Preventing repeat hospitalizations in dialysis patients: a call for action

Hospitalizations are frequent among dialysis patients, and reducing repeat hospitalizations could decrease costs and improve outcomes. Chan et al. found that hemoglobin monitoring along with erythropoietin-stimulating agent dose modification and vitamin D administration reduced the risk of repeat hospitalization. These and other interventions, especially those related to close monitoring immediately after hospitalization and better communication between hospital and dialysis providers to assure continuity of care, should be further explored in observational or randomized studies

The criterion-related validity of the Northwick Park Dependency Score as a generic nursing dependency instrument for different rehabilitation patient groups

Objective: To investigate the criterion or concurrent validity of the Northwick Park Dependency Score (NPDS) for determining nursing dependence in different rehabilitation groups, with the Barthel Index (BI) and the Care Dependency Scale (C D S).Design: Cross-sectional study.Setting: Centre for Rehabilitation of the University Medical Center Groningen, The Netherlands.Subjects: Patients after stroke, spinal cord injury, multitrauma, head injury, amputation, rheumatoid arthritis, diabetes mellitus, lung diseases, tuberculosis and coronary artery disease. One hundred and fifty-four patients were included.Measures: The Northwick Park Dependency Score (NPDS), the Barthel Index (BI) and the Care Dependency Scale (CDS).Results: The correlation (rho) between the NPDS and the BI for all groups was - 0.87-1 R-2 = 0.76 (n = 154). Per patient group rho varied from - 0.70 (R-2 = 0.49) to - 0.93 (R-2 = 0.86). The overall correlation between the NPDS and CDS was larger than the criterion of rho = 0.60 (r=- 0.74; R-2 = 0.55) but was &lt;0.60 in the rheumatoid arthritis and tuberculosis group. The overall correlation between BI and CDS exceeded the criterion (r = 0.75; R-2 = 0.56).Conclusions: The NPDS is a generic nursing dependency instrument that can be used as a valid measure across various patient groups in rehabilitation.</p

Experiences of informal caregivers of people with dementia with nursing care in acute hospitals:A descriptive mixed-methods study

Aims To explore the experiences of informal caregivers of people with dementia with the hospitalization of their relative concerning patient care, interactions with nurses, caregivers' situation and the acute hospital environment. Design Mixed-methods design. Methods The data were collected using an online questionnaire among a panel of caregivers (n = 129), together with a focus group and individual interviews from February to November 2019. The data were triangulated and analysed using a conceptual framework. Results Almost half of the respondents were satisfied with the extent to which nurses considered the patient's dementia. Activities to prevent challenging behaviours and provide person-centred care were rarely seen by the caregivers. Caregivers experienced strain, intensified by a perceived lack of adequate communication and did not feel like partners in care; they also expressed concern about environmental safety. A key suggestion of caregivers was to create a special department for people with dementia, with specialized nurses. Conclusion Positive experiences of caregivers are reported in relation to how nurses take dementia into account, involvement in care and shared decision making. Adverse experiences are described in relation to disease-oriented care, ineffective communication and an unfamiliar environment. Caregivers expressed increased involvement when included in decisions and care when care was performed as described by the triangle of care model. Caregivers reported better care when a person-centred approach was observed. Outcomes can be used in training to help nurses reflect and look for improvements. Impact This study confirms that caregivers perceive that when they are more involved in care, this can contribute to improving the care of patients with dementia. The study is relevant for nurses to reflect on their own experiences and become aware of patients' caregivers' perspectives. It also provides insights to improve nurses' training and for organizations to make the care and environment more dementia-friendly

Involvement, topics, and roles of nurses in shared decision-making with patients with dementia in acute hospitals:An integrative review

Aim: To describe nurses' roles, involvement, and topics in shared decision-making with older patients with dementia in acute hospitals. Design: An integrative review. Methods: A systematic search was performed until April 2022 in PubMed, PsychInfo, CINAHL, and Cochrane, followed by a manual search on the reference lists of relevant systematic reviews. Studies were independently screened, appraised using the Joanna Briggs Institute (JBI) methodology, and extracted by two reviewers. Results: Nine studies were included. Nurses were involved as treatment team members, intermediates, or patient supporters. Nurses' roles were most explicit in the preparatory phase of shared decision-making. The step of ‘developing tailor-made options’ was limitedly identified. ‘Deliberating and trying options to reach a decision’ were described from an outsider's perspective in which nurses attempted to influence the decision. In conclusion, nurses primarily have a role in decision-making by supplementing patient information. Patient and Public Contribution No Patient or Public Contribution.</p