In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. Discharge planning is a complex process and an important aspect of patient care as poor discharge planning has been associated with poor patient outcomes and increased risk of adverse events and readmission. This study addressed the following research questions: (a) How do acute care occupational therapists describe their role in the discharge planning process? (b) What guides acute care occupational therapists discharge decisions and recommendations? (c) How do acute care occupational therapists define optimal discharge planning? and (d) What actions can acute care occupational therapists take to optimize the effectiveness of their discharge planning skills within the current health care system? Using an action research methodology, two groups of five occupational therapists met online to discuss acute care occupational therapy discharge planning practices, and actions that could be taken to strengthen their practice. Action plans generated, implemented, and evaluated focused on improving communication with discharge planners, language used in documentation, and incorporating the use of standardized assessments to assist with discharge planning. Schell’s ecological model of professional reasoning as the theoretical model underlying this study was used to examine factors that influence occupational therapy discharge decision making. Data were collected from audio chat transcripts, survey responses, and researcher notes, and analyzed using Stringer’s action research sequential data analysis and interpretation methodology. Five themes emerged including (a) the role of occupational therapy, (b) the complexity of discharge planning, (c) pragmatics of practice, (d) why don’t they pay attention, and (e) the importance of stakeholder communication. Participants felt that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had more weight than occupational therapy recommendations. Participants felt that if patients were discharged without benefit of occupational therapy recommendations they could be at increased risk for an adverse event and compromised safety. Good communication among stakeholders was seen as essential for optimal discharge planning.

När en individ drabbas av en demenssjukdom och kognitiv svikt kan det leda till oförmågan att uttrycka smärta, på ett sätt som omgivningen kan förstå. Personer med demenssjukdom är ofta äldre och vårdas inom akutsjukvård på grund akut sjukdomstillstånd eller fall i hemmet som kräver omedelbar smärtbedömning och smärtlindring. Smärtbedömning samt smärtlindring för patienter med demenssjukdom är komplext och en utmaning för sjuksköterskor inom akutsjukvården. Syftet med studien var att belysa smärtbedömning av patienter med demenssjukdom inom akutsjukvård. En litteraturöversikt valdes som metod för att identifiera och lyfta fram aktuell forskning inom området. Mellan december 2015 och januari och februari 2016 gjordes sökningar i databaserna CINAHL, PubMed och PsykINFO. Totalt inkluderades 15 vetenskapliga artiklar, publicerade mellan 2004-2015. Artiklarna kvalitetsgranskades och analyserade utifrån syftet med studien och kring likheter och skillnader. Resultatet kom att beskriva tre huvudteman: kroppsspråk och beteendeförändringar; smärtskattninginstrument och sjuksköterskans erfarenhet. Slutsatsen från studien är att smärta orsakar lidande, vidare att smärtbedömning av patienter med demenssjukdom inom akutsjukvård är komplicerad. Flera smärtbedömningsinstrument identifierades som kan vara till hjälp vid smärtbedömning av patienter med demenssjukdom. Vårdrelation, personcentrerat förhållningssätt samt användning av flera strategier kan säkerställa en korrekt smärtbedömning av patient med demenssjukdom vid vård inom akutsjukvården. Fortsatt forskning behövs för att utvärdera olika smärtbedömningsinstrument inom svensk sjukvård.

