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Bavelaar L, Visser M, Walshe C, Preston N, Kaasalainen S, Sussman T, Cornally N, Hartigan I, Loucka M, di Giulio P, Brazil K, Achterberg WP, van der Steen JT. The impact of the mySupport advance care planning intervention on family caregivers' perceptions of decision-making and care for nursing home residents with dementia: pretest-posttest study in six countries. Age Ageing 2023; 52:7066941. [PMID: 36861181 PMCID: PMC9978311 DOI: 10.1093/ageing/afad027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. OBJECTIVES to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. DESIGN a pretest-posttest design. SETTING in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. PARTICIPANTS in total, 88 family caregivers completed baseline, intervention and follow-up assessments. METHODS family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. RESULTS family caregivers reported less decision-making uncertainty (-9.6, 95% confidence interval: -13.3, -6.0, P < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. CONCLUSIONS the mySupport intervention may be impactful in countries beyond the original setting.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Mandy Visser
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Paola di Giulio
- Department of Public Health and Pediatrics, University of Torino, Turin, Italy
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jenny T van der Steen
- Address correspondence to: Jenny T. van der Steen, Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Postbox 9600, 2300 Leiden, the Netherlands.
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Harding AJE, Doherty J, Bavelaar L, Walshe C, Preston N, Kaasalainen S, Sussman T, van der Steen JT, Cornally N, Hartigan I, Loucka M, Vlckova K, Di Giulio P, Gonella S, Brazil K. A family carer decision support intervention for people with advanced dementia residing in a nursing home: a study protocol for an international advance care planning intervention (mySupport study). BMC Geriatr 2022; 22:822. [PMID: 36289458 PMCID: PMC9607827 DOI: 10.1186/s12877-022-03533-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Where it has been determined that a resident in a nursing home living with dementia loses decisional capacity, nursing home staff must deliver care that is in the person's best interests. Ideally, decisions should be made involving those close to the person, typically a family carer and health and social care providers. The aim of the Family Carer Decisional Support intervention is to inform family carers on end-of-life care options for a person living with advanced dementia and enable them to contribute to advance care planning. This implementation study proposes to; 1) adopt and apply the intervention internationally; and, 2) train nursing home staff to deliver the family carer decision support intervention. Methods This study will employ a multiple case study design to allow an understanding of the implementation process and to identify the factors which determine how well the intervention will work as intended. We will enrol nursing homes from each country (Canada n = 2 Republic of Ireland = 2, three regions in the UK n = 2 each, The Netherlands n = 2, Italy n = 2 and the Czech Republic n = 2) to reflect the range of characteristics in each national and local context. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. Our mixed methods study design has three phases to (1) establish knowledge about the context of implementation, (2) participant baseline information and measures and (3) follow up evaluation. Discussion The use of a multiple case study design will enable evaluation of the intervention in different national, regional, cultural, clinical, social and organisational contexts, and we anticipate collecting rich and in-depth data. While it is hoped that the intervention resources will impact on policy and practice in the nursing homes that are recruited to the study, the development of implementation guidelines will ensure impact on wider national policy and practice. It is our aim that the resources will be sustainable beyond the duration of the study and this will enable the resources to have a longstanding relevance for future advance care planning practice for staff, family carers and residents with advanced dementia.
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Affiliation(s)
- Andrew J E Harding
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Doherty
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Laura Bavelaar
- grid.5132.50000 0001 2312 1970Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Catherine Walshe
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Nancy Preston
- grid.9835.70000 0000 8190 6402Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, Hamilton, Canada
| | - Tamara Sussman
- grid.14709.3b0000 0004 1936 8649School of Social Work, McGill University, Hamilton, Canada
| | - Jenny T van der Steen
- grid.5132.50000 0001 2312 1970Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Nicola Cornally
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Irene Hartigan
- grid.7872.a0000000123318773School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | | | | | - Paola Di Giulio
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Silvia Gonella
- grid.7605.40000 0001 2336 6580Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Kevin Brazil
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Condon M, Barrett A, Pope L, Goulding M, Healy L, O'Caoimh R, Hartigan I. Tele-rehabilitation: redefining stroke early supported discharge during the COVID-19. IRISH MEDICAL JOURNAL 2022; 115:3. [PMID: 36917460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Saab MM, Murphy M, Meehan E, Dillon CB, O'Connell S, Hegarty J, Heffernan S, Greaney S, Kilty C, Goodwin J, Hartigan I, O'Brien M, Chambers D, Twomey U, O'Donovan A. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res 2022; 26:1645-1665. [PMID: 34193026 DOI: 10.1080/13811118.2021.1938321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.
