivity Index survey (n = 86) and analysed using repeat measures ANOVA to compare mean scores across time points. Qualitative data were collected via debriefing discussions (N = 95) and focus groups (n = 38), and analysed using a systematic thematic analysis method. Data convergence occurred during the interpretation phase. Study reported with the TREND checklist.

RESULTS

Primarily, when quantitative and qualitative findings were merged they confirmed each others' empathy outcomes. Quantitative results showed a statistically significant increase in affective and cognitive empathy levels among nurses post-intervention. Qualitative findings expanded on quantitative results and revealed an increase in nurses' affective, cognitive and behavioural empathy represented in themes 'enhancing my empathy', 'impact of ageing', 'from self to others' and 'person-centred moments'.

CONCLUSIONS

This study adds empirical evidence how a mixed-methods design can be used to evaluate the influence of an ageing simulation intervention on nurses' empathy levels.

RELEVANCE TO CLINICAL PRACTICE

Ageing simulation interventions are a suitable experiential educational approach to improve acute care nurses' affective, cognitive and behavioural empathy towards older people.

Having the conversation about vision for safe driving with older adults: an exploratory study of eyecare professional experiences in England and Australia

CLINICAL RELEVANCE

Eyecare professionals assess older adults against the vision requirements for driving and discuss this with them on a regular basis. Improved access to resources/training would be beneficial and help eyecare professionals navigate more difficult conversations about driving, e.g., following acute vision changes.

BACKGROUND

The numbers of drivers aged >65 years is increasing in many countries, in line with ageing populations. In most countries the onus is on the driver to self-monitor their vision for driving, by engaging in regular eye tests. Eyecare professionals therefore could play an important role in older driver decision-making about their fitness to drive. There is limited guidance for eyecare professionals regarding how to approach conversations with older drivers about their vision, and when these conversations should be had.

METHODS

Semi-structured interviews were undertaken with eyecare professionals involved in vision assessments and decision-making about medical fitness to drive for older adults (optometrists, orthoptists, ophthalmologists). Framework analysis identified challenges and facilitators to conversations with older drivers about vision.

RESULTS

Twenty-six eyecare professionals from Australia (n = 17) and England (n = 9) participated from urban and regional/rural areas. Themes were divided into facilitators (clear standards and comprehensive testing; positive approach; preparation and patient self-awareness; relationships and trust; importance of multiple options in guiding a transition to driving retirement) and challenges (acute loss of visual function; limited self-awareness of the impact of visual problems on driving; and perceived lack of resources and need for training).

CONCLUSIONS

Eyecare professionals prefer to have early and regular conversations with older adults about their vision for driving. Acute visual field/acuity loss or onset of double vision, necessitating rapid changes to driving behaviour, were both identified as major challenges for eyecare professionals. Improved access to resources and training would be beneficial, to help eyecare professionals navigate these especially difficult conversations and signpost older drivers to appropriate support.

Evaluation of an education intervention for Australian health practitioners to support people with dementia with driving decisions: A pretest-posttest survey

OBJECTIVE

Drivers with dementia will at some stage need to stop driving. The timing of driving retirement is informed by the advice of health practitioners, however many find this task complex and challenging as they feel unprepared or lack confidence, having limited training and education on dementia and driving. Few opportunities exist for Australian health practitioners to advance learning about dementia and driving. This study evaluated the impact of a Dementia and Driving Education Module on practitioner self-perceived knowledge, confidence, and competence in supporting people living with dementia with decisions about driving.

METHODS

A single group, pretest-posttest survey was conducted for this study. Health practitioners were recruited over 19 months via email and invited to attend a face-to-face dementia and driving workshop. The workshop comprised of a two-hour Dementia and Driving Education Module including seven learning activities incorporating six vignettes, five self-reflections, one case study and a paper copy of a dementia and driving decision aid. Participants completed a survey prior to, immediately after and six weeks post completion of the education module.

