Utility of the Healthy Aging Brain Care Monitor as a Patient-Reported Symptom Monitoring Tool in Older Injury Survivors.

INTRODUCTION: The objective of this study was to evaluate the performance of the Healthy Aging Brain Care Monitor (HABC-M) as a patient-reported outcome tool to measure cognitive, functional, and psychological symptoms among older adults who sustained non-neurologic injuries requiring hospital admission. METHODS: We used data from a multicenter randomized controlled trial to evaluate the utility of the HABC-M Self-Report version in older patients recovering from traumatic injuries. A total of 143 patients without cognitive impairment were included in the analysis. Cronbach's alpha was used to measure the internal consistency, and Spearman's rank correlation test was used to evaluate the relationship of the HABC-M with standard measures of cognitive, functional, and psychological outcomes. RESULTS: The HABC-M subscales and the total scale showed satisfactory internal consistency (Cronbach's alpha = 0.64 to 0.77). The HABC-M cognitive subscale did not correlate with the Mini-Mental State Examination. The HABC-M functional and psychological subscales correlated with corresponding standard reference measures (|rs| = 0.24-0.59). CONCLUSIONS: The HABC-M Self-Report version is a practical alternative to administering multiple surveys to monitor functional and psychological sequelae in older patients recovering from recent non-neurologic injuries. Its clinical application may facilitate personalized, multidisciplinary care coordination among older trauma survivors without cognitive impairment.

Nurses' coping strategies during and after an adult in-hospital resuscitation attempt: A scoping study.

AIM: A scoping study was conducted to identify and synthesise literature about nurse coping strategies during and after cardiopulmonary resuscitations (CPRs). BACKGROUND: Nurses frequently engage in CPR events that often lead to patient deaths thereby negatively impacting nurses' mental and physical health compromising patient safety. Little research has been conducted to explore coping strategies nurses use during and after a CPR event. DESIGN: Arksey and O'Malley's framework was used to guide the review process and PRISMA-ScR checklist for reporting the study. METHODS: A comprehensive search (January 1, 1996 - August 1, 2021) using ProQuest, PsychINFO, CINAHL and PubMed databases to locate peer-reviewed publications that met the study's inclusion criteria. We included publications of data collected from nurses who experienced a non-simulated adult CPR event in an acute or critical care hospital setting. Lazarus and Folkman's Ways of Coping Checklist, based on the transactional theory of stress and coping, was used to guide data analysis and categorise and label the coping strategies used by nurses. RESULTS: The search returned 2689 articles, and nine articles comprised the sample after excluding duplicates, titles, abstracts and full-text articles not meeting the inclusion criteria. Nine articles were reviewed to identify the coping strategies used by nurses during and after a CPR event. These strategies were grouped into eight categories. CONCLUSION: When resuscitation was successful, the experience carried little to no stress. The coping strategy most often used during a resuscitation attempt was planful problem solving. The coping strategies used after a failed resuscitation attempt were planful problem solving and seeking social support. Nurses reported that debriefing sessions were not desirable venues for discussing post-resuscitation stress. RELEVANCE TO CLINICAL PRACTICE: The provision of support by employers and colleagues must be intentionally planned and offered to nurses exposed to the stress induced by unsuccessful attempts at CPR.

The Relationship Between Staff Nurses' Perceptions of Nurse Manager Caring Behaviors and Patient Experience: A Correlational Study.

OBJECTIVE: The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience. BACKGROUND: Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care. METHODS: A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. RESULTS: There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility. CONCLUSION: Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.

Staff Nurses' Perceptions of Nurse Manager Caring Behaviors: A Scoping Study.

OBJECTIVE: The purpose of this scoping study is to review the published evidence regarding staff nurses' perceptions of nurse manager caring behaviors. BACKGROUND: As healthcare administration becomes more complex and financial challenges continue, the ability of nurse managers to lead patient care environments that produce desirable outcomes becomes critical. Demonstrating caring behaviors that build relationships with individuals and groups is a necessary competency of nursing administrators to advance healthcare. METHODS: This scoping study was guided by Arksey and O'Malley's methodology to review existing literature. RESULTS: Published literature provided knowledge of staff nurses' perceptions of nurse manager caring behaviors. The final sample was 13 publications. The results were summarized in both numeric and thematic analysis. CONCLUSIONS: Further research is needed to explore the relationship between nurse manager caring behaviors and patient outcomes.

Nursing professional capital: a qualitative analysis.

