The power and importance of sleep Capezuti, Elizabeth A.
Geriatric nursing (New York),
November-December 2016, 2016 Nov - Dec, 2016-11-00, 20161101, Letnik:
37, Številka:
6
Journal Article
Recenzirano
Industries catering to the provision of a "good night's sleep" focus on environmental comfort measures to improve sleep quality. Hotel surveys, for example, have shown that customer satisfaction ...improves more with sleep comfort and attention to improving sleep quality than attention to lobby design. As a result, hotels have upgraded mattresses, provide a variety of pillow options, and installed block out shades/curtains, individual temperature controls and soundproofed walls. The airline industry, likewise, pro- vides earplugs, eye masks, socks, and blankets on long trips to maximize the comfort of its passengers and to promote sleep. While these approaches make good sense and seem obvious to aiding rest and sleep, they are not standard practice in hospitals where patients are recovering from acute illnesses that require rest and sleep. Here, Capezuti discusses the power and importance of sleep.
The relationship between nurse staffing and quality of care (QoC) in nursing homes continues to receive major attention. The evidence supporting this relationship, however, is weak because most ...studies employ a cross-sectional design. This review summarizes the findings from recent longitudinal studies.
In April 2013, the databases PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched. Studies were eligible if they (1) examined the relationship between nurse staffing and QoC outcomes, (2) included only nursing home data, (3) were original research articles describing quantitative, longitudinal studies, and (4) were written in English, Dutch, or German. The methodological quality of 20 studies was assessed using the Newcastle-Ottawa scale, excluding 2 low-quality articles for the analysis.
No consistent relationship was found between nurse staffing and QoC. Higher staffing levels were associated with better as well as lower QoC indicators. For example, for restraint use both positive (ie, less restraint use) and negative outcomes (ie, more restraint use) were found. With regard to pressure ulcers, we found that more staff led to fewer pressure ulcers and, therefore, better results, no matter who (registered nurse, licensed practical nurse/ licensed vocational nurse, or nurse assistant) delivered care.
No consistent evidence was found for a positive relationship between staffing and QoC. Although some positive indications were suggested, major methodological and theoretical weaknesses (eg, timing of data collection, assumed linear relationship between staffing and QoC) limit interpretation of results. Our findings demonstrate the necessity for well-designed longitudinal studies to gain a better insight into the relationship between nurse staffing and QoC in nursing homes.
•Swing hip flexion-extension variability associated with MTC variability.•A single joint movement explained 29% of MTC variability in healthy older adults.•Surface differences for joints related to ...minimum toe clearance may exist.
Approximately one-third of falls are caused by the swing foot contacting an object or the ground, resulting in a trip. The increased incidence of trip-related falls among older adults may be explained by greater within-person minimum toe clearance (MTC) variability.
Will kinematic variability at any of the 6 major joints in the lower limbs, individually or in combination, be associated with MTC variability?
This cross-sectional study investigated whether single or multiple joint movements best explained MTC variability in older adults. Twenty healthy older adults (7 males, 13 females; mean age = 71.3 ± 7.2 years) were recruited. Participants were fitted with a modified Cleveland Clinic marker set and walked for 50 trials at self-selected speeds over a 7-meter walkway (with a rest at 25 trials) while 6 infrared cameras recorded kinematics.
Seven joint movements were evaluated, and swing hip flexion-extension variability was the only joint movement significantly associated with MTC variability (r = 0.577, p = 0.008) and explained 29.6% (adjusted R2) of the variance of MTC variability in older adults (F (1, 18) = 8.897, p = 0.008).
Identifying the joint movement/s associated with inconsistencies in toe clearance will improve our understanding of endpoint control in older adults and may lead to the development of effective trip prevention strategies.
Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual ...autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.
We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated.
The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7-88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1-87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents.
The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.
