Calderon K, Van Landingham E, Purcell S
… +1 more, Kennard M
Nurs Older People
· 2021 Jun · PMID 33565283
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Sepsis, if not identified and treated early, can be fatal, particularly in older people. A lack of knowledge and understanding of sepsis among nursing staff can result in a missed or delayed diagnosis, leading to delayed...Sepsis, if not identified and treated early, can be fatal, particularly in older people. A lack of knowledge and understanding of sepsis among nursing staff can result in a missed or delayed diagnosis, leading to delayed treatment and potentially to patient death. A quality improvement project was conducted in nine hospitals and 200 nursing homes in the Lower and Upper Rio Grande Valley regions of Texas, in the US, to improve the identification and treatment of sepsis by nursing staff. Interventions included educational webinars for hospital staff and train-the-trainer sessions for nurse leaders in nursing homes. All participating hospitals had implemented a sepsis screening tool and sepsis care bundles by the end of the project, and an overall decline in sepsis mortality rates was seen in these hospitals. Among participating nurse leaders in nursing homes, a dramatic improvement in sepsis knowledge was seen. The outcomes of the project support the use of comprehensive nursing staff education on sepsis identification and treatment. Sepsis education needs to be ongoing to maintain optimal levels of knowledge among nursing staff.
Nurs Older People
· 2021 Jun · PMID 33501815
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Significant numbers of people in the UK care for someone living with dementia. Providing support for carers is socially and economically important, enabling them to continue in their caring role and improving their day-t...Significant numbers of people in the UK care for someone living with dementia. Providing support for carers is socially and economically important, enabling them to continue in their caring role and improving their day-to-day experience of caring. This article comprises a reflection by one dementia nurse specialist who ran a six-week educational support group for carers of people living with dementia. It describes the development of the group and the challenges faced, as well as discussing the future of the group, including the need to ensure its sustainability through collaborative working. The article also details some of the positive outcomes described by carers who attended the group.
Nurs Older People
· 2020 Dec · PMID 33403836
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Pain occurs in a wide range of diseases and long-term conditions associated with ageing and can affect every aspect of an individual's life, reducing their ability to recover, their independence and their quality of life...Pain occurs in a wide range of diseases and long-term conditions associated with ageing and can affect every aspect of an individual's life, reducing their ability to recover, their independence and their quality of life. The assessment of pain is an important aspect of nurses' role and requires them to obtain detailed information on how the older person experiences pain and how pain is affecting their life. However, there are many challenges to effective pain assessment in older people, including challenges concerning communication and cognition. This article provides an overview of pain assessment in older people, particularly those living with dementia, based on the author's expertise and on relevant literature, notably the recently revised UK national guidelines on the assessment of pain in older people.
Nurs Older People
· 2020 Dec · PMID 33354960
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In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, which generated concerns that the NHS could be overwhelmed. The predicted increase in the number of patients requiring hospitalisati...In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, which generated concerns that the NHS could be overwhelmed. The predicted increase in the number of patients requiring hospitalisation prompted the need to increase the number of clinical staff working on hospital wards, particularly healthcare support workers (HCSWs), who play a crucial role in addressing the care needs of older people. This article describes how one health board in Scotland trained and redeployed volunteers among its staff to work as temporary HCSWs in its main hospital during the pandemic. A fast-track, one-day training course was delivered in March and April 2020 to 104 staff from various backgrounds - some non-clinical - by a team of volunteer trainers. Staffing during an emergency, such as the COVID-19 pandemic, presents significant challenges, but the experience at NHS Borders shows that it is possible to develop a training course rapidly and provide additional band 2 staff to supplement the support workforce in a time of crisis.
Sharp B, Henderson J, Brown M
… +2 more, Jack-Waugh A, Macrae R
Nurs Older People
· 2020 Dec · PMID 33295157
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Despite growing understanding in recent years of the biological, psychological, social, environmental and spiritual aspects of dementia, people with advanced dementia continue to experience inequalities in accessing heal...Despite growing understanding in recent years of the biological, psychological, social, environmental and spiritual aspects of dementia, people with advanced dementia continue to experience inequalities in accessing healthcare capable of improving their lives. The complexities of advanced dementia challenge professional competence and demand the highest level of skilled, compassionate care. This article, the last in a series on living with advanced dementia, considers the status and direction of palliative care as it applies to people with dementia and explores contemporary issues regarding advanced dementia and end of life, with a focus on guidance for practitioners and support for best practice. It identifies that open communication, clear information and a person-centred approach adopted as early as possible in the syndrome can make this period less distressing. Crucially, people at the end of life should be offered care in line with best practice in palliative and end of life approaches.
