Structural validation of two person-centred practice inventories PCPI-S and PCPI-C - French version.

BACKGROUND: The shift towards person-centred care has become integral in achieving high-quality healthcare, focusing on individual patient needs, preferences, and values. However, existing instruments for measuring person-centred practice often lack theoretical underpinnings and comprehensive assessment. The Person-centred Practice Inventory - Staff (PCPI-S) and the Person-centred Practice Inventory - Care (PCPI-C) were developed in English to measure clinicians' and patients' experience of person-centred practice. The aim of this study was to investigate the psychometric properties of the French version of the PCPI-S and PCPI-C. METHODS: A multi-centred cross-sectional study was conducted in six hospitals in French-speaking Switzerland. Construct validity of the PCPI-S and the PCPI-C was evaluated by using confirmatory factor analysis and McDonald's Omega coefficient was used to determine the internal consistency. RESULTS: A sample of 558 healthcare professionals and 510 patients participated in the surveys. Psychometric analyses revealed positive item scores and acceptable factor loadings, demonstrating the meaningful contribution of each item to the measurement model. The Omega coefficient indicated acceptable to excellent internal consistency for the constructs. Model fit statistics demonstrated good model fit for the PCPI-S and PCPI-C. CONCLUSIONS: The findings support the construct validity and internal consistency of the PCPI-S and PCPI-C in assessing person-centred practice among healthcare professionals and patients in French-speaking Switzerland. This validation offers valuable tools for evaluating person-centred care in hospital settings.

Older patients referred for geriatric consultation in the emergency department: characteristics and healthcare utilization.

BACKGROUND: Comprehensive geriatric assessment (CGA) is difficult to perform in the emergency department (ED) environment and performance of screening tools in identifying vulnerable older ED patients who are best candidates for a geriatric consultation remain questionable. AIM: To determine the characteristics of older patients referred for a geriatric consultation by ED staff and to investigate these patients' subsequent healthcare utilization. METHODS: Secondary analysis of data previously collected for a prospective observational study of patients aged 75 + years visiting the ED of an academic hospital in Switzerland over four months (Michalski-Monnerat et al., J Am Geriatr Soc 68(12):2914-20, 2020). Socio-demographic, health, functional (basic activities of daily living; BADL), cognitive, and affective status data were collected at admission by a research nurse using a standardized brief geriatric assessment. Information on geriatric consultations, hospitalization, discharge destination, and 30-day readmission were retrieved from hospital database. Bivariable and multivariable analyses were performed using this data set collected previously. RESULTS: Thirty-two (15.8%) of the 202 enrolled patients were referred for a geriatric consultation. Compared to the others, they were older (84.9 ± 5.4 vs 82.9 ± 5.4 years, p = .03), more impaired in BADL (4.8 ± 1.6 vs 5.5 ± 1.0, p = .01), with more comorbid conditions (5.3 ± 1.5 vs 4.5 ± 1.9, p = .03), more frequently admitted after a fall (43.7% vs 19.4%, p = .01), and hospitalized over the previous 6-month period (53.1% vs 30.6%, p = .02). Multivariable analyses that adjusted for variables significantly associated with outcomes in bivariable analysis found that being admitted after a fall (AdjOR 4.0, 95%CI 1.7-9.4, p < .01) and previously hospitalized (AdjOR 2.7, 95% CI 1.2-6.2, p = .02) remained associated with increased odds of consultation, whereas the inverse association with BADL performance remained (AdjOR 0.7, 95%CI 0.5-0.9, p = .01). Patients referred for geriatric consultation had higher odds of hospitalization (84.4% vs 49.4%; AdjOR 5.9, 95%CI 2.1-16.8, p < .01), but similar odds of home discharge when admitted, and of 30-day readmission. CONCLUSION: About one in six older ED patients were referred for a geriatric consultation who appeared to be those most vulnerable, as suggested by their increased hospitalization rate. Alternative strategies are needed to enhance access to geriatric consultation in the ED.

