Concept Of Care Research Articles

IMPLEMENTATION OF PATIENT-CENTERED CARE AND MEDICAL CARE IMPROVEMENT: CURRENT STATE (review)

The aim of the research: to conduct an analysis and generalization of scientific publications on the issue of the patient-centered care implementation in clinical practice setting.
 Results. The concept of a patient-centered care, proposed in the USA in the early 1990s, was subsequently used by the WHO in the development of the program for the development of the health care system in the 21st century. This approach shifts the focus from the traditional biomedical model, in which the doctor is given a priority role in decision-making to a model that establishes a partnership among practitioners, patients, and their families. Recent scientific publications identified eight principles of patient-centered care: respect for patient's values, preferences, and expressed needs, provision of information and education, emotional support to relieve fear and anxiety, involvement of family and friends, physical comfort and symptom`s relief, continuity and secure transition between healthcare settings, coordination of care, access to care. The implementation of a patient-centered care in clinical practice faces a number of difficulties, in particular, with regard to the influence of social, economic, financial factors, training of medical personnel and patient education. Another aspect is the heterogeneity of patients in terms of their ability to take a partnership approach and be involved in the decision-making process. Further clinical trials are needed to provide evidence for the practical use of the most effective approaches to patient-centered care implementation.
 Conclusions: The patient-centered care has become a key element of the quality of medical care and assumes that the care provided should meet the individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The introduction of a patient-centered care requires appropriate medical education of doctors to improve communication skills and patient`s education for involve patients in the treatment process as partners.

Особливості психотерапевтичного супроводу в структурі паліативної допомоги хворим, які страждають на злоякісні новоутворення

Palliative medicine is aimed at achieving the best possible in a particular situation the level of quality of life of the patient. Purpose - to investigate that the grief reaction is one of the strongest and most painful human experiences. Materials and methods. There were 120 cancer patients observed. The reaction of grief consists of 4 stages: shock and protest - numbness, disbelief and acute dysphoria; absorption - acute longing, search and anger; disorganization - a sense of despair and acceptance of loss and decision. Results. The initial reaction of grief - shock, emotional numbness and disbelief. The excitement is most pronounced within about two weeks, followed by symptoms of depression, which reach its peak 4-6 weeks. Eventually, the former intense pain of severe loss begins to subside. In addition to the reaction of grief, there is a pathological, which is divided into suppressed (inhibited), delayed (delayed) and chronic. The role of the psychotherapist at this stage is to provide psychological support and assistance to both the patient and his environment to cope with this situation. Conclusions. The principle of the concept of palliative care is the need to ensure the psychological comfort of the patient. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

The Value of Ethics Education in Surgical Training.

Although ethics is not a new concept in the surgical care of patients, the focused attention to ethics education in surgical education is a recent phenomenon. As more options have become available in the treatment armamentarium of surgery, the central question of surgical care has changed from "What can be done for this patient?" to the more modern question, "What should be done for this patient?" To answer this question, surgeons must attend to patients' values and preferences. Surgical residents also spend much less time in the hospital today than they did several decades ago, increasing the necessity of focused attention to ethics education. Finally, with the shift to more outpatient care, surgical residents have fewer opportunities to engage in many of the important discussions about diagnosis and prognosis with patients. These factors have made ethics education in surgical training programs more important today than in previous decades.

Faculty Readiness and Learning Needs for Incorporating Virtual Healthcare into the Curriculum

Objective: Virtual healthcare technologies are becoming increasingly acceptable and available to patients and providers to deliver care. Although common in practice settings, many nursing schools have not integrated virtual care concepts into the curriculum. One reason may be because faculty are not prepared to teach these concepts. The purpose of this study was to assess the virtual healthcare learning needs of faculty. Methods: An exploratory, descriptive study design was used to evaluate faculty receptiveness and readiness to teach virtual nursing care concepts. Thirty-seven full time faculty members were asked to complete an anonymous survey consisting of demographic, open-ended, and Likert scale items based on the technology acceptance model, the Virtual Clinical Practicum Attitude Survey, and the Evidence-Based Practice Beliefs scale. Quantitative data was evaluated using descriptive statistics and qualitative data with a thematic analysis process. Results: Twenty-two faculties completed a survey regarding their beliefs about virtual healthcare technologies. Most respondents believe that virtual care improves access for patients and that students should have training in these technologies. However, few had used virtual technology in their own clinical practices and wanted further education about them. Faculty was receptive to integrating virtual care into the curriculum and reported their learning needs could be met through didactic content and simulation activities with faculty as learners. Conclusion: An opportunity exists to prepare faculty to teach virtual healthcare concepts. Addressing faculty learning needs could aid in the successful integration of virtual healthcare concepts into the curriculum, thus, better preparing students to deliver virtual care to their future patients.

Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS.

Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS poses challenges to both patients and health care professionals within the framework of care due to frequent visits to physicians, avoidable hospitalizations, comorbidities, complications, and the resulting polypharmacy. The concepts of integrated care (IC) represent sustainable approaches to solving the complex care situation of PLWH. This study aimed to describe the national and international models of integrated care and their benefits regarding PLWH as complex, chronically ill patients in the health care system. We conducted a narrative review of the current national and international innovative models and approaches to integrated care for people with HIV/AIDS. The literature search covered the period between March and November 2022 and was conducted in the databases Cinahl, Cochrane, and Pubmed. Quantitative and qualitative studies, meta-analyses, and reviews were included. The main findings are the benefits of integrated care (IC) as an interconnected, guideline- and pathway-based multiprofessional, multidisciplinary, patient-centered treatment for PLWH with complex chronic HIV/AIDS. This includes the evidence-based continuity of care with decreased hospitalization, reductions in costly and burdensome duplicate testing, and the saving of overall health care costs. Furthermore, it includes motivation for adherence, the prevention of HIV transmission through unrestricted access to ART, the reduction and timely treatment of comorbidities, the reduction of multimorbidity and polypharmacy, palliative care, and the treatment of chronic pain. IC is initiated, implemented, and financed by health policy in the form of integrated health care, managed care, case and care management, primary care, and general practitioner-centered concepts for the care of PLWH. Integrated care was originally founded in the United States of America. The complexity of HIV/AIDS intensifies as the disease progresses. Integrated care focuses on the holistic view of PLWH, considering medical, nursing, psychosocial, and psychiatric needs, as well as the various interactions among them. A comprehensive expansion of integrated care in primary health care settings will not only relieve the burden on hospitals but also significantly improve the patient situation and the outcome of treatment.

Integrating Surgical Palliative Care Into the Full Spectrum of Medical Education.

We describe our institutional approach to incorporating surgical palliative care education into the Undergraduate Medical Education, Graduate Medical Education and Continuing Medical Education spaces as a model to help guide similarly interested educators. We had a well-established Ethics and Professionalism Curriculum, but an educational needs assessment revealed that both the residents and faculty felt that additional training in palliative care principles was crucial. We describe our full spectrum palliative care curriculum, which begins with the medical students on their surgical clerkship and continues with a 4week surgical palliative care rotation for categorical general surgery PGY-1 residents, as well as a Mastering Tough Conversations course over several months at the end of the first year. Surgical Critical Care rotations, Intensive Care Unit debriefs after major complications, deaths, and other high-stress events are described, as is the CME domain, which includes routine Department of Surgery Death Rounds and a focus on palliative care concepts in Departmental Morbidity and Mortality conference. The Peer Support program and Surgical Palliative Care Journal Club round out our current educational endeavor. We describe our plans to create a full spectrum surgical palliative care curriculum that is fully integrated with the 5 clinical years of surgical residency, and include our proposed educational goals and year-specific objectives. The development of a Surgical Palliative Care Service is also described.

Prevalence of Dental Caries in Patients on Renal Replacement Therapy—A Systematic Review