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Cornally N, Kilty C, Buckley C, O’Caoimh R, O’Donovan MR, Monahan MP, O’Connor CD, Fitzgerald S, Hartigan I. The Experience of COVID-19 Visitor Restrictions among Families of People Living in Long-Term Residential Care Facilities during the First Wave of the Pandemic in Ireland. Int J Environ Res Public Health 2022; 19:ijerph19116559. [PMID: 35682143 PMCID: PMC9180630 DOI: 10.3390/ijerph19116559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 01/10/2023]
Abstract
Public health responses to COVID-19 in long-term residential care facilities (LTRCFs) have restricted family engagement with residents. These restrictions impact on quality of care and the psychosocial and emotional well-being of family caregivers. Following a national cross-sectional web-based survey, respondents were invited to provide personal reflections on visitor restrictions. This study aims to describe the consequences of these restrictions for individuals living in LTRCF and their families during the first wave of the COVID-19 pandemic. Data from open-ended questions contained within the survey were analyzed using Braun and Clarke’s (2006) method of thematic analysis. Four themes were identified: 1. Altered Communication and Connection; 2. Emotional and Psychological Impact; 3. Protecting and Caring Role of Staff; 4. Family Role. Throughout the narrative accounts, it is evident that the visitor restrictions impacted on the emotional and mental well-being of families. Some respondents expressed frustration that they could not assist staff in essential care provision, reducing meaning and purpose in their own lives. COVID-19 LTRCF visitor restrictions made little distinction between those providing essential personal care and those who visit for social reasons. A partnership approach to care provision is important and should encompass strategies to maintain the psychosocial and emotional well-being of families and their relatives during times of self-isolating or restrictive measures.
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Affiliation(s)
- Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
- Correspondence:
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
| | - Catherine Buckley
- Northridge House Education and Research Centre, St. Luke’s Home, T12H970 Cork, Ireland;
| | - Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, T12WE28 Cork, Ireland;
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, T12WE28 Cork, Ireland;
| | - Mark R. O’Donovan
- Health Research Board Clinical Research Facility, University College Cork, Mercy University Hospital, T12WE28 Cork, Ireland;
| | - Margaret P. Monahan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
| | - Caroline Dalton O’Connor
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
| | - Serena Fitzgerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, T12AK54 Cork, Ireland; (C.K.); (M.P.M.); (C.D.O.); (S.F.); (I.H.)
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Bavelaar L, McCann A, Cornally N, Hartigan I, Kaasalainen S, Vankova H, Di Giulio P, Volicer L, Arcand M, van der Steen JT, Brazil K. Guidance for family about comfort care in dementia: a comparison of an educational booklet adopted in six jurisdictions over a 15 year timespan. Palliat Care 2022; 21:76. [PMID: 35578219 PMCID: PMC9112535 DOI: 10.1186/s12904-022-00962-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 04/28/2022] [Indexed: 11/07/2022] Open
Abstract
Background To support family caregivers of people with dementia in end-of-life decision making, a family booklet on comfort care has been adapted and adopted by several European jurisdictions since the original publication in Canada in 2005. Methods We analyzed and compared the adaptations to the family booklets used in Canada, the Czech Republic, Italy, the Netherlands, the UK and Ireland that were made up to 2021. Qualitative content analysis was used to create a typology of changes to the original booklet. Interviews with the teams that adapted the booklets contributed to methodological triangulation. Further, using an established framework, we assessed whether the contents of the booklets addressed all domains relevant to optimal palliative dementia care. Results The booklets differed in the types of treatment addressed, in particular tube feeding, euthanasia, and spiritual care. There was also variability in the extent to which medical details were provided, an emphasis on previously expressed wishes in medical decision making, addressing of treatment dilemmas at the end of life, the tone of the messages (indirect or explicit) and the discussion of prognosis (as more or less positive), and the involvement of various healthcare professionals and family caregivers in care. All booklets addressed all domains of palliative dementia care. Conclusions We identified core elements in providing information on end-of-life care to family caregivers of people with dementia as related to optimal palliative care in dementia. Additionally, local adaptations and updates are required to account for socio-cultural, clinical, and legal differences which may also change over time. These results may inform development of educational and advance care planning materials for different contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00962-z.
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Bavelaar L, Nicula M, Morris S, Kaasalainen S, Achterberg WP, Loucka M, Vlckova K, Thompson G, Cornally N, Hartigan I, Harding A, Preston N, Walshe C, Cousins E, Dening KH, De Vries K, Brazil K, van der Steen JT. Developing country-specific questions about end-of-life care for nursing home residents with advanced dementia using the nominal group technique with family caregivers. Patient Educ Couns 2022; 105:965-973. [PMID: 34376304 DOI: 10.1016/j.pec.2021.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We aimed to develop question prompt lists (QPLs) for family caregivers of nursing home residents with advanced dementia in the context of a study involving Canada, the Czech Republic, Italy, the Netherlands, the United Kingdom and Ireland, and to explore cross-national differences. QPLs can encourage family caregivers to ask questions about their relative's end-of-life care. METHODS We used nominal group methods to create country-specific QPLs. Family caregivers read an information booklet about end-of-life care for people with dementia, and generated questions to ask healthcare professionals. They also selected questions from a shortlist. We analyzed and compared the QPLs using content analysis. RESULTS Four to 20 family caregivers per country were involved. QPLs ranged from 15 to 24 questions. A quarter (24%) of the questions appeared in more than one country's QPL. One question was included in all QPLs: "Can you tell me more about palliative care in dementia?". CONCLUSION Family caregivers have many questions about dementia palliative care, but the local context may influence which questions specifically. Local end-user input is thus important to customize QPLs. PRACTICE IMPLICATIONS Prompts for family caregivers should attend to the unique information preferences among different countries. Further research is needed to evaluate the QPLs' use.
