Abstract
Background
The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional ...activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluation of NitL.
Methods
A mixed-methods formative process evaluation with a predominantly qualitative approach was conducted. Qualitative data were collected by interviews with community nurses (
n
= 7), focus groups with team members (
n
= 31), and reviewing seven implementation plans and 28 patient records. Quantitative data were collected among community nurses and team members (
N
= 90) using a questionnaire to assess barriers in encouraging functional activities and attendance lists. Data analysis was carried out through descriptive statistics and content analysis.
Results
NitL was largely executed according to plan. Points of attention were the use and value of the background theory within the training, completion of implementation plans, and reporting in patient records by community nurses. Inhibiting factors for showing leadership and encouraging functional activities were a lack of time and a high complexity of care; facilitating factors were structure and clear communication within teams. Nurses considered the systematic approach useful and the training educational for their role. Most team members considered NitL practical and were satisfied with the coaching provided by community nurses. To optimise NitL, community nurses recommended providing the training first and extending the training. The team members recommended continuing clinical lessons, which were an implementation strategy from the community nurses.
Conclusions
NitL was largely executed as planned, and appears worthy of further application in community care practice. However, adaptations are recommended to make NitL more promising in practice in empowering community nurse leadership in implementing evidence.
Background: Commissioned by the Dutch minster of Health, Welfare and Sport a national advisory committee was installed advising the government on the need for future professions and education in the ...broad field of prevention, cure, care and welfare from an integrated care perspective. This advisory committee used as points of departure: (1) the demand of care in 2030 instead of the supply; (2) functioning instead of the disease or medical problem; and (3) the ability to adapt and self-manage instead of a complete state of physical, mental and social well-being. The committee published two reports (one on professions (2015) and one on education (2016)). Four regional breeding grounds were appointed by the committee to assess the challenges and develop initiatives in an interactive way involving citizens, professionals and educators.Aim and objectives: During this workshop a member of the national committee will highlight the findings of both reports. Then we will focus on one of the Dutch breeding grounds, the region of South-Limburg. We will present and discuss how interprofessional education is being developed and implemented in vocational and academic programmes, embedded in primary care and other health care settings. As part of these activities, two students will present their initiative aiming at shifting future healthcare professionals’ focus from the disease to a person’s functioning. The workshop will provide sufficient room to exchange experiences with the audience during a discussion part. Questions that could be raised are: what are the challenges we face? Do we need other professions or other educations? What are the implications for educating our future professionals working in practice and policy? What kind of approaches can be seen in other countries in order to learn from each other?Target audience: The target participants are all those working in policy, practice, education and research with the passion to provide our (future) populations with high-quality, accessible and affordable health care from an integrated care perspective.Learnings/Take away: This workshop will provide insight in the importance and necessity of interprofessional education for integrated care by presenting examples and exchanging ideas of initiatives from different countries.
Concerns about falls are frequently reported by older people. These concerns can have serious consequences such as an increased risk of falls and the subsequent avoidance of activities. Previous ...studies have shown the effectiveness of a multicomponent group programme to reduce concerns about falls. However, owing to health problems older people may not be able to attend a group programme. Therefore, we adapted the group approach to an individual in-home programme.
A two-group randomised controlled trial has been developed to evaluate the in-home multicomponent cognitive behavioural programme to manage concerns about falls and associated activity avoidance in frail older people living in the community. Persons were eligible for study if they were 70 years of age or over, perceived their general health as fair or poor, had at least some concerns about falls and associated avoidance of activity. After screening for eligibility in a random sample of older people, eligible persons received a baseline assessment and were subsequently allocated to the intervention or control group. Persons assigned to the intervention group were invited to participate in the programme, while those assigned to the control group received care as usual. The programme consists of seven sessions, comprising three home visits and four telephone contacts. The sessions are aimed at instilling adaptive and realistic views about falls, as well as increasing activity and safe behaviour. An effect evaluation, a process evaluation and an economic evaluation are conducted. Follow-up measurements for the effect evaluation are carried out 5 and 12 months after the baseline measurement. The primary outcomes of the effect evaluation are concerns about falls and avoidance of activity as a result of these concerns. Other outcomes are disability and falls. The process evaluation measures: the population characteristics reached; protocol adherence by facilitators; protocol adherence by participants (engagement in exposure and homework); opinions about the programme of participants and facilitators; perceived benefits and achievements; and experienced barriers. The economic evaluation examines the impact on health-care utilisation, as well as related costs.