OBJECTIVE: The objective of this study was to offer qualitative support for the assertion that nurses possess professional capital. BACKGROUND: Nurses embrace professional standards and tenets that have been measured as trust and ethics. By understanding forms of capital and combining quantitative public-opinion surveys and our qualitative findings, a case can be made that nurses possess professional capital. METHOD: This was a focused review of existing interview data and was conducted using inductive content analysis. FINDINGS: Patients provided unsolicited accounts of trust and positive regard for their nurses. CONCLUSION: Evidence supports that in combination with trust and positive regard, nurses possess professional capital. Nurses should judiciously use their professional capital to impact institutional, political, and economic policy.

Chronic disease self-management: a hybrid concept analysis.

BACKGROUND: Chronic diseases require chronic disease self-management (CDSM). Existing CDSM interventions, while improving outcomes, often do not lead to long-lasting effects. To render existing and new CDSM interventions more effective, an exploration of the concept of CDSM from both the literature and patient perspectives is needed. The purpose of this study was to describe the current conceptualization of CDSM in the literature, identify potential inadequacies in this conceptualization based on a comparison of literature- and patient-based CDSM descriptions, and to offer a more comprehensive definition of CDSM. METHODS: A hybrid concept analysis was completed. DISCUSSION: In the literature, CDSM is defined as behaviors influenced by individual characteristics. Patients in the fieldwork phase discussed aspects of CDSM not well represented in the literature. CONCLUSIONS: CDSM is a complex process involving behaviors at multiple levels of a person's environment. Pilot work to develop and test CDSM interventions based on both individual and external characteristics is needed.

"Our depression is different": Experiences and perceptions of depression in young Black men with a history of incarceration.

One in three Black men in the US faces difficulties obtaining employment, housing and maintaining self-sufficiency post incarceration. Felony records result in considerable social and economic vulnerability, placing many young Black men at risk for depression. Little is known about depression in Black men with felony records. Twenty Black men with a history of incarceration were interviewed to explore perceptions and experiences of depression. Emergent themes were anger and negativity, depression is weakness, invisible depression, being strong and going on, and our depression is different. Findings have implications for clinicians who initiate ongoing therapeutic relationships with young Black men.

Physical activity and sedentary behavior in middle-aged intensive care unit survivors discharged home: A systematic review.

OBJECTIVES: The purpose of this study was to review literature on physical activity and sedentary behavior of middle-aged adults post-discharge from the intensive care unit, with a particular focus on studies using wearable activity trackers. METHODOLOGY: Systematic review conducted using correlational, cohort, and intervention studies of physical activity and sedentary behavior of intensive care unit survivors' post-discharge. Literature in PubMed, Embase, and CINAHL was searched using keywords derived from patient status, activity, and activity monitoring. Two independent reviewers used the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess quality of articles and potential biases in study design. MAIN OUTCOME MEASURES: Physical activity and sedentary behavior assessed via wearable activity trackers. RESULTS: Two hundred and fifty-six studies met inclusion criteria; six studies comprising 265 participants were retained. Outcomes varied widely and were not synthesized, but instead discussed individually. Average steps/day ranged from 1278 to 4958 and average minutes of activity ranged from 26 to 45 min/day. One study reported 12 hours and 17 min/day spent in sedentary activity and another reported 90 % of hospitalization was in sedentary behavior compared to 58 % post-discharge. CONCLUSION: Few studies have examined physical activity and sedentary levels of middle-aged intensive care unit survivors wearing activity trackers. Findings are limited in generalizability, and no randomized controlled trials were included here. Eliciting support from clinical and post-discharge care teams to encourage activity and/or attend prescribed therapy or rehabilitation sessions is important. IMPLICATIONS FOR CLINICAL PRACTICE: Clinicians should emphasize the importance of physical activity throughout the day to decrease sedentary time during a hospital stay and to continue being active after discharge to home. Physical activity is valuable, even in short spurts, from hospital stay through discharge. Interventions to increase physical activity and decrease sedentary time are needed to improve intensive care unit survivor recovery and quality of life post-discharge.

Equine-assisted service's effect on cartilage and skeletal biomarkers for adults and older adults with arthritis: A pilot study.

