No description available.

<p>The purposes of this study are to compare the differences in research utilization among rural and urban nurses working in acute care hospitals and to examine the individual and contextual factors that may be associated with the differences. A quantitative research designed was used to compare the responses of 220 nurses (109 rural and 111 urban) working in a Local Health Integrated Network in South West Ontario, Canada. Data were collected using a modified version of Estabrooks’ (1997) self-report, mail-in, Research Utilization Survey. Results from the data analysis are discussed. Rural and urban nurses reported similar conceptual, instrumental, and persuasive research utilization (RU), with conceptual RU being the most commonly used form. However, rural nurses reported using overall RU significantly less than their urban counterparts did.</p> <p>Rural nurses reported having less access to organizational champions and resources, such as library research journals and computers, than nurses in urban practice had. An analysis of the association between the individual and contextual variables and overall RU indicates that approximately 26% of variance in nurses’ overall RU scores can be predicted from the variance in scores of the following variables: (a) positive RU attitude, (b) organizational relationships supportive of RU, (c) level of competence, and (d) location of nurses. The findings support a multi-dimensional conceptualization of RU and the merits of exploring individual factors as well as organizational and environmental context in future research, theory development, and implementation of strategies to promote RU among nurses.</p> / Doctor of Philosophy (PhD)

Background: Place of death is a commonly reported indicator for assessing palliative care quality, but does not provide details of healthcare service utilization at the end-of-life, such as acute care. In particular, early palliative care has shown to reduce acute care service use, but findings are mostly limited to cancer patients with few population-based data available. Objectives: The purpose of this research is to: 1) explore place of care trajectories in the last 2 weeks of life in a general population and among distinct illness cohorts, and 2) investigate whether early versus late palliative care affects acute care use and other publically-funded services in the last 2 weeks of life. Research Design: A retrospective population-based cohort study using linked administrative health data to examine all Ontario decedents between April 1st, 2010 and December 31st, 2012. Methods: Descriptive statistics were used to examine place of care trajectories and service utilization trends in the last 2 weeks of life. Multivariable logistic regression analyses were conducted to assess in the 2 weeks before death: 1) the odds of using an acute care setting (yes/no), and 2) the odds of time spent (≤1 week or >1week) in acute care settings among users. Results: Overall, 235,159 decedents were identified. About 32% had cancer, 31% had organ failure, and 29% had frailty. Overall, 29% of decedents used a hospital two weeks before death, but this increased to 61% on the day of death. Those with cancer were the largest users of palliative-acute hospital care, while those with organ failure were the largest users of acute- hospital care. Assessing palliative care timing, 27% were early palliative care recipients, 13% were late. About 45% of early recipients had a community-based palliative care initiation, 74% of late recipients had a hospital-based initiation. Late recipients were more likely to use acute care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute care settings (OR=1.84, 95%CI:1.83-1.85), frailty decedents were three times more likely (OR=3.04, 95%CI:3.01-3.07), and organ failure decedents were four times more likely (OR=4.04, 95%CI:4.02-4.06). Conclusion: Place of care trajectories differ greatly by disease cohort. Exploring place of care trajectories can provide details not evident when reporting solely place of death. Furthermore, early palliative care was associated with reduced acute care service use in cancer and non-cancer patients. Late initiations were associated with greater acute care use, and had the largest effect on those with organ failure and frailty, suggesting potential opportunities for improvement in non- cancer populations. / Thesis / Master of Science (MSc)

No / OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care. DESIGN: Randomized, controlled trial. SETTING: Seven community hospitals and five general hospitals in the midlands and north of England. PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness. INTERVENTION: Multidisciplinary team care for older people in community hospitals. MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services. RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups. CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.

No / Purpose. This article contrasts community hospital and general hospital philosophies of care and examines how they relate to patients' and caregivers' experiences. Methods. Semi-structured interviews with 42 staff were used to produce care setting vignettes in six community hospitals and four general hospitals in the midlands and north of England. The vignettes were used with 26 patients and 10 caregivers in semi-structured interviews. Results. Community hospital and general hospital staff identified shared understandings of requirements for post-acute rehabilitation care for older people. Distinctive features were: general hospital – medical efficiency, helping patients get better, high standard of care, need for stimulation; community hospital – homelike setting, quiet, calm ambience, good views, orientated to elderly people, encouragement of social interaction, involvement of relatives in care. In the main there was symmetry between staff aspirations and patients' experience. However some concepts used and assumptions made by staff were not recognised by patients. These were characteristically reframed in patients' answers as if they were discussing subjective dimensions of care. Conclusions. There was patient and caregiver preference for the homelike environment of community hospitals. In care of older people, where the focus is rehabilitation, patient preferences are particularly pertinent and should be considered alongside clinical outcomes and cost-effectiveness.

