Johanna Wiisak, Arja Suikkala, Helena Leino-Kilpi, Minna Stolt, Riitta Suhonen, Sanna Koskinen
Introduction
Nurses' well-being at work (WAW) is important for overall health care outcomes. Nurses often navigate complex roles, contending with time constraints, ethical challenges and societal undervaluation, underscoring the necessity of addressing their WAW.
Methods
The aim of this systematic review was to analyse the interventions that potentially improve nurses' WAW in care settings for older people. The ultimate goal is to provide an understanding of this field and advance the development of WAW interventions. We performed a systematic review which was registered in PROSPERO and conducted according to PRISMA guideline. We conducted a comprehensive literature search across five scientific databases and one platform in February 2023.
Results
Out of 5975 records, we included 21 full-text articles in the review. Interventions were typically complex and focused on (a) nurses' health, (b) nursing care, (c) care facilities and (d) management. Interventions resulted in a range of outcomes on the (a) physical, (b) psychosocial and (c) environmental dimensions of WAW, with most interventions leading to positive outcomes, albeit with instances of negative and neutral results.
Conclusions
Interventions focusing on nurses' health or care facilities can be promising to improve WAW of nurses working in care settings for older people. Interventions aimed at improving the WAW have focused on various aspects. Despite the mainly positive outcomes, some interventions can also compromise nurses' WAW.
Implications for Practice
Strategies and interventions aimed at improving nurses’ WAW are needed in practice as nurses’ WAW is crucial in recruiting to and retaining nurses in care settings for older people. Promoting WAW also contributes to the quality of care for older people and the provision of ethically high-quality health services.
Trial Registration
The review protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023399478)
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<p>Gerontological nurses around the world are increasingly and acutely aware that health and social care must become age friendly. The manifold, cascading effects of structural ageism and lack of gerontological competence in health and social care professions and systems are now widely recognised (Fulmer et al. <span>2020</span>). Thus, many of us are fighting for age friendly transformation of health and social care systems in countries around the world. Ever more, many gerontological nurses see similar concerns with planet friendliness and the negative impact of the healthcare industry on the health of the planet. Growing numbers of gerontological nurses and others are concerned that the healthcare industry worldwide is a major producer of greenhouse gases and a significant contributor to plastic pollution (Rizan et al. <span>2020</span>; Rodríguez-Jiménez et al. <span>2023</span>). Nurses everywhere, along with their colleagues in other disciplines, want to help mitigate the greenhouse gas and plastic pollution that the healthcare industry—in which most of them work and all of them use as patients and care partners—produces. As our recognition of these threats to the planet and its population builds, few of us stop to think about how naturally age friendliness and planet friendliness fit together.</p><p>Simply said, what is age friendly is most often planet friendly and vice versa. Pause and consider what we know about healthful ageing and what healthcare must do to support it. Supporting healthful ageing and respecting the person as they grow older both lie at the centre of age friendliness. The core elements of age friendliness are most often described with words beginning with M, forming a mnemonic to enhance recall and application. The M's used most often are knowing the person and what matters to them, promoting mobility and fitness, supporting mentation and brain health, and avoiding overuse and misuse of medications. Careful examination reveals that each of these elements is fundamentally planet friendly. Knowing the person is foundational, helping to avoid misplaced and excessive healthcare, especially that which is carbon intensive including all but the most imperative use of emergency, acute, and critical care. Mobility and fitness easily align with avoiding use of fossil fuel powered transportation while spending more time in nature moving under our own power. Brain health and physical fitness are inextricably linked, highlighting that fit bodies and fit brains rely on consistent physical exercise and lifelong social engagement. Finally, avoiding excessive and misapplied medications limits both greenhouse gas emissions and plastic waste used in producing and packaging drugs while simultaneously reducing risks of potential medication-related complications. Together, each domain of age friendly healthcare benefits our shared planetary environment.</p><p>Conversely, planet friendly healthcare easily promotes age friendliness. The acute
