Making the most of time: A Grounded Theory to explain what facilitates nursing home staff to connect with residents living with advanced dementia

Background: People living with advanced dementia in nursing homes often spend the majority of time alone, with little contact with anyone. The need to connect with others is a central part of a philosophy known as Person Centred Dementia Care. A significant body of literature demonstrates the effectiveness of a range of approaches that facilitate connections, yet, we know little about staff perspectives on what facilitates them to connect on a daily basis. Aim: To develop a Grounded Theory to explain what facilitates nursing home staff to connect with residents living with advanced dementia. Methods: Semi structured interviews were conducted with nursing home staff (n=21) and relatives (n=5) from seven nursing homes. Following Strauss and Corbin’s (1990, 1998) Interpretivist Grounded Theory methodology, data collection and analysis proceeded iteratively, and theoretical sampling was used to develop the emergent theory. Results: The Grounded Theory ‘making the most of time’ explains that most connections occurred during personal care. Interdependent contextual and individual factors facilitated staff to make the most of time. Effective leaders were described to create a caring culture in which informal leaders (experienced staff) acted as role models. Staff were then more likely to understand, accept and tolerate dementia, know connections were part of their role, get to know residents and express caring values. In the right physical environment, this then facilitated staff to make the most of time during personal care. Increased training and education from specialised dementia units and experiential knowledge from family engagement then supplement such contexts. Implications: Future research could empirically test the theory ‘making the most of time

On your marks, get set, pause: what care home teams should consider before partnering with a trial research group

Research has the potential to inform and enhance the care and experiences of people living and working in care homes. While there is a growing interest in research relevant for care homes, there is a need to ensure staff, residents and their families and friends are supported when considering taking part in research; particularly taking part in a type of research called a ‘trial’. Trials are one type of research study that can help guide decisions about the best treatment, care and support for both residents (and their families and friends) and care home staff. Whilst potentially important, trials are demanding for both care homes and trial research teams. Prior to agreeing to support a trial there are questions a care home manager, staff, residents and their families and friends can consider. These questions are outlined in this paper and will help a care home to determine the capacity, readiness and relationships in a home to support a trial. By taking the time to ‘pause’ and asking ‘are we ready’, care teams can support both care and science

A qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people: learning from frontline staff experiences

COVID‐19 had a devastating impact on older people living in care homes. This study explored the clinical trajectory and management of COVID‐19, as well as recovery of older people following infection during the early stages of the pandemic (May to August 2020). A two‐phase exploratory qualitative study was used. Frontline staff with experience of caring for older people with COVID‐19 were recruited to Phase 1, and senior care home operational and quality managers were recruited to Phase 2. During Phase 1 remote semi‐structured interviews (n = 35) were carried out with staff working in care homes, hospital and community settings in England. During Phase 2, a remote consultation event was carried out with senior care home operational and quality managers (n = 11) to share Phase 1 findings and check resonance, relevance and gaps. Data were analysed using Framework Analysis. Older people with COVID‐19 presented with wide ranging symptoms, and an unpredictable illness trajectory. The wide range of COVID‐19 symptoms required timely testing and supportive interventions. Staff used different interventions to manage symptoms and reported uncertainties of how individuals would respond. In care home settings, health and social care staff needed to work together when administering interventions such as subcutaneous fluids or oxygen therapy. Alongside symptom management, supportive care focused on nutrition and hydration, social interaction, and maintaining physical activity to meet both physical and emotional needs. The effects of prolonged periods of social isolation and inactivity on the health and well‐being of older people means rehabilitation is essential to enhance physical and emotional recovery, and to minimise impacts on cognition and function. The pandemic highlighted important areas for care of this population

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine