Pressure ulcers and nutritional deficits in elderly long-term care patients : effects of a comprehensive nutritional program on pressure ulcer healing, length of hospital stay and charges to patients

The elderly are at the highest risk of developing pressure ulcers that result in prolonged hospitalization, high health care costs, increased mortality, and decreased quality of life. The burden of pressure ulcers will intensify because of a rapidly increasing elderly population in the United States (US). Poor nutrition is a major predictor of pressure ulcer formation. The purpose of this study was to examine the effects of a comprehensive, interdisciplinary nutritional protocol on: 1) pressure ulcer wound healing 2) length of hospital stays, and 3) charges for pressure ulcer management. Using a pre-intervention/post intervention quasi-experimental design the study sample was composed of 100 patients 60 years or older, admitted with or acquiring a pressure ulcer. A pre-intervention group (n= 50) received routine pressure ulcer care (standard diet, dressing changes, and equipment). A post-intervention group received routine care plus an interdisciplinary nutrition intervention (physical therapy, speech therapy, occupational therapy, added protein and calories to the diet). Research questions were analyzed using descriptive statistics, frequencies, Chi-Square Tests, and T-tests. Findings indicated that the comprehensive, interdisciplinary nutritional protocol had a significant effect on the rate of wound healing in Week3 and Week4, total hospital length of stay (pre-intervention M= 43.2 days, SD=31.70 versus M=31.77, SD=12.02 post-intervention), and pressure ulcer length of stay (pre-intervention 25.28 days, SD5.60 versus 18.40 days, SD 5.27 post-intervention). Although there was no significant difference in total charges for the pre-intervention group ($727,245.00) compared to the post-intervention group ($702,065.00), charges for speech (m=$5885.12, SD=$332.55), pre albumin (m=$808.52,SD= $332.55), and albumin($278 .88, SD=55.00) were higher in the pre-intervention group and charges for PT ($5721.26, SD$3655.24) and OT($2544 .64, SD=1712.863) were higher in the post-intervention group. Study findings indicate that this comprehensive nutritional intervention was effective in improving pressure ulcer wound healing, decreasing both hospital length of stay for treatment of pressure ulcer and total hospital length of stay while showing no significant additional charges for treatment of pressure ulcers.

Beliefs of Icelandic elderly living in the greater Reykjavik area toward autonomy and paternalism in caregiving of the elderly

With the aging population and the increase in health care costs, issues of independence and autonomy will have a greater impact on formal and informal health care. Changes in occupational functioning that accompany increased age has raised the demandfor family assistance to the elderly. It is important for occupational therapists to understand the elderly's perceptions toward autonomy and paternalism in caregiving of the elderly because it is assumed that attitudes and beliefs affect how people interact and care for the elderly. A convenience sample of 57 Icelandic elderly were surveyed regarding their attitudes toward autonomy and paternalism in caregiving of the elderly. Results indicated that Icelandic elderly held strong beliefs toward autonomy but were undecided toward paternalism. Significant differences were found between groups. Elderly living at home indicated stronger beliefs on both autonomy and paternalism compared to those living in senior housing complexes. Elderly women held stronger beliefs in autonomy in contrast to the males, who were more paternalistic, and married subjects held stronger beliefs than did single respondents.

Development of an education resource for families and clients navigating through end-of-life care with at-home palliation

Background: Community health nurses (CHNs) play a pivotal role in providing end-of-life care to clients diagnosed with a life-threatening illness. Providing quality end-of-life care is an ethical obligation. Eastern Health’s palliative end-of-life care program (PEOLC) offers nursing care, equipment, services, and support. However, the caregiver’s need for practical information about end-of-life issues is not addressed. Purpose: To develop an educational resource to assist clients and families during end-of-life and to provide a framework for new CHNs in home palliation. Methods: An informal Needs Assessment, a literature review, an environmental scan, and consultations with four CHNs involved with home palliation. Results: An educational resource was developed to address the practical end-of-life issues identified in the literature review and consultations. Conclusion: An improved delivery of care for at-home palliation in the community for clients and families, and a framework for new CHNs.

