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Canadians are living longer with multiple complex illnesses. In turn, older adults are often in need of complex medical attention in crisis situations in acute care hospital settings. Although acute care settings are equipped with a growing variety of life saving technologies, hospitals are still the setting in which most people die. Yet, almost half of the Canadians who have been admitted to acute care centres with chronic life-limiting illnesses have not had advance care planning (ACP) conversations with their substitute decision-maker (SDM) about the personal values that bring quality to their lives. In fact, only 8% of the general Canadian population are ACP ready. Consequently, many SDMs are unprepared to make end of life (EOL) treatment decisions for their loved ones. One way to promote patient-centred care and ease the burden of in-the-moment EOL treatment decisions made by SDMs, is for nurses to engage their patients in ACP. However, very few registered nurses regularly engage their patients in ACP. The purpose of this research is to better understand the organizational factors influencing nurses’ decisions related to ACP in their hospital-based work. This ethnographic study was conducted on three acute care wards in two hospital sites located in Northern Ontario. Data collection methods included observational fieldwork, semi-structured interviews with administrators and registered nurses (n=23), and the collection of documents pertinent to the study purpose (i.e., accreditation reports, practice guidelines, etc.). Findings reveal that the work of nurses in hospital settings is embedded within a context that prioritizes patient flow, and efficiency. Consequently, hospitals often function at overcapacity, and nurses have extremely heavy workloads caring for complex patients with diagnoses that do not match the medical specialty of the units. Although participants state that they value ACP, they maintain that nurses have very little capacity to engage patients in these conversations in their practice. Findings support that expectations for hospital nurses to fully engage in ACP with their patients may be unrealistic given the context within which they work. Alternative models for considering ACP in acute care could be explored to ensure that patients with life-limiting conditions receive care that is best matched to their needs, values, and wishes. / Graduate

Abstract This study sought to understand the differences and similarities between social work practice and evidence-based practice (EBP). As evidence-based practice becomes popularized in areas of professional practice, challenges and tensions arise for social workers. This qualitative research study asked social workers working in the hospital setting how they define and use evidence-based practice in their work, and about the tensions they experience in using EBP. The study revealed that social workers maintain their scope of practice in areas related to advocacy, the use of systems theory and the importance of the therapeutic relationship with clients in the helping process. The social workers in the study identified that social workers understood the value of scientific research and indicated that as a profession, social work practice can use research to influence areas for social change. The participants in the study described that social work practice and evidence-based practice are distinct. Social work practice is intended to understand and respond to social problems, whereas EBP in mental health settings is designed to resolve more narrowly-defined problems of individual coping. The social workers recognized that the two practices could only really co-exist. However, they did note that social workers’ commitments to reinforce self-determination for clients have potentially important overlap with EBP’s attention to patient values and preferences. / Thesis / Master of Social Work (MSW)

Background: Many elderly people today have dementia, and many people with dementia encounter health care services, including in elderly care or in hospitals. Previous research indicates that relatives feel that nurses' treatment and contact can affect their well-being, and that patients with dementia feel that the hospital is not adapted to their needs and that communication with nurses is difficult. Aim: To describe nurses' experiences of treatment of patients with dementia in hospitals. Method: A general literature study of 4 quantitative articles, 6 qualitative articles. The articles were collected from two different databases. Results: Nurses strive to establish a caring relationship with patients with dementia in order to offer good care. Some nurses found it easy and challenging to meet and communicate with patients with dementia, while some nurses found it demanding. Lack of time was identified as a factor that caused stress and anxiety in nurses when dealing with patients with dementia. Conclusion: The results show that nurses who had a care relationship with patients with dementia contributed to the experience of good treatment, despise this there are many factors that can affect nurses' treatment such as prioritizing patients, lack of time, knowledge, experience and aggressive behavior from patients with dementia.