The Nurses Improving the Care of Healthsystem Elders (NICHE) program helps its more than 450 member sites to build the leadership capabilities to enact system‐level change that targets the unique ...needs of older adults and embeds evidence‐based geriatrics knowledge into practice. NICHE received expansion funding to establish a sustainable business model for operations while positioning the program to continue as a leader in innovative senior care programs. The expansion program focused on developing an internal business infrastructure, expanding NICHE‐specific resources, creating a Web platform, increasing the number of participating NICHE hospitals, enhancing and expanding the NICHE benchmarking service, supporting research that generates evidence‐based practices, fostering interorganizational collaboration, developing sufficient diversified revenue sources, and increasing the penetration and level of activity of current NICHE sites. These activities (improved services, Web‐based tools, better benchmarking) added value and made it feasible to charge hospitals an annual fee for access and participation. NICHE does not stipulate how institutions should modify geriatric care; rather, NICHE principles and tools are meant to be adapted to each site's unique institutional culture. This article describes the historical context, the rationale, and the business plan that has resulted in successful organizational outcomes, including financial sustainability of the business operations of NICHE.
Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes ...associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents.
The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered.
Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure.
Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices.
This expanded, one-of-a-kind reference of more than 250 entries provides a comprehensive guide to all of the essential elements of elder care across a breadth of health and social service ...disciplines. Responding to the needs of providers, directcare workers, family, and other caregivers, the diverse array of entries included in this encyclopedia recognize and address the complex medical, social, and psychological problems associated with geriatric care. In addition to a brief, accessible summary of each topic, entries include several key references, including web links and mobile apps for additional sources of information.This updated edition contains more than 30 new entries written by renowned experts that address a variety of elder care topics.New to the Fourth Edition:New entries addressing Ethics Consultation, Eye Disorders, Pain - Acute and Chronic, and many others
Function-focused care (FFC) is an approach to care in which nurses help patients engage in activities of daily living (ADL) and physical activity, with the goal of preventing avoidable functional ...decline. This prospective, observational study, conducted with hospitalized older adults (N = 93) examined: 1) the demographic and clinical characteristics of patients who were provided FFC activity, and 2) the relationship between change in physical activity and FFC activities. Patients who received FFC were more likely: to be younger (P = .028); had one or more falls during the hospitalization (P = .048); had demonstrated better functional performance at admission (P = .004) and better physical capability, measured by the Tinetti gait and balance scale (P = .004). FFC was associated with less decrement in ADL function, admission to discharge, while considering patient characteristics (t = 7.6; P < .008). Results suggest that hospitalized older persons can benefit from FFC.
Patient safety is a global concern, yet little is known about how and whether perceptions of patient safety culture (PSC) vary by nurses' countries of origin and preparation. This is particularly ...important in American nursing homes (NHs), which are increasingly hiring non-US born and prepared nurses to fill staffing needs.
This study compared the PSC perceptions of foreign and domestic born and trained nurses working in urban NHs in 5 states to analyze how nurses' PSC perceptions corresponded to their personal and professional characteristics.
We distributed 3539 surveys to registered nurses and licensed practical/vocational nurses employed in 98 urban NHs across 5 states with higher percentages of internationally prepared nurse workers. Respondents' perceptions of their workplace safety culture were measured with the NH Survey on PSC survey from the Agency for Healthcare Research and Quality (AHRQ) and examined 12 dimensions of PSC. A total of 1629 returned surveys indicated a 46% returned rate.
Results from 1133 analyzed surveys indicated that nurses born and educated abroad exhibited more favorable PSC perceptions in their workplaces, followed by nurses born abroad and educated in the United States. Nurses born and educated in the United States demonstrated the lowest perceptions of workplace PSC overall (P < 0.001).
Although foreign born and trained nurses report higher PSC perceptions than domestically born and educated nurses, further research is needed to understand why these differences occur.
Background Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care ...associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described. Methods This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas—(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders—at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system. Results CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely. Conclusions Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals.
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