Feedback on clinical team performance: how does it work, in what contexts, for whom, and for what changes? A critical realist qualitative multiple case study.

BACKGROUND: Feedback on clinical performance aims to provide teams in health care settings with structured results about their performance in order to improve these results. Two systematic reviews that included 147 randomized studies showed unresolved variability in professional compliance with desired clinical practices. Conventional recommendations for improving feedback on clinical team performance generally appear decontextualized and, in this regard, idealized. Feedback involves a complex and varied arrangement of human and non-human entities and interrelationships. To explore this complexity and improve feedback, we sought to explain how feedback on clinical team performance works, for whom, in what contexts, and for what changes. Our goal in this research was to present a realistic and contextualized explanation of feedback and its outcomes for clinical teams in health care settings. METHODS: This critical realist qualitative multiple case study included three heterogeneous cases and 98 professionals from a university-affiliated tertiary care hospital. Five data collection methods were used: participant observation, document retrieval, focus groups, semi-structured interviews, and questionnaires. Intra- and inter-case analysis performed during data collection involved thematic analysis, analytical questioning, and systemic modeling. These approaches were supported by critical reflexive dialogue among the research team, collaborators, and an expert panel. RESULTS: Despite the use of a single implementation model throughout the institution, results differed on contextual decision-making structures, responses to controversy, feedback loop practices, and use of varied technical or hybrid intermediaries. Structures and actions maintain or transform interrelationships and generate changes that are in line with expectations or the emergence of original solutions. Changes are related to the implementation of institutional and local projects or indicator results. However, they do not necessarily reflect a change in clinical practice or patient outcomes. CONCLUSIONS: This critical realist qualitative multiple case study offers an in-depth explanation of feedback on clinical team performance as a complex and open-ended sociotechnical system in constant transformation. In doing so, it identifies reflexive questions that are levers for the improvement of team feedback.

Evaluation of a theory-informed implementation of a nursing discharge teaching intervention for older adults.

AIMS: To evaluate the implementation process of a multi-site trial of a novel discharge teaching intervention. DESIGN: Hybrid type 3 trial. METHODS: A discharge teaching intervention for older adults was implemented in medical units from August 2020 to August 2021 with 30 nurse participants. The implementation process was guided by behaviour change frameworks. Outcome data comprised determinants of nurses' behaviours related to teaching and the acceptability, appropriateness, feasibility of the intervention and frequency of teaching activities received by the participants. This study adheres to StaRI and TIDieR reporting guidelines. RESULTS: Twelve of 18 determinants of nurses' behaviour domains improved post-implementation. Being trained reinforced nurses' knowledge and skills in patient teaching. Practicing the intervention increased their awareness on the gaps between evidence-based teaching principles and their actual practice. The intervention was considered acceptable and moderately appropriate and feasible. CONCLUSION: A theoretically informed implementation process can influence nurses' perceptions and behaviours related to discharge teaching by targeting specific behaviour domains. Practice change to improve discharge teaching will require organizational support from nursing management. NO PATIENT OR PUBLIC CONTRIBUTION: Although the conceptual foundations of the intervention tested in this study were informed by the priorities and experience of patients, this population was not directly involved in the design and conduct of the study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04253665.

Development of a Predictive Model for Hospital-Acquired Pressure Injuries.

Hospital-acquired pressure injuries are a challenge for healthcare systems, and the nurse's role is essential in their prevention. The first step is risk assessment. The development of advanced data-driven methods based on machine learning techniques can improve risk assessment through the use of routinely collected data. We studied 24 227 records from 15 937 distinct patients admitted to medical and surgical units between April 1, 2019, and March 31, 2020. Two predictive models were developed: random forest and long short-term memory neural network. Model performance was then evaluated and compared with the Braden score. The areas under the receiver operating characteristic curve, the specificity, and the accuracy of the long short-term memory neural network model (0.87, 0.82, and 0.82, respectively) were higher than those of the random forest model (0.80, 0.72, and 0.72, respectively) and the Braden score (0.72, 0.61, and 0.61, respectively). The sensitivity of the Braden score (0.88) was higher than that of long short-term memory neural network model (0.74) and the random forest model (0.73). The long short-term memory neural network model has the potential to support nurses in clinical decision-making. Implementation of this model in the electronic health record could improve assessment and allow nurses to focus on higher-priority interventions.

