Rehabilitation Hospital Setting Research Articles

Integrated oral care for patients with spinal cord injuries: perceptions of non-dental professionals

Purpose To understand the oral health attitudes, knowledge, and practices among non-dental professionals caring for patients with spinal cord injuries, as well as the barriers and facilitators to oral care across acute and rehabilitation hospital settings. Materials and Methods This study was a descriptive qualitative study. Nine focus groups with spinal cord injury clinicians from two Sydney hospitals were conducted (n = 35). A thematic analysis was undertaken. Results Four themes were constructed: understanding the impact of spinal cord injuries on oral health and wellbeing; limited support in the spinal cord injury unit to promote oral care; strategies that enable oral care promotion; and recommendations to expand scope in oral care and education. Although most clinicians considered oral health to be important there was a lack of guidelines to support standardised oral care practices. Barriers included lack of time, limited oral care resources, low priority and difficulty in accessing treatment. Staff were receptive to an integrated, multidisciplinary approach to oral care. Conclusion This Australian first study provides insight into spinal cord injury clinicians’ knowledge and practices of oral care. The findings will help guide future research in developing appropriate models of care to promote oral health among patients with spinal cord injuries.

Interdisciplinary team members’ experiences of family meetings in an Irish rehabilitation hospital: a social work action-research project

This study set out to gain a better understanding of how family meetings are facilitated and experienced in an Irish rehabilitation hospital setting from the perspectives of interdisciplinary team (IDT) members, patients and their family members. This article reports the findings from IDT members’ perspectives. A critical-realist action-research approach was utilised that involved medical social workers (N = 15) and a social work academic. A quantitative, descriptive study design was adopted, which utilised a cross-sectional survey of IDT members. A total of 85 clinical staff responded to the questionnaire, of which 69 were fully completed. Four key themes emerged: pre-meeting engagement and preparation – a critical step; the impact of organisational structures; supporting participation; and mechanisms for effective family meetings. Findings indicate the importance of pre-meeting preparation, the mutuality of the relationships between participants, a standardised approach and the use of patient-centred and inclusive practices to achieve truly participatory family meetings. Family meetings involve complex processes in which mutual influence, context, preferences, values, information shared, the nature of the relationships involved and the communicative style of participants all play significant roles in both the process and decision-making outcomes. This study concluded that social workers are perhaps in a unique position to work with IDTs in clarifying the reality of the limits of choice and the involvement of the patient and family in rehabilitation hospital settings. In preparation for the role of family-meeting facilitation, the implementation of education and training programmes for IDT members is strongly recommended.

The prototype of a frailty learning health system: The HARMONY Model.

Rapid translation of research findings into clinical practice through innovation is critical to improve health systems and patient outcomes. Access to efficient systems of learning underpinned with real-time data are the future of healthcare. This type of health system will decrease unwarranted clinical variation, accelerate rapid evidence translation, and improve overall healthcare quality. This paper aims to describe The HARMONY model (acHieving dAta-dRiven quality iMprovement to enhance frailty Outcomes using a learNing health sYstem), a new frailty learning health system model of implementation science and practice improvement. The HARMONY model provides a prototype for clinical quality registry infrastructure and partnership within health care. The HARMONY model was applied to the Western Sydney Clinical Frailty Registry as the prototype exemplar. The model networks longitudinal frailty data into an accessible and useable format for learning. Creating local capability that networks current data infrastructures to translate and improve quality of care in real-time. This prototype provides a model of registry data feedback and quality improvement processes in an inpatient aged care and rehabilitation hospital setting to help reduce clinical variation, enhance research translation capacity, and improve care quality.

Predictive factors for home discharge after femoral fracture surgery: a prospective cohort study.