Home birth in Ireland 1993-1997: a review of community midwifery practice

To date little is known about the practices of domiciliary midwives and the outcomes of home birth in Ireland. The purpose of this review is to provide some background information on the situation for women seeking a home birth and to document the outcomes of home births in Ireland between 1993 -1997. Design: Descriptive analysis of prospective data collected from domiciliary midwives regarding women who requested a home birth between 1993 and 1997. Participants: The questionnaire was distributed to 15 domiciliary midwives; this included all the domiciliary midwives known to the authors to be practising in Ireland at that time. Findings: During this period, 585 women planned to give birth in their home with the assistance of midwives, 500 women achieved this. The spontaneous vaginal delivery rate for women who commenced their labour at home was 96.9% (n = 554). These women gave birth without medications or other interventions. 544 (93%) of the women breastfed their babies and 538 (92%) were still breastfeeding at 6 weeks. This is the first review of domiciliary midwifery practice in Ireland in recent years. They obtained data from 11 independent midwives on 585 women who planned home births. Findings showed high rates of spontaneous vaginal delivery and breastfeeding. There were 500 babies born at home with three perinatal deaths, including one undiagnosed breech delivery, one infant with abnormal lungs on post-mortem and one infant with Potter's Syndrome who was stillborn.

Care home managers’ knowledge of palliative care: a Northern Irish study

The Importance of Work-Life Balance Opportunities and Support from the Perspective of Nursing Stu-dents in Dalarna, Sweden

There is a shortage of nurses leading to challenges in recruitment in Sweden and many other countries. Especially for less populated regions recruitment can be chal-lenging. Nurses often face difficulties with work-life balance (WLB). This study aims to identify the importance of WLB opportunities and support that make a work-place attractive from the perspective of nursing students studying in Dalarna. A questionnaire was distributed via email to 525 students enrolled in the nursing bach-elor program at Dalarna University. They were asked to rate the importance of 15 sub questions regarding WLB opportunities and support. These sub questions were asked in order to analyze the importance of 15 components regarding WLB oppor-tunities and support. 196 students (37 percent) answered the questionnaire. Three WLB components, working from home, childcare and rooms for breastfeeding, were found to be not important to nursing students studying in Dalarna. This was reason-able due to the profession of nursing and the WLB support provided by the Swedish government. Cultural factors, such as the organization being positive towards using WLB opportunities and support, were more important than structural factors, such as the possibility to work part-time. Moreover, to have a manager that is supportive towards using WLB opportunities and support was found to be the most important factor and having workplace practical support such as childcare was found least im-portant. Furthermore, contrary to the expected results, no statistical significance was found on the influence on the importance of all combined relevant WLB opportuni-ties and support by the sociodemographic variables; gender, semester of studies, age, having children, months of work experience and work experience in the healthcare sector. However, nine individual components were found to be influ-enced by one or more sociodemographic variables. Therefore, some recommenda-tions on how to target specific groups of individuals were made. However, the con-clusion of the study is that, regardless of the sociodemographic variables and gov-ernmental support, organizations should offer new nurses opportunities and support to gain a balance between work and life, especially in terms of cultural factors.

Caring for Children Dying from Cancer at Home: a Qualitative Study of the Experience of Primary Care Practitioners