Yes / Medical technologies have the potential to improve quality and efficiency of healthcare. The design of clinical trials should consider participants' perspectives to optimise enrolment, engagement and satisfaction. This study aims to assess patients' perceptions of their involvement in medical device trials, to inform the designs of future medical technology implementation and evaluation. Four focus groups were undertaken with a total of 16 participants who had participated in a study testing hospital inpatient remote monitoring devices. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis. Four main themes emerged: patients' motivations for participating in medical device research; patients' perceptions of technology in medicine; patients' understanding of trial methodology; and patients' perceptions of the benefits of involvement in medical device trials. The appeal of new technology is a contributing factor to the decision to consent, although concerns remain regarding risks associated with technology in healthcare settings. Perceived benefits of participating in device trials include extra care, social benefits and comradery with other participants seen using the devices, although there is a perceived lack of confidence in using technology amongst older patients. Future device trials should prioritise information sharing with participants both before and after the trial. Verbal and written information alongside practical demonstrations can help to combat a lack of confidence with technology. Randomised trials and those with placebo- or sham-controlled arms should not be considered as barriers to participation. Study results should be disseminated to participants in lay format as soon as possible, subject to participant permission. / The patients in this study were participating in a randomised controlled trial funded by a Health Foundation Innovating for Improvement Award (Grant number: GIFTS 7643 CRM 2674). Candice Downey is in possession of a Doctoral Research Fellowship (DRF-2016-09- 037) supported by the National Institute for Health Research. DGJ received funding support through an NIHR Research Professorship. The research is supported by the NIHR infrastructure at Leeds.

Bakgrund: Sjukhusens vårdavdelningar är den sista vårdplatsen för många människor, vilket innebär att många också dör i den kontexten. Organisationen är i huvudsak utformad för akutsjukvård och vård i livets slutskede är inte prioriterat, vilket gör att akutsjukvårdsmiljön är sämre utformad för den döende personen och närstående. Det finns behov av fler studier som fokuserar på vård i livets slutskede från dessa vårdkontexter.                                                                                                                                                                                                   Syfte: Syftet var att utforska närståendes erfarenheter av vad som är betydelsefullt i vårdmiljön inom akutsjukvården vid vård i livets slutskede. Metod: Den här studien är kvalitativ och designad utifrån tolkande beskrivning. Två akutsjukvårdsavdelningar i södra-mellersta Sverige rekryterades. Nio närstående, sex kvinnor och tre män, i åldrarna 23-63 år, deltog i studien. De blev individuellt intervjuade vid ett tillfälle. Vid intervjun användes fotoelicitering med utgångspunkt från bilder de själva hade tagit. Intervjuerna spelades in digitalt (ljud) och transkriberades ordagrant. Tolkande beskrivning användes för analys av materialet. Resultat: Närståendes erfarenheter av vårdmiljön presenteras i tre mönster, vilka är relaterade till varandra: Sensoriska upplevelser i den fysiska vårdmiljön som inkluderar visuella intryck, ljud och oljud samt ljus; Utrymme för privatliv och sociala relationer i den personliga vårdmiljön och avslutningsvis; Personalen som representanter för den institutionella vårdmiljön som omfattar förhållningssätt, möjliggöra orientering samt struktur och kontinuitet. Slutsats: Studien påvisar tre mönster som omfattar närståendes erfarenheter av det som är betydelsefullt. Betydelsen av sensoriska upplevelser, privatliv och sociala relationer samt personalen förhållningssätt och agerande beskrivs. Erfarenheter i och av vårdmiljön kunde öka eller minska deras stress i en svår livssituation. Utifrån dessa fynd är det av stor betydelse med ökad medvetenhet hos personalen om hur viktig vårdmiljön är och att miljön för vård i livets slutskede vid akutsjukvårdsavdelningar behöver uppmärksammas och tas om hand i större omfattning. / Background: Hospitals are and will continue to be the last place for care for many people, which also means that a lot of people die in these settings, within organizations for acute care. The main focus is not care at end-of-life and it is not prioritized, which means that these acute care environments not are adapted to the needs of dying persons and family members. More studies aiming at end-of-life care in acute care settings are needed.              Aim: The aim with this study was to explore important dimensions of the care environment in acute care settings from family members´ perspective during end-of-life care.                                                                Method: The design for this study was qualitative and used interpretive description. We recruited two acute care units from different hospitals in south-mid Sweden. The participants were nine family members, six women and three men, aged 23-63 years. They were at one occasion individually interviewed with the use of photo-elicitation and these photographs were participant-produced. These interviews were digitally audio-recorded and transcribed verbatim. The interviews were analysed with interpretive description.                                               Findings: These findings show family members´ experiences of the acute care environment, as described in three, interrelated patterns: Sensory experiences in the physical care environment including visual impressions, sound and noises, lighting; Space for privacy and social relations in the personal care environment; and Staff as representatives for the institutional care environment including attitude and manner, orientation, and structure and continuity.                                                                                                                                                              Conclusions: According to these findings three patterns are described from family members´ perspective, increasing or decreasing their distress in a demanding situation. Sensory experiences, privacy and social relations are of importance, just as staff. In line with these findings it is crucial with increased awareness among staff of how important the care environment is and the need for focusing more on and taking care of the end-of-life care environment in acute care settings. / Forskningsprogrammet DöBra / Plats och rum för vård i livets slutskede

Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation. / AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie.

Vascular access in pediatric emergency patients is essential with no doubt. This thesis is based on many scientific publications and studies focused on intravenous and intraoseal access and their aplication in pediatric emergency patients undergoing pre-hospital or hospital treatment. First part is theoretical and is concerned about technique of insertion and post-procedure care. The next part is about comparing different techniques and their successful inserting for the first attempt. The last part is aimed at research with predefined goals. The main goal of this thesis is to give a summary of available knowledge about the peripheral intravenous access and intraoseal access in pediatric emergency patients. The research is aimed at selected group of respondents and their knowledge of techniques and treating of intravenous and intraoseal access. The last goal is to find out which access is preferable in sudden cardiac arrest in children. Data obtained from different groups of respondents approved that none of the groups have sufficient knowledge in inserting and carrying the intravenous and intraoseal access in pediatric emergency patients. In an analysis of data the best results gain paramedics. The majority of respondents would prefer intravenous access in case of sudden cardiac arrest. As a...

Despite a myriad of studies on fall prevention, patient falls continue to be a longterm problem experienced by health care organisations world-wide. Falls impose a heavy burden in terms of social, medical, and financial outcomes, and continue to pose a threat to patient safety. Because the potential for a fall is a constant clinical safety issue in every health care organisation, protecting the patient from falls and subsequent injuries, and ensuring that the patient care environment facilitates, are fundamental aspects in providing quality care. Moreover, the current international focus on creating a culture of quality care and patient safety requires the implementation of fall prevention programs that decrease the risk of falls. As with other international health care organisations, the National University Hospital (where the principal investigator is working), has been challenged with the issue of how to prioritise and implement quality initiatives across all disciplines. Faced with persistent patient falls that affect care outcomes, fall prevention has been a priority initiative at the hospital since 2003. In response, a nursing task force was established in an attempt to resolve this problem. A root cause analysis undertaken by this task force revealed that the hospital protocol on fall prevention was outdated and not evidence-based. Furthermore, many nurses did not understand the importance of fall prevention, while the administration of the fall prevention program was instituted on an ad hoc basis rather than as a standard of care for all patients. The challenge for this task force, as with other health care professionals, was not only in finding an intervention that was effective, but also identifying who would benefit from its implementation. Although the need to apply current best practices to reduce patient falls is clear from the task force results, evidence of the effectiveness of fall prevention interventions in acute care hospitals is lacking in literature. In addition, there are no published studies on fall prevention in Singapore to support changes in nursing practices. Thus, it becomes apparent that research on fall prevention is greatly needed in Singapore so that an evidence-based fall prevention program can be developed. This topic coincides with the Doctor of Nursing course, which requires the student to gain knowledge through scholarly research on contemporary issues in nursing by undertaking two separate projects related to a single area of interest. Undertaking the two research projects on fall prevention in an acute care inpatient hospital as part of the doctoral studies provided an opportunity to address this deficit in a way that could raise awareness of the importance of fall prevention in Singapore hospitals. This research also provides a platform for the first body of research into fall prevention to be conducted within the Singapore health care environment, which is essential, as international studies are not always necessarily applicable to the Singapore context due to differences in educational preparation, skills-mix, organisational culture and nursing practices. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321300 / Thesis (D.Nurs.) -- University of Adelaide, School of Population Health and Clinical Practice, 2008