Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis.

BACKGROUND: With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. METHODS: Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. RESULTS: A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. LINKING EVIDENCE TO ACTION: This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.

The impact of ageing simulation education on qualified acute care nurses' empathy towards older people: A mixed-methods study.

AIMS AND OBJECTIVES: To evaluate the influence of an ageing simulation intervention on qualified acute care nurses' empathy towards older people. BACKGROUND: Life expectancy is increasing globally with an increased incidence of older people accessing healthcare services. As such, it is essential for qualified nurses within hospital settings to connect with older people by establishing healthful relationships. Empathy is an essential component of healthful nurse-patient relationships. Fortunately, empathy can be taught through education. DESIGN: A convergent mixed-methods design was utilised. METHODS: Nurses (N = 95) undertook an 8-hour ageing simulation intervention. Data were collected from April 2019 to May 2020 across three time points: before the intervention (T0); immediately after (T1) and at three months follow-up (T2). A mix of convenience (intervention) and purposeful (follow-up) sampling techniques were utilised. Quantitative data were collected via the Interpersonal Reactivity Index survey (n = 86) and analysed using repeat measures ANOVA to compare mean scores across time points. Qualitative data were collected via debriefing discussions (N = 95) and focus groups (n = 38), and analysed using a systematic thematic analysis method. Data convergence occurred during the interpretation phase. Study reported with the TREND checklist. RESULTS: Primarily, when quantitative and qualitative findings were merged they confirmed each others' empathy outcomes. Quantitative results showed a statistically significant increase in affective and cognitive empathy levels among nurses post-intervention. Qualitative findings expanded on quantitative results and revealed an increase in nurses' affective, cognitive and behavioural empathy represented in themes 'enhancing my empathy', 'impact of ageing', 'from self to others' and 'person-centred moments'. CONCLUSIONS: This study adds empirical evidence how a mixed-methods design can be used to evaluate the influence of an ageing simulation intervention on nurses' empathy levels. RELEVANCE TO CLINICAL PRACTICE: Ageing simulation interventions are a suitable experiential educational approach to improve acute care nurses' affective, cognitive and behavioural empathy towards older people.

Beyond the technology: Applying the NLN Jeffries Simulation Theory in the context of aging simulation.

BACKGROUND: Caring for older people has become a focus for simulation-based education. Specifically, aging simulation has emerged as an innovative and effective educational approach that utilizes aging-suits for nurses to gain insight into the aging process and the everyday difficulties faced by older people. There is limited evidence within the literature about how researchers and educators support decision-making processes in the design, implementation, and evaluation of aging simulation programs. AIM: This is a theoretical development paper and its purpose is to explore the practical application of the Jeffries Simulation Theory in the design, implementation, and evaluation of an aging simulation program to contribute to knowledge development and guide educational practices for nurse educators and researchers. RESULTS: The authors describe a practical application of the theory to an aging simulation program using the five key theory components: context, background, design, simulation experience, and outcomes. Specific theory strengths are highlighted in practical examples generated from the authors aging simulation interventional study example: engaging stakeholders, consideration of additional observer simulation roles, reflective debrief discussions, influence of facilitator and participant personal attributes, and outcomes beyond the participants. CONCLUSION: The Jeffries Simulation Theory is well suited for underpinning the design, implementation, and evaluation of aging simulation programs.

The impact of ageing simulation education on healthcare professionals to promote person-centred care towards older people: A literature review.

AIM: This review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people. BACKGROUND: Ageing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people. DESIGN: An integrative review approach was used. METHODS: Four databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed. RESULTS: Three interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult. CONCLUSIONS: Despite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.

Building workforce well-being capability: The findings of a wellness self-care programme.

