Care Settings Research Articles

Setting up activity groups for individuals living in a care setting

Adrian Ashurst discusses the benefits of setting up various discussion and activity groups for individuals living in a care setting.

Hope and dementia.

Dementia is a terminal and progressive condition which often brings with it a loss of hope, and feelings of hopelessness in those living with the condition and their family carers. Community nurses are in a unique position of being able to interact with people with dementia and their family carers in their own homes, or the care settings in which they reside, and in some case, will be the only professionals with regular contact with the family. Therefore, they have the opportunity to increase feelings of hope in those they work with. This article will discuss the concept of hope as it relates to dementia. It goes on to give an overview of Snyder's model of hope, which presents hope as a cognitive state, and therefore presents the opportunity for professionals to increase feelings of hope. An overview of the research evidence around hope-based interventions is then given, with the ideas applied to community nursing practice using a case study. This article aims to add some hope-based interventions to the toolkit of community nurses as they work with people and families affected by dementia.

Improving patient outcomes while reducing readmissions with data analytics

As post-acute care spend continues to rise and the Centers for Medicare and Medicaid Services (CMS) moves forward with promoting both value-based and risk-bearing models of care, it is essential for accountable care organisations (ACOs), payers and hospital providers to take proactive measures to find innovative and data-driven strategies to meet the future demands of healthcare. Yet disparate electronic health record (EHR) systems between acute and post-acute providers continue to pose challenges in the ability to access live patient data across care settings, which enables clinical line of sight to manage both patient and population-level quality outcomes. Utilisation of an EHR-agnostic platform, which mitigates interoperability issues, can improve care transitions, provide data analytics to manage the patient care journey, foster seamless implementation of standardised care pathways and ultimately reduce total costs within post-acute networks by decreasing readmissions and length of stay. St. Joseph’s Health implemented such a data analytics platform and instituted a post-acute nurse navigator, social worker and care manager roles to manage their value-based patients in the postacute setting. As a result, their Medicare Shared Savings Plan ACO, Mission Health Coordinated Care, achieved a significant reduction in readmissions from 24 per cent to 17.8 per cent, as well as a total cost of care savings of US$1.6m in its first year. Currently, the readmission rate is down to 13.6 per cent, and there has also been a 3.2-day reduction in average length of stay. Owing to their successful post-acute strategy and programming, the project was scaled to include all patients in value-based contracts.

Decomposition of medical imaging spending growth between 2010 and 2021 in the US employer-insured population.

Medical imaging, identified as a potential driver of unsustainable US health care spending growth, was subject to policies to reduce prices and use in low-value settings. Meanwhile, the Affordable Care Act increased access to preventive services-many involving imaging-for employer-sponsored insurance (ESI) beneficiaries. We used a large insurance claims database to examine imaging spending trends in the ESI population between 2010 and 2021-a period of considerable policy and benefits changes. Nominal spending on imaging increased 35.9% between 2010 and 2021, but as a share of total health care spending fell from 10.5% to 8.9%. The 22.5% growth of nominal imaging prices was below inflation, 24.3%, as measured by the Consumer Price Index. Other key contributors to imaging spending growth were increased use (7.4 percentage points [pp]), shifts toward advanced modalities (4.0 pp), and demographic changes (3.5 pp). Shifts in care settings and provider network participation resulted in 2.5-pp and 0.3-pp imaging spending decreases, respectively. In sum, imaging spending decreased as a share of all health care spending and relative to inflation, as intended by concurrent cost-containment policies.

‘She has saved my life on many occasions’: Care-experienced young women’s reflections on the significance of pets and the impact of loss

This article highlights the significance of pets for five young women with care experience, examining the impact of disruptions to those relationships when moving into or between care settings. Findings show that pets support the transition to independent living and mental health. Participants’ reflections also reveal how pets are a source of comfort and stability for children growing up in families experiencing difficult circumstances. Loss is therefore traumatic because of the support pets provided and the context surrounding loss. Despite their significance, pets were largely absent from discussions and processes associated with managing care transitions. Adults and perceived constraints in residential care dictated what happened with respect to pets. Neither consulted nor supported, children were left to cope on their own. Attention to pets should be an integral part of the process of managing care transitions and it is imperative that the impact of pet loss (at any stage in children’s lives) is understood and supported. Otherwise, the system may inadvertently foster a perpetual loop of mistrust and relational losses. We consider how some local authorities are starting to manage this process (considering pets in the family or foster carers’ homes), and existing guidance on introducing animals in residential care.

