Corroborating indicates nurses’ ethical values in a geriatric ward

The aim of the study was to identify nurses’ ethical values, which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic

Geriatric Aspects of Frail Nursing Home Residents : A Swedish cohort study

Background: The number and proportion of older people are increasing in Sweden as well as throughout the western world. Older people with increasing assistance needs that can no longer be met in their own home need institutional long-term care in nursing homes. A successive reduction of nursing home beds in combination with a future demographic development with a rapidly increasing number of older people will lead to higher demands on future medical care in nursing homes. Consequently, increased knowledge about the medical needs of nursing home residents is of great value. Objectives: This thesis explores some important geriatric aspects of frail nursing home residents. The specific aims was to characterise the population of nursing home residents, to explore the prevalence of anaemia, paying particular attention to risk factors and mortality, to investigate associations between falls and use of possible fall risk drug classes and to estimate the prevalence of diagnostic failure of cognitive impairment and to investigate whether diagnostic failure was associated with impaired medical care. Methods: All data originate from SHADES (the Study of Health and Drugs in Elderly nursing home residents in Sweden), a prospective cohort study that included nursing home residents at 12 nursing homes situated in three municipalities in southern Sweden between 2008 and 2011. The subjects were followed every six months with data collection from medical records concerning medications, diagnoses, hospital referrals and mortality, examinations including blood sample analyses, assessments with validated rating scales for cognitive evaluation, depression, risk of pressure ulcers, malnutrition or falls, and the need for care was rated through a questionnaire. Results: SHADES included a total of 428 subjects with a mean age of 85 years, of whom 71% were women. They demonstrated comorbidity with a mean of three registered medical diagnoses, and polypharmacy with a mean of seven regularly used drugs. More than half of the sample (60%) were at risk of malnutrition and one third were at risk of developing pressure ulcers. A set of single items from the performed risk assessments was found to be important in understanding frailty and need for care. One third of the women and half of the men had anaemia. For the men, anaemia was associated with significantly higher mortality. Haemoglobin decline was also associated with higher mortality. Almost everyone (93%) had an increased fall risk and 62% had fallen during the last year. There was an association between falls during the last year and regular use of non-benzodiazepine hypnotics. In the older age group there was also an association between these drugs and serious falls the next 6 months. Dementia was previously diagnosed in 42%. However, among subjects without a dementia diagnosis, 72% were cognitively impaired (Mini Mental State Examination <24). These subjects were significantly older, did not get anti-dementia treatment and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, possibly indicating heart failure. Their risks of malnutrition and pressure ulcers were similar to the dementia group. Conclusions: Nursing home residents are generally frail. Anaemia is associated with higher mortality among men. The fall risk is generally high and use of non-benzodiazepine hypnotics is associated with a higher occurrence of falls. Cognitive impairment is undiagnosed in half of the cases and may indicate underlying heart failure. Consequently, regular medical follow-ups in this population are proposed to include blood count, drug review, and cognitive evaluation. In the case of cognitive impairment, exclusion of underlying disease such as heart failure should be considered

Empirical and normative ethics : a synthesis relating to the care of older patients

The aim of this study was to synthesize the concepts from empirical studies and analyze, compare and interrelate them with normative ethics. International Council of nurses (ICN) and the Health and Medical Service Act are normative ethics. Five concepts were used in the analysis; three from the grounded theory studies and two from the theoretical framework on normative ethics. A simultaneous concept analysis resulted in five outcomes; interconnectedness, interdependence, corroboratedness, completeness and good care are all related to the empirical perspective of the nurse’s interaction with the older patient, and the normative perspective, i.e. that found in ICN code and SFS law. Empirical ethics and normative ethics are intertwined according to the findings of this study. Normative ethics are supporting documents for nurses as professionals and by extension also beneficial for older patients

