An essential care course for healthcare assistants.

Peripherally inserted central catheters (PICCs) are commonly inserted by nurses. This article gives an overview of the care and management of the PICC in general adult nursing.

BackgroundOlder people account for an increasing proportion of those receiving NHS acute care. The quality of health care delivered to older people has come under increased scrutiny. Health-care assistants (HCAs) provide much of the direct care of older people in hospital. Patients’ experience of care tends to be based on the relational aspects of that care including dignity, empathy and emotional support.Objective(s)We aimed to understand the relational care training needs of HCAs caring for older people, design a relational care training intervention for HCAs and assess the feasibility of a cluster randomised controlled trial to test the new intervention against HCA training as usual (TAU).Design(1) A telephone survey of all NHS hospital trusts in England to assess current HCA training provision, (2) focus groups of older people and carers, (3) semistructured interviews with HCAs and other care staff to establish training needs and inform intervention development and (4) a feasibility cluster randomised controlled trial.Setting(1) All acute NHS hospital trusts in England, and (2–4) three acute NHS hospital trusts in England and the populations they serve.Participants(1) Representatives of 113 out of the total of 161 (70.2%) NHS trusts in England took part in the telephone survey, (2) 29 older people or carer participants in three focus groups, (3) 30 HCA and 24 ‘other staff’ interviewees and (4) 12 wards (four per trust), 112 HCAs, 92 patients during the prerandomisation period and 67 patients during the postrandomisation period.InterventionsFor the feasibility trial, a training intervention (Older People’s Shoes™) for HCAs developed as part of the study was compared with HCA TAU.Main outcome measuresPatient-level outcomes were the experience of emotional care and quality of life during patients’ hospital stay, as measured by the Patient Evaluation of Emotional Care during Hospitalisation and the EuroQol-5 Dimensions questionnaires. HCA outcomes were empathy, as measured by the Toronto Empathy Questionnaire, and attitudes towards older people, as measured by the Age Group Evaluation and Description Inventory. Ward-level outcomes were the quality of HCA–patient interaction, as measured by the Quality of Interaction Scale.Results(1) One-third of trust telephone survey participants reported HCA training content that we considered to be ‘relational care’. Training for HCAs is variable across trusts and is focused on new recruits. The biggest challenge for HCA training is getting HCAs released from ward duties. (2) Older people and carers are aware of the pressures that ward staff are under but good relationships with care staff determine whether or not their experience of hospital is positive. (3) HCAs have training needs related to ‘difficult conversations’ with patients and relatives; they have particular preferences for learning styles that are not always reflected in available training. (4) In the feasibility trial, 187 of the 192 planned ward observation sessions were completed; the response to HCA questionnaires at baseline and at 8 and 12 weeks post randomisation was 64.2%, 46.4% and 35.7%, respectively, and 57.2% of eligible patients returned completed questionnaires.LimitationsThis was an intervention development and feasibility study so no conclusions can be drawn about the clinical effectiveness or cost-effectiveness of the intervention.ConclusionsThe intervention had high acceptability among nurse trainers and HCA learners. Viability of a definitive trial is conditional on overcoming specific methodological (patient recruitment processes) and contextual (involvement of wider ward team) challenges.Future workMethods to ease the burden of questionnaire completion without compromising ethics or methodological rigour need to be explored.Trial registrationCurrent Controlled Trials ISRCTN10385799.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 10. See the NIHR Journals Library website for further project information.