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Affiliation(s)
- Laura Bavelaar
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Maria Nicula
- School of Nursing, McMaster University, Ontario, Canada
| | - Sophie Morris
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Andrew Harding
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emily Cousins
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- School of Nursing and Midwifery, De Montfort University, Leicester, UK; Dementia UK , London, UK
| | - Kay De Vries
- School of Nursing and Midwifery, De Montfort University, Leicester, UK
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care, Radboud uNiversity Medical Center, Nijmegen, The Netherlands.
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Buckley C, Hartigan I, Coffey A, Cornally N, O'Connell S, O'Loughlin C, Timmons S, Lehane E. Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. Int J Older People Nurs 2022; 17:e12460. [PMID: 35362252 PMCID: PMC9539682 DOI: 10.1111/opn.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings. METHODS Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. RESULTS Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. CONCLUSIONS This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.
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Affiliation(s)
- Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Luke's Nursing Home, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Selena O'Connell
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Coffey A, Hartigan I, Timmons S, Buckley C, Lehane E, O'Loughlin C, O'Connell S, Cornally N. Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2021; 2:137. [PMID: 34895359 PMCID: PMC8665505 DOI: 10.1186/s43058-021-00241-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07). Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00241-7.
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Affiliation(s)
- Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland. .,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Lukes Nursing Home, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Selena O'Connell
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Donegan O, Hartigan I, Cowan K, Dunne N, Hally R, O'Connor CD, Fitzgerald S. 259 IDENTIFYING THE TOP 10 RESEARCH PRIORITIES FOR FAMILY CARERS: THE INTERFACE PROJECT. Age Ageing 2021. [PMCID: PMC8690100 DOI: 10.1093/ageing/afab219.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background In assessing the global impact of the COVID-19 pandemic on society, it is important to understand the communities most affected and develop methods of support. Family carers provide a vital, yet often invisible role in our society and healthcare system. Identifying research priorities for carers helps establish overall gaps in the research agenda and increases awareness of the role of carers in the community. Methods A priority setting partnership methodology was engaged and through collaboration with carers, healthcare professionals and researchers, a participatory process was conducted to identify gaps in the current literature and prioritise research questions and uncertainties. Focus group discussions followed, the first consisted of family carers (n = 5). The second (n = 3) interviewed stakeholders namely healthcare professionals, researchers and policy makers. After collating the data, researchable questions were developed through an iterative process with a Multi Stakeholder Advisory Committee to identify the top 10 research priorities for Family Carers Ireland. Results The top 10 researchable questions were distilled from a list of 16 and fit into 7 broad categories. 1) economic impact and financial strain 2) Systemic issues, education, resources and policy 3) technology 4) support services and infrastructure 5) mental health and wellbeing of the carer 6) carers in society 7) Recognition and acknowledgment of the family carer. Conclusion The partnership focus of this project allowed the ‘ground-up’ development of research priorities for carers by carers. The COVID-19 pandemic served to magnify systemic issues already present in society, as well as highlight new burdens. As a result, the subsequent development of 10 researchable questions will guide further investigation to improve the support and wellbeing of family carers.
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Affiliation(s)
- O Donegan
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - I Hartigan
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - K Cowan
- Katherine Cowan Consultancy, Hastings, United Kingdom
| | - N Dunne
- Family Carers Ireland, Dublin, Ireland
| | - R Hally
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - C D O'Connor
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - S Fitzgerald
- College of Medicine and Health, University College Cork, Cork, Ireland
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McCarthy B, Bessell N, Murphy S, Hartigan I. "Nursing and speech and language students' perspectives of reflection as a clinical learning strategy in undergraduate healthcare education: A qualitative study". Nurse Educ Pract 2021; 57:103251. [PMID: 34775226 DOI: 10.1016/j.nepr.2021.103251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/19/2021] [Accepted: 10/29/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to explore nursing and speech and language students' perspectives of reflection as a clinical learning strategy during years three and four of their undergraduate education programmes. BACKGROUND Reflection is recognised as a core student learning activity which is widely used in undergraduate healthcare education for clinical practice. Studies indicate that structured models and frameworks do help novice students to develop the process of reflection-on-practice particularly in years one and two. However, there is limited research on healthcare students' perspectives of reflection as a clinical learning strategy in the latter years of their undergraduate healthcare education (years 3 and 4). DESIGN A qualitative descriptive design was used. METHODS Using a self-reporting method whereby students respond to a series of questions posed by the researchers, data were collected from nursing (n = 20) and speech and language students (n = 26) in one university in Ireland and analysed using thematic analysis. RESULTS The findings from both nursing and speech and language students were similar. Three themes identified included: description of reflection, undertaking reflection and contribution to clinical learning. Most students expressed beneficial effects of reflection for personal and professional clinical learning. Some students reported negativities to the written reflections, expressing a preference for more diverse and less structured strategies and more face-to-face reflective discussions with clinical educators. CONCLUSIONS Whilst the benefits of reflection for clinical practice are well versed in this study, the authors suggest that academic and clinical educators employ more diverse and innovative reflective tools for healthcare students who are at a more competent level of their undergraduate education programme. Further interprofessional research in relation to different clinical reflective strategies for healthcare students in years three and four of their undergraduate education programmes is warranted.
