Hughes S, Woods B, Algar-Skaife K
… +1 more, Hedd Jones C
Nurs Older People
· 2019 Mar · PMID 31468780
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AIM: To investigate the quality of life (QoL) and well-being of people living with advanced dementia in care homes. METHOD: A mixed-methods approach was taken combining participant observations, interviews with the parti...AIM: To investigate the quality of life (QoL) and well-being of people living with advanced dementia in care homes. METHOD: A mixed-methods approach was taken combining participant observations, interviews with the participants' families and carers, and quantitative measurements. The quantitative measures included AwareCare assessments, QoL in Late-Stage Dementia scale ratings and semi-structured interviews with relatives and staff members. Ryff's psychological well-being framework, the Fairness, Respect, Equality, Identity, Dignity, Autonomy principles, and Kitwood's indicators of well-being, were examined to attempt to identify contributors to QoL for people living with advanced dementia. RESULTS: Participants had limited verbal abilities, but used non-vocal behaviours to communicate. These behaviours influenced their QoL and well-being. CONCLUSION: The indicators of well-being in Kitwood's personhood model were helpful in describing how relatives and staff perceived the QoL of the person with dementia.
Nurs Older People
· 2019 May · PMID 31468756
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Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that ol...Effective communication with older people is an important aspect of nursing practice. Ineffective communication can lead to older people feeling inadequate, disempowered and helpless. Nurses have a duty to ensure that older people think they are being listened to and that their concerns are being validated in a non-judgemental way. Central to effective communication is the ability of nurses to be self-aware, and monitor their thoughts and feelings about, for example, negative stereotypes associated with the ageing process. Effective communication can sometimes be difficult to achieve due to the effects of ageing, but nurses can overcome some barriers through thoughtful interventions. It is important to treat older people as individuals, and to monitor and adapt communication accordingly. By doing so, nurses can ensure older people feel empowered, respected and able to maintain their independence.
Nurs Older People
· 2018 Nov · PMID 30426731
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Delirium is a common neuropsychiatric disorder that all those working with older people will have encountered at some stage. Delirium is often poorly identified in hospital settings and therefore not optimally managed. A...Delirium is a common neuropsychiatric disorder that all those working with older people will have encountered at some stage. Delirium is often poorly identified in hospital settings and therefore not optimally managed. After data collection on the acute medical unit in an acute hospital trust in the UK it was evident that patients with signs of delirium were not being formally assessed and therefore not appropriately managed in many cases. A quality improvement project introduced the 4AT delirium assessment tool to try to ensure that patients with delirium were being identified. The project team carried out several plan-do-studyact cycles to bring about our changes, which included a 4AT assessment sticker for nursing staff to complete and teaching for all healthcare staff. Through involvement of all members of the multidisciplinary team and ongoing feedback and changes we were able to increase assessment of delirium from 0% to 64%. There is ongoing work to be done to continue to improve delirium management, but by initially improving the assessment and identification of delirium we will make a difference to these patients' outcomes.
Nurs Older People
· 2018 Nov · PMID 30398318
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The authors took part in a national research project that evaluated an intervention to enhance person-centred care for people with dementia in hospital. The Person, Interactions, Environment (PIE) programme involves staf...The authors took part in a national research project that evaluated an intervention to enhance person-centred care for people with dementia in hospital. The Person, Interactions, Environment (PIE) programme involves staff observing care on a ward, focusing on these three areas. Findings from observations form the basis for introducing changes to ward practices. Implementing PIE led to improvements in practice but proved challenging in the context of the NHS. Sustaining the programme after the research required important features to be in place, in particular the presence of a 'driver' to maintain momentum, the support of the ward manager to encourage ward staff to take part and a degree of flexibility and persistence in the implementation of the programme. Staff expressed satisfaction from taking part in PIE, which continues to be used to improve care in this area of practice.
Nurs Older People
· 2018 Nov · PMID 30375801
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Skin changes associated with age are inevitable. Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The most common functional skin changes are dryness (xerosi...Skin changes associated with age are inevitable. Ageing is associated with structural and functional changes of the skin that result in increased vulnerability. The most common functional skin changes are dryness (xerosis), which causes itching and discomfort, and skin fragility, increasing patients' vulnerability to skin damage. Dry skin and itching have a significant effect on older people, which can be further exacerbated by products used for washing and bathing. The management of dry skin and itching is fundamental to older people's care and nurses should act in their best interests to ensure that the potential for skin damage is addressed. However, many older people are often reluctant to discuss the problem, are embarrassed and will self-treat or try to hide an underlying problem such as incontinence or worries about being infectious or dirty. This can be challenging when managing their skin care because of under-reporting, self-medicating or the assumption that it is 'just old age'.