{"title":"Capitalising on the Co-Benefits of Age Friendliness and Planet Friendliness","authors":"Sarah H. Kagan","doi":"10.1111/opn.70009","DOIUrl":"10.1111/opn.70009","url":null,"abstract":"<p>Gerontological nurses around the world are increasingly and acutely aware that health and social care must become age friendly. The manifold, cascading effects of structural ageism and lack of gerontological competence in health and social care professions and systems are now widely recognised (Fulmer et al. <span>2020</span>). Thus, many of us are fighting for age friendly transformation of health and social care systems in countries around the world. Ever more, many gerontological nurses see similar concerns with planet friendliness and the negative impact of the healthcare industry on the health of the planet. Growing numbers of gerontological nurses and others are concerned that the healthcare industry worldwide is a major producer of greenhouse gases and a significant contributor to plastic pollution (Rizan et al. <span>2020</span>; Rodríguez-Jiménez et al. <span>2023</span>). Nurses everywhere, along with their colleagues in other disciplines, want to help mitigate the greenhouse gas and plastic pollution that the healthcare industry—in which most of them work and all of them use as patients and care partners—produces. As our recognition of these threats to the planet and its population builds, few of us stop to think about how naturally age friendliness and planet friendliness fit together.</p><p>Simply said, what is age friendly is most often planet friendly and vice versa. Pause and consider what we know about healthful ageing and what healthcare must do to support it. Supporting healthful ageing and respecting the person as they grow older both lie at the centre of age friendliness. The core elements of age friendliness are most often described with words beginning with M, forming a mnemonic to enhance recall and application. The M's used most often are knowing the person and what matters to them, promoting mobility and fitness, supporting mentation and brain health, and avoiding overuse and misuse of medications. Careful examination reveals that each of these elements is fundamentally planet friendly. Knowing the person is foundational, helping to avoid misplaced and excessive healthcare, especially that which is carbon intensive including all but the most imperative use of emergency, acute, and critical care. Mobility and fitness easily align with avoiding use of fossil fuel powered transportation while spending more time in nature moving under our own power. Brain health and physical fitness are inextricably linked, highlighting that fit bodies and fit brains rely on consistent physical exercise and lifelong social engagement. Finally, avoiding excessive and misapplied medications limits both greenhouse gas emissions and plastic waste used in producing and packaging drugs while simultaneously reducing risks of potential medication-related complications. Together, each domain of age friendly healthcare benefits our shared planetary environment.</p><p>Conversely, planet friendly healthcare easily promotes age friendliness. The acute","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/opn.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sherry Dahlke, Kathleen F. Hunter, Jeffrey I. Butler, Matthew Pietrosanu
Purpose
To determine if an online learning module on older people's care improved nursing students' self-assessed knowledge, and perceptions of older people, we developed a brief Feedback Survey. The aim of this study was to examine the internal consistency (a type of reliability) and construct validity of the feedback survey.
Design and Methods
Secondary analysis of data from the Awakening Canadian's to Ageism and McCalla e-learning intervention studies for postsecondary nursing students. Factor analysis and reliability analysis (via standardised Cronbach's alpha) were performed on the four-question, five-point Likert-type Feedback Survey, which was included in both intervention studies.
Results
Factor analysis yielded one factor interpretable as general satisfaction in students' experience with the module and perceived benefits of having completed it. Standardised Cronbach's alpha for this scale was high at 0.92, which suggests excellent internal consistency.
Implications for Practice
The feedback survey is a convenient and time-efficient measure to examine student nurses' self-assessed improvements in knowledge, perceptions about older people. The survey has potential for adaptation to measure perceived outcomes of other nursing student- focused education.
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Reminiscence therapy (RT) is a widely used approach to promote well-being among older adults and is an effective intervention method for older adults with diverse health conditions, including community-dwelling older adults.
Objectives
The aim of the study was to determine the impact of group RT on assessments of depression, anxiety and self-esteem in older adults living in the community.
Methods
We implemented sessions of group simple RT. The sample consisted of 24 older adults living in the community who attended a 12-week RT course. The duration of each reminiscence session was 60 min. The average age of the sample was 74.7 years. We used the Geriatric Depression Scale, the Geriatric Anxiety Inventory, the Rosenberg self-esteem scale, the Older adults' Quality of Life—Brief version and the Sense of Coherence scale to assess mental health outcomes before and after intervention.