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Affiliation(s)
- Bridie McCarthy
- School of Nursing & Midwifery, University College Cork, Cork, Ireland.
| | - Nicola Bessell
- School of Clinical Therapies, University College Cork, Cork, Ireland.
| | - Siobhan Murphy
- School of Nursing and Midwifery, University College Cork, Ireland.
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Ireland.
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12
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Kilty C, Goodwin J, Hartigan I, Meehan E, Murphy M, Dillon C, Heffernan S, Hegarty J, Greaney S, O'Brien M, Chambers D, Twomey U, Horgan A. Healthcare staff's views on responding to suicide and self-harm: Part I. Perspect Psychiatr Care 2021; 57:1693-1699. [PMID: 33616214 DOI: 10.1111/ppc.12737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/23/2020] [Accepted: 01/16/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To explore healthcare staff's knowledge and awareness of, and responses to, suicide and self-harm. DESIGN AND METHODS A qualitative design was adopted, and data were collected using a "World Café" approach (n = 143 participants), in addition to written submissions (n = 10). Data were analyzed using reflexive thematic analysis. FINDINGS There was variation relating to awareness of and responses to suicide and self-harm. Participants highlighted the need for further staff education and training, and a review of standardized assessment tools and referral processes. PRACTICE IMPLICATIONS Tailored training and education resources are required for healthcare staff. Clear protocols for assessing, treating, and referring people deemed at risk of suicide and self-harm are needed.
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Affiliation(s)
- Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), University College Cork, Cork, Republic of Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Elaine Meehan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Margaret Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Christina Dillon
- School of Public Health, University College Cork, Cork, Republic of Ireland
| | - Sinead Heffernan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | - Sonya Greaney
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,HSE South, HSE Mental Health Services, Cork, Republic of Ireland
| | - Maidy O'Brien
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland
| | | | - Una Twomey
- Service Improvement, HSE, Cork, Republic of Ireland
| | - Aine Horgan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Republic of Ireland.,ENGAGE (Interdisciplinary Clinical Mental Health Research Network), University College Cork, Cork, Republic of Ireland
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13
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Abstract
To prevent and reduce the transmission of the coronavirus to vulnerable populations, the World Health Organization recommended the restriction of visitors to nursing homes. It was recognised that such restrictions could have profound impact on residents and their families. Nonetheless, these measures were strictly imposed over a prolonged period in many countries; impeding families from remaining involved in their relatives' care and diluting the meaningful connections for residents with society. It is timely to explore the impact of public health measures on people living in nursing homes from an ethical perspective. In order to foreground the ethical dimensions of the implications of visitor restrictions in nursing homes, we compiled an ethical case that reflects some recent experiences of nursing homes residents and their families, in the Irish Republic. We describe a series of events encountered by a woman and her family during the first wave of the pandemic in 2020 and we deploy an ethical decision-making tool to guide and structure our analysis. Our case analysis draws attention to ethical principles that are relevant to explicating the ethical duties and obligations that arise in relation to the interests, well-being, and safety of residents and their families, as well as nursing home staff and the wider community during a pandemic. These include the right of autonomy, trust, minimising harm, and proportionality. We conclude that a number of different strategies should be adopted by nursing homes and relevant regulatory bodies. This includes honest, regular communication between the nursing home staff, the resident and their family. Central to communications is the resident's wishes, their current clinical status and the all-important wider public health obligations. National strategies include mass vaccination, the timely provision of guidance documents and interventions from regulatory bodies that are patient-centred, adaptable, and cost effective.
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Affiliation(s)
- Irene Hartigan
- University College Cork, Ireland.,University College Cork, Ireland
| | - Ann Kelleher
- South/Southwest Hospital Group, HSE, Ireland.,University College Cork, Ireland
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14
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Timmons S, O'Loughlin C, Buckley C, Cornally N, Hartigan I, Lehane E, Finn C, Coffey A. Dementia palliative care: A multi-site survey of long term care STAFF'S education needs and readiness to change. Nurse Educ Pract 2021; 52:103006. [PMID: 33690020 DOI: 10.1016/j.nepr.2021.103006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.
