Home Care Setting Research Articles

999 ACUTE FRAILTY ASSESSMENT UNIT: A 6-MONTH QUALITATIVE STUDY OF READMISSIONS WITHIN 28 DAYS OF DISCHARGE & COLLECTIVE CASE ANALYSIS

Abstract Introduction Readmissions can have a negative impact on the care of frail individuals in regards to increased length of stay, healthcare-related harm, reduced quality of life and mortality. Review of frailty readmissions should lead to improvements of frailty care and clinical effectiveness. Method We conducted a retrospective, qualitative analysis of readmissions of frail individuals discharged from our Acute Frailty Unit (AFU) over a six-month period. This is a collective case study in which we used instrumental cases to highlight specific learning points. We used the Electronic Patient Records database to measure the total number of readmissions related to AFU discharges. The Framework methodology was then utilised to further analyse and cluster cases. Common themes linked to readmissions and the time-to-readmission were studied, leading to structured (SMART) quality improvement interventions. Results Four hundred and thirty individuals were discharged from AFU. Eighty-nine (21%) were readmitted within 28 days of index hospital admission. Fifty-eight percent (50/89) of individuals were readmitted to hospital (any ward) with a different presenting complaint compared to index admission. Twenty-two (25%) cases were readmitted with the same initial complaint, while nine (10%) experienced problems due to ineffective discharge planning. In eight (7%) cases, readmission was linked to healthcare-associated complications. Forty (45%,40/89) individuals stayed at home for <7 days after their index discharge, whilst the remaining forty-nine (55%) returned to hospital after 7–28 days. Only eight (9%) readmissions were from care home settings. A bundle of SMART interventions has been developed, including post-discharge support with acute frailty clinics, enhanced frailty dietetic support and improved communication with community partners. Conclusion (s) This collective case study shares important learnings related to the readmission patterns of acute frailty units. Individual case studies are essential in understanding the ways that patient-centred care should be tailored to become more effective.

Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy.

Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique-Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5days. Two patients needed readmission in conventional hospital (1%) for less than 24h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home. Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care. What is Known: • Managing neonatal jaundice is provided in conventional hospital with phototherapy. • Neonatal jaundice increases the risk of prolonged hospitalization or readmission. What is New: • Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia. •The care pathway of neonates from conventional hospital to hospital at home is described.

Bereavement care provision and its associated factors among nurses in cancer care settings: a cross-sectional study.

The goals of this study were to (1) investigate bereavement care provision in practical settings, (2) examine the difference in care by nurses' affiliation (general hospital, hospice, or homecare setting), and (3) identify institutional and personal barriers associated with bereavement care provision. A cross-sectional survey was conducted using an online questionnaire. Nurses (n = 309) who had an experience of cancer patient care before death at least once in a previous year were included in the analysis. Kruskal-Wallis test and Mann-Whitney test were conducted to compare bereavement care provision by nurses' affiliation, and hierarchical logistic regression analysis was conducted to investigate the correlation between bereavement care provision and its associated factors. Less than 30% of nurses reported providing bereavement care in structured settings such as home visits, counseling at a hospital, or phone calls. The differences in bereavement care provision by nurses' affiliation were significant, and the nurses working in a hospital were less likely to provide bereavement care than those working in a hospice or homecare setting. Working in a palliative care setting (OR = 2.35, 95%CI 1.09-5.07, p < 0.05) and greater confidence (OR = 2.18, 95%CI 1.07-4.42, p < 0.05) and knowledge regarding bereavement care (OR = 12.46, 95%CI 5.69-27.29, p < 0.001) were significantly associated factors of bereavement care provision. This study indicated a lack of bereavement care provision, especially in general hospitals. Improving nurses' confidence and knowledge may encourage them to provide bereavement care provision.

Mobile Application for Home Healthcare: Physician's Expectations and Perceptions.

The aging of the population and the increase in chronic diseases generated the need for care at home for pluripathological patients, who can no longer access outpatient care due to functional and social problems. The use of Electronic Medical Records (EMR) improves continuity of care, simplifies data collection, decreases overhead costs, and reduces mortality in chronically ill patients. The use of an App to check and record data in the EMR during the home visit saves time for professionals and helps to avoid transcription errors. This article shares our experience with the design and implementation of a Mobile Application with EMR functionalities for the Homecare setting of the Hospital Italiano de Buenos Aires network.

