A theoretical perspective on planning and implementing pet therapy for older patients with dementia or cognitive impairment in an acute hospital setting.

Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients' function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting. To examine the nursing-therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting. A prospective study using a convenience sample. Acute care hospital. Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist. Interrater reliability for the AM-PAC ACISF among therapists and nurses. Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF. Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting. Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients' function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form "6-Clicks" (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

The challenges of end of life care in acute hospitals

Increased accountability and growing fiscal limitations in global health care continue to challenge how occupational therapy practices are undertaken. Little is known about how these changes affect current practice in acute hospital settings. This article reviews the relevant literature to further understanding of occupational therapy practice in acute physical hospital settings. A scoping review of five electronic databases was completed using the keywords Occupational therapy, acute hospital settings/acute physical hospital settings, acute care setting/acute care hospital setting, general medicine/general medical wards, occupational therapy service provision/teaching hospitals/tertiary care hospitals. Criteria were applied to determine suitability for inclusion and the articles were analysed to uncover key themes. In total 34 publications were included in the review. Analysis of the publications revealed four themes: (1) Comparisons between the practice of novice and experienced occupational therapists in acute care (2) Occupational therapists and the discharge planning process (3) Role of occupation in the acute care setting and (4) Personal skills needed and organisation factors affecting acute care practice. The current literature has highlighted the challenges occupational therapists face in practicing within an acute setting. Findings from this review enhance understanding of how occupational therapy department managers and educators can best support staff that practise in acute hospital settings.

Older adults are often exposed to elderspeak, a specialized speech register linked with negative outcomes. However, previous research has mainly been conducted in nursing homes without considering multiple contextual conditions. Based on a novel contextually-driven framework, we examined elderspeak in an acute general versus geriatric German hospital setting. Individual-level information such as cognitive impairment (CI) and audio-recorded data from care interactions between 105 older patients (M = 83.2 years; 49% with severe CI) and 34 registered nurses (M = 38.9 years) were assessed. Psycholinguistic analyses were based on manual coding (κ = .85 to κ = .97) and computer-assisted procedures. First, diminutives (61%), collective pronouns (70%), and tag questions (97%) were detected. Second, patients' functional impairment emerged as an important factor for elderspeak. Our study suggests that functional impairment may be a more salient trigger of stereotype activation than CI and that elderspeak deserves more attention in acute hospital settings.

