A qualitative study of nurses’ perspectives of caring for children with intellectual disability and their families in a paediatric acute care setting

Children with intellectual disability (ID) experience chronic and pervasive limitations across intellectual and adaptive functioning. They are also at risk of developing co-morbidities. They are likely to be hospitalised more frequently and for longer periods of time than other children. The purpose of this study was to understand the experiences of nurses when caring for children and teenagers with ID in an acute paediatric hospital setting. The aim of the research was to inform future directions for the delivery of equitable and effective care for this vulnerable population. This study used a qualitative thematic analysis of individual interviews conducted with eight registered and enrolled nurses who provided care to children and adolescents with ID in an Australian paediatric acute hospital setting. Themes which emerged from this analysis were (1) Recognising similarities and managing differences; (2) Nurse–parent relationships; and (3) Caring for children with ID requires additional time. This study highlights that navigating care delivery and relationships when working with young people with ID and their caregivers in an acute care setting is complex. Nursing children with ID in hospital requires sophisticated skills. To ensure quality healthcare for patients with ID, a range of strategies are proposed.

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Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence

BMJ Open ◽

10.1136/bmjopen-2020-039647 ◽

2021 ◽

Vol 11 (2) ◽

pp. e039647

Author(s):

Mairead Moloney ◽

Therese Hennessy ◽

Owen Doody

Keyword(s):

Intellectual Disability ◽

Acute Care ◽

Scoping Review ◽

Service Provision ◽

Care Setting ◽

Acute Care Setting ◽

Inclusion Criteria ◽

Health Service Provision ◽

Acute Care Settings ◽

Fair Access

ObjectivesPeople with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.DesignScoping review.SettingAcute care settings.MethodsFive databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.ResultsOf the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.ConclusionsThe scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.

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Care of the Acutely Ill Adult

10.1093/med/9780198793458.001.0001 ◽

2020 ◽

Keyword(s):

Acute Care ◽

Care Setting ◽

Care Delivery ◽

Clinical Signs ◽

Current Evidence ◽

Evidence Based ◽

Acute Care Setting ◽

Dynamic Nature ◽

Timely Manner ◽

Systematic Assessment

The new edition of Care of the Acutely Ill Adult enables nursing staff to develop an in-depth understanding of the knowledge required to care for patients whose condition is deteriorating. The book emphasizes the importance of systematic assessment, interpretation of clinical signs of deterioration, and the need to escalate the patient in a timely manner. Current evidence-based practice and up-to-date guidelines are included in each systems-based chapter and case studies are used throughout the book to enable nurses to apply knowledge to patient scenarios. In recognition of the dynamic nature of acute care delivery, new chapters have been included that focus on pain management and planning for care when recovery is unlikely. This book remains an essential purchase for any nurse working in an acute care setting.

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Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster’s Acute Care Certification Program

Journal of Doctoral Nursing Practice ◽

10.1891/2380-9418.9.1.124 ◽

2016 ◽

Vol 9 (1) ◽

pp. 124-127

Author(s):

Helen Miley ◽

Courtney Reinisch

Keyword(s):

Primary Care ◽

New Jersey ◽

Acute Care ◽

Nurse Practitioners ◽

Care Setting ◽

Care Delivery ◽

The State ◽

Inpatient Setting ◽

Acute Care Setting ◽

Term Care

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care educated and certified adult primary care APNs working in an inpatient setting to obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

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A conceptual framework identifying sources of risk to patient safety in primary care

Australian Journal of Primary Health ◽

10.1071/py11062 ◽

2012 ◽

Vol 18 (3) ◽

pp. 185 ◽

Cited By ~ 2

Author(s):

Logan McLeod ◽

JoAnn Kingston-Riechers ◽

Egon Jonsson

Keyword(s):

Primary Care ◽

Patient Safety ◽

Acute Care ◽

Care Setting ◽

Primary Care Setting ◽

Care Delivery ◽

Acute Care Setting ◽

Primary Care Delivery ◽

Potential Risks ◽

Organisational Structures

The potential risks to patient safety in a primary care setting are different than the risks to patient safety in an acute care setting. The main differences arise from the organisational structures of primary care delivery and the greater involvement of patients in their care. To account for these differences, we present the Patient Safety in Primary Care Framework to conceptualise the sources of risk to patient safety.