OBJECTIVE: The object of this study was to determine the effect of EAS (Equine-Assisted Services) on arthritis conditions, as measured by the sTnT (Skeletal troponin) and COMP (cartilage oligomeric matrix proteins) biomarkers, compared to an exercise attention control intervention. DESIGN: This was a secondary analysis of a randomized clinical trial comparing equine-assisted therapy to exercise education attention-control on cartilage and skeletal biomarkers in adults with arthritis. Twenty-one adults (Mage = 64 years) with arthritis who attended rheumatology clinics in the midwestern United States participated. RESULTS: No changes were found in sTnT from baseline to week six within either intervention nor were there differences in changes between the two groups (p = 0.91). COMP increased from baseline to week six for both conditions, suggesting increased deterioration of cartilage and joints. Although the attention-control condition demonstrated larger increases in cartilage oligomeric matrix proteins level, compared to the EAS condition, these differences were not statistically (p = 0.58) or clinically significant (i.e., trivial effect, d = -0.16). When 3 outliers were removed, the differences in changes between EAT and attention-control group could be arguably of clinical significance (d = - 0.33), suggesting that the attention-control group demonstrated larger increases in levels of COMP than those in the EAS condition, though this difference was not statistically significant (p = 0.28). CONCLUSION: Although equine-assisted therapy may reduce pain and improve quality of life for adults with arthritis, findings here are not fully corroborated with biomarkers.

Collaborative Care for Injured Older Adults: The Trauma Medical Home Randomized Clinical Trial.

Importance: Older adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs. Objective: To determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury. Design, Setting, and Participants: This was a single-blinded, randomized clinical trial conducted at 4 level I trauma centers in Indianapolis, Indiana, and Madison, Wisconsin. Between October 2017 and October 2021, patients aged 50 years and older with an Injury Severity Score (ISS) of 9 or greater and without traumatic brain or spinal cord injury were enrolled. Exclusions were significant brain injury or a spinal cord injury with a persistent neurologic deficit at the time of enrollment, extensive burns, pregnancy, incarceration, neurodegenerative disease, visual or auditory impairment that would preclude study participation, a life expectancy of less than 1 year, significant alcohol or drug use history, and acute stroke during admission. Of 10 276 patients screened, 430 were randomized and 299 completed 12-month follow-up. Data were analyzed from March to July 2023. Intervention: Intervention patients received 6 months of TMH delivered by a nurse care coordinator guided by an interdisciplinary team (trauma surgeon, pulmonary critical care and geriatrician physicians, nurses, and psychologist) in partnership with primary care. The care coordinator used standard protocols to monitor and treat biopsychosocial symptoms. Main Outcomes and Measures: Primary outcomes were Medical Outcome Study Short Form-36 (SF-36) score and Short Physical Performance Battery (SPPB) score at 12 months. Secondary outcomes were Patient Health Questionnaire-9 (PHQ-9) score, the Generalized Anxiety Disorder scale-7 (GAD-7) score, and health care utilization. Results: A total of 429 participants (228 [53.1%] female; mean [SD] age, 69.3 [10.8] years; mean [SD] ISS, 12.3 [4.6]) completed baseline assessments and were randomized. Follow-up was 76% (n = 324) at 6 months and 70% (n = 299) at 12 months. There were no differences between the TMH and usual care groups at 12 months in SF-36 Physical Component Summary score (mean [SD], 40.42 [12.82] vs 39.18 [12.43]), SF-36 Mental Component Summary score (mean [SD], 53.92 [10.02] vs 53.21 [10.82]), or SPPB score (mean [SD], 8.00 [3.60] vs 8.28 [3.88]). Secondary outcomes were also no different. Planned subgroup analysis revealed patients with baseline symptoms of anxiety or depression (high GAD-7 and PHQ-9 scores) experienced improvement in the Mental Component Summary score when randomized to the TMH intervention. Conclusions and Relevance: The TMH intervention did not significantly influence quality of life, depressive and anxiety symptoms, or physical function of older adults with injury at 12 months. Subgroup analysis showed positive impact in patients with a high burden of anxiety and depression symptoms at enrollment. Collaborative care interventions may improve long-term outcomes of select patients, but further research is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT03108820.

Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure: A Randomized Clinical Trial.

Importance: Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). Objective: To evaluate the efficacy of a post-intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. Design, Setting, and Participants: This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. Intervention: A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. Main Outcomes and Measures: The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. Results: In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, -1.06 to 4.29] for SF-36 PCS; -2.50 [95% CI, -5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Conclusions and Relevance: Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT03053245.

Older adults' perceptions of feeling safe in urban and rural acute care.