BackgroundPeople aged 75 years and over account for 1 in 4 of all hospital admissions. There has been increasing recognition of problems in the care of older people, particularly in hospitals. Evidence suggests that older people judge the care they receive in terms of kindness, empathy, compassion, respectful communication and being seen as a person not just a patient. These are aspects of care to which we refer when we use the term ‘relational care’. Healthcare assistants deliver an increasing proportion of direct care to older people, yet their training needs are often overlooked.Methods/DesignThis study will determine the acceptability and feasibility of a cluster randomised controlled trial of ‘Older People’s Shoes’ a 2-day training intervention for healthcare assistants caring for older people in hospital. Within this pilot, 2-arm, parallel, cluster randomised controlled trial, healthcare assistants within acute hospital wards are randomised to either the 2-day training intervention or training as usual. Registered nurses deliver ‘Older People’s Shoes’ over 2 days, approximately 1 week apart. It contains three components: experiential learning about ageing, exploration of older people’s stories, and customer care. Outcomes will be measured at the level of patient (experience of emotional care and quality of life during their hospital stay), healthcare assistant (empathy and attitudes towards older people), and ward (quality of staff/patient interaction). Semi-structured interviews of a purposive sample of healthcare assistants receiving the intervention, and all trainers delivering the intervention, will be undertaken to gain insights into the experiences of both the intervention and the trial, and its perceived impact on practice.DiscussionFew training interventions for care staff have been rigorously tested using randomised designs. This study will establish the viability of a definitive cluster randomised controlled trial of a new training intervention to improve the relational care proided by healthcare assistants working with older people in hospital.Trial registrationThe study was registered as an International Standard Randomised Controlled Trial (ISRCTN10385799) on 29 December 2014.

A qualitative research focused on contributing and obstructing factors for healthcare assistants in district nursing Older people with confused behavior have behavioral problems due to dementia, mental problems or social problems. For the Healthcare Assistant (HA) in district nursing, it is a daily challenge to care for older people with confused behavior. Aim of this research is to achieve an insight in the strategies the HA uses to deal with the daily care for older people with confused behavior. It is also the aim to have insight in factors which contribute to the daily care in a positive or negative way. Method: a qualitative explorative research. 17 HA's in district nursing participated in semi-structured interviews. All respondents had experience with caring for older people with confused behavior. The most important influencing factors are the experienced relationship between HA and the client and the experienced support by the team. Particularly behavioral problems due to mental problems can impede a relationship with the client. Further research is recommended to study the level of knowledge and competences of all levels of employees in district nursing.

Older people with confused behavior, have behavioral problems due to dementia, mental problems or social problems. For the Healthcare Assistant (HA) in district nursing, it is a daily challenge to care for older people with confused behavior. Aim of this research is to achieve an insight in the strategies the HA uses to deal with the daily care for older people with confused behavior. It is also the aim to have insight in factors which contribute to the daily care in a positive or negative way. Method: a qualitative explorative research. 17 HA’s in district nursing participated in semi-structured interviews. All respondents had experience with caring for older people with confused behavior. The most important influencing factors are the experienced relationship between HA and the client and the experienced support by the team. Particularly behavioral problems due to mental problems can impede a relationship with the client. Further research is recommended to study the level of knowledge and competences of all levels of employees in district nursing.

There is growing consensus that healthcare assistants (HCAs) need access to professional development, education and support. The authors describe a short course designed to educate and support HCAs working with cancer patients.

Caregivers play a significant role in the care of older people. However, their knowledge, practice and needs in the care of older people have been poorly characterised. Therefore, this review was performed to provide an overview of caregivers’ knowledge, practice and needs in the care of older people. A literature search was conducted using the following electronic databases: ProQuest Health and Medical Complete, Wiley Online Library, EBSCO Host, Science Direct and Scopus. Search terms used were “older people”, “caregiver”, “knowledge”, “practice” and “needs”. Two reviewers independently screened the studies and the extracted data. A total of 117 articles were initially found using the above keywords. After using a set of criteria in the screening process, nine articles were found relevant to include in this review. This review of the articles presents a summary of (1) caregivers’ knowledge about the care of older people, (2) caregivers’ practice in the care of older people and (3) caregivers’ needs in the care of older people. The analysis reveals that most of the caregivers addressed a lack of knowledge about and poor practice in the care of older people. This review also offers important insight into the needs of caregivers. Hence, this review recommends further studies on knowledge, practice and needs in the care of older people to identify contextual challenges and provide evidence-based solutions to improve caregivers’ knowledge, practice and needs in the care of older people.