[Transitional care from hospital to home: how to target the right population?] / Soins de transition entre l'hôpital et le domicile: pour quels patient-es ?

When patients are discharged from the hospital and return home, they are at risk of adverse events if the continuity of care is broken. So far, the evidence for transitional care models to reduce readmission rates has focused mainly on patients with a single condition. Based on this observation, we identified the population that may benefit the most from the development of a new transitional care model, as part of the INSTEAD project, by consensus between patients and professionals in hospitals and the community. To ensure continuity of care, it is necessary to consider the patients' perception, their understanding of the care plan and changes impacting the home care plan. Interprofessional collaboration is essential to achieve this.

Lorsqu'un-e patient-e retourne à domicile suite à une hospitalisation il-elle est souvent confronté-e à des événements indésirables si la continuité de ses soins n'est pas assurée. Jusqu'à ce jour, les modèles de soins de transition qui ont montré une diminution du taux de réadmission concernaient des patient-es ne souffrant que d'une seule pathologie. Partant de ce constat, nous avons identifié la population qui pourrait le plus bénéficier de soins de transition, dans le cadre du projet INSTEAD, par un consensus incluant d'une part des patient-es et, d'autre part, des professionnel-les hospitaliers et communautaires. Pour assurer la continuité des soins, il s'avère nécessaire de prendre en compte la perception de la personne, sa compréhension ainsi que les changements influençant son plan de soins à domicile. Pour ce faire, une collaboration interprofessionnelle est indispensable.

[Patient-oriented discharge summary : a tool for patients to prepare their hospital discharge]. / Le résumé de sortie de l'hôpital : un outil en main des patients.

More than providing information, teaching older patients during hospitalization is essential to ensure that they acquire the necessary knowledge and maintain the skills to self-manage their health. But did you know that more than half of patients forget the information discussed with professionals after hospital discharge ? Preparing hospital discharge is a difficult time to provide teaching: older patients are often overwhelmed with a lot of information and stressed about going home. This article presents an interprofessional tool to interact with patients in a concrete way and to engage them in their discharge preparation.

Plus que la transmission d'informations, l'enseignement aux patients âgés pendant l'hospitalisation est essentiel pour qu'ils acquièrent les connaissances et maintiennent les compétences nécessaires à l'autogestion de leur état de santé. Mais saviez-vous que plus de la moitié des patients oublient les informations discutées avec les professionnels après être sortis de l'hôpital ? La préparation au retour à domicile est un moment difficile pour dispenser de l'enseignement : les patients âgés sont souvent submergés par une quantité d'informations et stressés à l'idée de rentrer chez eux. Cet article présente un outil interprofessionnel permettant d'interagir de manière concrète avec les patients et de les engager dans leur préparation à la sortie.

Nursing discharge teaching for hospitalized older people: A rapid realist review.

