To explore the learning experiences of post-anaesthesia care unit nurses after their participation in a delirium care for older people education intervention.
Post-operative delirium is a common, yet major complication for people 65 years or older who have undergone surgery. Yet, post-operative delirium in older people continues to go undetected, has delayed detection or is entirely misdiagnosed. Inadequate delirium recognition and management is in part due to the lack of knowledge, competence and confidence of post-anaesthesia care unit nurses caring for older people. Multimodal education opportunities significantly contribute to nurses' improved knowledge, skills, confidence and competence in delirium care, as well as improvements in patient clinical outcomes. However, knowledge of which aspects of the learning experience that make the most impact to post-anaesthesia care unit nurses' clinical practice is limited.
Qualitative descriptive design.
Post-anaesthesia care unit nurses participated in a four-module multimodal delirium education intervention, which was co-designed by expert clinicians and tailored to the contextual needs of post-operative care. Nurses who participated in the educational intervention were invited to submit their completed learner workbooks. Qualitative data (n = 66 learner workbooks) were collected via 12 open-ended learner workbook questions.
Content analysis of 655 open-ended participant responses generated three categories and seven sub-categories: gains in knowledge (Category 1), emotional responses to learning (Category 2) and clinical practice changes (Category 3).
Multimodal education interventions are beneficial for post-anaesthesia care unit nurses caring for older people with delirium. Learning outcomes include changes in knowledge, attitudes and clinical practices. The use of simulation-based education is particularly impactful on positive learning experiences of post-anaesthesia care unit nurses.
Nurse educators are encouraged to utilise simulation-based education to enhance nurses' knowledge, competence and confidence of
Worldwide, healthcare systems continue to evolve approaches to acute care delivery for older people. The Swiss healthcare system, for example, utilises Diagnosis-Related Groups (Swiss DRG) to structure hospital stays. This system creates opportunities to enhance post-acute care services that support functional recovery and independence. The ‘Home, Instead of Nursing Home’ project collaboratively developed an integrated programme that combines staff education with structured care delivery processes to enhance person-centred, rehabilitative care for older people in acute transitional care, emphasising autonomy and quality of life.
The development process consisted of four steps: inter-professional workshops with healthcare professionals, interviews with residents of nursing homes providing acute transitional care and their relatives, data synthesis and programme development. Participants (N = 38) were individuals from three nursing homes, including healthcare professionals, residents and relatives. We conducted a thematic analysis to identify essential workshop and interview themes.
The analysis identified four main themes: promoting a person-centred, resource-oriented culture; implementing person-centred, resource-oriented care; fostering movement competence and developing a champion role. The derived programme for person-centred and resource-oriented care (PCC&ROC) consists of four pillars: PCC&ROC care culture, PCC&ROC care planning, movement promotion and coaching and consulting. We adapted the programme to the individual circumstances of the three nursing homes.
The programme integrates international best practices with a salutogenic perspective and the inclusion of residents and their relatives. It addresses the critical need for person-centred and resource-oriented care in the context of nursing home short-term care for older individuals, promoting autonomy and improving their quality of life. This research emphasises the importance of involving relevant stakeholders in evidence-based programme development to develop a programme tailored to the needs and challenges of the intended population.
Global ageing is increasing. Most older people live independently but at times require nursing care as they age. This care is provided in a variety of settings including acute, primary, community and residential care services. In such instances, it is important that older people feel comfortable and listened to, and it is imperative that student nurses are educated to competently care for and nurse older people in collaborative partnerships. Intergenerational initiatives promote shared learning and help break down barriers among different age cohorts. An online intergenerational café was developed to provide a learning opportunity for older people and student nurses to meet as equals and connect socially in a protected place and time. This paper reports on older people's views of their participation in an online intergenerational café.
Ethical approval was granted for this survey design research. Older people living in the community (n = 49) participated in online intergenerational cafés with student nurses. Following the online café, participants were invited to voluntarily participate in the study through completion of an anonymous online survey. Consent was indicated through the return of the survey questionnaire. All agreed to complete the survey. Likert scale quantitative data was analysed using descriptive statistical analysis (SPSS, version 21). Responses to the open-ended questions were thematically analysed.
The cafés supported intergenerational learning, and participants felt comfortable participating. Participants discovered some but not all key points of interest about students. In many ways, they were quite similar to students. Participants felt students would be respectful, empathetic and advocate for them in a care situation. Many agreed that the cafés were well organised, but some would have liked more clarity on the discussion topics.
This café initiative has merit as it helped reduce barriers and facilitated intergenerational learning.
Participation in Intergenerational cafés can help reduce barriers by faciliating understanding and mutual respect . They can provide a forum for discussion on nursing care expectations.
People with dementia admitted to hospital are at risk of developing delirium. Patients with delirium superimposed on dementia (DSD) have higher mortality rates, longer hospital stays and further cognitive loss. The role of family is often recommended as a resource to inform and support how patients with dementia's needs are understood. This review focuses on ward-based interventions that enable family carers and health care professionals to work together to improve patient experience and outcomes.
To review evidence on ward-based approaches involving family (or their proxies) and staff working together to prevent and manage delirium for patients living with dementia.
We undertook a scoping review including all types of research. Six electronic databases were searched (CINAHL, MEDLINE (run twice), EMBASE, Cochrane, PsycINFO and PubMed). The search was limited to papers written in English and published from 2009 to 2019. The search was updated in 2023. Papers were independently read by two researchers. Findings were presented through narrative synthesis (Prospero CRD42019130369).
Fifteen papers were included. Studies focused on educational and system change to improve the care of people with DSD. Family involvement ranged from enabling baseline assessment of delirium, commenting on different resources and measures designed to support their involvement in care or simulate their presence. The evidence of effectiveness was varied. Interventions to support personalised care and give family carers and staff confidence were positively evaluated in some studies but not all included both family carers and staff. Benefits to patients over time were less clearly demonstrated.
This review identified the potential of family to mitigate the risk of delirium and improve patient outcomes. Further research is needed to understand how system and practitioner changes to enable family involvement in the support of people with DSD benefit patients in the short and long term.
The review findings provide evidence for clinical practice when selecting existing interventions and approache
To ensure older people living in care homes receive optimal care, care home workers (CHWs) require access to specialist support and education. Extension for Community Healthcare Outcomes (ECHO) uses existing videoconferencing to connect CHWs to specialists using case-based learning. There is evidence in other settings to suggest that ECHO can improve practitioner knowledge and patient outcomes. There is a dearth of evidence regarding strategies for effective implementation of ECHO with CHWs.
To establish the experiences of ECHO, and the barriers and enablers to implementation, from the perspective of CHWs in Scotland.
Qualitative online focus groups (n = 4) with CHWs (n = 13) who had participated in at least one care home ECHO session and with facilitators/presenters (n = 6). Transcripts were thematically analysed.
Findings were grouped into three areas: perceived impact, inhibitors and enablers. CHWs reported the positive impact of ECHO including key benefits to enhance residents' care, satisfaction with the sessions and feeling valued. Inhibitors included limited digital skills, workforce challenges and the pitch and duration of ECHO sessions. Enablers included administrative and technical support, scheduling and the structure of the ECHO approach.
ECHO allows CHWs to access specialist support, enabling learning and development, with the potential to improve residents' care. Benefits to residents' care included CHWs' enhanced understanding of choices around death and dying, and insights and understanding of causation of challenging behaviours in older people and how to manage these. Adaptations to ECHO to suit a care home context are recommended.
CHWs require technical support to build competence and confidence in IT skills. This study highlights the potential for ECHO to support CHWs to access specialist support and learning for older adults in a care home context.
Much of the literature examining the experiences of advance care planning (ACP) in long-term care (LTC) has been from the perspectives of residents and their families. Largely absent from the literature are the perspectives of LTC nurses, who are key members of the healthcare team most involved with LTC residents/families and well positioned to facilitate the ACP process. The purpose of this study was to develop an inductively derived empirical model to address this gap in empirical knowledge.
A constructivist grounded theory (CGT) methodology was used in this study of 25 nurses working in 18 different LTC facilities in central Canada. Data were collected using a demographic questionnaire; in-depth, semi-structured, audio-recorded and face-to-face/telephone interviews; field notes; and memos. Descriptive statistics and specific CGT coding procedures were used to analyse the data.
The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL). The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page. This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture.
Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place.
Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.
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