Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.Siirretty Doriast

Intervention study of a foot‐care programme enhancing knowledge and practice among nurses and care workers at in‐home service providers

AimTo evaluate the foot‐care educational programme for nurses and care workers at in‐home service providers.DesignA non‐randomized controlled study with random cluster sampling method.MethodsStudy participants were nurses and care workers of 21 in‐home service providers, including home‐visit nursing and care providers, 1‐day care service centres or care centres with rehabilitation programme in Japan. Foot‐care programme with foot‐care tools as a package or standard care comprising 3–5 sessions over 2 months was provided to 110 participants (87 were on analysis). The outcomes were changes in foot‐care knowledge and scores in pre–post interventions. Data were analysed with descriptive statistics, t test, logistic regression analysis and ANCOVA.ResultsBefore adjusting for background, total scores of knowledge and practice categories were higher than the baseline in the intervention group (43 participants) compared with the control group (44 participants). After background correction due to potential bias of non‐random cluster sampling, significant between group differences were observed in mean score changes in skin and consultation subscales of the practice category.</p

Evaluation of the development process and effects of a foot care program with educational tools for nurses and care workers as in-home service providers

Objective: Nurses and care workers who provide in-home services play important roles in assessing and providing care for older people who lack foot self-care abilities. We aimed to evaluate the development process and effects of a foot care program with educational tools for nurses and care workers as in-home service providers. This is a process evaluation with a descriptive mixed-methods study of quantitative and qualitative data conducted from July to October 2019 in Japan.Results: Foot care education tools were developed to address the issues faced by participants with various work patterns and insufficient foot care education in Japan. The contents of these tools were discussed by a panel and reviewed by experts. Three outcomes were analyzed using descriptive statistics and Pearson's correlation. Changes in foot care practice scores were significantly correlated with performance scores. The evaluations of five of the eight field nurses suggested that excess information was included in the foot care booklet. Overall, 29 nurses and care workers showed higher than average evaluation scores [3.8-4.1 (standard deviation, 0.62-0.91)] for the motion pictures and PowerPoint presentation. A program according to this conceptual framework must be established and periodically evaluated for refinement. Trial Registration The trial registration number for the University Hospital Medical Information Network is UMIN000036307. Registration Date-2019/07/25.</p

Moral injury in healthcare professionals: A scoping review and discussion

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration

An Enquiry into Nurse-to-Nurse Collaboration Within the Older People Care Chain as Part of the Integrated Care : A Qualitative Study

Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary -healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.Peer reviewe

Nurse competence provides more individuality in the care of older hospitalized people

Aim: The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient-centred care competence, and individuality in the care of older patients and to explore their associations. Design: A descriptive correlative survey. Methods: Data were collected using questionnaires at one Finnish university hospital during winter 2016-2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis. Results: Registered Nurses assessed their general competence, patient-centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient-centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.Peer reviewe

Environment in institutional care settings as a promoting factor for older individuals' mobility: A systematic review

BackgroundMobility is important for health and well-being; however, older individuals in institutional care settings are relatively sedentary. The environment has an increased influence on mobility in older age due to changes in individual functioning; thus, environmental mobility support solutions for this population are needed.ObjectivesThe aim of this systematic review was to identify elements of the environment that have been used in the content and delivery of interventions to promote mobility and to assess the effects of these interventions on mobility outcomes.DesignA systematic literature search was conducted using CINAHL and MEDLINE from the earliest date through 30 September 2020 for randomised controlled trials, quasi-experimental and pre-post design studies. Inclusion and critical appraisal of articles were conducted by two independent researchers. Data were extracted and synthesised.Setting and participantsStudies were included if they had employed some element of the environment in the content and/or delivery of the intervention and had assessed mobility-related outcomes of older individuals in institutional long-term care settings providing full-time care.MeasuresStudies were included if they reported data on mobility-related outcomes including aspects of physical activity, physical function, life space and functional autonomy.ResultsEight studies were included. Physical, social and symbolic elements of the environment were utilised in the interventions. Positive effects on mobility outcomes were reported in exercise interventions utilising environmental elements mostly as supportive components.Conclusions and implicationsEmpirical evidence about effective mobility interventions employing elements of the environment as main intervention components is lacking. A serious dilemma exists about the need for older individuals’ independence and mobile/active late life and the lack of support for such initiatives in long-term care. Given the emphasised relationship of the environment and mobility with age due to changes in functioning, environmental solutions require further examination.</p

Ethical issues related to eHealth: An integrative review

Background: Identifying and safeguarding ethics in eHealth services from the service users' perspective in social care and healthcare is important. The use of eHealth services should not prejudice the quality of services or the social interaction required in care. There is a lack of studies about the ethics of eHealth services from the service users' perspective. Aim: The aim of this study is to identify and analyse ethical issues related to eHealth in social care and healthcare from the service users' perspective.Research design: An integrative literature review. Ethical considerations: The review followed good scientific conduct. Research context and data sources: A systematic literature search was performed using CINAHL, Scopus, PubMed/MEDLINE, Web of Science, Cochrane Library and Academic Search Premier to find relevant empirical studies published in English from their earliest up to 30 November 2018. In addition, reference lists from the identified research papers were searched. A quality appraisal of each paper included in the review was conducted before thematic analysis. Results: In total, 26 studies were included in the review, and from these four ethical themes were identified: (1) privacy in eHealth, (2) beneficence and nonmaleficence in eHealth, (3) justice in eHealth and (4) trust in eHealth. The ethical issues within these themes were related to information sharing; ownership; access to information and data protection; informed consent; defence of rights; and equity, equality and proportionality of response. Conclusion: eHealth inequality occurs in social care and healthcare. eHealth service designers and social care and healthcare professionals need to act to maintain and improve user access and data accuracy and provide different levels of security in eHealth services, relative to the information stored. There is a need for further research about ethical issues of eHealth from the user's perspective, including the customer-oriented availability and usability of eHealth services which avoid discrimination.</div