How transformational leadership appears in action with adverse events? A study for Finnish nurse manager

AimThe aim of this study was to determine whether elements of transformational leadership are present in nursing managers' actions following adverse events. BackgroundTransformational leadership exerts a positive influence on organisational culture and patient safety. MethodEleven nursing managers were interviewed individually using a semi-structured format. Data were analysed using inductive content analysis. ResultsFour themes emerged relating to nursing managers' actions following adverse events: patient-centredness as a principle for common action, courage to reform operational models to prevent future adverse events, nursing staff's encouragement of open and blame-free discussion, and challenge to recognize adverse events. ConclusionNursing managers must understand their responsibilities and the importance of making it clear to staff that patient-centredness should be evident in all health care actions. Nursing managers must also recognize the need to ensure that staff treat patients' interests as the top priority. Implications for Nursing ManagementIf an adverse event occurs, the situation should be discussed with the nursing staff and any unique aspects of the event must be accounted for. Nursing managers must have the skill to motivate and empower staff to find new ways to work, to prevent adverse events and to promote patient safety.Peer reviewe

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Background: Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. Methods: This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age >= 65) and 300 persons with a recent hip fracture (age >= 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried's frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant's home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant's home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Discussion: Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services.Peer reviewe

Ikääntyneiden kotiharjoittelu : Pitkäkestoinen liikuntaharjoittelu fysioterapeutin ohjauksessa henkilöillä, joilla on lonkkamurtuma tai hauraus-raihnausoireyhtymä

Ikääntyneiden erilaiset vaivat ja sairaudet kuormittavat terveydenhoitojärjestelmää ikääntyneiden määrän suurentuessa ja huoltosuhteen muuttuessa epäedulliseen suuntaan. Siksi on tärkeää kehittää uudenlaisia tapoja pitää huolta ikääntyvästä väestöstä. Lonkkamurtuma on vakava ikääntyneiden kaatumisvamma, mikä johtaa usein toimintakyvyn ja elämänlaadun heikkenemiseen ja altistaa laitoshoidolle. Myös heikentynyttä toimintakykyä aiheuttava hauraus-raihnausoireyhtymä (HRO) lisää sosiaali- ja terveydenhuollon palvelujen käyttöä ja laitoshoitoon joutumisen riskiä. Sekä lonkkamurtuman jälkeisessä kuntoutuksessa että hauraus-raihnausoireyhtymän hoidossa liikuntaharjoittelulla on tärkeä osa. Tämän raportin tarkoituksena on kuvata KauKoIKÄ-tutkimushankkeessa käytetty kotiharjoitteluinterventio, sen toteutuminen sekä tutkittavien GAS (Goal Attainment Scale) tavoitteiden saavuttaminen ja tutkimukseen osallistuneiden palautteet kotiharjoittelusta ja tutkimuksen toteutuksesta. KauKoIKÄ-tutkimukseen osallistui 121 lonkkamurtumapotilasta (keski-ikä 81,5 vuotta) ja 300 henkilöä (keski-ikä 82,5 v), joilla todettiin esi-HRO tai HRO. Molemmat potilasryhmät satunnaistettiin erikseen kahteen ryhmää: 1) fysioterapeutin ohjaama kotiharjoittelu kahdesti viikossa vuoden ajan (61 lonkkamurtumatutkittavaa ja 150 HRO-tutkittavaa) ja 2) tavanomainen hoito (60 lonkkamurtumatutkittavaa, 150 HRO-tutkittavaa). Kotiharjoittelu oli strukturoitua, yksilöllisesti suunniteltua, eteni progressiivisesti ja keskittyi alaraajojen lihasvoiman lisäämiseen. Harjoittelu sisälsi myös tasapaino-, liikkuvuus-, kestävyys- ja toiminnallisia harjoitteita sekä ravitsemus- ja liikuntaneuvontaa. Kotiharjoittelu oli molemmilla tutkimusjoukoilla samanlainen perusajatukseltaan ja -sisällöltään. Keskimäärin harjoittelu pystyttiin toteuttamaan riittävällä rasitustasolla ja progressiivisuutta harjoittelussa pystyttiin lisäämään, mutta yksilöllinen vaihtelu oli suurta. Erilaiset sairaudet, niiden paheneminen ja siitä seuranneet sairaalajaksot aiheuttivat keskeytyksiä ja harjoittelun uudelleen suunnittelua. Molemmissa potilasryhmissä GAS-tavoitteiden T-arvojen keskiarvo oli yli tavoitetason. Tutkittavien palaute vuoden ohjatusta kotiharjoittelusta oli myönteistä. Kotiharjoitteluun osallistuneet kokivat harjoittelun kohentaneen heidän elämäänsä ja liikuntakykyään. Moni toivoi harjoittelulle jatkoa tulevaisuudessa. Vuoden ajan, kaksi kertaa viikossa, fysioterapeutin ohjauksessa suoritettu kotiharjoittelu on turvallista ja sillä voidaan sitouttaa ikääntyneet lonkkamurtumapotilaat ja henkilöt, joilla on HRO, säännölliseen liikuntaharjoitteluun.nonPeerReviewedVertaisarvioimato

