OBJECTIVE: To understand dental service utilization by frail older adults residing in a long-term care (LTC) setting in the last two years of their life. To understand the types of dental services utilized by this demographic, the frequency of utilization and determine the characteristics that may be predictors of ‘higher dental service utilization’. METHODS: A retrospective cohort study was conducted by an electronic chart review of all LTC patients at two sites who died between 11/1/2014 - 12/30/2016 and had a dental visit in the two-year period prior to death, resulting in a sample of 369 patients. Based on the number of dental appointments attended prior to death, the patients were categorized into five groups: 0,1-2,3-5,6-9 and10 or more appointments. A multivariate logistic regression model was created to identify the factors associated with higher dental service utilization. RESULT: The study found that 84% of patients who died in the study period, utilized on-site dental services in the last two years of their life. Approximately 66% had 3 or more dental appointments. Diagnostic and preventive procedures were most commonly utilized (utilized by 81% and 73% of patients respectively). Multivariate analysis suggested that dentate patients and patients wearing removable dental prosthesis were about 7 and 12 times more likely respectively to have a higher utilization of dental services (OR=6.5 and OR=11.7). Medicaid beneficiaries were more likely (OR=1.9) to have a higher utilization of dental services than the others. CONCLUSIONS: This study showed that a large percentage of frail older adults utilized dental services even in the last years of their lives when given access to these services. As people are living longer and retaining their teeth longer, there is a rising need and subsequent demand for end-of-life dental services. Certain administrative and policy implementation strategies need to be developed to provide dental services to LTC patients in the last years of their lives.

Florence O. Holmes, for the Masters Of Science Degree in Behavioral Analysis and Therapy, presented on July, 2015, at Southern Illinois University Carbondale. TITLE: ACCEPTABILITY OF INTERVENTIONS OF STAFF IN SHORT TERM CARE SETTING FOR CHILDREN WITH BEHAVIORAL HEALTH ISSUES COMPARING RATING AND HIERARCHICAL SELECTION MAJOR PROFESSOR: Dr. Mark Dixon, Ph.D. The present study asked twenty active treatment team members, in a children’s behavioral health hospital in Springfield, IL to answer a pen and paper survey. This study extended research on treatment acceptability by replicating, Baker and LeBlanc (2011), who compared ratings and hierarchical selections in a long term care facility with older adults. Specifically, participants were given the opportunity to rate treatments using a treatment acceptability survey, and were then given a choice (i.e., asked to select which they would be most comfortable implementing) between various treatment options with using a variety of scenarios and choices. In this study it was interesting to find that though an individual selected a treatment as being a good treatment, when asked what they would feel comfortable using in a pinch did not always match what they related as being acceptable. In comparison the results of Baker and LeBlanc are very similar to the current study. In contrast, the rating for the behavioral intervention was higher in the present study and was also selected much more than in Baker and LeBlanc. Baker and LeBlanc reported statistically significant correlations between selections and ratings. Although this study did not recruit enough participants to allow for a statistical analysis, 50% of the participants in this study had a match for what they rated the highest compared to what they selected the most.

abstract: Greater than half of older adults who are admitted to an acute care setting experience delirium with an estimated cost between four to twenty billion dollars annually in the United States. As a strategy to address the gap between research and practice, this feasibility study used the Roy Adaptation Model to provide a theoretical perspective for intervention design and evaluation, with a focus on modifying contextual stimuli in a Trauma Intensive Care and a Trauma Orthopedic Unit setting. The study sample included older hospitalized patients in a Trauma Intensive Care and a Trauma Orthopedic setting where there is a greater incidence for delirium. Study participants included two groups, with one group assigned to receive either a music intervention or usual care. The music intervention included pre-recorded music, delivered using an iPod player with soft headsets, with music self-selected from a collection of music compositions with musical elements of slow tempo and simple repetitive rhythm that influence delirium prevention. For the proposed study a music intervention dose included intervention delivery for 60 minutes, twice a day, over a three day period following admission. Physiologic variables measured included systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate, which were electronically monitored every four hours for the study. The Confusion Assessment Method was used as a screening tool to identify delirium in the admitted patients. Specific aims of this feasibility study were to (a) examine the feasibility of a music intervention designed to prevent delirium among older adults, and (b) evaluate the effects of a music intervention designed to prevent delirium among older adults. Findings indicate there was a significant music group by time interaction effect which suggests that change over time was different for the music and usual care group. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2015

