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Coman R, Caponecchia C. Optimizing aged care environments to promote resident functional mobility and reduce staff injury risk. FRONTIERS IN AGING 2023; 4:1157829. [PMID: 37090486 PMCID: PMC10117947 DOI: 10.3389/fragi.2023.1157829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023]
Abstract
Introduction: This study aimed to evaluate the suitability and usability of the Pro-Mobility patient/person handling assessment tool (ProMob) within residential aged care. Physiological changes associated with ageing influence an older person's ability to perform functional mobility tasks such as transferring from furniture and walking. Strategies that improve capability and/or reduce the physical demands of the task have the potential to promote an older person's mobility, independence and wellbeing. Environment-related strategies in Manual Handling of People (MHP), such as optimum seated heights, in part address this challenge, as they can promote resident functional mobility while also protecting staff from injury. The ProMob tool was developed to address this issue through systematic evaluation of these environmental factors. Methods: The participants in this study were seven (7) residential aged care facilities (RACFs) operated by a not-for-profit aged care organization. A qualified assessor evaluated MHP risk management with the ProMob tool at each RACF through collection of data for a random sample of residents (n = 67) regarding their living environments and available mobility information. Data was transferred to an SPSS-22 statistical software database for analysis which involved descriptive statistics and cross tabulations. Results: Application of the ProMob tool provided effective quantification of the nature and extent of environment-related MHP interventions that may influence resident mobility. Areas for improvement with MHP risk management were identified, with variation evident across RACF's within the same organisation, which was not consistent with levels of care (e.g., lack of clear space to facilitate mobility). Low level care facilities were observed to have fewer adaptive environmental features that could potentially slow decline in independence. Discussion: Features of the aged care environment can be used to facilitate the functional mobility of aged care residents, and simultaneously reduce injury risk for staff in MHP interactions. The ProMob tool can be used for auditing care facilities, planning re-development, and continual improvement in provision of care and management of staff injury risk exposure.
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Affiliation(s)
- Robyn Coman
- Occupational Health and Safety (OHS) Academic Program, School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
- *Correspondence: Robyn Coman,
| | - Carlo Caponecchia
- School of Aviation, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
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Bacchin D, Pernice GFA, Pierobon L, Zanella E, Sardena M, Malvestio M, Gamberini L. Co-Design in Electrical Medical Beds with Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16353. [PMID: 36498422 PMCID: PMC9738800 DOI: 10.3390/ijerph192316353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Among the plethora of instruments present in healthcare environments, the hospital bed is undoubtedly one of the most important for patients and caregivers. However, their design usually follows a top-down approach without considering end-users opinions and desires. Exploiting Human-centered design (HCD) permits these users to have a substantial role in the final product outcome. This study aims to empower caregivers to express their opinion about the hospital bed using a qualitative approach. For a holistic vision, we conducted six focus groups and six semi-structured interviews with nurses, nursing students, social-health operators and physiotherapists belonging to many healthcare situations. We then used thematic analysis to extract the themes that participants faced during the procedures, providing a comprehensive guide to designing the future electrical medical bed. These work results could also help overcome many issues that caregivers face during their everyday working life. Moreover, we identified the User Experience features that could represent the essential elements to consider.
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Affiliation(s)
- Davide Bacchin
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | | | - Leonardo Pierobon
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | - Elena Zanella
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | | | | | - Luciano Gamberini
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
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Tan J, Krishnan S, Vacanti JC, Wheeler KK, Giovannini ST, Pimentel MP, Urman RD. Patient falls in the operating room setting: An analysis of reported safety events. J Healthc Risk Manag 2022; 42:9-14. [PMID: 35365927 DOI: 10.1002/jhrm.21503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Patient falls are a preventable public health problem, and they are among the most reported safety incidents in the hospital. We used a hospital safety reporting system to examine the nature of reported falls in the perioperative setting at an academic tertiary center. METHODS In this retrospective study, reports of perioperative safety events listed as "Falls" between 2014 and 2020 were analyzed for severity level and specific event type. RESULTS Out of 8337 safety reports from 2014 to 2020, 86 were "fall" related (1%). The most common "fall" event type was "ambulating with assistance and the severity level reported was mainly level 1 (no harm, did reach patient, 63%) followed by level 2 (temporary or minor harm, 28%). One of the most frequently reported types of perioperative falls was from a bed or stretcher (15% of falls)". CONCLUSIONS Our safety data reporting system identified falls as a safety event that causes patient harm in the perioperative setting that could be preventable with a multifaceted interdisciplinary approach. Risk managers can use these data to implement strategies to reduce falls such as creating screening protocols to identify high-risk patients, educating and training healthcare personnel, and optimizing operating room, hospital, and equipment design.