Patients under renal replacement therapy (RRT) often show oral problems, including dry mouth, periodontal and dental diseases. This systematic review aimed to evaluate the caries burden in patients on RRT. Therefore, a systematic literature search based on the databases PubMed, Web of Science and Scopus was performed by two independent individuals in August 2022. Search terms were: "caries" AND "dialysis", "caries" AND "renal replacement therapy", "caries" AND "kidney". The systematic process was complemented by manual search. Studies on adult patients (age ≥ 18 years), treated by any form of RRT and explicitly reporting caries prevalence or incidence were checked for their eligibility and subsequently analyzed qualitatively. For all included studies, a quality appraisal was applied. From the systematic search, 653 studies were identified, of which 33 clinical investigations were included in the qualitative analysis. The majority (31 studies) of all included patients underwent hemodialysis (HD), with a sample size between 28 and 512 participants. Eleven studies investigated a healthy control group. Oral examinations were heterogeneous across studies; the caries burden was primarily assessed by decayed-(D-T), missing- and filled-teeth index (DMF-T). The number of decayed teeth ranged between 0.7 and 3.87 across studies. Only six out of these 11 studies found significant differences in caries prevalence/incidence between RRT and controls, whereby only four studies confirmed worse caries burden in RRT individuals. No information was provided on caries stadium (initial caries, advanced caries, invasive treatment need), caries activity or location (e.g., root caries) across studies. Most of the included studies were assessed to be of moderate quality. In conclusion, patients on RRT suffer from a high prevalence of dental caries. Alongside a need for further research in the field, improved, multidisciplinary, patient-centered dental care concepts are required to support dental and overall oral health in individuals on RRT.

Patient and family-centered care for children: A concept analysis.

Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. This study aimed to clarify the concept of patient and family-centered care for children. Walker and Avant's concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.

Impact of Optimizing Critical Care Resources in Pediatric Surgery Patients

Background: Prediction scores could help to timely identify patients at risk. More intense care monitoring outside the pediatric intensive care unit (PICU) could improve outcomes. These concepts of critical care without borders could be implemented shortly with local resources and improve patient safety. Predict more, do less in PICUs, and more in the ward. The aim of this work was to evaluate the impact of prediction scores for identification of postoperative high risk surgical patients and their need for pediatric intensive care unit admission.
 Methods: This prospective study was carried out on 40 pediatric patients. The studied patients were divided into three groups. LR Group: 14 cases with ASA = 1, 2 PEWS ≤ 2, pSOFA ≤ 7, LqSOFA < 2. IR Group: 10 cases with PEWS = 3, 4 pSOFA = 8 -11 HiR Group: 16 cases with ASA = 3 -5, PEWS ≥ 5, pSOFA ≥ 12, LqSOFA ≥ 2. American Society of Anaesthesiologists (ASA) scoring was obtained from each patient preop. The Pediatric Early Warning (PEWS) Scoring was obtained from each patient immediately postop. The Pediatric Sequential Organ Failure Assessment (pSOFA) Scoring was obtained from patients admitted to PICU on day 1 and day 7. Liverpool quick Sequential Organ Failure Assessment (LqSOFA) scoring was obtained from all patients on admission.
 Results: Regarding prognostic performance of different scores to predict mortality. For ASA score: it was statistically significant with AUC = .882, cut off values > 3, sensitivity = 75%, specificity = 88.89%, PPV = 42.9% and NPV = 97%. -For PEW score: it was statistically significant with AUC = .892, cut off values > 5, sensitivity = 79%, specificity = 80.56%, PPV =30% and NPV = 96.7%. -For pSOFA score: it was statistically significant with AUC = .931, cut off values > 14, sensitivity = 85%, specificity = 86.11%, PPV =37.5%, and NPV = 96.9%. All ASA, PEW, and pSOFA were statistically significant as univariate but none was significant as multivariate.
 Conclusions: ASA score, pSOFA score and PEWS score were significant predictor to length of stay (>21 days). ASA score, PEW score and pSOFA score were significant as predictor to mortality. ASA score and PEWS score were highly significant as to predict PICU Admission postop. PEWS score was highly significant as to predict PICU Admission postop. ASA, PEWs, and pSOFA were predictors for LOS for more than 21 days, predictors of mortality and predictors for PICU admission Postop. Decreased platelets and increased WBCs, urea, creatinine, AST, and RBG were significant with HiR. LqSOFA is a simple variable bedside tool for identifying septic patients at high risk for poor outcomes.