Pitkäkestoinen, kotona tehtävä liikuntaharjoittelu lonkkamurtumapotilailla ja gerasteenisilla ikääntyneillä : Satunnaistettu kontrolloitu tutkimus

Tutkimuksessa selvitetään, miten vuoden pituinen harjoittelu kahdesti viikossa kotona fysioterapeutin ohjauksessa vaikuttaa kaatumishuolestuneisuuteen, ravitsemustilaan, masennusoireisiin ja sosiaaliseen tukeen henkilöillä, joilla on lonkkamurtuma tai gerastenia, sekä kaatumisten määrään ja gerastenian esiintymiseen lonkkamurtumapotilailla. Lisäksi tarkastellaan omaisten kuormittuneisuutta ja tuen tarvetta. Molemmat tutkittavat ryhmät satunnaistettiin erikseen vuodeksi a) ohjattuun kotona tapahtuvaan liikuntaharjoitteluun tai b) tavanomaiseen hoitoon. Osa tutkittavien kanssa samassa taloudessa asuvista omaisista osallistui kyselytutkimukseen. Tutkimuksen alussa sekä kolmen, kuuden ja 12 kuukauden kuluttua tehtävillä mittauksilla mitattiin kaatumishuolestuneisuutta, kaatumisten lukumäärää, gerastenian esiintyvyyttä, ravitsemustilaa, sosiaalista tukea ja omaisten kokemaa kuormittuneisuutta. Lonkkamurtuman saaneiden (n = 121) keski-ikä oli 81 vuotta, 75 % oli naisia ja 60 %:lla oli reisiluun kaulan murtuma. Gerasteenisten (n = 299) keski-ikä oli 82 vuotta, 75 % oli naisia, 39 %:lla oli gerastenia ja 61 %:lla sen esiaste. Vuoden kestänyt ohjattu liikuntaharjoittelu vähensi lonkkamurtuman saaneiden tutkittavien gerastenian esiintyvyyttä ja gerasteenisten henkilöiden kaatumishuolestuneisuutta ja masennusoireita. Harjoittelulla ei ollut vaikutusta muihin mitattuihin muuttujiin. Harjoittelu ei myöskään vaikuttanut omaisten (n = 43) kokemaan kuormitukseen tai tuen tarpeeseen.40,00 euroapeerReviewedVertaisarvioit

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

Abstract Background Health concerns, such as frailty and osteoporotic fractures decrease functional capacity and increase use of health and social care services in the aging population. The ability to continue living at home is dependent on functional capacity, which can be enhanced by rehabilitation. We study the effects of a 12-month home-based physiotherapy program with 12-month follow-up on duration of living at home, functional capacity, and the use of social and health care services among older persons with signs of frailty, or with a recently operated hip fracture. Methods This is a non-blinded, parallel group, randomized controlled trial performed in South Karelia Social and Health Care District, Finland (population 131,000). Three hundred community-dwelling older persons with signs of frailty (age ≥ 65) and 300 persons with a recent hip fracture (age ≥ 60) will be recruited. Frailty is screened by FRAIL questionnaire and verified by modified Fried’s frailty criteria. Both patient groups will be randomized separately to a physiotherapy and a usual care arm. Individualized, structured and progressive physiotherapy will be carried out for 60 min, twice a week for 12 months at the participant’s home. The primary outcome at 24 months is duration of living at home. Our hypothesis is that persons assigned to the physiotherapy arm will live at home for six months longer than those in the usual care arm. Secondary outcomes are functional capacity, frailty status, health-related quality-of-life, falls, use and costs of social and health care services, and mortality. Assessments, among others Short Physical Performance Battery, Functional Independence Measure, Mini Nutritional Assessment, and Mini-Mental State Examination will be performed at the participant’s home at baseline, 3, 6, and 12 months. Register data on the use and costs of social and health care services, and mortality will be monitored for 24 months. Discussion Our trial will provide new knowledge on the potential of intensive, long-term home-based physiotherapy among older persons at risk for disabilities, to enhance functional capacity and thereby to postpone the need for institutional care, and diminish the use of social and health care services. Trial registration ClinicalTrials.gov Identifier: NCT02305433 , Registered Nov 28, 2014

