Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia.

INTRODUCTION: Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health. METHODS AND ANALYSIS: The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up. ETHICS AND DISSEMINATION: Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER: NCT04997681, Pre-results.

Nursing students' experiences with clinical placement in residential aged care facilities: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on nursing students' experiences with clinical placement in residential aged care facilities. INTRODUCTION: Nursing education programs play a key role in preparing future nurses to care for the growing number of older adults who will require health care. A key component of this preparation involves ensuring that curricula optimize student learning through carefully designed clinical learning practice experiences. Residential aged care facilities provide students with opportunities to work exclusively with older adults. Studies that address clinical placements in residential aged care facilities highlight both the benefits and concerns of student learning and professional development. Insight into student experiences of clinical placements in residential aged care facilities can help inform nursing curricula and contribute to a better understanding of how best to prepare students to care for an aging population. INCLUSION CRITERIA: This review considered all qualitative studies that included undergraduate and diploma nursing students. Nursing students included individuals or groups identified as nursing students independent of the type of program, level of learning, or time spent in the setting. METHODS: A three-step search strategy was used to identify English language qualitative primary research studies. Two reviewers independently appraised the included studies using the JBI Critical Appraisal Checklist for Qualitative Research. Key findings were extracted and classified as unequivocal or credible. RESULTS: Fourteen qualitative studies were included, published between 2003 and 2018. A total of 53 findings were extracted and aggregated into seven categories. From the seven categories, two synthesized findings were developed: the evolution of learning and embracing opportunity. CONCLUSION: This review captured student experiences of clinical placement in residential aged care facilities. The findings highlight the importance of students entering the setting with knowledge of how to care for older adults and being able to respond to challenging resident behavior. Equally important is the need for students to understand the roles and contributions of all care staff in the setting, including nurses and unregulated care providers. Although the residential aged care setting can be a challenging learning environment for students, it also offers opportunities for student growth and professional development, especially when there are clearly articulated learning outcomes and appropriate role models available.

An Analysis of Falls and Those who Fall in a Chronic Care Facility.

OBJECTIVES: Falls in hospitals lead to adverse patient outcomes and prevention of falls is of upmost importance. Little is known about fall and injury rates in chronic care facilities, which are similar to skilled nursing facilities in the United States. Current fall risk tools in this setting are not well studied. Enhancing the understanding of how patient characteristics relate to fall circumstances is also needed. DESIGN: Retrospective analysis of falls over 3 years on consecutive admissions and discharges. SETTING AND PARTICIPANTS: A 104-bed geriatric chronic care facility. MEASURES: Fall and injury data, descriptive data for patients measuring mobility, balance, cognition, function, and frailty in relation to risk of falls and fall circumstances were analyzed. RESULTS: There were 1141 falls, with an overall fall rate of 8.48 falls per 1000 occupied bed days. The overall injury rate was 37.2 injuries per 100 falls. Being male and frail, having a mobility aid, poor mobility, balance, or cognition were associated with falling. Patients with good balance but poor cognition was more likely to fall outside their room, while those with poor mobility/balance fell more often in their room. The Clinical Frailty Scale performed modestly well at predicting falls with an odds ratio of 2.5 (95% confidence interval 1.9-3.2). CONCLUSIONS AND IMPLICATIONS: Fall rates in chronic care facilities differ from what is reported in other settings. Patient characteristics such as male, use or misuse of a mobility aid, and poor cognition are more common in fallers. Fall circumstances differ in those with poor cognition compared with those with poor mobility and balance. More research focusing on frailty, cognition, and mobility/balance is needed to develop accurate tools that can predict those at a high risk of falls in these facilities.

Nursing students' experiences with clinical placement in residential aged care facilities: a systematic review protocol of qualitative evidence.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to analyze and synthesize the best available evidence on nursing students' experiences with clinical placement in residential aged care facilities.The specific review questions are.

Putting Performance Measurement Recommendations into Practice: Building on Current Practices.