Falls prevention in the care home setting: a new study

Nursing and Residential CareVol. 24, No. 5 CommentFalls prevention in the care home setting: a new studyAysha MendesAysha MendesCorrespondence to: Aysha Mendes; E-mail Address: [email protected]Freelance Journalist, Oshawa, CanadaSearch for more papers by this authorAysha MendesPublished Online:3 Jun 2022https://doi.org/10.12968/nrec.2022.0024AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Logan PA, Horne JC, Gladman JRF et al. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ. 2021;375:e066991. https://doi.org/10.1136/bmj-2021-066991 Google Scholar FiguresReferencesRelatedDetails 2 June 2022Volume 24Issue 5ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 3 June 2022 Published in print 2 June 2022 Information© MA Healthcare LimitedPDF download

Recognizing Early Deterioration in Elderly Care Home Setting - a Snapshot

AimsOur aim is to measure the baseline physical and mental health early deterioration recognition of carers in the care home setting in Harrogate, North Yorkshire. This is part of a larger undergoing quality improvement project that looks at improving elderly care in care homes in the region by implementing a training package.MethodsThe approach was to contact local authorities, in this case, the NHS clinical commissioning group North Yorkshire to identify a struggling care home. We then engaged the care home and designated a leader to coordinate the project. We collected common themes by using focus groups with both carers and our professionals which led to the creation of a 16-item questionnaire covering deterioration literacy. Finally, we electronically and anonymously surveyed the carers (December 2021) and analysed the data via Google Forms.ResultsWe had 22 responses out of 30 possible. As an overview, 100% felt confident in recognizing deterioration, however, 31.8% don't feel confident in managing deterioration. 90.9% need tools to aid recognition, from which 45.5% find tools confusing. Only 50% feel confident to appropriately escalate the incident, from which 36.4% did not know when or to whom to escalate and 13.6% were not sure if escalation was needed but will refer to secondary care regardless. 27.3% think their escalation process needs improvement. When it comes to deterioration themes, 4.6% don't feel confident in identifying confusion, 13.6% feel their knowledge on confusion could be improved and 9.1% don't know how to identify, manage, or escalate confusion. 22.7% don't feel confident in identifying mobility decline and 9.1% don't know how to manage this accordingly. 9.1% feel like their knowledge of skin changes needs improvement. 22.7% feel that their confidence in identifying toilet habits could be improved and 4.5% don't know how to manage or escalate these changes. In terms of carers’ mental health, 50% and 13.6% have mild and moderate anxiety, respectively.ConclusionDeterioration recognition in the elderly is currently a hot topic. Recent studies highlight the need to improve deterioration management to minimize inappropriate referrals and admissions and unnecessary infection exposure of a vulnerable elderly individual. Our results show that besides improving the theoretical knowledge we also must think about a clear escalation process, an easy-to-read deterioration tool, and managing carers' anxiety as part of the training package.

Exploration of the impact of the COVID-19 pandemic on the mental health of home health care workers in Japan: a multicenter cross-sectional web-based survey