Society for Maternal-Fetal Medicine Statement: RhD immune globulin after spontaneous or induced abortion at less than 12 weeks of gestation

Guidelines for management of first-trimester spontaneous and induced abortion vary regarding RhD testing and Rho(D) immune globulin administration. These existing guidelines are based on limited data that do not convincingly demonstrate the safety of withholding Rho(D) immune globulin for first-trimester abortions or pregnancy losses. Given the adverse fetal and neonatal outcomes associated with RhD alloimmunization, prevention of maternal sensitization is essential in RhD negative patients who may experience subsequent pregnancies. In care settings where RhD testing and Rho(D) immune globulin administration are logistically and financially feasible and do not hinder access to abortion care, we recommend both RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation in unsensitized, RhD-negative individuals.

Utilization of the Intimacy and Sexuality Expression Preference tool in long-term care: a case study.

Sexual wellness plays a crucial role in an individual's quality of life, interpersonal relationships, and self-concept, particularly among older adults residing in residential aged care facilities, including those with dementia. However, there is currently a limited person-centered approach to understanding the unique preferences of each older person regarding their intimate and sexual behaviors. To address this gap, the Intimacy and Sexuality Expression Preference (ISEP) tool was developed to facilitate meaningful discussions between healthcare professionals or workers and older individuals about their intimacy and sexuality needs and preferences. This paper explores the use of the ISEP tool with residents in long-term aged care, including those with dementia via a user-centric case study. ISEP tool interviews were conducted with 14 residents in a single residential aged care facility in Queensland, Australia. The study presented valuable insights and contextual information from using the ISEP tool, including an example of a resident's response, which provided recommendations for better supporting the resident. This involves engaging in supportive conversations to facilitate the exploration, implementation, and assessment of practical and actionable strategies to meet intimacy and sexuality needs and preferences. The ISEP tool shows promise in improving care practices and addressing the intimacy and sexuality needs of older individuals in aged care facilities. However, it is important to acknowledge that the study was conducted in a single aged care facility with a small group of residents, potentially limiting the generalisability of the findings. Further large-scale studies are necessary to establish the tool's broader applicability across different care settings.

PRECIOUS demonstrated satisfactory measurement properties for assessing the quality of care for children with serious illnesses

ObjectivesTo determine the measurement properties of PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS), a parent-reported measure of Quality of Care for seriously ill children across care settings and illness trajectories. Study Design and SettingParents self-administered baseline and 2-week follow-up surveys online. Exploratory Factor Analysis was used to determine PRECIOUS’s factor structure and select items. Internal consistency was evaluated with Cronbach’s α, test-retest reliability with intraclass correlation coefficients, and convergent validity with Spearman’s correlations between PRECIOUS scales and subscales of Measure of Processes of Care and Quality of Children’s Palliative Care Instrument. ResultsOf 152 parents [108 (71%) mothers, 44 (29%) fathers] who completed the baseline survey, 123 (81%) completed follow-up. Exploratory Factor Analysis grouped PRECIOUS into five scales: collaborative and goal-concordant care (12 items), caregiver support and respectful care (15 items), access to financial and medical resources (five items), reducing caregiving stressors (nine items), and hospitalization-specific processes (four items). Root Mean Square Error of Approximation was 0.040 and Comparative Fit Index was 0.980. Cronbach’s α ranged from 0.85 to 0.96. Intraclass correlation coefficients ranged from 0.72 to 0.86. Significant correlations with Measure of Processes of Care and Quality of Children’s Palliative Care Instrument confirmed convergent validity. The original 56-item tool was reduced to 45 items. ConclusionPRECIOUS demonstrates satisfactory measurement properties for assessing Quality of Care for seriously ill children.