Needs assessment for developing a train-the-trainer educational program to improve healthcare professionals' knowledge and skills inolder diabetes care.

BackgroundNurses’ knowledge and attitude regarding the care of older people can have an impact on patient outcomes such as reduced length of hospital stays, reduced readmission rates, and increased patient and family satisfaction. However, evidence is scarce in Ethiopia, particularly in the study area. Therefore, the study aimed to assess the knowledge, attitude, and associated factors towards the care of older people among nurses working at public hospitals in West Shoa Zone, Ethiopia.MethodsInstitutional based cross-sectional study was conducted from April1–30, 2021 among 423 nurses who were working in adult care units. Data were collected through a self-administered questionnaire. The sample was selected using simple random sampling. The logistic regression analysis model was fitted and the Adjusted Odds Ratio at 95% confidence interval was used. P-values less than or equal to 0.05 were considered statistically significant.ResultsA total of 411 nurses participated in the study with a 97.16% response rate. The mean age of the participants was 29.11 (SD ± 3.84) years. The study showed that 37.2% (95% CI: 33, 42%) of the participants had good knowledge and 45.7% (95% CI: 40.9, 50.6%) had a favorable attitude toward the care of older people. The significantly associated factors positively affected both the knowledge and the attitude of nurses. Age greater than 30 years (AOR:2.37, 95% CI: 1.18, 4.75), experience greater than 5 years (3.00: 1.21, 7.41), being BSc degree holder and above (3.57: 1.40, 9.09), lived with older people (2.14: 1.34, 3.42), and nurses working in adult intensive care unit (3.03: 1.03, 8.91) were significantly associated with knowledge. Likewise, being female (2.04: 1.33, 3.12), being BSc degree holder and above (2.77: 1.35, 5.65), lived with older people (1.59: 1.03, 2.44), and care for older people (1.63: 1.06, 2.53) were significantly associated with attitude.ConclusionIn this study, less than half of the nurses had good knowledge and a favorable attitude towards the care of older people. Continuous professional development regarding the care of older people is important to enhance nurses’ knowledge and attitude.

Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is known about how these individual resources and home-care-specific tasks are recognised in older people's care and service plans. To describe the content of care and service plans in older people's home care with special attention to their individual resources and home-care-specific tasks. This was a document-based cross-sectional study with mixed-methods analysis, carried out in Eastern Finland during Spring 2018. A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n=71). The data were analysed with descriptive statistical methods. Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n=628, 57%) focused on individual resources and the remainder (n=476, 43%) on home-care-specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions. Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home-care-specific tasks that support older people's independence and safety at home. Individual resources need to be recognised in order to enable home-care professionals to provide tailored, high-quality home care services. Home-care-specific tasks should be supported by documentation with updated, sensitive home care classifications.

The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research

Polypharmacy is common in older people who often live with disability and dependency. The number of older people living with unmet needs for social care is also believed to be rising. Polypharmacy is simple to operationalise, whilst unmet needs are not routinely identified but are known to adversely affect health and well‐being. Therefore, this systematic review aimed to investigate whether polypharmacy is a marker of unmet needs for social care in older people. Sixteen databases were searched from inception to January 2021. Studies were included if they reported quantitative data for polypharmacy (“multiple medicines”) in relation to unmet needs for social care (“relative or absolute”) in older people (“study criteria aged ≥55 years or mean age ≥55 in the sample as a whole or stratified data for the ≥55‐year age group”) and were from a high‐income country (defined by the World Bank). Quality was assessed using the National Institute for Health tool for observational studies. Four studies were identified from 2,549 citations, and overall, the quality of evidence was low. Some older people using multiple medications had their social care needs met, whilst others did not. However, there is a clear rationale as to why polypharmacy may be linked to unmet social care needs. Given the limited studies identified in this review, future research should explore this further. The type of unmet need measure may be important to understand the nature of the relationship between the use of multiple medications and unmet social care needs.