BackgroundThe COVID-19 pandemic has caused home health care workers (home-HCWs) to experience anxiety. The mental health of home-HCWs and related factors during the COVID-19 pandemic have not been clarified; therefore, we aimed to investigate the status and associated factors of fear of COVID-19 infection, anxiety, and depression among home-HCWs in Japan.MethodsWe conducted a multicenter cross-sectional web-based anonymous survey of home-HCWs in August 2021, during the fifth wave of the pandemic in Japan. We surveyed members of facilities that provided home visit services during the COVID-19 pandemic. We measured the Japanese version of the Fear of COVID-19 scale (FCV-19S-J) and the Hospital Anxiety and Depression scale (HADS) as objective variables, and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II (J-AITCS-II) as an explanatory variable.ResultsA total of 328 members of 37 facilities responded to the survey, and we ultimately analyzed 311 participants. The most frequent occupation was nurse (32.8%), followed by doctor (24.8%) and medical office staff (18.0%). The mean score of the FCV-19S-J was 16.5 ± 5.0 (7.0 – 31.0), and the prevalences of definitive anxiety and depression were 7.4% and 15.7%, respectively. Multivariate regression analysis revealed that the J-AITCS-II teamwork subscale was significantly negatively associated with FCV-19S-J, HADS-anxiety, and HADS-depression (β = -0.171, p = 0.004; β = -0.151, p = 0.012; β = -0.225, p < 0.001, respectively). Medical office staff showed significant positive associations with FCV-19S-J and HADS-depression (β = 0.219, p = 0.005; β = 0.201, p = 0.009, respectively), and medical social workers with HADS-anxiety and HADS-depression (β = -0.166, p = 0.011; β = -0.214, p < 0.001, respectively) compared with doctors. The unmet support need for expert lectures on COVID-19 was significantly positively associated with FCV-19S-J (β = 0.131, p = 0.048), and the unmet support need for support systems for psychological stress and emotional exhaustion was significantly positively associated with HADS-anxiety (β = 0.141, p = 0.022).ConclusionsFear of COVID-19 infection and depression of nurses, medical office staff, and other occupations was significantly higher than those of doctors. These findings suggest that non-physicians were more likely to be fearful and depressed during the COVID-19 pandemic; thus, it is necessary to tailor mental health support based on occupation in the home care setting.

Health information exchange in relation to point-of-care testing in home care: Issues in Japan

Laboratory tests, especially point-of-care testing (POCT), and related health information exchange (HIE) are necessary for patient management in the home care setting, where clinic-hospital cooperation and interprofessional collaboration are important. We raised the issues ahead of HIE in relation to POCT in home care in Japan, including issues in electronic medical record use, localized interprofessional collaboration networks with information and communication technology, personal health record use and open connectivity. HIE system may depend on the initiatives of expert communities with non-expert partnership, as well as national healthcare policies. We promote future challenges in this growing area.

Community nurses’ perspectives on a novel blended training approach: a qualitative study

BackgroundTransiting into the community setting often presents novel difficulties for nurses because the role demands skills that might not have been obtained through usual clinical experience or training. The Ageing-in-Place Community Care Team (AIP-CCT) Community Nurse Basic Training programme was developed to address this learning gap. This training programme prepares nurses to lead in a multi-disciplinary team in delivering patient-centred care to patients with progressive or life-limiting conditions in the community setting. This study evaluated the inaugural training programme provided to a group of nurses from an acute hospital in Singapore.MethodsQualitative in-depth interviews were carried out with 13 participants from the training programme three-months after completion of the AIP-CCT Community Nurse Basic Training programme provided by an acute hospital to understand the programme’s impact on their knowledge, skills and clinical practice, as well as barriers and facilitators to learning.ResultsOverall, perception towards the training course was mixed. Course content was found to be relevant, and participants reported that training led to improvement in their practice. However, experienced nurses felt that the content of some modules were lacking in depth. This could have explained why only junior nurses tended to hold favourable attitudes and felt that the training led to increase in their confidence level. Although medical content was assessed favourably, the course was not able to address some of the constraints faced by community nurses such as managing expectations and handling difficult patients in the home care setting. For some modules, face-to-face training was preferred and e-learning components can be improved to increase communication and interaction.ConclusionThis study provided insights into how a community nurse training programme could be developed to meet the needs of community nurses. The training was able to reinforce skills and knowledge, address knowledge gaps and provide new clinical care approaches and communication strategies. These incremental effects on experienced community nurses could be extrapolated to have greater benefits for inexperienced community nurses. Based on findings of the study, potential changes to the training programme were discussed to improve training outcomes.

Wishes and Needs of Nursing Home Residents: A Scoping Review.