Executive summary of the consensus document on the shared care of patients with HIV infection between Primary and Hospital Care

The current reality of the diagnosis and treatment of HIV infection justifies a coordinated, multidisciplinary approach between primary care and hospital care. This entails a two-way relationship and communication between the two care settings. This consensus document, coordinated by the AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC-GeSIDA) and the Spanish Society of Family and Community Medicine (semFYC), arose because of this need. This document summarizes the recommendations of the four blocks that comprise it: the first tackles aspects concerning the prevention and diagnosis of HIV infection; the second addresses the clinical care and management of people living with HIV; the third deals with social aspects, including legal and confidentiality issues, quality of life, and the role of NGOs; finally, the fourth addresses two-way and shared training/teaching and research. Keywords: HIV, Primary Care, Hospital Care, Shared Care.

Socioeconomic factors influence surgical wait times for non-emergent gynecologic surgical procedures: a retrospective analysis

BackgroundIn various disciplines, an association between surgical wait times and patient outcomes has been identified. This study is among the first to investigate whether practice setting influences wait times for elective surgeries in benign gynecology.MethodsThis retrospective study of patients at three New York hospitals from 10/2019–2/2020 compared surgical wait times among patients seen in federally-qualified health centers (FQHC’s) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of the procedure. A multivariable mixed model was used to model surgical wait time by setting of care, adjusting for age, BMI, race, ethnicity, insurance, need for medical clearance, and scheduled block time. A univariable analysis was then utilized to assess surgical wait times by clinical setting for each insurance type.ResultsFive hundred forty patients were identified with a median age of 45.6 years (range 16–87). Average surgical wait time was 27 days (range 1–288 days). In multivariable analysis, longer surgical wait times were associated with being seen preoperatively in a FQHC compared to the private practice setting (102% longer, 59.5 days vs. 22 days, p < 0.0001), and with needing medical clearance (56.4% longer, 45 days vs. 22 days. p = 0.0001).ConclusionsThese results suggest that in benign gynecology, surgical wait times are significantly influenced by the practice setting in which a patient gets care, with notable delays in care among patients who are seen in a federally qualified health center preoperatively.

Prevalence of Adverse Childhood Experiences in Adolescents with Special Educational and Care Needs in the Netherlands: A Case-File Study of Three Special Educational and Care Settings

To date, Adverse Childhood Experiences (ACEs) in adolescents with special educational and care needs have received little attention as an important risk factor for their behavioral, emotional, and learning problems. This study provides insight into ACE prevalence and family risk factors in three Dutch special educational and care settings for vulnerable school-aged youth. 268 adolescents (10–18 years old) with severe and persistent problems at individual and family level, from a special educational setting (setting 1; n = 59), a residential care setting (setting 2; n = 86) and an alternative educational setting (setting 3; n = 123) were included. A retrospective cross-sectional study design was used. Data were collected between 2016 and 2019 through structured case-file analysis. A substantial proportion of the adolescents in all settings experienced at least one ACE, with 69.5% in setting 1, 84.9% in setting 2 and 95.1% in setting 3. Family risk factors were relatively common, among which a limited social network in all settings (20–50%) and debts in setting 2 and 3 (25–40%). The substantial ACE prevalence underlines the need for early ACE awareness. Trauma-informed care and education are needed to adequately understand trauma-related behaviors, prevent retraumatization, and enhance learning and healthy development. Given that ACEs regarding household dysfunction and family risk factors seem to be common in adolescents with special educational and care needs, family centered approaches should be implemented as well in the interest of lifelong health and well-being for both adolescents and their families.

