Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study.

AIM: Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration. DESIGN: Qualitative study. METHODS: Semi-structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews. RESULTS: Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working. CONCLUSION: In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals. IMPACT: The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice. REPORTING METHOD: In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Perceived quality of collaboration in dehydration care among Dutch nursing home professionals: A cross-sectional study.

AIM: To explore the perceived quality of collaboration in dehydration care among nursing and medical staff in Dutch nursing homes. DESIGN: A cross-sectional study. METHODS: An online questionnaire was administered to nursing and medical staff in February 2020 to assess the quality of collaboration in dehydration care and its influencing factors. Descriptive statistics, chi-square tests and multinomial logistic regression analysis were used to describe the results and examine differences between groups. RESULTS: In total, 695 questionnaires were completed by multiple levels of (specialized) nursing staff and nursing home physicians. The quality of collaboration was assessed as good (23.2%), sufficient (59.4%) and insufficient (17.4%). Predicting factors related to perceiving the quality of collaboration as good were working experience, dehydration training during education and the presence of a dehydration protocol/guideline in the nursing home. Enabling factors related to collaboration in dehydration care were 'availability of sufficient aids to detect dehydration', 'continuity in the care relationship' and 'sufficient background data of the resident in the care record'. Factors that hinder collaboration were 'insufficient knowledge about dehydration among nursing and medical staff', 'the absence of a team meeting in which the topic dehydration is discussed' and 'insufficient staffing level among nursing and medical staff'. CONCLUSION: Collaboration in dehydration care was generally assessed as sufficient. Participants with >10 years of working experience, who received dehydration training during their education and had a dehydration protocol/guideline available in the nursing home, perceived the quality of collaboration more often as good. Experienced barriers and enablers for collaboration in dehydration care varied between professional groups. Therefore, it is important to gain more insight into (informal) caregivers' perceptions on what is expected from each other about dehydration care. IMPACT: Care professionals experience several limiting factors in collaborating in dehydration care. Addressing these factors could optimize dehydration care in Dutch nursing homes.

Dehydration in the nursing home: Recognition and interventions taken by Dutch nursing staff.

AIMS: To examine which signs/symptoms registered nurses (RNs) and certified nurse assistants (CNAs) (nursing staff) in Dutch nursing homes associate with dehydration, if they observe these signs/symptoms themselves and what they do after observing them. DESIGN: A cross-sectional study. METHODS: In February 2020, using an online questionnaire based on a diagnostic strategy to diagnose dehydration, nursing staff was asked: (1) which signs/symptoms they associate with dehydration; (2) if they observe these signs/symptoms themselves; and (3) which actions they take after observing these signs/symptoms in a resident. Descriptive statistics and Chi-square statistics were used to describe the answers and explore significant differences between groups. RESULTS: In total, 250 RNs and 226 CNAs participated. Among RNs, 67%-99% associated the signs/symptoms of the strategy to dehydration compared with 45%-98% of the CNAs. RNs and CNAs often indicated to observe signs/symptoms from the strategy themselves (80.1% and 92.6%), but they also often relied on information given by other care professionals and the informal caregiver. Interventions taken were mainly focused on communicating findings to colleagues. CONCLUSION: Many signs/symptoms from the diagnostic strategy trigger nursing staff to think of dehydration. Results also show that a variety of formal and informal caregivers are involved in dehydration care. As RNs and CNAs did often not receive dehydration training after entering workforce, this could have limited their ability to recognize signs/symptoms related to dehydration. To ensure timely recognition of dehydration, a clear description of roles and responsibilities about dehydration care in, and between, formal and informal caregivers is essential with structurally embedded dehydration training in the nursing home. IMPACT: Tackling dehydration in the nursing home requires interdisciplinary collaboration and communication with family members. Without clear roles and responsibilities, a risk of dehydration can be left unattended.

Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study.

PURPOSE: Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. METHODS: Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (≥ 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. RESULTS: After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. CONCLUSION: This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account.

Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review.

OBJECTIVES: To provide an overview of the prevalence rates and risk factors of dehydration among nursing home residents. DESIGN: Systematic literature review. SETTING: Nursing homes. PARTICIPANTS: Nursing home residents or institutionalized long-term care residents. MEASUREMENTS: A systematic literature review was executed on March 15, 2018, using the databases PubMed, CINAHL, and EMBASE to retrieve all articles focused on the prevalence rates and risk factors for acute and chronic dehydration. Studies were included if the target population involved nursing home residents or institutionalized long-term care residents. RESULTS: Nineteen studies were included in this systematic review. Prevalence rates of dehydration varied between 0.8% and 38.5% and were measured using different methods. Furthermore, 49 potential risk factors for dehydration were identified. Of the 12 potential risk factors that were investigated in more than 1 study, cognitive impairment and fever were significantly associated with dehydration among nursing home residents. CONCLUSIONS/IMPLICATIONS: Dehydration is a relevant and frequently occurring problem among nursing home residents. This systematic review shows that a wide variety of methods are used to assess dehydration and that it is often unclear which type of dehydration (chronic or acute) is measured. This makes it difficult to compare prevalence rates among studies. Moreover, only 2 of 49 potential risk factors (fever and cognitive impairment) were more than once significantly associated with dehydration in the respective studies. Most of the other risk factors were assessed by only 1 study or showed inconsistent results. Therefore, more research into dehydration among nursing home residents is needed.