Nurs Older People
· 2018 Nov · PMID 30358335
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This article explores the development of an ambulatory community service that demonstrates multidisciplinary working to meet the diverse needs of frail older people and their carers. The service comprises advanced nurse...This article explores the development of an ambulatory community service that demonstrates multidisciplinary working to meet the diverse needs of frail older people and their carers. The service comprises advanced nurse practitioners, a pharmacist, a community navigator, consultants, occupational therapists, physiotherapists, a nurse, rehabilitation assistants, a healthcare assistant and an administrator. This multidisciplinary team (MDT) serves adults with complex medical and rehabilitation needs who are being discharged from hospital, staying in bedded rehabilitation units or living at home by offering assessments, investigations and rehabilitation, where appropriate closer to home. The aims of the service are to: keep people well, prevent unplanned hospital admissions, promote health and well-being, reduce the risk of falls, enable independent living and provide rehabilitation. Personalised care plans are developed with patients and their carers. Advanced nursing practice is demonstrated in assessment, investigation, diagnosis, management, referral and non-medical prescribing. Development of this MDT is required to support and promote integrated, evidence-based work. Such development leads to integrated care across communities, and bridges gaps between patients and carers, GPs, home, residential and hospital-based services, and the voluntary, statutory and non-statutory sectors.
Faecal incontinence is an impaired ability to control the passage of stool, often described as involuntary loss of solid or liquid stool, and the symptom of an underlying diagnosis. It is a common problem in older adults...Faecal incontinence is an impaired ability to control the passage of stool, often described as involuntary loss of solid or liquid stool, and the symptom of an underlying diagnosis. It is a common problem in older adults. Although not a life-threatening condition, it can have a significant negative effect on an individual's quality of life and adverse medical, social and economic consequences. Due to the taboo and stigmatising nature of the condition many individuals do not seek assistance. Healthcare professionals should take every opportunity to ask about faecal incontinence symptoms so that symptomatic relief and treatment interventions can be initiated. There are several conservative approaches available for the treatment of faecal incontinence, which should be considered as first line to target symptomatic relief.
Early identification of frailty at the front door of the acute hospital is vital to allow rapid comprehensive geriatric assessment and care pathway development in the most appropriate location. This article discusses the...Early identification of frailty at the front door of the acute hospital is vital to allow rapid comprehensive geriatric assessment and care pathway development in the most appropriate location. This article discusses the importance of developing robust processes to enable early identification and management of frailty in the acute hospital. It also highlights the benefits of developing a dynamic team of professionals at the front door of the acute hospital who are effectively trained to undertake comprehensive assessment. Effective care planning for older people with frailty requires meticulous coordination through collaboration across health and social care and this is demonstrated using an effective model which has been developed in a district general hospital in Scotland.
BACKGROUND: Nursing students and registered nurses often feel underprepared for their roles in dementia care. Extracurricular activities offer nursing students additional opportunities for professional development. A stu...BACKGROUND: Nursing students and registered nurses often feel underprepared for their roles in dementia care. Extracurricular activities offer nursing students additional opportunities for professional development. A student-academic partnership initiative was developed in which nursing students delivered dementia friends sessions to their peers before formal taught content. AIM: To explore dementia champion nursing students' experiences, identify factors that affect collaborative working and make recommendations for future student-academic partnership projects. METHOD: In individual and dual interviews, three students were asked about their experiences of participating in the initiative. Interviews were recorded, transcribed and analysed using a thematic analysis framework. FINDINGS: Four themes were identified: commitment to working with people who have dementia, difficulties in taking on extracurricular responsibilities, personal development, and relationships and collaboration. CONCLUSION: Students were motivated by the need to provide high-quality dementia care. They identified benefits of collaborative working including development of time management, team working, leadership, communication and presentation skills. Future projects should take into account student workloads and offer rewards that are congruent with nursing students' values.
