Transitioning into long term care for older adults with intellectual disabilities: A concept analysis

Aim: To undertake a concept analysis of transitioning to long-term care for older adults with intellectual disabilities. Background: Individuals with an intellectual disability are experiencing increased longevity which is associated with an increase in transitions in later life to long-term care. Their experience of later life transitions is likely to be different to the general older population. Methodology: Concept Analysis was undertaken using the Walker and Avant framework. Results: Eight studies met the inclusion criteria. Defining attributes are an older person with intellectual disability; a planned relocation to a long-term care facility; person-centred; and supported decision-making. Conclusion: There is a dearth of empirical evidence and theorisation on this concept. Transitions of this nature have been inadequately informed by the perspective of the older person with an intellectual disability, and future research and practice requires greater efforts to include their voice

Incentivising a career in older adult nursing: the views of student nurses

Background and aim: Nurse vacancy rates in older adult services are disproportionately high compared to other areas of nursing. This is partly because few student nurses consider it an attractive career option once qualified due to perceptions of low‐status, strenuous nature of the work and impoverished care environments. The study aimed to explore students' perceptions of incentives that could counterbalance the barriers for new graduate nurses joining this speciality. Methods: A qualitative descriptive design using focus group interviews was carried out with six groups of student nurses (n = 27) following completion of their acute care older adult placements in three hospitals. Data were analysed using thematic analysis. Results: The barriers from students' perspectives were constructed as a vicious cycle of staff shortages and inadequate resources that created impoverished environments leading to a dissonance between ideal and delivered care. Over one‐third of students were unlikely to consider a career in older adults nursing, but the remaining students could identify incentives that may tempt them. Four main themes and eight subthemes were identified: gerontological status and leadership (ward leadership; respected others); relational care (legitimising emotional support, care vs. cure goals); quality work environment (pay as recognition, 12‐hr shifts); and education‐career pathways (gerontological knowledge, career progression). Conclusion: Radical new approaches, based on student and nurse engagement, are required to incentivise a career in gerontological nursing. A combination of shorter and longer term strategies that include education‐career pathways, a focus on relation care, and improved work conditions including financial incentives should be trialled. Implications for practice: In terms of practice, addressing high nurse vacancy rates in older adult services that negatively impacts on patient outcomes requires a suite of incentives informed by ‘what matters’ to students and nurses working in the speciality

Shared decision making with adults transitioning to long-term care: A scoping review

Background: Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area. Objective: The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care. Methods: A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. Results: Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. Conclusions: The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making

Nurses', physicians' and radiographers' perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

Background: A new initiative was introduced in Ireland following legislative changes that allowed nurses with special training to prescribe ionising radiation (X-ray) for the first time. A small number of studies on nurse prescribing of ionising radiation in other contexts have found it to be broadly as safe as ionising radiation prescribing by physicians. Sociological literature on perceptions of safety indicates that these tend to be shaped by the ideological position of the professional rather than based on objective evidence. Objectives: To describe, compare and analyse perceptions of the safety of a nurse prescribing of ionising radiation initiative across three occupational groups: nursing, radiography and medicine. Design: A cross-sectional survey design. Settings: Participants were drawn from a range of clinical settings in Ireland. Participants: Respondents were 167 health professionals comprised of 49 nurses, 91 radiographers, and 27 physicians out of a total of 300 who were invited to participate. Non-probability sampling was employed and the survey was targeted specifically at health professionals with a specific interest in, or involvement with, the development of the nurse prescribing of ionising radiation initiative in Ireland. Methods: Comparisons of perspectives on the safety of nurse prescribing of ionising radiation across the three occupational groups captured by questionnaire were analysed using the Kruskal–Wallis H test. Pairwise post hoc tests were conducted using the Mann–Whitney U test. Results: While the majority of respondents from all three groups perceived nurse prescribing of ionising radiation to be safe, the extent to which this view was held varied. A higher proportion of nurses was found to display confidence in the safety of nurse prescribing of ionising radiation compared to physicians and radiographers with differences between nurses’ perceptions and those of the other two groups being statistically significant. Conclusion: That an occupational patterning emerged suggests that perceptions about safety and risk of nurse prescribing of ionising radiation are socially constructed according to the vantage point of the professional and may not reflect objective measures of safety. These findings need to be considered more broadly in the context of ideological barriers to expanding the role of nurses

Evaluation of an emergency department Falls Pathway for older people: A patient chart review

The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. Aim: This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. Methods: The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. Results: The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. Conclusion: The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team

The Development of the Older Person's Nurse Fellowship: Education concept to delivery.