RESULTS

A total of 240 health practitioners, from over six disciplines, took part in one of eleven workshops delivered via face-to-face and online across five states of Australia. Significant increases occurred in all outcome measures of perceived knowledge, confidence and competence between baseline and immediately post-education module survey responses and between baseline and six weeks post-survey responses.

CONCLUSIONS

The Dementia and Driving Education Module and accompanying decision aid demonstrate an efficacious solution for a diverse range of health practitioners to enhance their knowledge, confidence, and competence in supporting people living with dementia with driving retirement decisions.

Recognizing Intensive Care Unit Delirium: Are Critical Care Nurses Ready?

BACKGROUND

Delirium remains significantly undetected in the intensive care unit (ICU). Little is known regarding the level of delirium care knowledge among critical care nurses in Taiwan.

PURPOSE

This study was designed to investigate the level of knowledge about delirium care among critical care nurses using a multiple-choice question quiz.

METHODS

A descriptive, cross-sectional approach was used, and data were collected using a web-based survey. The demographic characteristics including age, years worked as critical care nurse, gender, advanced ICU training, educational level, and type of ICU, along with a delirium care knowledge quiz, were collected. The quiz consisted of 16 items measuring (a) symptoms, types, and outcomes; (b) high-risk groups; (c) predisposing and precipitating factors; and (d) assessment and detection of delirium. Data were collected between October 6 and November 16, 2020.

RESULTS

In total, 324 critical care nurses completed the survey. The rate of correct response on the delirium care quiz for each domain was measured: (a) symptoms, types, and outcomes: 67.1%; (b) high-risk groups: 76.2%; (c) predisposing and precipitating factors: 78.9%; and (d) assessment and detection: 41.5%. The item with the lowest correct response rate was related to the interpretation of delirium assessments.

CONCLUSION/IMPLICATIONS FOR PRACTICE

The findings of this study suggest that future studies and education should focus on the use and interpretation of the assessment using a valid delirium assessment tool to improve the ability of critical care nurses to detect delirium in ICU settings.

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions

BACKGROUND AND OBJECTIVES

General practitioners (GPs) in New South Wales are required to perform annual medical assessments of driving fitness in patients aged 75 years or older. The objective of this study was to understand GPs' attitudes towards driving assessments and to highlight guideline limitations and possible solutions.

METHOD

Semi-structured interviews with a sample of 10 GPs were audio-recorded, transcribed and thematically analysed.

RESULTS

The key themes that emerged were challenges GPs face with the current driving fitness assessment, techniques used to overcome these challenges, and the process of negotiating with patients.

DISCUSSION

The findings highlighted the need for further support of GPs and for more statistical evidence of driving risks. Key areas of uncertainty were applying licence restrictions, calculating the sum of effects of comorbidities and assessment of new patients. This study might prompt consideration of a range of supports to assist GP decision making, as well as contribute to a decision aid for older drivers.

Beyond the technology: Applying the NLN Jeffries Simulation Theory in the context of aging simulation

BACKGROUND

Caring for older people has become a focus for simulation-based education. Specifically, aging simulation has emerged as an innovative and effective educational approach that utilizes aging-suits for nurses to gain insight into the aging process and the everyday difficulties faced by older people. There is limited evidence within the literature about how researchers and educators support decision-making processes in the design, implementation, and evaluation of aging simulation programs.

AIM

This is a theoretical development paper and its purpose is to explore the practical application of the Jeffries Simulation Theory in the design, implementation, and evaluation of an aging simulation program to contribute to knowledge development and guide educational practices for nurse educators and researchers.

RESULTS

The authors describe a practical application of the theory to an aging simulation program using the five key theory components: context, background, design, simulation experience, and outcomes. Specific theory strengths are highlighted in practical examples generated from the authors aging simulation interventional study example: engaging stakeholders, consideration of additional observer simulation roles, reflective debrief discussions, influence of facilitator and participant personal attributes, and outcomes beyond the participants.

