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Kunkel MC, Bowblis JR, Straker J, Van Haitsma K, Abbott KM. Can Implementing Person-Centered Care Tools Reduce Complaints? Evidence from the Implementation of PELI in Ohio Nursing Homes. J Aging Soc Policy 2024; 36:141-155. [PMID: 37796766 DOI: 10.1080/08959420.2023.2265775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 10/07/2023]
Abstract
Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P < .05) and any substantiated complaints by 11.5% points (P < .001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool.
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Affiliation(s)
- Miranda C Kunkel
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - John R Bowblis
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
- Department of Economics, Miami University Farmer School of Business, Oxford, OH, USA
| | - Jane Straker
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, PA, USA
- The Polisher Research Institute at Abramson Senior Care, Blue Bell, PA, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
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Kuusisto A, Saranto K, Korhonen P, Haavisto E. Social and healthcare professionals' experiences of end-of-life care planning and documentation in palliative care. Nurs Open 2023; 10:6445-6454. [PMID: 37334750 PMCID: PMC10416050 DOI: 10.1002/nop2.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
AIM To explore social and healthcare professionals' experiences of end-of-life (EOL) care planning and documentation in palliative care. DESIGN A qualitative study with narrative methodology. METHODS A narrative method with interviews was used. Data were collected from purposively selected registered nurses (n = 18), practical nurses (n = 5), social workers (n = 5) and physicians (n = 5) working in palliative care unit in five hospitals in three hospital districts. Content analysis within narrative methodologies was undertaken. RESULTS Two main categories - patient-oriented EOL care planning and multi-professional EOL care planning documentation- were formed. Patient-oriented EOL care planning included treatment goals planning, disease treatment planning and EOL care setting planning. Multi-professional EOL care planning documentation included healthcare professionals' and social professionals' perspectives. Healthcare professionals' perspectives on EOL care planning documentation included benefits of structured documentation and poor support of electronic health record (EHR) for documentation. Social professionals' perspective on EOL care planning documentation included usefulness of multi-professional documentation and externality of social professionals in multi-professional documentation. CONCLUSION The results of this interdisciplinary study demonstrated a gap between what healthcare professionals consider important in Advance Care Planning (ACP), that is, proactive, patient-oriented and multi-professional EOL care planning and the ability to access and document this in a useful and accessible way in the EHR. RELEVANCE TO CLINICAL PRACTICE Knowledge of the patient-centered EOL care planning and multi-professional documentation processes and their challenges are prerequisites for documentation to be supported by technology. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research checklist was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anne Kuusisto
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- The Wellbeing Services County of Satakunta, Satasairaala Central Hospital PoriPoriFinland
| | - Kaija Saranto
- Department of Health and Social ManagementUniversity of Eastern FinlandKuopioFinland
| | - Päivi Korhonen
- Department of General Practice, Turku University HospitalUniversity of TurkuTurkuFinland
| | - Elina Haavisto
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Health Sciences Unit of the Faculty of Social SciencesTampere UniversityTampereFinland
- Tampere University HospitalTampereFinland
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Xie F, Wen S, Deng A, Chen J, Xiong R. Evaluation of a community-based integrated care model (CIE) for frail older people in rural Foshan, China: study protocol for a stepped-wedge cluster randomized controlled trial {1}. Trials 2023; 24:315. [PMID: 37158975 PMCID: PMC10165829 DOI: 10.1186/s13063-023-07328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND While community-based eldercare has proven to be effective in qualitative studies, there is limited evidence on the effectiveness of this geriatric care model in rural communities where caring for older people is traditionally the responsibility of family members, but a formal long-term care was recently introduced in China. CIE is a rural community-embedded intervention using multidisciplinary team, to provide evidenced-based integrated care services for frail older people including social care services and allied primary healthcare and community-based rehabilitation services. METHODS CIE is a prospective stepped-wedge cluster randomized trial conducted at 5 community eldercare centers in rural China. The multifaceted CIE intervention, guided by chronic care model and integrated care model, consists of five components: comprehensive geriatric assessment, individualized care planning, community-based rehabilitation, interdisciplinary case management, and care coordination. The intervention is rolled out in a staggered manner in these clusters of centers at an interval of 1 month. The primary outcomes include functional status, quality of life, and social support. Process evaluation will also be conducted. Generalized linear mixed model is employed for binary outcomes. DISCUSSION This study is expected to provide important new evidence on clinical effectiveness and implementation process of an integrated care model for frail older people. The CIE model is also unique as the first registered trial implementing a community-based eldercare model using multidisciplinary team to promote individualized social care services integrated with primary healthcare and community-based rehabilitation services for frail older people in rural China, where formal long-term care was recently introduced. TRIAL REGISTRATION {2A}: China Clinical Trials Register ( http://www.chictr.org.cn/historyversionpub.aspx?regno=ChiCTR2200060326 ). May 28th, 2022.