Results
After intervention, we observed statistically significant improvements in assessments of depression (p < 0.001), anxiety (p = 0.011), self-esteem (p = 0.007) and the comprehensibility dimension of the sense of coherence scale (p = 0.039). Depression showed the largest effect size (Cohen's d = 0.870; 95% CI: 0.392 to 1.335), indicating a large effect, followed by self-esteem (Cohen's d = 0.612; 95% CI: −1.044 to −0.170) and anxiety (Cohen's d = 0.543; 95% CI: 0.108 to 0.967), both of which demonstrated a moderate effect.
Conclusions
We found group RT to be effective for several outcomes among older adults. Reminiscence is a good non-invasive treatment for the promotion of mental health in community-dwelling older adults.
Implications for Practice
As research has now established RT to be an essential component of activities for older adults in senior care facilities, we should also offer it to those living in the community as an effective activity for the promotion of healthy aging among older adults.
{"title":"The Effect of Reminiscence Therapy on the Assessment of Depression, Anxiety and Self-Esteem in Community-Dwelling Older Adults: An Intervention Study","authors":"Renáta Zeleníková, Jiřina Hosáková, Radka Kozáková, Katka Bobčíková, Radka Bužgová","doi":"10.1111/opn.70004","DOIUrl":"10.1111/opn.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reminiscence therapy (RT) is a widely used approach to promote well-being among older adults and is an effective intervention method for older adults with diverse health conditions, including community-dwelling older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The aim of the study was to determine the impact of group RT on assessments of depression, anxiety and self-esteem in older adults living in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We implemented sessions of group simple RT. The sample consisted of 24 older adults living in the community who attended a 12-week RT course. The duration of each reminiscence session was 60 min. The average age of the sample was 74.7 years. We used the Geriatric Depression Scale, the Geriatric Anxiety Inventory, the Rosenberg self-esteem scale, the Older adults' Quality of Life—Brief version and the Sense of Coherence scale to assess mental health outcomes before and after intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After intervention, we observed statistically significant improvements in assessments of depression (<i>p</i> < 0.001), anxiety (<i>p</i> = 0.011), self-esteem (<i>p</i> = 0.007) and the comprehensibility dimension of the sense of coherence scale (<i>p</i> = 0.039). Depression showed the largest effect size (Cohen's <i>d</i> = 0.870; 95% CI: 0.392 to 1.335), indicating a large effect, followed by self-esteem (Cohen's <i>d</i> = 0.612; 95% CI: −1.044 to −0.170) and anxiety (Cohen's <i>d</i> = 0.543; 95% CI: 0.108 to 0.967), both of which demonstrated a moderate effect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found group RT to be effective for several outcomes among older adults. Reminiscence is a good non-invasive treatment for the promotion of mental health in community-dwelling older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for Practice</h3>\u0000 \u0000 <p>As research has now established RT to be an essential component of activities for older adults in senior care facilities, we should also offer it to those living in the community as an effective activity for the promotion of healthy aging among older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/opn.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachid Akrour, Henk Verloo, Philip Larkin, Patrizia D'Amelio
<p>Hospitalisation of older adults with a chronic conditions is associated with higher risk of nosocomial infections, delirium, falls, functional decline and even early mortality (Richardson <span>2006</span>; Sharek et al. <span>2011</span>; Shepperd et al. <span>2017</span>; Sprivulis et al. <span>2006</span>; Vasilevskis et al. <span>2012</span>). Hospital-at-Home (HaH) interventions provide acute care treatments of a predetermined duration in the patient's home as an alternative to traditional hospital care. These interventions could shorten a hospital stay by enabling an early discharge or even becoming a complete substitution for hospital care. This would allow for continuity of acute care at home