CONCLUSION

The Jeffries Simulation Theory is well suited for underpinning the design, implementation, and evaluation of aging simulation programs.

Using the nursing delirium screening scale in assessing postoperative delirium: A meta-regression

The nursing delirium screening scale (Nu-DESC) was developed for the rapid assessment of delirium, but little is known regarding the performance of the Nu-DESC in assessing postoperative delirium. The purpose of this systematic review and meta-analysis was to review and summarize the evidence of the diagnostic accuracy of the Nu-DESC in assessing postoperative delirium. The EMBASE, MEDLINE, Cochrane Library, CINAHL, and a Chinese e-Journal database were searched from the period of the inception of the Nu-DESC to June 18, 2020. Participants were adult (age ≥ 18 years) postoperative patients who received any type of surgery and any method of anesthesia. The quality assessment of diagnostic accuracy studies-2 was employed to assess the risk of bias among the selected studies, and meta-regression analyses were used to detect sources of between-study heterogeneity. Eleven studies involving 2062 postoperative patients in surgical settings were included. The Nu-DESC revealed a pooled sensitivity of 0.73 (95% confidence interval, 0.44-0.90) and a specificity of 0.93 (0.87-0.96). The area under the summary receiver operating characteristics curve was 0.94 (0.91-0.96), which also confirmed the accuracy of the Nu-DESC. Covariates, including the region of study and the standard reference used, were identified as possible sources of heterogeneity in the meta-regression. The findings of this review can update existing clinical guidelines for postoperative delirium. On the basis of its satisfactory diagnostic performance, we suggest that the Nu-DESC could be considered for nurses and allied health professionals for assessing postoperative delirium. However, because of the heterogeneity, the result of this meta-analysis should be considered with caution.

Postoperative Delirium in Older Patients: A Systematic Review of Assessment and Incidence of Postoperative Delirium

BACKGROUND

Postoperative delirium is the most common complication of surgery particularly in older patients.

AIMS

The current study aimed to summarize the commonly used delirium assessment tools in assessing postoperative delirium (POD) and to estimate the incidence rates of POD.

METHODS

A systematic review that included empirical cohort studies reporting the use of delirium assessment tools in assessing POD between 2000 and 2019. Five core databases were searched for eligible studies. The methodological quality assessment of the included studies was undertaken using the Joanna Briggs Institute (JBI) critical appraisal checklist to examine the risk of bias. Pooled incidence estimates were calculated using a random effects model.

RESULTS

Nineteen studies with a total of 3,533 postsurgery older patients were included in this review. The confusion assessment method (CAM) and CAM-ICU were the most commonly used tools to assess POD among older postoperative patients. The pooled incidence rate of POD was 24% (95% CI [0.20, 0.29]). The pooled incidence estimates for mixed (noncardiac) surgery, orthopedic surgery, and tumor surgery were 23% (95% CI [0.15, 0.31]), 27% (95% CI [0.20, 0.33]), and 19% (95% CI [0.15, 0.22]), respectively. More than 50% of included studies used CAM to assess POD in different types of postoperative patients. Using CAM to assess delirium is less time-consuming and it was suggested as the most efficient tool for POD detection.

LINKING EVIDENCE TO ACTION

We identified that CAM could be implemented in different settings for assessing POD. The incidence and risk factors for POD introduced can be used for future research to target these potential indicators. The incidence rate, risk factors, and predictors of POD explored can provide robust evidence for clinical practitioners in their daily practice.

[Driving Cessation and Mental Health in Persons With Dementia: A Preliminary Study]

BACKGROUND

The driving safety of persons with dementia (PwD) is an important public-health issue worldwide. Driving is closely related to personal autonomy, self-esteem, and independence. When PwD lose their driving privileges, this may lead to negative effects on mental health.

PURPOSE

The purpose of this study was to evaluate the relationship between driving cessation and mental health in PwD.

