Nurses' experience with the clinical application of a research-based nursing protocol in a long-term care setting

Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study

Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.

Context as a Facilitator of the Implementation of Evidence-based Nursing: A Meta-synthesis

Nurses have numerous difficulties in implementing science due to obstacles related to the work context. The aim is to explore the work-context-related facilitators of the application of evidence in clinical practice by nursing professionals. Qualitative meta-synthesis of primary studies on nurses' experiences of work-context-related facilitators, as defined by the Promoting Action on Research Implementation in Health Services model. Using the Qualitative Appraisal and Review Instrument of the Joanna Briggs Institute. Of the total 57 primary research articles included, an explanatory model of the facilitating factors related to the work context was generated on the basis of four general categories: institutional support (leadership), multidisciplinary support (teamwork and communication), culture of improving quality of care (nursing professionals' attitudes towards change) and use of research (valuing research). Action can be taken on the facilitating factors of the evidence-based practice application in nursing clinical environments, providing resources and motivation from the organization.

Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation

Background

A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and challenging behaviour.

Objectives

To describe the experiences around the implementation of the intervention; to examine the extent to which the STA OP! intervention was delivered and implemented as intended (at the level of the team, and the individual resident/professional); and to understand factors influencing the implementation process.

Methods

A process evaluation was performed using a mixed-methods design encompassing several data sources. Quantitative data (i.e. from the written evaluations by healthcare professionals, management, and the research database) were analysed using descriptive statistics. Qualitative data (i.e. semi-structured interviews, notes, completed intervention forms, and written evaluations) were analysed according to the principles of thematic analysis. The implementation process and the influencing factors were categorised according to the i) organisational level, ii) the team level, and iii) the level of the individual resident/professional.

Results

In total, 39.2% of the residents with pain and/or challenging behaviour were treated following the stepwise approach of the STA OP! intervention. The training manual and forms used were found to be relevant and feasible. Factors inhibiting the implementation process at the i) organisational level concerned instability of the organisation and the team (e.g. involvement in multiple projects/new innovations, staff turnover/absence of essential disciplines, and/or high workload). At the team level (ii), we found that presence of a person with a motivational leadership style facilitated the implementation. Also, interdisciplinary cooperation through the design/setting of the multidisciplinary training, securing the intervention by use of clear agreements, and written reporting or transfers facilitated implementation. At the individual level (iii), perceived value of the stepwise working method, and enhanced awareness facilitated the implementation.

Conclusion

Although the intervention was not implemented as planned, the intervention empowered healthcare professionals and increased their awareness of the signals of pain and challenging behaviour. Future implementation of the intervention should start on units with a motivational leader, and specific features of the organisation and the team should be considered to facilitate implementation, e.g. stability, support, and shared focus to change.

A Concept Analysis of Resistiveness to Care

People with cognitive impairment often require assistance with activities of daily living. It is when providing assistance with these activities that many caregivers experience behaviors that have been categorized as disruptive or problematic and called resistiveness to care. These behaviors are considered to be a source of burden and job burnout for caregivers. Nurses wanting to help caregivers, who manage these trying situations, need to understand the concept of resistiveness to care and communicate this knowledge clearly with health care providers. Therefore, a literature search was conducted in 2012 within the databases CINAHL, Medline (PubMed), ProQuest, and PsychINFO. This produced 40 relevant articles. Because no concept analysis existed for resistiveness to care, a principle-based concept analysis was performed. The analysis helped construct a theoretically defined concept. Further analysis highlighted that more research is needed to advance the concept of resistiveness to care to enhance professional communication surrounding this phenomenon.

Individualized formulation-led interventions for analyzing and managing challenging behavior of people with dementia - an integrative review

OBJECTIVE

Individualized formulation-led interventions offer a promising approach for analyzing and managing challenging behaviors in people with dementia. Little is known about which individualized formulation-led interventions exist and what effects these interventions have on people with dementia and their caregivers. Therefore, the review aims to describe and examine existing interventions and to review their evidence.

METHODS

An integrative review of individualized formulation-led interventions for managing challenging behavior in people with dementia was conducted. PUBMED, PsycINFO [EBSCO] and CINAHL [EBSCO] databases were searched between February and April 2014 using key terms related to dementia, challenging behavior and individualized formulation- led interventions. The literature search was limited to German and English publications published from 1995. No limitations were placed on the type of paper, type of study design and stage of disease or setting. 37 relevant papers that met the inclusion criteria were included in this review.