Falling birth rates and rising life expectancy are leading to global aging. The proportional increase in older people can be observed in almost all countries and regions worldwide. As a result, more people spend their later years in nursing homes. In homes where person-centered care is implemented, residents report greater satisfaction and quality of life. This approach is based on the wishes and needs of the residents. Therefore, the purpose of this scoping review is to explore the wishes and needs of nursing home residents. A scoping review of the literature was conducted in which 12 databases were systematically searched for relevant articles according to PRISMA-ScR guidelines. Both quantitative and qualitative study designs were considered. A total of 51 articles met the inclusion criteria. Included articles were subjected to thematic analysis and synthesis to categorize findings into themes. The analysis identified 12 themes to which the wishes and needs were assigned: (1) Activities, leisure, and daily routine; (2) Autonomy, independence, choice, and control; (3) Death, dying, and end-of-life; (4) Economics; (5) Environment, structural conditions, meals, and food; (6) Health condition; (7) Medication, care, treatment, and hygiene; (8) Peer relationship, company, and social contact; (9) Privacy; (10) Psychological and emotional aspects, security, and safety; (11) Religion, spirituality; and (12) Sexuality. Nursing home residents are not a homogeneous group. Accordingly, a wide range of needs and wishes are reported in the literature, assigned to various topics. This underscores the need for tailored and person-centered approaches to ensure long-term well-being and quality of life in the nursing home care setting.

Health outcomes and implementation barriers and facilitators of comprehensive geriatric assessment in community settings: a systematic integrative review [PROSPERO registration no.: CRD42021229953

BackgroundComprehensive geriatric assessment (CGA) addresses the bio-psycho-social needs of older adults through multidimensional assessments and management. Synthesising evidence on quantitative health outcomes and implementation barriers and facilitators would inform practice and policy on CGA for community-dwelling older adults.MethodsWe systematically searched four medical and social sciences electronic databases for quantitative, qualitative, and mixed methods studies published from 1 January 2000 to 31 October 2020. Due to heterogeneity of articles, we narratively reviewed the synthesis of evidence on health outcomes and implementation barriers and facilitators.ResultsWe screened 14,151 titles and abstracts and 203 full text articles, and included 43 selected articles. Study designs included controlled intervention studies (n = 31), pre-post studies without controls (n = 4), case-control (n = 1), qualitative methods (n = 3), and mixed methods (n = 4). A majority of articles studied populations aged ≥75 years (n = 18, 42%). CGAs were most frequently conducted in the home (n = 25, 58%) and primary care settings (n = 8, 19%). CGAs were conducted by nurses in most studies (n = 22, 51%). There was evidence of improved functional status (5 of 19 RCTs, 2 of 3 pre-post), frailty and fall outcomes (3 of 6 RCTs, 1 of 1 pre-post), mental health outcomes (3 of 6 RCTs, 2 of 2 pre-post), self-rated health (1 of 6 RCTs, 1 of 1 pre-post), and quality of life (4 of 17 RCTs, 3 of 3 pre-post). Barriers to implementation of CGAs involved a lack of partnership alignment and feedback, poor acceptance of preventive work, and challenges faced by providers in operationalising and optimising CGAs. The perceived benefits of CGA that served to facilitate its implementation included the use of highly skilled staff to provide holistic assessments and patient education, and the resultant improvements in care coordination and convenience to the patients, particularly where home-based assessments and management were performed.ConclusionThere is mixed evidence on the quantitative health outcomes of CGA on community-dwelling older adults. While there is perceived positive value from CGA when carried out by highly skilled staff, barriers such as bringing providers into a partnership, greater acceptance of preventive care, and operational issues could impede its implementation.

Expanding the conversation: A Person-centred Communication Enhancement Model.

The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers’ use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes. Thus, several person-centred care and communication theoretical perspectives have been employed to ground study in this field. However, a comprehensive theoretical position to underpin person-centred communication in dementia and older adult research does not exist to our knowledge. To offer expansion to the theoretical work in this emerging field, a Person-Centred Communication Enhancement Model for long-term care and dementia care is proposed, as well as rationale for its development. This discussion will also provide an overview and critique of the extant philosophies, theories, frameworks and models that have been utilized in the study of person-centred communication within the context of long-term care and dementia care.