Anecdotal and research evidence suggests that poor adherence and persistence with oral bisphosphonates can result in patients being at increased risk of osteoporotic fractures. Several interventions have been researched...Anecdotal and research evidence suggests that poor adherence and persistence with oral bisphosphonates can result in patients being at increased risk of osteoporotic fractures. Several interventions have been researched for their effectiveness with adherence and persistence, but the most effective method of supporting patients with oral bisphosphonate medications is clinician reviews, generally identified as doctors and nurses. This service evaluation aimed to explore the knowledge and views of multidisciplinary community-based clinicians about adherence and persistence with oral bisphosphonates. The results indicated a positive attitude to a multidisciplinary approach supporting patients to take their medication as prescribed, with recommendations for future research.
Ageism has numerous negative effects on the lives of older people, including their health and well-being. In this reflective account a nursing student explores these effects in the context of an incident where she was in...Ageism has numerous negative effects on the lives of older people, including their health and well-being. In this reflective account a nursing student explores these effects in the context of an incident where she was inadvertently ageist. She considers what she has learned from this incident and the implications for nursing practice.
A venous leg ulcer (VLU) is defined as the loss of skin below the knee on the leg or foot in the presence of venous disease, which takes more than two weeks to heal. The prevalence of VLUs is increasing, especially in ol...A venous leg ulcer (VLU) is defined as the loss of skin below the knee on the leg or foot in the presence of venous disease, which takes more than two weeks to heal. The prevalence of VLUs is increasing, especially in older people, which will increase the demand for nursing care. Development of a lower leg ulcer should trigger immediate assessment of risk factors for chronic venous disease followed by action to identify the cause and initiate treatment, which should prevent progression to more complex and chronic problems. Justification for choice of appropriate wound management and application of compression therapy should be based on the assessment and diagnosis. Management of patients with VLUs can be cyclical and lifelong, which highlights the importance of helping patients to understand the rationale for management strategies so that cooperation in self-care is achieved.
With an ageing population comes an increasing risk of illnesses such as dementia and a growing need for care. There are 670,000 informal, unpaid carers in the UK, reducing costs for health and social care services but pr...With an ageing population comes an increasing risk of illnesses such as dementia and a growing need for care. There are 670,000 informal, unpaid carers in the UK, reducing costs for health and social care services but presenting other concerns for healthcare professionals. Carer burden and carer stress are well-documented concepts, and can lead to depression and a risk of suicide in some individuals. It is important that this risk is considered when supporting informal carers of people living with dementia. Admiral Nurses work with families living with dementia to provide the one-to-one support and expert guidance they need to manage. This article discusses a case study that highlights how caring can affect an individual, leading to thoughts of suicide. It also demonstrates how an Admiral Nurse could support the carer in a relationship-centred way, using appropriate interventions to avoid crisis. The article offers implications for practice and provides recommendations for nurses working in this field.
Nurs Older People
· 2018 May · PMID 29767481
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The community matron care homes team (CHT) was set up in Sandwell, West Midlands in 2011 to support care home staff to manage residents' care safely and reduce unplanned and/or avoidable use of acute health services. The...The community matron care homes team (CHT) was set up in Sandwell, West Midlands in 2011 to support care home staff to manage residents' care safely and reduce unplanned and/or avoidable use of acute health services. The service was reviewed in 2015 and attention focused on care homes with the highest levels of hospital use and emergency 999 services. Working with these care home staff and health professionals, a training and education opportunity to aid staff to manage residents in crisis was sourced, organised and implemented. The outcome of this training was positive: it demonstrated a reduction in hospital attendances and admissions and an increase in the confidence and morale of care home staff. The community matron CHT won the Nursing Older People category of the RCNi Nurse Awards in May 2017. This award has resulted in the team's profile being raised, and the team being asked to participate in further initiatives to provide enhanced support for care homes.
Nurs Older People
· 2018 May · PMID 29737673
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Joint contractures, or limitations in the full range of movement of joints, are common in older people living in long-term care settings. They result in physical discomfort, social isolation, loss of independence and inc...Joint contractures, or limitations in the full range of movement of joints, are common in older people living in long-term care settings. They result in physical discomfort, social isolation, loss of independence and increased staffing demands. Studies conclude that the prevention of contractures should be the first line of treatment. This article aims to raise awareness of contractures in older people living in nursing homes and individualised preventive strategies that can be used by nursing staff such as maintaining functional ability, risk identification, stretching and correct bed and seating position.