Background. The rarity of childhood cancers makes providing palliative care in the community an unusual event for primary care practitioners. Providing this care requires effective interprofessional collaboration with the team that forms to provide the care often working together for the first and only time. Objective. To explore the experiences of primary care practitioners following their involvement in the palliative care of a child with cancer at home. Methods. The study design was a community-based qualitative study. The study location was the West Midlands region. Purposeful sample of GPs and community nurses involved in providing palliative care to 12 children. One-to-one in-depth interviews with 47 primary care professionals (10 GPs and 37 community nurses) and 5 facilitated case discussions were undertaken. Field notes were documented and grounded theory data analysis undertaken: chronological comparative data analysis identifying generated themes. Results. GPs had minimal input into the preceding care of children undergoing treatment for cancer but sought to re-establish their role at the child’s transition to palliative care. GPs felt they had a role to play and could add value to this phase of care, highlighted their continuing role with the child’s family and acknowledged that they had gained from the experience of contributing. However, lack of specialist knowledge and uncertainty about their role within the team made this more challenging. In contrast, community nurses were routinely involved in both active treatment and palliation care phases. There was little evidence of collaboration between the specialist and primary care professionals involved. There was considerable variation in out of hours provision across cases. Conclusions. Engaging primary care practitioners needs to be more actively anticipated and negotiated at the transition to palliation. Variation in out of hours care is another cause for concern. Enhancing inter-professional collaboration and planning during both active and palliative care phases may help. Keywords. Cancer, family medicine, palliative care, paediatric.

GPs Experience of Caring for Children with Cancer Receiving Palliative Care at Home

Background The study being undertaken builds on earlier work that found general practitioners (GPs) were at times uncertain of their role in paediatric palliative care and questioned whether their involvement had been beneficial to the child and family. The rarity of childhood cancer makes it difficult for GPs to develop or maintain palliative care knowledge and skills yet the GP is perceived by the family as the gatekeeper of care within the community. Aim The study is examining GPs perception of their role in caring for an individual child with cancer receiving palliative care and comparing this with families' perceptions of their GP's roles. Methodology The methodology incorporates tape-recorded semi-structured interviews, thematic framework analysis and Q methodology (QM) to capture the experiences of GPs who have cared for a child with cancer receiving palliative care as well as the perspectives of care experienced by the families. The semi-structured interview sample comprises 10 families (parents/guardians) whose child has been treated at a regional childhood cancer centre and their GPs. A further 40–60 GPs will be involved in the QM. Findings Findings detailing GP experiences from the initial study along with the preliminary findings of the semi-structured interviews with parents and GPs will be presented. Papers' contribution The results will identify and clarify GPs perceptions of their roles, and what families perceive their GPs role to be, enabling development of strategies to support GPs roles. It is anticipated that findings will inform the wider field of palliative care generally and the practice of both hospital and community paediatricians.

Stressful Life Events and their Trajectories among Midlife Women: Observations from the Seattle Midlife Women's Health Study

Thesis (Ph.D.)--University of Washington, 2016-08

Fatores associados e preditores de quedas em idosos domiciliados de acordo com a Classificação Internacional da Funcionalidade, Incapacidade e Saúde