Nurs Older People
· 2020 Nov · PMID 33174401
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BACKGROUND: Being in an unfamiliar environment away from family can exacerbate emotional stress in hospitalised older people with dementia. Technology solutions can be used to address their mental and emotional health ne...BACKGROUND: Being in an unfamiliar environment away from family can exacerbate emotional stress in hospitalised older people with dementia. Technology solutions can be used to address their mental and emotional health needs. AIM: To generate greater understanding of technology adoption and to test strategies supporting virtual care interventions in hospitalised older people with dementia, such as the use of an iPad to connect them with their family members. METHOD: Older people with dementia in two Canadian hospitals were observed and interviewed to explore their experiences of using an iPad. Focus groups were conducted with staff and interviews were undertaken with two frontline nurses and three research partners with lived experience of dementia in hospitalised older people. Data were thematically analysed in collaboration with 12 stakeholders. Strategies to overcome the barriers identified were tested as part of the study. FINDINGS: There were three main barriers to implementing virtual care interventions: lack of familiarity with the technology; difficulties with operating the device; and privacy and connectivity issues. Strategies to overcome these barriers included providing personalised support, working with users to support adaptation, and ensuring privacy and optimal connectivity. CONCLUSION: Using an iPad has the potential to enable hospitalised older people with dementia to connect with their family members and take part in activities that support person-centred care. This is particularly important in times, such as the COVID-19 pandemic, when restrictions to hospital visits lead to social isolation.
Nurs Older People
· 2020 Nov · PMID 33146475
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While sexuality is integral to being human and supporting sexual expression is fundamental to delivering person-centred care, many nurses find this area challenging. This is particularly true when working with people liv...While sexuality is integral to being human and supporting sexual expression is fundamental to delivering person-centred care, many nurses find this area challenging. This is particularly true when working with people living with a dementia, irrespective of their age. However, it can be especially challenging in older adults. This article aims to support nurses in their work with individuals and couples living with a dementia. After briefly defining the term 'sexuality' and acknowledging the effects of the most common types of dementia, the article discusses the importance of person-centred conversations. It details a new person-centred paradigm that can assist nurses to learn about people's sexuality and sexual wishes. Through enhanced understanding and increased objectivity, nurses can be better equipped to support people to continue living fulfilled sexual lives according to their choices and priorities. The article concludes by summarising the legal and professional context and nursing responsibilities involved in addressing sexuality with people living with a dementia, specifically when mental capacity becomes an issue.
Nurs Older People
· 2021 Mar · PMID 33084258
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Research is important because it underpins evidence-based care. However, people who lack capacity to consent are often excluded from research, due partly to ethical concerns and practical challenges, and partly to a lack...Research is important because it underpins evidence-based care. However, people who lack capacity to consent are often excluded from research, due partly to ethical concerns and practical challenges, and partly to a lack of awareness among professionals of the legal framework that supports their inclusion. The COVID-19 pandemic, which has extensively affected care home residents, has reinforced the importance of including older people with cognitive impairment in research. Nurses who care for older people with impaired cognition have an important role in ensuring these people have the opportunity to contribute to and benefit from research. This article discusses some of the challenges associated with the inclusion in research of older people who lack capacity to consent, including the involvement of relatives and friends in decision-making. The article describes the findings of recent research and shares resources with the aim of supporting nurses to ensure that older people in their care who lack capacity can participate in research.
Nurs Older People
· 2021 Feb · PMID 33025771
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This article, part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia, considers learning and leadership. It outlines learning opportunities about advanced dementia and...This article, part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia, considers learning and leadership. It outlines learning opportunities about advanced dementia and what developments are needed. The need for strong leadership at all levels and settings is explored along with the challenges of educating those who care for the person with advanced dementia. It also outlines educational opportunities and programmes before illustrating how one nurse leads advanced dementia care in practice.
