Healthcare interventions for older people with dementia and family caregivers in Europe: A scoping review.

AIM: This study aimed to examine the extent, range and variety of research in Europe describing healthcare interventions for older people with dementia (PwD) and family caregivers. METHODS: This was a scoping review and followed the PRISMA Scoping Review guideline. MEDLINE, CINAHL and Cochrane library databases were searched for studies published between 2010 and 2020. Studies reporting healthcare interventions in Europe for PwD over 65 years and their family caregivers were included. RESULTS: Twenty-one studies from six European countries were included. The types of healthcare intervention identified were categorized as follows: (1) family unit intervention (interventions for both PwD and their family caregiver), (2) individual intervention (separate interventions for PwD or family caregivers) and (3) family caregiver only intervention (interventions for family caregivers only but with outcomes for both PwD and family caregivers). CONCLUSIONS: This review provides insight into healthcare interventions for older PwD and family caregivers in Europe. More studies are needed that focus on the family as a unit of care in dementia.

Nurses' attitudes towards family importance in nursing care across Europe.

AIMS AND OBJECTIVE: To explore differences in nurses' attitudes regarding the importance of family in nursing care and factors associated with nurses' attitudes across 11 European countries. BACKGROUND: Family involvement in healthcare has received attention in many European healthcare systems. Nurses have a unique opportunity to promote family involvement in healthcare; however, their attitudes and beliefs may facilitate or impede this practice. DESIGN: A cross-sectional survey across European countries. METHOD: A broad convenience sample of 8112 nurses across 11 European countries was recruited from October 2017 to December 2019. Data were collected using the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire. We used the STROBE checklist to report the results. RESULTS: There were significant differences in nurses' attitudes about families' importance in nursing care across Europe. Country was the factor with the strongest association with the total scores of the FINC-NA. Older age, higher level of education, increased years since graduation, having a strategy for the care of families in the workplace, and having experience of illness within one's own family were associated with a higher total FINC-NA score. Being male and working in a hospital or other clinical settings were associated with a lower total FINC-NA score. CONCLUSION: Nurses' attitudes regarding the importance of family in nursing care vary across 11 European countries. This study highlights multiple factors associated with nurses' attitudes. Further research is necessary to gain a deeper understanding of the reasons for nurses' different attitudes and to develop a strong theoretical framework across Europe to support family involvement in patient care. The inclusion of family healthcare programs in the baccalaureate curriculum may improve nurses' attitudes. RELEVANCE FOR CLINICAL PRACTICE: In clinical practice, the focus should be on identifying influencing factors on nurses' attitudes to enhance families' importance in nursing care across Europe.

Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review.

BACKGROUND: In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure. AIMS: This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps. MATERIALS & METHODS: A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020. RESULTS: A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach. DISCUSSION: This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.

Health practices in Europe towards families of older patients with cancer: a scoping review.

INTRODUCTION: In Europe, cancer is one of the predominant causes of mortality and morbidity among older people aged over 65. A diagnosis of cancer can imply a negative impact on the quality of life of the older patients and their families. Despite research examining the impact of cancer on the family, it is unclear what kind of information is available about the types of clinical practice towards older patients with cancer and their families. The aim is to determine the extent, range and variety of research in Europe describing health practices towards families of older patients with cancer and to identify any existing gaps in knowledge. METHODS: Scoping review. RESULTS: A total of 12 articles were included, showing that family interventions are generally based on end-of-life care. Most studies used a qualitative approach and involved different types of family member as participants. Most studies were conducted in the UK. CONCLUSIONS: Review findings revealed limited knowledge about health practices in Europe towards families with an older patient with cancer. This review indicates a need to increase family-focused research that examines health practices that meet the needs of families of older patients with cancer. Seeing cancer as a chronic disease, there is an urgent need for the implementation of family-focused interventions.

Characteristics of patients treated for severe hypoglycaemia in emergency care settings - Analysis of routinely collected data.

