80 An Exploration of What Stakeholders Reveal About the Behaviours and Personality of Registered Nurses Working in Older People’s Acute Care Settings and the Potential Influence on Nursing Care

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i25-i26
Author(s):  
H Day
Keyword(s):  
Older People ◽  
Personality Traits ◽  
Acute Care ◽  
Nursing Care ◽  
Nursing Staff ◽  
Positive Impact ◽  
Care Delivery ◽  
Structured Interviews ◽  
Authentic Self ◽  
Acute Care Settings

Abstract Background Concern around poor standards of nursing care for older people in hospital has been explored in relation to workload and operational pressures. What is less evident from existing literature is an explanation as to why nurses behave differently under the same pressures within the same concrete situations. Notions of personality and associated behaviours as possible influencers on nursing care delivery are variables that required consideration. Aim To critically explore the behaviours of registered nursing staff working in older people's acute care settings from the perspectives gathered from key stakeholders, and to identify whether there are any distinguishing personality traits that influence effective care delivery for older people. Methods A constructivist grounded theory methodology was used. Semi structured interviews were conducted to gather data from 12 stakeholder participants. Results Through the analysis of data gathered from stakeholders a rubric describing specific behaviours with associated traits emerged leading to the identification of two major types of nursing staff. One group of nurses who work with older people are perceived to have no real desire to do so and in turn their care behaviours are perceived as ‘cold’ and task based. The second group of nurses are perceived as having a true commitment to older people’s wellbeing and their behaviours lead to the delivery of care that is perceived as being highly skilled and compassionate. The proposed theoretical framework that was constructed from this data analysis identifies four key personality traits related to nursing behaviours: conscientiousness, sociability, integrity and coping under a core category heading of ‘the authentic self’. Whilst the authentic self is identified as being the direct influencer on how care is delivered which is defined as the consequence, the influence of context is also taken into account. Conclusions This research offers insights into the meaning of four key traits and the behavioral facets comprising them, the associated behaviors that are displayed and what effect these have on nursing care delivery. Implications for healthcare practice include the potential for further research that can inform the development of educational and recruitment strategies for older people’s nurses which will have a positive impact on the care of the older patient in hospital.

scholarly journals Nursing care time and quality indicators for adult intensive care: correlation analysis

2012 ◽  
Vol 20 (4) ◽  
pp. 651-658 ◽  
Author(s):  
Paulo Carlos Garcia ◽  
Fernanda Maria Togeiro Fugulin
Keyword(s):  
Intensive Care ◽  
Correlation Analysis ◽  
Intensive Care Units ◽  
Quality Indicators ◽  
Nursing Care ◽  
Nursing Staff ◽  
Care Delivery ◽  
Average Length ◽  
Quality Care ◽  
Descriptive Study

The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

Development of an Oral Care Multidisciplinary Initiative in an Acute Care Community Hospital: Framework, Timeline, and Outcomes

2021 ◽  
Vol 30 (2) ◽  
pp. 517-531
Author(s):  
Laurie Wennerholm ◽  
Nilsa Rubin Perez ◽  
Suzanne Abt ◽  
Karen Fon ◽  
Kerri Elsabrout
Keyword(s):  
Acute Care ◽  
Task Force ◽  
Care Delivery ◽  
Oral Care ◽  
Care Organization ◽  
Convenience Sample ◽  
Care Community ◽  
Current State ◽  
Acute Care Settings ◽  
Hospital Acquired

Purpose Published literature universally supports the provision of oral care in acute care settings to decrease hospital-acquired aspiration pneumonia (HAAP) events. This evidence-based practice project aimed to implement a comprehensive oral care initiative to reduce a problematic HAAP rate. Method Through a comprehensive, multidisciplinary approach, the project scope included an assessment of the current state of oral care delivery, development of an Oral Care Task Force, creation of risk stratification criteria with recommended oral care products, and robust education for the clinical staff. Data were gathered using a small convenience sample of inpatients and hospital-wide HAAP rates. Results Over the 1 year of implementation and education associated with this multidisciplinary project, the organization saw an increase in oral care tools being available to patients and staff at the bedside, an increase in patients' awareness of oral care tools in their rooms, and a decrease in the overall HAAP rate. Conclusions Creating a multidisciplinary team within an acute care organization with a focus on oral care delivery can be substantially advantageous to patients and hospitals alike. Although this project was limited in its analysis, the demonstrated results are nonetheless interesting and may be applicable to other acute care settings. Ultimately, attention to the importance of oral care and consistent care delivery can provide improved patient outcomes.