Concepts of Midwifery Nurse's Quality care of Practice in Normal Delivery at Rajshahi Medical College Hospital

Background: The study aimed to identify and explain the variety of ways midwives managed normal labour and to see if it was possible to identify midwife concepts associated with different stage management practices. At first, the focus was on labor-specific types of midwifery care. The mechanism by which midwives develop expertise in all stage management. Materials and Methods: A qualitative approach was a comparative method utilized to collect and analyze Study was performed. Fifty (N=50) Midwives in Rajshahi Medical College Hospital, Rajshahi, Bangladesh, were interviewed from December 2020 to June 2021. with the practice midwives observed. Results: In this Study, normal labour management is needed together with an evaluation of the role of practice guidelines that attempt to standardize practice. Amount of time midwifery nurses spent with 80% yes and 20% no. they always being a midwifery nurse around if you needed one,80% yes and 20% no. Midwives' conduct delivered 88% yes and 12% no; how nurses listened to your worries and Concerns, 88% yes and 12%no. The midwives told the mother about immunization, 84% yes and 16% no. The number of information midwifery nurses gave to you About your condition and treatment,80% yes and 20% no. Midwifery Nurses' manner will deliver 92% yes, and 8% no. The way midwives explained to you about bear-down effort during the 2nd stage, 88% yes and 12% no. After delivery, the midwives give you uterine massage, 86% yes and 14% no. Decision-making in labor is a complicated process that is influenced by the learning opportunities available to midwives. Conclusion: In this Study, practice variation in all three-stage care was a reflection of the individuality of midwives and the way midwives chose to individualize the care of women. Priority was given to models of midwifery care during childbirth at the outset of this research; in normal labour management is needed, and an evaluation of the role of practice guidelines that attempt to standardize practice.

Care is not a tally sheet: rethinking the field of gender divisions of domestic labour with care-centric conceptual narratives

This article addresses two puzzles that are at the heart of the field of gender divisions of domestic labour. How is it that care concepts seldom appear in a field that is focused on unpaid care work? Why does the field focus on divisions rather than on relationships and relationalities? To address these puzzles, I interrogate some of the conceptual underpinnings in the field’s dominant theories: social exchange and ‘doing gender’. Through a weaving of Margaret Somers’ historical sociology of concept formation and Nancy Fraser’s historical mapping of capitalism, care and social reproduction, I aim to rethink and remake the field of gender divisions of domestic labour through care theories, especially feminist care ethics and care economies research. I argue that care concepts – which highlight relationalities, responsiveness and responsibilities – can radically re-orient how we approach the ‘who’ and ‘what’ questions of this field’s long-standing central focus on ‘who does what?’

Effect of Early Patient Contact on the Empathy of Medical Students in Qom, Iran

Background and Objectives: Empathy is one of the most important concepts in patient care. This study aims to design and implement an early patient contact program and investigate its effect on the empathy of medical students in Qom, Iran. Methods: This is a case-control interventional study. Sixty-four students from Qom University of Medical Sciences were recruited by a convenience sampling method and were randomly divided into intervention and control groups. The instrument was the Jefferson Scale of Empathy. First, empathy training was provided to the both groups. Then, the intervention group participated at three sessions of attending hospital. The collected data were entered into SPSS software, verion 22 and analyzed by chi-square test and paired t-test. Results: There was no significant difference between the two groups before the intervention. After the intervention, the empathy score was 74.04±10.32 in the intervention group and 68.31±8.14 in the control group; the difference between the groups was statistically significant. Conclusion: Early patient contact before the start of the internship period increases the empathy of medical students.

Social studies learning modules to improve concept understanding and attitude of the environmental care

This study aimed to produce a suitable module to improve the understanding of environmental care concepts and attitudes of fourth-grade elementary school students and determine the module’s effectiveness. The data collection instruments consisted of a teacher interview guide, a student preliminary study questionnaire, a media expert validation questionnaire, material and instrument experts, a teacher response questionnaire, a student response questionnaire, and environmental care attitude assessment questionnaire, and a concept understanding ability test. The feasibility assessment uses assessments from media experts, learning material experts, and learning instruments. The practicality assessment of the module consists of a teacher response questionnaire and a student response questionnaire. The data analysis of the module’s effectiveness on the ability to understand the concept and attitude of caring for the environment was analyzed using the t-test and MANOVA test with a significance level of 0.05. The results of the study showed that: i) The module met the eligibility criteria based on the results of assessments from media experts, learning materials experts, and learning instruments that get an assessment in the “very feasible” category to use; ii) The module met the practicality criteria based on the results of the teacher response questionnaire assessment and the student response assessment questionnaire who received an assessment in the “very feasible” category; iii) The module was effective in increasing students’ understanding of concepts and environmental care attitudes. The effectiveness is shown from the t-test and MANOVA test results with a significance level of 0.001.