OBJECTIVE: Severe hypoglycaemic events (SHE) commonly require emergency care. This study investigates the presentation of patients with SHE to a single Swiss emergency service, including pre-hospital care with emergency medical services (EMS) and emergency department (ED) presentations. METHOD: Retrospective analysis of routinely collected data by the EMS and ED during 2014. All adult patients with diabetes type 1 or type 2 with SHE were included in the analysis. RESULTS: 43 SHE were recorded in 38 patients with diabetes. Mean age of all patients was 65 years (SD ±â€¯17.51), 54% (n = 23) were men, 55.8% (n = 24) were living in a relationship, and 54.8% (n = 23) were diagnosed with type 2 diabetes. Of the 43 episodes, 65% (n = 28) of the presentations used EMS and were then taken to the ED, 28% (n = 12) involved contact with the EMS only, and 7% (n = 3) were seen by the ED but did not use EMS. Patients seen by the EMS only (n = 12) were younger compared to those admitted to ED (n = 28); Md 54 years vs Md 72 years; U = 98; p = .039. The same age difference was similar between patients in the ED setting discharged home (n = 11) and with in-patients (n = 20); Md 61 years vs. Md 79 years; U = 51; p = .013. CONCLUSIONS: People most likely to suffer a SHE were men, those living with a partner, over 65 years old, and living with type 2 diabetes. Younger patients treated by EMS at home tended to remain at home, in contrast to the older patients who were admitted to hospital. This was also true for the ED where older people in particular became in-patients after such an event. Elderly care specialist brief interventions conveyed by EMS and ED healthcare professionals might be of value to prevent further SHE. Validating these findings in multiple emergency settings is warranted to support the delivery of targeted interventions.

Consenting on Principles of Rehabilitation Nursing Care: A Delphi Study.

PURPOSE: Patient-centeredness, evidence-based interventions, and interdisciplinary teamwork have been described as key in neurological rehabilitation nursing. In order to develop future action plans, a group of Swiss rehabilitation nurses sought agreement on concrete principles that led the efforts to develop a common understanding of rehabilitation nursing care in Switzerland. DESIGN: A three-round Delphi study was conducted. METHODS: Literature-based statements were formulated and sent out twice to 54 rehabilitation nursing stakeholders. In the third round, the participants ranked the three most important statements out of 13. FINDINGS: Highest priority reached the statements: Rehabilitation nursing care (1) considers the uniqueness of the patients and their family, (2) offers support that promises the greatest potential for patients and their family, and (3) uses evidence-based knowledge. CONCLUSION: Statements on patient- and family-centeredness were ranked highest. Patients and families' preferences have to be considered as much as evidence-based knowledge and interventions to support patients and family. CLINICAL RELEVANCE: The study supported the discussion on action plans and enlivened new services and nursing interventions in a Swiss nursing community.

[End-of-Life Care in Intensive Care Units: Nursing strategies of family involvement at the end of life]. / End-of-Life-Care auf der Intensivstation.

Background: Family members of people dying in the intensive care unit (ICU) are exposed to many stress factors and they often do not experience involvement in End-of-Life (EoL) situations. For example, they criticize a low degree of participation in patients care, delayed or incomplete information and lack of privacy. Even nursing staff is facing various obstacles in EoL situations in ICUs. Aim: This study investigates strategies used by ICU nursing staff in German-speaking Switzerland to increase family members participation in situations at the end of life. Method: Data was collected by conducting 12 semi-structured interviews using an approach based on Grounded Theory. A model was developed to explain nursing strategies for family involvement in EoL situations in the ICU. Conclusions: Nurses provide personal space and tranquillity for family members and allow them to be present at any time. Against this background, they support family members and enable them to say goodbye consciously to a loved one. Subsequent work should examine the effectiveness of the strategies described, particularly in terms of stress reactions displayed by family members in the aftermath of EoL situations. In practice, family members should be provided space for privacy. The entire healthcare team is recommended to identify and pursue common values and objectives. Moreover, intradisciplinary exchange and mentoring need to be encouraged. In order to prepare future nursing staff for EoL situations in the ICU, recognizing and promoting their educational skills is mandatory.