Femoral fractures require protracted hospitalization and often preclude return to pre-fracture levels of mobility, function and prior residential status following hospital discharge. Early prediction of rehabilitation and discharge potential in patients with femoral fracture would optimize discharge planning. To identify predictive factors of discharge destination during the early phase of femoral fracture rehabilitation. Prospective cohort design. Acute and postoperative rehabilitation hospital settings. Data from 109 participants (65 women [59.6%]) admitted for unilateral femoral fracture were included. Sociodemographic information, hip pain severity during gait (Numeric Pain Rating Scale), mobility (Elderly Mobility Scale), activities of daily living (Modified Barthel Index), cognition (Mini-Mental State Examination [MMSE]), exercise self-efficacy (Self-Efficacy for Exercise Scale), amount of physiotherapy received, and caregiver availability were assessed pre- and/or postoperatively. Discharge destination was assessed via telephone interviews 6 weeks after discharge from acute care. Receiver operating characteristic curves were used to determine optimal cut-off scores for all outcomes based on discharge destination. Outcomes demonstrating a significant area under the curve were entered as dichotomous independent variables (i.e., above or below ROC-derived cut-off values) in subsequent logistic regression analyses to determine predictors of discharge destination. SEE Score ≥53 (odds ratio [OR]=5.975, 95% confidence interval [CI]=1.674-21.333, P=0.006), female sex (OR=3.421, 95% CI=1.187-9.861, P=0.023), ≥8 physiotherapy sessions (OR=4.633, 95% CI=1.559-13.771, P=0.006), MMSE Score ≥17 (OR=3.374, 95% CI=1.047-10.873, P=0.042), and caregiver availability (OR=3.766, 95% CI=1.133-12.520, P=0.030) were identified as significant predictors of home discharge. Exercise self-efficacy, female sex, more physiotherapy rehabilitation training, better pre-operative cognitive function, and caregiver availability emerged as important predictors of home discharge following femoral fracture. These findings are highly translational and may be useful for informing clinical guidelines and policy decisions regarding rehabilitation potential and discharge pathway selection during early hospitalization following femoral fracture surgery.

RE-EXAMINING PATIENT-CENTERED CARE THROUGH DESIGN PROCESS

Abstract Service design is the adoption of design process to healthcare and other service sectors. This was a transdisciplinary research project in which investigators were faculty members from Graphic Design and Health Administration. In addition, two student research assistants were recruited from undergraduate Graphic Design and Health Science majors. The objective of service design is to involve consumers, designers, and businesspeople in an integrative process, which can be applied to post-acute rehabilitation hospital settings focusing specifically on the experience of those who are 65 and older. The aim of this pilot study was to explore “designing with people rather than just for them”, an approach to improve the patient experience. Our first step involved on-site interviews. The patient narratives raised challenges and positive aspects of their interactions with the facility. On our initial site visit, we interviewed five members of clinicians and administrative staff. During the two follow-up visits, our student research assistants interviewed seven patients. Based on our staff member interview findings, we developed a revised set of questions for patients. The questionnaire was divided into three sections related to appointments: pre-arrival, during the visit, and after their appointments. Interview results were summarized in a visual data format and collaborative recommendations were made during the final presentation such as interior layout, wayfinding, online portal and their functionalities. Our findings also confirmed that the interior signage created confusion, promoting frequent questions to staff. These results will engage stakeholders and contribute to a co-designing process that will ultimately improve the patient journey.

315 “I JUST GOT ON WITH IT”: EXPLORING THE PATIENT EXPERIENCE OF STROKE REHABILITATION DURING THE COVID-19 PANDEMIC

Abstract Background There are emerging studies examining the pandemic experiences for older adults and healthcare staff, however the impact of COVID-19 on stroke rehabilitation has yet to be examined. Family involvement and social support is central to adjustment during stroke rehabilitation and this was impacted by the pandemic and its restrictions. The aim of this study was to explore first-person lived experiences of stroke rehabilitation in an Irish rehabilitation hospital setting during the COVID-19 pandemic and understand how COVID-19 restrictions impacted on patients’ experiences of stroke rehabilitation. Methods A qualitative descriptive design was implemented with a purposive sample of stroke survivors, who had undergone stroke rehabilitation between January – December 2021 at an Irish post-acute rehabilitation hospital. Semi-structured interviews were used as the primary data collection method and were audio-recorded and transcribed verbatim. Data were analysed using Braun & Clarke’s (2018) six-step approach and external data validator was used for inter-coder reliability. Results Eight stroke survivors were interviewed (male n=5, female n=3). Four main themes were identified: (i) Resilience and coping, (ii) Feeling supported along the journey, (iii) The pinch of COVID-19, (iv) Adjustment and moving on. The stroke survivors’ resilience was an important recurring theme throughout the analysis. A sense of feeling supported by hospital staff and peers was also prominent. The impact of COVID-19 restrictions was felt by all participants, however, resilience, support from hospital staff and peers were the strongest recurring themes. Conclusion COVID-19 restrictions had an impact on the stroke rehabilitation experience, however, stroke survivors felt well-supported and showed resilience in spite of this. To the best of the researchers’ knowledge, this is the first study which examines first-person accounts of stroke survivors during the COVID-19 pandemic, thus offering a unique perspective on the experiences of this cohort, who were hospitalised during this time.