AIM: To develop, refine and put forward a programme theory that describes configurations between context, hidden mechanisms and outcomes of nursing discharge teaching. DESIGN: Rapid realist review guided by Pawson's recommendations and using the Realist and Meta-narrative Evidence Syntheses: Evolving Standards. DATA SOURCES: We performed searches in MEDLINE, Embase, CINAHL Full text, Google Scholarand supplementary searches in Google. We included all study designs and grey literature published between 1998-2019. REVIEW METHODS: We followed Pawson's recommended steps: initial programme theory development; literature search; document selection and appraisal; data extraction; analysis and synthesis process; presentation and dissemination of the revised programme theory. RESULTS: We included nine studies and a book to contribute to the synthesis. We developed 10 context-mechanisms-outcome configurations which cumulatively refined the initial programme theory. These configurations between context, mechanisms and outcome are classified in four categories as follows: relevancy of teaching content; patients' readiness to engage in the teaching-learning process; nurses' teaching skills and healthcare team approach to discharge teaching delivery. We also found that some of the same contexts generated similar outcomes, but through different mechanisms, highlighting interdependencies between context-mechanisms-outcome configurations. CONCLUSION: This rapid realist review resulted in an explanatory synthesis of how discharge teaching works to improve patient-centred outcomes. The proposed programme theory has direct implications for clinical practice by giving meaning to the 'hidden' mechanisms used by nurses when they prepare patients to be discharged home and can inform curricula for nursing education. IMPACT: The essential components, process mechanisms, contexts and impacts of the nursing discharge teaching are not consistently or clearly described, explained or evaluated for effectiveness. This review uncovers underlying contexts and mechanisms in the teaching/learning process between patients and nurses. The resulting programme theory can guide nurse clinicians and managers towards improvements in conducting discharge teaching.

[Medication literacy in older patients : skills needed for self-management of medications]. / Littératie en matière de médicaments des patients âgés : compétences nécessaires à l'autogestion des medicaments.

For a patient, the daily preparation and self-administration of medication require a wide range of cognitive and social skills : these skills fall under the concept of medication literacy. Individuals with insufficient skills have difficulties to understand instructions from professionals, to communicate their concerns and are at greater risk of inappropriate use of their medications. In this new area of research, standardised instruments have been developed but their conceptual basis lacks consensus and none have been designed for older patients and their specificities. This article proposes some benchmarks so that physicians, pharmacists and nurses can better understand this concept and identify patients with difficulties.

Pour un patient, la préparation quotidienne et l'autoadministration de médicaments nécessitent un large éventail de compétences cognitives et sociales : elles se réunissent sous le concept de littératie en matière de médicaments. Les personnes ayant des compétences insuffisantes ont des difficultés à comprendre les instructions que les professionnels leur donnent, à communiquer leurs inquiétudes et sont plus à risque d'une utilisation inadéquate de leurs médicaments. Dans ce nouveau domaine de recherche, des instruments standardisés ont été développés, mais leur base conceptuelle manque de consensus et aucun n'a été conçu pour les patients âgés et leurs spécificités. Cet article propose des repères pour que les médecins, pharmaciens et infirmiers puissent mieux comprendre ce concept, et identifier les patients ayant des difficultés.

Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home.

AIM: To determine the effectiveness of nursing discharge planning interventions on health-related outcomes for older inpatients discharged home. BACKGROUND: Inadequate discharge planning for the ageing population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing interventions for older people. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be evaluated in practice. DESIGN: Systematic review and meta-analysis. DATA SOURCES: A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000-2015. REVIEW METHODS: Critical appraisal, data extraction and meta-analysis followed the methodology of the Joanna Briggs Institute. RESULTS: Thirteen studies were included in the review, 2 of 13 were pilot studies and one had a pre-post design. Included studies involved 3,964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission or quality of life, except readmission was lower across studies conducted in the USA. The overall effect score for nurse discharge planning on length of stay was statistically significant and positive. CONCLUSION: Nursing discharge planning is a complex intervention and difficult to evaluate. Findings suggest that nursing discharge planning for older inpatients discharged home increases the length of stay yet neither reduces readmission rate nor improves quality of life.

[Development of a care performance management system in a Swiss university hospital.] / Développement d'un système de gestion de la performance des soins dans un centre hospitalier universitaire suisse.