Nurs Older People
· 2020 Nov · PMID 32996301
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BACKGROUND: Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs. AIM: An online survey was conducted to identify...BACKGROUND: Nurses in England play a prominent role in NHS continuing healthcare (CHC) assessments, but there are no overview data on their knowledge and educational needs. AIM: An online survey was conducted to identify the educational status and development needs of nurses involved in CHC assessments. METHOD: The survey was informed by a literature review and focus group discussions, and distributed via email to the members of the Royal College of Nursing older people's forum. Descriptive data analysis was undertaken. RESULTS: Overall, respondents were confident about their ability to undertake CHC-associated work and manage each aspect of the CHC process. However, respondents were less confident about how to determine whether a primary health need exists based on the four main criteria - nature, complexity, intensity and unpredictability - of a person's health and social care needs. This was one of the respondents' priorities for training and development. CONCLUSION: The survey demonstrates the importance of face-to-face and multidisciplinary CHC training delivered locally. It also confirms the need for a standardised approach and more consistency in the CHC assessment process. A CHC competency framework would contribute to standardise the process and benefit all involved.
Nurs Older People
· 2021 Feb · PMID 32935501
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BACKGROUND: The initial interaction between an older person and a nurse, and how the older person interprets this interaction, is important and sometimes overlooked. Evidence suggests that the way healthcare workers spea...BACKGROUND: The initial interaction between an older person and a nurse, and how the older person interprets this interaction, is important and sometimes overlooked. Evidence suggests that the way healthcare workers speak to older people can negatively affect older people's well-being. AIM: To interview community-dwelling older people aged ≥65 years who had recently held a conversation with a healthcare worker and to understand the meanings older people attributed to these conversations. METHOD: Ten community-dwelling older people were recruited and interviewed. Interviews were recorded and transcribed verbatim. Qualitative analysis was informed by narrative methods. FINDINGS: Participants freely and readily interpreted their conversations with healthcare workers in terms of the values and attitudes conveyed. Their preferences for forms of address ranged from formal to informal. They were sensitive to a range of contextual factors shaping the use of language. While they were generally tolerant of forms of address that did not match their personal preferences, some inferred disrespect from the unthinking use of first names and some resented assumptions being made based on age. CONCLUSION: Nurses are encouraged to be skilful and sensitive when speaking to older people. It is advisable to follow older people's preferences regarding forms of address, as these are important markers of dignity and respect.
This article is part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia. When someone with advanced dementia can no longer communicate verbally and has limited movement...This article is part of a series in Nursing Older People exploring the nursing care of people living with advanced dementia. When someone with advanced dementia can no longer communicate verbally and has limited movement, activities they once enjoyed may no longer be possible. This limits opportunities for self-realisation and can lead to a preoccupation in advanced dementia care about the routines associated with the maintenance of comfort and nourishment, at the expense of contentment and moments of fulfilment. Such a narrow focus can lead to changes in behaviour, indicating boredom, frustration and distress. Yet there are opportunities for a more creative approach to activity that can be adapted to the person's changing needs and the human desire to feel connected and engaged. Examples of these evidence-informed, creative interventions for people living with advanced dementia care include music, doll-focused activity, animal-assisted interventions, multisensory experiences such as Namaste Care and complementary therapies. These activities can engage the person with advanced dementia in a close connection with another human being through individualised and sensory-based care.
Nurs Older People
· 2021 Feb · PMID 32851821
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A recent review of the progress that has been made in meeting the government's Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The rev...A recent review of the progress that has been made in meeting the government's Challenge on Dementia 2020 detailed the variability, and in some cases suboptimal quality, of hospital care for people with dementia. The review also identified the need for improvements in assessing the individual needs of people with dementia while in hospital, including their emotional and social needs. This article focuses on the development and implementation of an evidence-based toolkit to improve the hospital care of older patients with cognitive impairment, including dementia and/or delirium. The toolkit's focus is on optimising the patient experience of people with cognitive impairment who have been admitted to hospital. The toolkit also promotes the importance of person-centred care and communication skills.
Nurs Older People
· 2020 Nov · PMID 32815326
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Identifying frailty is essential to support older people living with complex health and social care needs. This article discusses how a Florence Nightingale Foundation travel scholar used her scholarship to explore best...Identifying frailty is essential to support older people living with complex health and social care needs. This article discusses how a Florence Nightingale Foundation travel scholar used her scholarship to explore best practice in identifying frailty in acute and community settings in Scotland with the aim of developing services for people living with frailty locally and regionally in England. As the move to integrated care services develops in England, valuable insights from Scotland will assist in the proactive design of bespoke services around the needs of individuals in the community and, when acutely unwell, in the hospital setting.