Patient Characteristics Associated With a Successful Response to Nurse-Led Care Programs Targeting the Oldest-Old: A Comparison of Two RCTs.

BACKGROUND: To improve the effectiveness of community-based care programs, especially those targeting the oldest-old population (80+), data are needed that elucidate those factors associated with a successful response to the intervention. Two comparable nurse-led care programs have been evaluated in two large randomized controlled trials (RCTs), one in Switzerland and one in the Netherlands. AIMS: To identify common patient characteristics that are related to a successful response to proactive nurse-led care, we explored if and to what extent, identical factors were present in both study populations. METHODS: A secondary data analysis using trial data from the intervention group of both RCTs was conducted. The study sample consisted 461 older adults, 230 from the U-PROFIT trial (the Netherlands) and 231 from the HPC trial (Switzerland). The mean age of the total sample was 85.1 years (SD 3.7). The UPROFIT intervention, delivered by registered nurses, included a frailty assessment and a comprehensive geriatric assessment (CGA) at home followed by an individualized evidence-based care plan, care coordination, and follow-up. The HCP intervention was delivered by advanced practice nurses consisting of four home visits and three phone calls, and was guided by the principles of health promotion, empowerment, partnership, and family-centeredness. A successful response was defined as "stable" or "no decline" in daily functioning at follow-up. Daily functioning was measured with 13 items of activities of daily living and instrumental activities of daily living. Multivariate logistic regression models were applied to calculate the association between individual characteristics and a successful response. RESULTS: Almost half of the participants in the U-PROFIT trial (50.9%), and two-thirds (65.7%) of the participants in the HCP trial had a successful response at follow-up. Fewer comorbidities and a better self-rated health had the strongest predictive value for benefiting from the intervention (OR = 0.83 [95% CI 0.66-1.03], and OR = 1.5 [95% CI 0.92-2.45]), respectively. LINKING EVIDENCE TO ACTION: Two large RCTs demonstrated that a preventive nurse-led care program can preserve daily functioning in the oldest-old population. Older people with few comorbidities and higher self-rated health had a higher likelihood of a positive outcome. Unraveling the characteristics associated with a successful response provides important information for further refining and targeting an intervention to obtain maximum effectiveness. More effort is needed to modify interventions for the oldest-old with multiple morbidities and low levels of education.

Hypoglycaemia and brief interventions in the emergency department - A systematic review.

OBJECTIVE: For people with diabetes, severe hypoglycaemia is the most common reason for emergency service usage and emergency department (ED) presentations. Brief interventions (BI) are a recognised intervention strategy in the ED for other conditions but to date, they have not been applied to those with hypoglycemia. This review aims to identify components and outcomes of BI for people with diabetes mellitus to inform the development of BI in the ED. METHOD: A systematic review of randomized controlled trials was undertaken in MEDLINE, CINAHL, PsychINFO and EMBASE. Studies that examined brief interventions for people with diabetes were considered. Eligible studies were critically appraised and included in a narrative synthesis. RESULTS: A total of 2475 citations were identified, 171 full papers were reviewed and four articles were included for review. The components 'advice' and 'assistance' from the five A Framework were the most frequently used BI components. Statistically significant improvements were achieved in psychological, functional, and satisfaction outcomes. However, clinical outcomes were not improved and economic outcomes like costs of BI were not evaluated. CONCLUSIONS: The literature review demonstrated a lack of evidence related to BI in diabetes within the emergency setting despite the ED being an ideal environment. Future research needs to be conducted to investigate the effectiveness of BI for patients with diabetes.

Relocation experiences with unplanned admission to a nursing home: a qualitative study.

