Exploring associations between older adults' demographic characteristics and their perceptions of self-care actions for communicating with healthcare professionals in southern United States.

AIMS: This study examined associations between older adults' demographic factors and their perceived importance of, desire to and ability to perform seven self-care behaviours for communicating with healthcare professionals. DESIGN: This cross-sectional survey study analysed subset data of 123 older adults 65 years and older, living in southern United States. METHODS: The Patient Action Inventory for Self-Care (57 items, grouped into 11 categories) was used to collect self-reported self-care data. Demographic characteristics were also collected. Descriptive statistics and logistic regression analyses were used to tests for relationships between the variables relevant to the research objective. RESULTS: Regression findings showed that separated older adults felt less able to share ideas about their healthcare experiences compared to married older adults. Male older adults reported less desire to list issues to discuss and less desire to share ideas about their care experience with their healthcare professionals compared to their female counterparts.

Are older adults' demographic characteristics social determinants of their perceived importance, desire, and ability to perform end-of-life self-care actions?

BACKGROUND: Demographic characteristics play a role in influencing the decision to make end-of-life (EOL) directives among older adults living in the United States. AIMS: To examine the associations between older adults' demographic characteristics (age, sex, marital status, residential site, and educational level) and their perceived importance of four self-care actions for EOL planning, as well as their desire and ability to perform these actions. SETTINGS: A cross-sectional survey study of community-dwelling adults living in the southern United States from 2015 to 2016. PARTICIPANTS: Community-dwelling adults aged 65 years and older (N = 123). METHODS: A self-administered tool, the Patient Action Inventory for Self-Care and a demographic questionnaire were used. Multiple logistic regression was performed. RESULTS: Forty-seven of (38.2%) participants lived in an urban community and 76 (61.8%) in a rural community. Demographic variables that were significant across the predictive models were older adults' residence, education levels, age, and marital status. Four demographic characteristics of living in rural areas, without a high school education, being 75 years or older, and married could be social determinants of EOL planning. CONCLUSIONS: Older adults may need community-based support to address their end-of-life needs, especially those elders who want to remain independent in their home environment.

Older adults' suggestions to engage other older adults in health and healthcare: a qualitative study conducted in western Canada.

AIM: This qualitative study reports identified themes from suggestions made by 533 Canadian older adults, aged ≥65 years in response to the open-ended question contained in a Saskatchewan Telephone Survey: "What suggestions can you make to engage someone in their health and healthcare?". BACKGROUND: In 2016, seniors accounted for 16.9% of the Canadian population. As Canadians age over the next 30 years, emergency room visits are predicted to increase by 40%, outpacing the expected 30% population growth. Avoiding this increase could save the nation about $210 million annually. A recent US study reported that the ability of seniors to carry out self-care actions predicted lower likelihood of emergency department use within 3 months. MATERIALS AND METHODS: We conducted a secondary data analysis based on a province-wide, cross-sectional Saskatchewan (Canada) Telephone Survey of seniors' self-care needs conducted in March-June 2018 (N=1,000). Results were analyzed using qualitative thematic content analysis. Data were charted and coded separately by two researchers; coding conflicts were resolved by consensus. RESULTS: A total of 533 seniors answered the open-ended question. Content analysis resulted in 11 contextual content areas with 956 total suggestions. Five key themes emerged, which included the following: feasible healthcare access, being proactive toward healthy living, having social support systems, being more open to alternative medicine, and other self-care options, and having more trained healthcare professionals to care for seniors. CONCLUSION: This study reveals facilitators and challenges that currently face seniors. Seniors want equitable access to professional healthcare services and an environment that fosters self-care actions in everyday living. There is a gap in supports that would assist seniors to engage in their health and healthcare. Additional research on this issue could further inform health and human service providers to develop patient-centered strategies for promoting self-care among seniors.

Exploring the Associations Between Patient Affect, Self-Care Actions, and Emergency Department Use for Community-Dwelling Adults.

BACKGROUND: Nurses and other health care providers need to ensure that patients receive care that addresses their specific needs and wants. PURPOSE: This exploratory study examined the associations between patients' self-reported positive and negative affect, the perceived importance of 57 self-care actions, the desire and ability to perform them, and emergency department use in the past 3 months. METHODS: A secondary analysis from a cross-sectional survey project that surveyed 250 community-dwelling adults living in the southern United States, 2015-2016. Independent t tests and the χ test were used. RESULTS: Positive affect was associated with positive perceptions of self-care actions and having no emergency department visit. Patients with a more negative affect perceived finding and using services that support their health behaviors as being important and expressed a desire to participate in local health screening or wellness events. CONCLUSIONS: Patients' perceptions of their self-care actions could lead to better outcomes.

Do patients' demographic characteristics affect their perceptions of self-care actions to find safe and decent care?

AIM(S): This exploratory study examined the relationship of five patient demographic characteristics (residence in an urban or rural site, gender, age group, marital status, and education level) with the patients' (1) perceived importance of, (2) desire to, (3) ability to perform four patient engagement self-care actions that result in finding safe and decent care. BACKGROUND: Equitable access to health care is essential in a humanized health care system. Healthcare providers must engage patients in discussions about their desires for their care to create person-centered care plans reflecting patient values and wishes. METHODS: This secondary data analysis from a cross-sectional survey project surveyed community-dwelling adults living in the southern United States, 2015-2016. This paper only includes responses of participants aged 65 years and older (N = 123). Data collected in The Patient Action Inventory for Self-Care and demographic questions were used. Chi-square tests and multiple logistic regression analyses were used. RESULTS: As revealed in the Chi-square and logistic regression findings, self-care actions of "finding a doctor or practitioner who meets your needs," "using available information to choose a doctor or practitioner," and "using data to choose a hospital or clinic" showed some associations with whether seniors resided in an urban or rural community, age group, and marital status (P < 0.05). No significant associations between these four self-care actions with gender or education were found. CONCLUSIONS: A community-based solution is warranted to leverage between patient demographic characteristics and their perceived self-care actions by harnessing local factors in collaboration with identified patient needs.

i Engaging user testing: lessons learned from inpatients and health care providers.

