Effects of changes in staff mix in a specialized dementia ward

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenTilgangur rannsóknarinnar var að skoða áhrif breytinga á samsetningu mönnunar á gæði hjúkrunar, starfsánægju og upplifun starfsmanna. Rannsóknin fór fram á annarri af tveimur deildum fyrir sjúklinga með heilabilun á öldrunarsviði Landspítalans. Sjúkraliðar með framhaldsnám og hjúkrunarfræðingar á tilraunadeildinni fengu breytt starfssvið. Þátttakendur voru sjúklingar og starfsmenn á rannsóknardeildinni og einnig hjúkrunarfræðingar af báðum deildum. Rannsóknin var unnin samkvæmt hugmyndafræði starfendarannsókna og fjórar rannsóknaraðferðir notaðar til að fá fram mismunandi sjónarhorn á viðfangsefnið. Gögnum um gæði hjúkrunar var safnað með stöðluðu megindlegu mælitæki (RAI) og innbyggðir gæðavísar skoðaðir. Gögnum um starfsánægju var safnað með skriflegum spurningalista og gögnum um upplifun starfsmanna af breytingunum var safnað með viðtölum við rýnihópa og dagbókarskrifum. Gagnasöfnun fór fram fyrir og við upphaf breytinga og svo aftur þegar breyting var vel á veg komin. Niðurstöður rannsóknarinnar gáfu vísbendingar um að gæði hjúkrunar og starfsánægja hefðu haldist stöðug. Í rýnihópum og dagbókum komu fram þrjú meginþemu: Breytt hlutverk, togstreita og ný tækifæri. Það tók á fyrir alla að skilgreina ný hlutverk og breytt fagleg samskipti. Einnig var átak að breyta viðteknum vinnuvenjum á deildinni og togstreita kom fram á milli stétta. Sjúkraliðar með framhaldsnám í öldrunarhjúkrun fundu fyrir ákveðinni fyrirstöðu en jafnframt að hjúkrunarfræðingarnir vildu styðja við bakið á þeim og leiðbeina inn í þetta nýja hlutverk sem hafði í för með sér ný tækifæri. Niðurstöður þessa rannsóknarverkefnis varpa ljósi á hvernig hægt er að nýta betur menntun sjúkraliða með framhaldsnám í öldrunarhjúkrun og um leið þróa nýjar leiðir í starfi hjúkrunarfræðinga. Rannsóknin er því mikilvægt innlegg í umræðu um hvernig starfskraftar sjúkraliða með framhaldsnám verða nýttir í öldrunarþjónustu í framtíðinni.The purpose of this study was to examine the effects of changes in staff mix model on quality of care, staff satisfaction, and staff perception of this change. The study was conducted in one of two specialized dementia wards at the Division of Geriatric Medicine at the Landspitali University Hospital. Geriatric-Licensed Practical Nurses (G-LPNs) and registered nurses (RNs) gained different roles on the ward. Patients and staff from the study ward and RNs from the other specialized dementia ward participated in the study. The theoretical framework of the study was Action Research and four methods were used to obtain different views on the issue. Data on quality of care were collected using a quantitative instrument (RAI) and inherent quality indicators observed. Data on job satisfaction were collected using a questionnaire and data regarding staff experience were obtained by discussions in focus-groups and diaries. Data were gathered before and after changes and finally after changes had been in place for awhile. Findings indicated that the quality of care as well as staff satisfaction remained constant. In focus groups and diaries three main themes emerged: Role change; conflict and new opportunities. It required a great effort for everyone to define new roles and changes of professional interaction. Changing the usual way of working in the ward was stressful as well because of conflicts between professions. The G-LPNs encountered certain barriers but also realized that the RNs were ready to provide support and guidance into their new role. The altered role had also the potential for new opportunities. The study results illuminate how the G-LPNs´ further education can be utilized as well as how new roles for RNs can be developed. The study findings are important for the discussion on the role G-LPNs will have in care of the elderly in the future