BACKGROUND: In many countries, people over 85 years of age are relocated involuntarily or unplanned to a nursing home. In Switzerland, 43% of elderly over 85 years are admitted to nursing homes after hospital discharge. This percentage is higher than in the USA with 32.5% or in Germany with only 19%. Despite those more frequent Swiss admissions, no research has been conducted exploring how unplanned admissions to nursing homes affect the adaptation. Therefore, the aim of this study was to gain an in-depth understanding into unplanned admissions to nursing homes and to explore its impact on adaptation. METHODS: The study used a qualitative interview design based on Meleis' transition model. Secondary data analysis was guided by Mayring's qualitative content analysis. Face-to-face interviews with elderly over 77 years (n = 31) were conducted from a convenience sample in Switzerland between January and March 2013. RESULTS: The following four patterns of adaptation emerged from the analysis: "being cut-off," "being restricted," "being cared for," and "moving on." The patterns evaluate the relocation into nursing homes and provide an opportunity to appraise the stages of adaption. CONCLUSIONS: This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

Variances in family carers' quality of life based on selected relationship and caregiving indicators: A quantitative secondary analysis.

AIMS AND OBJECTIVES: To determine subgroups of family carers based on family relational and caregiving variables and to explore group differences in relation to selected carer outcomes. BACKGROUND: Family caregiving in later life holds a myriad of positive and negative outcomes for family members' well-being. However, factors that constitute family carers' experience and explain variances are less well understood. DESIGN: A secondary data analysis using cross-sectional data from a controlled randomised trial with community-dwelling people 80 years or older and their families. METHODS: A total of 277 paired data sets of older persons and their family carers were included into the analysis. Data were collected via mailed questionnaires and a geriatric nursing assessment. A two-step cluster analysis was performed to determine subgroups. To discern group differences, appropriate tests for differences with Bonferroni correction were used. RESULTS: Two family carer groups were identified. The low-intensity caregiver group (57% of carers) reported high relationship quality and self-perceived ease of caregiving. In contrast, the high-intensity caregiver group (43% of carers) experienced significantly lower relationship quality, felt less prepared and appraised caregiving as more difficult, time intensive and burdensome. The latter cared for older, frailer and more dependent octogenarians and had significantly lower levels of quality of life and self-perceived health compared to the low-intensity caregiver group. CONCLUSIONS: A combination of family relational and caregiving variables differentiates those at risk for adverse outcomes. Family carers of frailer older people tend to experience higher strain, lower relationship quality and ability to work together as a family. IMPLICATIONS FOR PRACTICE: Nurses should explicitly assess family carer needs, in particular when older persons are frail. Family carer support interventions should address caregiving preparedness, demand and burden, as well as concerns situated in the relationship.

Nurse-led palliative care services facilitate an interdisciplinary network of care.

BACKGROUND: Caring for palliative patients at home is complex and challenging. Specialist palliative care exists to provide high quality of care in complex situations. This study aimed to describe the characteristics of a specialist nurse-led palliative care service in an urban Swiss region. METHODS: A qualitative study design adopting a grounded theory approach was used. Semi-structured interviews were conducted with 41 participants including family caregivers, home care nurses, referring services, treating physicians, specialist nurses and external politicians. In addition, statistical information was included. FINDINGS: Specialist nurses played an important role in building and maintaining an interdisciplinary network of care, necessary for the management of complex palliative situations. They performed tasks such as to "include" members and to "negotiate" the network of care with the family and providers. They "tailored" the support to patients and families' needs and as a result "empowered" the network of care. CONCLUSION: A nurse-led palliative care service facilitated interdisciplinary palliative home care to the benefit of all agents involved.

Constipation prophylaxis in children undergoing orthopedic surgery: A quasi-experimental study.

PURPOSE: This study evaluated the effectiveness of constipation prophylaxis administered with the support of an advanced practice nurse. DESIGN: A quasi-experimental study with a historical control group of 112 pediatric (age 1-18) orthopedic patients and an intervention group of 59 patients was conducted in a surgical ward in Switzerland. RESULTS: The implementation of a standardized constipation prophylaxis led to an absolute risk reduction (27%) of constipation. Fisher's exact test showed a significant difference in the prevalence of constipation in the two samples, p = .001. PRACTICE IMPLICATIONS: Constipation prophylaxis is a necessity in pediatric orthopedics.