A Review on WMSN (Wireless Medical Sensor Networks) for Health Monitoring Systems

Wireless Medical Sensor (WMSN) networks have become a great technology to allow for the best kind of applications. Recent developments at WMSN have helped to create a comprehensive health monitoring concept in both home and hospital care settings. Current technological advances in sensors, integrated dynamic circuits, and wireless connectivity have allowed the event of smaller, heavier, less expensive, and clever body sensors. These modules are able to hear, process, and communicate with one or more important signals. In addition, they will be used on local wireless networks (WPANs) or wireless nerve networks (WBSNs) to monitor health. Many studies are being conducted and/or ongoing to develop flexible, reliable, secure, realistic, and effective WBSNs for health applications. The importance of wireless nerve networks in health surveillance is constantly evolving, due to the growing need for safety and security in cities. The rapid development of wireless technology has significantly aided the advancement of monitoring systems that have been developed through the combination of wireless sensors. The wireless health monitoring introduces emerging innovations with significant advantages when compare to conventional communication networks, which has the advantages of lowering the cost of installation and maintenance while increasing the effectiveness of the health monitoring system in the field of medicine.

Experiences of children with central venous access devices: a mixed-methods study

BackgroundOur study aims to explore the experience of having a central venous access device (CVAD) from the perspective of the child and family and how movements within and outside of hospital environments influence this experience.MethodsA mixed-methods study was conducted across Children’s Health Queensland (Australia), including inpatient and home-care settings. Children less than 18 years with CVADs were eligible and followed for 3 months or CVAD removal. A subgroup of primary caregivers participated in semi-structured interviews. Quantitative and qualitative measures of child and family CVAD experiences were explored.ResultsIn total, 163 patients with 200 CVADs were recruited and followed for 6993 catheter days (3329 [48%] inpatients; 3147 [45%] outpatients; 517 [7%] home). Seventeen participants were interviewed. Experiences of having a CVAD were complex but predominantly positive primarily related to personalized CVAD care, healthcare quality, and general wellbeing. Their experience was shaped by their movements through hospital and home environments, including care variation and distress with procedures. Device selection and insertion location further influenced experience, including safety, impairments in activities of daily living, school, and recreation.ConclusionsCVAD experiences were influenced by nonmodifiable (e.g., diagnosis) and modifiable factors (e.g., education; care variation). Clinical approaches and policies that account for family and child considerations should be explored.ImpactVariation in decision making and management for pediatric CVADs is accepted by many clinicians, but the influence this variation has on the health experience of children and their families is less well explored.This is the first study to draw from a broad range of children requiring CVADs to determine their experience within and outside of healthcare facilities.Interdisciplinary clinicians and researchers need to work collaboratively with children and their families to provide resources and support services to ensure they have positive experiences with CVADs, no matter where they are managed, or who they are managed by.

Designing Take-Back for Single Use Medical Devices: The Case of ReturpenTM.

Focus on take-back of waste products is currently enjoying increased importance, as attention on environmental sustainability and circular economy grows. Single-Use or Disposable Medical Devices (SUDs), which in homecare settings often end up in landfills or incineration, are currently subject to attention, regarding the potential to slow the flow of waste and seek new value creation possibilities. Via a descriptive single-case study of the "ReturpenTM" initiative-a collaborative take-back initiative launched in three municipalities in Denmark-characteristics are elicited, of the planning, launch, and implementation, of the first 6-month pilot of the ReturpenTM initiative. ReturpenTM is a collaborative partnership of 15 public and private organizations and is adopting an end-to-end approach for its development and execution, including numerous professional workstreams. The pilot of the ReturpenTM achieved participation of 66 of the existing 73 pharmacies in 3 municipalities (90% participation rate), and an overall return rate of 13% for the used insulin pens, despite the limitations caused by the covid-19 pandemic. The return rates ranged from 10% to 15% in the 3 municipalities, and overall, the second quarter recovery (15%) was higher than the first quarter (11%). ReturpenTM demonstrates how a workstream-based approach can provide a practical framework for the development and implementation of SUD take-back in a homecare setting. The case describes how the pharmaceutical industry is taking proactive measures to contribute to a more circular economy for disposable medical devices, including the infrastructure and ecosystem necessary to ensure a closed-loop system for medical devices.

Before the COVID-Vaccine-Vulnerable Elderly in Homecare.

Background: At the beginning of 2020, the COVID-19 virus was spreading all over the world. Frail elderly were at risk for illness and death. Isolation seemed to be the best solution. The aim of this paper was to describe how the lockdown affected elderly homecare patients. Methods: We used an international self-reported screening instrument built on well-documented risk factors adapted to COVID-19. We considered ethical, legal, and practical concerns. The research included telephone interviews with 30 homecare patients. Results: Seventy percent lived alone. Seventy-three percent of the sample suffered from major comorbidity. Cardiovascular disorder was the most frequent diagnosis. Nineteen (63.3%) needed help for personal care. Several of the participants were lonely and depressed. The homecare teams struggled to give proper care. The health authorities encouraged the population to reduce their outside physical activities to a minimum. The restrictions due to COVID-19 affected daily life and several respondents expressed uncertainties about the future. Conclusions: It is important to describe the patients’ experiences in a homecare setting at the initiation of lockdowns due to COVID-19. The isolation protected them from the virus, but they struggled with loneliness and the lack of physical contact with their loved ones. In the future, we need to understand and address the unmet needs of elderly homecare patients in lockdown.

Enablement of nursing home residents in infection prevention during general practitioner visits: A qualitative study.

Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents' knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.

Enhancement of Aging in Place: An Evolving Understanding of Person-Centered Dementia Care in Home Settings.

There has been a rich body of literature on informal caregivers of persons with dementia (PWD). However, little has been discussed on how to facilitate person-centered dementia care in home settings with spouses as primary caregivers. We tend to take it for granted that spouses provide person-centered care for PWD. However, being spouses of PWD and living with them for several decades does not necessarily mean that it is easier for them to provide person-centered dementia care and maintain valued and healthy relationships. The current study aimed to explore dyadic experiences of PWD and their spousal caregivers and develop a culturally and contextually-sensitive understanding of person-centered dementia care in home-based settings. A total of 20 dyads of PWD and their care partners were selected for this study. A trained qualitative interviewer conducted a one-on-one interview with each participant with dementia and their care partners separately. We adopted both conventional and directed content analyses. Our findings provide examples of care partners provide person-centered care, resulting in a profound positive impact on their wellbeing. Adaptive leadership and collaborative work emerged as a key finding in facilitating person-centered dementia care. Cultural relevancy of person-centered dementia care was also interpreted from the data. The study findings provide implications for the evolving of person-centered dementia care model in home-based settings. Findings from this study highlight the significance of facilitating person-centered dementia care in home-based settings between PWD and their primary family caregivers.

Nursing Activities and Job Satisfaction of the Licensed Practical Nurse Workforce in New Jersey

Background Licensed practical nurses (LPNs) are important members of the nursing workforce in the United States, particularly in long-term care and home care settings. A previous qualitative study found LPNs have expanded their role, yet detailed information about the nursing activities performed by LPNs is lacking in New Jersey (NJ). Purpose The purpose of this study was to describe current nursing activities and job satisfaction of LPNs in NJ and to determine whether there is a difference in the nursing activities and job satisfaction of LPNs working in nursing homes and those working in other settings. Methods For this descriptive, cross-sectional study, LPNs who had email addresses listed with the NJ Board of Nursing were sent a survey about their nursing activities and job satisfaction. Results The 804 LPNs who completed the survey were representative of the NJ LPN workforce. The top nursing activities that LPNs performed daily were documenting, providing basic nursing care, checking vital signs, and administering medications. LPNs working in nursing homes also identified supervising unlicensed assistive personnel as an additional top nursing activity. Many LPNs also reported independently performing comprehensive and focused assessments and formulating care plans. Compared with LPNs working in other settings, LPNs working in nursing homes had less job satisfaction. Conclusion Our findings reveal that LPN scope of practice has increased, and some LPNs are functioning beyond their scope of practice. With a shared agenda, nurse leaders in practice, academe, trade organizations, and regulatory bodies should convene to discuss and ensure a clear understanding of the LPN role and scope of practice. Licensed practical nurses (LPNs) are important members of the nursing workforce in the United States, particularly in long-term care and home care settings. A previous qualitative study found LPNs have expanded their role, yet detailed information about the nursing activities performed by LPNs is lacking in New Jersey (NJ). The purpose of this study was to describe current nursing activities and job satisfaction of LPNs in NJ and to determine whether there is a difference in the nursing activities and job satisfaction of LPNs working in nursing homes and those working in other settings. For this descriptive, cross-sectional study, LPNs who had email addresses listed with the NJ Board of Nursing were sent a survey about their nursing activities and job satisfaction. The 804 LPNs who completed the survey were representative of the NJ LPN workforce. The top nursing activities that LPNs performed daily were documenting, providing basic nursing care, checking vital signs, and administering medications. LPNs working in nursing homes also identified supervising unlicensed assistive personnel as an additional top nursing activity. Many LPNs also reported independently performing comprehensive and focused assessments and formulating care plans. Compared with LPNs working in other settings, LPNs working in nursing homes had less job satisfaction. Our findings reveal that LPN scope of practice has increased, and some LPNs are functioning beyond their scope of practice. With a shared agenda, nurse leaders in practice, academe, trade organizations, and regulatory bodies should convene to discuss and ensure a clear understanding of the LPN role and scope of practice.