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Affiliation(s)
- Fengjiao Xie
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shuang Wen
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Aiwen Deng
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Jianhao Chen
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ribo Xiong
- Department of Rehabilitation, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China.
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Eltaybani S, Yasaka T, Fukui C, Inagaki A, Takaoka M, Suzuki H, Maruyama M, Igarashi A, Noguchi-Watanabe M, Sakka M, Weller C, Yamamoto-Mitani N. Family-oriented interventions in long-term care residential facilities for older people: A scoping review of the characteristics and outcomes. Nurs Forum 2022; 57:800-818. [PMID: 35810335 DOI: 10.1111/nuf.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Family-oriented interventions in long-term care (LTC) residential facilities are heterogenous in design, characteristics, and outcomes. OBJECTIVES To synthesize characteristics (e.g., type, provider, and duration) and outcomes of family-oriented interventions in LTC residential facilities. METHODS We followed the JBI methodology and searched seven databases for quantitative, qualitative, and mixed method studies that reported family-oriented interventions in LTC residential settings for older people; defined in this review as ≥60 years. Interventions that included residents, resident families, health professionals, or any combinations of these three were included if the study reported post-intervention assessment of at least one family-related outcome. RESULTS Thirteen studies met the inclusion criteria. Interventions were found to be multifaceted, and education was the most common element. Nurses were the most common intervenors, and most interventions had more than one target (residents, resident families, or staff). Most outcomes were related to family involvement, satisfaction with care, quality of life, communication, symptom management, and shared decision making, and none of the studies reported a negative impact. CONCLUSIONS Family-oriented interventions were associated with high care quality and better resident-staff-family partnership. Staff education and staff-family conversation are relatively cheap interventions to help family involvement, facilitate shared decision-making, and improve family satisfaction.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Taisuke Yasaka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Chie Fukui
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Asa Inagaki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Manami Takaoka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Haruno Suzuki
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Miyuki Maruyama
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
- Department of Home Care Nursing, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mariko Sakka
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
| | - Carolina Weller
- School of Nursing and Midwifery Monash University, Monash, Australia
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, Tokyo, Japan
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Structured Care Protocols for People Living With Dementia in Nursing Homes: Reflections for Research. J Am Med Dir Assoc 2022; 23:1127-1128. [PMID: 35788267 DOI: 10.1016/j.jamda.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/21/2022]
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Feldthusen C, Forsgren E, Wallström S, Andersson V, Löfqvist N, Sawatzky R, Öhlén J, J Ung E. Centredness in health care: A systematic overview of reviews. Health Expect 2022; 25:885-901. [PMID: 35261138 PMCID: PMC9122448 DOI: 10.1111/hex.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The introduction of effective, evidence‐based approaches to centredness in health care is hindered by the fact that research results are not easily accessible. This is partly due to the large volume of publications available and because the field is closely linked to and in some ways encompasses adjoining fields of research, for example, shared decision making and narrative medicine. In an attempt to survey the field of centredness in health care, a systematic overview of reviews was conducted with the purpose of illuminating how centredness in health care is presented in current reviews. Methods Searches for relevant reviews were conducted in the databases PubMed, Scopus, Cinahl, PsychINFO, Web of Science and EMBASE using terms connected to centredness in health care. Filters specific to review studies of all types and for inclusion of only English language results as well as a time frame of January 2017–December 2018, were applied. Results The search strategy identified 3697 unique reviews, of which 31 were included in the study. The synthesis of the results from the 31 reviews identified three interrelated main themes: Attributes of centredness (what centredness is), Translation from theory into practice (how centredness is done) and Evaluation of effects (possible ways of measuring effects of centredness). Three main attributes of centeredness found were: being unique, being heard and shared responsibility. Aspects involved in translating theory into practice were sufficient prerequisites, strategies for action and tools used in safeguarding practice. Further, a variety and breadth of measures of effects were found in the included reviews. Conclusions Our synthesis demonstrates that current synthesized research literature on centredness in health care is broad, as it focuses both on explorations of the conceptual basis and the practice, as well as measures of effects. This study provides an understanding of the commonalities identified in the reviews on centredness in healthcare overall, ranging from theory to practice and from practice to evaluation. Patient or Public Contribution Patient representatives were involved during the initiation of the project and in decisions about its focus, although no patient or public representatives made direct contributions to the review process.
