Advising older people on physical activity: challenges and strategies.

Appropriate physical activity has more benefits than risks for older people. Increased physical activity enhances older people's mental and physical well-being and can contribute to reduced morbidity and early mortality. Nurses have an important role in advising older people on the level of physical activity that is right for them. Based on the national requirements for physical activity in older people, nurses can tailor their advice to each individual, address the person's concerns about potential risks and emphasise the likely benefits of them becoming more physically active. This article explains the role of nurses in promoting and encouraging physical activity in older people. It describes the historical background of this area of health promotion, considers the challenges nurses experience and discusses the strategies they can use when advising older people on physical activity.

The changing role of Advanced Clinical Practitioners working with older people during the COVID- 19 pandemic: A qualitative research study.

BACKGROUND: COVID-19 was identified as a pandemic by the World Health Organisation (WHO) in December 2020. Advanced Clinical Practitioners (ACPs) in England working with older people with frailty, experienced their clinical role changing in response to the emergency health needs of this complex population group. In contrast to other countries, in England Advanced Clinical Practitioners are drawn from both nursing and allied health professions. Whilst much of the literature emphasises the importance of ensuring the sustainability of the Advanced Clinical Practitioners' role, the pandemic threw further light on its potential and challenges. However, an initial review of the literature highlighted a lack of research of Advanced Clinical Practitioners' capabilities working with uncertainty in disaster response situations. AIM: To capture the lived experience of how English Advanced Clinical Practitioners working with older people adapted their roles in response to the COVID-19 pandemic (October 2020-January 2021). DESIGN, SETTING AND PARTICIPANTS: A qualitative research design was used. Following ethical approval, 23 Advanced Clinical Practitioner volunteer participants from across England with varied health professional backgrounds were recruited from Advanced Clinical Practitioners' professional and social media networks on Twitter using a snowballing technique. METHODS: Depending on preference or availability, 23 participants (nurses (18), physiotherapists (2), paramedics (2) and a pharmacist (1)) were interviewed singularly (n = 9) or as part of 3 focus groups (n = 14) using Zoom video communication. Audio recordings were transcribed and using qualitative data analysis software, NVivo 12 pro, coded for an essentialist thematic analysis of Advanced Clinical Practitioners' responses using an inductive approach. 27 codes were identified and collated into five themes. For the purposes of this paper, four themes are discussed: experiencing different work, developing attributes, negotiating barriers and changing future provision. FINDINGS: Advanced Clinical Practitioners successfully transferred their advanced practice skills into areas of clinical need during the pandemic. Their autonomous and generic, high level of expertise equipped them for management and leadership positions where speed of change, and the dissolution of traditional professional boundaries, were prioritised. Barriers to progress included a lack of knowledge of the Advanced Clinical Practitioner role and friction between Advanced Clinical Practitioners and physicians. DISCUSSION AND CONCLUSION: The study demonstrated the successful adaption of the Advanced Clinical Practitioner role to enable more creative, personalised and sustainable solutions in the care of older people living with frailty during the pandemic. The potential of Advanced Clinical Practitioner development is in a juxtaposition to the threat of pandemic services being dismantled once the emergency nature of care has passed. Healthcare organisations have a vital part to play in considering the enablers and barriers of Advanced Clinical Practitioner capability-based practice when responding to uncertainty.

Improving communication when caring for acutely ill patients with dementia.

People living with dementia have complex needs, which may be compounded when they develop an acute illness. It is vital to recognise any deterioration in a patient and respond appropriately to prevent serious complications and, in some cases, mortality. It is necessary for all healthcare professionals to develop assessment skills that take account of potential communication difficulties. This article reviews the literature on communicating with people with dementia, and considers the main issues involved in managing patients with an acute illness who are already living with dementia. The aim is to ensure that nurses consider how they communicate in these situations and to recognise the benefits that can be gained by healthcare professionals and patients from enhanced communication.

Why intermediate care services need to be refreshed.

Intermediate care services are usually intended for frail, older people and those with complex needs. Their aims are to avoid unnecessary hospital admission, help people regain independence after a hospital stay and prevent premature admission to long-term care. Services are time limited and delivered in patients' own homes, community hospitals and sometimes nursing homes. But, as Louise Hunt reports, the second national audit of intermediate care, published late last year, found capacity in England is just half of what is needed. There is also significant variation between localities in capacity outside hospital and in the balance of bed-based, home-based and re-enablement services. Two case studies are presented of intermediate care services where nurses play an important role in achieving positive outcomes for patients and saving the health service money.