What Determinants Affect Inpatient Satisfaction in a Post-Acute Care Rehabilitation Hospital?

ObjectiveTo examine how specific hospital service domains (personal issues domain, discharge domain, rehabilitation doctor domain, nursing domain, physical therapist domain, occupational therapist domain, and food domain) influence final patient satisfaction scores, the overall quality of care, and willingness to recommend the hospital to others among patients in an inpatient rehabilitation hospital. DesignLongitudinal study. SettingPatient-level data from electronic medical records were joined with Press Ganey (www.pressganey.com) satisfaction data for a single post-acute care inpatient rehabilitation facility in northeast Florida. ParticipantsPatients who participated in the inpatient rehabilitation survey (N=4,785). InterventionsNot applicable. Main Outcome MeasuresMain outcome measures included final patient satisfaction scores, overall rating of care during the stay, and willingness to recommend the hospital to others. ResultsThis study found the personal issues domain to be the most important factor in determining the final patient satisfaction score, overall rating of care, and likelihood to recommend the hospital to others, followed by the physical therapist, nurse, discharge, and food domains (P<.0001). Within the personal issues domain score, staff promptness and explanation upon arrival were areas identified as opportunities to make improvements that would result in the greatest positive effect. ConclusionsThis work represents novel findings by investigating the major determinants of positive patient experience in a rehabilitation hospital setting. These findings provide actionable information to improve patient experience as well as where to focus improvement efforts using limited resources.

Transition between inpatient rehabilitation and National Disability Insurance Scheme for Traumatic Brain Injury and Spinal Cord Injury.

ObjectiveTo understand the pathway and diverse levels of functional impairment for people with traumatic brain injury (TBI) and spinal cord injury (SCI) as they transition from inpatient rehabilitation (IR) hospital setting to ongoing care and support under the National Disability Insurance Scheme (NDIS) in Australia.&#x0D; ApproachThe Australasian Rehabilitation Outcomes Centre (AROC) has data on almost every inpatient rehabilitation episode of care since 2002, including TBI and SCI. AROC data is de-identified with a statistical linkage key (SLK-581). The NDIS dataset contains identified administrative data on participants of the scheme from which the SLK-581 was derived. Datasets were restricted to TBI and SCI records and the SLK with key dates used to link records together. The linkage was done in multiple passes with different levels of information with each link being validated using secondary information relating to date of injury, date of admission and geographical location.&#x0D; ResultsOver the period 2012-2019, approximately 2,000 records from AROC episodes were linked to an NDIS participant following data validation and individual review of borderline matches We will compare the functional independence of the individual upon leaving rehabilitation with their need for support under the NDIS. Functional independence in rehabilitation is measured by clinicians using the Functional Independence Measure (FIM), a tool that requires clinicians to be trained and credentialed in its use as it is part of the funding model for IR in Australia. Need for support under the NDIS is measured by the funded supports available to a participant under the plan. We expect to demonstrate a correlation between FIM scores and funded supports and identify and analyse any unexpected results.&#x0D; ConclusionThese results will inform resource allocation within the NDIS. This project demonstrates how de-identified research datasets can be linked with administrative datasets to draw new and powerful insights into government service delivery and population health while maintaining privacy. Challenges to accurate linkage can be overcome through iterative and non-deterministic approaches.

Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals

Objective: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. Design: Qualitative study. Setting: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. Participants: Twelve PTs and ten OTs from nine sites across eight provinces participated. Outcome Measures: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. Results: We identified three themes that influenced therapists’ use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists’ decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients’ motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). Conclusions: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

Patient-reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross-sectional survey.

Nutrition and mealtime interventions can improve nutritional intake amongst hospital inpatients; however, patient-reported experience is rarely considered in their development and evaluation. The present study aimed to measure patient-reported food and mealtime experience to evaluate and inform continuous quality improvement of hospital nutrition care. A cross-sectional survey with inpatients in seven acute care and rehabilitation wards was conducted. A 27-item validated questionnaire measured five domains of patient experience: food choices, organisational barriers, feeling hungry, physical barriers to eating and food quality. Responses were summarised descriptively and compared between settings (acute versus rehabilitation), patient demographics (age, gender) and time in hospital. Responses from 143 participants (mean age 67years, 57% male, 28% rehabilitation, median 6days into hospitalisation) showed that 10% or fewer respondents reported difficulties with food choices, feeling hungry or food quality. The most common difficulties were opening packets (36%), insufficient menu information provided (29%), being interrupted by staff when eating (28%), being disturbed when eating (27%), being in an uncomfortable position when eating (24%) and difficulty reaching food (21%). There were no significant differences in domain patterns by sex, age group or time in hospital. Organisational barriers were reported less frequently amongst rehabilitation participants compared to acute care (P=0.01). This survey highlights areas of positive patient-reported experience with nutrition care and suggests that local improvement efforts should focus on physical assistance needs and organisational barriers, especially in acute care wards. The questionnaire may be useful for informing and evaluating systematic nutrition care improvements.

The Experiences of Couples Affected by Stroke and Nurses Managing Patient Rehabilitation: A Descriptive Study in Singapore.

Stroke in a family affects both patients and their spousal caregivers. Despite advances in the medical management of stroke, less is known about the social and cultural factors that impact couples regarding stroke recovery. The purpose of this study was to explore the experiences of stroke from the perspectives of couples affected by stroke and the nurses managing patient rehabilitation. An interpretive descriptive study was conducted. Purposive sampling was used to enroll 17 participants, comprising eight nurses, five spousal caregivers, and four stroke survivors. Individual, in-depth interviews were performed at a rehabilitation hospital in Singapore in June 2018. The primary theme was the diverse meanings of stroke recovery attributed to limited conversations about the care decisions made by couples and rehabilitation nurses. The second theme was the challenges in nursing responsibilities that hindered the recovery of patients with stroke. The meaning of recovery differs between patients and their informal and formal care providers. This issue should be explored in patient-provider conversations, as these conversations highlight the values and preferences that affect the stroke recovery trajectory. Enhancing shared decision making by patients, spousal caregivers, and healthcare providers during the stroke trajectory may promote the alignment of values that are critical to the stroke recovery experience. Further research into whether and how to incorporate shared decision making in rehabilitation hospital settings as an interventional component is warranted to better support stroke survivors before discharge.

Informal Caregivers’ Well-Being at the Transition to Caregiving

The aim of this study was to describe the psychological and physical health needs of informal caregivers in a rehabilitation hospital and explore differences related to informal caregiver and care recipient characteristics. Readiness to engage in health promotion and perspectives on mindfulness meditation were assessed. Informal caregivers ( N = 33) to patients receiving inpatient or outpatient treatment completed the Multidimensional Health Profile screening tools. Readiness to change was assessed using the readiness ruler approach. Almost half of participants (45.5%) had a chronic illness and 18.2% reported that it interferes with daily functioning. Low Positive Health Habits were reported by 43% of participants, and Negative Health Habits were reported by 25%. A subgroup (15%–20%) reported both physical and mental health concerns. A majority of participants indicated it was both very important for them to improve their physical and mental health and felt very confident they could do so. Receptivity to mindfulness meditation was high, with 72.7% reporting an interest. Comprehensive screening and counseling interventions to address the physical and mental health of informal caregivers in physical rehabilitation hospital settings are needed, and information gained from screening could be addressed in interventions delivered by systems-oriented rehabilitation counselors. A mindfulness meditation intervention may be a useful strategy for promoting well-being in this population.