METHODS

A cross-sectional design with convenient sampling was used, Data were collected using structured questionnaires. Participants were all PwDs who were recruited from a medical center in northern Taiwan.

RESULTS

A total of 78 PwD were recruited. Two-fifths (41%) of the participants were still driving, with motorcycle the most common vehicle used. The participants who had retired from driving were older, and most did not have a spouse, were less socially active, had a lower mean level of functional ability, and perceived a lower association between driving and quality of life. Driving cessation was found to be positively correlated with age and the instrumental activities of daily living. Depression and anxiety levels in former drivers were higher than in current drivers, although the differences were not significant.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

Among PwD, depression and anxiety is higher in former drivers. It is suggested that a prospective study should be conducted, that driving safety issues for PwD should be addressed in public health education, and that standards of driving safety for PwD should be developed and enacted.

Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial

AIMS

To evaluate the effects of a simulation-based education programme on critical care nurses' knowledge, confidence, competence and clinical performance in providing delirium care.

DESIGN

Single-blinded randomized controlled trial.

METHODS

Registered nurses who work in intensive care units were recruited from a university-affiliated acute major metropolitan teaching hospital. The intervention group received: (i) five online-learning delirium care videos, (ii) one face-to-face delirium care education session and (iii) a simulation-based education programme with a role-play scenario-based initiative and an objective structured clinical examination. The control group received only online videos which were the same as those provided to the intervention group. Delirium care knowledge, confidence, competence, and clinical performance as outcomes were collected at: baseline, immediately after intervention, and within 6 weeks post-intervention to test whether there were any changes and if they were sustained over time. Data were collected between 2 October and 29 December 2020. The repeated-measures analysis of variance was used to examine for changes in delirium care knowledge, confidence, and competence within groups.

RESULTS

Seventy-two critical care nurses participated with 36 each allocated to the intervention group and control group. No statistically significant difference was observed between the two groups in outcome variables at 6 weeks post-intervention. In the intervention group, significant within-group changes were observed in terms of delirium care knowledge, confidence, and competence over time. By contrast, no significant changes were observed in outcome measures over time in the control group.

CONCLUSION

The simulation-based education programme is an effective and feasible strategy to improve delirium care by enhancing the knowledge, confidence, competence and clinical performance of critical care nurses.

IMPACT

Our findings provide evidence regarding the development and implementation of a simulation-based education programme in hospitals for health professional education in Taiwan.

The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review

AIM

This review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people.

BACKGROUND

Ageing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people.

DESIGN

An integrative review approach was used.

METHODS

Four databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed.

RESULTS

Three interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult.

CONCLUSIONS

Despite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.

The use and effect of OSCES in post-registration nurses: An integrative review

BACKGROUND

Objective structured clinical examinations (OSCEs) have been used in the undergraduate medical setting since the 1970s, however little is known about its use and effectiveness in post-registration nurse education.

OBJECTIVES

The purpose of this review was to critically analyse studies using OSCEs in post-registration nurse education and to explore the use and effectiveness of OSCEs in this cohort.

DESIGN

This review was conducted using the Whittemore and Knafl's framework for integrated reviews.

DATA SOURCES

Using the search terms OSCE OR OSCA OR objective structured clinical examination AND nursing NOT undergraduate, a comprehensive review was conducted using CINHAL and MEDLINE.

METHODS

The initial search located 173 studies. After screening and checking eligibility 19 studies were critically appraised. The final number of studies included in this review was 16.

RESULTS

Three themes were generated: (i) Application of OSCEs in post-registration level nursing (ii) OSCEs more than an exam: Learning enhancements and (iii) Participant perceived impact of OSCEs.