over a proscribed period of time (Gonçalves-Bradley et al. <span>2017</span>; Shepperd et al. <span>2016</span>; Shepperd and Iliffe <span>1998</span>). HaH interventions were developed to minimise, or even avoid, the potential iatrogenic effects of hospitalisation, improve patient and caregiver satisfaction, and reduce healthcare costs (Leong, Lim, and Lai <span>2021</span>). There is growing evidence from systematic reviews demonstrating the effectiveness of HaH interventions on patient outcomes with lower mortality, reduced readmissions and lengths of stay, lower risk of long-term care admission, lower depression and anxiety reduced costs, and improved patient satisfaction (Arsenault-Lapierre et al. <span>2021</span>; Caplan et al. <span>2012</span>; Conley et al. <span>2016</span>; Leong, Lim, and Lai <span>2021</span>). Patients with chronic diseases who presented to emergency departments and then received HaH interventions had lower risks of readmission and long-term admission. They also showed lower rates of depression and anxiety than patients who had received inpatient care (Arsenault-Lapierre et al. <span>2021</span>). Moreover, a meta-analysis and a scoping review showed that patients and caregivers had positive perceptions and experiences with HaH services (Chua et al. <span>2022</span>; Wang, Stewart, and Lee <span>2024</span>).</p><p>Older people with chronic conditions are prone to multiple specialist follow-ups, thereby generating significant care fragmentation (Le Couteur, Flicker, and Hilmer <span>2022</span>; Sadler et al. <span>2023</span>). Care fragmentation leads to adverse health outcomes and undermines patient's care experiences (Duan-Porter et al. <span>2020</span>), and contributes also to risks of medication errors (Daunt, Curtin, and O'Mahony <span>2023</span>; Squires et al. <span>2020</span>). Deficiencies in prioritising patient-centred care and in the multidisciplinary continuity of care have, nevertheless, been identified (Wang, Stewart, and Lee <span>2024</span>). In fact, the complex needs of an older people with multiple chronic conditions cannot be adequately addressed by a single healthcare professional; they require coordination and multidisciplinary collaboration (Araujo de Carvalho et al. <span>2017</span>
患有慢性疾病的老年人住院与院内感染、谵妄、跌倒、功能衰退甚至早期死亡的高风险相关(Richardson 2006；Sharek et al. 2011；sheppard et al. 2017；Sprivulis等人，2006；Vasilevskis et al. 2012)。居家医院（HaH）干预措施在患者家中提供预定持续时间的急性护理治疗，作为传统医院护理的替代方案。这些干预措施可以缩短住院时间，使患者能够早日出院，甚至可以完全替代医院护理。这将允许在规定的时间内继续在家中进行急性护理(gon<s:1> alves- bradley等人，2017；sheppard et al. 2016；谢泼德和伊利夫1998)。开发HaH干预措施是为了尽量减少甚至避免住院的潜在医源性影响，提高患者和护理人员的满意度，并降低医疗保健成本（Leong, Lim, and Lai 2021）。越来越多来自系统评价的证据表明，HaH干预措施在降低患者死亡率、减少再入院率和住院时间、降低长期护理入院风险、降低抑郁和焦虑、降低成本和提高患者满意度方面的有效性(Arsenault-Lapierre等人，2021；Caplan et al. 2012；Conley et al. 2016；Leong, Lim, and Lai 2021)。慢性病患者在急诊科就诊后接受HaH干预的再入院和长期住院的风险较低。与接受住院治疗的患者相比，他们的抑郁和焦虑率也较低（Arsenault-Lapierre et al. 2021）。此外，一项荟萃分析和范围评估显示，患者和护理人员对健康护理服务有积极的看法和体验(Chua et al. 2022；Wang, Stewart, and Lee 2024)。患有慢性疾病的老年人容易接受多次专科随访，从而产生严重的护理碎片化(Le Couteur， Flicker和Hilmer 2022；Sadler et al. 2023)。护理碎片化会导致不良的健康结果，破坏患者的护理体验（Duan-Porter et al. 2020），也会增加用药错误的风险(Daunt, Curtin, and O'Mahony 2023；Squires et al. 2020)。然而，在优先考虑以患者为中心的护理和护理的多学科连续性方面存在缺陷（Wang, Stewart, and Lee 2024）。事实上，患有多种慢性疾病的老年人的复杂需求无法由一名卫生保健专业人员充分解决；它们需要协调和多学科合作(Araujo de Carvalho et al. 2017；Larsen, Broberger, and Petersson 2017)。因此，世界卫生组织建议实施综合护理模式，确保对患有慢性病的老年人的护理的连续性，并尽量减少护理的碎片化（世界卫生组织，2017年）。在综合医疗模式下，由护士支持的护理协调对老年人是有效的（Prajankett and Markaki 2021）。护士主导的干预模式在护理协调方面改善了患者的结果(Gabbard et al. 2021；McParland, Johnston, and Cooper, 2022)、慢性病的一级和二级预防和管理（Beks et al. 2023）、住院（Imhof et al. 2012）、急诊室就诊（Counsell et al. 2007）、死亡率（Dorr et al. 2008）、身体功能、营养状况和生活质量（Kasa et al. 2023）。尽管近几十年来已经有相当多的科学研究为患有慢性疾病的老年人提供HaH干预措施，但对护士专门领导的这些干预措施的调查相对较少。使用附录中的搜索字符串，对Medline Ovid SP上截至2024年2月21日发表的文章进行文献和文献计量学检索，比较已发表的研究，涉及一般的健康照护干预和护士主导的老年人慢性疾病健康照护干预，表明缺乏关于护士主导的健康照护干预模式对健康照护影响的已发表研究（图1）。重要的是，未来的护理研究应侧重于强调护士主导的健康照护干预对老年人和照护者的结果以及对卫生系统的作用和影响。此外，护士主导的模式在这一领域的有效性需要通过回顾性、前瞻性和干预性研究进行严格的评估。这将增强我们对可向患有慢性疾病的老年人提出的HaH护理方案的理解和知识。它还将为决策者和卫生保健机构提供理由，为这一人口扩大有效的、以家庭为基础的、以人为本的护理。参与了文章的设计、数据分析和撰写。p.d.， H.V.和P.L.对本文的编辑进行了监督、更正和贡献。 作者声明无利益冲突。