Background Preparing the nursing workforce to meet the challenges of an ageing population is a priority for many countries. The development of an Older Person's Nurse Fellowship (OPNF) programme for senior clinical nurses is an important innovation. Objectives This article describes the philosophical development, delivery and early evaluation of the OPNF. Design In 2014, Health Education England funded 24 senior clinical nurses to participate in the OPNF. The Fellowship was designed to build clinical leadership and innovation capability and develop a network of nurses to influence local and national strategy for older people's care. The Fellows selected were drawn from mental health (n = 4), community/primary care (n = 9) and acute care (n = 11). The twelve month programme consisted of two Masters-level modules, delivered through study days and e-learning. The first cohort (n = 12) commenced the course in November 2014 with a module designed to enhance clinical knowledge and skills. Methods Evaluation data were collected from the first cohort using anonymous surveys (n = 11) and focus group interviews (n = 9). Descriptive statistics are presented for the quantitative data and common themes are described in the qualitative data. Results The overall satisfaction with the clinical module was high with a median score of 18/20 (range 17–20). Topics such as comprehensive geriatric assessment, frailty, pharmacology and cognitive assessment were regarded as highly relevant and most likely to result in a change to clinical practice. In the focus group interviews students discussed their learning experience in terms of: module specificity, peer-to-peer learning and using the OPNF as leverage for change. Conclusions The OPNF is a timely innovation and a positive commitment to developing an academic pathway for senior nurses. It marks an important step in the future development of the older person's nursing workforce

Ethical frameworks for quality improvement activities: An analysis of international practice

Purpose: To examine international approaches to the ethical oversight and regulation of quality improvement and clinical audit in healthcare systems. Data sources: We searched grey literature including websites of national research and ethics regulatory bodies and health departments of selected countries. Study selection: National guidance documents were included from six countries: Ireland, England, Australia, New Zealand, the United States of America and Canada. Data extraction: Data were extracted from 19 documents using an a priori framework developed from the published literature. Results: We organised data under five themes: ethical frameworks; guidance on ethical review; consent, vulnerable groups and personal health data. Quality improvement activity tended to be outside the scope of the ethics frameworks in most countries. Only New Zealand had integrated national ethics standards for both research and quality improvement. Across countries, there is consensus that this activity should not be automatically exempted from ethical review, but requires proportionate review or organisational oversight for minimal risk projects. In the majority of countries, there is a lack of guidance on participant consent, use of personal health information and inclusion of vulnerable groups in routine quality improvement. Conclusion: Where countries fail to provide specific ethics frameworks for quality improvement, guidance is dispersed across several organisations which may lack legal certainty. Our review demonstrates a need for appropriate oversight and responsive infrastructure for quality improvement underpinned by ethical frameworks that build equivalence with research oversight. It outlines aspects of good practice, especially The New Zealand framework that integrates research and quality improvement ethics

An international perspective on definitions and terminology used to describe serious reportable patient safety incidents: A systematic review

Objectives: Patients are unintentionally, yet frequently, harmed in situations that are deemed preventable. Incident reporting systems help prevent harm, yet there is considerable variability in how patient safety incidents are reported. This may lead to inconsistent or unnecessary patterns of incident reporting and failures to identify serious patient safety incidents. This systematic review aims to describe international approaches in relation to defining serious reportable patient safety incidents. Methods: Multiple electronic and gray literature databases were searched for articles published between 2009 and 2019. Empirical studies, reviews, national reports, and policies were included. A narrative synthesis was conducted because of study heterogeneity. Results: A total of 50 articles were included. There was wide variation in the terminology used to represent serious reportable patient safety incidents. Several countries defined a specific subset of incidents, which are considered sufficiently serious, yet preventable if appropriate safety measures are taken. Terms such as “never events,” “serious reportable events,” or “always review and report” were used. The following dimensions were identified to define a serious reportable patient safety incident: (1) incidents being largely preventable; (2) having the potential for significant learning; (3) causing serious harm or have the potential to cause serious harm; (4) being identifiable, measurable, and feasible for inclusion in an incident reporting system; and (5) running the risk of recurrence. Conclusions: Variations in terminology and reporting systems between countries might contribute to missed opportunities for learning. International standardized definitions and blame-free reporting systems would enable comparison and international learning to enhance patient safety