CONCLUSION

OSCEs for post-registration nurses have evolved from the original OSCE design and have been adapted to a wide range of clinical settings and specialities. OSCEs were recognized as a valuable learning and assessment tool across the world for post-registration nurses. OSCEs offered strengths in terms of learner satisfaction and increased self-efficacy for this cohort. There was limited evidence supporting the effects of OSCEs within post-registration nursing education in comparison with other educational tools. Further research is needed to explore whether the knowledge gained in OSCEs is translated into clinical practice and whether simulation-based education is more effective in achieving enhanced knowledge compared to traditional-based education. Future research is required using RCT methods to compare the impact of OSCE to traditional-based education.

Delirium care knowledge in critical care nurses: A multiple-choice question-based quiz

BACKGROUND

Lack of evidence regarding whether a useful examination instrument such as an multiple choice question (MCQ) quiz is reliable for assessing delirium care knowledge.

AIM

To develop and psychometrically test a MCQ-based quiz for assessing the delirium care knowledge in critical care nurses.

DESIGN

Instrument development and psychometric evaluation study.

METHODS

The development and validation process consisted of two phases. The first Phase focused on the quiz development, which was achieved through the following steps: (a) generation of an initial 20-item pool; (b) assessment of content validity; (c) assessment of face validity; (d) conduction of a pilot test, involving the collection of data from 217 critical care nurses through an online survey; and (e) item analysis and item elimination according to item difficulty and discrimination indices. The MCQ quiz was finalized through the development process. The second phase emphasized quiz validation through estimation of the internal consistency, split-half and test-retest reliability, and construct validity using parallel analysis with exploratory factor analysis (EFA).

RESULTS

A final 16-item MCQ quiz was emerged from the item analysis. The Kuder-Richardson formula 20 coefficient for the overall quiz indicated good internal consistency (0.85), and the intraclass correlation coefficient with a 30-day interval also indicated that the questionnaire had satisfactory stability (0.97). EFA confirmed that the quiz had appropriate construct validity, and four factors could explain 60.87% of the total variance.

CONCLUSION

In this study, the MCQ, and single best answer quiz for assessing delirium care knowledge was developed, and its reliability and validity for this purpose were demonstrated.

RELEVANCE TO CLINICAL PRACTICE

This study introduced an evidence-based quiz designed for future use in delirium care research and education that has significant implications for MCQ-based knowledge assessment in clinical practice.

Mandarin version of dementia and driving decision aid (DDDA): Development and stakeholder evaluation in Taiwan

BACKGROUND

Dementia causes cognitive and memory difficulties which can reduce the driving safety of the individuals. The decision-making process for driving retirement is challenging, and yet limited guidance is available.

OBJECTIVES

This article reports the development of the Taiwanese version of dementia and driving decision aid (DDDA) and the evaluation from stakeholders through a dementia and driving education programme.

METHODS

A multi-method approach was adopted using a pre-test, post-test survey and focus group interviews. A total of 154 healthcare professionals, family caregivers and people with dementia participated education programme, and 12 experts attended the focus group discussion. The survey included demographics, knowledge, confidence, competence and awareness of using DDDA. Participants completed a survey prior and immediately after the education programme. We translated a 32-page interactive DDDA booklet from the original English version to Mandarin. The education programme consisted of three-hour dementia and driving education module delivered both face-to-face and online.

RESULTS

The majority of participants described the booklet as balanced (91.7%) with the information presented in a 'good' or 'excellent' manner (93.4%). Most participants (85.3%) felt that DDDA helps them in making decisions about driving. Five themes were extracted from the focus group interview: (1) approach targeted to people with dementia, (2) specific content and additional information, (3) culturally appropriate modification, (4) having the right to drive and (5) booklet dissemination. The knowledge, confidence, competence and awareness of using the DDDA increased significantly (p < 0.001) after the education programmes.