{"title":"Nothing Feels Better Than Home: Why Must Nursing-Led Integrated Care Interventions for Older People With Chronic Conditions in Hospital-At-Home Be Considered?","authors":"Rachid Akrour, Henk Verloo, Philip Larkin, Patrizia D'Amelio","doi":"10.1111/opn.70002","DOIUrl":"10.1111/opn.70002","url":null,"abstract":"<p>Hospitalisation of older adults with a chronic conditions is associated with higher risk of nosocomial infections, delirium, falls, functional decline and even early mortality (Richardson <span>2006</span>; Sharek et al. <span>2011</span>; Shepperd et al. <span>2017</span>; Sprivulis et al. <span>2006</span>; Vasilevskis et al. <span>2012</span>). Hospital-at-Home (HaH) interventions provide acute care treatments of a predetermined duration in the patient's home as an alternative to traditional hospital care. These interventions could shorten a hospital stay by enabling an early discharge or even becoming a complete substitution for hospital care. This would allow for continuity of acute care at home over a proscribed period of time (Gonçalves-Bradley et al. <span>2017</span>; Shepperd et al. <span>2016</span>; Shepperd and Iliffe <span>1998</span>). HaH interventions were developed to minimise, or even avoid, the potential iatrogenic effects of hospitalisation, improve patient and caregiver satisfaction, and reduce healthcare costs (Leong, Lim, and Lai <span>2021</span>). There is growing evidence from systematic reviews demonstrating the effectiveness of HaH interventions on patient outcomes with lower mortality, reduced readmissions and lengths of stay, lower risk of long-term care admission, lower depression and anxiety reduced costs, and improved patient satisfaction (Arsenault-Lapierre et al. <span>2021</span>; Caplan et al. <span>2012</span>; Conley et al. <span>2016</span>; Leong, Lim, and Lai <span>2021</span>). Patients with chronic diseases who presented to emergency departments and then received HaH interventions had lower risks of readmission and long-term admission. They also showed lower rates of depression and anxiety than patients who had received inpatient care (Arsenault-Lapierre et al. <span>2021</span>). Moreover, a meta-analysis and a scoping review showed that patients and caregivers had positive perceptions and experiences with HaH services (Chua et al. <span>2022</span>; Wang, Stewart, and Lee <span>2024</span>).</p><p>Older people with chronic conditions are prone to multiple specialist follow-ups, thereby generating significant care fragmentation (Le Couteur, Flicker, and Hilmer <span>2022</span>; Sadler et al. <span>2023</span>). Care fragmentation leads to adverse health outcomes and undermines patient's care experiences (Duan-Porter et al. <span>2020</span>), and contributes also to risks of medication errors (Daunt, Curtin, and O'Mahony <span>2023</span>; Squires et al. <span>2020</span>). Deficiencies in prioritising patient-centred care and in the multidisciplinary continuity of care have, nevertheless, been identified (Wang, Stewart, and Lee <span>2024</span>). In fact, the complex needs of an older people with multiple chronic conditions cannot be adequately addressed by a single healthcare professional; they require coordination and multidisciplinary collaboration (Araujo de Carvalho et al. <span>2017</span>","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irina Dumitrescu, Minne Casteels, Kristel De Vliegher, Charlotte Hubens, Tinne Dilles
<div> <section> <h3> Background</h3> <p>Age, polypharmacy and comorbidity are examples of known factors that increase the risk of adverse drug reactions in patients. The use of high-risk medication also entails a heightened risk of harm. There is currently no information available on the home care patients' experiences and medication burden experienced due to their high-risk medication use and how they manage their medication. Further investigation with regard to this combination is necessary. The patient's experiences and medication burden related to high-risk medication use can be taken into account when drawing up guidelines and standards of care for healthcare professionals.</p> </section> <section> <h3> Objectives</h3> <p>To describe home care patients' experiences and medication burden related to high-risk medication use, more specifically how patients manage their high-risk medication use, which professional support they receive and which potential adverse drug reactions they experience.</p> </section> <section> <h3> Design</h3> <p>A cross-sectional study of home care patients in Belgium, aged 65 years and older who took at least one high-risk medication.