A total number of 389 participants is included in the study. Final results are expected in 2012.
NCT01358032.
Nursing home care for people with dementia is increasingly organized in small-scale and homelike care settings, in which normal daily life is emphasized. Despite this increase, relatively little is ...known about residents' characteristics and whether these differ from residents in traditional nursing homes. This study explored and compared characteristics of residents with dementia living in small-scale, homelike facilities and regular psychogeriatric wards in nursing homes, focusing on functional status and cognition.
A cross-sectional study was conducted, including 769 residents with dementia requiring an intensive level of nursing home care: 586 from regular psychogeriatric wards and 183 residents from small-scale living facilities. Functional status and cognition were assessed using two subscales from the Resident Assessment Instrument Minimum Data Set (RAI-MDS): the Activities of Daily Living-Hierarchy scale (ADL-H) and the Cognitive Performance Scale (CPS). In addition, care dependency was measured using Dutch Care Severity Packages (DCSP). Finally, gender, age, living condition prior to admission and length of stay were recorded. Descriptive analyses, including independent samples t- tests and chi-square tests, were used. To analyze data in more detail, multivariate logistic regression analyses were performed.
Residents living in small-scale, homelike facilities had a significantly higher functional status and cognitive performance compared with residents in regular psychogeriatric wards. In addition, they had a shorter length of stay, were less frequently admitted from home and were more often female than residents in regular wards. No differences were found in age and care dependency. While controlling for demographic variables, the association between dementia care setting and functional status and cognition remained.
Although residents require a similar intensive level of nursing home care, their characteristics differ among small-scale living facilities and regular psychogeriatric wards. These differences may limit research into effects and feasibility of various types of dementia care settings. Therefore, these studies should take resident characteristics into account in their design, for example by using a matching procedure.
To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a ...pilot study.
The iterative user-centered development process consisted of the following phases: (1) selection of user representatives; (2) analysis of users and their context; (3) identification of user requirements; (4) development of the interface; and (5) evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ); higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system.
The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in) weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5.2 (standard deviation 0.90) on the modified PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their physical functioning. However, usability was negatively influenced by a few technical errors.
Involvement of elderly users during the development process resulted in an interface with good usability. However, the technical functioning of the monitoring system needs to be optimized before it can be used to support elderly people in their self-management.
Increasing numbers of persons with dementia (PWD) augment the pressure on dementia care, especially informal care. Care technology can support the network of PWD. We tested the usability and ...perceived value of an online platform that aims to support the communication and collaboration between family and professional caregivers of PWD. A mixed methods design was used for this pilot study, including semistructured interviews, a postal questionnaire, and monitoring of log data. Seven family and thirty-two professional caregivers involved with four PWD participated during a 10-week period. Overall, the results indicate that the platform is easy to use and valuable for both family and professional caregivers. They felt better informed and prepared regarding the situation of the PWD and felt supported by the more direct lines of communication within the network. Also, a broadening and deepening of the relationship between family and professional caregivers was experienced. Although connecting care organizations’ record systems with the platform and an active contribution of all care professionals involved (e.g., general practitioners and those working at day care units) were suggested for optimal use of the platform, family and professional caregivers positively valued the platform for improving the efficiency and ease of communication and collaboration.
Higher levels of frailty result in higher risks of adverse frailty outcomes such as hospitalisation and mortality. There are, however, indications that more factors than solely frailty play a role in ...the development of these outcomes. The presence of resources, e.g. sufficient income and good self-management abilities, might slow down the pathway from level of frailty to adverse outcomes (e.g. mortality). In the present paper we studied whether resources (i.e. educational level, income, availability of informal care, living situation, sense of mastery and self-management abilities) moderate the impact of the level of frailty on the adverse outcomes mortality, hospitalisation and the development of disability over a two-year period.
Longitudinal data on a sample of 2420 community-dwelling pre-frail and frail older people were collected. Participants filled out a questionnaire every six months, including measures of frailty, resources and outcomes. To study the moderating effects of the selected resources their interaction effects with levels of frailty on outcomes were studied by means of multiple logistics and linear regression models.
