Patient Activation and its Predictors in Hospitalized Older Adults in Singapore.

BACKGROUND: Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AIMS: To explore patient activation and its predictors in hospitalized older adults in Singapore. METHODS: Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. RESULTS: 300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (ß=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care. CONCLUSION: Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.

The impact of a Web-based educational program on the recognition and management of deteriorating patients.

AIMS AND OBJECTIVES: To evaluate the effectiveness of a Web-based educational program to enhance enrolled nurses' knowledge and skills in the recognition and management of deteriorating patients. BACKGROUND: Ward nurses of different skill levels play a pivotal role in detecting and responding to deteriorating patients. A skill mix of registered nurses, enrolled nurses, licensed practical nurses or healthcare assistants is often employed for the provision of nursing care in acute settings. Non-registered nurses frequently perform bedside care and are in the best position to detect deteriorating patients and initiate immediate actions, including commanding the attention of registered nurses. Education is needed to improve the knowledge and skills of these nurses. DESIGN: A randomised controlled trial with a pretest-post-test design. METHODS: The sample included enrolled nurses from an acute care tertiary hospital. Following a baseline evaluation, the experimental group received a Web-based educational intervention. Pre-post assessment of skills and knowledge was performed with a simulated scenario and a knowledge questionnaire. Sixty-four nurses completed the entire study. RESULTS: Following the intervention, participants from the experimental group were significantly more likely than those in the control group to monitor the patient's respiratory and pulse rates. In addition, they had significantly higher post-test mean scores for knowledge and skills in assessing and managing clinical deterioration and reporting deterioration. CONCLUSION: The Web-based educational intervention significantly improved enrolled nurses' knowledge and skills in the recognition and management of a deteriorating patient in a simulated setting. RELEVANCE TO CLINICAL PRACTICE: Ease of access to the Web-based platform contributed to the feasibility and acceptability of this study, which has the potential to positively impact patient safety.