scholarly journals Older Adults and Family Perspective on Interaction with Nurses in Hospital: the Role of Mutual Understanding

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1048-1049
Author(s):  
Orly Tonkikh ◽  
Nurit Gur-Yaish ◽  
Ksenya Shulyaev ◽  
Amos Rogozinski ◽  
Elena Siegel
Keyword(s):  
Older Adults ◽  
Structural Characteristics ◽  
Family Members ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Acute Hospitalization ◽  
Family Perspective ◽  
Centered Care ◽  
Hospitalized Older Adults ◽  
Family Centered

Abstract Optimal nurse-patient-family interaction is required to provide effective family-centered care for hospitalized older adults and their families. This qualitative descriptive study explored nurses’ interactions with older adult patients and their family members during acute hospitalization. We used semi-structured interviews to collect data from a convenience sample of nine dyads of older adults (aged 62-85) and family members (7 children and 2 spouses) who accompanied them during an acute hospitalization in medical or surgical units. Interviews were performed via Zoom beginning in December 2020 until August 2021, 1-12 months after the hospitalization. Thematic analysis was used to inductively capture key patterns in data. Both patients and family members revealed three factors contributing to the way nurses interact with patients and families: (1) nurses’ recognition and understanding of patients’ needs for family members’ presence and participation in care; (2) nurses recognition that family members expect dedication of attention, beyond nurses’ focus on patient’s care (3) patient and family members’ recognition of the extreme workload of nursing staff. Participants described a range of informal approaches used by both nurses and families to address each other’s needs. Both patients and families emphasize the benefits and costs of nurses engaging in “exceptional” interactions with patients and families considering structural characteristics such as establishing a personal relationship or accepting family visits beyond the rules. The findings provide direction for further exploration of hospitalization structures and processes needed to support optimal nurses’ interactions with families accompanying older adults and family-centered approach training in acute care context.

scholarly journals 346 How Do we Increase Adherence to Home Exercise Programmes? Interviews with Older Adults and Physiotherapists

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Siti Khalijah ◽  
Suzanne Timmons
Keyword(s):  
Older Adults ◽  
Cardiovascular Health ◽  
Home Exercise ◽  
Video Content ◽  
Structured Interviews ◽  
Timed Up And Go ◽  
Convenience Sample ◽  
Improve Compliance ◽  
Exercise Programmes ◽  
Purposive Sample

Abstract Background Regular exercise and physical activity can maintain function and cardiovascular health, and prevent cognitive decline, in older adults. However, studies show that there is often poor adherence to home exercise programmes (HEP). The purpose of this study was to explore how HEP are perceived by both older adults and physiotherapists. Methods A convenience sample of 28 older adults attending outpatient physiotherapy clinics were given an exercise journal to record their adherence to the HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with a purposive sample, and the corresponding prescribing physiotherapists, to achieve maximal variation in terms of HEP adherence, age and sex. The interviews were audio recorded, transcribed, and simple content analysis performed. Results Fourteen participants returned their exercise journal. Median age was 80; half were female; median Berg Balance Score and Timed-up-and-Go-Test were 49 and 16 seconds respectively. Participants exercised a median 79.8% of the prescribed dose, or 5.6 days per week. Seven older adults were interviewed; about half had a positive attitude towards exercise. They were also moderately positive about their HEP (comments ranged from “doable” and “nothing bad about it” to “enjoyable”). Barriers included time, mood, boredom, remembering to do the HEP, and variable health status. Enablers included simple instructions and design, family encouragement, and sense of achievement. Physiotherapists (n=5) perceived that many older adults aren’t compliant with HEPs, but there was some therapeutic nihilism (“you can’t force them”). Their HEP instructions varied from verbal to written instructions/diagrams; one physiotherapist used individualised video content. Notably, participants with good adherence understood their HEP well in terms of content and purpose, although this may be cause or effect. Conclusion To improve compliance with HEP, healthcare professionals need to take time to motivate the recipient, simplify their instructions, and trouble-shoot potential barriers at the time of prescription.

scholarly journals Orthostatic Hypotension and Falls in Hospitalized Older Adults