Frail older participants had increased odds of mortality and hospitalisation, and had more deteriorating disability scores compared to their pre-frail counterparts. No moderating effects of the studied resources were found for the outcomes mortality and hospitalisation. Only for the outcome disability statistically significant moderating effects were present for the resources income and living situation, yet these effects were in the opposite direction to what we expected. Overall, the studied resources showed hardly any statistically significant moderating effects and the directions of the trends were inconsistent.
Frail participants were more at risk of mortality, hospitalisation, and an increase in disability. However, we were unable to demonstrate a clear moderating effect of the studied resources on the adverse outcomes associated with frailty (among pre-frail and frail participants). More research is needed to increase insight into the role of moderating factors. Other resources or outcome measures should be considered.
Abstract Objective: To assess the effects of preventive home visits to elderly people living in the community. Design: Systematic review. Setting: 15 trials retrieved from Medline, Embase, and the ...Cochrane controlled trial register. Main outcome measures: Physical function, psychosocial function, falls, admissions to institutions, and mortality. Results: Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects. Conclusions: No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.
Abstract
Background and Objectives
The transition from home to a nursing home is a stressful event for both older persons and informal caregivers. Currently, this transition process is often ...fragmented, which can create a vicious cycle of health care-related events. Knowledge of existing care interventions can prevent or break this cycle. This project aims to summarize existing interventions for improving transitional care, identifying their effectiveness and key components.
Research Design and Methods
A scoping review was performed within the European TRANS-SENIOR consortium. The databases PubMed, EMBASE (Excerpta Medica Database), PsycINFO, Medline, and CINAHL (Cumulated Index to Nursing and Allied Health Literature) were searched. Studies were included if they described interventions designed to improve the transition from home to a nursing home.
Results
17 studies were identified, describing 13 interventions. The majority of these interventions focused on nursing home adjustment with 1 study including the entire transition pathway. The study identified 8 multicomponent and 5 single-component interventions. From the multicomponent interventions, 7 main components were identified: education, relationships/communication, improving emotional well-being, personalized care, continuity of care, support provision, and ad hoc counseling. The study outcomes were heterogeneous, making them difficult to compare. The study outcomes varied, with studies often reporting nonsignificant changes for the main outcome measures.
Discussion and Implications
There is a mismatch between the theory on optimal transitional care and current transitional care interventions, as they often lack a comprehensive approach. This research is the first step toward a uniform definition of optimal transitional care and a tool to improve/develop (future) transitional care initiatives on the pathway from home to a nursing home.
To investigate the construct validity of a bathroom scale measuring balance in elderly people.
Cross-sectional study.
Participants were recruited via nursing homes and an organization that provides ...exercise classes for community-dwelling elderly people.
Nursing home patients were compared with active community-dwelling elderly people. Eligibility criteria for both groups were: aged 65 years or older and being able to step onto a bathroom scale independently.
The balance measurement of the bathroom scale was compared with the following three clinical balance measurements: Performance Oriented Mobility Assessment (POMA), Timed Up and Go (TUG), and Four Test Balance Scale (FTBS). An independent samples t-test was performed to determine whether nursing home patients scored lower on these four balance tests compared with community-dwelling elderly people. Correlations were calculated between the bathroom scale balance scores and those of the clinical balance tests for nursing home patients and community-dwelling elderly people separately.
Forty-seven nursing home patients with a mean age of 81 years (SD 6.40) and 54 community-dwelling elderly people with a mean age of 76 years (SD 5.06) participated in the study. The results showed that nursing home patients had significantly lower scores on all four balance tests compared with community-dwelling elderly people. Correlations between the bathroom scale scores and the POMA, TUG, and FTBS in nursing home patients were all significant: .49, -.60, and .63, respectively. These correlations were not significant in active community-dwelling elderly people, -.04, -.42, and .33, respectively. Linear regression analyses showed that the correlations for the bathroom scale and POMA, bathroom scale and TUG, and bathroom scale and FTBS did not differ statistically between nursing home patients and community-dwelling elderly people.
These results suggest that the modified bathroom scale is useful for measuring balance in elderly people. However, the added value of this assessment method for clinical practice remains to be demonstrated.
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