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Affiliation(s)
- S Timmons
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C O'Loughlin
- University of Limerick, Limerick, V94 X5K6, Ireland
| | - C Buckley
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - N Cornally
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - I Hartigan
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - E Lehane
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - C Finn
- University College Cork, College Road, Cork, T12 K8AF, Ireland
| | - A Coffey
- University of Limerick, Limerick, V94 X5K6, Ireland.
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15
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Dillon CB, Saab MM, Meehan E, Goodwin MJ, Murphy M, Heffernan MS, Greaney MS, Kilty C, Hartigan I, Chambers D, Twomey U, Horgan A. Staff awareness of suicide and self-harm risk in healthcare settings: A mixed-methods systematic review. J Affect Disord 2020; 276:898-906. [PMID: 32739708 DOI: 10.1016/j.jad.2020.07.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicide risk screening in healthcare settings plays a significant role in suicide prevention. Healthcare staff who are poorly informed about self-harm and suicide risk are less likely to identify and subsequently screen at-risk individuals. This mixed-method systematic review aimed to appraise and synthesise evidence from studies that explored and promoted healthcare staff's knowledge and awareness of suicide and self-harm risk in healthcare settings. METHODS Electronic databases (CINAHL, MEDLINE, APA PsycInfo, APA PsycARTICLES, Psychology and behavioural Science Collection, ERIC, and SocINDEX), the Cochrane Library, and various grey literature databases were searched for relevant studies. The level of evidence and methodological quality of the included studies were assessed. RESULTS Eighteen empirical studies were included. Levels of knowledge about suicide and self-harm risk varied significantly across the reviewed studies. Face-to-face group training and educational programmes, digital or online educational programmes, and an educational poster campaign were amongst the strategies used to promote awareness of suicide and self-harm risk, with the majority marginally succeeding in doing so. LIMITATIONS The reviewed studies were heterogeneous in terms of design, interventions, and outcome measures which made it difficult to make comparisons. The overall level of scientific evidence was classified as being relatively low. The lack of blinding and lack of a control group were amongst the limitations for experimental studies. CONCLUSIONS Long-term, routine face-to-face group training programmes should be established to educate healthcare staff about suicide risk across all professions and in specific patient groups.
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Affiliation(s)
- Christina B Dillon
- Environmental Research Institute/School of Public Health, University College Cork, Ireland.
| | - Mohamad M Saab
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Elaine Meehan
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Mr John Goodwin
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Margaret Murphy
- School of Nursing and Midwifery, University College Cork, Ireland
| | | | | | - Caroline Kilty
- School of Nursing and Midwifery, University College Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Ireland
| | | | - Una Twomey
- Health Service Executive Southern Area, Ireland
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Ireland.
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16
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O'Caoimh R, O'Donovan MR, Monahan MP, Dalton O'Connor C, Buckley C, Kilty C, Fitzgerald S, Hartigan I, Cornally N. Psychosocial Impact of COVID-19 Nursing Home Restrictions on Visitors of Residents With Cognitive Impairment: A Cross-Sectional Study as Part of the Engaging Remotely in Care (ERiC) Project. Front Psychiatry 2020; 11:585373. [PMID: 33192731 PMCID: PMC7649131 DOI: 10.3389/fpsyt.2020.585373] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background: COVID-19 has disproportionately affected older people. Visiting restrictions introduced since the start of the pandemic in residential care facilities (RCFs) may impact negatively on visitors including close family, friends, and guardians. We examined the effects of COVID-19 visiting restrictions on measures of perceived loneliness, well-being, and carer quality of life (QoL) amongst visitors of residents with and without cognitive impairment (CI) in Irish RCFs. Methods: We created a cross-sectional online survey. Loneliness was measured with the UCLA brief loneliness scale, psychological well-being with the WHO-5 Well-being Index and carer QoL with the Adult Carer QoL Questionnaire (support for caring subscale). Satisfaction with care ("increased/same" and "decreased") was measured. A history of CI was reported by respondents. Sampling was by convenience with the link circulated through university mail lists and targeted social media accounts for 2 weeks in June 2020. Results: In all, 225 responses were included of which 202 noted whether residents had reported CI. Most of the 202 identified themselves as immediate family (91%) and as female (82%). The majority (67%) were aged between 45 and 64 years. Most (80%) reported that their resident had CI. Approximately one-third indicated reduced satisfaction (27%) or that restrictions had impaired communication with nursing home staff (38%). Median loneliness scores were 4/9, well-being scores 60/100 and carer QoL scores 10/15. Visitors of those with CI reported significantly lower well-being (p = 0.006) but no difference in loneliness (p = 0.114) or QoL (p = 0.305). Reported CI (p = 0.04) remained an independent predictors of lower WHO-5 scores, after adjusting for age, sex, RCF location, and dementia stage (advanced), satisfaction with care (reduced), and perception of staff support measured on the Adult Carer QoL Questionnaire. Conclusion: This survey suggests that many RCF visitors experienced low psychosocial and emotional well-being during the COVID-19 lockdown. Visitors of residents with CI report significantly poorer well-being as measured by the WHO-5 than those without. Additional research is required to understand the importance of disrupted caregiving roles resulting from visiting restrictions on well-being, particularly on visitors of residents with CI and how RCFs and their staff can support visitors to mitigate these.