Objetivo geral da pesquisa foi identificar os fatores associados e preditivos de quedas em idosos domiciliados em uma cidade do Rio Grande do Sul, Brasil, considerando as características sociodemográficas e epidemiológicas e utilizando-se de fatores ambientais da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Objetivos específicos: identificar as características sociodemográficas e epidemiológicas de idosos domiciliados em uma cidade do Rio Grande do Sul, Brasil; descrever os fatores sociodemográficos e epidemiológicos que influenciam nas quedas em idosos domiciliados; Relacionar os fatores ambientais da Classificação Internacional de Funcionalidade, Incapacidade e Saúde em idosos domiciliados com riscos de quedas. Pesquisa epidemiológica transversal, ocorrida de junho a julho de 2013, com 167 idosos das áreas de abrangência de uma unidade básica de saúde. Critérios de inclusão na pesquisa: ambos os sexos, cadastrados e com residência fixa nas áreas de abrangência de uma unidade básica de saúde. Critérios de exclusão: idosos com alterações cognitivas. Utilizou-se entrevista estruturada com três etapas: levantamento das características dos idosos investigados; questões relacionadas às quedas; informações sobre os fatores ambientais da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Os dados foram agrupados para tratamento estatístico/descritivo. A média das idades 71 anos, com desvio padrão de 7,1. A maioria dos idosos era do sexo feminino, casados, com escolaridade de quatro e oito anos, residindo com filhos e companheiro, aposentados e com renda de um salário mínimo. As doenças mais prevalentes foram circulatórias, osteomusculares, e endócrinas e os idosos apresentaram pelo menos uma comorbidade. Dos 167 idosos, 65 caíram nos últimos doze meses, no ambiente domiciliar, com prevalência em: banheiro, cozinha e na rua, sendo as calçadas as mais destacadas. A maior proporção de permanência no chão foi de dez minutos, e a maioria dos idosos, após as quedas, não procuraram os serviços de saúde. Como tratamento para as quedas, obteve-se o não cirúrgico. Quanto à Classificação Internacional da Funcionalidade, Incapacidade e Saúde, houve destaque para o uso de medicações como fator influente nas quedas dos idosos domiciliados. Percebe-se a importância de avaliação constante por parte dos profissionais de saúde sobre os idosos caidores e não-caidores, no sentido de identificar os fatores de riscos intrínsecos e extrínsecos para implementar estratégias de prevenção que compreendam reabilitação da força muscular, equilíbrio e capacidade funcional, redução da polifarmácia, educação para o autocuidado e um olhar do enfermeiro voltado para os períodos e locais de maior incidência de quedas, melhorando desta forma a qualidade de vida dos idosos residentes em diferentes contextos. A pesquisa traz como contribuição social um re-olhar acerca do redimensionamento do cuidado à pessoa idosa que teve queda no próprio ambiente, a partir da Classificação Internacional de Funcionalidade, Incapacidade e Saúde.

Ikääntyneen voimavaraistumista tukeva potilasohjaus päivystysosastolla kotiutumisen yhteydessä

Lisääntyvä ikääntyneiden määrä asettaa vaatimuksia terveydenhuollon järjestämiselle niin Suomessa kuin maailmanlaajuisestikin. Ikääntyneiden monialaiset ongelmat yhdessä perussairauksien kanssa muodostavat monimutkaisen kokonaisuuden, joka voi johtaa avun hakemiseen päivystyksestä. Ikääntyneiden hoidossa esiintyvät erityispiirteet, hoidettavien kognitiivisen toimintakyvyn heikkeneminen, lyhentyneet hoitoajat ja hoidon painopisteen siirtyminen kotiin vaativat hoitohenkilökuntaa yhä enenevässä määrin kiinnittämään huomiota potilasohjaukseen. Tutkimuksen tarkoituksena oli kuvata päivystysosastolta kotiutuvien ikääntyneiden ja sairaanhoitajien välisten ohjauskeskusteluiden rakennetta ja sisältöä. Tavoitteena oli tuottaa tietoa siitä, mitä voimavaraistumista tukevia piirteitä ja tiedon osa-alueita esiintyy ohjauskeskusteluissa. Tutkimuksen aineisto kerättiin ei-osallistuvalla havainnoinnilla videoimalla päivystysosastolta kotiutuvien ikääntyneiden ohjaustilanteita (n=22) syksyllä 2015. Osallistuneiden potilaiden keski-ikä oli 79 vuotta. Aineisto analysoitiin deduktiivisella sisällönanalyysilla. Ohjauskeskustelun rakenteesta etsittiin voimavaraistumista tukevia piirteitä ja sisältöä analysoitiin kuuden voimavaraistumista tukevan tiedon osa-alueen pohjalta (biofysiologinen, toiminnallinen, kokemuksellinen, sosiaalinen, eettinen ja taloudellinen). Ohjauskeskustelujen alussa ei asetettu ohjauksen tavoitteita tai arvioitu ikääntyneiden aikaisemman tiedon tasoa. Ohjauskeskustelut etenivät pääosin hoitajien määrittäminä. Ikääntyneet kysyivät vähemmän kysymyksiä ja heidän yksisanaisten puheenvuorojensa määrä oli suurempi kuin hoitajilla. Ikääntyneiden osallistumista ohjauskeskusteluun ei myöskään tuettu. Kysymyksen esitettyään hoitajat antoivat ikääntyneille mahdollisuuden vastata, mutta eivät varmistaneet, olivatko nämä ymmärtäneet ohjauksen. Ohjauskeskusteluiden sisältöä tarkasteltaessa tietoa ikääntyneille välitettiin pääasiassa biofysiologisen tiedon osa-alueelta (tietoa hoidosta ja oireista). Toiseksi eniten tietoa välitettiin ikääntyneille toiminnallisen tiedon osa-alueelta (liikkuminen ja kotona selviytyminen) ja sosiaalisen tiedon osa-alueelta (omaisten osallistuminen hoitoon). Taloudellisen tiedon osa-alue jäi aineistossa pieneksi. Tutkimuksen tulokset osoittavat tarvetta kiinnittää huomiota ohjauskeskusteluiden rakenteeseen ja sisältöön etenkin hoidettaessa ikääntyneitä, joilla on monitahoisia terveysongelmia. Tutkimuksesta saatavaa tietoa voidaan hyödyntää suunniteltaessa ja toteuttaessa ikääntyneiden potilasohjausta päivystyksessä sekä suunniteltaessa sairaanhoitajien potilasohjauskoulutusta.

