Adding physical therapy services in the emergency department to prevent immobilization syndrome - a feasibility study in a university hospital.

BACKGROUND: The association between the functional decline occurring with bedrest and hospitalization in older persons is well-known. A long wait in the emergency department (ED), where patients can be bedridden, is a risk factor for the development of an immobilization syndrome (IS). IS is one of the unwanted consequences of inactivity, which causes pathological changes in most organs and systems. Early mobility interventions, such as physical therapy (PT) delivered in the ED, may prevent its development. To our knowledge, no prior studies have reported on this topic. The goal of this study was to (i) assess the feasibility and (ii) explore the potential clinical value of adding PT services to the ED, in collaboration with nursing staff, to prevent IS. METHODS: For 12 weeks, PT services were delivered in the ED to older persons (>65 years old) presenting with ≥1 clinical signs associated with the development of IS. Patients were screened by ED nurses and then seen by the physiotherapist. In order to assess feasibility, access to patients, percentage of patients who met eligibility criteria, acceptability of the intervention, and barriers/facilitators to the implementation were measured. To describe the clinical benefits of early PT services, we counted the number of new IS cases among patients after their admission to the ward. RESULTS: After 12 weeks, the ED nurses screened 187 potential patients and 20 received PT services in the ED (before their admission to the ward). Accessibility was not an issue and we observed good acceptability from the milieu. We did not find majors problems or insurmountable obstacles to implementation of the intervention. Clinical outcomes showed that nine patients received PT treatments in the ED and on the ward (after their admission). For the 11 other patients, no PT interventions were done in the ED following the assessment. Follow-up of these 11 patients showed that two of them developed IS during their hospital stay. As for the nine patients who began PT treatments in the ED, none of them developed IS. CONCLUSION: Based on the results of this feasibility study, it would be likely and potentially beneficial to implement PT services in the ED, which could have a positive impact on preventing the development of IS in older persons presenting risk factors. While only a small proportion of patients (11 %) received PT services, better screening tools/methods should be developed.

Relationship Between Empathy and Well-Being Among Emergency Nurses.

INTRODUCTION: A large number of patients who are in pain upon arriving at the emergency department are still in pain when they are discharged. It is suggested that nurses' personal traits and their level of empathy can explain in part this issue in pain management. The purpose of this study was to better understand the shortfalls in pain management provided by emergency nurses by considering nurses' characteristics. METHODS: A cross-sectional descriptive correlational design was used for this pilot study. French validated self-administrated questionnaires (sociodemographic characteristics, empathy, psychological distress, and well-being) were presented to 40 emergency nurses. Thirty emergency nurses completed all questionnaires during work hours. Descriptive statistics, group comparisons, and correlation analyses were used for the data analysis. RESULTS: Emergency nurses appear to have low levels of empathy. High levels of psychological distress and low levels of well-being were also observed in our sample. Among these variables, only empathy and well-being appear to be related, because we found higher empathy scores in nurses with higher well-being. DISCUSSION: The poor mental health we found among emergency nurses is alarming. A clear need exists for supportive interventions for nurses. Finally, well-being was the only variable related to empathy. To our knowledge, this is the first study to report this relationship in nurses.

[Improvement in perception of nurse's competence in screening for delirium: a quasi-experimental study]. / Amélioration du sentiment de compétence des infirmières pour le dépistage du délirium en médecine générale: une étude quasi-expérimentale.

INTRODUCTION: Up to 60% of elderly will develop delirium during the course of their hospitalization. Less than 50% of nurses can screen for delirium, although it is a medical emergency and that the evaluation of mental state constitutes one of their responsibilities. OBJECTIVE: Evaluate the effect of a training program on screening for delirium on the competence perception of nurses in a medicine unit. METHODOLOGY: Quasi experimental, comparing two groups of nurses working on medicine units, in two different hospitals. The independent variable, an active training taking into account experience and knowledge of nurses, did include a tool based on the "confusion assessment method". The dependent variable, the perception of competence, was measured before training and 6 months later with a pre-tested self-administered questionnaire. RESULTS: Response rate was higher than 90% at time 1 and 2. There was no difference in the perception of competence between groups before training. The experimental group improved statistically but not the comparison group. CONCLUSION: This study suggests a significant improvement in perception of competence following an active training hopefully enhancing screening of delirium, thus the well-being of hospitalized elderly.