På Sveriges akutmottagningar ökar vistelsetiden för varje år och väntan på vårdplats kan bli lång. Längre vistelsetider ökar risken för vårdskador såsom trycksår. Vårdskador innebär lidande för patienten, förlänger vårdtiden och leder till ökade kostnader för hälsooch sjukvården. Akutsjuksköterskans preventiva omvårdnadsarbete minskar onödigt lidande och för tidig död. Trots att trycksår till stor del går att förebygga har det varit svårt att minska dess förekomst. Syftet var att beskriva det trycksårspreventiva arbetet inom akutsjukvård samt belysa vilka faktorer som kan påverka utförandet av detta arbete. Som metod valdes litteraturöversikt. Artikelsökningar genomfördes i databaserna PubMed, CINAHL och PsycINFO med sökord som bedömdes kunna svara på syftet. Sökningarna resulterade i att 20 vetenskapliga artiklar publicerade 2008-2017 inkluderades.  Bearbetningen av artiklarna resulterade i tre huvudkategorier: Riskbedömning och dokumentation, Det trycksårspreventiva arbetet och Faktorer som påverkar trycksårsprevention. Resultatet visade på en varierad förekomst av trycksårsprevention inom akutsjukvård, där flera faktorer påverkar dess utförande. Trycksårspreventiva åtgärder reducerar andelen trycksår vilket talar för hur viktigt det är. Slutsatsen var att för ett lyckat implementeringsarbete om trycksårsprevention behöver personal erhålla kunskap och utbildning, ha nära tillgång till trycksårspreventiv utrustning och erhålla feedback på sitt arbete samt stöd från sjukvårdens ledning. / The waiting time at Sweden's emergency departments increases for each year. Longer stays increases the risk of near misses such as pressure ulcers. Near misses in the health care causes suffering for the patient, prolongs hospital stays and leads to increased costs for the health care system. The preventive work of the emergency nurse reduces unnecessary suffering. Although pressure ulcers are preventable, it has been difficult to reduce them. The aim was to describe the pressure ulcer prevention in acute care and to highlight the factors that may affect the performance of different measures. The chosen method was a literature review including 20 articles related to the aim and published 2008-2017. The articles were retrieved from the databases PubMed, CINAHL and PsycINFO. The articles revealed three main categories: Risk assessment and documentation, Pressure ulcer preventive strategies, Factors affecting pressure ulcer prevention. The result showed a varied occurrence of pressure ulcer prevention in acute care, where several factors affect its occurrence. Preventive work reduces pressure ulcers, which proves how important it is. In conclusion a successful implementation of pressure ulcer prevention requires that staff need to receive knowledge and education, have close access to preventive instruments and receive feedback on their work and support from the healthcare management.

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.

No description available.

BACKGROUND: One of the most recurrent complaints after total joint replacement is difficulty sleeping. Sleep disturbance after major surgery is common. The “stress response” to surgery, personal factors and environmental factors can affect quality and quantity of sleep in the hospital setting. Occupational therapy intervention for individuals that have problems with function as a result of sleep insufficiency is an emerging practice area. However, there are few occupational therapy practitioners who have addressed the important occupation of sleep in acute care settings. There is a need to develop science-driven research and establish evidence to support acute care occupational therapy interventions that address sleep hygiene, a set of behavioral and environmental practices designed to improve both quality and quantity of sleep. In response to this need, the author designed and carried out a non- randomized controlled study to evaluate the effectiveness of a non-pharmacological occupational therapy intervention to improve quality and quantity of clients’ sleep in a fast track joint replacement center. OBJECTIVE: In the author’s study, the aim was to compare sleep quality, sleep quantity, and activities of daily living (ADL) performance before and after fast track total joint replacement surgery for clients who received an occupational therapy intervention targeted at improving sleep hygiene, in addition to conventional acute care occupational therapy, compared to those that received only conventional acute care occupational therapy. The project focused on 1) identifying evidence-based literature to support the benefit of non-pharmacological interventions for joint replacement surgery clients, 2) designing a program that represented best practice while incorporating the holistic and occupation-based theoretical base of occupational therapy, 3) implementing the program, 4) conducting summative program evaluation, and 5) developing a dissemination plan and implementation budget. RESULTS: There were no initial significant differences between the control and experimental groups. The quality of sleep in the experimental group at discharge was significantly better than in the controls and this group reported significantly improved quality of sleep at discharge compared to 2 weeks before surgery. At discharge the experimental group reported significantly longer sleep duration compared to the control group and the increase in duration from 2 weeks before surgery to discharge was significant. CONCLUSION: The results of this study demonstrated that improvement in sleep quality and quantity can be achieved in clients undergoing fast track joint replacement surgery who receive an occupation-based intervention that incorporates implementation of sleep hygiene practices. Moreover the change appears to persist after the client returns home. More research examining the effectiveness of this intervention with other surgical populations and the persistence of learned sleep hygiene practices over time after hospital discharge are warranted. / 2018-11-07T00:00:00Z