scholarly journals An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shinichi Tomioka ◽  
Megumi Rosenberg ◽  
Kiyohide Fushimi ◽  
Shinya Matsuda
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Acute Care ◽  
Waiting Time ◽  
Older Patients ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Severe Dementia ◽  
People With Dementia ◽  
Acute Care Settings

Abstract Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

scholarly journals Consequences of ‘conversations not had’: insights into failures in communication affecting delays in hospital discharge for older people living with frailty

2020 ◽  
Vol 25 (4) ◽  
pp. 213-219 ◽  
Author(s):  
Sabi Redwood ◽  
Bethany Simmonds ◽  
Fiona Fox ◽  
Alison Shaw ◽  
Kyra Neubauer ◽  
...  
Keyword(s):  
Older People ◽  
End Of Life ◽  
Hospital Discharge ◽  
Acute Care ◽  
Health Care Professionals ◽  
Comparative Method ◽  
Care Hospital ◽  
Structured Interviews ◽  
Effective Discharge ◽  
Health And Social Care

Objectives Older people living with frailty (OPLWF) are often unable to leave hospital even if they no longer need acute care. The aim of this study was to elicit the views of health care professionals in England on the barriers to effective discharge of OPLWF. Methods We conducted semi-structured interviews with hospital-based doctors and nurses with responsibility for discharging OPLWF from one large urban acute care hospital in England. The data were analysed using the constant comparative method. Results We conducted interviews with 17 doctors (12 senior doctors or consultants and 5 doctors in training) and six senior nurses. Some of our findings reflect well-known barriers to hospital discharge including service fragmentation, requiring skilled coordination that was often not available due to high volumes of work, and poor communication between staff from different organizations. Participants’ accounts also referred to less frequently documented factors that affect decision making and the organization of patient discharges. These raised uncomfortable emotions and tensions that were often ignored or avoided. One participant referred to ‘conversations not had’, or failures in communication, because difficult topics about resuscitation, escalation of treatment and end-of-life care for OPLWF were not addressed. Conclusions The consequences of not initiating important conversations about decisions relating to the end of life are potentially far reaching not only regarding reduced efficiency due to delayed discharges but also for patients’ quality of life and care. As the population of older people is rising, this becomes a key priority for all practitioners in health and social care. Evidence to support practitioners, OPLWF and their families is needed to ensure that these vital conversations take place so that care at the end of life is humane and compassionate.

Frailty is associated with pain and cognitive function in older people in post-acute care settings

2020 ◽  
Vol 41 (5) ◽  
pp. 530-535
Author(s):  
Mimi M.Y. Tse ◽  
Rick Y.C. Kwan ◽  
Simone S.M. Ho ◽  
Patricia M. Davidson ◽  
Peggy P.P. Cheng ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Older People ◽  
Acute Care ◽  
Acute Care Settings ◽  
Post Acute Care

Perspectives on cancer care delivery from oncology patients who experienced unplanned acute care events.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 201-201
Author(s):  
Tara L. Kaufmann ◽  
Katharine A. Rendle ◽  
Erin Aakhus ◽  
Andrea Bilger ◽  
Peter Edward Gabriel ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Acute Care ◽  
Care Delivery ◽  
System Level ◽  
Self Management ◽  
Structured Interviews ◽  
Patient Factors ◽  
Management Interventions ◽  
High Level ◽  
Oncology Providers