Functioning and needs of elders waiting for in-hospital respite care

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Tilgangur þessarar rannsóknar var að fá lýsandi mynd af líkamlegri, andlegri og félagslegri færni og þörfum aldraðra sem biðu eftir hvíldarinnlögn á öldrunarsviði Landspítala vorið 2007. Einnig var leitast við að kanna væntingar aldraðra og aðstandenda til þjónustunnar. Rannsóknin var megindleg með lýsandi sniði. Úrtakið var 24 einstaklingar sem bjuggu á eigin heimilum og voru á biðlista fyrir hvíldarinnlögn á öldrunarsviði Landspítala. Tekin voru viðtöl við þátttakendur eða aðstandendur þeirra. Notað var RAI-HC-matstæki sem greinir þarfir og styrkleika einstaklinga á ýmsum sviðum og er ætlað heilbrigðis- og félagsþjónustu. Niðurstöður sýndu að allir þurftu aðstoð við böðun og almennt var mikil þörf fyrir aðstoð við daglegar athafnir. Hjá 16 af 24 hafði orðið afturför í sjálfsbjargargetu við daglegar athafnir síðustu mánuði. Um helmingur þátttakenda var með minnisskerðingu og þurftu margir aðstoð og eftirlit allan sólarhringinn. Af 24 þátttakendum töldu 16 þeirra töldu heilsufar sitt vera lélegt eða sæmilegt. Meðal þátttakenda var andleg vanlíðan, einangrun og einmanaleiki algeng og þátttaka í félagslífi lítil. Álykta má út frá niðurstöðum að þessi hópur aldraðra þarfnist mikillar aðstoðar og að hún sé að miklu leyti veitt af nánasta aðstandanda. Þar sem mikið álag er á aðstandendum er þörf á aukinni heilbrigðis- og félagsþjónustu fyrir þennan hóp. Hjúkrunarfræðingar og annað heilbrigðisstarfsfólk gegnir mikilvægu hlutverki við mat á þjónustuþörf þess aldraða og umönnunaraðila hans sem og að leiðbeina um hugsanleg þjónustuúrræði.The aim of this study is to receive a descriptive picture of the physical, mental, and social functioning and needs of elders waiting for in-hospital respite care at the Division of Geriatric Medicine, Landspitali-University Hospital in the spring of 2007. Furthermore the aim was to explore the expectations of the elders and their relatives to the service. The research was quantitative with a descriptive design. The sample was 24 persons who live in private homes and were on a waiting list for in-hospital respite care. Participants or their relatives were interviewed. The RAI-HC instrument was used as it evaluates needs and strengths of individuals and is intended for health and social services. The findings showed that participants were severely burdened with health problems. All needed some assistance when bathing and most of them needed help in their activities of daily living. Their main caregivers were therefore under a lot of stress. Sixteen out of 24 participants had in the last months experienced a decline in their ability to take care of themselves. Half of the participants had dementia and many of them needed assistance and supervision 24 hours a day. Poor emotional condition was prevalent, isolation and loneliness were common and social participation restricted. The participants were in great need of assistance, most of which came from their closest relative. Increased health and social services are needed for this group. Nurses and other health care workers play an important role in assessing the need of elderly people and their caregivers for service as well as informing about available services

Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study

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 FilesBACKGROUND: Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses' and auxiliary nurses' view of the implementation. METHODS: A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation. RESULTS: Improved nursing documentation was found for 23 items (N = 37), which was significant for nine items focusing mobility (p = 0.002, p = 0.024, p = 0.012), pain (p = 0.012), patient teaching (p = 0.001, p = 0.000) and discharge planning (p = 0.000, p = 0.002, p = 0.004). Improved guideline use was found for 20 QIT-items (N = 30), with significant improvement on six items focusing on mobility (p = 0.023), depression (p = 0.033, p = 0.025, p = 0.046, p = 0.046), discharge planning (p = 0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p = 0.019) and Context (p = 0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care. CONCLUSION: Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.Icelandic Nursing Association Scientific Fund of Landspitali University Hospital, Reykjavik, Icelan

Stroke survivors' experiences with rebuilding life in the community and exercising at home: A qualitative study.

