Development and validation of a nurse-assessed patient comfort score for colonoscopy.

BACKGROUND: Comfort during colonoscopy is a critical component of safety and quality. OBJECTIVE: To develop and validate the Nurse-Assessed Patient Comfort Score (NAPCOMS). DESIGN: Prospective scale validation. SETTING: Colorectal cancer screening centers in the United Kingdom and Canada. PATIENTS: A total of 300 consecutive patients undergoing colonoscopy at participating colorectal cancer screening centers. INTERVENTION: The NAPCOMS was developed by using a modified Delphi process. During colonoscopy, two endoscopy room nurses independently observed and rated patient comfort and tolerability by using NAPCOMS. In addition, endoscopists reported global comfort scores and patients' reported global comfort by using visual 4-point Likert and National Health Service-United Kingdom Global Rating Scales. MAIN OUTCOME MEASUREMENTS: Reliability and validity of NAPCOMS was measured by using intraclass correlations (ICC) between nurse ratings of colonoscopies and between NAPCOMS, endoscopist ratings, and patient ratings of global comfort. RESULTS: The ICC for the overall NAPCOMS was 0.84 (95% confidence interval [CI], 0.80-0.87). There was high agreement between the NAPCOMS and endoscopist ratings of comfort (ICC = 0.77; 95% CI, 0.72-0.81), moderate agreement between the NAPCOMS and patient ratings (ICC = 0.61; 95% CI, 0.53-0.67), and moderate agreement between the endoscopist and patient ratings (ICC = 0.52; 95% CI, 0.43-0.60). LIMITATIONS: NAPCOMS was validated in outpatients who received colonoscopy with minimal to moderate sedation as part of a screening and surveillance program, so performance among inpatients or those requiring deep sedation was not tested. CONCLUSION: NAPCOMS is a reliable and valid tool for assessing patient comfort in the setting of outpatient colonoscopy performed with minimal to moderate sedation.

Transitioning dementia residents from assisted living to memory care units: a pilot study.

Our study examined the process of transitioning residents of assisted living facilities (ALFs) who have Alzheimer's disease or a related disorder to memory care units (MCUs). In-depth surveys with 10 ALF administrators in South Carolina were conducted. Grounded theory identified major themes; thematic analysis organized content. Most administrators used a preadmission screening process to assess cognitive status. About half reported that they discussed the possibility of future transfer to another level of care with the family at admission. Most administrators said that their facilities had transfer policies in place; of these, only two-thirds discussed their policies with families on admission. Transfer triggers included leaving the facility without anyone's knowledge, disturbing behaviors, and increased care needs. Challenges included family resistance and greater costs of MCUs. Assisted living facilities that were part of continuing care retirement communities used more multidisciplinary transfer decision-making than free-standing ALFs. Suggested improvements stressed educating families about dementia and MCUs.

Dementia and transitioning from assisted living to memory care units: perspectives of administrators in three facility types.

PURPOSE: This study examines transitioning residents with Alzheimer's disease or a related disorder (ADRD) from assisted living facilities (ALFs) to memory care units (MCUs) from the perspective of 3 ALF organizational models: freestanding ALFs, ALFs with MCUs, and ALFs in continuing care retirement communities (CCRCs) with MCUs. DESIGN AND METHODS: In-depth interviews were conducted with 37 ALF administrators, representing the 3 ALF types. Grounded theory identified major themes. Thematic analysis organized content. The constant comparison method compared themes among ALF types. RESULTS: Administrators in freestanding ALFs were notably more likely to discuss transfer policies on admission. CCRCs with MCUs were more likely to make multidisciplinary decisions. In ALFs with MCUs, typically, the administrator and the director of nursing or resident care coordinator decided. In all ALFs, challenges included family resistance and denial of deficits, although there was notably less resistance in freestanding ALFs. CCRCs were much less likely than ALFs with MCUs to have trial admissions. IMPLICATIONS: ALF administrators may reduce family resistance to the MCU transfer by maintaining ongoing dialogue with family, discussing transfers at admission, conducting periodic resident reassessments, and providing opportunities for families to learn about ADRD.

Caregiver perspectives on transitions to assisted living and memory care.

This study describes family caregivers' experiences moving relatives with Alzheimer's disease or related disorders (ADRD) from their homes to assisted living facilities (ALFs) and subsequently to memory care units (MCUs). We also examined how these experiences differed between caregiver dyad types, such as adult children caring for parents. In-depth interviews with 15 caregivers were transcribed verbatim. Grounded theory identified themes. Constant comparative analysis compared experiences of caregiver dyads. Most caregivers recognized the likely need for future specialized care at the time of the move to the ALF, but did not recall receiving information about transfer policies. The ALF move was harder for spouses, the MCU move for adult children. Assisted living facilities can improve support for caregivers facing a relative's MCU transition through education about advantages of MCU placement and information about transfer policies. Support needs during transitions may differ between adult children and spouses.

Evaluating the roles of professional geriatric care managers in maintaining the quality of life for older Americans.

This study examined the roles of professional geriatric care managers (PGCMs). In-depth telephone surveys were completed with 19 PGCMs. Qualitative data were coded independently by two researchers. PGCMs reported that most clients and/or families seek services in response to a health crisis or because a family member was providing care at a distance. Most emphasized the importance of treating clients as autonomous decision-makers. Services described as most useful were supporting families and caregivers, being an advocate for clients, conducting initial assessments and ongoing follow up, and educating families about community resources and the financing of long term care. Regarding maintaining the quality of life for their older clients, a number of care managers described assisting clients to live independently at home, arranging for transfer to an appropriate level of care, and helping clients die peacefully with dignity. Major challenges PGCMs encountered were family conflicts and obtaining needed services. Recommendations to improve PGCM practice include increasing awareness of services, and establishing minimum professional standards through certification.

Evaluating best practices for social model programs for adults with Alzheimer's disease in South Carolina.

Our study has two objectives. First, we reviewed the literature, and identified best practices for social model day programs providing care for adults with Alzheimer's disease (AD). Second, in-depth telephone interviews were conducted with directors in all social model day programs (n = 21) dedicated to serving adults with AD in South Carolina to compare practices to those identified. Programs implemented many best practices, despite their rural location and small size. All programs assessed clients' activity preferences, and reassessed activity effectiveness regularly. Most programs provided volunteers and staff with AD-focused training. Many programs incorporated innovative programming such as intergenerational activities. Most programs were offered in a setting not designed for adult day services; thus many programs did not provide suggested environmental features such as extra lighting or walking paths. Most programs evaluated activities from caregivers' perspectives. All programs provided support for caregivers. Practice and policy recommendations are described.