2021 ◽  
pp. 105477382098668
Author(s):  
Kathleen Schell ◽  
Denise Lyons ◽  
Barry Bodt
Keyword(s):  
Older Adults ◽  
Orthostatic Hypotension ◽  
Electronic Medical Records ◽  
Fall Prevention ◽  
Medical Records ◽  
The Elderly ◽  
Chi Square ◽  
Convenience Sample ◽  
Chi Square Test ◽  
Hospitalized Older Adults

The aim of this retrospective study was to determine the prevalence of orthostatic hypotension (OH) among a convenience sample of older adults on two Acute Care of the Elderly (ACE) units of the ChristianaCare™ in Delaware. Another aim was to determine if subjects with documented OH experienced falls. Retrospective de-identified data was obtained from electronic medical records for the years 2015 to 2018. Among all patients who had valid first orthostatic vital sign (OVS) readings ( n = 7,745), 39.2% had orthostatic hypotension on the first reading. Among the patients, 42.8% were found to be hypotensive during OVS. Thirty-one (0.9%) of those with OH fell at some point during their stay. The odds ratio for falls in the presence of OH was 1.34 with a 95% confidence interval (0.82, 2.21), but a chi-square test failed to find significance ( p = .2494). The results could not determine if OVS should be mandatory in fall prevention protocols.

scholarly journals Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care

2018 ◽  
Vol 9 (9) ◽  
pp. 523-533 ◽  
Author(s):  
Alec W. Petersen ◽  
Avantika S. Shah ◽  
Sandra F. Simmons ◽  
Matthew S. Shotwell ◽  
J. Mary Lou Jacobsen ◽  
...  
Keyword(s):  
Older Adults ◽  
Usual Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Patient Centered ◽  
Convenience Sample ◽  
Point Reduction ◽  
Significant Difference ◽  
Hospitalized Older Adults

Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. Results: There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 ( p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5–6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI −0.01 to 1.1) in the drug burden index. Conclusions: A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.

scholarly journals Walking Speed Threshold for Classifying Walking Independence in Hospitalized Older Adults

2010 ◽  
Vol 90 (11) ◽  
pp. 1591-1597 ◽  
Author(s):  
James E. Graham ◽  
Steve R. Fisher ◽  
Ivonne-Marie Bergés ◽  
Yong-Fang Kuo ◽  
Glenn V. Ostir
Keyword(s):  
Older Adults ◽  
Sensitivity And Specificity ◽  
Walking Speed ◽  
Community Dwelling ◽  
Community Based ◽  
Convenience Sample ◽  
Cut Point ◽  
Risk Threshold ◽  
Risk Thresholds ◽  
Hospitalized Older Adults

Background Walking speed norms and several risk thresholds for poor health outcomes have been published for community-dwelling older adults. It is unclear whether these values apply to hospitalized older adults. Objective The purpose of this study was to determine the in-hospital walking speed threshold that best differentiates walking-independent from walking-dependent older adults. Design This was a cross-sectional study. Methods This study recruited a convenience sample of 174 ambulatory adults aged 65 years and older who had been admitted to a medical-surgical unit of a university hospital. The participants' mean (SD) age was 75 (7) years. Fifty-nine percent were women, 66% were white, and more than 40% were hospitalized for cardiovascular problems. Usual-pace walking speed was assessed over 2.4 m. Walking independence was assessed through self-report. Several methods were used to determine the threshold speed that best differentiated walking-independent patients from walking-dependent patients. Approaches included a receiver operating characteristic (ROC) curve, sensitivity and specificity, and frequency distributions. Results The participants' mean (SD) walking speed was 0.43 (0.23) m/s, and 62% reported walking independence. Nearly 75% of the patients walked more slowly than the lowest community-based risk threshold, yet 90% were discharged home. Overall, cut-point analyses suggested that 0.30 to 0.35 m/s may be a meaningful threshold for maintaining in-hospital walking independence. For simplicity of clinical application, 0.35 m/s was chosen as the optimal cut point for the sample. This threshold yielded a balance between sensitivity and specificity (71% for both). Limitations The limitations of this study were the small size of the convenience sample and the single health outcome measure. Conclusions Walking speeds of older adults who are acutely ill are substantially slower than established community-based norms and risk thresholds. The threshold identified, which was approximately 50% lower than the lowest published community-based risk threshold, may serve as an initial risk threshold or target value for maintaining in-hospital walking independence.

