Use of psychiatric medication in three Arctic nursing homes: association with dementia and psychiatric symptoms.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAs more people reaches advanced age, more people experience cognitive impairment and dementia. Dementia is a degenerative disease in which behavioural and psychological symptoms frequently occur, resulting in admissions to nursing homes (NHs), where the most common treatment has been medical treatment. The aim was to compare three rural Arctic NHs in Iceland in their use of psychiatric medication, type of dementia among residents, level of cognitive impairment and selected quality indicators, as well as considering national data, for the period 2016-2018. Data from the interRAI-MDS 2.0 evaluation were used. Residents with severe cognitive impairment used more antipsychotic medications, and residents with mild and severe cognitive impairment used more antidepressants than residents with no cognitive impairment did. Diagnoses of Alzheimer's Disease and Related Dementias (ADRD) are more common in the capital area and the national average than they are in the rural NHs. This indicates need for diagnostic assessments of ADRD to be conducted in rural areas. Benchmarking is beneficial for local and national regulatory bodies to find areas for improvement. The NHs did not have a lower quality of care compared with the whole country, but areas for improvement were identified. One of the NHs has already started this process. Keywords: Nursing homes; arctic areas; dementia; psychiatric medication.Icelandic Nurses Associatio

Developing ActivABLES for community-dwelling stroke survivors using the Medical Research Council framework for complex interventions.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Novel technical solutions are called for to promote home-based exercise among community-dwelling stroke survivors supported by their caregivers. Lack of resources and knowledge about how to accomplish it, has been demonstrated. The objective of this study is to describe in detail the development of ActivABLES, a technical intervention to promote home-based exercise and physical activity engagement of community-dwelling stroke survivors with support from their caregivers. Methods: The technical development process of ActivABLES was guided by the Medical Research Council (MRC) framework for development and evaluation of complex interventions as well as by principles of human-centred design and co-design. The main steps included: (1) Synthesis of evidence supporting the inclusion of balance exercises, mobility and walking exercises and exercises for the upper arm; (2) Implementation of initial user studies with qualitative data collection from individual interviews with stroke survivors, and focus group interviews with caregivers and health professionals; (3) Preliminary testing of eight prototypes with seven stroke survivors and their caregivers. Results: After the preliminary testing of eight prototypes, four prototypes were not further developed whereas four prototypes were modified further. In addition, two new prototypes were developed, leaving six prototypes for further modification: 1) ActivFOAM for balance exercises, 2) WalkingSTARR to facilitate walking, 3) ActivBALL for hand exercises, 4) ActivSTICKS for upper arm exercises, and 5) ActivLAMP and 6) ActivTREE which both give visual feedback on progress of daily exercise and physical activities. ActivFOAM, ActivBALL and ActivSTICKS are all connected to a tablet where exercise instructions are given. All the exercise prototypes can be connected to ActivLAMP and ActivTREE to give feedback on how much exercise the user has done. Settings can be individualised and recommended daily time and/or repetition can easily be changed as the user progresses to higher activity levels. Conclusions: The development process of ActivABLES was guided by the principles of human-centred design, with iterative testing of future users, and by the MRC framework of complex intervention, with a repeated process of development and testing. This process resulted in six prototypes which are available for feasibility testing among a small group of community-dwelling stroke survivors. Keywords: Home-based exercise; Stroke survivors; Technical intervention.NordForsk ActivABLES project Icelandic Physiotherapy Association Icelandic Ministry of Welfar

Health status and functional profile at admission of nursing home residents in Iceland over 11-year period.

Health status and functional profile at admission of nursing home residents in Iceland over 11-year period. International Journal of Older People Nursing doi: 10.1111/j.1748-3743.2011.00287.x Background. The knowledge over time of the health status and changes in care needs of newly admitted nursing home residents is limited. Objectives. To investigate trends in residents' health status and functional profile at admission to nursing homes and compare rural and capital areas in Iceland over an 11-year period. Design. Retrospective analysis of nursing home data over 11 years (1996-2006). Participants. Residents, who had been assessed with the Minimum Data Set assessment within 90 days from admittance (n = 2206). Method. Non-parametric tests for descriptive statistics and linear regressions were used to analyse time trends. Results. The mean age ranged from 80.1 to 82.8, and women accounted for 52.7% to 67.1%. The level of independency indicated intact cognitive performance in 28.6-61.4% and in 42.5-68% in activities of daily living performance. A weak, but significant, linear trend was seen in residents' health becoming less stable, their cognitive performance improving, more pain being reported and greater participation in social activities over the 11 years. Conclusion. Some residents might have stayed at home longer had they been given appropriate home care and the opportunity of rehabilitation. Pain management and social activities are areas where more staff knowledge seems to be needed. Implications for practice. Resources to enable old people to remain at home need to be explored before their entry into nursing homes. Whereas providing services at the appropriate level is important for society as well as older people

Quality of care in Icelandic nursing homes measured with Minimum Data Set quality indicators: Retrospective analysis of nursing home data over 7 years.

