Factors associated with daytime sleep in nursing home residents

A retrospective, cross-sectional study was conducted to describe the occurrence of daytime sleep (DS) and to examine factors associated with DS in nursing home residents. We used the Minimum Data Set 2.0 records of 300 residents in a nursing home from January 2005 to March 2010. Descriptive statistics, independent t-test, chi-square, Pearson correlations, and logistic regression were utilized in analysis. About 71.3% of the residents slept more than 2 hours during the day, and this was significantly associated with residents’ comorbidity (t = 2.0, p = .04), cognitive performance (t = 7.3, p = .01), activities of daily living (t = 3.7, p = .01), and social involvement (t = −7.6, p = .01). Cognitive performance and social involvement significantly predicted the occurrence of DS with social involvement being the strongest predictor (odds ratio: .58; 95% confidence interval: [.45, .75]). The findings suggest that interventions to engage nursing home residents in more social activities during the day may be beneficial to minimize their DS, especially for those who have difficulties with engaging socially on their own

Predicting the severity of radiation skin reactions in women with breast cancer

Skin reactions are unavoidable side effects of radiotherapy for breast cancer that may limit the amount of treatment a patient is able to receive. As well, the discomfort associated with the treatment may negatively affect the patient\u27s quality of life and their willingness to complete a course of treatment that typically extends over seven weeks. Prior literature suggests that variations in patients\u27 tissue reactions to radiation may be related to Individual patient characteristics. Before health care providers can intervene to prevent or minimise skin reactions, a clinical model that helps predict which patients will experience more skin reactions is needed. The purpose of the study was twofold: firstly, to test the theoretical relationships between factors that impair healing and the severity of radiation skin reactions; and secondly, to develop a model to predict the severity of radiation skin reactions in women being treated for breast cancer. The theoretical framework for the study was based on two bodies of knowledge, radiobiology and wound healing. This framework specified three sets of potential predictors of radiation induced skin reactions. These were radiation factors (e.g. dose, fractionation), genetic factors (e.g. personal and family history or cancer, radiosensitive conditions) and personal factors (e.g. age, smoking history, nutritional status). It was hypothesised that the severity of the skin reaction was a function of the relationship between these constructs. A sample of 126 women was recruited to the study over a 14-month data collection period. All the women had undergone lumpectomy and were commencing a standard radiation protocol of 45 Gray to the whole breast delivered in daily fractions of 1.8 Gray over five weeks, and a 20 Gray electron boost to the lumpectomy site delivered in daily fractions of 2 Gray over two weeks. After obtaining written informed consent, data on potential factors were collected by interview at the commencement of treatment and from the medical records. Weekly observations of the skin using the Radiation Therapy Oncology Group scoring system were recorded throughout the seven weeks of treatment. The breast was divided into eight anatomical sites to increase specificity in the final analysis. The mean inter-rater reliability of RTOG scoring between the three observers was 0.85. Chi square analysis revealed that several factors were associated with a more severe reaction. Significant factors from the personal construct included smoking, chemotherapy, history of skin cancer, reaction of the skin to UV radiation, lymphocele aspiration, condition of the lumpectomy scar at the commencement of treatment, weight, and the size of the breast. Stepwise logistic regression analysis revealed the relative risk and predictive value of the factors. A predictive model was developed for each of the eight anatomical Sites of the breast for weeks three to seven of radiation treatment. The principal predictors were a large breast size, smoking during the treatment period, and having had a lymphocele aspirated on at least one occasion prior to radiotherapy. The results show that it is possible to predict the severity of skin reactions in individual patients. The research contributes to theory development in radiation skin reactions and to the practice of radiation oncology nursing. Practice implications centre on individualising the preparation, education and management of women undergoing radiation therapy for breast cancer. Further research with larger samples and using different anatomical sites will contribute to the development of a skin reaction risk assessment tool for general use in radiation oncology nursing

Physical activity for people with young-onset dementia and carers: protocol for a scoping review

Background: Physical activity has been cited as a potential symptomatic treatment option for people living with dementia. At present, much of the research concerning physical activity and dementia considers older adults, and there are several review articles summarising the evidence in this area. Less is known about physical activity for younger people with dementia, despite the marked differences in needs and preferences between the two groups. The aim of this scoping review is to systematically explore and critically appraise the current state of the evidence regarding physical activity for people with young-onset dementia and carers. Methods: Several electronic databases (i.e. MEDLINE, SPORTDiscus, CINAHL, Cochrane Library, PsycINFO, Applied Social Sciences Index & Abstracts (ASSIA) and Scopus), grey literature (i.e. NICE Evidence Search (UK) and targeted international organisations e.g. Alzheimer's Society (UK), Age UK, Young Dementia UK, Alzheimer's Association (USA), Dementia Australia) and trial registries (i.e. UK Clinical Trials Gateway, International Clinical Trials Registry Platform and EU Clinical Trials Register) will be searched for published and unpublished evidence regarding physical activity for people with young-onset dementia and carers. Studies included in the review will be subjected to a narrative synthesis to explore similarities and differences, both within and between studies, to identify patterns and themes and to postulate explanations for research findings (e.g. how and why certain interventions or programmes have worked (or not); factors that might have influenced the findings ). Discussion: This will be the first review to systematically explore and critically appraise the current state of the evidence regarding physical activity for people with young-onset dementia and carers. It is hoped that findings from this review will be used to inform the development of future physical activity interventions, to serve as a basis for consultation with key stakeholders and to identify appropriate outcome measures relevant to people with young-onset dementia and carers. Systematic review registration: At present, scoping reviews are not eligible for registration on the international prospective register of systematic reviews (i.e. PROSPERO). © 2018 The Author(s)