Children with individual features in a pedagogical process in kindergartens

Bakalaura darbs izstrādāts par tēmu „Bērns ar individuālām īpatnībām pedagoģiskajā procesā pirmsskolā”. Pētījuma aktualitāti noteica izmaiņas mūsdienu skatījumā uz tādiem bērniem, turklāt daudzas ģimenes un audzinatājas nezin, kā pareizi rīkoties un strādāt šādā situācijā. Darba mērķis ir noteikt darbam ar tādiem bērniem atbilstošas pedagoģiskās darbības pirmsskolas pedagoģiskajā procesā. Pētījums sastāv no 2 daļām – teorētiskās un praktiskās. Teorētiskajā daļā analizēti tādi jautājumi kā apdāvinātības problēma pedagoģijā un psiholoģijā, izskatot tādu autoru pētījumus kā V.Bļinova, K.Hellers, Šumakova u.c. Plaši pētīta pedagoģisko metožu izmantošana izglītojošajā darbā ar pirmsskolas vecuma bērniem, metodes, kas orientētas uz konkrēto vecumposmu. Šajā pētījumā tiek pētīts vidējais 3-4 gadu vecuma posms. Darba pētījuma daļā aprakstīts pētījuma metodoloģiskais pamats, sniegts pētāmās grupas raksturojums un pētījuma norises apraksts – bērnu novērošana, aptauja, vecāku anketēšana, vērojumu salīdzināšana, kā arī iegūto kopīgo rezultātu analīze. Praktiskajā daļā pētīta bērnu apmācības nestandarta pieeja pirmsskolas mācību procesā. Pētījuma ietvaros 12 bērni vecumā no 3 gadiem līdz 4 gadiem, tika vērtēts viņu tēlotājdarbības apguves līmenis saskaņā ar izstrādātajiem kritērijiem. Tēlotājdarbībai un veidošanai tika izmantotas netradicionālas tēlotājdarbības tehnikas un nestandarta nodarbību pieeja. Darba rezultāti: mērķis tika sasniegts – bērni ir apguvuši dažādas nestandarta tehnikas tēlotājdarbībā. Tas ļoti sekmēja bērnu darbu nodarbībās un bērnu vispārējo attīstību.The topic of the diploma thesis is “Children with individual features in a pedagogical process in kindergartens”. Determined research actuality change the modern way of how we percieve those children, besides in many families and preschool teachers don’t know how to behave and work in that type of situation. A research objective is to determine the correct pedagogical way of cooping with those children due to the pedagogical process in preschool. Research stands from 2 parts - theoretical and practical. In the theoretical part there is such question analyzed as a problem of gift children in pedagogics and psychology. The research is based upon such authors as V. Blinova, K.Heler, Shumakova e.a. Use of the pedagogical methods is investigated to be clarifying at work with the children of a preschool age. Method is oriented on a significant age. In this research the age group is 3-4 years old children. The research part of the paper contains the methodological foundation of the study, description and research motion description of the investigate group are given - infantile look after, questioning, questionnaire of parents, compare of supervisions, as also analysis of the obtained general results. In non-standard approach is the practical department investigated to the children in a macību process pirmsskolā. In research frames 12 children in age from 3 years to 4 years, after produced criteria valuing anof their level of graphic activity. Work results: an aim was arrived at - children mastered non-standard techniques in graphic activity, and it very helped them not only employments but also in lif

Diagnostic Failure of Cognitive Impairment in Nursing Home Residents May Lead to Impaired Medical Care

BACKGROUND/OBJECTIVES: Dementia and cognitive impairment are common in nursing homes. Few studies have studied the impact of unnoted cognitive impairment on medical care. This study aimed to estimate the prevalence of diagnostic failure of cognitive impairment in a sample of Swedish nursing home residents and to analyze whether diagnostic failure was associated with impaired medical care.METHOD: A total of 428 nursing home residents were investigated during 2008-2011. Subjects without dementia diagnosis were grouped by result of the Mini Mental State Examination (MMSE), where subjects with <24 points formed a possible dementia group and the remaining subjects a control group. A third group consisted of subjects with diagnosed dementia. These three groups were compared according to baseline data, laboratory findings, drug use, and mortality.RESULTS: Dementia was previously diagnosed in 181 subjects (42%). Among subjects without a dementia diagnosis, 72% were cognitively impaired with possible dementia (MMSE <24). These subjects were significantly older, did not get anti-dementia treatment, and had higher levels of brain natriuretic peptide compared to the diagnosed dementia group, but the risks of malnutrition and pressure ulcers were similar to the dementia group.CONCLUSIONS: Unnoted cognitive impairment is common in nursing home residents and may conceal other potentially treatable conditions such as heart failure. The results highlight a need to pay increased attention to cognitive impairment among nursing home residents