</p> </section> <section> <h3> Results</h3> <p>In our population of 106 home care patients, a median use of 8 medications per patient is reported, of which 2 can be considered high-risk medication. Metformin, insulin and lormetazepam are the most frequently used high-risk medications. Home care patients believe their medication is important to them, are able to manage the intake and seem to have a high level of therapy adherence. Most patients do not believe their medication intake implies a certain risk. Most patients are supported by a home care nurse for the preparation of their medication. A mean number of 5 symptoms/potential adverse drug reactions is reported out of the 21 potential adverse drug reactions questioned. The potential adverse drug reaction most frequently attributed to medication use was bleeding.</p> </section> <section> <h3> Conclusions</h3> <p>Practice guidelines with detailed medicine-specific protocols are needed to enhance (high-risk) medication-related care in an overall high-risk medication policy. Understanding the patient's risk experiences and communicating with the patient is important to ensure safe medication care but also to identify patients at risk for nonadherence and adverse reactions. The patient's experiences with their medication intake provide rich information for healthcare providers and should therefore be included in patient observations. Home care n
{"title":"Home Care Patient's Experiences and Medication Burden Related to High-Risk Medication Use: A Cross-Sectional Study","authors":"Irina Dumitrescu, Minne Casteels, Kristel De Vliegher, Charlotte Hubens, Tinne Dilles","doi":"10.1111/opn.70003","DOIUrl":"10.1111/opn.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Age, polypharmacy and comorbidity are examples of known factors that increase the risk of adverse drug reactions in patients. The use of high-risk medication also entails a heightened risk of harm. There is currently no information available on the home care patients' experiences and medication burden experienced due to their high-risk medication use and how they manage their medication. Further investigation with regard to this combination is necessary. The patient's experiences and medication burden related to high-risk medication use can be taken into account when drawing up guidelines and standards of care for healthcare professionals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To describe home care patients' experiences and medication burden related to high-risk medication use, more specifically how patients manage their high-risk medication use, which professional support they receive and which potential adverse drug reactions they experience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cross-sectional study of home care patients in Belgium, aged 65 years and older who took at least one high-risk medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our population of 106 home care patients, a median use of 8 medications per patient is reported, of which 2 can be considered high-risk medication. Metformin, insulin and lormetazepam are the most frequently used high-risk medications. Home care patients believe their medication is important to them, are able to manage the intake and seem to have a high level of therapy adherence. Most patients do not believe their medication intake implies a certain risk. Most patients are supported by a home care nurse for the preparation of their medication. A mean number of 5 symptoms/potential adverse drug reactions is reported out of the 21 potential adverse drug reactions questioned. The potential adverse drug reaction most frequently attributed to medication use was bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Practice guidelines with detailed medicine-specific protocols are needed to enhance (high-risk) medication-related care in an overall high-risk medication policy. Understanding the patient's risk experiences and communicating with the patient is important to ensure safe medication care but also to identify patients at risk for nonadherence and adverse reactions. The patient's experiences with their medication intake provide rich information for healthcare providers and should therefore be included in patient observations. Home care n","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care.
