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Nasu K, Miyashita M, Hirooka K, Endo T, Fukahori H. Ambulance use and emergency department visits among people with dementia: A cross-sectional survey. Nurs Health Sci 2023; 25:712-720. [PMID: 37987542 DOI: 10.1111/nhs.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web-based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits in the month before death as dependent variables. Age and gender of people with dementia and their family caregivers, home care use, decision-makers, comorbidities, degree of independence in daily living, and caregivers' preparedness for death were independent variables. Data were collected from 817 caregivers of people with dementia who had died at hospitals (52.4%), long-term care facilities (25.0%), or own homes (22.4%). Caregivers' lack of preparedness for death was significantly associated with ambulance use in the month before death. Comorbidites and males with dementia were significantly associated with ED visits in the month before death. Better death preparedness of family caregivers may reduce ambulance use for symptoms that can be more effectively addressed by palliative care than acute care for people with dementia.
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Affiliation(s)
- Katsumi Nasu
- Keio Research Institute at SFC, Fujisawa, Japan
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | | | - Kayo Hirooka
- Graduate School of Health Care Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Endo
- International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Fujisawa, Japan
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Tsuji M, Fukahori H, Sugiyama D, Doorenbos A, Nasu K, Mashida Y, Ogawara H. Factors related to liability for damages for adverse events occurring in long-term care facilities. PLoS One 2023; 18:e0283332. [PMID: 37205652 DOI: 10.1371/journal.pone.0283332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 03/07/2023] [Indexed: 05/21/2023] Open
Abstract
Globally, residents of long-term care facilities (LTCFs) often experience adverse events (AEs) and corresponding lawsuits that result in suffering among the residents, their families, and the facilities. Hence, we conducted a study to clarify the factors related to the facilities' liabilities for damages for the AEs that occur at LTCFs in Japan. We analyzed 1,495 AE reports from LTCFs in one Japanese city. A binomial logistic regression analysis was conducted to identify factors associated with liability for damages. The independent variables were classified as: residents, organizations, and social factors. In total, 14% of AEs resulted in the facility being liable for damages. The predictors of liability for damages were as follows: for the resident factors, the increased need for care had an adjusted odds ratio (AOR) of 2.00 and care levels of 2-3; and AOR of 2.48 and care levels of 4-5. The types of injuries, such as bruises, wounds, and fractures, had AORs of 3.16, 2.62, and 2.50, respectively. Regarding the organization factors, the AE time, such as noon or evening, had an AOR of 1.85. If the AE occurred indoors, the AOR was 2.78, and if it occurred during staff care, the AOR was 2.11. For any follow-ups requiring consultation with a doctor, the AOR was 4.70, and for hospitalization, the AOR was 1.76. Regarding the type of LTCF providing medical care in addition to residential care, the AOR was 4.39. Regarding the social factors, the reports filed before 2017 had an AOR of 0.58. The results of the organization factors suggest that liability tends to arise in situations where the residents and their family expect high quality care. Therefore, it is imperative to strengthen organizational factors in such situations to avoid AEs and the resulting liability for damages.
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Affiliation(s)
- Mayumi Tsuji
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki-shi, Nagasaki, Japan
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hiroki Fukahori
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Daisuke Sugiyama
- Graduate School of Health Management, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Ardith Doorenbos
- Department of Bio-behavioral Health Science, College of Nursing, University of Illinois, Illinois, Chicago, United States of America
| | - Katsumi Nasu
- Faculty of Nursing, Yasuda Women's University, Hiroshima-shi, Hiroshima, Japan
| | - Yuriko Mashida
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hirofumi Ogawara
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Nasu K, Fukahori H, Miyashita M. Long-term care nurses' perceptions of a good death for people with dementia: A qualitative descriptive study. Int J Older People Nurs 2021; 17:e12443. [PMID: 34957680 DOI: 10.1111/opn.12443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The number of people with dementia (PwD) dying in long-term care (LTC) settings is expected to increase. However, effective care strategies to promote a good death for PwD remain unclear. This study aimed to explore nurses' perceptions of a good death for PwD in LTC settings for older adults. METHODS Interviews were conducted with 19 nurses providing end-of-life care in LTC settings for older adults in Japan. The transcribed texts were analysed using inductive content analysis. RESULTS We identified two themes: (1) ambiguity and (2) preparedness. Participants perceived that there was ambiguity regarding a good death for PwD and emphasised the need for preparedness of those around PwD for a good death. Five categories represented preparedness: (a) reaffirming the original personality before dementia; (b) respecting that PwD change; (c) interpreting and fulfilling obscure desires, feelings, and sensations; (d) providing care consistent with an agreed-upon natural death process; and (e) maintaining relationships. CONCLUSION Long-term care nurses should encourage families and multidisciplinary team members, including the nurses themselves, to prepare for a good death of the PwD. Future research should focus on healthcare professionals' perspectives on advance care planning in the early stages of dementia, as well as the perceptions of PwD, their family members and other healthcare professionals regarding the natural death process.
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Affiliation(s)
- Katsumi Nasu
- Yasuda Women's University, Hiroshima, Japan.,Keio Research Institute at SFC, Kanagawa, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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The Nursing Stress Scale-Spanish Version: An Update to Its Psychometric Properties and Validation of a Short-form Version in Acute Care Hospital Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228456. [PMID: 33203132 PMCID: PMC7697776 DOI: 10.3390/ijerph17228456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
Stressful working conditions are correlated with a negative impact on the well-being of nurses, job satisfaction, quality of patient care and the health of the staff. The Nursing Stress Scale (NSS) has been shown to be a valid and reliable instrument to assess occupational stressors among nurses. This study updates the psychometric properties of the “NSS-Spanish version” and validates a short-form version. A cross-sectional design was carried out for this study. A reliability analysis and a confirmatory factor analysis and an exploratory factor analysis were undertaken. Items were systematically identified for reduction using statistical and theoretical analysis. Correlation testing and criterion validity confirmed scale equivalence. A total of 2195 Registered Nurses and 1914 Licensed Practical Nurses were enrolled. The original 34-item scale obtained a good internal consistency but an unsatisfactory confirmatory and exploratory factor analysis. The short-form Nursing Stress Scale (11-items) obtained a good internal consistency for Registered Nurses (α = 0.83) and for Licensed Practical Nurses (α = 0.79). Both Nursing Stress Scales obtained a strong correlation for Registered Nurses (rho = 0.904) and for Licensed Practical Nurses (rho = 0.888). The 11-item version of the Nursing Stress Scale is a valid and reliable scale to assess stress perception among Registered Nurses and Licensed Practical Nurses. Its short-form nature improves the psychometric properties and the feasibility of the tool.
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Omori M, Jayasuriya J, Scherer S, Dow B, Vaughan M, Savvas S. The language of dying: Communication about end-of-life in residential aged care. DEATH STUDIES 2020; 46:684-694. [PMID: 32401636 DOI: 10.1080/07481187.2020.1762263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article explores implications of language used in communicating death and dying in residential aged care, which increasingly emphasizes a "family-centered" approach to end-of-life care. Based on focus groups with care professionals and families, our findings reveal a persistent clinical culture that resists frank discussions of dying, with many staff preferring to use euphemisms for dying. Our results emphasize the importance of end-of-life education for families, which families acknowledged was lacking. Cultural change in institutional control over disclosing dying is imperative in order to gain family trust and support in professional care and promote death literacy.
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Affiliation(s)
- Maho Omori
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Victoria, Australia
| | - Jude Jayasuriya
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Sam Scherer
- Royal Freemasons Limited, Melbourne, Victoria, Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Marie Vaughan
- Royal Freemasons Limited, Melbourne, Victoria, Australia
| | - Steven Savvas
- National Ageing Research Institute, Parkville, Victoria, Australia
- Royal Freemasons Limited, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Australia
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