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Affiliation(s)
- Caroline Feldthusen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Emma Forsgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Viktor Andersson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Noah Löfqvist
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Richard Sawatzky
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,School of Nursing, Trinity Western University, Langley, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eva J Ung
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Damiaens A, Van Hecke A, De Lepeleire J, Foulon V. Resident and informal caregiver involvement in medication-related decision-making and the medicines' pathway in nursing homes: experiences and perceived opportunities of healthcare professionals. BMC Geriatr 2022; 22:81. [PMID: 35081924 PMCID: PMC8793219 DOI: 10.1186/s12877-022-02773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centered care has been shown to be beneficial for nursing home residents. The know-how and attitude of healthcare professionals, however, can make its implementation difficult. Also, research on person-centered care with regard to medication decision-making and the medicines' pathway in nursing homes is lacking. This study aimed to provide an understanding of healthcare professionals' attitudes and perspectives on current resident and informal caregiver involvement in medication decision-making and the medicines' pathway in nursing homes. METHODS A qualitative, explorative study using semi-structured interviews with a sample of 25 healthcare professionals from four different nursing homes was performed. Interview transcripts were analyzed by means of an inductive thematic framework. RESULTS Three overarching domains were identified: 1) features of, 2) drivers and barriers for, and 3) perceived consequences of resident and informal caregiver involvement in medication decision-making and the medicines' pathway. Involvement was mainly initiated by residents and informal caregivers themselves, pointing towards information and participation needs among both groups. Nevertheless, actions of healthcare professionals towards resident and informal caregiver involvement were mainly reactive and fragmentary. Their actions were influenced by the perception of residents and informal caregivers' desire and capabilities to be involved, the perception of their own professional role, but also by organizational factors such as the nursing home's philosophy. Furthermore, organizational concerns tempered the motivation to provide residents and informal caregivers with more medication-related responsibilities. CONCLUSIONS Resident and informal caregiver involvement in medication decision-making and the medicines' pathway remains limited in nursing homes. Information and participation needs of residents and informal caregivers were not fully acknowledged by healthcare professionals. As such, we can conclude that there is a need for initiatives, both on an individual and on an organizational level, to create and improve awareness on opportunities to improve resident and informal caregiver involvement in medication decision-making and the medicines' pathway.
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Affiliation(s)
- Amber Damiaens
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N II - Herestraat 49 - Box 521, B-3000, Leuven, Belgium.
| | - Ann Van Hecke
- Department of Nursing director, Ghent University Hospital, University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, UGent, Corneel Heymanslaan 10, B- 9000, Ghent, Belgium
| | - Jan De Lepeleire
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 - Blok H - Box 7001, B-3000, Leuven, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, O&N II - Herestraat 49 - Box 521, B-3000, Leuven, Belgium
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Robinson-Lane SG, Block L, Bowers BJ, Cacchione PZ, Gilmore-Bykovskyi A. The Intersections of Structural Racism and Ageism in the Time of COVID-19: A Call to Action for Gerontological Nursing Science. Res Gerontol Nurs 2022; 15:6-13. [PMID: 35044863 PMCID: PMC8856583 DOI: 10.3928/19404921-20211209-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The health consequences of systemic racism and ageism have received growing attention as the coronavirus disease 2019 pandemic has illuminated long-standing inadequacies and injustices that are structurally engrained in our health systems. The current State of the Science Commentary addresses the intersecting influences of systemic racism and ageism, and other "-isms" that conspire to create disparate health outcomes for older adults from historically excluded and marginalized backgrounds. We focus specifically on the long-term care sector as a representative microcosm of structural inequities, while recognizing that these unjust barriers to health are widespread, endemic, and pervasive. We present a call to action for gerontological nursing science to engage deeply and robustly in these realities, and the ethical and scientific imperative they present to ensure that all older adults encounter just conditions for maximizing their health and well-being. [Research in Gerontological Nursing, 15(1), 6-13.].