Issues with eating and drinking are common in all stages of dementia but are most prevalent in the middle and late stages of the condition. This can lead to unintentional weight loss and malnutrition. Previous work by th...Issues with eating and drinking are common in all stages of dementia but are most prevalent in the middle and late stages of the condition. This can lead to unintentional weight loss and malnutrition. Previous work by the authors has attempted to understand how to improve the nutritional care of people living with dementia, and has resulted in the development of a guide for care staff to improve their knowledge and skills regarding nutrition in people with dementia. The aim of this service evaluation was to investigate how use of the nutritional guide for care staff could improve the provision of nutritional care for people living with dementia in care homes. An online survey questionnaire was emailed to care homes who had received copies of the guide between November 2018 and August 2019. Completion of the survey was sought eight weeks after use of the guide. Forty-seven questionnaires were returned from staff working in care homes. Respondents reported that the guide had supported them to increase the appetite and fluid intake of people living with dementia. The guide prompted staff members to monitor for malnutrition using validated screening tools and provided strategies to encourage people living with dementia to eat more at mealtimes. These findings indicated that the guide has contributed to changes in the practice of care home staff when providing nutritional care for people with dementia.
This is the second article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article considers the complexity of providing personal care, including the...This is the second article in a six-part series in Nursing Older People exploring the nursing care of people living with advanced dementia. This article considers the complexity of providing personal care, including the need for expert nursing practice to assess and lead the fundamentals of care: washing, dressing, continence care, nutrition and hydration. The contemporary evidence base for effective assessment, care planning, partnership working and evaluation of personal care for people with advanced dementia is presented, supported by sources of further information.
Advanced clinical practitioners (ACPs) are master's-level educated, experienced and competent nurses or allied healthcare professionals who practise a high degree of autonomy and undertake complex decision-making. This a...Advanced clinical practitioners (ACPs) are master's-level educated, experienced and competent nurses or allied healthcare professionals who practise a high degree of autonomy and undertake complex decision-making. This article offers a reflective account of advanced clinical practice in an older person's unit specialising in rehabilitation and complex discharge planning. It illustrates how ACPs work autonomously with medical colleagues to provide patient-focused care, enhance the multidisciplinary team and provide safe, high-quality care. The article also describes various aspects of the role for nurses or allied healthcare professionals who might consider this career path.
People with dementia are often admitted to acute hospital settings and it is essential that nurses recognise their complex needs. However, research shows that this patient group often experiences suboptimal care in acute...People with dementia are often admitted to acute hospital settings and it is essential that nurses recognise their complex needs. However, research shows that this patient group often experiences suboptimal care in acute hospital settings as well as increased mortality rates. This article reports the findings of a literature review into the attitudes of nurses who care for patients with dementia in acute hospital settings. It sets out the findings under four themes: the unworthy patient, safety before care, breaking routines and knowledge in dementia care. These themes detail nurses' negative attitudes towards these patients, but also identify that a person-centred approach can support more positive attitudes. The review concludes that acute hospital nurses require education about caring for people with dementia to foster more positive attitudes. Also, there is a need for further research into why nurses hold various attitudes to people with dementia and the association between these attitudes and care outcomes.
Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (AC...Dementia is the leading cause of death in England and Wales, but traditionally it has not been considered a terminal or life-limiting condition. As a result, little significance may be placed on advance care planning (ACP) for people with dementia. Evidence suggests that most patients with advanced dementia have often not been given an opportunity to complete an advance care plan and have not had conversations with their families about their wishes and preferences at the end of life. This article reports on a literature review that aimed to explore the evidence on the introduction of ACP in achieving preferred place of care or death for people living with dementia, and reducing carer burden. The literature review found that ACP discussions have several benefits for people with dementia and their family carers, but that various factors can support or hinder such discussions. It concludes that these people and their families need to plan for end of life and suggests that ACP can increase the likelihood of achieving their preferred place of care and death and reducing decisional burden for carers.
Nurs Older People
· 2020 Jun · PMID 32548985
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An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a n...An ageing population has led to a substantial increase in the prevalence of visual impairments, which can compromise lifestyle, health and general physical and psychological well-being. Age-related cataracts can have a negative effect on older people's quality of life but can be corrected by surgery. It is imperative that older people have access to cataract surgery and, given government objectives of NHS efficiency gains, advanced level nurse practitioners have the potential to increase capacity for and access to cataract surgery. This article outlines the aetiology of cataracts, developments in ophthalmic nursing and the broadened scope of practice of advanced ophthalmic nurse practitioners (AONPs). It explores how the AONP is well-placed to provide high quality care to the older person who requires cataract surgery. Professional drivers for role development are explored in relation to older people.