RESULTS

The literature review provided 14 different individualized formulation-led interventions. The effects on people with dementia were diverse, as only half of the studies showed a significant reduction in behaviors compared with the control group. Family caregivers felt less upset about the challenging behavior and more confident in their ability to manage the behavior.

CONCLUSION

There is a clear need for further research on individualized formulation-led interventions. The results of this review have the potential for developing interventions and for designing methodological robust evaluation studies that take into account the effectiveness of individualized formulation-led interventions on patient and caregiver outcomes.

Dissemination and implementation research in dementia care: a systematic scoping review and evidence map

Background

The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.

Methods

We sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.

Results

Eighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.

Conclusion

This scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0528-y) contains supplementary material, which is available to authorized users.

Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill

BACKGROUND

Poor nursing adherence to evidence-based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence-based practice has the potential to minimize complications and discrepancies between nurses.

AIM

This study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition (EN) in the critically ill.

DESIGN AND METHODS

This descriptive correlational design was applied to nurses working in intensive care units (ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre-prepared questionnaire focusing on nurses' practice and perception towards EN was used.

RESULTS

A total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for 'preventing complications' and 'evaluation' more than 'assessment' and 'identifying goals'. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence-based protocol.

CONCLUSION

It is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence-based protocol for EN should be adopted in the critically ill.

RELEVANCE TO CLINICAL PRACTICE

This article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base.

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

Background

Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities.

Methods/Design

This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer's Disease.

Discussion

There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.

Trial Registration

This clinical trial is registered with ClinicalTrials.gov (trial registration number: NCT01474616).

Preconditions for successful guideline implementation: perceptions of oncology nurses

Background

Although evidence-based guidelines are important for improving the quality of patient care, implementation in practice is below expectations. With the recent focus on team care, guidelines are intended to promote the integration of care across multiple disciplines. We conducted an exploratory study to understand oncology nurses' perceptions of guideline implementation and to learn their views on how their experiences affected the implementation.

Methods

A qualitative study was used with focus group interviews. We collected data from 11 nurses with more than 5 years of oncology nursing experience in Japan. The data were analyzed using grounded theory.

Results

Results of the analysis identified "preconditions for successful guideline implementation" as a core category. There were 4 categories (goal congruence, equal partnership, professional self-development and user-friendliness) and 11 subcategories related to organizational, multidisciplinary, individual, and guideline levels.

Conclusions

Although the guidelines were viewed as important, they were not fully implemented in practice. There are preconditions at the organizational, multidisciplinary, individual, and guideline levels that must be met if an organization is to successfully implement the guideline in clinical settings. Prioritizing strategies by focusing on these preconditions will help to facilitate successful guideline implementation.

Die deutsche Fassung der «Serial Trial Intervention» (STI-D)

In fortgeschrittenen Demenzstadien treten häufig so genannte herausfordernde Verhaltensweisen auf, die den nicht-kognitiven Symptomen der Demenz zugerechnet werden. Sie lassen sich als Ausdruck eines unbefriedigten Bedürfnisses des Demenzkranken betrachten. Im Zuge der dargestellten Studie soll eine deutsche Fassung der Serial Trial Intervention (STI-D) entwickelt und getestet werden. Die STI gibt einen strukturierten Rahmen zum Erkennen unbefriedigter Bedürfnisse von Pflegeheimbewohnern mit Demenz und der darauf basierenden Reduktion herausfordernder Verhaltensweisen vor, unter besonderer Berücksichtigung von Schmerzen. In einem ersten Schritt erfolgt unter Einbezug von Fachexperten eine Anpassung der STI-D an die deutschen Erfordernisse. Anschließend wird in einer clusterrandomisierten, kontrollierten, verblindeten klinischen Studie mit drei Messzeitpunkten die Effektivität der STI-D getestet. Primärer Endpunkt ist dabei das Auftreten herausfordernder Verhaltensweisen, sekundäre Endpunkte sind Schmerzen, Lebensqualität sowie die Gabe von Analgetika und Psychopharmaka. Mit Ergebnissen wird im Jahr 2010 gerechnet.