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Affiliation(s)
- Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Mark R O'Donovan
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Margaret P Monahan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Catherine Buckley
- Northridge House Education and Research Centre, St. Lukes Home, Cork, Ireland
| | - Caroline Kilty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Serena Fitzgerald
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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17
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Hartigan I, Brazil K, Kaasalainen S, Sussman T, Van Der Steen J, Loucka M, Di Giulio P, Cornally N. 333 A Transnational Effectiveness-Implementation Study of the Family Carer Decision Support Intervention to Improve End of Life Care in Long-Term Care. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Family Carer Decision Support (FCDS) intervention has been designed to inform family carers about end of life care options available to a person living with advanced dementia. The FCDS intervention demonstrated a statistically significant impact in reducing family carer decision uncertainty on establishing goals of care at the end of life and, improved family carer satisfaction on quality of care in a study conducted in the United Kingdom.
Methods
The aim of this research is to adapt the application of the FCDS for use in different countries. Funding supported through the EU Joint Programme – Neurodegenerative Disease Research (JPND) project has supported the scaling up of the FCDS transnationally in the United Kingdom; Republic of Ireland; Netherlands; Canada; Czech Republic ; and, Italy. Launched in April 2019, this presentation will report on present activities including: a) description of the FCDS intervention; b) strategy for implementing the FCDS in care homes; c) study design employed for the evaluation of the FCDS; and d) work packages and that will be deployed to achieve intended outcomes
Results
Expected project outcomes of this work will include a) develop guidelines to facilitate transnational use of the FCDS within care homes; (b) staff education material including web learning resources; (c) family carer informational material including web learning resources; (d) measures and tools to evaluate the uptake and outcome of the FCDS intervention; (e) establish a transnational FCDS community of practice across study care homes; (f) estimated costs of providing the FCDS intervention; (g) evidence of enhancing decision making among family members regarding resident care and satisfaction with care.
Conclusion
Recent research revealed that care home structures and staff play an important role in the successful implementation and adoption of innovations such as the FCDS intervention, this is further examined in this transnational study.
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Affiliation(s)
| | - Kevin Brazil
- Queen's University Belfast, Belfast, United Kingdom
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18
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Abstract
Abstract
Background
Early recognition of stroke symptoms and immediate response is necessary to ensure timely access to treatment of stroke. However, many individuals fail identify symptoms of stroke or delay in seeking medical attention. The Irish Heart Foundation launched the “Act Fast” campaign which included three waves of broadcasting on national television and radio, throughout 2010 and 2011. Stroke awareness campaigns may have the potential to influence behaviour and response to stroke.
Methods
A non-experimental, descriptive, quantitative, cross-sectional study was conducted. The Stroke Action Test (STAT)1 was used to investigate how participants would respond to specific symptoms of stroke. A convenience sample (n=89) of older adults attending an outpatient clinic in a university teaching hospital completed the questionnaire. The mean age of respondents was 79.6 years (SD =9.3).
Results
Just 4.5% (n=4) of respondents identified what all 4 letters of FAST represent. Overall, 48% (n=43) of respondents recognised all 6 symptoms of stroke and 100% (n=89) recognised at least 2 symptoms of stroke as per STAT. The stroke symptom most frequently recognised was sudden numbness of the face, arm or leg at 99% (n=88). The stroke symptom least frequently recognised was sudden trouble seeing in one or both eyes at 56% (n=50). Despite this 81% (n=64) of respondents would not respond appropriately to 50% of symptoms of stroke described in the STAT. 52% (n=46) of respondents identified irregular heart beat as a risk factor for stroke. Finally, 29% (n=26) of respondents had heard of thrombolysis while just 2% (n=2) had heard of thrombectomy.
Conclusion
Awareness of stroke symptoms does not necessarily influence response to stroke in older adults. Future stroke awareness campaigns should consider FAST2 which speaks to treatment (thrombolysis or thrombectomy) as well as time.
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19
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Hartigan I, Cornally N, Foley T, Timmons S, Park G, Jennings A, Müller N. 325 Exploring the Complexity of Dementia and Loneliness in Ireland. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dementia and loneliness are both complex phenomenon’s that impact on both mental and physical health. Research has identified that loneliness can increase a person’s risk of mortality as much as smoking or alcohol consumption. People with dementia are at particular risk of loneliness and social isolation. This can negatively impact on a person with dementia’s health. To effectively address loneliness in dementia, we must first understand how people with dementia experience loneliness.
Methods
Interviews were conducted with people living with dementia. Participants comprised of eight community-dwelling individuals, aged 55 years and older (mean = 63.8; range = 55-77), who were each diagnosed with dementia at least one year prior to interview (range = 1.16 – >5 years). Interviews were conducted in participants’ homes using a semi-structured format and lasted between 37-74 minutes.