CONCLUSION

We anticipate that use of the DDDA booklet will raise awareness of this social and health issue among the general public and facilitate collaborations with clinicians, municipalities and related organisations in providing a decision-making resource material for those with people living with dementia and their families. This study was not a clinical trial and the focus of this study was development and evaluation of the DDDA booklet. As mentioned in the methods section, participants were invited to attend the education program and provided their thoughts on the DDDA booklet based on their satisfaction level. Moreover, the education program was a one-day, workshop type program. This study was neither "prospectively assigns human participants or groups of humans to one or more health-related interventions" nor "to evaluate the effects on health outcomes", according to the definition of clinical trial by WHO. Therefore, we did not consider this study was a clinical trial.

IMPLICATIONS FOR PRACTICE

There is an urgent need for supporting people with dementia and their families to negotiate the complex decision-making involved in deciding to change their approach to driving. The DDDA booklet can fill an important gap in service delivery to people with dementia who are adjusting to life without driving.

Review of Food Intake Difficulty Assessment Tools for People with Dementia

This review aimed to summarise the validity and reliability of feeding difficulties assessment tools for Individual with dementia. PubMed, PsycINFO, MEDLINE, CINAHL and Scopus were searched for feeding difficulty measurements studies published between 1990 and 2019. Sixteen publications were included and identified three tools: Edinburgh Feeding Evaluation in Dementia (EdFED), Feeding Behaviour Inventory (FBI), and Feeding Difficulty Index (FDI). Results showed the EdFED was translated and tested in various languages. The EdFED and FDI demonstrated high content and construct validity. The FBI was not validated. The EdFED had high inter-rater reliability, with Cronbach's alpha ranging from 0.75 to 0.90. The FDI and FBI showed moderate inter-rater reliability. Although the EdFED has been tested and widely used, unlike FDI, which addresses multi-aspects of feeding difficulty. The FDI have higher clinical utility but future research needs to test the psychometric properties of FDI to determine its effectiveness in assessing feeding difficulties.

Dementia knowledge, art, research and education - Teaching primary school children about dementia

ISSUE ADDRESSED

To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children.

METHODS

A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10 years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks.

RESULTS

Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos.

CONCLUSION

Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities.

Diagnostic Performance of Delirium Assessment Tools in Critically Ill Patients: A Systematic Review and Meta-Analysis

BACKGROUND

Critical care nurses are in the best position to detect and monitor delirium in critically ill patients. Therefore, an optimum delirium assessment tool with strong evidence should be identified with critical care nurses to perform in the daily assessment.

AIM

To evaluate and compare the diagnostic performance of delirium assessment tools in diagnosing delirium in critically ill patients.

METHODS

We searched five electronic databases including the Cochrane Library, PubMed, Embase, CINAHL, and a Chinese database for eligible diagnostic studies published in English or Mandarin up to December 2018. This diagnostic test accuracy meta-analysis was limited to studies in intensive care unit (ICU) settings, using the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a standard reference to test the accuracy of delirium assessment tools. Eligible studies were critically appraised by two investigators independently. The summary of evidence was conducted for pooling and comparing diagnostic accuracy by a bivariate random effects meta-analysis model. The pooled sensitivities and specificities, summary receiver operating characteristic curve (sROC), the area under the curve (AUC), and diagnostic odds ratio (DOR) were calculated and plotted. The possibility of publication bias was assessed by Deeks' funnel plot.

DATA SYNTHESIS

We identified and evaluated 23 and 8 articles focused on CAM-ICU and ICDSC, respectively. The summary sensitivities of 0.85 and 0.87, and summary specificities of 0.95 and 0.91 were found for CAM-ICU and ICDSC, respectively. The AUC of the CAM-ICU was 0.96 (95% CI, 0.94-0.98), with DOR at 99 (95% CI, 55-177). The AUC of the ICDSC was 0.95 (95% CI, 0.92-0.96), and the DOR was 65 (95% CI, 27-153).

LINKING EVIDENCE TO ACTION

CAM-ICU demonstrated higher diagnostic test accuracy and is recommended as the optimal delirium assessment tool. However, the results should be interpreted with caution due to the between-study heterogeneity of this diagnostic test accuracy meta-analysis.