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Affiliation(s)
| | | | | | - Pamela Z. Cacchione
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andrea Gilmore-Bykovskyi
- School of Nursing, Madison, Wisconsin, USA,University of Wisconsin-Madison Center for Health Disparities Research, Madison, Wisconsin, USA
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Wachholz PA, Melo RCD, Jacinto AF, Villas Boas PJF. Impacto del tamaño de las instituciones de larga estancia en la adhesión a las orientaciones de prevención de infecciones por COVID-19. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5581.3556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: evaluar la adhesión de instituciones brasileñas de larga estancia a las orientaciones de Prevención y Control de Infecciones de la Organización Mundial de la Salud y evaluar la asociación entre su tamaño y la adhesión a esas recomendaciones. Método: estudio transversal realizado con gerentes de establecimientos. Los autores desarrollaron un cuestionario de 20 ítems basado en estas directrices y un puntaje general de cumplimiento acorde a la observancia de estas recomendaciones. La adhesión se calificó (1) excelente para aquellas que cumplieron con ≥14 de 20 recomendaciones; (2) buena para 10 a 13 artículos; y (3) baja para aquellas con menos de diez elementos. El tamaño de las instalaciones se clasificó como pequeños, medianos y grandes de acuerdo con un análisis de clúster de dos pasos. Se utilizó estadística descriptiva y la prueba de chi-cuadrado con un nivel de significancia del 5%. Resultados: de las 362 instituciones incluidas, 308 (85,1%) se adhirieron a 14 o más recomendaciones. En cuanto a su tamaño, la adhesión al cribado de síntomas de COVID-19 de los visitantes (p=0,037) y al aislamiento de los pacientes hasta que tengan dos pruebas de laboratorio negativas (p=0,032) fue menor en los establecimientos más grandes en comparación con los establecimientos medianos y pequeños. Conclusión: la adhesión a las medidas de mitigación de la COVID-19 en las unidades brasileñas fue considerada excelente para la mayoría de las recomendaciones, independientemente del tamaño de las unidades.
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Wachholz PA, Melo RCD, Jacinto AF, Villas Boas PJF. Impact of long-term care facilities’ size on adherence to COVID-19’ infection prevention guidance. Rev Lat Am Enfermagem 2022. [PMID: 35507956 PMCID: PMC9052776 DOI: 10.1590/1518-8345.5581.3516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the adherence of Brazilian long-term care facilities to the World Health Organization Infection Prevention and Control guidance, and assess the association of their size with the adherence to these recommendations. Method: cross-sectional study conducted with facilities’ managers. Authors developed a 20-item questionnaire based on this guidance, and a global score of adherence, based on the adoption of these recommendations. Adherence was classified as (1) excellent for those who attended ≥14 out of 20 recommendations; (2) good for 10 to 13 items; and (3) low for those with less than ten items. Facilities’ sizes were established as small, intermediate, and large according to a two-step cluster analysis. Descriptive statistics and chi-square tests were used at a 5% significance level. Results: among 362 included facilities, 308 (85.1%) adhered to 14 or more recommendations. Regarding its size, adherence to screening COVID-19 symptoms of visitors (p=0.037) and isolating patients until they have had two negative laboratory tests (p=0.032) were lower on larger ones compared to medium and small facilities. Conclusion: adherence to COVID-19 mitigation measures in Brazilian facilities was considered excellent for most of the recommendations, regardless of the size of the units.
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Wachholz PA, Melo RCD, Jacinto AF, Villas Boas PJF. Impacto do tamanho das instituições de longa permanência na adesão às orientações de prevenção de infecções por COVID-19. Rev Lat Am Enfermagem 2022; 30:e3557. [DOI: 10.1590/1518-8345.5581.3557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: avaliar a adesão das instituições de longa permanência brasileiras às orientações de Prevenção e Controle de Infecções da Organização Mundial da Saúde, observando a associação entre seu porte e a adesão a essas recomendações. Método: estudo transversal realizado com gestores de estabelecimentos. Os autores desenvolveram um questionário de 20 itens, com base nessas orientações, e um escore global de adesão, com base na adesão a essas recomendações. A adesão foi classificada como (1) excelente para aquelas que atenderam ≥14 de 20 recomendações, (2) bom para 10 a 13 itens e (3) baixo para aquelas com menos de dez itens. O tamanho das instalações foi classificado como pequeno, médio e grande, de acordo com uma análise de cluster em duas etapas. Estatística descritiva e teste de qui-quadrado foram utilizados com nível de significância de 5%. Resultados: das 362 instituições incluídas, 308 (85,1%) aderiram a 14 ou mais recomendações. Em relação ao seu tamanho, a adesão à triagem de sintomas de COVID-19 dos visitantes (p=0,037) e ao isolamento de pacientes até que tenham dois exames laboratoriais negativos (p=0,032) foi menor em estabelecimentos maiores, em comparação com estabelecimentos de médio e pequeno porte. Conclusão: a adesão às medidas de mitigação da COVID-19 nas unidades brasileiras foi considerada excelente para a maioria das recomendações, independentemente do porte das unidades.
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Xue T(M, Colón-Emeric CS, Herndon L, Hecker EJ, Berry SD, Little MO, McConnell ES. Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities. THE GERONTOLOGIST 2021; 62:1112-1123. [PMID: 34971374 PMCID: PMC9451018 DOI: 10.1093/geront/gnab193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. RESEARCH DESIGN AND METHODS Descriptive qualitative study using framework analysis applied to open-ended semistructured interviews (n = 28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from 3 SNFs in the Eastern United States (Massachusetts and North Carolina). RESULTS Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. DISCUSSION AND IMPLICATIONS Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.
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Affiliation(s)
- Tingzhong (Michelle) Xue
- Address correspondence to: Tingzhong (Michelle) Xue, MS, RN, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA. E-mail:
| | - Cathleen S Colón-Emeric
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA,Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laurie Herndon
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Emily J Hecker
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Milta O Little
- Division of Geriatrics in the Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Duke University School of Nursing, Durham, North Carolina, USA,Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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13
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Wallin V, Omerov P, Mattsson E, Klarare A. Experiences of food and mealtime from the perspective of patients with chronic life-limiting disease: A mixed-method systematic review. J Adv Nurs 2021; 77:4400-4413. [PMID: 34133759 DOI: 10.1111/jan.14927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
AIM To describe and synthesise experiences of food and mealtimes from the perspective of patients with chronic life-limiting disease. DESIGN A mixed-method systematic review. DATA SOURCES The databases Academic Search Complete, CINAHL, Nursing and Allied Health Database, PsycINFO, PubMed, Soc Index and Web of Science Core Collection were searched (January 2000 to March 2019). REVIEW METHODS Out of 3151 identified articles, 24 were included for appraisal and synthesis, using a data based convergent design. RESULTS Four themes were derived: 'understanding hampered eating-perhaps it is best to let nature run its course'; 'food and meals evoke distress-reducing joy, testing interim ways'; 'struggling with food and meals-eating to please others and to postpone death'; and 'food and meals as caring and love-flanked by social disconnecting'. CONCLUSION For patients with chronic life-limiting disease, food entailed potential to remain healthy, improve well-being and prolong life. Meanwhile, eating difficulties were experienced as fundamentally affecting social life and interactions; consequently, joy around food and meals was lost.
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Affiliation(s)
- Viktoria Wallin
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Pernilla Omerov
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Elisabet Mattsson
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
| | - Anna Klarare
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Uppsala, Sweden
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14
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Towsley GL, Wong B, Baier RR, Neller S. An Efficacy Trial of Long-Term Care Residents With Alzheimer's Disease Using Videos to Communicate Care Preferences. J Am Med Dir Assoc 2021; 22:1559-1560. [PMID: 33798485 DOI: 10.1016/j.jamda.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Gail L Towsley
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Bob Wong
- University of Utah College of Nursing, Salt Lake City, UT, USA
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI, USA
| | - Sarah Neller
- University of Utah College of Nursing, Salt Lake City, UT, USA
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15
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Lepore MJ, Lima JC, Miller SC. Nursing Home Culture Change Practices and Survey Deficiencies: A National Longitudinal Panel Study. THE GERONTOLOGIST 2020; 60:1411-1423. [PMID: 32478393 PMCID: PMC7681213 DOI: 10.1093/geront/gnaa063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH) adoption of culture change practices has substantially increased in recent decades. We examined how increasing adoption of culture change practices affected the prevalence of health, severe health, and quality of life (QoL) deficiencies. RESEARCH DESIGN AND METHODS Novel data on culture change practice adoption from a nationally representative NH panel (N = 1,585) surveyed in 2009/2010 and 2016/2017 were used to calculate change in practice adoption scores in 3 culture change domains (resident-centered care, staff empowerment, physical environment). These data were linked to data on health, severe health, and QoL deficiencies and facility-level covariates. Multinomial logistic regression models, with survey weights and inverse probability of treatment weighting, examined how increased culture change practice adoption related to change in deficiencies. RESULTS We generally observed less increase in deficiencies when culture change practices increased. However, after weighting and controlling for baseline deficiencies and culture change scores, we found few statistically significant effects. Still, results show increased physical environment practices resulted in a higher likelihood of decreases or no change (vs increases) in QoL deficiencies; increased resident-centered care practices resulted in decreases or no change (vs increases) in health deficiencies; and increased staff empowerment practices resulted in a higher likelihood of no change (vs increases) in severe health deficiencies. DISCUSSION AND IMPLICATIONS This study provides some evidence that culture change practices can help reduce the risk of increasing some types of deficiencies, but the impact of increases in each culture change domain related differently to different types of deficiencies.