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Affiliation(s)
- Joy Tan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Sindhu Krishnan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua C Vacanti
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly K Wheeler
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sheila T Giovannini
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marc P Pimentel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, and Center for Perioperative Research (CPR), Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dangor S, Jayaraman-Pillay P, Maddocks S, Chetty V. Pre-operative physiotherapy following unilateral ankle fractures at a tertiary hospital in South Africa: Perceptions of patients and nurses. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1501. [PMID: 33604479 PMCID: PMC7876942 DOI: 10.4102/sajp.v77i1.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background Ankle fractures are a common injury because of an increase in levels of physical activity, as well as senescence worldwide. Ankle fractures often require surgical management for optimal stabilisation. Pre-operative physiotherapy is necessary to prepare patients for early mobilisation and home discharge. There is a lack of information on the influence of pre-operative physiotherapy on post-operative rehabilitation success, as well as timeous discharge, in patients with ankle fractures. Objectives To explore the perceptions of patients receiving pre-operative physiotherapy care following a unilateral ankle fracture and the perceptions of nursing staff managing these patients at a tertiary hospital in South Africa. Method A descriptive qualitative design, using semi-structured interviews, including both patients with unilateral ankle fractures and nurses caring for these patients, was adopted. Interviews were recorded and verbatim transcriptions were analysed utilising thematic analysis. Results Four overarching themes emerged: the perceived benefits of pre-operative physiotherapy; inhibitors to physiotherapy rehabilitation; hidden enablers to pre-operative physiotherapy and future initiatives for rehabilitation. Conclusion The perceived benefits included improved functional independence and safety of patients, as well as reduced burden of care for nurses. Patients also believed that pain and fear were two inhibitors to physiotherapy. Furthermore, nurses identified that organisational limitations, such as short-staffing and inadequately trained staff, inhibited pre-operative physiotherapy and continuity of care. Early post-operative discharge was a crucial hidden enabler to the pre-operative physiotherapy protocol. Recommendations included improved health education; the potential role of nursing staff as facilitators in pre-operative rehabilitation and regular, pre-operative in-patient monitoring of physiotherapy intervention. Clinical implications Health education was perceived to have improved patient safety and compliance which subsequently reduced patient safety incidences as well as served as a risk mitigation measure. Furthermore, gait training and muscle strengthening exercises was perceived to have resulted in safe, independent mobility to ensure prompt discharge home. Consequently, a reduced post-operative length of in hospital stay results in major cost savings per patient as well as improved access and bed availability. Future studies may need to explore the effects of pre-operative physiotherapy on post-operative success and return to pre-injury activity.
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Affiliation(s)
- Sabeeha Dangor
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Prithi Jayaraman-Pillay
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Stacy Maddocks
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Verusia Chetty
- Department of Physiotherapy, Faculty of Health Science, University of KwaZulu-Natal, Durban, South Africa
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Xu H, Li X, Shi Y, An L, Taylor D, Christman M, Morse J, Merryweather A. Hospital bed height influences biomechanics during bed egress: A comparative controlled study of patients with Parkinson disease. J Biomech 2020; 115:110116. [PMID: 33228960 DOI: 10.1016/j.jbiomech.2020.110116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
Although a significant proportion of patient falls occur during egress from the hospital bed, the biomechanical adaptations during egress from different bed heights are still largely unknown. The purpose of this study was to evaluate the effect of hospital bed height on natural transition during egress in patients with Parkinson disease (PD). Twelve patients with PD and fourteen healthy elderly adults (HEA) were recruited and the natural transition during egress from three different bed heights (low, medium and high) were recorded for each participant using a motion capture system and force plates. The bed egress time, joint kinematics, ground reaction force and center of mass (CoM) were compared using a two-factor repeated ANOVA to determine the effects of three bed heights and two groups. The results showed that patients with PD had a significantly increased bed egress time, decreased peak of pelvis anterior tilt, hip flexion, and anteroposterior distance between pelvis center and CoM compared to HEA. Additionally, both PD and HEA groups increased the peak of trunk, hip and knee flexions to generate forward CoM momentum and joint torque to rise from a low bed height. These findings indicated that patients with PD invoked a more conservative movement pattern than HEA during egress to improve postural stability. The low bed height increased demands of balance and postural control during egress which exacerbates the risk of falls for patients with PD.
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Affiliation(s)
- Hang Xu
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Xiaotong Li
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Yuanyuan Shi
- The Second Clinical Medicine College, Xuzhou Medical University, Xuzhou, China
| | - Lun An
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, China
| | - Dorothy Taylor
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Marissa Christman
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Janice Morse
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA.
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An Internet of Things Based Bed-Egress Alerting Paradigm Using Wearable Sensors in Elderly Care Environment. SENSORS 2019; 19:s19112498. [PMID: 31159252 PMCID: PMC6603575 DOI: 10.3390/s19112498] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/17/2022]
Abstract
The lack of healthcare staff and increasing proportions of elderly population is alarming. The traditional means to look after elderly has resulted in 255,000 reported falls (only within UK). This not only resulted in extensive aftercare needs and surgeries (summing up to £4.4 billion) but also in added suffering and increased mortality. In such circumstances, the technology can greatly assist by offering automated solutions for the problem at hand. The proposed work offers an Internet of things (IoT) based patient bed-exit monitoring system in clinical settings, capable of generating a timely response to alert the healthcare workers and elderly by analyzing the wireless data streams, acquired through wearable sensors. This work analyzes two different datasets obtained from divergent families of sensing technologies, i.e., smartphone-based accelerometer and radio frequency identification (RFID) based accelerometer. The findings of the proposed system show good efficacy in monitoring the bed-exit and discriminate other ambulating activities. Furthermore, the proposed work manages to keep the average end-to-end system delay (i.e., communications of sensed data to Data Sink (DS)/Control Center (CC) + machine-based feature extraction and class identification + feedback communications to a relevant healthcare worker/elderly) below 1 10 th of a second.
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