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 DownloadAim: This study aimed to explore how stroke survivors deal with stroke-related impairments when rebuilding their lives in the community and their experiences of exercising at home. Design: An explorative and descriptive qualitative study. Methods: A purposive sample of ten stroke survivors residing at home was recruited to explore experiences of rebuilding their lives in the community and exercising at home. One focus group interview was conducted followed by semi-structured interviews. Data were analysed using thematic analysis. Results: Three main themes were identified: "Framing exercise within the context of everyday life" describes how stroke survivors integrate exercise in everyday activities with varying success and the social importance of exercising; "Managing the challenges of physical impairment" describes the taxing undertakings in daily living, loss of concentration and identity; "Long-term challenges of everyday life" describes how the stroke survivors manage depression and live with a sense of uncertainty. Keywords: home rehabilitation; qualitative research; rehabilitation; stroke patients; stroke rehabilitation.NordForsk programme on Health and Welfar

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

Klínískar leiðbeiningar um hjúkrun heilablóðfallssjúklinga í endurhæfingu

Bakgrunnur: Heilablóðfall er þriðja algengasta dánarorsökin á Íslandi og jafnframt ein af meginorsökum fötlunar fullorðinna einstaklinga. Afleiðingar heilablóðfalls eru margvíslegar, svo sem lamanir, tjáskiptaerfiðleikar, kyngingarerfiðleikar, einbeitingar¬skortur, þunglyndi og yfirþyrmandi þreyta. Hjúkrun heilablóðfallssjúklinga er því flókin og krefst sérþekkingar hjúkrunarfræðings, en einkennin geta haft í för með sér mikla byrði fyrir sjúklinginn, fjölskylduna og samfélagið. Á Íslandi hefur skort klínískar leiðbeiningar fyrir hjúkrun heilablóðfallssjúklinga í endurhæfingu, en slíkar leiðbeiningar, unnar í samvinnuverkefni á milli Íslands og Hollands, komu út í Hollandi árið 2009. Tilgangur: Að aðlaga og staðfæra Klínískar leiðbeiningar um hjúkrun heilablóð¬fallssjúklinga í endurhæfingu að íslenskum aðstæðum. Markmið: Að stuðla að faglegri, öruggri og skilvirkri hjúkrun í endurhæfingu heilablóðfallssjúklinga. Efnisval: Fjórir af ellefu köflum Klínísku leiðbeininganna voru valdir vegna hagnýts gildis þeirra fyrir hjúkrun og til þess að afmarka verkefnið. Kaflarnir eru: Endurhæfing eftir heilablóðfall, hreyfing og sjálfsbjargargeta, þunglyndi eftir heilablóðfall og fræðsla til heilablóðfallssjúklinga og aðstandenda þeirra. Aðferð: Ráðleggingar úr köflum leiðbeininganna voru frumþýddar úr hollensku yfir á íslensku og þær valdar sem taldar voru henta íslenskum aðstæðum. Umfjöllun og fræðilegur bakgrunnur hverrar ráðleggingar var unnin út frá heimildalista viðkomandi kafla leiðbeininganna og fræðilegir kaflar skrifaðir. Jafnframt því var stuðst við fræðileg kerfisbundin yfirlit og framkvæmd ný heimildaleit á flestum efnisatriðum verkefnisins. Niðurstöður: Lagðar voru fram 69 ráðleggingar, innan fjögurra kafla og 11 þeirra uppfærðar með nýjum heimildum. Af ráðleggingunum hafa 12 vísindalegan styrk A, 9 styrk B, 26 styrk C og 17 styrk D. Fimm ráðlegginganna voru ekki stigaðar. Umræða og ályktanir: Klínísku hjúkrunar- og endurhæfingarleiðbeiningarnar fela í sér gagnreynda þekkingu og munu þær nýtast hjúkrunarfræðingum vel í hjúkrun og meðferð heilablóðfallssjúklinga. Notkun þeirra er góð leið til þess að veita sjúklingum gagnreynda hjúkrun og meðferð sem er líkleg til að leiða til bættra lífsgæða þeirra. Mikilvægt er að huga vel að innleiðingu leiðbeininganna í daglega hjúkrun sjúklinga