Studies show high variability in the quality of care and a significant incidence of adverse events. The care management direction of a university hospital center (CHU) has developed a care performance measuring system. The aim of the article is to present the different development stages of this system. The authors used May's Normalization Process Theory, which focuses on factors influencing the engagement of individuals, groups, and organizations in sustaining change.The CHU's approach led to the following results : 1) reaching a consensus on performance concept and identifying five areas of performance, 2) selection of 12 priority indicators to assess performance, 3) measures development, 4) setting up the method of collecting information 5) creation of a mechanism for analyzing the results by care teams and 6) dissemination of results via dashboards.The approach focuses on strategies for mobilizing managers and health care teams. Specific recommendations relate to the need to provide expert resources, review clinical guidance and ensure accountability of health care providers.

Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample.

AIM: To develop and psychometrically test Readiness for Hospital Discharge Scale for older people and to reduce the scale to a more practical short form. BACKGROUND: The Readiness for Hospital Discharge Scale is the only available and validated scale measuring patients' perceived readiness just prior to discharge. DESIGN: Secondary analysis of hospital studies data from three countries. METHOD: Data were collected between 2008-2012. The study sample comprised 998 medical-surgical older patients. Factor analysis was undertaken to identify the factor structure of the Readiness for Hospital Discharge Scale. Group comparisons for construct validity and predictive validity for readmission were also conducted. RESULTS: The Readiness for Hospital Discharge Scale original four factor solution does not appear to be consistent with the observed data of older people in the three countries. Confirmatory factor analysis revealed that a 17-item scale with three factors produced the best model fit. Nine items, three from each factor, loaded consistently on their respective factors in each country sample. Confirmatory factor analysis of this short form model indicated that the model adequately fit the data. Patients who lived alone, were older, or who indicated 'not ready' for discharge had lower Readiness for Hospital Discharge Scale for Older People scores, which were also associated with readmission risk. CONCLUSION: The revised three factor structure of the Readiness for Hospital Discharge Scale for Older People in long and short forms more adequately assesses core components of discharge readiness in the older adult population than the original adult form.

Translation and psychometric evaluation of a French version of the Readiness for Hospital Discharge Scale.

AIMS AND OBJECTIVES: To evaluate the reliability and the factor structure of the Readiness for Hospital Discharge Scale-French version. BACKGROUND: The patient's perspective is essential when assessing risk for adverse events at hospital discharge. Developed in the USA, the Readiness for Hospital Discharge Scale is the only instrument that measures an individual's self-perception of readiness before leaving the hospital. A French version of the Readiness for Hospital Discharge Scale was developed and validated. DESIGN: Cross-sectional study. METHODS: A convenience sample of 265 older inpatients from four medical units was selected. The translation and cultural adaptation of the scale involved experts in gerontology and the French language and included back translation. The items were semantically evaluated and pretested in 10 older inpatients. The scale's psychometric properties were internally validated by using confirmatory and exploratory factor analyses. Reliability was assessed by examining the internal consistency of its items. RESULTS: Goodness-of-fit indices of the confirmatory factor analyses were not adequate, but reliability was acceptable (Cronbach's α = 0·80). Exploratory factor analysis of the French version provided results close to those described for the English version, with three similar subscales (physical and emotional readiness, coping with medical treatment and personal care), whereas the initially described Expected Support subscale was not identified in the French version. CONCLUSION: The Readiness for Hospital Discharge Scale-French version appears to be partially consistent with its original English version, but requires additional adaptation to fully take into account the Swiss context and culture to achieve its original aim. RELEVANCE TO CLINICAL PRACTICE: Assessing patient readiness for hospital discharge before leaving hospital could help nurses to improve the discharge planning process and achieve better patient preparedness and care coordination.

Nursing discharge planning for older medical inpatients in Switzerland: A cross-sectional study.

Nursing discharge planning for elderly medical inpatients is an essential element of care to ensure optimal transition to home and to reduce post-discharge adverse events. The objectives of this cross-sectional study were to investigate the association between nursing discharge planning components in older medical inpatients, patients' readiness for hospital discharge and unplanned health care utilization during the following 30 days. Results indicated that no patients benefited from comprehensive discharge planning but most benefited from less than half of the discharge planning components. The most frequent intervention recorded was coordination, and the least common was patients' participation in decisions regarding discharge. Patients who received more nursing discharge components felt significantly less ready to go home and had significantly more readmissions during the 30-day follow-up period. This study highlights large gaps in the nursing discharge planning process in older medical inpatients and identifies specific areas where improvements are most needed.

