Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study.

INTRODUCTION: The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS: This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS: The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION: Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

Factors that influence continuing professional development over a nursing career: A scoping review.

AIMS: Systematically synthesize research about factors that influence CPD over a nursing career. BACKGROUND: Continuing professional development (CPD) in nursing is defined as 'a life-long process of active participation in learning activities that assist in developing and maintaining continuing competences, enhancing professional practice and supporting achievement of career goals'. Research has shown that inability to access resources and activities for CPD influences quality of care and adversely affects nurses' satisfaction, recruitment and retention. Although more and more research regarding CPD is done, a comprehensive overview about the needs of nurses for successful CPD is missing. DESIGN: Scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews ensuring all quality standards are met. METHODS: Between February and April 2020 the electronic databases CINAHL, PubMed, Scopus, Psychinfo and Eric were searched as well as reference lists of included papers. Papers published in peer-reviewed journals were included without restrictions on publication date, design or setting. Thematic analysis was done to synthesize the data. RESULTS: The search yielded 2673 papers of which 60 papers were included. Analyses showed that factors that influence CPD differ over a nursing career, which led to the identification of three groups: newly graduated nurses; experienced nurses; and experienced nurses with ambitions for advanced roles. Furthermore, analyses showed that factors for all three groups are related to personal and contextual facilitators and barriers. Newly graduated nurses find it important to be an accepted member of the team. They experience barriers when integrating into the nursing profession, where they for instance experience workplace incivility. Experienced nurses experience contextual barriers related to a lack of supportive structures and inaccessibility of CPD resources. There is limited time and availability of role models and a lack of support from managers and other colleagues. Moreover, the clinical care dynamics influence their ability to pursue CPD. For the experienced nurses with ambitions for advanced roles, an important barrier is that nursing culture emphasizes direct patient care. Often it is unclear what the value is of new nursing roles which makes it difficult for them to develop these. CONCLUSIONS: All nurses strive for CPD. However, organizations need to recognize nurses' personal goals and unique strategies as this leads to different needs in CPD. In addition, resources must be made available and accessible before CPD can be successfully pursued by all nurses.

Hospital nurses' knowledge regarding older patients: a multicenter study.

BACKGROUND: Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses' knowledge and attitudes regarding older patients. METHODS: A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients. RESULTS: From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult. CONCLUSIONS: This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.

Minimizing the knowledge-to-action gap; identification of interventions to change nurses' behavior regarding fall prevention, a mixed method study.

BACKGROUND: The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients. METHODS: This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n = 26). Geriatric experts (n = 11), managers (n = 13) and educators (n = 13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability. RESULTS: In Geriatric experts' opinions interventions targeting behavior change of nurses regarding fall prevention should aim at 'after-care', 'estimating fall risk' and 'providing information'. However, in nurses' opinions it should target; 'providing information', 'fall prevention' and 'multifactorial fall risk assessment'. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning. CONCLUSIONS: The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice.