May 202014
 
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The challenges of achieving person-centred care in acute hospitals: a qualitative study of people with dementia and their families.

Int J Nurs Stud. 2013 Nov;50(11):1495-503

Authors: Clissett P, Porock D, Harwood RH, Gladman JR

Abstract
BACKGROUND: Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood.
OBJECTIVES: Using Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia.
DESIGN: Data collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia.
SETTINGS: Recruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards.
PARTICIPANTS: Participants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment.
METHOD: The study involved 72 h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation.
RESULTS: While there were examples of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia.
CONCLUSIONS: There is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings.

PMID: 23548170 [PubMed - indexed for MEDLINE]

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May 202014
 
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Patient preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: results of a randomised controlled trial.

Int J Nurs Stud. 2013 Nov;50(11):1537-49

Authors: Utens CM, Goossens LM, van Schayck OC, Rutten-van Mölken MP, van Litsenburg W, Janssen A, van der Pouw A, Smeenk FW

Abstract
BACKGROUND: In the absence of clear differences in effectiveness and cost-effectiveness between hospital-at-home schemes and usual hospital care, patient preference plays an important role. This study investigates patient preference for treatment place, associated factors and patient satisfaction with a community-based hospital-at-home scheme for COPD exacerbations.
METHODS: The study is part of a larger randomised controlled trial. Patients were randomised to usual hospital care or early assisted discharge which incorporated discharge at day 4 and visits by a home care nurse until day 7 of treatment (T+4 days). The hospital care group received care as usual and was discharged from hospital at day 7. Patients were followed for 90 days (T+90 days). Patient preference for treatment place and patient satisfaction (overall and per item) were assessed quantitatively and qualitatively using questionnaires at T+4 days and T+90 days. Factors associated with patient preference were analysed in the early assisted discharge group.
RESULTS: 139 patients were randomised. No difference was found in overall satisfaction. At T+4 days, patients in the early assisted discharge group were less satisfied with care at night and were less able to resume normal daily activities. At T+90 days there were no differences for the separate items. Patient preference for home treatment at T+4 days was 42% in the hospital care group and 86% in the early assisted discharge group and 35% and 59% at T+90 days. Patients' mental state was associated with preference.
CONCLUSION: Results support the wider implementation of early assisted discharge for COPD exacerbations and this treatment option should be offered to selected patients that prefer home treatment.

PMID: 23582671 [PubMed - indexed for MEDLINE]

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Jul 232013
 
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Risk factors associated with patient and visitor violence in general hospitals: results of a multiple regression analysis.

Int J Nurs Stud. 2013 Mar;50(3):374-85

Authors: Hahn S, Müller M, Hantikainen V, Kok G, Dassen T, Halfens RJ

Abstract
BACKGROUND: Patient and visitor violence (PVV) is the most dangerous occupational hazard that health professionals must contend with. Staff training is recommended to prevent and manage PVV. There is minimal research focusing on risk factors associated with PVV in general hospital settings. Therefore, staff training is mostly based upon expert knowledge and knowledge from psychiatric and emergency settings.
OBJECTIVES: This study investigates health professionals' experiences with PVV in order to describe risk factors related to PVV that occur in general hospital settings.
DESIGN: A retrospective cross-sectional survey was conducted in 2007.
SETTING: A university general hospital in Switzerland.
PARTICIPANTS: 2495 out of 4845 health professionals participated (58.0% nurses & midwives, 19.2% medical doctors, 3.6% physical therapists, occupational therapists & nutritionists, 6.1% ward secretaries, medical & radiology assistants, 6.3% nursing assistants or less qualified nursing staff and 5.1% other staff). All had direct patient contact and 82% were female.
METHODS: Data were collected via questionnaires using the Survey of Violence Experienced by Staff German-Version-Revised, the German version of the shortened Perception of Aggression Scale and the Perception of Importance of Intervention Skills Scale. Descriptive statistics and multiple logistic regression analyses were used.
RESULTS: Risk factors associated with PVV depend upon the form of violence. Those trained in aggression management and/or those who work predominantly with patients over 65 years of age experience twice as much PVV as others. Health professionals working in emergency rooms, outpatient units, intensive care units, recovery rooms, anesthesia, intermediate care and step-down units also experience PVV more often. When health professionals are older in age, are from the medical profession, are students, or when they have an attitude rating preventive measures as being less important and aggression as emotionally letting off steam, they experience less PVV.
CONCLUSION: Training could change the perception and the recognition of PVV, and could therefore increase the risk of experiencing PVV. The health professionals' specific occupation along with attitude and age, the patients' age, the communication and the workplace are all relevant risk factors. Further studies should investigate the impact of aggression management training and other measures that would reduce PVV.