A systematic review of quantitative studies exploring staff attitudes to antipsychotic use in residents with dementia in care homes

Abstract Introduction Despite significant warnings of adverse effects associated with giving antipsychotics to patients with dementia, these medicines continue to be prescribed for managing the Behavioural and Psychological Symptoms of Dementia (BPSD) in care homes. Information provided by staff working within care homes is a factor that can influence prescribing decisions and how BPSD is managed (1). This provides the rationale for the current study to understand staff attitudes towards antipsychotic prescribing in dementia within care home settings. Aim This quantitative systematic review of survey and questionnaire studies aims to explore the attitudes of staff within care homes towards giving antipsychotics to residents with BPSD. Methods A comprehensive search of the literature published in ten databases was conducted between 26-05-2020 and 19-07-2020 and updated in July 2021. The review protocol was registered and has been published on PROSPERO (CRD42021256879). No time limit was imposed on publication dates. Two reviewers (AR &amp; HP) independently performed the systematic search of the electronic databases and assessed the reporting quality of the papers, again independently, using ‘A Consensus-Based Checklist for Reporting of Survey Studies’ (CROSS) (2). All the identified papers were read in detail, and a structured summary was produced for each according to the following four themes: attitudes toward antipsychotics; barriers to reduced usage; measures implemented within the settings; perceived needs of staff. These summarized data were then formulated as a table to allow comparison of each study and consolidation of the findings. Results 14 papers with 2059 participants, all published in the last decade, were identified for inclusion in the review. Where measured, staff appeared to hold positive beliefs about the effectiveness of antipsychotics in BPSD (n=5). GPs were held responsible for reluctance to complete medication reviews and discontinue antipsychotics in residents (n=1). Antipsychotics were thought to be mainly prescribed for the management of behavioural problems such as agitation, aggression, resistance to care, wandering, hallucination (n=5). Risperidone was stated as a commonly prescribed antipsychotic (n=1). The most frequently reported adverse effects of antipsychotics were increased risk of falls and sedation (n=3). Lower staff education, lack of training, poor antipsychotic medication reviews, lack of resources to implement nonpharmacological methods, and longer working hours/lack of time were viewed as barriers to deprescribing of antipsychotics (n=6). Time was a constraint in managing behavioural problems (n=1). Measures used by the staff to reduce antipsychotic usage included medication reviews, staff education about dementia and its management, dose adjustment of antipsychotics, behavioural assessment tools and nonpharmacological interventions (n=5). Some staff highlighted the need for education, training, resources, and financial and clinical support to reduce the use of antipsychotics (n=4). Conclusion This is the first systematic review which synthesizes quantitative data exploring staff attitudes towards giving antipsychotics to care home residents with BPSD. The positive beliefs about the effectiveness of antipsychotics and the barriers to deprescribing identified provide the impetus for further research. This study was limited by excluding non-English papers. Another limitation was that some domains were rarely explored, e.g. commonly-prescribed medicines, meaning medication preferences could not be summarised. References (1) Janus SI, van Manen JG, IJzerman MJ, Bisseling M, Drossaert CH, Zuidema SU. Determinants of the nurses’ and nursing assistants’ request for antipsychotics for people with dementia. Int Psychogeriatr. 2017 Nov 21;29(3):475-84. (2) Sharma A, Duc NT, Thang TL, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021 Apr 22;36(10):3179–87.