Nonpharmacological methods: frequency of use and follow-up actions among healthcare staff in the care of older people.

Older people are at risk of developing multi-comorbidity and thus being exposed to multiple treatments and drugs to manage the emerging health complaints. More focus has been put on nonpharmacological alternatives. However, studies revealing the healthcare staff perspective on using nonpharmacological methods (NPMs) in the care of older people are still lacking. Thus, the aim of this study was to map the use of NPMs in daily practices and the follow-up thereof. A population-based survey with questionnaires was performed, included all healthcare professionals (n = 163; nurses and paramedical professionals) working in one district of elderly care in Sweden. The older person's anxiety and worry (76.1%), sleeping problems (53.1%) and pain (41.1%) were the health problems in daily life most likely to trigger use of NPMs. To manage the emerging health problems, interactions (87.1%), diet and nutrition supplements (63.2%) and physical activity were commonly used, particularly by nurses. One third (n = 54) stated that they did not evaluate the NPMs used, with no statistical differences between nurses and paramedical professionals. The present study indicated that NPMs were used in care of older people among nurses and paramedical professionals, but not in a systematic way and often without follow-up.

The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial.

AIM: During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS: The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION: There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT: This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER: ISRCTN: 74345449.

Care Plan Standardization for Older Adults: Opportunities for Nursing Leadership.

Care plans guide and document achievement of short- and long-term goals. However, most care plans are discipline oriented, document medical problems, and lack person-centered information such as care preferences. The current authors' goal was to explore the status of comprehensive care plans and the future application of sharing data among health care providers and settings. Semi-structured interviews were conducted among a variety of professionals in six geographically diverse settings to learn the status and performance of care plans. Various biases, regular and irregular omissions, and lack of long-term perspectives in the care plan generation processes were found. These deficits support the need for developing comprehensive standardized care plans to improve access, coordination, and quality of care for older adults. Nurses are in an ideal position to lead local, state, and national initiatives to drive policies for comprehensive care plans that will improve access to and quality of care delivery to older adults. [Journal of Gerontological Nursing, 44(12), 11-16.].

The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.

AIMS AND OBJECTIVES: To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents' skin wounds. METHODS: A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. RESULTS: Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. CONCLUSION: A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. RELEVANCE TO CLINICAL PRACTICE: Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

Family members' expectations regarding nurses' competence in care homes: a qualitative interview study.

BACKGROUND: Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well-being of older people living in care homes, and family members' can provide valuable information about competence requirements. AIM: To explore the expectations of the care home residents' family members regarding the competence of nurses in care homes for older people. METHODS: A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 care home residents' family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis. ETHICS: Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants. FINDINGS: The care home residents' family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high-quality basic care and nursing and support residents' well-being individually and holistically. CONCLUSIONS: Family members' expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence-based practice competencies are required to provide high-quality care. Nurses' ability to provide person-centred, individual and holistic care is vital to ensure care home residents' well-being.

Ethnocultural Gerontological Nursing: An Integrative Literature Review.

The aging population is growing increasingly more diverse, with one in four older adults from an ethnic minority group by 2050, while the nursing force will largely remain members of a single race White population. The purpose of this review is to appraise the state of nursing knowledge in relationship to meeting the needs of elders in unique racial/ethnic groups using two approaches: evaluating the efficacy of current knowledge and evaluating the state of nursing knowledge about ethnocultural gerontological nursing based on an integrative review of nursing literature. Thirty-four articles were reviewed. Most articles used qualitative methodology focused on a single ethnic group, with several articles focused on health promotion/prevention. Cultural perspectives were better addressed than aging concepts and few articles integrated ethnocultural and gerontological nursing concepts. This evaluation indicates many gaps in the knowledge base about ethnocultural gerontological nursing. Specific areas for future knowledge development are identified.

Competence for older people nursing in care and nursing homes: An integrative review.

BACKGROUND: People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. AIMS AND OBJECTIVES: The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. DESIGN: Integrative literature review. METHODS: We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. RESULTS: Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. CONCLUSIONS: The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. IMPLICATIONS FOR PRACTICE: Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people.

Diagnosis and management of patients with hypercalcaemia.

Hypercalcaemia is a common biochemical abnormality in the blood that can be caused by malignancy, hyperparathyroidism, medications or underlying medical conditions. Initial signs and symptoms are often vague, however, if someone has severe hypercalcaemia it is treated as an emergency, requiring prompt management to prevent life-threatening complications such as dehydration, cardiac arrhythmias or coma. Understanding the pathophysiology, signs and symptoms of hypercalcaemia enables effective diagnosis and holistic management of the patient with complex health needs.

Falls prevention and support: translating research, integrating services and promoting the contribution of service users for quality and innovative programmes of care.