Results
Three key themes emerged: the importance of maintaining meaningful relationships, maintaining independence and socio-cultural influences on individual perceptions of loneliness and dementia. The results emphasise the importance of maintaining both a sense of self and meaningful relationships with others post-diagnosis for individuals who identified themselves as “not lonely”. People living with dementia reported that the maintenance of social connection aids in fostering a sense of self-worth and self-management, which in turn mitigates feelings of loneliness.
The majority of participants existing social connections with others was established prior to their diagnosis, although the maintenance of these relationships may have required an adjustment of their premorbid routines and method of social engagement.
Conclusion
Human contact and a meaningful relationship are superior in preventing loneliness. Individual feelings of loneliness or lack thereof are not directly correlated to the coping mechanisms most commonly employed by individuals with dementia. Further exploration is need to understand how people with dementia, who live at home, perceive or experience loneliness.
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Affiliation(s)
| | | | | | - Suzanne Timmons
- University College Cork, Cork, Ireland
- Health Service Executive, Cork, Ireland
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20
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Timmons S, Cornally N, Hartigan I, Lehane E, Buckley C, O’Loughlin C, Finn C, Lynch M, Coffey A. 186 Tailoring Change Management - Learning from “Readiness-to-Change” and Learning Needs Analyses, Focused on Dementia Palliative Care, in Three Long-term Care Settings. Age Ageing 2019. [DOI: 10.1093/ageing/afz103.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Over one third of people with dementia in Ireland reside in Long Term Care (LTC) settings. Dementia palliative care is complex; healthcare staff in LTC settings have requested specific guidance to support practice. This participatory action research project will introduce national evidence-based guidance documents relating to pain, hydration/nutrition, and medication management, into three LTC settings in Munster, using a tailored Work-based Learning approach, informed by a baseline multi-modal situational analysis.
Methods
Site and staff data were collected using a site profile tool; staff demographic and learning needs surveys; and the ‘VOCALISE’ readiness-to-change survey, in the three sites.
Results
Within the sites, 42-88% of residents had probable/definite dementia. Multidisciplinary input varied considerably between sites. In total, 69 staff (predominantly nurses and healthcare attendants) completed learning needs surveys. Many reported prior dementia education (range 53-76% across sites). This was twice as often on hydration/nutrition and medication topics than pain. Reflecting this, staff in all sites identified knowledge deficits, but particularly in pain identification, assessment and management. Other learning needs included supporting and communicating with families; resident care planning and advance care planning; and resident ‘comfort’.
Of 58 staff with completed VOCALISE data, 33% were rated as ‘ready to change’, 14% ‘not’, and the remainder ambivalent. Interestingly, staff had high confidence in the ability of change to happen, but low motivation scores; and overall ambivalence towards their own power to make change happen. Some barriers were site-specific, but overall, staffing levels, managing risk during change and perceived reluctance in others were common barriers to change, as was the possibility that patient wishes hadn’t informed the change process.
Conclusion
Our baseline data highlights that education and change implementation needs to be tailored to the recipient site, recognising site-specific barriers to change. We will now use this data in our Work-based Learning intervention.
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Affiliation(s)
- Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | | | - Colette Finn
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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21
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Timmons S, Cornally N, Hartigan I, Lehane E, Buckley C, Lynch M, Coffey A. 17Implementing Guidance for Palliative Care in Dementia Using Consolidated Framework for Implementation Research (CIFR): Results of a Multisite Situational Analysis. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Hartigan I, O’Connell E, O'Brien S, Weathers E, Cornally N, Kilonzo B, McCarthy G. The Irish national stroke awareness campaign: a stroke of success? Appl Nurs Res 2014; 27:e13-9. [DOI: 10.1016/j.apnr.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 12/26/2022]
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23
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Walshe N, O’Brien S, Hartigan I, Murphy S, Graham R. Simulation Performance Evaluation: Inter-rater Reliability of the DARE2-Patient Safety Rubric. Clin Simul Nurs 2014. [DOI: 10.1016/j.ecns.2014.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Abstract
AIM To test an evidence base patient education leaflet to evaluate older adults' knowledge of pressure ulcers and prevention strategies. BACKGROUND The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional's verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. METHODS A quasi-experimental uncontrolled pre-test, post-test study of participants' knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult's knowledge was measured pre- and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. CONCLUSION The results indicate that an education leaflet enhanced patients' knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. IMPLICATIONS FOR PRACTICE An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.
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Affiliation(s)
- Irene Hartigan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland.
