Human T cell generation is restored in CD3δ severe combined immunodeficiency through adenine base editing.

CD3δ SCID is a devastating inborn error of immunity caused by mutations in CD3D, encoding the invariant CD3δ chain of the CD3/TCR complex necessary for normal thymopoiesis. We demonstrate an adenine base editing (ABE) strategy to restore CD3δ in autologous hematopoietic stem and progenitor cells (HSPCs). Delivery of mRNA encoding a laboratory-evolved ABE and guide RNA into a CD3δ SCID patient's HSPCs resulted in a 71.2% ± 7.85% (n = 3) correction of the pathogenic mutation. Edited HSPCs differentiated in artificial thymic organoids produced mature T cells exhibiting diverse TCR repertoires and TCR-dependent functions. Edited human HSPCs transplanted into immunodeficient mice showed 88% reversion of the CD3D defect in human CD34+ cells isolated from mouse bone marrow after 16 weeks, indicating correction of long-term repopulating HSCs. These findings demonstrate the preclinical efficacy of ABE in HSPCs for the treatment of CD3δ SCID, providing a foundation for the development of a one-time treatment for CD3δ SCID patients.

Polycomb proteins remain bound to chromatin and DNA during DNA replication in vitro.

The transcriptional status of a gene can be maintained through multiple rounds of cell division during development. This epigenetic effect is believed to reflect heritable changes in chromatin folding and histone modifications or variants at target genes, but little is known about how these chromatin features are inherited through cell division. A particular challenge for maintaining transcription states is DNA replication, which disrupts or dilutes chromatin-associated proteins and histone modifications. PRC1-class Polycomb group protein complexes are essential for development and are thought to heritably silence transcription by altering chromatin folding and histone modifications. It is not known whether these complexes and their effects are maintained during DNA replication or subsequently re-established. We find that when PRC1-class Polycomb complex-bound chromatin or DNA is replicated in vitro, Polycomb complexes remain bound to replicated templates. Retention of Polycomb proteins through DNA replication may contribute to maintenance of transcriptional silencing through cell division.

Nursing Students' Perceptions on a Pain Management E- Learning Module: An Exploratory Quantitative Study.

BACKGROUND: Nursing students are graduating ill-prepared to assess and manage pain in older adults. To address this gap, we developed an e-learning module on the topic. AIM: To examine nursing students' perceptions on a pain management e-learning module focused on older adults. METHODS: Utilizing an exploratory quantitative design, we assessed nursing students' perceptions of the e-learning module. We used a feedback survey (four 5-point, Likert-type items) and one open-ended question to assess students' perceptions. Descriptive statistics were used to summarize students' perceptions and demographic characteristics. Responses to the open-ended question were content analyzed. RESULTS: A total of 181 of 249 students completed the module, of whom two-thirds were female. Students perceived that the module enhanced their knowledge, confidence, and perception in working with older people. Students also found the method of instruction interactive and enjoyable. CONCLUSIONS: The e-learning module on pain management was viewed by nursing students to be helpful and its interactive method of learning improved their knowledge, confidence, and perceptions of working with older adults in pain.

The Effects of Stigma: Older Persons and Medicinal Cannabis.

Cannabis has long been stigmatized as an illicit drug. Since legalization in Canada for both medical and recreational purposes, older adults' cannabis consumption has increased more than any other age group. Yet, it is unclear how the normalization of cannabis has impacted perceptions of stigma for older adults consuming cannabis medicinally. Qualitative description was used to elucidate the experiences of older Canadians aged 60+ related to stigma and their consumption of cannabis for medicinal purposes. Data collection involved semi-structured interviews. Data analysis examined how participants managed stigma related to cannabis use. Perceived stigma was evident in many participants' descriptions of their perceptions of cannabis in the past and present, and influenced how they accessed and consumed cannabis and their comfort in discussing its use with their healthcare providers. Participants employed several distinct strategies for managing stigma-concealing, re-framing, re-focusing, and proselytizing. Findings suggest that while medical cannabis consumption is becoming increasingly normalized among older adults, stigma related to cannabis persists and continues to shape older adults' experiences. A culture shift needs to occur among healthcare providers so that they are educated about cannabis and willing to discuss the possibilities of medicinal cannabis consumption with older adults. Otherwise, older adults may seek advice from recreational or other non-medical sources. Healthcare providers require education about the use of medical cannabis, so they can better advise older adults regarding its consumption for medicinal purposes.

'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay.

INTRODUCTION: Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay. METHODS: We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed. RESULTS: We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates. CONCLUSIONS: Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.

Nursing Students' Views on an e-Learning Activity About Health Promotion for Older Adults: A Cross-Sectional Study.