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Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting

Journal of Holistic Nursing ◽

10.1177/0898010116644834 ◽

2016 ◽

Vol 35 (1) ◽

pp. 97-107 ◽

Cited By ~ 4

Author(s):

Joel G. Anderson ◽

Mary Ann Friesen ◽

Diane Swengros ◽

Anna Herbst ◽

Lucrezia Mangione

Keyword(s):

Patient Care ◽

Registered Nurses ◽

Acute Care ◽

Care Setting ◽

Care Delivery ◽

Acute Care Setting ◽

Healing Touch ◽

The Impact ◽

Acute Care Nursing ◽

Care Nursing

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

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Intervention Goals Determine Physical Therapists' Workload in the Acute Care Setting

Physical Therapy ◽

10.2522/ptj.20090390 ◽

2010 ◽

Vol 90 (10) ◽

pp. 1468-1478 ◽

Cited By ~ 14

Author(s):

Eva Grill ◽

Erika O. Huber ◽

Thomas Gloor-Juzi ◽

Gerold Stucki

Keyword(s):

Resource Allocation ◽

Physical Therapy ◽

Acute Care ◽

Care Setting ◽

Physical Therapists ◽

Body Position ◽

Hospital Setting ◽

Acute Care Hospital ◽

Care Hospital ◽

Acute Care Setting

Background Investigating determinants of physical therapy workload in the acute care setting is essential for planning interventions, for justifying resource allocation, and for reimbursement. Objective The objective of this study was to examine whether International Classification of Functioning, Disability and Health (ICF) intervention goals (ICF categories representing goals of physical therapy interventions typical for an acute care hospital) could predict physical therapy workload in the acute care hospital setting. Design This investigation was a multicenter, observational cohort study. Methods Patients were recruited from a representative sample of 32 acute care hospitals across Switzerland if they received physical therapy during their inpatient stay for the treatment of any injury or disease in 1 of 3 main diagnostic categories: musculoskeletal, neurological, and cardiopulmonary conditions. Physical therapists completed questionnaires at the time of the patients' discharge to report on ICF intervention goals. Information on workload was collected retrospectively from hospital documentation systems. Multivariable regression models were used to identify the intervention goals independently associated with workload. Results The mean workload for 642 patients (mean age=61 years [SD=18 years], 45% women) was 370 minutes. The daily workload for interventions ranged from 33 minutes (cardiopulmonary conditions) to 49 minutes (neurological conditions). There were significant variations in workload across hospital sites and medical disciplines. The goal “maintaining a body position” emerged as a significant indicator of a higher workload for all condition groups; the goals “attention functions” and “transferring oneself” were indicators for neurological and musculoskeletal conditions, respectively. Limitations Not all potential predictors of workload could be examined. Other, person- or setting-specific variables might have been relevant to workload. Case mix and clinical practice were representative only for Swiss hospitals. Conclusions A small set of intervention goals were the major factors influencing physical therapy workload, independent of diagnosis or clinical specialty. Describing variability in physical therapists' practices in the acute care setting and relating these data to relevant patient-centered outcomes are the initial steps for improving resource allocation and reimbursement for interventions that maintain or improve functioning.

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Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster’s Acute Care Certification Program

Clinical Scholars Review ◽

10.1891/1939-2095.8.1.39 ◽

2015 ◽

Vol 8 (1) ◽

pp. 39-42

Author(s):

Helen Miley ◽

Courtney Reinisch

Keyword(s):

Primary Care ◽

New Jersey ◽

Acute Care ◽

Nurse Practitioners ◽

Care Setting ◽

Care Delivery ◽

The State ◽

Inpatient Setting ◽

Acute Care Setting ◽

Term Care

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care–educated and primary care–certified adult primary care APNs working in an inpatient setting obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

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Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000445883 ◽

2016 ◽

Vol 6 (2) ◽

pp. 268-275 ◽

Cited By ~ 13

Author(s):

Chin Yee Cheong ◽

Jane An Qi Tan ◽

Yi-Lin Foong ◽

Hui Mien Koh ◽

Denise Zhen Yue Chen ◽

...

Keyword(s):

Music Therapy ◽

Acute Care ◽

Older Patients ◽

Care Setting ◽

Rating Scale ◽

Hospital Setting ◽

Acute Hospital ◽

Acute Care Setting ◽

Creative Music ◽

The Impact

Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

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