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Affiliation(s)
- Michael J Lepore
- LiveWell Institute, Southington, Connecticut
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Julie C Lima
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Susan C Miller
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
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16
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Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Kang B, Scales K, McConnell ES, Song Y, Lepore M, Corazzini K. Nursing home residents' perspectives on their social relationships. J Clin Nurs 2020; 29:1162-1174. [PMID: 31889360 DOI: 10.1111/jocn.15174] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 01/28/2023]
Abstract
AIMS AND OBJECTIVES To explore nursing home residents' perspectives on their relationships with other residents, family members and staff. BACKGROUND The cultivation of social relationships is central to promoting well-being in nursing homes, as these relationships allow residents, family members and staff to be valued as unique persons and empowered as partners in care. Few studies have examined how nursing home residents perceive the relationships in their social networks, both within and beyond the facility. DESIGN Qualitative secondary analysis. METHODS We analysed individual and group interviews obtained during "stakeholder engagement sessions" with cognitively intact residents (N = 11 sessions; N = 13 participants) from two nursing homes in North Carolina. The interviews were conducted as part of a larger study on person-directed care planning. We integrated thematic and narrative analytic approaches to guide the analysis of interview data, using a three-cycle coding approach. The COREQ checklist was followed. RESULTS Four broad themes emerged from this analysis: (a) peer relationships foster a sense of belonging, purpose, achievement and significance; (b) residents' relationships with family members support a sense of belonging, continuity and significance; (c) mutual respect and reciprocity between residents and nursing home staff promote a sense of belonging and significance; and (d) organisational factors pose barriers to forging meaningful relationships. Each type of relationship-peer, family and staff-made distinctive contributions residents' psychosocial well-being. CONCLUSION Recognising the diverse roles of different actors from residents' social networks raises questions for future research to optimise the distinctive contributions of network members that promote residents' psychosocial well-being. RELEVANCE TO CLINICAL PRACTICE This study highlights the need for nursing home staff to understand how residents' social relationships influence residents' psychosocial outcomes. Staff training programmes are needed to support residents' rights and to dispel inaccurate interpretations of regulations that threaten sustained meaningful relationships.
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Affiliation(s)
- Bada Kang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Eleanor S McConnell
- Duke University School of Nursing, Durham, NC, USA.,Durham Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Durham, NC, USA
| | - Yuting Song
- University of Alberta Faculty of Nursing, Edmonton, Alberta, Canada
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18
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Lepore M, Scales K, Anderson RA, Porter K, Thach T, McConnell E, Corazzini K. Person-directed care planning in nursing homes: A scoping review. Int J Older People Nurs 2018; 13:e12212. [PMID: 30358099 PMCID: PMC6282715 DOI: 10.1111/opn.12212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/07/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Abstract
AIM Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP). METHODS A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis. RESULTS Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end-of-life care. Essential elements of PDCP include knowing the person, integrating the person's goals in care planning and updating care plans as individuals' needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies. CONCLUSION This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP. IMPLICATIONS FOR PRACTICE These findings can be used to guide implementation of PDCP.
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Affiliation(s)
| | - Kezia Scales
- Duke University School of NursingDurhamNorth Carolina
- Present address:
PHIBronxNew York
| | - Ruth A. Anderson
- The Office of Research Support and Consultation (RSC)University of North Carolina‐Chapel Hill School of NursingChapel HillNorth Carolina
- Present address:
Department of Health Policy and ManagementUniversity of North CarolinaChapel HillNorth Carolina
| | | | - Trini Thach
- RTI InternationalResearch Triangle ParkNorth Carolina
- Present address:
Department of Health Policy and ManagementUniversity of North CarolinaChapel HillNorth Carolina
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