AIM: To implement and evaluate a co-designed staff well-being programme. BACKGROUND: Working in health care can be physically and psychologically demanding. The job demands-resources model indicates job resources moderate the impact of job demands on staff well-being. Well-being initiatives introduced by organisations improve staff commitment, and reduce absences and incidents. METHODS: A qualitative descriptive design was applied. In 2019, within an Australian local health district, 232 health care professionals across eight hospitals and two community settings attended a six-week well-being programme, which included a variety of self-care strategies, for example mindfulness. Nine 1-hr focus groups were completed 2-4 weeks post-programme. Data were analysed using thematic analysis to explore participants' thoughts and experiences. RESULTS: Participants experienced joy from workshops and guilt for leaving peers with their workload. Participants developed strong interpersonal relationships with workshop attendees within a 'safe well-being space'. Broader impacts expressed by participants were; learnt coping mechanisms and proactive self-care practices and can be easily embedded into daily routines. Participants shared their 'toolkit' with colleagues, family and friends, positively impacting the well-being of people around them. CONCLUSION: Participants encouraged by their new well-being 'toolkit' engaged with colleagues, better managed stressors and shared learnings. IMPLICATIONS FOR NURSING MANAGEMENT: Building well-being capability within a health organisation requires nursing management to make staff well-being a strategic priority, use a co-design approach and embed coping mechanisms at the grassroots levels.

Exploring the use of ageing simulation to enable nurses to gain insight into what it is like to be an older person.

AIM AND OBJECTIVES: To explore the thoughts and experiences of aged care nurses following participation in an ageing-suit simulation intervention. BACKGROUND: Globally, people are living longer, and for nurses, there are increasing challenges to meet the needs of the higher numbers of older people in hospital. Educating nurses to understand the ageing process and the experiences of older people in hospital is crucial to addressing these challenges. Ageing-suits were identified as a possible approach to assist with these educational needs. DESIGN: This study adopted a qualitative descriptive design. METHOD: A convenience sample of nurses (n = 15) were selected from a single aged care ward. Volunteered nurses participated in a four-hour ageing-suit simulation session. Their immediate thoughts and experiences were explored via postsimulation debriefs, and three 30-to 50-min follow-up focus groups were conducted at 3 months to explore perceptions on the impact of their experience on clinical practices. The data were analysed with the Braun and Clarke's six-step thematic analysis method. To ensure quality reporting of this study, the COREQ checklist was utilised (see Appendix S1). RESULTS: Data analysis generated three main themes. Nurses in the study highlighted that the experience of the ageing-suit resulted in "it feels real" (theme 1) and helped them in "enhancing understanding" (theme 2) about older people and their practices and supported a process of "changing me" (theme 3). CONCLUSION: Ageing-suits are emerging as a promising innovative educational approach for aged care nurses to gain insight into the challenges of ageing and subsequently making changes to themselves and their individualised practices towards older people. Future research is required to determine whether this educational approach is useful for a broader population of healthcare professionals. RELEVANCE TO CLINICAL PRACTICE: Ageing-suits were identified as a worthwhile educational approach for aged care nurses to improve their specialised clinical practices with older people.

Caring for the carers in a public health district: A well-being initiative to support healthcare professionals.

AIMS AND OBJECTIVES: To assess the impact of the proactive organisational resource allocation in terms of a 6-week well-being initiative to support public healthcare professionals' workplace engagement, well-being and job satisfaction. BACKGROUND: Burnout of healthcare professionals can be a major cost to the Australian economy and public healthcare sector. According to the social exchange theory, when healthcare professionals perceive that their organisation proactively allocates resources to caring for its employees, then they are more likely to reciprocate and become more engaged in their work roles. DESIGN: The study used a pre- and postsurvey of healthcare professionals who participated in the well-being initiative. METHODS: Between February-June 2019, 172 healthcare professionals were surveyed before and after a well-being initiative. The survey included questions on workplace engagement, workplace well-being and job satisfaction. Paired t tests were used to determine whether the difference between before and after averages was significant. The TREND statement was used to ensure the quality reporting of this study. RESULTS: The well-being initiative had a positive impact on the healthcare professionals involved in the initiative. Nursing staff benefitted the most from the well-being initiative, while the full-time staff members and highly experienced demonstrated an increase in engagement. CONCLUSION: Well-being initiatives can be a targeted strategy to help alleviate burnout amongst healthcare professionals and build a mutually beneficial relationship between management and employees. RELEVANCE TO CLINICAL PRACTICE: This study shows how implementing a staff well-being initiative increases workplace engagement, which benefits both the individual and the organisation.