Understanding of home care and interest level of nursing students working as home care nurses

Introduction: Comprehension materials in the learning curriculum allow students to think critically about nursing care while practicing in-home care. It also can foster an interest in working as a home care nurse but not all nurses students want to be home care nurses as hope. The purpose of this study is to analyze the relationship of understanding about home care with the interest level of nursing students to be home care nurses. Methods: This study is a quantitative correlational method with a cross-sectional approach. Data were examined in the univariate and bivariate analysis with Pearson correlation. Sixty participants were recruited by using a stratified random sampling technique. Results: This study showed that respondents have a good understanding of home care, as many as 51 respondents (85%). Also, most of the respondents are interested in working as a home care nurse, as many as 25 respondents (41.7%). The results obtained a p-value 0.000 (p<0.05) (r=0.633). This study showed that the level of understanding of nursing students is good, and the interest in working students as home care nurses is high. It can be concluded that the understanding of home care influences the work interests of nursing students to work as home care nurses. Conclusion: The theory and concept of home care as one of the working areas of nurses should be delivered to nursing students since they are in the academic stage, and clinical exposure to home care during the nurse profession will enhance them to involve more caring people in the home care setting.

The influence of spirituality at the beginning and at the end of life. Study from the perspective of nursing professionals

Spirituality is the human dimension that helps human beings to reflect about their own existence, to try to answer to questions like: what are we living for? This search of meaning is still more pronounced in those who suffer an advanced and incurable disease. This clear need is nevertheless not always acknowledge by the patient, making it difficult to detect and manage it in the daily care by healthcare professionals. In an effort to establish an effective therapeutic relationship, they have to keep in mind also this spiritual dimension, already integrated in the concept of comprehensive care and usually offered to all patients, especially in those who are at the end of life. With this work we have tried, on the one hand, to know the opinion of nurses and TCAE about spirituality through a self-design survey. On the other hand, we wanted to know how this suffering experience may impact on the professionals, as well as if the development of their own spirituality, differently expressed, may have positive effects on the patients. To this end, healthcare professionals have been selected from an oncology unit, those who day by day are facing the impact of suffering and death of their patients.

Implementation Status of Palliative Care for Patients Died in Peking Union Medical College Hospital,2019

Objective To reveal the current situation of palliative care for patients who died in Peking Union Medical College Hospital,so as to guide the practice of palliative care for patients in terminal stage. Methods A retrospective study was conducted on patients who died in Peking Union Medical College Hospital from January 1,2019 to December 31,2019.The general clinical data of the patients,whether they received palliative care,and the treatment details including invasive rescue measures,symptom controlling,and psychological,social,and spiritual care status before dying were collected for descriptive analysis. Results A total of 244 inpatients died in 2019,including 135 males and 109 females,with an average age of (65.9±16.4) years (1 day to 105 years).Among the 244 patients,112 (45.9%) died of neoplastic diseases and 132 (54.1%) died of non-neoplastic diseases.Sixty-one (25.0%) patients received palliative care before death,and they were mainly distributed in internal medicine departments such as nephrology (100.0%),gastroenterology (80.0%),and geriatrics (72.7%).Twenty-nine patients received sound palliative care,with all symptoms under control and no invasive treatment before death,and twenty-six patients received psychological,social,and spiritual care.Compared with the patients who were not exposed to the concept of palliative care,the patients who received palliative care showed decreased probabilities of cardiopulmonary resuscitation (0 vs 20.2%;χ2=13.009,P<0.001),tracheal intubation (3.3% vs 48.6%;χ2=38.327,P<0.001),and invasive mechanical ventilation (4.9% vs 47.5%;χ2=33.895,P<0.001) and an increased probability of psychological,social,and spiritual care (54.1% vs 2.4%;χ2=91.486,P<0.001). Conclusion The concept of palliative care has a positive impact on the death of end-stage patients.Palliative care services can increase the probability of end-stage patients receiving psychological,social,and spiritual care and reduce the use of invasive treatment.