Functioning and needs of elders waiting for in-hospital respite care

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Tilgangur þessarar rannsóknar var að fá lýsandi mynd af líkamlegri, andlegri og félagslegri færni og þörfum aldraðra sem biðu eftir hvíldarinnlögn á öldrunarsviði Landspítala vorið 2007. Einnig var leitast við að kanna væntingar aldraðra og aðstandenda til þjónustunnar. Rannsóknin var megindleg með lýsandi sniði. Úrtakið var 24 einstaklingar sem bjuggu á eigin heimilum og voru á biðlista fyrir hvíldarinnlögn á öldrunarsviði Landspítala. Tekin voru viðtöl við þátttakendur eða aðstandendur þeirra. Notað var RAI-HC-matstæki sem greinir þarfir og styrkleika einstaklinga á ýmsum sviðum og er ætlað heilbrigðis- og félagsþjónustu. Niðurstöður sýndu að allir þurftu aðstoð við böðun og almennt var mikil þörf fyrir aðstoð við daglegar athafnir. Hjá 16 af 24 hafði orðið afturför í sjálfsbjargargetu við daglegar athafnir síðustu mánuði. Um helmingur þátttakenda var með minnisskerðingu og þurftu margir aðstoð og eftirlit allan sólarhringinn. Af 24 þátttakendum töldu 16 þeirra töldu heilsufar sitt vera lélegt eða sæmilegt. Meðal þátttakenda var andleg vanlíðan, einangrun og einmanaleiki algeng og þátttaka í félagslífi lítil. Álykta má út frá niðurstöðum að þessi hópur aldraðra þarfnist mikillar aðstoðar og að hún sé að miklu leyti veitt af nánasta aðstandanda. Þar sem mikið álag er á aðstandendum er þörf á aukinni heilbrigðis- og félagsþjónustu fyrir þennan hóp. Hjúkrunarfræðingar og annað heilbrigðisstarfsfólk gegnir mikilvægu hlutverki við mat á þjónustuþörf þess aldraða og umönnunaraðila hans sem og að leiðbeina um hugsanleg þjónustuúrræði.The aim of this study is to receive a descriptive picture of the physical, mental, and social functioning and needs of elders waiting for in-hospital respite care at the Division of Geriatric Medicine, Landspitali-University Hospital in the spring of 2007. Furthermore the aim was to explore the expectations of the elders and their relatives to the service. The research was quantitative with a descriptive design. The sample was 24 persons who live in private homes and were on a waiting list for in-hospital respite care. Participants or their relatives were interviewed. The RAI-HC instrument was used as it evaluates needs and strengths of individuals and is intended for health and social services. The findings showed that participants were severely burdened with health problems. All needed some assistance when bathing and most of them needed help in their activities of daily living. Their main caregivers were therefore under a lot of stress. Sixteen out of 24 participants had in the last months experienced a decline in their ability to take care of themselves. Half of the participants had dementia and many of them needed assistance and supervision 24 hours a day. Poor emotional condition was prevalent, isolation and loneliness were common and social participation restricted. The participants were in great need of assistance, most of which came from their closest relative. Increased health and social services are needed for this group. Nurses and other health care workers play an important role in assessing the need of elderly people and their caregivers for service as well as informing about available services

Tangible interaction for stroke survivors : Design recommendations

In this paper we outline the initial stages of a human centered design process aimed at the design of novel technology (tangible interactive objects) for stroke survivors. We found it useful to support standard methods, such as interviews and focus groups, with a video prototype in order to make the concept of tangible interaction, which was novel to our users, more clear. In addition we carried out a co-design workshop together with stroke survivors. Based on these activities, we present a set of preliminary design guidelines for tangible interaction for stroke survivors

Designing interactive systems for balance rehabilitation after stroke

This paper presents four different tangible interactive prototypes designed to support the continuation of balance rehabilitation at home. The interactive prototypes are designed to provide a more enjoyable and experience when performing balance rehabilitation exercises. Early results from preliminary tests with stroke survivors and rehabilitation professionals are promising. The aim of the designs is to allow people at different levels of rehabilitation to engage into balance training and perform the exercises according to their current skills