Psychometric evaluation of the French version of the questionnaire attitudes towards morphine use; a cross-sectional study in Valais, Switzerland.

BACKGROUND: In Switzerland, nurses are allowed to prescribe and administer morphine in emergency situations without a doctor. Still, nurses and other health professionals are often reluctant to prescribe and administer morphine for pain management in patients. No valid French-speaking instrument is available in Switzerland to assess the attitudes of nurses and other health professionals towards the prescription and administration of morphine. In this study, we evaluated the psychometric properties of the French version of the questionnaire "Attitudes towards morphine use". METHODS: The instrument was derived from an Italian version. Forward and back translations of the questionnaire were performed. Item analysis and construct validity were assessed between April and December 2010 in a cross sectional study including five Swiss hospitals in a sample of 588 health professionals (533 nurses, mean age 38.3 ± 10.2 years). Thirty subjects participated in test-retest reliability. RESULTS: The time to complete the instrument ranged between 12 and 15 minutes and neither floor nor ceiling effect were found. The initial 24-item instrument showed an intraclass correlation (ICC) of 0.69 (95% CI: 0.64 to 0.73, P < 0.001), and a Cronbach's α of 0.700. Factor analysis led to a six-component solution explaining 52.4% of the total variance. After excluding five items, the shortened version showed an ICC of 0.74 (95% CI, 0.70 to 0.77, P < 0.001) and a Cronbach's α of 0.741. Factor analysis led to a five-component solution explaining 54.3% of the total variance. The five components were named "risk of addiction/dependence"; "operational reasons for not using morphine"; "risk of escalation"; "other (non-dependence) risks" and "external (non-operational) reasons". In test-retest, the shortened instrument showed an ICC of 0.797 (95% CI, 0.630 to 0.911, P < 0.001) and a Cronbach's α of 0.797. CONCLUSIONS: The 19-item shortened instrument assessing attitudes towards the prescription and administration of morphine showed adequate content and construct validity.

A qualitative exploration of changes and mechanisms of changes in a psychoeducational intervention for family dementia caregivers.

BACKGROUND: 'Learning to feel better… and help better' is a psychoeducational intervention that aims to empower family caregivers of people with dementia by helping them cope better with the daily stress of dementia caregiving. The intervention has been adapted to a Swiss context and evaluated with a mixed-method design, yielding promising results in caregivers, such as a reduced subjective burden and improved self-efficacy. Qualitative findings have provided insight into potentially relevant intermediate changes that must be further explored to better understand how the intervention precipitates the achieved changes. We aim to qualitatively explore such changes, related mechanisms and key intervention components in the context of this intervention. METHODS: A constructivist grounded theory approach was used to achieve this aim. Changes, related mechanisms and key intervention components were identified by exploring the following: 1) longitudinal qualitative data, collected from 13 family caregivers via interviews performed before, during and after the intervention (39 interviews total) and 2) cross-sectional post-intervention interview data collected from 22 family caregivers (22 interviews). RESULTS: Experiencing calmness was the most important change for caregivers in the context of this intervention. The calmness model, developed based on the qualitative analysis, illustrates the intermediate changes that contributed to calmness, such as being able to cope with daily life and experiencing positive interactions with the family member with dementia. Related key intervention components were the coping strategy 'reframing', employed in diverse ways by the caregivers to reduce daily stress, and the didactic method 'active skills' training', which involved active participation by the caregivers and the guidance of a professional group leader. One important factor hampering changes in caregivers was having difficulties accepting the caregiver role or accepting the losses due to dementia. CONCLUSION: The calmness model offers valuable insight into how this intervention can benefit family caregivers and aid in developing interventions targeting similar mechanisms and changes. TRIAL REGISTRATION: ISRCTN13512408 (registration date 17.05.2021, retrospectively registered).

Relationship quality perceived by family caregivers of people with dementia in the context of a psychoeducational intervention: A qualitative exploration.

BACKGROUND: Caring for a person with dementia can be a challenging experience, often associated with chronic stress and a heavy burden on family caregivers. Dementia also impacts the relationship between the caregiver and the person with dementia. The quality of this relationship is, in turn, an important factor influencing the well-being of both dyad members. The psychoeducational intervention "Learning to feel better . . . and help better" has shown positive results regarding family caregivers' subjective burden, psychological distress, and self-efficacy. However, relationship quality has not been addressed in the context of this intervention. METHODS: A longitudinal constructivist grounded theory approach was used to explore relationship quality as perceived by caregivers, possible changes and intervention components facilitating or preventing such changes. Three qualitative, semi-structured interviews (before, during and after the intervention) were performed with 13 family caregivers from three different intervention groups. The resulting 39 interviews were analysed regarding individual caregiver trajectories, per time point for all caregivers and regarding specific caregiver subgroups. FINDINGS: A model focusing on sustaining relationship quality in dementia was developed. It shows strategies that family caregivers develop and apply to facilitate positive interactions and feelings of connectedness with their family members with dementia. It also indicates that mastering such strategies requires reflective skills based on specific knowledge of dementia and coping strategies, which can be enhanced through active skills training, in which caregivers are guided to work on their individual stressful situations. Factors hampering change included difficulties in accepting dementia-related changes. CONCLUSION: Findings suggest that psychoeducation, with active skills training based on caregivers' current daily life situations, providing systematic procedures to handle daily challenges and specific knowledge about the impact of the disease, could support them in developing and applying supportive strategies to sustain or improve their relationship to their family member with dementia.

Medication Literacy in Hospitalized Older Adults: Concept Development.

BACKGROUND: Medication literacy encompasses the cognitive and social skills necessary for individuals to obtain, comprehend, communicate, calculate, and process medication-related information necessary to make informed decisions. Personal and contextual factors are widely recognized to influence the way that individuals acquire and maintain medication literacy skills. Despite a growing number of studies on medication literacy, current definitions remain general, lacking consideration for the specificities of older adults and hospitalization. OBJECTIVE: The project was conducted to identify, compare, and summarize the attributes, antecedents, and consequences of medication literacy in hospitalized older adults and to propose a refined definition. METHODS: A three-phase hybrid model of concept development was performed that included a literature review and focus groups with hospital nurses. In the final analytic phase, findings from the literature and focus groups were compared, and a refined definition of the concept was elaborated. KEY RESULTS: From the synthesis of 24 publications and the narrative data of 14 hospital nurses, 19 themes were described: 4 related to attributes, 8 to antecedents, and 7 to consequences. Medication literacy of hospitalized older adults has been further defined as the degree to which older adults and/or their natural caregivers can develop and maintain multidimensional skills, namely functional, interactive, and critical medication literacy skills. Adjustment of these skills is characterized by a dynamic and potentially complex process. In practice, optimal medication literacy might be achieved through control of and involvement in the medication regimen and the decisions related to it, and/or by using practical means to facilitate medication self-management (e.g., using lists, notes, reminders). CONCLUSIONS: The proposed refined definition might enhance professionals' common understanding of the concept and its application in practice, policy, and research. Managing a medication regimen is a complex activity that requires a high level of integration and coordination of cognitive and social skills. [HLRP: Health Literacy Research and Practice. 2022;6(2):e70-e83.] Plain Language Summary: Based on the literature on medication literacy and the experiences of nurses working in hospitals, this article defines medication literacy in hospitalized older adults. This definition will help professionals to better understand challenges related to medication literacy in older patients and to propose adequate support (i.e., provide education, simplify medication prescriptions, propose practical aids such as a pillbox).