OBJECTIVE: The purposes of this study were to identify factors that influenced hospitalized older adults' perceptions of feeling safe and to identify differences in perceptions between rural and urban contexts. BACKGROUND: Efforts are underway to ensure patient physical safety and improve care quality in acute-care environments. Perception of care is a unique and independent dimension of quality that includes patients' views of care and how these perceptions might affect responses to illness. METHOD: Grounded theory method was used to identify the basic social process of feeling safe in acute care. RESULTS: Older adults felt safe when nurses provided oversight, were predictable, provided personalized care, and were willing to advocate for them. CONCLUSIONS: Findings are consistent with professional models that center on the human relational components of care. Nurse leaders can facilitate practice environments where relational aspects of nurse work, including patients' perceptions of feeling safe, are the norm, thereby creating exceptional patient care delivery systems.

Oncology nurses' experiences with prognosis-related communication with patients who have advanced cancer.

BACKGROUND: Oncology nurses have opportunities to engage in prognosis-related communication with patients who have advanced cancer but encounter barriers that impede the patient's understanding of prognosis, delay transitions to end-of-life care, and contribute to nonbeneficial treatments. PURPOSE: To describe nurses' experiences with prognosis-related communication with patients who have advanced cancer. METHOD: Thematic analysis of audio-recorded interviews with oncology nurses (n = 27). After data coding, themes were identified, and a thematic map was developed. Methods to ensure trustworthiness of the findings were used. RESULTS: Six themes were identified: being in the middle, assessing the situation, barriers to prognosis communication, nurse actions, benefits of prognosis understanding, and negative outcomes. Nurses managed barriers through facilitation, collaboration, or independent actions to help patients with prognosis understanding. CONCLUSIONS: Shortcomings in prognosis-related communication with patients who have advanced cancer may contribute to negative outcomes for patients and nurses. Interventions that empower nurses to engage in prognosis communications are needed. Interprofessional communication skills education also may be beneficial.

Psychometric Testing of a Scale Measuring Preceptor Preparedness: The Cap-ExPresSTM Study.

Background and Purpose: Preceptors educate nursing students to practice as novice, generalist nurses. There are no instruments measuring preceptor preparedness. The purpose of this study was to psychometrically test the Capstone-Experience Preceptor Preparedness Scale (Cap-ExPresS™). Methods: A cross-sectional multi-site survey design was used. Results: A convenience sample of 118 preceptors was recruited from four Midwest hospitals. Exploratory factor analysis supported a 22-item scale representing four factors demonstrating internal consistency reliability using Cronbach's alpha: total scale, 0.95, student-centeredness, 0.90, pedagogic competence, 0.90, clinical competence, 0.81, and nurse professionalism, 0.87. Test-retest reliability was adequate for clinical competence at 0.71, 0.50-0.61 for other scores. Some evidence of predictive validity was observed via regression. Conclusions: Psychometric testing supported the validity and reliability of inferences made about preceptor preparedness with Cap-ExPresS™ scores. Scale scores indicate preceptor learning needs, evaluate interventions influencing preceptor preparedness, and assist clinicians to develop best practices for preceptor preparedness.

The Nurses' Perception of Expressive Touch: An Integrative Review.

Introduction: Nurses use physical touch to interact with patients and address their needs. Human touch benefits social development, stress/anxiety reduction, and rapport building. Touch has been a part of nursing care for centuries, however nurses' perceptions of expressive touch are not easily ascertained from the literature. Literature currently offers one review on the perceptions of various medical professionals regarding touch of all kinds. No reviews specific to the nurses' perception of expressive touch exist. This integrative review provides a greater understanding of nurses' perceptions of expressive touch. Methods: Using Cooper's steps for integrative review, CINAHL, Medline, Academic Search Premier, and Complimentary Index were searched from 2000-2022; using search term expressive touch or caring touch or compassionate touch and nurse/nurses/nursing and perception or perspective. Results: Of 283 articles identified, 22 articles remained for full-text review after duplicate removal and application of inclusion/exclusion criteria. Five topics on nurses' perceptions of expressive touch were identified: Comfort with touch and job satisfaction, expressive touch as an essential part of nursing practice, expressive touch as a form of compassion and/or communication, the impact of expressive touch on the humanization of patients in the nurses' perception, and nurse discomfort with expressive touch. Conclusion: This integrative review provides findings that assist in understanding nurses' perceptions of expressive touch. Further research should examine the impact of gender, education, and experiences on nurses' perceptions as they use expressive touch in nursing practice.

Older homebound women's perceived risk of being unable to reach help quickly: influence of situations involving age-peers.

The purpose of this facet of a longitudinal descriptive phenomenological study of the experience of reaching help quickly for older homebound women was to explore the personal-social context (life-world) of situations when age-peers had needed to reach help quickly (RHQ). Twenty-five women aged 85-95 (13 subscribers to a personal emergency response system and 12 non-subscribers) reported 80 peer situations. Life-world was characterized by sharing with peers the risk of being unable to RHQ. Knowledge of peer situations had varying degrees of influence on participants' decisions to adopt and use RHQ devices. Findings support the need for healthcare professionals to explore the influences of age-peer RHQ situations upon adoption and use of devices to RHQ by older homebound women.