Objective
This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care.
Method
Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method.
Results
Four key life story phases were identified: before transition, crisis event, transition and after transition. These phases varied in time duration and involvement of healthcare providers. The longest phase was ‘before transition’ where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period ‘crisis event’ where the older person was admitted to tertiary care. Two permeating themes: family dynamics and knowledge/understanding underpinned all life story phases.
Conclusions
Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process.
Implications for Practice
Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.
{"title":"A Narrative Exploration of Family Members' Perspectives of Life Story Phases Following Transition of an Older Family Relative Into Long-Term Care","authors":"Melissa Corbally, Orla Ffrench, Daragh Rodger, Rachele Ricci, Amanda Phelan","doi":"10.1111/opn.70001","DOIUrl":"10.1111/opn.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four key life story phases were identified: <i>before transition, crisis event, transition and after transition</i>. These phases varied in time duration and involvement of healthcare providers. The longest phase was ‘before transition’ where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period ‘crisis event’ where the older person was admitted to tertiary care. Two permeating themes: <i>family dynamics</i> and <i>knowledge/understanding</i> underpinned all life story phases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for Practice</h3>\u0000 \u0000 <p>Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Care homes can create a culture of community where residents, their families and staff are supported to develop positive relationships with one another, to interact and explore ideas together in an informal way. This concept is reported in the literature as a Westernised construct and so far, little is known about its meanings from a Middle Eastern cultural perspective and context.
Aim
The aim of this study is to contribute to the understanding of how partnership between the three stakeholders may contribute to changing the organisation and focus of care homes, supporting a transition to the development of a community culture.
Method
A constructivist case study method is employed following Stake's collective case study model. Two care homes were chosen purposively to capture the experience of residents, families and staff working in different types of care homes. Data collection methods include interviews, focus groups and field observations with triangulation of methods and data. Data collection and data analysis occurred simultaneously.
Results
Analysis of data resulted in the emergence of four themes: organisational flexibility, a vision of care incorporating fundamental elements such as caring and dignity, connectedness/reciprocity, enhancing job satisfaction and morale of staff. These findings indicate that residents, staff and families are interdependent, and this needs to be considered when fostering a culture of community in care homes as an important value. Findings prove that organisational flexibility and individualised care should be set as priorities over care only directed towards disease and illness.
Implications
The findings will have implications for developing policy and practice in care homes to improve experience of older residents thus enhancing quality of life in care homes in Lebanon.
{"title":"Promoting a Culture of Community in Lebanese Care Homes Through Forging Partnerships: A Constructivist Case Study Approach","authors":"Marina Gharibian Adra, Nour Abdallah","doi":"10.1111/opn.70000","DOIUrl":"10.1111/opn.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Care homes can create a culture of community where residents, their families and staff are supported to develop positive relationships with one another, to interact and explore ideas together in an informal way. This concept is reported in the literature as a Westernised construct and so far, little is known about its meanings from a Middle Eastern cultural perspective and context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study is to contribute to the understanding of how partnership between the three stakeholders may contribute to changing the organisation and focus of care homes, supporting a transition to the development of a community culture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A constructivist case study method is employed following Stake's collective case study model. Two care homes were chosen purposively to capture the experience of residents, families and staff working in different types of care homes. Data collection methods include interviews, focus groups and field observations with triangulation of methods and data. Data collection and data analysis occurred simultaneously.