유보통합에서 돌봄에 대한 학문적 탐구

This study academically explores the recent issue of integrating of caring with early education in terms of epistemological evolution for caring. The integration of early education and caring is significant and urgent issue that impact not only on young children but also many stakeholders in early education. The integrating caring and education have been generally understood as feeding and raring which exclusively focused on physical caring on weak people such as young children. However, this study attempted to deconstruct this concept of physical care and reconstruct that meaning of caring into new epistemological caring. In this study epistemology of caring particularly highlight on the human’s thinking and making judgement about the things with mind of caring about. With academical exploration that review adequate philosophy of caring including feminism and post-humanism, etc. Then this study tried to introduce many cases of children’s epistemological perception of caring in the class which ultimately used to build of evidence to persuade those think caring only of physical care. In conclusion, this study suggests the paradigm shift of integrating care-edu into caring based curriculum which means caring should be the all matters of only education over the limited concept of physical care.

Pregnant Women’s Preferred Birthing Positions In A Tertiary Health Facility In Cross River State, Nigeria

Objective: In recent times, there have been a shift in the focus of health sector towards respectful maternity care. The concept of respectful maternity care is inclined towards client centred care with the right of women to make informed decisions concerning birth choices. The right of a woman to decide which position to adopt during childbirth has been limited the supine position in most maternity service centres and hospital settings. This study sought to investigate pregnant women’s preferred birthing positions in a tertiary health care facility in Calabar, Cross River State, Nigeria&#x0D; Materials and methods This study utilized the descriptive cross-sectional design to recruit 169 pregnant women using the purposive sampling techniques. The instrument for data collection was a structured and validated questionnaire.&#x0D; Results: Finding showed that 89.3% had good knowledge on birthing positions. Also, a good number of participants preferred the squatting position and position change as they deem comfortable during childbirth. Supine positions where the least preferred. Additionally, most participants agreed that level of education, age, previous childbirth familiarities, place of birth and support from midwives were factors that could influenced their choice of birthing positions.&#x0D; Conclusion: Based on these findings, the researchers recommended that midwives update their knowledge on the different birthing positions in order to educate and assist pregnant women who may desire these positions during childbirth. This will encourage the utilization of Skilled Birth Attendants (SBAs) which will help reduce maternal morbidity and mortality that would occur during childbirth on the overall.

Keperawatan Spiritual di Bali

This study aims to determine the description of spiritual nursing in Bali. The research method used is quantitative observational research with a cross-sectional approach. The research results on the fulfillment of spiritual needs by nurses in Bali are primarily in the medium category of 50%. At the same time, 32.5% are in the high class. Only 17.5% are in a common type. The fulfillment of spiritual needs by nurses in Bali is mainly in the medium and high categories. Only a tiny proportion of spiritual realization is in a low type. Caring has been embedded in nursing care, which is a form of implementing the spiritual dimension. In conclusion, the nurse's activity in implementing the concept of caring is an indirect part of spiritual care. A holistic and humanist approach is a strategy that needs to be instilled as part of professional nursing care. The aspect of spirituality is an essential dimension for providing excellent care in the era of disruption.&#x0D; &#x0D; Keywords: Tourism Health, Spiritual Nursing

Item distribution, scalability and internal consistency of the QUALIDEM quality of life assessment for patients with dementia in acute hospital settings

BackgroundQuality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD’s QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not yet demonstrated their feasibility in acute hospitals because their use takes up too much time or their validity depends on observation periods that usually exceed the average length of hospital stays. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed.MethodsData stem from a study that analyzed the impact of a special care concept on the QoL of patients with dementia in acute hospitals. Total sample size consisted of N = 526 patients. Study nurses were trained in using an assessment questionnaire and conducted the data collection from June 2016 to July 2017. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis.ResultsFor people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two (positive self-image, feeling at home) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65–0.91). Only the item social relations had insufficient reliability (ρ = 0.55).ConclusionsIn comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is necessary because the qualification of the nurses and the length of stay of the patients in the hospital differ from the previous investigations of the inter-rater reliability of QUALIDEM in the nursing home.