Integrated working for enhanced healthcare in English nursing homes

Background: The increasingly complex nature of care home residents’ health status means that this population requires significant multi-disciplinary team input from health services. To address this, a multi-sector and multi-professional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. Study aim: To explore the views and experiences of practitioners, social care officers and carers involved in the enhanced healthcare in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of healthcare to older residents. Method: A qualitative constructivist methodology was adopted. The study had two stages. Stage one explored the experiences of the programme enhanced healthcare workforce through group, dyad and individual interviews with 45 participants. Stage two involved two workshops with 28 participants to develop stage one findings (data was collected during February - March 2016). Thematic and content analysis were applied. Findings: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organisational and professional boundaries that support effective decision making and problem solving

Coping Mediates the Association Between Type D Personality and Perceived Health in Chinese Patients with Coronary Heart Disease

Background: Increasing evidence show that Type D personality is a risk factor for morbidity, mortality, and quality of life of patients with coronary vascular disease. Few studies examined coping as a potential behavioral mechanism to explain the harmful effect of Type D personality. Purpose: This study examined the association between Type D personality, coping, and perceived health among Chinese patients with coronary heart disease (CHD). Methods: One hundred seventeen CHD patients completed the assessments on Type D personality, coping, perceived severity of CHD, and morale. Results: There was no difference on severity of coronary artery stenosis between Type D and non-Type D patients. Compared to the non-Type D patients, the Type D patients perceived higher severity of CHD (5.31±2.41 versus 4.45±2.17, p<0.05) and lower morale (12.67±4.71 versus 15.00±4.43, p<0.05), and used less confrontation (16.90±5.39 versus 20.88±4.95, p<0.001) and more acceptance-resignation coping (10.16±3.50 versus 8.35±3.48, p<0.05). Mediation analyses showed that confrontation coping mediated the association between Type D personality and perceived severity of disease, and acceptance-resignation coping mediated the association between Type D personality and morale after controlling for age, gender, and clinical variables. Conclusion: The Type D patients used maladaptive coping in response to disease. These coping strategies fully mediated the association between Type D personality and perceived health. Implications for integrating coping training into the intervention for patients with a Type D personality are discussed. © 2010 The Author(s).published_or_final_versionSpringer Open Choice, 21 Feb 201

Older persons' experiences of whole systems: the impact of health and social care organizational structures

Aim(s) An in-depth case study of whole systems working. Background This paper reports on the second part of a two-part study exploring whole systems working. Part 1 of the study focused on an in-depth review of the literature pertaining to continuity of care and service integration. The second part, reported here, focused on an in-depth case study of one whole system. Evaluation Informed by the findings of part 1 of the study, data collection methods included in-depth interviews, real-time tracking of 18 older people, focus groups and consensus conferencing. Different data sets were analysed individually and synthesized using matrices derived from the literature review findings. Key issue(s) Key themes from data synthesis include: (1) access to the most appropriate services; (2) service fragmentation; (3) continuity of care; and (4) routinized care. Conclusion(s) The four themes of the case study reflect the need to address issues of demarcation of professional responsibilities, complicated channels of communication, information flows, assessment and reassessment in whole systems working. Implications for nursing management The impact of disempowering relationships on actual continuity of care and perceptions of quality among service users and providers. Lessons need to be learnt from specialist services and applied to service delivery in general

Orientation strategies during delirium: are they helpful?

Aim: This paper critiques literature that reports older person experiences of orientation strategies in relation to current recommendations for the management of older person delirium and makes recommendations for future research. Background: Delirium is a common syndrome in hospitalised older people and a difficult syndrome for health care staff to manage. During delirium, older people describe experiencing altered states of reality and use of orientation strategies as part of their care. Orientation, a non-pharmacological approach to the management of delirium, is recommended as a care strategy in evidence-based guidelines and protocols. Method: Discursive paper. Discussion: This paper considers published research into the experiences of hospitalised older people during an episode of delirium and questions the appropriateness of orientation strategies. How care strategies are experienced by older people is emphasised. An approach to care which is a flexible balance of reality orientation and validation therapy, synchronised with the changing reality and reactions of the older person, is identified as a care recommendation from research. Conclusion: When delirium is experienced during hospitalisation, health care staff have a responsibility to provide care that is person-centred and sensitive to the older person’s needs. It has been assumed that no harm comes from the use of orientation approaches, and delirium management guidelines have recommended this approach. However, orientation strategies can lead to mistrust of, and distancing from, health care staff and family, so impeding their relationships with carers. Care practices that consider the older person to be unique and that synchronise with the older person’s changing experiences of reality are suggested for further research. Relevance to clinical practice: Caring for an older person in delirium is challenging for health care staff. Reconsideration of, and research into, care strategies during delirium has the potential to improve the quality of care for hospitalised older people