Incidence and risk factors for new-onset atrial fibrillation following coronary artery bypass grafting: A systematic review and meta-analysis

OBJECTIVES

To estimate the incidence of new-onset post-operative atrial fibrillation after isolated coronary artery bypass surgery and summarise the evidence on risk factors that predispose people to developing the complication.

STUDY DESIGN/METHODS

A systematic review was conducted to identify studies from the CINAHL, MEDLINE and Cochrane databases. A title and abstract review was conducted by one reviewer. Full text review and quality assessment processes were conducted by two reviewers. Incidence data was combined in meta-analysis using the 'metaprop' routine in Stata and risk factor data were synthesised in narrative and table format.

RESULTS

Ten studies, including 6173 participants, were included in the review. The estimated pooled incidence of post-operative atrial fibrillation was 25% (CI 0.19-0.30). In a secondary meta-analysis including studies that only included first time bypass surgery recipients the estimated pooled incidence was 26% (CI 0.14-0.41). Due to high levels of heterogeneity these results should be interpreted with caution. Risk factors with the strongest associations to post-operative atrial fibrillation were chronic obstructive pulmonary disease, decreased partial pressure of oxygen on air, congestive heart failure, right coronary artery disease, male gender, prolonged cross clamp time and port-operative inotropic exposure.

CONCLUSION

Further prospective studies are needed to strengthen the current evidence base.

Synergistic Effect of Low Neutrophil-Lymphocyte Ratio With Physical Activity on Quality of Life in Type 2 Diabetes Mellitus: A Community-Based Study

BACKGROUND

Physical inactivity and Type 2 diabetes mellitus (T2DM)-associated inflammatory biomarkers are correlated with poor quality of life (QoL). However, no study has investigated the synergistic effect of physical activity (PA) and lower neutrophil-lymphocyte ratio (NLR) on QoL.

OBJECTIVE

We examined the independent and synergistic effects of PA and inflammatory biomarkers on three domains of QoL in T2DM.

METHODS

This cross-sectional study included 294 patients with T2DM from community clinics in Indonesia. The 36-item Short Form Survey and a questionnaire about PA engagement were used to measure QoL and metabolic equivalent of task (MET)-hr/week, respectively. Inflammatory biomarkers were measured in fasting blood. Adjusted coefficients β and 95% confidence interval (CI) were estimated using multiple linear regression. The synergistic effect was analyzed using additive interaction for linear regression.

RESULTS

Patients with PA ≥ 7.5 MET-hr/week exhibited significantly higher total QoL (β = 8.41, 95% CI = [6.04, 10.78]) and physical component score (PCS; β = 13.90, 95% CI = [10.52, 17.29]) than those with PA < 7.5 MET-hr/week. Patients with NLR < 1.940 had significantly higher total QoL (β = 4.76, 95% CI = [3.41, 6.11]), mental component score (MCS; β = 2.62, 95% CI = [0.75, 4.49]), and PCS (β = 6.89, 95% CI = [4.97, 8.82]) than patients with NLR ≥ 1.940. PA ≥ 7.5 MET-hr/week and NLR < 1.940 exhibited a synergistic effect on total QoL, MCS, and PCS.

CONCLUSIONS

High PA level and low NLR had a positive synergistic effect on QoL among patients with T2DM.

What are we asking for when requesting "Specialling" for the confused hospitalised older person? A concept analysis

BACKGROUND AND/OR RATIONALE: "Specialling" is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness. To facilitate further investigation, a concept analysis of "specialling" was undertaken.

AIMS

The aim of this paper was to report on a concept analysis on the practice of "specialling" pertaining to older people who have cognitive impairment when in hospital.

METHODS

This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of "specialling." Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding.

FINDINGS

A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the "Special" role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; and Organisational risk. The consequences of "specialling" were diverse with 6 themes: the "Special" role; the Older persons experience; Costly; "Special" use and nursing beliefs; Safety outcomes; and Opportunities.