Nurses’ Caring Behavior, Parental Anxiety and Satisfaction in Pediatric Inpatient War

Caring behavior should consistently be applied by nurses in all care settings, including pediatric inpatient wards.Children undergoing hospitalization will experience traumatic and highly stressful events, this condition can lead to anxiety in parents. Caring can reduce anxiety for both the child and parents. Furthermore, if nurses implement caring optimally, patients will feel satisfied, leading to an improvement in the quality of nursing services. This research aims to identify the relationship between nurses' caring behavior and parental satisfaction and anxiety in pediatric inpatient wards. The research design utilizes descriptive correlational with a cross-sectional approach involving 97 parents sampled through quota sampling. The instrument for measuring caring behavior uses the Caring Assessment Tools (CAT), a satisfaction questionnaire containing five SERVQUAL dimensions, and a parental anxiety questionnaire using the Zung Self-Rating Anxiety Scale. Sprearman rank was used as data analysis. The research results indicate that almost all respondents (90.7%) do not feel anxious, the majority of respondents (75.3%) are highly satisfied with the service, and most of respondentds (62.9%) assess nurses' caring behavior as adequate. Spearman-ranks test results show a significant relationship between anxiety and satisfaction with nurses' caring behavior (p=0.036 &amp; p=0.001). These findings suggest that the better the nurses' caring behavior, the lower the level of parental anxiety, and the higher the patient satisfaction in the pediatric inpatient ward. Nurses need to undergo training and develop caring attitudes and behaviors in delivering nursing services.

Professional Learning Supporting Multilingual Children’s Social and Emotional Development in Diverse Australian Early Childhood Education and Care Settings

AbstractThis research examined the conditions under which codesigned approaches to educator professional learning in multilingual, birth to five settings were accessible and supportive of children’s social and emotional development across diverse types of Australian early childhood services. The research sites, in the suburbs of a capital city, comprised a long day childcare center, two short term informal community creches for birth to 5-year-old children of migrants and refugees attending English classes, and a family hub short term informal community creche for children of Afghan refugees. Professional learning mentors visited the participating sites eight times for 2 h every 2 weeks for 16 Weeks in 2021, demonstrating resources and strategies to assist young children to identify their own and others’ emotions and engage with social settings. Over 20 weeks, 97 participants provided data, commencing before and extending after the professional learning program. Participants included professional learning mentors, staff and volunteers, parents, and children via observation. Using Reggio Emilia principles, the research identified that professional learning, flexibly delivered over time, enabled educators and volunteers to build their social and emotional development knowledge, and to try resources and strategies with children in their care. Recruiting educators who shared children’s home or community languages, in addition to professional learning, supported multilingual children to engage with emotional literacy resources, while still developing spoken English. The research affirmed that educators, volunteers, parents, and children benefitted from a sustained focus on children’s social and emotional development in the early childhood education and care settings.

Sleep quality assessment of adults in care settings using non-wearable sleep trackers: Scoping review.

This review aimed to explore and map the literature on sleep quality assessments of adults in care settings using non-wearable sleep trackers. Sleep-monitoring technology is advancing, and sleep quality assessments using non-wearable sleep trackers can provide objective evidence for quality care. This was a scoping review. Four electronic databases (PubMed, CINAHL, PsycInfo and Embase) were searched on 23 September 2022. This review followed the Joanna Briggs Institute's methodology and used the PRISMA-ScR checklist. Thirty studies met our inclusion criteria. Sleep quality was assessed at home and in acute, non-acute and long-term care facilities. Physiological (heart rate and respiratory rate) and sleep parameters were assessed alone or in combination during patient care using non-wearable sleep trackers. Sleep parameters representing sleep quality varied across studies. Real-time monitoring with non-wearable sleep-tracking devices effectively shortened the length of hospital stay. However, studies investigating caregivers and nursing outcomes are lacking in the literature. Sleep quality assessments using non-wearable sleep trackers may facilitate the provision of quality care in home-based and clinical care settings. Future studies should focus on caregivers and care outcomes that could contribute to evidence-based nursing practice for sleep care in adults.