In the context of hospital architecture, the incorporation of biophilic elements, such as natural light, greenery, and organic materials, is crucial for enhancing patient outcomes and well-being. These elements not only evoke a sense of connection with nature but also contribute to stress reduction, improved cognitive function, and accelerated recovery rates. Through the lens of Vastu Shastra, which emphasizes harmony between the individual and their surroundings, we explore how the alignment of architectural elements with natural forces can create environments that resonate with the inherent flow of life energy, or prana, within the human body. Furthermore, this abstract delves into the nature of space within hospital environments, recognizing it as a dynamic continuum that encompasses mystery, refuge, and prospect. By creating spaces that evoke a sense of mystery through subtle interplays of light and shadow, hospitals can offer moments of contemplation and introspection for patients and staff alike. Similarly, the provision of refuge zones, characterized by tranquil green spaces and secluded alcoves, serves as havens for relaxation and rejuvenation amidst the bustling clinical environment. Additionally, spaces designed to offer prospect, such as panoramic views of natural landscapes or expansive skyward vistas, instill a sense of hope and optimism, inspiring patients to envision a brighter future beyond their current circumstances. Central to this exploration is the role of materiality in shaping the permeability of hospital spaces. By carefully selecting and deploying materials that evoke tactile sensations and visual richness, it can enhance the sensory experience of occupants while fostering a sense of connection with the natural world. Whether by using sustainably sourced wood for interior finishes, biophilic patterns in architectural ornamentation, or the incorporation of water features to evoke a sense of fluidity and renewal, materiality becomes a powerful medium through which the essence of nature can permeate the built environment, promoting healing and well-being. / Master of Architecture / This summary discusses how incorporating natural elements such as sunlight, plants, and natural materials into hospital design can significantly improve patient health and recovery. Research shows that exposure to natural light can boost mood, reduce stress, and regulate sleep patterns, which are crucial for healing. Greenery, such as indoor plants or garden views, can create a calming environment and have been linked to faster recovery times and reduced need for pain medication. The summary also explores an ancient design philosophy called Vastu Shastra, which focuses on creating harmony between individuals and their surroundings. According to Vastu Shastra, aligning architectural elements with natural forces can enhance the flow of life energy, or prana, within the body, contributing to overall well-being. This philosophy suggests that well-designed hospital spaces can support both physical and mental health by promoting balance and tranquility. The design principles highlighted include creating areas for reflection and relaxation, such as quiet nooks or peaceful gardens, where patients and staff can take breaks and rejuvenate. Additionally, providing inspiring views of nature, whether through windows or rooftop gardens, can instill a sense of hope and positivity, encouraging patients to envision a brighter future. Using materials that feel and look natural, like sustainably sourced wood for furniture and finishes, or incorporating water features like fountains or ponds, can further enhance the healing atmosphere. These natural materials can evoke tactile sensations and visual richness, making the hospital environment feel more welcoming and less clinical. Overall, integrating these biophilic and Vastu Shastra-inspired elements into hospital design can create a supportive and nurturing environment that promotes healing and well-being for patients and staff alike.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Yes / The purpose of this paper is to study the effect of the implementation of Lean bundles on hospital performance in private hospitals in Jordan and evaluate how much the size of organization can affect the relationship between Lean bundles implementation and hospital performance. Design/methodology/approach The research is considered as quantitative method (descriptive and hypothesis testing). Three statistical techniques were adopted to analyse the data. Structural equation modeling techniques and multi-group analysis were used to examine the research’s hypothesis, and to perform the required statistical analysis of the data from the survey. Reliability analysis and confirmatory factor analysis were used to test the construct validity, reliability and measurement loadings that were performed. Findings Lean bundles have been identified as an effective approach that can dramatically improve the organizational performance of private hospitals in Jordan. Main Lean bundles – just in time, human resource management, and total quality management are applicable to large, small and medium hospitals without significant differences in advantages that depend on size. Originality/value According to the researchers’ best knowledge, this is the first research that studies the impact of Lean bundles implementation in healthcare sector in Jordan. This research also makes a significant contribution for decision makers in healthcare to increase their awareness of Lean bundles.