BACKGROUND The European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery. OBJECTIVE This paper describes the aim, development, structure, content, and dissemination of this survey. METHODS The mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians. RESULTS The survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students). CONCLUSIONS This survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/64985

BackgroundThe European Cooperation in Science and Technology (COST) Action 21122, PROmoting GeRiAtric Medicine in countries where it is still eMergING (PROGRAMMING) developed an online open survey to assess the educational interests and needs of health care professionals and final-year medical students across participating countries. This survey aims to establish a current baseline for developing educational content on geriatric medicine for nongeriatricians and a framework for its delivery.ObjectiveThis paper describes the aim, development, structure, content, and dissemination of this survey.MethodsThe mixed methods electronic survey, initially developed in English through a cocreation process with key stakeholders, was subsequently translated into 24 languages. It received ethics approval from multiple participating countries. Within- and cross-country analyses of the survey data will be conducted using descriptive and inferential statistics for quantitative data and content analyses for qualitative data. National and international teams will conduct analyses in parallel exploring responses within a specific country or region, professional category (or among medical students), or setting of work. Basic descriptive statistics and chi-square tests will evaluate differences in knowledge, relevance, and interest in geriatric topics across countries, professions, and settings of work. The effectiveness of formal education in geriatric medicine and clinical rotations in geriatric settings versus the lack thereof in promoting higher self-perceived knowledge on geriatric medicine topics will be explored using binary logistic regression. We will provide basic descriptive statistics (frequencies) of reported barriers to receiving further training in geriatric medicine and the effectiveness of various teaching methods as rated by the respondents and explore differences across countries, professions, and settings using chi-square tests. We will conduct qualitative content analyses of free-text responses to the questions exploring professionals’ and medical students’ thoughts on caring for older people and medical students’ thoughts on becoming geriatricians.ResultsThe survey included the following sections: Informed Consent, Demographics, Topics and Skills, Medical Students vs. Professionals, Current Profession (for professionals), Previous Education in Geriatric Medicine (for professionals), Education in Geriatric Medicine (for medical students), Interest in Care of Older People or Geriatric Medicine, Suggestions for Courses in Care for Older People or Geriatric Medicine, and Closure. The survey was disseminated between October 9, 2023, and June 5, 2024, and received 6099 responses; after cleaning, there were 5922 (97.1%) responses (n=5474, 92.43% from professionals and n=448, 7.57% from medical students).ConclusionsThis survey’s findings will inform educational projects across the PROGRAMMING countries. We will share these findings with national and international stakeholders, including professional societies, medical schools, and other relevant organizations. We will advocate for professional educational curricula to include geriatric topics rated as relevant by the survey respondents and promote clinical rotations in geriatric settings and teaching methods rated as effective by the survey respondents.International Registered Report Identifier (IRRID)DERR1-10.2196/64985

Background To enhance the quality of care of older people living and dying in nursing homes, it has been suggested that palliative care should be integrated into this care. This study aims to explore what palliative care means in the context of older person residential care. Methods Action research, using a co-operative inquiry (CI) approach was used. A total of 18 healthcare assistants (HCAs) and 16 registered nurses (RGNs) in two residential older person care units, participated. A reflection on deaths that occurred on the units over a six-month period N=23 took place. This facilitated reflection on care given to the residents and assisted in developing an understanding of how palliative care is understood and integrated into caring for residents. Results A number of actions took place. A debriefing group, acknowledging the importance of relationships and a sense of loss experienced by staff on the death of a resident, a group reflection on recognising dying and how this might impact on care a resident receives, and a healthcare assistant group which contributed to developing an understanding of the unique role HCA’s have in this context. Categories that evolved to describe palliative care include, communication, decision making, transitions in care, grief, relationships, experience and the importance of knowing a resident. Conclusion This study has illustrated that palliative care in older person care, is often aligned with dying. In general, end of life care and person-centred care were more commonly used terms. It was suggested that palliative care is an inherent part of this care. There is a need to value the expertise and experience of the nurses and healthcare assistants caring for older people living and dying in residential care. There is also a need to improve the interdisciplinary roles between older person care and specialist palliative care.