The aim of this study was to explore and describe the perceptions of registered nurses regarding the factors that influence service delivery in expansion programmes in a primary health care setting. A qualitative approach was used to conduct this study. Purposive sampling methods were used to select participants from the registered nurses who had been working in the clinics for more than two years and had been exposed to the expansion programmes in the clinics. The researcher collected data by means of focus group interviews, conducted in a neutral setting. Data were analysed,according to the Tesch method of data analysis, by the researcher and an independent co-coder. Categories, sub-categories and themes were identified. The categories that form the basis of the discussion are: disabling factors, enabling factors, client related factors, service related factors and solutions of problems. It was recommended that the integration and coordination of programmes at provincial level should be planned in conjunction with the training. The regional information system should introduce an electronic recordkeeping system, which links all clinics to one database, allowing these clinics to monitor clients who shop around and move between clinics. Training in expansion programmes should be continually conducted in the region in the form of in-service training. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.

No description available.

Bakgrund: Vid forskningsgenomgång framkom det i internationell forskning att det finns kunskap om sjuksköterskans arbetsbelastning, om stressfaktorer på arbetsplatsen och dess negativa påverkan på sjuksköterskans hälsa. Sjuksköterskan upplever en stark arbetsrelaterad stress, där tidspress och hög arbetsbelastning är återkommande fenomen på akutvårdsavdelningar. En kunskapsbrist råder kring sjuksköterskans upplevda hälsa, specifikt i relation till hennes upplevda möjlighet att ge god omvårdnad. Syfte: Studiens syfte var att undersöka sjuksköterskans upplevda hälsa i relation till hennes upplevda möjlighet att ge god omvårdnad i en akutvårdskontext. Metod: Enkätundersökning av empirisk deskriptiv design med kvantitativ ansats. Resultat: Utifrån sjuksköterskornas skattning av hälsa och god omvårdnad sorterades frågorna in i rubrikerna: sjuksköterskans upplevda hälsa, omvårdnadens atmosfär, sjuksköterskans upplevda möjlighet att underhålla omvårdnadens kvalitet och stressorer i arbetsmiljön. Slutsats: Studien illustrerar ett gott exempel på sjuksköterskans upplevelse av hälsa och upplevelse av god omvårdnad i relation till varandra och KASAM. Sjuksköterskan kan ha en hög KASAM eller låg KASAM beroende på hög begriplighet och hanterbarhet men låg meningsfullhet, eller låg begriplighet och hanterbarhet men hög meningsfullhet. Det vill säga att en sjuksköterska väl kan ha god hälsa utan att hon har relation till god omvårdnad om begriplighet och hanterbarhet finns. Likaså kan sjuksköterskan uppleva avsaknad av hälsa med att detta är i relation till att uppleva god omvårdnad om meningsfullhet finns. Klinisk betydelse: Det krävs en insikt om vad relationen hälsa och välmående hos sjuksköterskan, satt i sammanhang med huvuduppgiften, det utförda omvårdnadsarbetet, egentligen kräver. / Background: Internationally, there is an existing knowledge about nurses’ workload, stress factors in workplaces and its negative impact on nurses’ health. In acute care settings, the nurses experience a strong work-related stress, where time pressure and heavy workload are recurring phenomena. A lack of knowledge exists about the nurse's perceived health, specifically in relation to her experienced ability to provide good care. Aim: The aim of this study was to examine nurses’ experienced health, in relation to her experienced ability to provide good nursing, in acute care settings. Method: A survey of empirical descriptive design with quantitative approach. Result: Based on nurses' estimates of health and good nursing, the questions were arranged under the following headlines: experienced health – good nursing, lack of health – absence of nursing, experienced health – absence of nursing and lack of health – good nursing. Conclusion: The study is a good example of the relation between a nurse's experienced health, her cognition of well performed nursing and sense of coherence. The nurse may have a high or low sense of coherence due to high comprehensibility and manageability but low meaningfulness, or low comprehensibility and manageability but high meaningfulness. Due to high comprehensibility and manageability the nurse can experience good health, but it may not be related to good nursing. The nurse can also experience a lack of health but perform good nursing, due to high meaningfulness. Clinical significance: The study indicates that it requires an understanding for the relation between health and well-being of the nurses, put in context with the main task, the nursing.

During the last several decades, venous thromboembolism (VTE) has been identified as a preventable health condition. The gaps in clinical practice have led to an increased incidence of VTE. The lack of using existing evidence-based VTE prevention guidelines in practice has limited the implementation of VTE risk assessment stratifications and affected the appropriateness and timeliness of addressing pharmacologic and mechanical prophylaxis. The purpose of the scholarly project was to educate practitioners on existing VTE prevention practice guidelines. The practice-focused question explored whether an educational learning activity on evidence-based VTE prevention guidelines improved the awareness, knowledge, and compliance with existing evidence-based VTE guidelines of practitioners that assess and treat patients at risk for VTE. The theoretical framework for the project was Lewin's change process theory. A total of 38 participants comprised registered nurses (82%), physicians (5%), nurse practitioners (2%), and nonclinical personnel (11%). A program evaluation was provided to determine the effectiveness of the project. The findings showed that practitioners participated in the learning activity to improve knowledge (48%), increase VTE awareness (43%), and would change the management and treatment of patients at risk for VTE (39%). Hospitalized patients at risk for VTE can benefit from the results of this project through a change in clinical practice that might decrease the incidence of VTE and potentially bring about social change by reducing the number of preventable deaths.

Bakgrund: Akutsjukvård innefattar olika typer av vård på avdelningar på och utanför ett sjukhus. Inom akutsjukvård kan miljön upplevas stressande för de äldre personerna som är känsliga för bland annat ljud och ljus. Ett personcentrerat bemötande kan hjälpa dem i situationen. Bemötandet är därför en av sjuksköterskans uppgifter inom akutsjukvård. Syfte: Att belysa äldre personers upplevelser av att vårdas inom akutsjukvård. Metod: Arbetet utformades som en strukturerad litteraturöversikt vilken fokuserade på äldre personer över 65 år. Resultatet sammanställdes utifrån 13 vetenskapliga artiklar som var publicerade mellan årtalen 2012–2023 i databaserna CINAHL, PubMed och APA PsycINFO. De delar av resultaten i de inkluderade vetenskapliga artiklarna som svarade mot arbetets syfte markerades och överfördes till post-it-lappar som parades ihop efter liknande betydelse och framkomna kategorier. Resultat: De äldre personerna upplevde miljön inom akutsjukvård som stressfylld och med bristfällig information samt kommunikation vilket sågs främst vid utskrivningen. Bemötandet visade sig spela en betydande roll för deras känsla av respekt, värdighet och delaktighet i många vårdsituationer, detta visade sig svårt att möta inom just akutsjukvård. De äldre personerna delade med sig av flest negativa upplevelser av personalen och organisationen inom akutsjukvård. Slutsats: De äldre personernas upplevelser visade att det fanns förbättringspotential inom miljö, omvårdnad, bemötande och utskrivning i området akutsjukvård för dem äldre personerna. / Background: The acute care included different kinds of care in separate wards in and outside the hospital setting. The environment in the acute care setting could be experienced as stressful for the older persons who were sensitive to noise and lighting among other things. A person-centered care could help them in this situation. The nurse in acute care setting therefore had personal treatment as a work task. Aim: To explore the older persons experiences of care in the acute care setting. Method: This study was designed as a structured literature review with focus on older persons over 65 years. The results are compiled of data from 13 research articles published between the years 2012-2023 from the databases CINAHL, PubMed and APA PsycINFO. The parts of the results who met the study’s aim was marked and transferred to post-it-notes witch was paired by similar meaning and emerged categories. Results: The older persons experienced the environment in the acute care setting as stressful and with flaws in information and communication regarding their care mainly at discharge. The treatment was shown to be a part of their sense of respect, dignity, and participation in their care, this proved difficult to achieve in the acute care setting. The older people shared mainly negative experiences with the staff and organization in the acute care. Conclusions: The older persons experiences of the acute care setting have shown potential to advance in environment, care, treatment, and discharge in area of the acute care for older persons.