Improving performance measurement within the Canadian healthcare system is proving to be challenging despite advances in evidence-informed care and best practices for healthcare delivery. Perhaps what is most challenging is the need to meet requirements to measure what most Canadians hold dear - being seen as a person during a healthcare encounter. Measures of healthcare delivery have typically been developed to capture patient satisfaction during isolated healthcare encounters. Such measures simply do not get to the essence of what matters to patients and their families. This paper outlines a response to the paper by Kuluski and colleagues (2017) that calls for a thorough review of the way data are currently captured on patients' experiences with healthcare. Using geriatric medicine as a context, the authors highlight elements of our current care delivery models that must be preserved, modified or created to allow patients and families to play a larger role in improving our healthcare system.

Moving to a culture of nurse as knowledge worker and a new way of knowing in nursing.

In this paper, the authors speculate on the future of nursing practice as it will be informed by emerging technologies for the management of clinical information and knowledge and the generation of new understandings. It is postulated that without a concomitant effort to transform nursing practice, the fulsome benefits of electronic health records and associated tools will not be realized for nurses, other clinicians and patients. The path to creating a nursing practice culture of integrated knowledge management necessitates new thinking about clinical care delivery and an expansion of the ways of knowing in nursing. For the purpose of this paper, clinical practice transformation is defined as: moving beyond the form and function of nursing practice as we know it today by boldly advancing the redesign of clinical processes and being open to emerging transformative possibilities within society and healthcare through the use of technology.

eDoc evaluation - at eighteen months into the challenge.

We describe an evaluation plan for electronic clinical documentation. Guided by Canada Health Infoway Benefits Evaluation Framework, the evaluation was performed across a single organization with four health care sites and included reviews of documentation practices from the nursing and health disciplines. Data collection methods included chart audits, shadowing, surveys and focus group meetings. Key recommendations drawn from the data analysis will help to guide documentation format and practice improvements.

Caring for families: double binds in neuroscience nursing.

Despite the proliferation of literature related to nurse-family relationships, little is known about such relationships in acute care neuroscience environments. A grounded theory study illuminated the experiences of nurses caring for families of patients with acquired brain injuries in the context of acute care hospital environments. Nurses, working in pressure-cooker-like environments, tried to meet information and emotional needs of families. During data analysis, a communication pattern emerged that impacted on nurses' experiences and relationships with families. This communication pattern, known as a double bind, contributed to a pattern of nursing that emerged and offers an explanation for the behaviours of the nurses in coping with family members. Nurses felt "damned if they did and damned if they didn't". To provide family-centred care, we need to fully understand the experiences of nurses caring for these families. This paper describes the concept of double bind and its application to neuroscience nursing.

Neuroscience nurses caring for family members of patients with acquired brain injury in acute ward settings: nursing defensively in a double bind.

This article presents the findings from a doctoral research study that led to the development of an inductively derived substantive theory, "Nursing Defensively". This theory describes the process of coping used by staff nurses when caring for family members of acquired brain injury (ABI) patients. This study was conducted in two acute care teaching and one non-teaching neuroscience wards in Toronto, Canada, using grounded theory method. A total of 20 registered nurses participated in the study. Supporting data are presented to permit the reader to "hear" the voices of the nurses caring for families of ABI patients in today's clinical environments. In addition, the author's interpretation of the significance of the findings for nursing is offered for the reader's reflection for applicability to relevant clinical environments and a call for clinical leadership in practice, education and research.

Unit manager's role with family members of clients in complex continuing care settings: An untold story.

Most literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC) environments from the perspective of staff were found in the literature. A qualitative study that draws on a grounded theory approach was conducted to explore staff-family relationships in CCC, and the findings presented in this article illuminate the unit manager's role. Data were collected through in-depth interviews with nine unit managers and a follow-up focus group with five unit managers who work in three CCC facilities. Three categories reflecting the unit manager's role with family members of clients in CCC settings were derived: establishing supportive entry; building and preserving relationships; and closing the loop. Implications of the findings for practice and future research are presented.