Healthy Days at home: A novel population-based outcome measure

BackgroundHealthy Days at Home (HDAH) is a novel population-based outcome measure developed in conjunction with the Medicare Payment Advisory Commission. MethodsWe identified beneficiary age, sex, race, and Medicaid eligibility, death date, chronic conditions and healthcare utilization among a 20% sample of Medicare beneficiaries in 2016. For each beneficiary we calculated HDAH for the year by subtracting the following measure components from 365 days: mortality days, the total number of days spent in inpatient, observation, skilled nursing facilities (SNF), inpatient psychiatry, inpatient rehabilitation and long-term hospital settings as well as the number of outpatient emergency department and home health visits. We examined how HDAH and its components varied by beneficiary demographic characteristics and chronic condition burden as well as by healthcare market (Hospital Referral Region). We specified a patient-level linear regression adjustment model with HDAH as the outcome and incorporated market fixed effects as well as beneficiary age, sex, and Chronic Conditions Warehouse categories as covariates. We examined the impact of including home health visits in the measure, as well as the association between market demographics and health system characteristics and mean market HDAH. We examined how HDAH changed from 2013 to 2016. ResultsThe 6,637,568 beneficiaries age 65 and older in our sample had a mean of 347.2 HDAH, those 80 and older had a mean of 325.3 while those with three or more chronic conditions had a mean of 333.7. The components that led to the largest reduction in HDAH were mortality (7.4 days), home health (2.7 visits), SNF utilization (2.4 days) and inpatient care (1.5 days). The worst performing market had 5.8 fewer adjusted HDAH on average compared to the national mean, while beneficiaries in the best-performing market had 5.0 more HDAH on average compared to the national mean, among all beneficiaries age 65 and older. ConclusionsHDAH is a population-based quality measure with substantial market-level variation. ImplicationsHDAH recognizes the multidimensional nature of healthcare and may afford providers greater flexibility to tailor quality-improvement initiatives to the unique needs of their patients. Level of evidenceLevel II.

Differences of Relative and Absolute Strength of Individuals With Spinal Cord Injury From Able-Bodied Subjects: A Discriminant Analysis

Strength training is one of the most common interventions employed to increase functional independence during rehabilitation of individuals with spinal cord injury (SCI). However, in the literature, different results have been reported in terms of strength modifications after a SCI compared with a control group (CG). This study aimed to verify whether discriminant analysis using relative and absolute strength is able to discriminate individuals with different levels of SCI from a CG and to compare strength values of men with different levels of SCI with a CG. Cross-sectional study. Rehabilitation hospital setting. A total of 36 individuals with SCI stratified in tetraplegia (TP; C6-C8), high paraplegia (HP; T1-T6), and low paraplegia (LP; T7-L2), and 12 matched control subjects were enrolled in the study. The subjects performed a maximum strength test of elbow extension/flexion and also shoulder abduction/adduction and flexion/extension in an isokinetic dynamometer. Discriminant analysis was carried out to identify which strength variables would be able to discriminate the TP, HP, or LP groups from the CG. A 1-way analysis of variance was performed to compare peak torque and agonist/antagonist ratio means. Shoulder adduction, followed by elbow extension peak torque, was the best variable for discriminating the TP group from the CG (function coefficients: -0.056 and 0.051, respectively, Wilks Λ = 0.41, P ≤ .05). There were no significant differences between the HP group, LP group, and CG. The strength similarity of the paraplegic groups and the CG should not be extrapolated for activities of daily living or sports. The TP group demonstrated lower peak torque for all movements than the CG.

Poster 219: Twelve Knee Extensor Tendon Ruptures Treated in an Acute Rehabilitation Hospital Setting: A Case Series

PM&RVolume 10, Issue 9S1 p. S73-S73 Poster 219: Twelve Knee Extensor Tendon Ruptures Treated in an Acute Rehabilitation Hospital Setting: A Case Series William A. Berrigan MD, William A. Berrigan MD Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington DC, United StatesSearch for more papers by this authorRoderick Geer MD, Roderick Geer MDSearch for more papers by this authorRobert D. Bunning MD FACP FACR, Robert D. Bunning MD FACP FACRSearch for more papers by this author William A. Berrigan MD, William A. Berrigan MD Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington DC, United StatesSearch for more papers by this authorRoderick Geer MD, Roderick Geer MDSearch for more papers by this authorRobert D. Bunning MD FACP FACR, Robert D. Bunning MD FACP FACRSearch for more papers by this author First published: 26 September 2018 https://doi.org/10.1016/j.pmrj.2018.08.231Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume10, Issue9S12018 AAPM&R Annual Assembly AbstractsSeptember 2018Pages S73-S73 RelatedInformation

Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study.