INTRODUCTION: Children in inpatient settings are in an unfamiliar environment that does not facilitate engagement in typical occupations. Children report multiple concerns with the hospital environment and experience including physical pain, loss of independence, loss of meaningful activities, lack of routine, and loss of control. Occupational therapists play a distinct role in improving the hospitalization experience for children by addressing these concerns. By improving the evaluation and treatment of visual deficits for children in inpatients settings, occupational therapists can increase children’s function and independence in meaningful activities and maximize psychological well-being. THEORETICAL PERSPECTIVE AND EVIDENCE: Self-determination theory posits that humans have three innate psychological needs – competence, autonomy, and relatedness. These needs are not being met for children in inpatient settings as shown by multiple qualitative studies, however occupational therapy can aid in meeting these needs through proper intervention. DESCRIPTION OF PROJECT: Resources were developed to improve the evaluation and treatment of visual deficits in children in inpatient settings including a vision screening tool, treatment protocol, referral protocol, and functional implications of visual deficits chart. METHODS: The vision screening tool and protocols were used on a small sample of patients (n=6) to identify and treat visual deficits. A survey was provided to occupational therapists to determine feasibility, usefulness, and effectiveness of the resources. CONCLUSION: The resources are useful and feasible for evaluating and treating visual deficits in children in the inpatient setting.

Bakgrund: Den ökande invandringen i Sverige har bidragit till ökad mångfald i landet med människor som kommer från olika bakgrunder och talar olika språk. Språk är en avgörande faktor för effektiv kommunikation mellan sjuksköterskan och patienten, vilket utgör förutsättningar för personcentrerad vård och delaktighet. I akutvårdsmiljön råder det oftast tidspress och språkbarriärer kan vara ett hinder som påverkar vårdkvalitet. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda patienter i akuta situationer när verbala språkbarriärer föreligger. Metod: En allmän litteraturstudie med induktiv ansats, baserad på 12 vetenskapliga artiklar. Artiklarna hämtades från databaserna PubMed, CINAHL och PsycInfo. Resultat: Efter analys av samtliga artiklar identifierades fyra kategorier utifrån artiklarnas resultat: Erfarenheter av att använda kommunikationsfrämjande metoder, Erfarenheter av språkbarriärers påverkan på vårdkvalitet, Erfarenheter av språkbarriärer som utmaning för sjuksköterskan och Erfarenheter av anpassningar och förändringar i sjuksköterskans roll. Konklusion: I akuta situationer upplevde sjuksköterskor utmaningar med att effektivtkommunicera med patienter när språkbarriärer förekom. Trots dessa utmaningar försökte sjuksköterskorna anpassa sig genom olika kommunikationsmetoder. Stress och tidspress påverkade vårdkvaliteten och patient-sjuksköterska relationen negativt. Det ansågs vara viktigt att anpassa sig till patienternas unika behov för att övervinna språkbarriärer. / Background: The increasing immigration in Sweden has contributed to diversity in the country, with people coming from different backgrounds and speaking different languages. Language is crucial for effective nurse-patient communication that forms the basis for person-centered care and participation. In acute care, there is often time pressure, and language barriers can be an obstacle affecting care quality. Aim: The aim was to describe nurses’ experiences of caring for patients in acute situations when verbal language barriers are present. Method: A general literature review with an inductive approach, based on 12 articles retrieving from PubMed, CINAHL and PsycInfo databases. Results: Four categories were identified from the analysis of the articles’ findings: Experiences of communication-promotion methods, Experiences of language barriers’ impacts on quality of care, Experiences of language barriers as challenges for the nurse and Experiences of adaptations and changes in nursing role. Conclusion: Nurses working in acute situations experienced challenges in communicating effectively with patients when language barriers were present. Despite the challenges, nurses tried to adapt through various communication methods. Stress and time pressure negatively affected the quality of care and the patient-nurse relationship. It was considered important to adapt to every patient’s unique needs to overcome language barriers.

Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.

No description available.