Prevalence and predictive importance of anemia in Swedish nursing home residents - a longitudinal study

Background: Anemia is common in elderly people and especially in nursing home residents. Few studies have been performed on the consequences of anemia in a nursing home population. This study explored the prevalence of anemia in nursing homes in Sweden, including risk factors and mortality associated with anemia or hemoglobin (Hb) decline. Methods: Three hundred ninety patients from 12 nursing homes were included during 2008-2011. Information about medication, blood samples, questionnaire responses and information about physical and social activities was recorded. The baseline characteristics of the patients were compared for subjects with and without anemia. Vital status was ascertained during the following 7 years from baseline to compare the survival. Hb levels amp;lt;120 g/L in women and amp;lt;130 g/L in men were used to define anemia. For 220 of the subjects Hb change during one year was registered and the quartiles in Hb change were compared in terms of baseline characteristics and mortality. Results: The prevalence of anemia at baseline was 52% among men and 32% among women. The men with anemia had a two-year mortality significantly higher (61%) than the men without anemia (29%, p = 0.001) but there was no statistical difference in two- year survival in women. In anemic men there was a higher mortality (Hazard Ratio = 1.58) during a total follow-up period of up to 7 years after adjustment for age, increased B-type natriuretic peptide (BNP) and decreased estimated Glomerular Filtration Rate (eGFR). Among men, but not women, we found baseline correlations between anemia and elevated BNP (amp;gt;100 ng/L) and severely reduced eGFR (amp;lt;30 ml/min). When the lowest quartile of Hb change (decline amp;gt;9 g/L) was compared with the highest (improvement amp;gt;6 g/L) the mortality was higher in the lowest quartile (p = 0.03). Conclusions: Anemia is common in nursing home residents in Sweden, especially among men for whom it is related to higher mortality. A rapid Hb drop is associated with higher mortality. Regardless of earlier Hb values, monitoring Hb regularly in a nursing home population seems important for catching rapid Hb decline correlated with higher mortality.Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); Futurum - academy of health and care, Region Jonkoping county; Swedish Society of Medicine; Fromma Foundation; ALF funding from Region Skane</p

Responding to Elder Abuse in GERiAtric care (REAGERA) educational intervention for healthcare providers : a non-randomised stepped wedge trial

Introduction Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers’ propensity to ask older patients questions about abusive experiences. Methods and analysis Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices. The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care–Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics. Trial registration number NCT05065281.Funding: internal sources at Region Ostergotland; Kamprad family foundation [20210151]Licensing: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.</p

Use of non-benzodiazepine hypnotics is associated with falls in nursing home residents : a longitudinal cohort study

BACKGROUND: Falls and related injuries are common among older people, and several drug classes are considered to increase fall risk.AIMS: This study aimed to investigate the association between the use of certain drug classes and falls in older nursing home residents in Sweden, and relate these to different age groups.METHODS: Information on falls that occurred in the previous year and regular use of possible fall risk drugs including non-benzodiazepine hypnotics (zopiclone and zolpidem) was collected from 331 nursing home residents during 2008-2011. Over the following 6 months, the occurrence of serious falls, requiring a physician visit or hospital care, was registered. Association between serious falls and drug use was compared between an older (≥ 85 years) and a younger group.RESULTS: An increased fall risk (Downton Fall Risk Index ≥ 3) was found in 93% of the study subjects (aged 65-101 years). Baseline data indicated an association between falls that occurred in the previous year and regular use of non-benzodiazepine hypnotics (p = 0.005), but not with the other studied drug classes. During the following 6 months, an association between use of non-benzodiazepine hypnotics and serious falls in the older group (p = 0.017, odds ratio 4.311) was found. No association was found between the other studied drug classes and serious falls.DISCUSSION: These results indicate an association between falls and the use of non-benzodiazepine hypnotics, compounds that previously have been considered generally well-tolerated in older people.CONCLUSIONS: Caution is advocated when using non-benzodiazepine hypnotics regularly in older people living in nursing homes