Assessing acute functional decline in older patients in home nursing care settings using the Modified Early Warning Score: A qualitative study of nurses’ and general practitioners’ experiences

Abstract Background: Acute functional decline is a common clinical syndrome in geriatric health care that is typically characterised by nonspecific symptoms and presents with a mix of physical, psychological, social and functional manifestations.Early warning score (EWS) systems are widely implemented in nursing homes and home care to detect clinical deterioration. The effects of EWS systems have been thoroughly evaluated in hospital care settings, but few studies have evaluated these systems in community health care.The purpose of this study is to describe the experiences of registered nurses (RNs) and general practitioners (GPs) when using the Modified Early Warning Score (MEWS) to support clinical reasoning and decision-making with geriatric home care patients who suffer from acute functional decline.Method: A qualitative methodology was used with a descriptive exploratory design. Data were collected from seven focus group interviews. GPs and RNs were purposively sampled from large, medium and small municipalities in Norway. Data were analysed using an inductive content analysis method.Results: MEWS was used as an additional decision-making tool with elderly home care patients when acute functional decline was detected. RNs and GPs emphasised that MEWS supported the clinical reasoning and decision-making process. Additionally, those applying MEWS required comprehensive reasoning skills and specific knowledge of the patients. RNs identified the need for contextual adjustments to the use of MEWS in home care settings. Implementing MEWS has improved the collaboration and clinical practice of RNs and GPs. The adherence to MEWS follow-up recommendations was adjusted to the home care setting, accounting for potentially limited medical availability.Conclusion: MEWS supported RNs and GPs in conducting comprehensive clinical assessments and reasoning when acute functional decline was detected. Interdisciplinary communication and collaboration appeared to be strengthened, and GPs’ work was streamlined. Several limitations were identified with the use of MEWS reference values with geriatric patients, which could lead to ambiguity and misjudgements. MEWS trigger recommendations were experienced as inappropriate in the home care context. This study identifies the need for a modified, evidence-based EWS adjusted for geriatric patients in home care.

Download Full-text

Bereaved family members' perspectives on suffering among older rural cancer patients in palliative home nursing care: A qualitative study

European Journal of Cancer Care ◽

10.1111/ecc.12609 ◽

2016 ◽

Vol 26 (6) ◽

pp. e12609 ◽

Cited By ~ 3

Author(s):

S.A. Devik ◽

O. Hellzen ◽

I. Enmarker

Keyword(s):

Qualitative Study ◽

Cancer Patients ◽

Nursing Care ◽

Family Members ◽

Home Nursing ◽

Bereaved Family ◽

Home Nursing Care

Download Full-text

Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study

Home Health Care Management & Practice ◽

10.1177/10848223211034774 ◽

2021 ◽

pp. 108482232110347

Author(s):

Kristin Jeppestøl ◽

Valeria Vitelli ◽

Marit Kirkevold ◽

Line K. Bragstad

Keyword(s):

Health Care ◽

Observational Study ◽

Hospital Admission ◽

Nursing Care ◽

Community Care ◽

Functional Decline ◽

Home Nursing ◽

Factors Associated ◽

Levels Of Care ◽

Home Nursing Care

Health policies and previous research highlight the importance of early identification and treatment of clinical deterioration in older patients to prevent frailty, higher levels of care, and mortality. This study explores older home nursing care patients’ care trajectories and factors associated with clinical response (type and level of intervention) from the health care services, final level of community care and death within 3 months after an incidence of acute functional decline. This observational study with a prospective, descriptive design includes a sample of 135 older home nursing care patients with acute functional decline. Demographic, health-related, and clinical characteristics were analyzed and prediction models for care trajectories were fitted using Bayesian generalized mixed models. Age ranged from 65 to 100, with a median age of 85. Hospital admission were registered for 13.33% ( T1) and 8.77% ( T2) of the participants. Nine patients (6.7%) were transferred to a higher level of community care, and 11 patients (8.1%) died. Frequent transitions between levels of care characterized care trajectories for patients experiencing more severe functional decline. Age, living in a private home, and increased Modified Early Warning Scores (MEWS) were associated with level of clinical responses throughout the care trajectory. Living in a private home was associated with the patients’ final level of community care. Female gender, hospital admission, and increased MEWS scores were associated with death. Health care personnel must be vigilant when MEWS scores rise even slightly, as this might be an indication of acute functional decline with possible increased risk of mortality.

Download Full-text

Applying the Modified Early Warning Score (MEWS) to assess geriatric patients in home care settings: A qualitative study of nurses’ and general practitioners’ experiences

10.21203/rs.2.16666/v1 ◽

2019 ◽

Author(s):

Kristin Jeppestøl ◽

Line Kildal Bragstad ◽

Marit Kirkevold Kirkevold

Keyword(s):

Decision Making ◽

Home Care ◽

Registered Nurses ◽

General Practitioners ◽

Clinical Reasoning ◽

Early Warning ◽

Geriatric Patients ◽

Functional Decline ◽

Early Warning Score ◽

Design Data

Abstract Background : Acute functional decline is a common clinical syndrome in geriatric health care and is typically characterised by nonspecific symptoms and presentations with a mix of physical, psychological, social and functional manifestations. Early warning score (EWS) systems are widely implemented in nursing homes and home care to detect clinical deterioration. The effects of EWS systems have been thoroughly evaluated in hospital care settings, but few studies have evaluated EWS systems in community healthcare. The purpose of this study was to describe the experiences of registered nurses and general practitioners experiences when using the Modified Early Warning Score (MEWS) to support clinical reasoning and decision-making with geriatric home care patients who suffer from acute functional decline. Method: A qualitative methodology was used with a descriptive exploratory design. Data were collected from seven focus group interviews. General practitioners (GPs), and registered nurses (RNs) were purposively sampled from large, medium and small municipalities in Norway. Data were analysed using an inductive content analysis method. Results: MEWS was used as an additional decision-making tool with elderly home care patients when acute functional decline was detected. RNs and GPs highlighted that MEWS supported the clinical reasoning and decision-making process. Additionally , comprehensive reasoning skills and specific knowledge of the patients were needed. RNs identified the need for contextual adjustments to the use of MEWS in home care settings. Implementing MEWS has improved the collaboration and clinical practice of RNs and GPs. The adherence to MEWS follow-up recommendations was adjusted to the home care setting, accounting for potentially limited medical availability. Conclusion : MEWS supported RNs and GPs in conducting comprehensive clinical assessments and reasoning when acute functional decline was detected. Interdisciplinary communication and collaboration appeared to be strengthened, and the GP's work was streamlined. Several limitations were identified with the use of MEWS reference values with geriatric patients, which could lead to ambiguity and misjudgements . MEWS trigger recommendations were experienced as inappropriate to comply within home care. This study identifies the need for a modified evidence-based EWS adjusted for geriatric patients in home care.

Download Full-text

“Looking for Deviations”: Nurses’ Observations of Older Patients With COPD in Home Nursing Care

Global Qualitative Nursing Research ◽

10.1177/2333393620946331 ◽

2020 ◽

Vol 7 ◽

pp. 233339362094633

Author(s):

Ruth Øfsti ◽

Siri Andreassen Devik ◽

Ingela Enmarker ◽

Rose Mari Olsen

Keyword(s):

Home Care ◽

Nursing Care ◽

Older Patients ◽

Qualitative Content Analysis ◽

Standard Procedure ◽

Study Data ◽

Chronic Obstructive ◽

Home Nursing ◽

Obstructive Pulmonary Disease ◽

Home Nursing Care

Nurses working in home care play a significant role in observing and identifying changes in the health status of patient with chronic obstructive pulmonary disease (COPD). The aim of this study was to explore and describe nurses’ observations of older patients with COPD when providing home nursing care. In this qualitative explorative study, data were collected through observations of 17 home care visits using the think-aloud technique, followed up with individual interviews with the nurses. Qualitative content analysis was used to analyze the data. The findings showed that the nurses’ observations (focus, methods, and interpretation) were characterized by their search for deviations from what they judged to be the patient’s habitual state. The nurses did not use any tool or guidelines, nor did they follow a standard procedure. Instead, when observing and interpreting, they performed a complex process guided by their experience and knowledge of the patient, and the patient’s individual and contextual circumstances. This knowledge contributes to warranted reflection on nurses’ practice in this context to secure COPD patients’ safety and quality of life.

Download Full-text

Work system analysis of home nursing care and implications for medication errors

PsycEXTRA Dataset ◽

10.1037/e577352012-022 ◽

2005 ◽

Author(s):

K. L. Calvin ◽

Gail R. Casper ◽

Ben-Tzion Karsh ◽

Patricia F. Brennan ◽

Laura J. Burke ◽

...

Keyword(s):

Medication Errors ◽

Nursing Care ◽

System Analysis ◽

Home Nursing ◽

Work System ◽

Home Nursing Care

Download Full-text

Smart technology-assisted Home Nursing Care Program for Persons with Dementia or Hip Fracture: Implementation Difficulties: Thematic Analysis (Preprint)

10.2196/preprints.26338 ◽

2020 ◽

Author(s):

Yea-Ing Shyu ◽

Chung-Chih Lin ◽

Ching-Tzu Yang ◽

Pei-Ling Su ◽

Jung-Ling Hsu

Keyword(s):

Hip Fracture ◽

Family Caregivers ◽

Nursing Care ◽

Care Program ◽

Wearable Devices ◽

Elderly Persons ◽

Home Nursing ◽

Smart Technology ◽

Smart Clothing ◽

Home Nursing Care

BACKGROUND Wearable devices have been developed and implemented to improve data collection in remote health care and smart care. Wearable devices have the advantage of always being with individuals, enabling easy detection of their movements. In this study, we developed and implemented a smart-care system using smart clothing for persons with dementia and with hip fracture. We conducted a preliminary study to understand family caregivers’ and care receivers’ experiences of receiving a smart technology-assisted (STA) home-nursing care program. OBJECTIVE This paper reports the difficulties we encountered and strategies we developed during the feasibility phase of studies on the effectiveness of our STA home-nursing care program for persons with dementia and hip fracture. METHODS Our care model, a STA home-nursing care program for persons with dementia and those with hip fracture included a remote-monitoring system for elderly persons wearing smart clothing was used to facilitate family caregivers’ detection of elderly persons’ movements. These movements included getting up at night, staying in the bathroom for more than 30 minutes, not moving more than 2 hours during the day, leaving the house, and daily activities. Participants included 13 families with 5 patients with hip fracture and 7 with dementia. Research nurses documented the difficulties they encountered during the process. RESULTS Difficulties encountered in this smart-care study were categorized into problems setting up the smart-care environment, problems running the system, and problems with participant acceptance/adherence. These difficulties caused participants to drop out, the system to not function or delayed function, inability to collect data, extra costs of manpower, and financial burden. Strategies to deal with these problems are also reported. CONCLUSIONS During the implementation of smart care at home for persons with dementia or hip fracture, different aspects of difficulties were found and strategies were taken. The findings of this study can provide a reference for future implementation of similar smart-home devices.

Download Full-text