Experiences of family carers of older people with mental health problems in the acute general hospital: a qualitative study

Aims To explore the experiences of family carers of people with cognitive impairment during admission to hospital. Background Providing appropriate care in acute hospitals for people with co-morbid cognitive impairment, especially dementia or delirium or both, is challenging to healthcare professionals. One key element is close working with family members. Design Qualitative interview study. Methods Semi-structured interviews with family carers of 34 older people who had been admitted to a UK general hospital and had co-morbid cognitive impairment. Interviews conducted in 2009 and 2010. Analysis was undertaken using Strauss and Corbin's framework. Findings The findings elaborate a core problem, ‘disruption from normal routine’ and a core process, ‘gaining or giving a sense of control to cope with disruption’. Family carers responded to disruption proactively by trying to make sense of the situation and attempting to gain control for themselves or the patient. They tried to stay informed, communicate with staff about the patient and plan for the future. The interaction of the core problem and the core process resulted in outcomes where family members either valued the support of hospital staff and services or were highly critical of the care provided. Conclusion Family carers are not passive in the face of the disruption of hospitalization and respond both by trying to involve themselves in the care and support of their relative and by trying to work in partnership with members of staff. Nurses need to foster this relationship conscientiously

National priorities for dementia care : perspectives of individuals living with dementia and their care partners

The current article reports the consensus recommendations from individuals living with dementia and their care partners on priorities for public policy and research funding, which were found using a nationwide, Delphi study. A modified snowball sample was used. Listservs, personal contacts, and advocacy groups were asked to distribute the survey. Paper versions were provided upon request. In Rounds 1 and 2 of the study, 388 and 301 responses, respectively, were received. Borda counts produced a ranked order consensus of priorities. Research ranked third, after the need for caregiver support and resources for the provision of long-term care. Education and training in person-centered practices for all care partners was also a high priority. Responses indicated that research funding should be expanded beyond its current emphasis on cure. Policymakers should reconsider the current priorities of the National Alzheimer's Project Act to better address the long-term needs of individuals living with dementia and their care partners

Emergency department transfers from residential aged care: What can we learn from secondary qualitative analysis of Australian Royal Commission data?

Objectives: To use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care. Design: The Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective. Results: Three overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure. Conclusions: The results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step

Measuring the ‘dose’ of person-centred care in aged care: Development of staff and family questionnaires

Aims: To develop a theoretically and psychometrically sound instrument to measure the ‘dose’ of person-centred care practice in long-term care. Background: Although person-centred care has been adopted for long-term care across the world, there is a lack of theory-based instruments to measure its impact. Two questionnaires were developed to measure person-centred care from the perspectives of staff and family based on current person-centred care frameworks: Kitwood, Nolan, and Eden Alternative. Methods: Phase I: literature review and focus groups identified potential items for the questionnaires. Phase II: academic experts, local staff, and family members of residents assessed content validity. Phase III: psychometric testing. Results: A 34-item staff questionnaire (Cronbach\u27s Alpha = 0.942) with two factors “Making person-centredness real” and “Making the environment meaningful for life and work”. A 30-item family questionnaire (Cronbach\u27s Alpha = 0.947), with three factors “Staff care about what is meaningful to my family member”, “Staff know and respect my family member”, and “We are all part of a family”. The factors did not directly reflect the theoretical constructs from Kitwood\u27s and Nolan\u27s work. Conclusion: Two instruments, capturing the ‘dose’ or active practice of delivering person-centred care, have demonstrated sound psychometric properties. The study contributes to understanding the theoretical components of person-centred care. Impact: The study addressed the lack of robust tools to measure how much person-centred care is taking place in aged care facilities. Staff and family questionnaires were produced based on strong theoretical foundations combining concepts of prominent person-centred theories and rigorous psychometric testing. The instruments can be used to determine if person-centred care makes a difference, to compare if person-centred care changes or develops over time or between facilities. Ultimately residents, families, and staff will benefit from the ability to measure how much person-centred care residents receive

Barriers to adherence to standard precautions among community health workers: A scoping review

Aim: This review aims to map available evidence on the adherence level and barriers to standard precautions among home-based community health workers. Methods: A scoping review using the JBI protocol searched multiple databases (Medline, CINAHL, PsycINFO and Web of Science) as well as Google Scholar for published articles on standard precaution practices of community health workers during home visits. Search terms included “standard precautions”, “guideline adherence”, “community health” and “home care”. Two-stage screening (title/abstract and full-text) was conducted to select relevant articles. Results: Eight eligible studies yielded three major themes: home environment context, individual factors and organisational factors. Findings indicated low adherence to standard precautions in home care, attributed to factors such as home layout, family or pet interference, cleanliness, limited access to protective equipment (e.g. gloves) and personal protective equipment allergies. Conclusion: Providing healthcare at home is challenging, impacting care quality. Further studies on standard precautions in home care can improve adherence, quality of care and patient outcomes