PURPOSE: Nurses are graduating ill-prepared to work with older adults across care contexts. The education nursing students receive about older adults often focuses on managing illnesses rather than promoting health. To expand the education that nursing students receive regarding health promotion and older adults, we examined nursing students' perceptions of an e-learning activity on health promotion with older adults. METHOD: We used a cross-sectional survey design. We included first-year baccalaureate nursing students (N = 260) at a Canadian university. Students were required to complete the module, but only those who wanted to participate in the study completed the survey (n = 167; response rate = 64.2%). We used a feedback survey to assess students' perceptions of the e-learning activity using four 5-point, Likert-type items. We also asked one open-ended question to solicit participants' feedback and suggestions for improving the e-learning activity. Descriptive statistics (frequency, mean [SD]) were used to summarize participants' perceptions and demographic characteristics. Content analysis was used to explore responses to the open-ended question. RESULTS: Participants reported that the module increased their knowledge about health promotion, as well as their perceptions and confidence in working with older adults. Participants also found the method of instruction interactive and enjoyable. CONCLUSION: Our e-learning activity on health promotion was perceived by nursing students as helpful in sensitizing them to their role in promoting health among older adults. [Journal of Gerontological Nursing, 50(3), 19-24.].

Environmental stress, minority status, and local poverty: risk factors for mental health in Berlin's inner city.

This study examines whether climate change-associated environmental stressors, including air and noise pollution, local heat levels, as well as a lack of surrounding greenspace, mediate the effects of local poverty on mental health, using the 28-item General Health Questionnaire. We recruited 478 adults who were representative of eleven of Berlin's inner-city neighborhoods. The relationship of individual-level variables, neighborhood-level sociodemographic and environmental data from the Berlin Senate (Department for Urban Development, Building and Housing) to mental health was assessed in a multilevel model using SPSS. We found that neither local exposure to environmental stressors, nor available greenspace as a protective factor, mediated the effects of local poverty on variance in mental health (all p values > 0.2). However, surrounding greenspace (r = -0.24, p < 0.001), nitrogen dioxide levels (r = 0.10, p < 0.05), noise pollution (rho = 0.15, p < 0.01), and particle pollution (r = 0.12, p < 0.001) were associated with local poverty, which, more strongly than individual factors, accounted for variance in mental health (ß = 0.47, p < 0.001). Our analysis indicates that the effects of local poverty on mental health are not mediated by environmental factors. Instead, local poverty was associated with both an increased mental health burden and the exposure to climate-related environmental stressors.

Improving practicing nurses' knowledge of the cognitive impairment, continence, and mobility needs of older people.

OBJECTIVES: To test if two e-learning modules - one on cognitive impairment, and one on continence and mobility - in older people would improve the knowledge of nurse members from the Canadian Gerontological Nurses Association and College of Licensed Practical Nurses of Alberta. METHODS: A pre-post-test design was used to test 88 nurses' knowledge of cognitive impairment and 105 nurses' knowledge of continence and mobility and their perceptions of how the modules contributed to their learning. RESULTS: There was a statistically significant increase in practicing nurses' knowledge about cognitive impairment (0.68 increase), continence (2.30 increase), and its relationship to mobility. Nurses' self-report on the feedback survey demonstrated increases in knowledge, confidence, and perceptions about older people. CONCLUSION: These results suggest the modules have strong potential to enhance practicing nurses' knowledge about cognitive impairment, continence, and mobility.

E-learning modules to enhance student nurses' perceptions of older people: a single group pre-post quasi-experimental study.

OBJECTIVES: To examine whether e-learning activities on cognitive impairment (CI), continence and mobility (CM) and understanding and communication (UC) improve student nurses' knowledge and attitudes in the care of older adults. METHODS: A quasi-experimental single group pre-post-test design was used. We included 299 undergraduate nursing students for the CI module, 304 for the CM module, and 313 for the UC module. We administered knowledge quizzes, Likert scales, and a feedback survey to measure student nurses' knowledge, ageist beliefs, and feedback on the modules respectively. RESULTS: Participants demonstrated significantly more knowledge and reduced ageist attitudes following the e-learning activities. CONCLUSIONS: Findings suggest that e-learning activities on cognitive impairment, continence and mobility, and understanding and communication improve knowledge and reduce ageist attitudes among nursing students.

Family caregivers' preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study.

BACKGROUND: Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients' engagement in physical activity. Yet, there is very little research on family caregivers' perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored the challenges related to family caregivers' preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission. METHODS: In this interpretive descriptive study, semi-structured interviews were conducted by telephone with 16 family caregivers. Interview transcripts were analyzed using thematic analysis. RESULTS: Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26-67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 75%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers generally felt unprepared to support their relative's physical activity, 2) some family caregivers believed that rest was more important than physical activity to their relative's recovery, 3) insufficient physical activity preparation led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity. CONCLUSIONS: Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers' ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative's physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

Healthcare consumers' and professionals' perceived acceptability of evidence-based interventions for rural transitional care.