PMID: 23102404 [PubMed - indexed for MEDLINE]

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Feb 142012
 

Comparison of post-dural puncture headache and low back pain between 23 and 25 gauge Quincke spinal needles in patients over 60 years: randomized, double-blind controlled trial.

Int J Nurs Stud. 2011 Nov;48(11):1315-22

Authors: Kim M, Yoon H

Abstract
BACKGROUND: Even though the use of a 25 gauge or smaller Quincke needle is recommended for spinal anesthesia to reduce post-dural puncture headache in Korea, lumbar puncture in older patients using a 25 gauge or smaller Quincke needle can be difficult. However, most previous studies concerning post-dural puncture headache have chosen children, parturients, and young adults as study participants.
OBJECTIVES: The study compared post-dural puncture headache, post-operative back pain, and the number of lumbar puncture attempts using a 23 or 25 gauge Quincke needle for spinal anesthesia of Korean patients >60-years-of-age.
DESIGN: Randomized, double-blinded controlled trial.
PARTICIPANTS: The 53 participants who underwent orthopedic surgery under spinal anesthesia were recruited by informed notices from December 2006 through August 2007 at a 200-bed general hospital located in Kyunggido. Inclusion criteria were an age >60 years, ASA I-II, and administration of patient controlled analgesia for the first 48 h post-operatively.
METHODS: The 53 patients were randomly allocated to either the experimental (23 gauge Quincke needle) or control group (25 gauge Quincke needle). All patients had 24 h bed rest post-operatively. Post-dural puncture headache was assessed by the Dittmann Scale and post-operative back pain was assessed by a visual analogue scale at 24, 48, and 72 h post-operatively. The statistical methods included the Mann-Whitney U-test and Spearman correlation.
RESULTS: There were no differences in post-dural puncture headache, and post-operative back pain at 24, 48, and 72 h post-operatively, and no differences in the number of lumbar punctures, with the 23 and 25 gauge Quincke needle. Forty-eight hour post-operative back pain was positively associated with the number of lumbar punctures (p=.036) and age (p=.040). There were no statistically significant associations among post-dural puncture headache, the number of lumbar punctures, and 48 h post-operative back pain. Pre-operative back pain was positively associated with 48 h post-operative back pain (p<.001).
CONCLUSIONS: The choice of a 23 or 25 gauge Quincke needle for spinal anesthesia has no significant influence on post-dural puncture headache and post-operative back pain for Korean patients greater than 60-years-of-age. The 23 gauge Quincke needle is an option for lumbar punctures in this patient population.

PMID: 21561619 [PubMed - indexed for MEDLINE]

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Dec 282011
 

Implementation of inpatient geriatric consultation teams and geriatric resource nurses in acute hospitals: A national survey study.