Darbo tikslas - įvertinti Kauno Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninės darbo organizavimo ypatumus ir jo gerinimo galimybes. Tyrimo metodika. Kauno Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninės 2005-2007 metų veiklos statistinių rodiklių analizė, anketinė pacientų (n = 102) ir personalo (n = 82) apklausa, bei jų vertinimų palyginimas. Duomenų analizė atlikta naudojant statistinę programą SPSS for Windows 12,0. Rezultatai. Palaikomojo gydymo ir slaugos ligoninių poreikis auga: 2007 metais Raudonojo Kryžiaus slaugos ir palaikomojo gydymo ligoninėje gydyta 18 proc. pacientų daugiau nei 2005 metais. Ligoninėje slaugomų ligonių daugumą sudaro asmenys sergantys širdies ir smegenų kraujotakos sutrikimais (70 proc.), po traumų (11 proc.) ir sergantys onkologiniais susirgimais (8 proc.). Lovos funkcionavimo rodiklis ir vidutinė ligonio gulėjimo ligoninėje trukmė aukšti (364,9 ir 74,9 dienos), lyginant su kitomis Lietuvos slaugos ligoninėmis (atitinkamai 345,2 ir 51,7), galimai dėl nemažo skaičiaus savivaldybės finansuojamų ligonių, laukiančių eilėje į globos įstaigas (2007 m. 1,2 proc. gydytų ligonių pateko į globos namus, 2008 m.sausio 1 d. - 34 laukiantys eilėje). Patekti į ligoninę galima greitai – 70 proc. pacientų pateko iš karto arba laukė eilėje iki 7 d. Didelė problema ligoninėje yra slaugos personalo kaita: per tris metus įsidarbino 82, o atleista 57 slaugytojų padėjėjos, priimta 11 ir atleista 8 bendrosios praktikos slaugytojos. Tiriant... [toliau žr. visą tekstą] / Aim of the study – to evaluate the management and potential for improvement at Kaunas Red Cross long-term care hospital. Material and methods. The study included analysis of statistical performance indicators at hospital setting during 2005–2007, the questionnaires for patients (n = 102) and staff (n = 82). Data analysis was conducted using statistical package „SPSS for Windows 12.0“. Results. The demand of long-term care institutions is increasing: in 2007 the number of patients was increased by more then 18% compare to 2005. The majority of patients had cardiovascular disorders (70%), post-traumatic conditions (11%), or cancer (8%). The bed occupancy and average length of stay were relatively high (364.9 and 74.9 days, respectively), compared to other hospital care settings in Lithuania (345.2 and 51.7, respectively), probably due to high number of patients waiting for municipality-financed nursing homes (in 2007 only 1.2% of patients got to nursing home, while on 1st January 2008 the waiting list contained 34 persons). On the other hand, the acceptance to long-term care is quite fast – 70% of patients were hospitalized immediately or were on the waiting list up to 7 days. However, a significant issue is the changing of staff: during 3 years, 82 nurse assistants were employed and 57 dismissed, while general practice nurses 11 and 8, respectively. Analysis of quality of care revealed, that lowest scores were for hospital signalization system (average scores 3.0 by staff and... [to full text]