Management of language discordance in clinical nursing practice--A critical review.

BACKGROUND: Language plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice. OBJECTIVES: This critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing. DESIGN: A critical review of the literature was performed and 24 relevant research papers were included. DATA SOURCES: A search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA). REVIEW METHODS: Both authors independently screened the titles (n=299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP). FINDINGS: In total, 24 publications met the inclusion criteria. Most of the studies (n=20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language. CONCLUSIONS: Health care institutions should provide more strategies for clinical practice to overcome language discordance.

Decision-making in caring for people with dementia at the end of life in nursing homes.

BACKGROUND: Alleviating symptoms, fulfilling psychosocial needs, and the inclusion of family are among the criteria that determine care quality in palliative treatment. The care quality is especially inadequate for people with dementia (PwD) at the end of life. To improve this, it is necessary to understand the process of nurses' clinical decision-making in symptom management in the terminal phase of PwD. AIM: The aim of the study was to examine the decision-making process of symptom management for PwD in nursing homes in their terminal phase of life. DESIGN: A qualitative design was chosen with a constructivist approach. Individual interviews were conducted with nurses (n=32) in four Swiss nursing homes. RESULTS: 'Recount and reflect' plays a vital role in the care of PwD in terminal phase, enabling symptom recognition and facilitating symptom management. A process of thinking during the course of action enables nursing staff members to understand what, when, and how symptom changes have taken place. CONCLUSION: Highly-trained nurses need to support health care assistants through counselling, coaching, and leadership to help reduce the symptom burden experienced by PwD. Relatives are necessary to maintain an exchange of ideas regarding the appropriate treatment to reduce symptom burden.

[Being cared for and caring: living with multiple chronic diseases (Leila)-a qualitative study about APN contributions to integrated care]. / Umsorgt werden und umsorgen: Leben mit mehreren Langzeiterkrankungen (Leila) - Eine qualitative Studie zum Beitrag von APN in integrierter Versorgung.

BACKGROUND: Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called "Living with chronic disease" (Leila) was initiated. AIM: The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? METHODS: A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. RESULTS: The findings revealed "Being cared for and caring" as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category "organizing everyday life" describes how patients learned to cope with the consequences of living with multiple chronic diseases. "Using all resources" as another category demonstrates how capabilities and strengths were adopted. CONCLUSIONS: The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing.

Effects of Mobility-Enhancing Nursing Intervention in Patients with MS and Stroke: Randomised Controlled Trial.

Background. Multiple sclerosis (MS) or stroke causes functional impairment which can have a major impact on patients' life. Objectives. This RCT investigated the effect of a new nursing intervention (Mobility Enhancing Nursing Intervention-MFP) designed to improve rehabilitation outcomes. Method. The study took place in a rehabilitation clinic in Switzerland. One hundred forty participants diagnosed with MS, stroke, and brain injuries were randomly assigned to control group (CG = standard care) or intervention group (IG). The IG combined standard care with 30 days of MFB. MFP placed patients on a mattress on the floor and used tactile-kinaesthetic stimulation to increase spatial orientation and independency. Outcomes were functionality (Extended Barthel Index, EBI), quality of life (WHOQoL), and fall-related self-efficacy (FES-I). Results. There was a significant main effect of the intervention on functionality (EBI-diff/day mean = 0.30, versus mean = 0.16, P = 0.008). There was also a significant main effect on QoL (WHOQoL-diff mean = 13.8, versus mean = 5.4, P = 0.046). No significant effect was observed on fall-related self-efficacy. Conclusions. The positive effect of MFP on rehabilitation outcomes and quality of life suggests that this specialized nursing intervention could become an effective part of rehabilitation programs. The study was approved by the Ethics Committee of St. Gallen (KEK-SG Nr. 09/021) and registered at ClinicalTrial.gov NCT02198599.