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of data resulted in the emergence of four themes: organisational flexibility, a vision of care incorporating fundamental elements such as caring and dignity, connectedness/reciprocity, enhancing job satisfaction and morale of staff. These findings indicate that residents, staff and families are interdependent, and this needs to be considered when fostering a culture of community in care homes as an important value. Findings prove that organisational flexibility and individualised care should be set as priorities over care only directed towards disease and illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications</h3>\u0000 \u0000 <p>The findings will have implications for developing policy and practice in care homes to improve experience of older residents thus enhancing quality of life in care homes in Lebanon.</p>\u0000 </section>\u0000 </div>","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"19 6","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anh Huynh Phuong Nguyen, Huy V. Nguyen, Thanh Xuan Nguyen, Huong Thi Thu Nguyen, Tam Ngoc Nguyen, Thu Thi Hoai Nguyen, Robert J. Goldberg, Yiyang Yuan, Jerry H. Gurwitz, Hoa L. Nguyen, Huyen Thi Thanh Vu
<div> <section> <h3> Background</h3> <p>Nurses' competencies are crucial in providing effective dementia care in healthcare settings for older people. Understanding nurses' current knowledge, attitudes and confidence in this area is essential for developing education programmes for healthcare professionals to improve patient care. The purpose of this study was to assess the knowledge, attitudes and confidence related to providing dementia care among nurses practicing in geriatric hospital wards and nursing homes in Hanoi, Vietnam.</p> </section> <section> <h3> Methods</h3> <p>A total of 269 out of 313 (response rate was 86%) full-time nurses working at six geriatric wards in hospitals and nursing homes in Hanoi were surveyed using three self-administered questionnaires: the Dementia Knowledge Assessment Scale (DKAS), Dementia Attitude Scale (DAS) and the Confidence in Dementia Scale (CODE). Multiple regression models were constructed to identify factors associated with dementia care knowledge, attitudes and confidence.</p> </section> <section> <h3> Results</h3> <p>The overall mean scores of nurse's knowledge, attitudes and confidence were 28.1 ± 8.0, 102.1 ± 13.4 and 28.3 ± 6.4, respectively. A positive correlation was reported between the knowledge and attitude scores and between the attitudes and confidence scores. Greater seniority (β: 0.29; 95% CI: 0.03–0.56) and having learned information through colleagues or experts (β: 3.02; 95% CI: 0.88–5.16) were associated with better dementia knowledge. A higher level of dementia training desirability was associated with increased knowledge (β: 0.74; 95% CI: 0.28–1.20) and favourable attitudes (β: 0.94; 95% CI: 0.15–1.74), whereas frequent exposure to dementia cases was associated with higher confidence (β: 3.56; 95% CI: 1.39–5.73) and more favourable attitudes (β: 3.96; 95% CI: 0.27–7.66).</p> </section> <section> <h3> Conclusion</h3> <p>Our study highlights deficits in knowledge, low levels of social comfort in nurses' attitudes towards people with dementia and a lack of confidence in providing effective care among nurses practicing in healthcare settings for older adults in Hanoi, Vietnam. With the ageing of the population and with increasing numbers of persons living with dementia, our findings suggest the importance of improving the training of nurses to specifically address these deficits.</p> </section> <section> <h3> Implications for Practice</h3> <p>Multidisciplinary consultation meetings need to be encouraged in the healthcare workplace setting as well as ensuring the presence of qualified counse
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Connie Schumacher, Grace Pyatt, Fabrice Mowbray, Aaron Jones, Dawn Prentice, Andrew Costa
Background
Digital health tools can significantly contribute to the continuum of care and support for persons with their self-management role. Despite the increasing adoption of digital health tools, little is known about the uptake and comfort of use among older persons.
Methods
A mixed methods design was used to assess the feasibility and utility of the check-up (CU), a self-administered digital health assessment for older persons. For the older person, qualitative interviews and de-identified CU assessment data were collected. A focus group was held to gain the health provider perspective.
Results
A total of 32 online CU assessments were completed, and 17 individuals participated in interviews. Three main themes were identified: digital literacy and accessibility, communication of risk and role within the circle of care.
Conclusion
Self-administered digital assessments are feasible for older adults. Strategies for adoption should focus on accessibility and collaboration with health professionals to maximise utility and understanding of assessment results.
背景：数字健康工具可以极大地促进持续护理，并支持老年人发挥自我管理的作用。尽管数字健康工具的采用率越来越高，但人们对老年人的接受程度和使用舒适度却知之甚少：方法：采用混合方法设计，评估老年人自我管理数字健康评估工具 "体检"（CU）的可行性和实用性。针对老年人，收集了定性访谈和去标识化的 CU 评估数据。此外，还举行了一次焦点小组会议，以了解医疗服务提供者的观点：共完成了 32 项在线 CU 评估，17 人参加了访谈。确定了三大主题：数字扫盲和可及性、风险沟通和在护理圈中的角色：结论：自我管理的数字评估对老年人来说是可行的。采用策略应侧重于可访问性和与医疗专业人员的合作，以最大限度地提高实用性和对评估结果的理解。
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