BACKGROUND: There is a pressing need for high quality hospital-to-home transitional care in rural communities. Four evidence-based interventions (discharge planning, treatments, warning signs, and physical activity) have the potential to improve rural transitional care. However, there is limited understanding of how the perceptions of healthcare consumers and professionals compare on the acceptability of the interventions. Convergent views on intervention acceptability support implementation, whereas divergent views highlight areas requiring reconciliation prior to implementation. AIMS: This study compared the acceptability of four evidence-based interventions proposed for rural transitional care, as perceived by healthcare consumers and professionals. METHODS: A cross-sectional, comparative design was used. The convenience sample included 36 healthcare consumers (20 patients and 16 family caregivers) who had experienced a hospital-to-home transition in the past month and 30 healthcare professionals (29 registered nurses and one nurse practitioner) who provided transitional care in rural Ontario, Canada. Participants were presented with descriptions of the four interventions and completed an established intervention acceptability measure. Presentation of the four intervention descriptions and respective acceptability measures was randomized to control for possible order effects. The perceived overall acceptability of the interventions and their attributes (i.e., effectiveness, appropriateness, risk, and convenience) were compared using independent samples t-tests. RESULTS: Consumer ratings were consistently higher across all four interventions in terms of overall acceptability as well as effectiveness, appropriateness, and convenience (all p's < .01; effect sizes 0.70-1.13). No significant between-group differences in perceived risk were found. LINKING EVIDENCE TO ACTION: Contextual and methodological differences may account for variability in ratings, but further research is needed to explore these propositions. The results support future qualitative inquiry targeting professionals to better understand their perspectives on the effectiveness, appropriateness, and convenience of the four interventions.

Improving practicing nurses' knowledge and perceptions of older people: a quasi-experimental study.

OBJECTIVES: This study aimed to determine if an e-learning module about understanding and communicating with older people can improve practicing nurses' ageist perceptions about older people. METHODS: We used a quasi-experimental pre-post-test design. Participants completed a 13-item Ambivalent Ageism Scale before and after completing the Understanding and Communicating with Older People e-learning module as well as a Likert-style feedback survey with the option for written feedback on an open-ended question. RESULTS: Pre-post-test comparisons indicated a statistically significant decrease in ageist attitudes and self-reported increases in knowledge and confidence in working with older people. Qualitative analysis of written feedback revealed that most participants felt the module enhanced their understanding of older people. CONCLUSIONS: The e-learning activity has the potential to improve practicing nurses' knowledge and perceptions about working with older people and is likely to be associated with better patient-level outcomes.

Awakening Canadians to ageism: a study protocol.

BACKGROUND: Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses-the largest and most trusted group of healthcare professionals-to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies. METHODS: To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies. DISCUSSION: Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses' perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging-older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

[Good practice in health reporting-from the beginning to version 2.0]. / Gute Praxis Gesundheitsberichterstattung ­ von der Idee bis zur Version 2.0.

In the context of public health, health reporting functions as a mediator between science and policy. The development of guidelines for good practice in health reporting took place in response to needs that were frequently expressed by experts in this public health area. The pilot version of the guidelines was drawn up in 2011 and discussed at a number of relevant conferences. After the publication of version 1.0 in 2017, another peer review process followed, which led to the extensively revised guidelines for good practice in health reporting as version 2.0. As health reporting is currently in a process of innovation and increasing in importance, it is foreseeable that the guidelines will have to be revised again in the not too distant future.

Nurses' Perspectives on Interprofessional Communication in the Prevention of Functional Decline in Hospitalized Older People.

Older people present with complex health issues on admission to hospital and are at high risk for functional decline and related complications. Thus, they require the services of diverse health-care professionals working in concert to support their functioning. Despite nurses' central role in caring for this patient population, and evidence indicating that interprofessional communication is a persistent challenge for nurses in acute-care settings, little is known about nurses' views on interprofessional communication in care preserving functioning in acutely admitted older people. To fill this knowledge gap, we gathered acute-care staff nurses' perspectives on interprofessional communication in a function-focused, interprofessional approach to hospital care for older adults. Thirteen focus groups were conducted with a purposeful, criterion-based sample of 57 nurses working in acute-care hospitals. Thematic analysis revealed two overarching themes capturing nurses' perspectives on key factors shaping interprofessional communication in a function-focused interprofessional approach to care (1) context of direct communication and (2) context of indirect communication. The first theme demonstrates that nurses preferred synchronous modes of communication, but some ascribed greater importance to unstructured forms of direct information-sharing, while others stressed structured direct communication, particularly interprofessional rounds. The second theme also documents divergence in nurses' views on asynchronous communication, with some emphasizing information technology and others analog tools. Perceptions of some modes of interprofessional communication were found to vary by practice setting. Theoretical and pragmatic conclusions are drawn that can be used to optimize interprofessional communication processes supporting hospitalized older people's functioning.