Student narratives of faculty incivility.

Academic incivility remains a problem on college campuses. Nursing research has refocused from student impropriety to aberrant faculty behaviors. Our original study using the Nursing Education Environment Survey showed that 133 of 152 student participants experienced uncivil treatment. Latent, inductive content analysis was undertaken to analyze narratives about their "worst experience" of negative faculty behavior. Four categories were identified: "In front of someone," "Talked to others about me," "Made me feel stupid," and "I felt belittled." Incivility had a profound effect on students and is problematic because it increases already significant academic pressure; it interferes with learning and safe clinical performance; it is contrary to caring, a central nursing concept; and it decreases program satisfaction and retention. Few nursing schools have civility policies for faculty behavior. Formal procedures that promote professional interaction should be crafted and implemented. Equally important is creating ways for nursing students to document incivility without fear of retaliation.

Cross-sectional study of the relationship between experiences of incivility from staff nurses and undergraduate nursing students' sense of belonging to the nursing profession.

AIM: This study examined the frequency of incivility for undergraduate nursing students and the relationship between staff nurse incivility and nursing students' sense of belonging. Factors between program semester and students' body mass index (BMI) to staff nurse incivility and students' sense of belonging were assessed. BACKGROUND: Sense of belonging enhances belonging development to the profession. However, no studies address the relationship between incivility and nursing students' sense of belonging. METHODS: A cross-sectional design assessed the relationship between staff nurse incivility and undergraduate nursing students' sense of belonging to the nursing profession. An online survey was administered to 123 pre-licensure junior and senior undergraduate nursing students from February 1, 2021, to May 5, 2021. Correlation coefficient, descriptive statistics, Fisher r-to-z transformation, 95% confidence intervals were calculated. RESULTS: Staff nurse incivility inversely correlated with undergraduate nursing students' sense of belonging (rs=-.358; p <.001). American Indian or Alaskan Native students reported the highest mean frequency of incivility (1.25 ± .421). There were no significant differences in correlations based on semester or BMI. CONCLUSION: Staff nurse incivility is inversely associated with sense of belonging in students. Further research is needed to test interventions mitigating the effects of incivility on belonging.

Pre-Existing Anxiety and Depression in Injured Older Adults: An Under-Recognized Comorbidity With Major Health Implications.

To compare differences in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Background: Little is known about the prevalence and impact of psychiatric comorbidities on early postinjury depression and anxiety in nonneurologically injured older adults. Methods: This was a retrospective post-hoc analysis of data from the Trauma Medical Home, a multicenter randomized controlled trial (R01AG052493-01A1) that explored the effect of a collaborative care model on postinjury recovery for older adults compared to usual care. Results: Nearly half of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9. Forty-one percent of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) had greater odds of at least mild depression at the time of hospital discharge after traumatic injury. Conclusions: Anxiety and depression are prevalent in the older adult trauma population, and affect women disproportionately. A dual diagnosis of depression and anxiety is particularly morbid. Mental illness must be considered and addressed with the same importance as other medical diagnoses in patients with injuries.

Older adults' perceptions of feeling safe in an intensive care unit.

AIM: This paper is a report of a study of older adults' perceptions of feeling safe in an intensive care unit. BACKGROUND: Significant ageing of the world population is expected. Correspondingly, there is a growing global urgency for healthcare systems to prepare for the increased number of older adults who will require intensive care. Although patients have recounted situations in which feeling safe was essential to their experience, there is little empirical evidence about feeling safe for older adults in intensive care. METHOD: In 2008, 10 older adults who suffered unexpected critical health events and who were admitted to intensive care units were recruited for this grounded theory study. Participants were interviewed after transferring to an intermediate care unit and again after discharge. They were asked to reflect upon and discuss their experiences of feeling safe in intensive care. FINDINGS: Participants' actual and expected interaction with intensive care nurses was essential to their perceptions of feeling safe. Four main categories were identified as requisite to interaction with nurses: proximity, oversight, predictability and initiative. A substantive grounded theory of feeling safe for older adults in intensive care is presented. CONCLUSION: Nurses must present themselves as accessible so patients perceive that they can initiate interaction with a qualified nurse. Patients must also see that nurses are monitoring them and believe that the nurses will help them if they experience a critical health event while in the intensive care unit.