201 Background: Unplanned acute care is debilitating and burdensome for patients with advanced cancer and their caregivers. There is a pressing need to understand how available evidence-based practices (EBPs) to reduce acute care 1) align with the needs and priorities of patients and 2) are best implemented within large health systems. We are conducting a mixed methods study to assess patient- provider- and system-level factors that shape the decision to seek acute care during active cancer treatment in order to select and adapt EBPs for implementation. Here we present data from patients’ perspectives. Methods: Purposive sampling approach to identify solid tumor cancer patients on active treatment with unplanned acute care events at a large health system from Aug 2018-Jan 2019. We conducted semi-structured interviews to elicit patients’ perspectives on factors that shape their decision to seek acute care and to inform intervention strategies. Results: Forty-nine patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ guilt for burdening their oncology team and to provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED, but do prefer in-person evaluation for new and distressing symptoms for safety. They express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care. Patients identify three areas for improvement: 1) enhanced peer support and education to manage uncertainty about cancer treatment; 2) accessible portals for patient-clinician communication; and 3) home or clinic-based after-hours oncology symptom management. Interventions to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.

scholarly journals Street Clinic Nursing for coping with vulnerabilities

Rev Rene ◽  
2021 ◽  
Vol 22 ◽  
pp. e67967
Author(s):  
Giulia Romano Bombonatti ◽  
Débora de Souza Santos ◽  
Dalvani Marques ◽  
Fernanda Mota Rocha
Keyword(s):  
Qualitative Study ◽  
Nursing Care ◽  
Nursing Staff ◽  
Participant Observation ◽  
Collaborative Work ◽  
Health Inequities ◽  
Homeless Population ◽  
Structured Interviews ◽  
Nursing Team

Objective: to unveil the perceptions of the Street Clinic nursing staff about coping with vulnerabilities. Methods: qualitative study, carried out by means of participant observation of the team’s activities, recording in a field diary and semi-structured interviews with the nursing team, totaling 17 participants. Results: situations experienced by people living on the streets that deepen health inequities by violating rights were revealed. Among the nursing work tools, the potential of collaborative work, listening, and welcoming technologies stand out as mediators of a more humanized care. There is a need for specific strategies to guide nursing care on the streets. Conclusion: nursing has great potential for addressing the vulnerabilities of the homeless population using soft and soft-hard technologies.

scholarly journals Design and evaluation protocol for ‘DEALTS 2’: a simulation-based dementia education intervention for acute care settings

2019 ◽  
Vol 32 (12) ◽  
pp. 1439-1448 ◽  
Author(s):  
Michelle Heward ◽  
Michele Board ◽  
Ashley Spriggs ◽  
Jane Murphy
Keyword(s):  
Acute Care ◽  
Care Delivery ◽  
Intervention Development ◽  
Practice Change ◽  
Train The Trainer ◽  
People With Dementia ◽  
Simulation Based ◽  
Acute Care Settings ◽  
The Impact ◽  
Dementia Education

ABSTRACTBackground:There is a paucity of simulation-based dementia education programmes for acute care settings that support the development of interpersonal skills pertinent to good care. Moreover, few studies measure the effectiveness of such programmes by evaluating the persistence of practice change beyond the immediate timeframe of the workshops. We were commissioned by Health Education England (HEE) to develop and evaluate ‘DEALTS 2’, a national simulation-based education toolkit informed by the Humanisation Values Framework, developed at Bournemouth University and based on an experiential learning approach to facilitate positive impacts on practice. This paper describes the process of developing DEALTS 2 and the protocol for evaluating the impact of this intervention on practice across England.Methods:Intervention development: Following an initial scoping exercise to explore the barriers and enablers of delivering the original DEALTS programme, we developed, piloted, and rolled out DEALTS 2 across England through a Train the Trainer (TTT) model. Key stakeholders were asked to critically feedback during the development process.Evaluation design:Mixed methods approach underpinned by Kirkpatrick Model for evaluating effectiveness of training; assessing reaction, learning, behaviour, and results. Evaluation forms and telephone interviews (quantitative and qualitative) with trainers that attended TTT workshops (n = 196) and, once implemented in individual Trusts, the staff that the trainers train.Conclusions:Evaluation of implementation and impact on care delivery for people with dementia will provide evidence of effectiveness. This will support the future development of simulation-based education programmes, amidst the current complexity of pressure in resource limited healthcare settings.

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