Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
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Item New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis(Wiley, 2018-03-24) Rhynas, Sarah J.; Garcia Garrido, Azucena; Burton, Jennifer K.; Logan, Gemma; MacArthur, JulietAims and objectives: To gain an in-depth understanding of the decision- making pro-cesses involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records.Background: The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision- making.Method: A purposive sample of 10 cases was selected from a cohort of 100 individu-als admitted to hospital from home and discharged to a care home. Cases were se-lected to highlight important personal, relational and structural factors thought to affect the decision- making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making.Results: Care home discharge decision- making is a complex process involving stake-holders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient’s voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice.Implications for practice: Nurses have a critical role in the involvement of older peo-ple making discharge decisions in hospital, improved documentation of the patient’s voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs.Item New institutionalisation following acute hospital admission: A retrospective cohort study(Oxford University Press, 2016-10-15) Harrison, Jennifer Kirsty; Garcia Garrido, Azucena; Rhynas, Sarah J.; Logan, Gemma; MacLullich, Alasdair M. J.; MacArthur, Juliet; Shenkin, SusanBackground: institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. Objective: to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. Design and setting: a retrospective cohort study of people admitted to a single large Scottish teaching hospital. Subjects: 100 individuals admitted to the acute hospital from home and discharged to a care home. Methods: a single researcher extracted data from ward-based case notes. Results: people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital. Conclusions: care home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.Item Towards the development of a national patient transfer document between residential and acute care—A pilot study(Wiley, 2021-03-24) Tuohy, Dympna; Fahy, Anne; O'Doherty, Jane; Meskell, Pauline; O'Reilly, Pauline; O'Brien, Brid; Murphy, Jill; Doody, Owen; Graham, Margaret; Barry, Louise; Kiely, Michelle; O'Keeffe, Jonathon; Dewing, Jan; Lang, Deirdre; Coffey, AliceBackground A lack of standardisation of documentation accompanying older people when transferring from residential to acute care is common and this may result in gaps in information and in care for older people. In Ireland, this lack of standardisation prompted the development of an evidence based national transfer document.Item Strategies to prevent dehydration in older people with dementia: A literature review(2019-11-26) Wilson, Kirsty; Dewing, JanDehydration is prevalent in hospitalised older people and residents in care homes, and older people with dementia are particularly at risk. A literature review was conducted to determine the evidence-based interventions used to prevent and manage dehydration in older people with dementia. Three databases were searched for relevant literature: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE, alongside hand-searching. In-depth reading of the 12 studies included in this literature review was undertaken. Five themes were identified in relation to the hydration of older people: physical and social environment; staff communication strategies; access to drinks; drinking vessels; and individual preferences. The evidence suggests that dehydration in older people with dementia is an ongoing concern that needs to be addressed. There is evidence supporting the use of essential nursing interventions to improve hydration, such as coloured cups and verbal prompts, but less is known about the barriers preventing nurses from implementing these evidence-based interventions.Item Collaboration between home care staff, leaders and care partners of older people with mental health problems: A focus on personhood(Wiley, 2019-05-20) Anker-Hansen, Camilla; Skovdahl, Kirsti; McCormack, Brendan; Tønnessen, SiriAim: To explore home care staff and leaders’ experiences of collaborating with care partners of older people with mental health problems through a personhood perspective.Item Stories from people living with frailty(Cambridge University Press, 2019-08-09) Lloyd, Anna; Haraldsdottir, Erna; Kendall, Marilyn; Murray, Scott A.; McCormack, BrendanWe describe the findings of a qualitative longitudinal interview study of a group of initially community dwelling frail older people, their informal and formal carers. We used a narrative approach to explore the role that narrative may have for people living with frailty. This has been less explored comparative to the experiences of those living with chronic illness. The frail older people told stories of their experiences that revealed three distinct shapes or typologies. These were either stable, unbalancing or overwhelmed and related to how the person managed to adapt to increasing challenges and losses and to reintegrate their sense of self into a cohesive narrative. Each is illustrated by an individual case story. Frailty is described as both biographically anticipated yet potentially biographically disruptive as older people may struggle to make sense of their circumstances without a clear single causative factor. Findings are discussed in relation to biographical disruption and reconstruction in chronic illness and the rhetoric around ‘successful ageing’. We conclude by drawing attention to the complex individual and social factors that contribute to the experience of living with frailty in later life.Item Facilitating Implementation of Research Evidence (FIRE): An international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework(BioMed Central, 2018-11-16) Seers, Kate; Rycroft-Malone, Jo; Cox, Karen; Crichton, Nicola; Edwards, Rhiannon Tudor; Eldh, Ann Catrine; Estabrooks, Carole A.; Harvey, Gill; Hawkes, Claire; Jones, Carys; Kitson, Alison; McCormack, Brendan; McMullan, Christel; Mockford, Carole; Niessen, Theo; Slater, Paul; Titchen, Angie; van der Zijpp, Teatske; Wallin, LarsBackground - Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. Methods - A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. Results - Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. Conclusions - This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.Item Invisible cornerstones. A hermeneutic study of the experience of care partners of older people with mental health problems in home care services.