Strategies to customize responsible gambling messages: a review and focus group study.

BACKGROUND: Responsible gambling messages are widely used as a tool to enable informed choice and encourage appropriate gambling behavior. It is generally accepted that gamblers have different levels of risk of developing gambling problems and require various harm minimization tools and resources. Therefore, it is reasonable to expect that responsible gambling messages should be customized and target specific groups of gamblers. This project aimed to understand hypothesized differences between cohorts of gamblers and receive qualitative feedback on archetypal targeted messages used to increase use of responsible gambling tools. METHODS: Focus groups were held to test messages for specific cohorts: young adults (18-24 years), seniors (60+ years), frequent gamblers (weekly), and gamblers of skill-based games (poker, sports betting). RESULTS: Cohorts exhibited different preferences and responses to message archetypes. Seniors preferred messages about limit setting, whilst young adults and frequent gamblers responded to messages about their own play and expertise. Skill game gamblers were interested in the odds of winning and their own outcomes over time. However, all groups agreed that using positive, non-judgmental language in messaging is important. CONCLUSIONS: This research makes an important contribution to the field by demonstrating that the wording of message content will likely influence the effectiveness of such messages differentially across various groups of gamblers for engaging gamblers in harm reduction tools. Guidance is provided on themes that can be used by public health marketers.

The Relationships Between the Geriatric Practice Environment, Nursing Practice, and the Quality of Hospitalized Older Adults' Care.

PURPOSE: To test the relationships between the geriatric practice environment, geriatric nursing practice, and overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics. DESIGN: A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada. METHODS: Participants (N = 2,005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling. FINDINGS: Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (ß = 0.52) and overall quality of care (ß = 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (ß = -0.02). Final model fit was acceptable, with the root mean square error of approximation = 0.07, comparative fit index = 0.93, and Tucker-Lewis Index = 0.87. CONCLUSIONS: A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice. CLINICAL RELEVANCE: The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.

Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

A Multi-Method Study of the Geriatric Learning Needs of Acute Care Hospital Nurses in Ontario, Canada.

Older people are at risk of experiencing functional decline and related complications during hospitalization. In countries with projected increases in age demographics, preventing these adverse consequences is a priority. Because most Canadian nurses have received little geriatrics content in their basic education, understanding their learning needs is fundamental to preparing them to respond to this priority. This two-phased multi-method study identified the geriatrics learning needs and strategies to address the learning needs of acute care registered nurses (RNs) and registered practical nurses (RPNs) in the province of Ontario, Canada. In Phase I, a survey that included a geriatric nursing knowledge scale was completed by a random sample of 2005 Ontario RNs and RPNs. Average scores on the geriatric nursing knowledge scale were in the "neither good nor bad" range, with RNs demonstrating slightly higher scores than RPNs. In Phase II, 33 RN and 24 RPN survey respondents participated in 13 focus group interviews to help confirm and expand survey findings. In thematic analysis, three major themes were identified that were the same in RNs and RPNs: (a) geriatric nursing is generally regarded as simple and custodial, (b) older people's care is more complex than is generally appreciated, and (c) in the current context, older people's care is best learned experientially and in brief on-site educational sessions. Healthcare providers, policy-makers, and educators can use the findings to develop educational initiatives to prepare RNs and RPNs to respond to the needs of an aging hospital population.

Nurses' perspectives on how operational leaders influence function-focused care for hospitalised older people.

AIMS: To explore nurses' perspectives on how leaders influence function-focused care, defined as care that preserves and restores older people's functional abilities. BACKGROUND: Hospitalised older people are at risk of functional decline. Although leaders have the potential to influence function-focused care, few studies have explored nurses' perspectives on how leaders influence function-focused care. METHODS: Thirteen focus groups were held with 57 acute care nurses. Semi-structured questions prompted discussion on nurses' perspectives, needs and strategies to meet their needs. Data were thematically analysed. RESULTS: Three themes were identified: (1) the emphasis in hospitals is on moving older people quickly through the system, not supporting their functioning; (2) leaders are generally seen as too disconnected from practice to design system efficiency initiatives that support older people's functioning and nurses' provisioning of function-focused care; and (3) leadership strategies to better support nurses in providing function-focused care to older people in the context of system efficiency. CONCLUSIONS: Leaders should connect with practice to devise age-sensitive efficiency initiatives that support function-focused care. Nurses need support from leaders in four areas to provide function-focused care to older people in the current hospital context. IMPLICATIONS: The findings provide direction on how leaders can facilitate function-focused care in the current health-care environment emphasising system efficiency.