While in the past the focus of speech pathologists working in the acute hospital setting has beenservice provision to people with communication disorders and their families, their primary role isnow in dysphagia. In the limited literature regarding aphasia management in acute hospital settings,there is a lack of consistency regarding the type and amount of intervention being provided topeople with aphasia; however, there is consensus that current practice is inconsistent with bestpracticerecommendations. Given that aphasia intervention has been identified as being central toimproved communicative outcomes, an increased capacity to effectively communicate healthcareneeds, a decrease in hospital negative events, and an increased sense of satisfaction for people withaphasia, this is of concern. Little is known about the reasons underlying this evidence-practice gap.The overall aim of this thesis was to provide an understanding of current acute aphasia managementpractice and the factors that influence it. Specifically, the research aimed to: (a) provide an in-depthunderstanding of the current aphasia management pathway in the acute hospital setting; (b) exploreacute speech-language pathologists’ conceptualisation, experiences, and perceptions of post-strokeaphasia management, and provide a greater understanding of the factors that influence theirpractice; and, (c) understand the factors that influence acute aphasia management from theperspectives of speech pathologists, people with aphasia, and their close others, through a culturallens.In order to address the research aims, the empirical aspects of this research were conducted in twoPhases. Phase One, an interpretative phenomenological investigation, aimed to provide a deepunderstanding of aphasia management from the perspective of acute speech pathologists. Semistructured,in-depth interviews were undertaken with 15 Australian speech pathologists workingwith people with aphasia (one of which was later excluded resulting in a total n=14). Interviewswere transcribed verbatim, and data were analysed using a thematic analysis. Key themes identifiedincluded: role perception; competing priorities; the de-prioritisation of aphasia; and, the sense ofdisempowerment experienced by speech pathologists as a result of their relationship with evidencebasedpractice for acute aphasia management. In addition, a qualitative content analysis wasundertaken to describe the current aphasia management pathway. Grounded within the guidingconstruct, First contact with the profession, the findings represented the significant diversity in the pathways of care for people with aphasia and their families in the acute hospital setting. Overall,analysis revealed the complex, diverse, and multi-faceted nature of the phenomenon.Phase Two was designed based on the findings of Phase One. It examined the culture of acuteaphasia management by speech pathologists in depth, through the use of focused ethnography in asingle acute stroke unit. Three participant triads, consisting of a speech pathologist, person withaphasia, and at least one close other, were included as key informants in the research. Using avariety of qualitative research methods, including document analysis, participant reflective diaries,interviews, and observation, data collection occurred across the duration of the acute hospitaladmission of the person with aphasia. Data were analysed using an inductive thematic approach.Findings suggest that the central theme of Creating a positive experience is contributed to by adiverse array of cultural factors that influence acute aphasia management and modify healthcareexperiences and outcomes.The overarching themes provide insight into the centrality that cultural and personal perceptionsand influences play on practice. They suggest that re-conceptualisation of the acute speechpathologist’s role in aphasia management, at both an individual and cultural level, is likely to bepowerful.Future research will focus on implementing knowledge transfer and exchange interventions toincrease the uptake of evidence-based recommendations in clinical settings. Interventions includeaddressing the psychological and structural empowerment of clinicians, as well as cultural levelinterventions targeting the creation of a stronger ‘communication culture’ in acute hospitals.In conclusion, whilst the experiences of aphasia in the acute hospital setting are unique for peoplewith aphasia, their families, and speech pathologists alike, the narratives and themes contained inthe findings of this study offer a positive message for all stakeholders in aphasia management.Speech pathologists strive to provide evidence-based practice that creates a positive experience forpeople with aphasia, and people with aphasia and their families value the service provided byclinicians in the acute hospital. Despite this, a loud and resonating sense of dissonance regardingcurrent service provision persists. If, societally, value is placed on the management of aphasia in the acute hospital setting, then change needs to occur. Such change has the potential to not onlyimprove service provision to people with aphasia and their families, but also to decrease the senseof dissonance for speech pathologists working in this setting.

EXECUTIVE SUMMARYBackgroundTeamwork is seen as an important element of patient care in acute hospital settings. The complexity of the journey of care for patients highlights the need for health professionals to collaborate and communicate clearly with each other. Health organizations in western coun

Technology that detects early when a patient at risk of falling leaves the bed can support nurses in acute care hospitals. To develop a better understanding of nurses' perspectives and experiences with a bed-exit information system (BES) in an acute care hospital setting. BES was implemented on 3 wards of a university medical center. Nurses completed 2 online surveys at each time point (P0 and P1) and participated in focus groups before (P0) and after (P1) implementation. Additional patient data were collected. Descriptive statistics summarized the survey results, while content analysis was applied to focus group data. Patient rates and adverse events in both phases were compared using negative binomial models. Reporting of this study adhered to the GRAMMS checklist. A total of 30 questionnaires were completed at P0 (30/72, 42%) and 24 at P1 (24/71, 33%). Of the participants, 15 completed both questionnaires (complete cases). At P1, 64% (9/14) of participants agreed that their perceived workload and strain in caring for patients with cognitive impairment was reduced by the use of the BES. The adverse event rate per patient per day was reduced by a factor of 0.61 (95% CI 0.393-0.955; P=.03). In addition, 11 nurses participated in 4 focus groups before and after the intervention. Participants found it challenging to operationalize the use of the BES due to the heterogeneity of care settings, but certain behaviors of patients with cognitive impairment were recognized as indicating a need for intervention. Negative experiences included information overload and alarm fatigue, leading to occasional removal of the system. While BES provides some support in managing patients with cognitive impairment, its impact remains limited to specific scenarios and does not significantly reduce nurses' workload or strain. Our findings highlight the need to manage expectations of BES performance to ensure alignment between expected and actual benefits. To improve BES effectiveness and long-term implementation, future research should consider both objective measures of patient care and subjective factors such as nurse experience, structural conditions, and technical specifications. Improving information mechanisms within call systems could help reduce alarm fatigue and increase perceived usefulness. Overall, successful integration of BES in acute care settings will require close collaboration with nursing staff to drive meaningful healthcare innovation and ensure that the technology meets the needs of both patients and nurses. German Register for Clinical Studies DRKS00021720; https://drks.de/search/de/trial/DRKS00021720.