Nurs Older People
· 2018 May · PMID 29717845
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This article aims to assist nurses and nursing students to consider the presentation of delirium in older patients and the resulting assessment and nursing interventions required. It considers the three types of delirium...This article aims to assist nurses and nursing students to consider the presentation of delirium in older patients and the resulting assessment and nursing interventions required. It considers the three types of delirium: hyperactive, hypoactive and mixed. It also discusses potential causes of delirium. Older patients are at increased risk of delirium due to factors such as cognitive impairment, co-morbidities and acute illness. Nurses should be confident in the use of the 4AT score to assess patients with delirium. Use of the mnemonic PINCH ME is suggested to guide management of delirious patients in acute settings. Families of patients with delirium have emotional and other care needs and there are several ways in which nurses can meet them.
Nurs Older People
· 2018 Mar · PMID 29569863
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This work was part of a National Institute for Health Research participatory action research and practice development study, which focused on the use of a therapeutic, robotic baby seal (PARO, for personal assistive robo...This work was part of a National Institute for Health Research participatory action research and practice development study, which focused on the use of a therapeutic, robotic baby seal (PARO, for personal assistive robot) in everyday practice in a single-site dementia unit in Sussex. From the beginning of January 2017 until the end of September 2017, the cleaning and cleanliness of PARO was monitored through a service audit process that focused on the cleaning, amount of use and testing of contamination of PARO being used in everyday clinical practice with individuals and in group sessions. Its use and cleaning followed protocols developed by the study team, which incorporated hand hygiene and standard precaution policies. Its cleanliness was determined using an adenosine triphosphate (ATP) luminometer, with a benchmark of 50 relative light units (RLU). A reading of ATP below 50RLU is the level of cleanliness recommended for social areas in hospital settings. Throughout the study period, monitoring showed that all swab zones on PARO were within the benchmark of the 50RLU threshold for cleanliness. PARO has an emerging evidence base as a useful therapeutic device. However, introducing such devices into clinical practice may encounter barriers or concerns from an infection prevention and control (IPC) perspective. This study of PARO in clinical practice aims to address the IPC concerns raised and offers cleaning and testing protocols and results.
Nurs Older People
· 2018 Mar · PMID 29569862
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Dermatoporosis is a chronic skin fragility syndrome, caused by age and environmental factors. People with dermatoporosis have skin whose protective mechanical function is reduced and which has a decreased tolerance for f...Dermatoporosis is a chronic skin fragility syndrome, caused by age and environmental factors. People with dermatoporosis have skin whose protective mechanical function is reduced and which has a decreased tolerance for friction and shearing forces. Skin tears are another clinical consequence of age-associated skin vulnerability and people with dermatoporosis are at increased risk of skin tears. Dermatoporosis may also delay the healing of skin tears, making it vital that healthcare professionals are aware of this condition. Skin tears have profound effects on the health and well-being of older people, and these kinds of injuries are being seen more frequently in clinical practice as the average age of the population increases. The treatment of skin tears in three older people with dermatoporosis is discussed and the clinical decisions made in each case.
Nurs Older People
· 2018 Mar · PMID 29569861
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A literature review found an association between increased falls risk and malnutrition, sarcopenia, vitamin D deficiency and dehydration. Strategies to identify, prevent and treat these conditions can help to reduce fall...A literature review found an association between increased falls risk and malnutrition, sarcopenia, vitamin D deficiency and dehydration. Strategies to identify, prevent and treat these conditions can help to reduce falls risk in at-risk groups such as frail, older people. Nurses can reduce falls risk in older people by raising awareness of risk factors and embedding nutritional strategies in local falls reduction strategies.
Nurs Older People
· 2018 Feb · PMID 29480658
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Sepsis is a common condition caused by the body's immune and coagulation systems being 'switched on' by the presence of infection, either through bacteria or viruses in the blood. If untreated, sepsis can be life-threate...Sepsis is a common condition caused by the body's immune and coagulation systems being 'switched on' by the presence of infection, either through bacteria or viruses in the blood. If untreated, sepsis can be life-threatening and is a leading cause of death in hospital patients worldwide. However, awareness of sepsis is low. This article provides an overview of the important role played by nurses in acute hospital settings in the early identification and treatment of suspected sepsis in frail older patients, and in escalating the care and management of deteriorating patients. It also explores recommendations in the 2016 National Institute for Health and Care Excellence guideline on sepsis recognition, diagnosis and early management.