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The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. / Master of Health Science (Hons)

This randomized controlled trial examined the effects of Music Therapy (MT), Music Medicine (MM), or Attention Control (AC) on physiological and psychological parameters of stress for adult and older adult patients receiving care in the Intensive Care Unit of a community general hospital. Previous studies have indicated effectiveness of music therapy or music medicine for these medical patients, but few data are available for music therapy interventions. This study was an attempt to add to available information about the effects of music therapy compared to the effects of music medicine or attention control for this patient population. Participants (twenty-eight adults, ranging in age from 37-83 years; not mechanically ventilated at the time of session) were randomly assigned to music therapy, music medicine or the attention control group. Repeated measures of heart rate, blood pressure, respiratory rate, oxygen saturation, and anxiety and pain levels were collected before the session, immediately after the session and at 60 minutes post-session. Anxiety was measured using the Faces Anxiety Scale, and pain was self-reported via a Visual Analog Scale. Post-session length of stay was collected from the participants' medical records. Overall, there were no significant interactions among study groups and outcome measures. There was a statistically significant difference between length of stay for music therapy participants and attention control. Over time from pre-session to post-session, statistically significant decreases in anxiety scores were measured for both music medicine and music therapy groups. Pain scores decreased for both music medicine and music therapy groups, however not significantly. Some medically beneficial effects of music therapy or music medicine were evident in the data. / Music Therapy

<p>Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is the most preventable cause of death in hospitalized patients. Due to its high mortality, morbidity, and cost, health care providers are obligated to not only effectively diagnose and treat VTE, but also to prevent it if possible. This has been reinforced by a number of national and international quality initiatives to prevent hospital-acquired VTE. Despite the existence of well-accepted clinical practice guidelines on VTE prophylaxis, 1 in 3 hospitalized medical patients receives an inappropriate VTE prophylaxis strategy. Both underuse of prophylaxis in patients with VTE risk, and overuse of prophylaxis in patients without VTE risk are problems. The use of inappropriate VTE prophylaxis strategies is likely due to the complexity and heterogeneity of hospitalized medical patients, and the difficulty of applying “one size fits all” practice guidelines to this group. Institution-wide knowledge translation strategies are required to close the gap between evidence and practice, and promote evidence-based VTE prophylaxis strategies in hospitalized medical patients. The objective of this thesis is to design a cluster randomized controlled trial to determine if a standardized electronic order set, with an embedded computerized decision support system and audit and feedback component, affects the use of appropriate VTE prophylaxis in hospitalized medical patients. The unit of randomization in this study is the hospital, which serves as the cluster. The unit of observation in this study is the individual patient. The primary outcome of this study is the proportion of in-hospital days during which appropriate VTE prophylaxis is administered, in intervention versus control hospitals. Secondary outcomes are the rates of hospital-acquired VTE, major bleeding and mortality, in intervention versus control hospitals. Design, analytic and ethical challenges unique to cluster randomized trials will also be discussed. Strategies to overcome them in this trial will be presented.</p> / Master of Science (MSc)

Determining the prognosis or risk of an individual experiencing a specific health outcome within a certain time period is essential to improve health. An important aspect of prognostic research is the development of risk assessment models (RAMs). In support of the movement towards personalized medicine, health care professionals have employed RAMs to stratify an individual patient’s absolute risk of developing a health condition and select the optimal management strategy for that patient. The development of RAMs is generally conducted using data driven methods or through expert consensus. However, these methods present limitations. Accordingly, we recognized the need to select factors for RAM development or update that are evidence-based and clinically relevant using a structured and transparent approach. In this sandwich thesis, I highlight the methods used to select prognostic factors for VTE and bleeding RAMs for hospitalized medical patients. However, the same methods can be applied to any clinical outcome of interest. This work presents a conceptualized and tested novel mixed methods approach to select prognostic factors for VTE and bleeding in hospitalized medical patients that are evidence-based, clinically meaningful and relevant. Our findings may inform the development of new RAMs, the update of widely used RAMs, and external validation and prospective impact assessment studies. Also, these findings may assist decision makers in evaluating the risk of an individual having an outcome to optimize patient care. / Thesis / Doctor of Philosophy (PhD) / Measuring the probability of an individual experiencing a specific health outcome in a certain period of time based on that individual’s risk factors is important to improve health. Prediction tools are often used to calculate the probability of an outcome. Health care practitioners use prediction tools to assess an individual’s risk of a certain health outcome and in turn provide individualized management. Prediction tools include a number of agreed upon risk factors that should be assessed in order to best estimate the risk of an outcome. These risk factors are usually selected through exploring sets of data or by consulting a group of experts in the field. However, these methods have limitations. Therefore, we recognized that it is important, when developing prediction tools, to select risk factors that are evidence-based and clinically relevant by adopting a systematic, comprehensive, structured and transparent approach. These sets of risk factors can then aid health researchers when developing new prediction tools or updating existing ones and help clinicians predicting risk. In this thesis, I highlight the methods used to select factors for prediction tools that evaluate the risk of having a venous clot or a bleeding event in patients that are hospitalized for a medical condition. However, the same methods can be applied to any clinical condition and outcome of interest. This work presents a new approach that we conceptualized and tested to select risk factors for venous clots and bleeding events in hospitalized medical patients that are evidence-based, clinically meaningful and relevant. Our findings may inform the development of new prediction tools, the update of widely used tools, and the design of studies to validate these tools. Also, these findings may assist decision makers in evaluating the risk of an individual having an outcome to optimize patient care.