Older persons with signs of frailty in a home-based physical exercise intervention: baseline characteristics of an RCT

Background Increasing the level of physical activity among persons with signs of frailty improves physical functioning. There is a lack of long-term supervised physical exercise intervention studies including a validated definition of frailty. Aims To present baseline characteristics of persons with signs of frailty participating in a randomized long-term home-based physical exercise trial (HIPFRA), and to study associations between the severity of frailty, functional independence and health-related quality-of-life (HRQoL). Methods Three hundred persons, >= 65 years old and with signs of frailty (assessed by Fried ' s phenotype criteria) were recruited from South Karelia, Finland and randomized to a 12-month physiotherapist-supervised home-based physical exercise program (n = 150), and usual care (n = 150). Assessments at the participants' homes at baseline, and after 3, 6 and 12 months included the Short Physical Performance Battery (SPPB), the Functional Independence Measure (FIM), HRQoL (15D) and the Mini-Mental State Examination (MMSE). Results Eligibility was screened among 520 persons; 300 met the inclusion criteria and were randomized. One person withdrew consent after randomization. A majority (75%) were women, 182 were pre-frail and 117 frail. The mean age was 82.5 (SD 6.3) years, SPPB 6.2 (2.6), FIM 108.8 (10.6) and MMSE 24.4 (3.1) points, with no significant differences between the study groups. Inverse associations between the severity of frailty vs. FIM scores and HRQoL (p <0.001 for both) were found. Conclusions Our participants showed marked physical frailty without major disabilities. The severity of frailty seems to be associated with impaired functional independence and HRQoL.Peer reviewe

Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT

Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.Peer reviewe

Kuntoutuskeskuksen kehitystyö opetti pitkäjänteisyyttä ja johtamista

Prosessien sujuvoittaminen, hukan poistaminen ja valmentava johtaminen mahdollistivat kuntoutujalle enemmän toimintakykyä edistävää toimintaa. Kuntoutuksen kehittäminen Lean-ajattelun keinoin toi Armilan kuntoutuskeskukselle Lääkäriliiton laatupalkinnon 2015

Effect of 12-month supervised, home-based physical exercise on functioning among persons with signs of frailty : Randomized Controlled Trial

Objectives To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. Design A randomized controlled trial with a 1:1 allocation Setting Home-based Participants Home-dwelling persons aged ≥65 years meeting at least one frailty phenotype criteria (n=300). Intervention 12-month, individually tailored, progressive and physiotherapist-supervised, physical exercise twice a week (n=150) vs. usual care (n=149). Main outcome Measures Functional Independence Measure (FIM), Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed four times at home over 12 months. Results The mean age of the participants was 82.2 (SD 6.3), 75% were women, 61% met 1–2 frailty criteria and 39% ≥3 criteria. FIM deteriorated in both groups over 12 months, -4.1 points (95% CI: -5.6 to -2.5) in the exercise group and -6.9 (-8.4 to -2.3) in the usual care group (group p=0.014, time p<0.001, interaction p=0.56). The mean improvement in SPPB was significantly greater in the exercise group [1.6 (1.3 to 2.0)] than in the usual care group [0.01 (-0.3 to 0.3)] (group p<0.001, time p=0.11, interaction p=0.027). The exercise group reported significantly fewer falls per person-year compared to the usual care group (incidence rate ratio, IRR 0.47 [95% CI 0.40 to 0.55]; p<0.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function or self-reported physical activity. Conclusions One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL or handgrip strength.peerReviewe

1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling : A Preliminary Investigation

In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.peerReviewe