Prospective cohort study using the Rick Hansen SCI Registry (RHSCIR) and retrospective medical chart review. To describe treatment patterns of in-patient anti-spasticity medication use following traumatic spinal cord injury (SCI) in acute and rehabilitation hospital settings in British Columbia, Canada. Quaternary trauma center, rehabilitation center. Individuals with traumatic SCI between 2005 and 2014 enrolled in the Vancouver RHSCIR site (N = 917) were eligible for inclusion. Oral and injectable anti-spasticity medication use were the main outcome measures. In 769 participants, higher neurological level and injury severity were associated with in-patient anti-spasticity medication use (p < 0.001 for both). Of individuals with cervical and thoracic injuries (n = 589), 37% were prescribed anti-spasticity medication during hospital admission. Baclofen was the most commonly used first line oral therapy. Mean (SD) and median time from injury to Baclofen initiation was 70 (69) and 50 days, respectively. The probability of having initiated an in-patient anti-spasticity medication was 55% (95% CI (49, 60)) for individuals 6 months post-injury, and 71% (95% CI (62, 79)) for individuals 12 months post-injury. At community discharge, the prevalence of oral and injectable anti-spasticity medication use was 26 and 5%. Practice patterns of anti-spasticity medication use (2005-2009 vs. 2010-2014) have not changed significantly over time. This is the first large prospective cohort study of in-patient anti-spasticity medication use following traumatic SCI. Results from our study inform clinicians and individuals of "real world" anti-spasticity medication use among individuals with traumatic SCI and may help guide care for this population in the community.

The ‘unworthy’ patient with dementia in geriatric rehabilitation hospitals

BackgroundThe number of people presenting to hospital with dementia is escalating worldwide. Hospitals are inadequately prepared leading to a poor patient experience. AimTo explore the perspectives of nurses caring for people with dementia to critically evaluate the reasons behind the widely reported poor care received by such patients. The study examined what was privileged in the care of patients with dementia in geriatric rehabilitation facilities. MethodThe study used critical ethnography. Data were obtained from interviews with 29 nurses working with patients with dementia in geriatric rehabilitation hospitals. The interviews were audio-recorded and transcribed verbatim. FindingsThe theme of the ‘unworthy’ patient was supported by sub-themes of people with dementia and hospital performance targets, risk, nurse workload and acute care issues. DiscussionHospitals have increasing pressure to conform to tight budgets and must justify all expenditure, increase patient throughput and minimise risk. Patients with dementia can have a longer hospital stay complicated by frailty, complications and social problems. The focus on rapid discharge influences the mind-set of nurses and nurse habitus. Patients with multiple chronic co-morbidities are unpopular and considered low priority and less worthy of resources. Privileging care for certain patients and tasks is supported by organisational cultural beliefs. Nurses require support to maintain empathetic caring practices in the face of managerial priorities. ConclusionThe research found that patients with dementia were considered unworthy in the geriatric rehabilitation hospital setting. The difficulties caring for patients with dementia are considerable. Nurses need education and support to improve practice.

Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting.

Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients.

Initial Response to Prism Treatment in an Inpatient Rehabilitation Hospital Setting: Preliminary Results

Initial Response to Prism Treatment in an Inpatient Rehabilitation Hospital Setting: Preliminary Results

Nursing students' experiences of professional patient care encounters in a hospital unit: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students. The range of participants includes all nursing students independently of the level of their clinical period. There will be no limitations regarding the age, gender or ethnicity of participants. Types of phenomena of interest This review will consider studies that investigate nursing students' learning experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing interventions in nurse-patient relations, e.g. bed bath, an admission interview, administration of medicine or a meeting with a terminally ill patient, will also be included. Types of contexts This review will consider studies that investigate the clinical education in any area within a hospital. Studies that consider acute intensive, chronic long-term, rehabilitation or palliative care hospital settings will be included.