PERCEPTIONS AND EXPERIENCES OF FAMILY CAREGIVERS OF BEDRIDDEN ELDERLY

Objective: To know the perceptions and experiences of family caregivers of bedridden elderly. Methods: A qualitative descriptive exploratory study conducted in January 2015 with four caregivers in a Family Health Center in the municipality of Araripe, CE. Data were collected through semi-structured interviews and the information was organized using the content analysis technique. A total of three categories emerged from the analysis of the reports of caregivers: the dependence process of the elderly; daily difficulties experienced by the caregiver; and satisfaction with the home care service. Results: The dependence process of the elderly took place as a consequence of pathological processes such as neoplasm, cerebrovascular accident and dementia. However, it could also be observed that physiological phenomena – common in old age – can also make individuals dependent on caregivers. As to the difficulties faced by the caregivers, they reported the need for greater involvement by the family, given that the centralization of work generates an overload and hence affects the care of the elderly. Teamwork in the home care context is fundamental, given that it allows a complementary and comprehensive care to the ledrely/caregiver binomial. Conclusion: Healthy aging is a major challenge to be overcome given that the development of a healthy lifestyle is difficult in all social strata. It is necessary to improve home care in order to provide support to caregivers so that the quality of life of bedridden elderly and caregivers is improved.

Sketching the temporal landscape : The case of night nursing

We take for granted that we exist in dimensions of time and space. We accept that time passes and that space extends as a matter of course. Just as our personal space is important to us, so is time of our own. The individual is capable of developing a variety of time perspectives or orientations, each applicable to a different aspect of life, for instance, home, leisure, economic, political and organisational. Our temporal perspective influences a wide range of psychological processes, from motivation, emotions and spontaneity to risk-taking creativity and problem-solving. Our temporal landscapes are made up of recognisable domains, with permeable borders – private time and public time, home time and work time, past, present and future time, cyclical time. Just as a geography of space contains recognisable natural features – rivers, deserts, mountains – and features created by human beings – canals, roads, skyscrapers – so our temporal landscape contains natural features – day and night, the seasons – and features created by us – the ordering of social, economic, legal, and organisational time into, among others, the practices of family life, financial periods, prison sentences and workloads. This paper views the temporal landscapes of night nurses, and is based on longitudinal ethnographic research. It highlights areas such as shift work, workload, and the temporal aspects of caring. The result is the production of a map, albeit a rough one, of the temporal landscape inhabited by night nurses as they go about their working lives.