DISCUSSION

The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person-centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study.

IMPLICATIONS FOR PRACTICE

Nurses have an opportunity to lead care improvements by ensuring person-centred approaches in the care of older people with cognitive impairment.

Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan

OBJECTIVES

This study aimed to translate the Oral Health Literacy Adult Questionnaire into a Mandarin version (MOHL-AQ) and to examine its psychometric properties.

METHODS

A methodological research using psychometric testing and evaluation of a translated instrument. A convenience sample of 402 participants from northern Taiwan were recruited for the validation of the MOHL-AQ. Internal consistency reliability, split-half reliability, inter-rater reliability, face validity, content validity, and construct validity were evaluated.

RESULTS

The value of internal consistency and split-half reliability of the MOHL-AQ were 0.77 and 0.78, respectively. Content validity reported a high content validity index (CVI = 95%). Exploratory factor analysis (EFA) and parallel analysis (PA) were used to determine a unidimensional model and confirmatory factor analysis (CFA) was employed to confirm the model. The indices of good fit model were achieved at GFI = 0.93, AGFI = 0.92, RMSEA = 0.04, CFI = 0.90, PGFI = 0.73, χ² /df = 1.86 (p < .001). Most of the item-total correlations indicated adequate and acceptable convergent validity (r > .30).

CONCLUSION

MOHL-AQ demonstrates adequate psychometric properties for measuring the oral health literacy in Mandarin-speaking population. Public health nurses can use MOHL-AQ to assess oral health literacy in the community settings and further screen potential population with inadequate oral health literacy.

Graphic designed bedroom doors to support dementia wandering in residential care homes: Innovative practice

Dementia-friendly designs are important in residential care homes but an aspect that remains neglected is the potential role of door designs in promoting wayfinding. A pilot project in NSW, Australia, tested the effects of unique room door designs for a small group of individuals living with dementia in a residential care home. Internal doors were transformed using a giant adhesive poster created by a commercial graphic designer. The poster replicated the look of traditional front doors, including a range of bright bold colours and architectural features, such as brass doorknockers, letterboxes and door guards. The Revised Algase Wandering Scale (RAWS) was used to identify the effects of introducing the doors on persistent walking, eloping behaviours and spatial disorientation. A total of nine individuals living with dementia participated in the project. The post-intervention data demonstrated that there was a reduction in persistent walking, eloping behaviours and spatial disorientation. In addition, ongoing anecdotal evidence found that individuals continued to seek out others to showcase their unique door.

Application of the Integrated Behavioral Model to oral self-care behavior of community-dwelling middle-aged and older people in Taiwan

OBJECTIVES

This study evaluated the Integrated Behavioral Model and examined oral self-care behavior of community-dwelling middle-aged and older people.

DESIGN

A cross-sectional design was used.

SAMPLE

Purposive sampling was employed to recruit middle and older age community-dwelling individuals, with research locations in public health centers in northern Taiwan.

MEASUREMENTS

Structured questionnaires comprised: participant demographics, oral health literacy, oral self-care attitude, self-efficacy, intention, and behavior, and significant others' perceptions and beliefs as well as environmental constraints. The Model verification was evaluated by path analysis.

RESULTS

Two hundred and sixty-three participants (N = 263) completed the questionnaire survey. Results identified significant direct effects of the independent variables of oral health care literacy, intention of oral self-care, and perception of environmental constraints on the dependent variable of oral self-care behavior; and significant indirect effects on attitude of oral self-care, perception of significant other beliefs, self-efficacy of oral self-care.

CONCLUSION

Public health nurses work with the whole community and can potentially improve the oral self-care behavior of middle-aged and older adults by enhancing their oral health knowledge, maintaining their positive attitudes, assisting acceptance of recognition and support from others, increasing their ability to perform oral self-care, reducing environmental constraints, and thereby enhancing their oral self-care awareness.