To explore staff perceptions of the impact of weekly music and movement sessions involving older patients and staff on the wards where 'Dance for Health' sessions take place. Dance for Health is a programme of weekly group dance sessions, which take place on wards in an acute hospital setting. Recent research demonstrates the value of creative arts activities in clinical settings across the globe. However, there is little research exploring the impact of dance programmes for frail older people in acute hospital settings, or healthcare professionals' perceptions of the impact of these sessions on patients, staff and the ward environment. A qualitative descriptive approach was used. Twenty-one semi-structured interviews were conducted with staff who had supported patients participating in Dance for Health and the ward managers where the sessions took place. Data analysis was undertaken using a thematic analysis approach. The sessions challenged staff assumptions about older patients' musical preferences and the level of physical activity patients were able to undertake. Staff felt that the shared experience and interactions within the group enhanced staff-patient relationships. Staff taking part in the sessions reported feeling pleasure seeing their patients enjoying themselves and valued being a part of delivering the sessions. The Dance for Health programme in an acute hospital setting has the potential to promote person-centred care through encouraging self-expression and individuality. It is a meaningful and enjoyable activity, which encourages physical activity and social interaction and enriches the aesthetic experience of the hospital environment. This is the first study reporting on the use of dance sessions for older people in an acute hospital setting. Dance for Health had a positive impact on staff attending the sessions and enhanced staff-patient relationships. Staff support is key for effective delivery.

Nurses' perceptions of their knowledge and barriers to ambulating hospitalized patients in acute settings

The MediStori. A personal health record and standardised self-management toolkit which can improve integrated care systems

BackgroundEffective pain management is a fundamental human right. However, global disparities in pain management practices exist across health settings. This study explored healthcare practitioners’ views on pain management in the acute care hospital setting.MethodsThe focus groups included clinical specialties most likely to encounter patients with ‘difficult to manage pain’, namely those in the Geriatrics and Palliative Care Unit (2 doctors and 3 nurses), Critical Care Unit (7 doctors), and the Pain Management Team (3 doctors and 2 nurses). The transcripts were analyzed using a qualitative thematic analysis. ResultsThe data analysis revealed four themes. Theme 1, ‘Being too safe’ described the presence of apprehensive attitudes among patients and healthcare practitioners that limits the appropriate use of diverse and tailored pain medications in acute care hospital settings. Theme 2, ‘Working as a team’ described the need for collaborative approaches to achieve hospital-wide evidence-based pain management. Theme 3, ‘Adaptation for local and cultural preferences’ explored how pain was perceived through cultural lenses and suggested strategies to tailor pain management to local and cultural preferences. Finally, Theme 4, ‘Driving acute pain management forward’ listed clinician solutions for improving pain management in acute care hospital settings toward a pain-free hospital initiative. ConclusionDespite advances in pain medicine and pain teaching strategies, effective pain management is proportionate to both clinical and cultural preferences. Future studies should investigate the standardization of global pain management tools and guidelines to fit the local culture and context.

Commentary on: Hennessy N, Neenan K, Brady V, et al . End of life in acute hospital setting—A systematic review of families' experience of spiritual care. J Clin Nurs 2020;29:1041–52....

Pilot Study to Enhance Recovery Through Physical Activity and Healthy Lifestyles in an Acute Psychiatric Day Hospital Setting

depression is common in later life, particularly in people with poor physical health. In the acute hospital setting this is associated with poor outcomes, increased length of stay and compromised care. The recognition and diagnosis of depression is therefore a key first step in managing depression in the general hospital, and this may be facilitated by the use of an appropriate screening instrument. the aim of this study is to review all relevant literature on rating scales used to detect depression in older people in general hospitals so as to identify the most appropriate tool and cut-off score with optimal performance. an electronic search was conducted applying key search terms. Selection of articles was conducted in a staged manner and by utilising predetermined quality criteria. When appropriate pooled analysis was undertaken. only 14 studies satisfied the inclusion criteria and only one instrument-the Geriatric Depression Scale (GDS)-has been studied to an adequate extent in older people in the acute general hospital setting. Best performance for the GDS was for a cut-off of 5/6 for the GDS-15 and 10/11 for the GDS-30. further research is required before recommending the use of brief depression screening instruments (single or two items) in the acute hospital setting. The GDS would appear the most validated instrument currently (in either 15 or 30 item versions), though other tools such as the BASDEC show promise.

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount.