ABSTRACT
Introduction: Diabetes mellitus (DM) is a global health issue. Diabetic wounds have become a severe health complication. Interdisciplinary education and the use of homecare have led to improvements in the health of patients with chronic disease. The family caregiver's knowledge and self-efficacy positively impact the DM patient's self-care in the physical and psychological dimensions. There is still a need for interdisciplinary education to enhance family caregivers' knowledge and self-efficacy regarding diabetic wound care. Objective: To determine the effect of 6 months of interdisciplinary education on family caregivers' knowledge and self-efficacy regarding diabetic wound care. Methods: A quantitative longitudinal study with a quasi-experimental, one-group, pretest-posttest design was conducted. Family caregivers received 6 months of interdisciplinary education regarding diabetic wound care. The Foot Care Confidence Scale (FCCS) was used to measure the family caregivers' knowledge and self-efficacy regarding diabetic wound care. The dependent samples t test and the Wilcoxon signed-rank test were used for statistical analysis. Results: Sixteen caregivers of patients with diabetic ulcer wounds in the homecare unit participated in this intervention with a 6-month follow-up. Six months of interdisciplinary education significantly increased the family caregivers' knowledge (p = 0.001) and self-efficacy (p = 0.001). However, there was no significant correlation between self-efficacy and gender, age, education level, or duration of wound care (p = 0.91; 0.93; 0.38; 0.40, respectively). Long-term interdisciplinary education improved caregiver performance across genders, ages, education levels, and wound care experience durations. Conclusion: Long-term interdisciplinary education of family caregivers is recommended as one method to enhance the family support system with respect to diabetic ulcer care management. In addition, interprofessional collaboration could be performed to enhance the understanding of healthcare, especially diabetic ulcer care.
ABSTRACT
Introduction: Palliative care is critically important for the world's aging population and can change illness trajectories and promote advances in health care technologies. As health care team members, nurses have the most contact with palliative care patients. However, misconceptions about which patients need to receive palliative care may be an obstacle to meeting patients' needs for palliative care. Objectives: This study aimed to describe preceding events, characteristics and outcomes of patients in palliative care according to current concept analysis studies. Methods: A literature review was conducted. Inclusion criteria were: (1) concept analysis studies, (2) use of the term palliative care or palliative nursing care, (3) palliative care explanation including antecedents, attributes, and consequences, and (4) articles written in English published between 2004 and 2021. Results: Four concept analysis studies on palliative care were included in this review. Palliative care was described as an approach to alleviating physical and psychological suffering and improving patients' and families' quality of life in the early stages of diagnosed illness. Terminal illnesses, acute or chronic diseases, and actual or potentially life-threatening illnesses were confirmed as the events preceding palliative care. Characteristics of palliative care include holistic care, interdisciplinary teamwork, and compassionate, patient- and family-centered care. Improved patient and family quality of life, enhanced human dignity, improved self-care, and strengthened coping abilities are outcomes of palliative care. Conclusions/Implications for Practice: Palliative care is a concept that is related to the early stage of an illness, the timing of illness diagnosis, and the onset of symptoms. Including palliative care terms in nursing education and training and developing palliative care models in clinical practice are recommended to ensure nurses understand the services of the palliative care needs of patients and their families. Future reviews, including grounded qualitative studies on the concept of palliative care, are recommended.
ABSTRACT
BACKGROUND: Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs. PURPOSE: This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery. METHODS: The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations. RESULTS: Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.
ABSTRACT
BACKGROUND: Hip fractures in persons with cognitive impairments represent a major public health issue in older populations that often results in poor health-related quality of life (HRQoL). PURPOSE: The aim of this systemic review was to examine the changes in HRQoL in older, cognitively impaired patients with hip fracture who had received surgical treatment. METHODS: A literature search of PubMed, Scopus, MEDLINE, PsycINFO, and CINAHL (EBSCO) databases was conducted for studies published up to July 2018 that addressed the issue of HRQoL in cognitively impaired patients with hip fracture after surgery. Studies that met the following criteria were included: Patients with hip fracture were over 60 years old and had cognitive impairment or dementia, patients had undergone hip fracture repair surgery, HRQoL was determined using standardized questionnaires, a descriptive or interventional methodology was used, and the full-text article was available in English. RESULTS: A primary search of databases yielded 1,528 studies, 621 duplicates were removed, and the remaining 907 abstracts were screened. Thirty-four full-text articles were deemed relevant for full review; of these, 10 articles met the criteria for inclusion in the review. Cognitive impairment was found to impact negatively on the patients' HRQoL after hip fracture surgery (n = 809). Severity of cognitive impairment was correlated with deterioration in HRQoL after hospital discharge. When compared with prefracture measures of HRQoL, the greatest deterioration in HRQoL postsurgery occurred during the first 4 months after discharge. Impacts on HRQoL for patients with cognitive impairment at later time points differed depending on type of hip fracture and type of surgical treatment. However, for most of the patients, HRQoL remained relatively unchanged at 6, 12, and 24 months postdischarge. CONCLUSIONS: We recommend nursing care interventions for older persons with cognitive impairment be initiated immediately after surgery for hip fracture to prevent a significant decline in HRQoL. Further examination of interventions that are effective in maintaining HRQoL for these patients such as interdisciplinary care is necessary. In addition, the influences of hip fracture type and surgical approach on changes in HRQoL suggest a need for further investigations to determine what contributed to the observed inconsistencies in the outcomes.