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26
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Hartigan I, O'Mahony D. The Barthel Index: comparing inter-rater reliability between Nurses and Doctors in an older adult rehabilitation unit. Appl Nurs Res 2011; 24:e1-7. [DOI: 10.1016/j.apnr.2009.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 11/18/2009] [Accepted: 11/20/2009] [Indexed: 11/28/2022]
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27
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Hartigan I, Cooke J, Barry P, O’Connor M, O’Mahony D. The incidence of acute stroke emergency admissions in an Irish teaching hospital. Ir J Med Sci 2010; 179:67-71. [DOI: 10.1007/s11845-009-0379-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 06/08/2009] [Indexed: 11/24/2022]
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Hartigan I, Murphy S, Flynn AV, Walshe N. Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses. Nurse Educ Pract 2010; 10:291-7. [PMID: 20167537 DOI: 10.1016/j.nepr.2010.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 11/21/2009] [Accepted: 01/19/2010] [Indexed: 11/18/2022]
Abstract
On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.
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Affiliation(s)
- Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Ireland.
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Hartigan I, Cummins A, O'Connell E, Hughes M, Hayes CC, Noonan B, Fehin P. An evaluation of lecturer practitioners in Ireland. Int J Nurs Pract 2009; 15:280-6. [DOI: 10.1111/j.1440-172x.2009.01763.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Noonan BJ, Hughes M, Hayes CC, Hartigan I, O'Connell L, Cummins A, Fehin P. The effectiveness of the lecturer practitioner role in clinical practice: an Irish perspective. Nurse Educ Today 2009; 29:561-565. [PMID: 19171411 DOI: 10.1016/j.nedt.2008.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 11/25/2008] [Accepted: 12/16/2008] [Indexed: 05/27/2023]
Abstract
BACKGROUND Demands within academia such as teaching, publishing, research activity and generating grant income can make it difficult for nurse educators to protect time for clinical practice. In an effort to overcome this problem lecturer practitioner posts have been introduced with designated responsibilities in both clinical and educational settings. METHODS Using a mixed method descriptive methodology student nurses and registered nurses completed a modified questionnaire to examine the impact of lecturer practitioners (LPs) in clinical practice. Focus groups were also conducted with lecturer practitioners themselves. RESULTS The results identified that by having a clinical remit, LPs forged good relationships with student nurses and registered nurses in clinical practice, who considered the LP as being a learning resource with realistic expectations of the clinical environment. DISCUSSION The results provide further evidence to support the continuation of nurse educators in clinical practice for their own development, their students and registered nurses.
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Affiliation(s)
- Brendan J Noonan
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland.
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Gallagher P, Barry P, Hartigan I, McCluskey P, O'Connor K, O'Connor M. Prevalence of pressure ulcers in three university teaching hospitals in Ireland. J Tissue Viability 2008; 17:103-9. [PMID: 18378140 DOI: 10.1016/j.jtv.2007.12.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/18/2007] [Accepted: 12/26/2007] [Indexed: 11/20/2022]
Abstract
AIM Pressure ulceration is a significant, but preventable, cause of morbidity and resource utilisation in hospital populations. Data on pressure ulcer prevalence in Ireland are limited. This study aims to determine (i) the point-prevalence of pressure ulcers in three teaching hospitals in Ireland and (ii) risk factors for their development. METHODS Eight teams of one doctor and one nurse visited 672 adult patients over a 2-day period in three teaching hospitals. Each patient was examined and pressure ulcers graded with the European Pressure Ulcer Advisory Panel system. Mental test score, Barthel index, type of support surface, length of stay, documentation of risk assessment and serum albumin were recorded. RESULTS Point-prevalence of pressure ulceration was 18.5%. Seventy-seven percent of pressure ulcers were hospital-acquired, 49% grade 1, 37% grade 2, 11% grade 3 and 3% grade 4. Reduced mobility, urinary incontinence, cognitive impairment, low serum albumin and length of stay were significantly associated with pressure ulcers. Multivariate logistic regression analysis found reduced mobility (odds ratio 8.84; 95% CI 5.04-15.48, p<0.0001) and length of stay (odds ratio 1.02; 95% CI 1.01-1.02, p<0.0001) to be predictive of the presence of pressure ulcers. Age, gender and risk assessment documentation were not associated with pressure ulcers. Sixty-five percent of patients with pressure ulcers were positioned on appropriate support surfaces. DISCUSSION Point-prevalence of pressure ulceration was 18.5%, similar to international data. Regular audit of prevalence, prevention and management strategies may raise awareness, influence resource allocation and ultimately improve patient care.
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Affiliation(s)
- Paul Gallagher
- Department of Geriatric Medicine, Cork University Hospital, and School of Nursing and Midwifery, University College Cork, Wilton, Cork, Ireland.
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Gallagher PF, Barry PJ, Ryan C, Hartigan I, O'Mahony D. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria. Age Ageing 2008; 37:96-101. [PMID: 17933759 DOI: 10.1093/ageing/afm116] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers' Criteria applied. RESULTS Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.
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Affiliation(s)
- Paul F Gallagher
- Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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Hartigan I. A comparative review of the Katz ADL and the Barthel Index in assessing the activities of daily living of older people. Int J Older People Nurs 2007; 2:204-12. [DOI: 10.1111/j.1748-3743.2007.00074.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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