Yes / Dog bite injuries are a common cause of patient presentation to NHS emergency departments (EDs) and minor injuries units, and are generally associated with a low level of acuity, despite an inherent capacity for significant soft tissue damage to be inflicted by canine jaws capable of exerting terrific bite forces. Anatomical sites for injury correlate to victim age, with hand and wrist injuries predominating in the adult population. The most common complication is infection secondary to inoculation of oral flora, with the hands being particularly vulnerable due to their anatomy. Injuries to structures such as tendons can be discreet, and retained foreign bodies can easily be overlooked. Wound care has a propensity to attract a disproportionately high level of malpractice actions, and approaches to the management of dog bite injuries have largely been empirical, which may render the practitioner particularly exposed. In response to increasing pressures on healthcare systems, paramedics with extended scopes of practice, including wound care and suturing, are being utilised to assess, manage, treat, and either refer or discharge patients with apparently minor injuries, in strategies aimed at reducing hospital admissions. This article adopts a case study format to examine and evaluate treatment modalities and the current evidence base informing best practice in terms of dog bite injuries from the perspective of a paramedic practitioner, with critical reflection on the decision making process and complexities of such episodes of care in the pre-hospital setting.

Yes / Pain and delirium are common in people with dementia admitted to hospitals. These are often under-diagnosed and under-treated. Pain is implicated as a cause of delirium but this association has not been investigated in this setting. To investigate the relationship between pain and delirium in people with dementia, on admission and throughout a hospital admission. Design: Exploratory secondary analysis of observational prospective longitudinal cohort data. Setting: Two acute hospitals in the UK. Methodology: Two-hundred and thirty participants aged ≥70 years were assessed for dementia severity, delirium ((Confusion Assessment Method (CAM), pain (Pain Assessment in Advanced Dementia (PAINAD)) scale and prescription of analgesics. Logistic and linear regressions explored the relationship between pain and delirium using cross-sectional data. Results: Pain at rest developed in 49%, and pain during activity for 26% of participants during their inpatient stay. Incident delirium developed in 15%, of participants, and 42% remained delirious for at least two assessments. Of the 35% of participants who were delirious and unable to self-report pain, 33% of these participants experienced pain at rest, and 56 experienced pain during activity. The odds of being delirious were 3.26 times higher in participants experiencing pain at rest (95% Confidence Interval 1.03–10.25, P = 0.044). Conclusion: An association between pain at rest and delirium was found, suggesting pain may be a risk factor for delirium. Since pain and delirium were found to persist and develop during an inpatient stay, regular pain and delirium assessments are required to manage pain and delirium effectively. / The Impact of Acute Hospitalisation on People with Dementia: The Behaviour and Pain (BepAID Study (jointly funded by the Alzheimer’s Society and BUPA foundation (Grant reference number: 131). Dr Sampson’s, Dr White’s, Dr Kupeli’s and Miss Vickerstaff ’s posts are supported by Marie Curie core funding, grant (MCCC-FCO-16-U).

Yes / The COVID-19 pandemic placed the UK healthcare system under unprecedented pressure, and recovery will require whole-system investment in innovative, flexible and pragmatic solutions. Positioned at the heart of the healthcare system, ambulance services have been tasked with addressing avoidable hospital conveyance and reducing unnecessary emergency department and hospital attendances through the delivery of care closer to home. Having begun to implement models of care intended to increase ‘see and treat’ opportunities through greater numbers of senior clinical decision makers, emphasis has now been placed upon the use of remote clinical diagnostic tools and near-patient or point-of-care testing (POCT) to aid clinical decision making. In terms of POCT of blood samples obtained from patients in the pre-hospital setting, there is a paucity of evidence beyond its utility for measuring lactate and troponin in acute presentations such as sepsis, trauma and myocardial infarction, although potential exists for the analysis of a much wider panel of analytes beyond these isolated biomarkers. In addition, there is a relative dearth of evidence in respect of the practicalities of using POCT analysers in the pre-hospital setting. This single-site feasibility study aims to understand whether it is practical to use POCT for the analysis of patients’ blood samples in the urgent and emergency care pre-hospital setting, through descriptive data of POCT application and through qualitative focus group interviews of advanced practitioners (specialist paramedics) to inform the feasibility and design of a larger study. The primary outcome measure is focus group data measuring the experiences and perceived self-reported impact by specialist paramedics. Secondary outcome measures are number and type of cartridges used, number of successful and unsuccessful attempts in using the POCT analyser, length of time on scene, specialist paramedic recruitment and retention, number of patients who receive POCT, descriptive data of safe conveyance, patient demographics and presentations where POCT is applied and data quality. The study results will inform the design of a main trial if indicated. / The full-text of this article will be released for public view at the end of the publisher embargo on 1 Jun 2024.