Elements of care, part 2: maintaining a safe environment

Maintaining a safe environment is one of the 12 activities of living identified in the Roper-Logan-Tierney model (2000) . Maintaining a safe environment is a basic survival skill, which involves managing our own safety and adapting our physical and intellectual abilities to manage risk. This article focuses on the activity of maintaining a safe environment in health and illness for the duration of a person's lifespan. The person's dependence and independence in the activity are discussed, along with factors influencing the activity. Understanding hazards in the care setting and how to promote patient safety effectively are key attributes of a safe and effective care provision.

Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments.

Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.

Abstract WP85: Evaluating the Strengths and Limitations to Patient-Reported Modified Rankin Scale Studies: A Systematic Review

Background: Studies evaluating patient-reported modified Rankin scales (mRS) in patients with stroke in different cultural and language settings have not been aggregated to determine validity of these adapted assessments. Objectives: To systematically review all patient-reported mRS studies performed outside of the United States (US). Methods: We searched PubMed and Web of Science for non-US based studies that evaluated patient-reported mRS against in-person clinician mRS among patients with stroke. Studies were analyzed for country of investigation, mRS self-assessment modality, care setting (inpatient vs outpatient), study limitations, and concordance between patient-reported and in-person mRS scores. Results: We identified 13 patient-reported mRS evaluation studies across all continents except Africa. The most common self-reported mRS assessment was the telephone mRS questionnaire. Average time between in-person and self-reported mRS assessments was ~14 days. The weighted kappa agreement between patient-reported and in-person mRS scores ranged from moderate to very good (K w range: 0.56 to 0.90), though unweighted kappa scores were significantly lower (K range: 0.27 to 0.68). Discrepancies between patient-reported and clinician-evaluated mRS scores tended to result from patients at the scale extremes. Patients with good mRS outcomes (mRS &lt; 2) tended to rate themselves better than their clinicians while those with poor outcomes (mRS &gt; 3) tended to rate themselves worse than their clinicians did. Major limitations across studies included sampling bias in the in-patient setting, time delays between in-person and self-reported mRS assessments, and differences in the structure of the clinician-led vs patient-reported mRS assessments. Conclusion: While patient-reported mRS validation studies to date have generally displayed good agreement with clinician-reported outcomes, significant scoring discrepancies exist for patients with very poor and very good outcomes. Future studies should consider limiting time between mRS assessments and understanding reasons for differences in patient and clinician assessments. Further, data on validity of self-report mRS tools are lacking from much of the world, especially Africa.

Experiences with neonatal jaundice management in hospitals and the community: interviews with Australian health professionals

IntroductionWorldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong...

Prevention of oral diseases for the older person (Part 2).

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Social needs screening in primary care: A tool in the fight for health equity?

Progress on addressing health inequalities is slow and in many places around the world the gap between the privileged and the disadvantaged is widening. This is driven largely by an unfair and unequal distribution of the social determinants of health. While upstream policy and agenda commitment is needed to improve social determinants of health at a population level, healthcare also has a role. Currently social information is sporadically collected and used in healthcare. Improving our understanding of social problems is crucial in targeting services and to reduce the overreliance on area-level measures of deprivation. This has the potential to improve patient care as well as more accurately capture socio-economic disadvantage. Here we argue that there is a role for primary care in screening for social needs to help address inequalities.Social needs screening, more commonly used in North America than Europe, aims to systematically collect social information in health and care settings. Healthcare professionals ask patients about social issues including employment, finances, housing, education and social isolation and this information is used to prompt referral to community services to address any need identified.Social needs screening has potential to address negative impacts of social determinants of health at an individual and population level. Providing a reliable measure of social need, screening gives healthcare professionals an opportunity to tailor and improve quality of care for patients and offer individualised support. It has been shown to improve individual social and health outcomes and positively impact healthcare utilisation. At a population level, social needs screening can improve the data on social determinants of health and therefore support policy makers and service delivery leaders to target resources and services more effectively to the communities most in need. Implementing social needs screening must take account of local healthcare service capacity and available community resources but where sustainable, effective programmes can be introduced, the potential benefits are manifold.While primary care alone cannot solve the root causes of health inequalities, we argue it could be a powerful actor in the fight for health equity.