Care of older people with Cognitive Impairment or Dementia Hospitalized in Traumatology Units (CARExDEM): a quasi-experiment.

BACKGROUND: In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia. METHODS: A quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia. DISCUSSION: Our aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes. TRIAL REGISTRATION: Registered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/ Protocol Record HCB/2017/0499. SPONSOR: Hospital Clinic Barcelona.

Impact of Hospitalization of People With Dementia or Cognitive Impairment on Family Caregivers.

People with dementia (PWD) have a higher risk of hospitalization than people without dementia. Hospitalizations are stressful events for PWD and their caregivers, representing a considerable change to their routines. The current descriptive longitudinal study aimed to identify the positive and negative reactions, experiences related to health and social integrated care, resource use, and work status of family caregivers of PWD or cognitive impairment admitted to the hospital with a proximal femur fracture undergoing surgery. Findings indicated that family caregivers (N = 174) are fully committed to providing assistance in activities of daily living and supervision, showing positive attitudes on self-esteem and negative attitudes toward lack of family support and impact on finances, schedule, and health. Overall caregiver experiences with integrated health and social care improved after hospitalization but decreased after discharge. One month after hospitalization, family caregivers maintained the same work hours but used fewer health care resources. Hospitalization represents a good opportunity to approach family caregivers and determine their needs to provide them with interventions to minimize their burden and improve their well-being. [Research in Gerontological Nursing, 16(6), 283-290.].

Validation of the Spanish Version of the Double Knowledge Expectations and Received Knowledge Significant Other Scale for Informal Caregivers of People with Dementia (KESO-DEM/RKSO-DEM).

Dementia is associated with cognitive decline. Becoming an informal caregiver raises questions, requiring information and support from health professionals to guide home care. A multicenter, longitudinal study was carried out to validate the Spanish version of the double scale of expected and received knowledge for informal caregivers of people with dementia (KESO-DEM/RKSO-DEM), the analysis of the dimensional structure of the instrument, its validity and reliability, and temporary stability was carried out. An analysis of criterion and construct validity, internal consistency, and test−retest stability was performed. The evaluation of the interrelation between dimensions was statistically significant. Regarding internal consistency, the scale values were good both for the scale totals and for each dimension of knowledge, with Cronbach's alpha coefficients of 0.97. For criterion validity, all items showed temporal stability for both questionnaires (p < 0.05). The availability of a valid, reliable tool for the measurement of expected and received knowledge in caregivers of people with dementia allows an approach based on the real needs of the family and the patient. It is important to design care protocols for people with dementia that are adapted to their needs and expectations and to their non-curative treatment, to improve the emotional well-being of patients and informal caregivers.

Profile of Patients with Dementia or Cognitive Impairment Hospitalized with a Proximal Femur Fracture Requiring Surgery.

This study reports the characteristics of patients with dementia or cognitive impairment hospitalized with a proximal femur fracture requiring surgery. METHODS: Multicentric descriptive longitudinal study conducted in three traumatology units, representing high-technology public hospitals across Spain. Data collection took place between August 2018 and December 2019 upon admission to hospital, discharge, one month and three months after discharge. RESULTS: Study participants (n = 174) were mainly women (81.6%), and the mean age was 90.7± 6.3 years old. Significant statistical differences were noted in the decline of functional capacity at baseline and one month later, and after three months they had still not recovered. Malnutrition increased from baseline to the one-month follow-up. The use of physical restraints increased during hospitalization, especially bilateral bedrails and a belt in the chair/bed. After one month, 15.2% of patients had pressure ulcers. Although pain decreased, it was still present after three months. CONCLUSION: Hospitalization after hip surgery for elderly people with dementia or cognitive impairment negatively impacted their global health outcomes such as malnutrition and the development of pressure ulcers, falls, functional impairment and the use of physical restraints and pain management challenges. Hospitals should implement policy-makers' strategic dementia care plans to improve their outcomes.

Experiences of nursing students as healthcare aid during the COVID-19 pandemic in Spain: A phemonenological research study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused a worldwide health and social crisis directly impacting the healthcare system. Hospitals had to rearrange its structure to meet clinical needs. Spain has been experiencing a shortage of working nurses. Student nurses in their last year at university were employed to help the National Health System respond to the COVID-19 crisis. AIM: The aim of this study was to explore and understand the experience of nursing students' roles as healthcare aid in responding to the COVID-19 crisis. METHODS: A qualitative phenomenology design was used to explore undergraduate nursing students' perceptions of their experiences as HAs during the COVID-19 outbreak. Open face-to-face interviews were conducted to nursing students (n = 10) in May 2020. Data was analyzed using the hermeneutic interpretative approach. RESULTS: All participants were women aged between 21 and 25 years. Seven main themes emerged: learning, ambivalent emotions and adaptation were classified at a personal level; teamwork, patient communication, and unclear care processes were categorized under hospital structure; and coping mechanisms were part of external factors. CONCLUSIONS: Orientation, follow-up, and emotional support in crisis situations are key to unexperienced healthcare workers overcoming stressful emotions. Previous academic education and training may help novice future nurses feel more confident about their tasks and responsibilities as well as improve patient outcomes, resource management, and staff safety.

Lived Experiences of Hospitalized COVID-19 Patients: A Qualitative Study.

The COVID-19 pandemic has resulted in many hospitalized patients and deaths worldwide. Coronavirus patients were isolated from their relatives and visits were banned to prevent contagion. This has brought about a significant change in deeply rooted care habits in Mediterranean and Latin American countries where the family normally accompanies vulnerable hospitalized patients. The aim of this qualitative study was to examine the hospitalization experience of COVID-19 patients and their family members. A phenomenological qualitative approach was used. Data collection included inductive, in-depth interviews with 11 COVID-19 hospitalized patients. The mean age of patients was 55.4 years and 45% were female. Nearly 50% required Intensive Care Unit (ICU) admission. Ten meaningful statements were identified and grouped in three themes: Positive and negative aspects of the care provided, the patient's perspective, and perception of the experience of the disease. In conclusion, COVID-19 patients, aware of the severity of the pandemic, were very adaptable to the situation and had full confidence in health professionals. Patient isolation was perceived as necessary. Technology has helped to maintain communication between patients and relatives.