Int J Nurs Stud. 2011 Dec 23;

Authors: Deschodt M, Flamaing J, Rock G, Boland B, Boonen S, Milisen K

Abstract
BACKGROUND: Inpatient geriatric consultation teams are multidisciplinary teams that advice and sensitize health care professionals in the hospital for the care of older patients. Despite the lack of clear evidence that these teams are effective, they were rated highly relevant and introduced in Belgian hospitals in 2007. OBJECTIVES: To evaluate the implementation and performance of geriatric consultation teams and geriatric resource nurses (GRNs) in Belgium. DESIGN: A cross-sectional survey was performed in March and April 2010. SETTING: Acute hospitals. PARTICIPANTS: Sixty-six hospitals completed the questionnaire (response rate of 68.8%); 63 geriatric consultation teams were included. METHODS: A newly developed questionnaire was sent to all hospitals. The head of the geriatric department completed the general parts of the questionnaire. The other parts, covering the organization of the consultation teams and geriatric resource nurses, respectively, were completed by the geriatrician or the head nurse of the geriatric consultation team. All data were analysed in a descriptive manner. RESULTS: The mean number of full time equivalents (FTE) per consultation team was 4.3 (SD±1.3; range 1.9-10.1). The nurse, represented by a mean of 1.7 FTE (SD±0.8), was a core member in almost all teams (n=60; 98.4%). The occupational therapist, geriatrician, dietician, psychologist and speech therapist were core members in more than 59% of the teams. Twenty-seven teams (42.9%) estimated that more than 75% of the patients (?75 years) were screened for having a geriatric profile. This screening was mostly performed using the Triage Risk Screening Tool (n=23) or the Identification of Seniors At Risk (n=20). A positive screening automatically resulted in a request for a geriatric consultation team intervention in 45 teams (71.4%). Thirty-five teams (55.5%) had an advisory role only, while the other 28 teams (44.5%) had both advisory and executive roles. The median number of patients for whom recommendations were formulated per year, was 423 (Q1=230; Q3=633). Most participants rated the function of GRNs as 'poor' or 'bad'. CONCLUSION: To increase their impact, inpatient geriatric consultation teams focus on frail older persons using screening tools for detection of high-risk patients. More intense collaboration with GRNs is essential, and the function of GRNs needs further improvement.

PMID: 22197652 [PubMed - as supplied by publisher]

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Nov 232011
 

Predictors of hospitalized patients' intentions to prevent healthcare harm: A cross sectional survey.

Int J Nurs Stud. 2011 Nov 16;

Authors: Davis R, Anderson O, Vincent C, Miles K, Sevdalis N

Abstract
BACKGROUND: Patients can play an important role in reducing healthcare harm but little is known about the factors that may affect patients' willingness to participate. In order to encourage the 'active' patient it is critical that we gain a deeper understanding of the antecedents of safety-relevant behaviours. Doing this will enable the implementation of effective interventions aimed at supporting patients to work with healthcare professionals in ensuring safe care. OBJECTIVE: To examine predictors of patients' intentions to engage in two safety behaviours: (1) reminding healthcare staff to wash their hands and; (2) notifying healthcare staff if they are not wearing a hospital identification bracelet. DESIGN: Cross-sectional survey study. PARTICIPANTS: A purposive sampling method was employed to recruit 80 medical and surgical hospital inpatients aged 18-80 (mean 48) from one inner city London teaching hospital. METHODS: A 42 item survey that measured the extent that patients' control beliefs, behavioural beliefs, normative beliefs and perceived susceptibility and severity towards a hospital-acquired infection or a misidentification error could predict their intentions to ask doctors/nurses about their hand washing compliance or notify doctors/nurses if they are not wearing a hospital identification bracelet. Data was analysed using multiple regression analysis. RESULTS: Control beliefs, normative beliefs and perceived severity were the strongest predictors of patients' intentions to participate in both behaviours. The regression models accounted for a smaller percentage of the variance in patients' intentions to ask doctors/nurses if they have washed their hands (42%/37%) than notifying staff if they were not wearing an identification bracelet (54%/56%). CONCLUSIONS: If patients understand why a behaviour is beneficial, they perceive it as acceptable to participate in and that they have control over the decision to engage in the behaviour, we hypothesise that more patients will intend to participate in that behaviour. When designing interventions aimed at encouraging the participation of patients in promoting their own safety, consideration should be given to the potential influence of patients' control beliefs, normative beliefs and perceived severity of errors on their intentions to participate.

PMID: 22098924 [PubMed - as supplied by publisher]

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