(Wiley, 2018-11-16) Anker-Hansen, Camilla; Skovdahl, Kirsti; McCormack, Brendan; Tønnessen, SiriTo explore the lived experiences and support needs of the care partners of older people with mental health problems living at home with assistance from home care services. Care partners face significant challenges in their care role and they often feel unsupported. An understanding of their experiences may help improve home care to support their needs. An exploratory qualitative approach was used. The study is based on the SRQR and COREQ reporting guidelines. In-depth interviews were conducted with six Norwegian care partners from two municipalities. Data were collected during 2012-2013 and 2016. The data were analysed using Gadamer's hermeneutics. Three themes were identified: "invisible cornerstones," "dimensions of collaboration" and "unwanted roles." Few or no routines for collaboration exist between care partners and home care, and the care partners seem to have little knowledge of legal rights. They request more information, spare time and the opportunity to remain in their original family role. However, their main focus is for the patient to receive the necessary help from home care. Home care have restricted resources for meeting these needs and share a sense of powerlessness and lack of influence over their own everyday life with the care partners. There is a need for a systematic, person-centred approach to collaboration. A correlation is necessary between what is communicated at the system level and the means of realising this in practice for home care to meet care partners' needs. [Abstract copyright: © 2018 John Wiley & Sons Ltd.]Item A realist process evaluation within the Facilitating Implementation of Research Evidence (FIRE) cluster randomised controlled international trial: An exemplar(BioMed Central, 2018-11-16) Rycroft-Malone, Jo; Seers, Kate; Eldh, Ann Catrine; Cox, Karen; Crichton, Nicola; Harvey, Gill; Hawkes, Claire; Kitson, Alison; McCormack, Brendan; McMullan, Christel; Mockford, Carole; Niessen, Theo; Slater, Paul; Titchen, Angie; van der Zijpp, Teatske; Wallin, LarsBackground Facilitation is a promising implementation intervention, which requires theory informed evaluation. This paper presents an exemplar of a multi-country realist process evaluation that was embedded in the first international randomised controlled trial evaluating two types of facilitation for implementing urinary continence care recommendations. We aimed to uncover what worked (and did not work), for whom, how, why and in what circumstances during the process of implementing the facilitation interventions in practice. Methods This realist process evaluation included theory formulation, theory testing and refining. Data were collected in 24 care home sites across four European countries. Data were collected over four time-points using multiple qualitative methods: observation (372 hours), interviews with staff (n=357), residents (n=152), next of kin (n=109) other stakeholders (n=128), supplemented by facilitator activity logs. A combined inductive and deductive data analysis process focused on realist theory refinement and testing. Results The content and approach of the two facilitation programmes prompted variable opportunities to align and realign support with the needs and expectations of facilitators and homes. This influenced their level of confidence in fulfilling the facilitator role, and ability to deliver the intervention as planned. The success of intervention implementation was largely dependent on whether sites prioritised their involvement in both the study and the facilitation programme. In contexts where the study was prioritised (including release of resources) and where managers and staff support was sustained, this prompted collective engagement (as an attitude and action). Internal facilitators’ (IF) personal characteristics and abilities, including personal and formal authority, in combination with a supportive environment prompted by managers triggered the potential for learning over time. Learning over time resulted in a sense of confidence and personal growth, and enactment of the facilitation role, which resulted in practice changes. Conclusion The scale and multi-country nature of this study provided a novel context to conduct one of the few trial embedded realist informed process evaluations. In addition to providing an explanatory account of implementation processes, a conceptual platform for future facilitation research is presented. Finally a realist informed process evaluation framework is outlined, which could inform future research of this nature.Item Exploring the meaning of home and its implications for the care of older people(Wiley-Blackwell, 2018-04-04) Board, Michele; McCormack, BrendanAims and Objectives To explore the meaning of home for six baby boomers and consider how this insight can be used when caring for older people in hospital or residential settings. Background Feeling at home is important to help retain a sense of autonomy, security and well-being, but home is a complex concept to understand. The baby boomers are a large cohort entering later life and understanding their sense of home is not only an example of anticipatory gerontology but it could also provide the tools to explore home with the current older population, who may be in a variety of care settings. Design and Methods A qualitative hermeneutic approach was adopted to explore the meaning of home of six baby boomers. The participants were asked to take photographs showing what home meant to them and interpret these in a recorded photo-elicitation interview. Small teams then reviewed the images to provide further insight. Finally, all the data was reviewed to provide an overall analysis of the revealed meaning of home. Results Having possessions or stuff was important for the meaning of home; being familiar with the local environment was also 'homely', as well as certain textures and familiar sounds and smells; relationships with others and the ability to have choice in where and how the participants live were also significant for their meaning of home. Conclusions The meaning of home is complex. Nevertheless, in this study an evocative sense of home was revealed and these insights could be used in discussions with older people in care settings to help increase their sense of autonomy, security and well-being. Furthermore these insights could also be used to develop a framework to help nursing staff guide these discussions.