scholarly journals What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

2021 ◽  
Vol 30 (1) ◽  
pp. 11-20
Author(s):  
Catherine L. Auriemma ◽  
Michael O. Harhay ◽  
Kimberley J. Haines ◽  
Frances K. Barg ◽  
Scott D. Halpern ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Decision Rules ◽  
Family Members ◽  
Life Quality ◽  
Patient Comfort ◽  
Patient Centered ◽  
Surrogate Outcomes ◽  
Constant Pain ◽  
Centered Care ◽  
Family Centered

Background Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU. Objectives To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death. Methods Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members. Two investigators reviewed all transcripts line by line to identify key concepts. Codes were created and defined in a codebook with decision rules for their application and were analyzed using qualitative content analysis. Results Salient themes were identified and grouped into 2 major categories: (1) processes of care within the ICU— communication, patient comfort, and a sense that the medical team was “doing everything” (ie, providing exhaustive medical care) and (2) patient and surrogate outcomes after the ICU—survival, quality of life, physical function, and cognitive function. Several outcomes were deemed worse than death: severe cognitive/physical disability, dependence on medical machinery/equipment, and severe/constant pain. Conclusion Although survival was important, most participants qualified this preference. Simple measures of mortality rates may not represent patient- or family-centered outcomes in evaluations of ICU-based interventions, and new measures that incorporate functional outcomes and patients’ and family members’ views of life quality are necessary to promote patient-centered, evidence-based care.

scholarly journals Family Centered Care: A Literature Review

2021 ◽  
Author(s):  
Ari Damayanti Wahyuningrum
Keyword(s):  
Literature Review ◽  
Family Members ◽  
Narrative Form ◽  
Family Centered Care ◽  
Member Care ◽  
The Family ◽  
Literature Reviews ◽  
Centered Care ◽  
Family Centered

Collaborative action between families and health professionals, in this case nurses, doctors, nutritionists, pharmacies in forming harmonious support is the philosophy of family centered nursing care which aims to involve families as the main focus in care. The aim of this literature review is to identify family-centered family member care: a literatu review. This language method uses literature reviews which are summaries of 10 articles in the publication years of 2020-2021 on search 4 databased electronic searches containing namely Scopus, ProQuest, Pubmed, and Scient Direct. This review used prisms. The eligibility of these studies were from its title, abstract, research methodology, results and discussion. The results of the review were presented in narrative form. The results of a review of 10 articles found that the form family centered care Conclusion: The family is considered a partner in the care of other family members. The concept of family centered care is a philosophy in nursing where the role of the family is very important in caring for family members who are sick.

scholarly journals Effects of Isolation Among Older Adults Due to Coronavirus Restrictions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 483-484
Author(s):  
Cynthia Thomas
Keyword(s):  
Older Adults ◽  
Close Contact ◽  
Family Members ◽  
Daily Activities ◽  
New Disease ◽  
Structured Interviews ◽  
Daily Lives ◽  
Social Distancing ◽  
The Past ◽  
The Us

Abstract Semi-structured interviews were conducted with 35 residents in a Maryland condominium, four to six months after the presence of the epidemic in the US was recognized in mid-March. The objective was to determine to what extent the restrictions resulting from the presence of a new disease was affecting older adults in their daily lives, and in their plans for the future. All respondents were over the age of 60 and half were more than 80 years old. Two-thirds lived by themselves; most others lived with a husband or wife. Respondents for the most part were following guidelines to wear masks, practice social distancing and avoid close contact with persons outside their homes, including other family members. Over half had already made dramatic changes in their daily activities. Some found an opportunity to develop new skills, had connected with people from the past, or had become more introspective. Others, while exhibiting some of the same characteristics, were more focused on the restrictions they faced, and were more aware than ever of the limited amount of time left in their lives. Differences between respondents in the emphasis of their perspectives are explored, by age, gender, and other characteristics.

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