Falls are a significant threat to the safety, health and independence of older citizens. Despite the substantial evidence that is available around effective falls prevention programmes and interventions, their translation into falls reduction programmes and policies has yet to be fully realised. While hip fracture rates are decreasing, the number and incidence of fall-related hospital admissions among older people continue to rise. Given the demographic trends that highlight increasing numbers of older people in the UK, which is broadly reflected internationally, there is a financial and social imperative to minimise the rate of falls and associated injuries. Falling is closely aligned to growing older (Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010). According to the World Health Organization, around 30% of older people aged over 65 and 50% of those over 80 will fall each year (Falls Fact Sheet Number 344, WHO, Geneva, 2010). Falls happen as a result of many reasons and can have harmful consequences, including loss of mobility and independence, confidence and in many cases even death (Cochrane Database Syst Rev 15, 2009, 146; Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010; Falling Standards, Broken Promises: Report of the National Audit of Falls and Bone Health in Older People 2010, Health Care Quality Improvement Partnership, London, 2011). What is neither fair nor correct is the common belief by old and young alike that falls are just another inconvenience to put up with. The available evidence justifiably supports the view that well-organised services, based upon national standards and expert guidance, can prevent future falls among older people and reduce death and disability from fractures. This paper will draw from the UK, as an exemplar for policy and practice, to discuss the strategic direction of falls prevention programmes for older people and the partnerships that need to exist between researchers, service providers and users of services to translate evidence to the clinical setting. Second, it will propose some mechanisms for disseminating evidence to healthcare professionals and other stakeholders, to improve the quality and capacity of the clinical workforce.

Interview with a quality leader: Dr. Eric Coleman, on care for geriatric populations. Interview by Kathleen Tornow Chai.

Dr. Coleman serves as the founding Director of The Care Transitions Program, a national program with a mission to improve quality and safety at times of transitions or care "hand-offs" across settings for persons with complex care needs. This program recognizes that a multifaceted strategy is needed and has taken action to address the problem from multiple angles, including supporting patients and their family caregivers, articulating the key roles and competencies for practitioners, developing and testing quality performance measures, creating new tools to identify medical errors, promoting the role of health information technology, and working directly with policy makers. To date, over 400 leading healthcare organizations have adopted the Care Transitions Intervention. The National Quality Forum endorsed and subsequently re-endorsed the Care Transitions Measure for use in performance measurement and public reporting and over 3,500 organizations in 15 countries have requested permission for its use. To meet this demand, the Care Transitions Measure is available in seven languages. Dr. Coleman is currently a Professor of Medicine at the University of Colorado, Denver. He is currently the Primary Investigator for seven active grants.

Lack of compliance of staff in an intervention study with focus on nutrition, exercise and oral care among old (65+ yrs) Danish nursing home residents.

BACKGROUND AND AIMS: Lack of compliance on the part of old participants has been reported in several randomised nutritional intervention studies. However, lack of compliance by staff may also have a significant impact on the effect of interventions. The aim of this paper is to test the hypothesis that, in an intervention study with focus on nutrition, exercise and oral care in old nursing home residents, lack of compliance by staff rather than residents is the major problem. METHODS: An eleven week randomized, controlled trial in seven nursing homes, with nutrition, exercise and oral care strategies, and 62 residents in the intervention group. Staff and researchers documented compliance of residents with the various strategies, including notes about problems. RESULTS: The nutrition and exercise strategies were well accepted by participating residents. The main reason for non-compliance may be related to staff problems. Up to one-sixth of the planned nutrition interventions were not documented as having been given to the residents. CONCLUSIONS: Lack of compliance by staff rather than residents seemed to be the main problem. In order to improve compliance in future studies, more focus should be put on the effect of practical implementation on staff. Insight into these matters may give valuable information to counteract staff problems, facilitate implementation in long term, and hence improve the benefits of nutrition interventions.

A qualitative study explaining nurses' perceptions of quality care for older people in long-term care settings in Ireland.

AIM: The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. BACKGROUND: The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. METHOD: The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. FINDINGS: The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. CONCLUSION: There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. RELEVANCE TO PRACTICE: This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

Stakeholder engagement and public policy evaluation: factors contributing to the development and implementation of a regional network for geriatric care.

The development and implementation of a regional network that provides universally accessible and consistent services to the frail elderly living in Southwestern Ontario is described. Through continuous stakeholder engagement, clear network goals were identified and operationalized. Stakeholder commitment to the integration of expertise and specialized services, to evidence-based public policy and to iterative evaluation cycles were key to network success.

Enhancing service delivery capacity through knowledge exchange: the Seniors Health Research Transfer Network.

The Seniors Health Research Transfer Network (SHRTN) was launched in 2005 in Ontario to improve the quality of health care provided to seniors by facilitating knowledge exchange opportunities for formal and informal caregivers, researchers and policymakers. This article describes the conceptual basis and development of SHRTN, as well as achievements, challenges and lessons learned during its first year of operation, which ended in March 2006. We begin by discussing knowledge exchange networks and their conceptual basis. We then offer a brief history of SHRTN, tracing its origins to both a broad interprofessional interest in creating and sharing knowledge within and across organizations, and also to the efforts of a small group of early champions. After this, we describe the main events, achievements and surprises of SHRTN's first year. Experience with SHRTN has highlighted the importance of careful attention to governance issues in the organization of knowledge exchange networks, and the challenge of balancing management control with broad participation and flexibility. Collaboration can yield synergy and innovation, but requires commitment from participants. The SHRTN experience has demonstrated that planning and coordinating a provincial network that engages diverse stakeholders is a logistical challenge that requires dedicated infrastructure and funding support.

E-health web portals: delivering holistic healthcare and making home the point of care.

E-health delivers healthcare services and education, via a Web portal, to older persons with chronic conditions and their caregivers and enables the patient's home to be the point of care. This growing industry is ripe for exploration by nurses who can empower the patient and caregiver to gain self-care and coping skills. Advances in information technology now make this dream a reality.