BACKGROUND: The increasing need for long-term care as well as diminished financial resources may compromise the quality of care of older people. Thus the need for clinically based quality of care monitoring to guide development of long-term services has been pointed out. OBJECTIVES: The aim of this study was to investigate trends in quality of care during 2003-2009 as reflected in the Minimum Data Set quality indicator outcome in Icelandic nursing homes and to investigate the association of Minimum Data Set quality indicators with residents' health status (health stability, pain, depression and cognitive performance) and functional profile (activities of daily living and social engagement). DESIGN: Retrospective analysis of nursing home data over 7 years. METHODS: The sample used for analysis was 11,034 Minimum Data Set assessments of 3694 residents living in Icelandic nursing homes in 2003-2009. Minimum Data Set quality indicators were used to measure quality of care. The chi-square test for trend and multivariate logistic regression were used to analyse the data. RESULTS: The mean age of residents during the period of the study ranged from 82.3 (SD 9.1) to 85.1 (SD 8.3) and women accounted for from 65.2% to 67.8%. Findings for 16 out of 20 quality indicators indicated a decline in quality of care (p<0.05), although in 12 out of 20 indicators the prevalence was lower than 25%. One quality indicator showed improvement, i.e. for "Bladder and bowel incontinence without a toileting plan" from 17.4% in 2003 decreasing to 11.5% in 2009 (p<0.001). Residents' health and functional status partially explain the increased prevalence of the quality indicators over time. CONCLUSION: Further developments in quality of care in Icelandic nursing homes need to be monitored as well as the association between residents' health and functional status and the Minimum Data Set quality indicator outcome. The areas of care where the Minimum Data Set quality indicators showed need for improvement included treatment of depression, number of medications, resident activity level and behavioural symptoms

Challenges in maintaining satisfactory documentation routines and evidence-based diabetes management in nursing homes

To access publisher's full text version of this article click on the hyperlink belowIntroduction: The increasing prevalence of diabetes worldwide entails an expected rise in the number of older individuals with diabetes needing nursing home placement. Internationally, a consistent lack of adherence to clinical guidelines has been identified in the care of older people. In this study, we therefore investigated whether diabetes management in a sample of nursing homes in Norway and Iceland was in accordance with clinical guideline recommendations. Methods: We used a descriptive cross-sectional study design to assess diabetes management in 12 nursing homes: eight in Norway and four in Iceland. Results: We identified 162 residents with diabetes. The diagnosis of diabetes was available for 100% of the residents in the nursing homes in Iceland and respectively for 81 and 51% of the residents in southwestern and northern Norway. Totally, 3% of the residents with diabetes had a treatment goal for blood glucose regulation (HbA1c) documented in their medical record, 48% had agreed individualized routines for blood glucose measurements and 37% had a HbA1c value measured within the past 6 months available in their medical record. Conclusion: This study has shown a significant discrepancy between diabetes guideline recommendations and clinical diabetes practice related to documenting the diagnosis and type of diabetes, the establishment of individualized treatment goals for HbA1c and the establishment of routines for blood glucose and HbA1c measurements in nursing homes in Norway and Iceland. The results indicate a potential for improvement and a need for more nurses with advanced competence within diabetes in nursing homes

Patients in need of comprehensive geriatric assessment: The utility of the InterRAI emergency department screener.

To access publisher's full text version of this article click on the hyperlink belowIntroduction: The interRAI Emergency Department-Screener (ED-screener) is a risk stratification instrument incorporating functional and social aspects to identify older adults in EDs. The aim was to assess the construct validity and utility of the ED-screener in comparison with more established instruments. Methods: The ED-screener, Triage Risk Screening Tool (TRST) and Identification of Seniors at Risk (ISAR) were administered to older ED-patients. Construct validity was assessed by correlation with TRST and ISAR. The ED-screener scores that corresponded to the established cut-offs for ISAR and TRST were assessed with linear regression. The sensitivity and specificity of the ED-screener for mortality at 4-months were calculated. Results: Two hundred patients were included (mean age 78.5 years, 44% male). Majority (85%) lived at home, 43% lived alone and 53% received home care. The scores of 3.02 and 3.01 on ED-screener corresponded to the cut-off score of 2 on the other instruments. The correlation of the ED-screener with ISAR and TRST was 0.56 and 0.41 respectively. A score of 3 on the ED-screener was 100% sensitive and 28% specific for 4-month mortality. Conclusion: These findings provide support for the construct validity of the ED-screener and its ability to predict outcomes in its intended setting. Keywords: Comprehensive geriatric assessment; Emergency department; InterRAI ED-screener; Screening.Landspitali University Hospital Research Fund University of Iceland Research Fun

Visibility of nursing in policy documents related to health care priorities

Aim - To explore the visibility of nursing in policy documents concerning health care priorities in the Nordic countries. Background - Nurses at all levels in health care organisations set priorities on a daily basis. Such prioritization entails allocation of scarce public resources with implications for patients, nurses and society. Although prioritization in health care has been on the political agenda for many years, prioritization in nursing seems to be obscure in policy documents. Methodology - Each author searched for relevant documents from their own country. Text analyses were conducted of the included documents concerning nursing visibility. Results - All the Nordic countries have published documents articulating values and criteria relating to health care priorities. Nursing is seldom explicitly mentioned but rather is included and implicit in discussions of health care prioritization in general. Conclusion - There is a need to make priorities in nursing visible to prevent missed nursing care and ensure fair allocation of limited resources. Implications for nursing management - To highlight nursing priorities, we suggest that the fundamental need for nursing care and what this implies for patient care in different organisational settings be clarified and that policymakers explicitly include this information in national policy documents

Ethical elements in priority setting in nursing care: A scoping review

Background Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses’ professional and moral values. Objective To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses. Design, data sources and methods A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis. Results Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients’ daily care needs, prioritising work by essential tasks and participating in priority setting for patients’ access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting in discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient’s situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses’ moral distress, care missing, which impacts on both patient outcomes and nursing professional practice and quality of care compromise. Conclusions Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require at assist them in priority setting