This user-testing study assessed the feasibility of the functional prototype of an innovative fall prevention intervention, i Engaging, to engage patients in their own fall prevention care during hospital stays. The i Engaging application as well as its approaches to engage patients in fall prevention care during hospital stays was perceived as being easy to use, effective, and practical. The user-testing study consisted of adults 65 years of age or older and health care providers.

Engaging Patients in Their Care Versus Obscurantism.

PROBLEM: Could engaging patients in their care be a means to oppose obscurantism? Obscurantism is defined by Merriam-Webster as "the practice of keeping knowledge or understanding about something from people". METHODS: This paper discusses the importance of promoting patient engagement and emphasizes that patients and healthcare providers are equally important stakeholders in health care. FINDINGS: The discussion occurs in the context of hospital inpatient care as nurses play a critical role in patients' hospitalization experience, including engaging patients in their own care during hospital stays. Paternalism of healthcare providers is recognized as one of the main barriers to integrating the concepts of patient engagement and patient centeredness into every aspect of the care system. Promoting patient engagement is a two-way responsibility, and it requires the cooperation of both patients and healthcare providers. CONCLUSIONS: As scientists and healthcare providers, we have the duty to counter obscurantism by promoting understanding of the health of individual citizens and society at large. A culture change in healthcare systems toward being patient-centric and placing value on patient engagement is warranted, and this change must come from healthcare providers. Patient-centered tools that support patient engagement, patient portals, or personal health records are still needed.

Patient Engagement in Hospital Fall Prevention.

Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input).

Exploring post-fall audit report data in an acute care setting.

This retrospective, descriptive, chart review study was done to demonstrate one strategy for communicating aggregated and actionable fall data to bedside nurses. It was conducted at a nonprofit acute care hospital in the northwestern United States to analyze the quantitative data captured in post-fall audit reports of patient falls (March 1-December 31, 2012, N = 107 falls). Descriptive and binary statistical analyses were used. The quarterly National Database of Nursing Quality Indicators 2011 and 2012 reports showed that implementation of post-fall audit reports can lead to a lower overall fall rate and a lower fall-injury rate. Increased nursing hours could be a confounding factor of the positive impact of conducting post-fall audits in this study. It is concluded that timely and systematic reporting, analysis, and interpretation of fall data in an electronic format can facilitate prevention of falls and fall injuries.

Perceived top 10 highly effective interventions to prevent adult inpatient fall injuries by specialty area: a multihospital nurse survey.

PURPOSE: This study identified the perceived top 10 highly effective interventions to prevent fall injuries of adult inpatients based on the perceptions of RN staff by specialty area in acute hospital settings. BACKGROUND: The fall prevention precautions to focus on may vary by patients' medical problems and thus by specialty area. METHODS: This cross-sectional nurse survey was conducted at five U.S. health systems (July 2011-February 2012, 68 study units, 10 specialty areas). 560 staff participants completed the survey, yielding an overall response rate of 25.81%. This work is part of a larger project. Descriptive statistics were used. RESULTS: Each specialty area had its own top 10 effective interventions identified by RNs. The complexity and differences in the top 10 highly effective interventions by the 10 included specialty areas are apparent. For example, only one common intervention (keeping hospital bed brakes locked) appeared in the lists from the medical units and surgical units. CONCLUSION: Addressing the unique needs of the patient population by specialty area is essential. Adopting the perceived top 10 highly effective interventions for preventing injurious falls by specialty area with staff consensus might be more feasible for staff buy-in and compliance in inpatient acute care settings. Since patients' characteristics may change over time and the science in fall prevention is advancing, re-prioritizing effective interventions as needed every 2 years is recommended.

i Engaging as an innovative approach to engage patients in their own fall prevention care.

Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fall prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients' needs, we developed "i Engaging", a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.

Environment of care: vertical evacuation concerns for acutely ill patients and others with restricted mobility.

This perspective paper was intended to raise awareness and the urgency of needing additional evacuation-related, hospital building design policies. We addressed the challenges to maintain the integrity of exits and inadequate hospital design considerations for individuals with restricted mobility. Hospitals are occupied by people who may have restricted mobility and visitors who are likely unfamiliar with their surroundings. A hospital fire threatens all people in the building, but especially patients in the intensive care unit who are frail and have limited mobility. Evacuating immobile patients is complex, involving horizontal and vertical evacuation approaches. Hospital design must consider the needs of individuals with restricted mobility, who are the most vulnerable in case of a hospital fire. Consequently, we urge that acutely ill patients and others with restricted mobility should occupy units located on the ground floor or Level 2. In addition, when configuring the physical environment of hospitals, providing step-free ground floor access (indoor or outdoor ramps) and evacuation aids for vertical evacuation is crucial. Step-free ground floor access between Level 2 and the ground floor should be wide enough to allow transporting patients on their beds. A standard revision to include these recommendations is desperately needed.

Staff response time to call lights and unit-acquired pressure ulcer rates in adult in-patient acute care units.

The US National Pressure Ulcer Advisory Panel claimed that most pressure ulcers are avoidable (2007). Identifying nursing-process indicators that are objective and associated with pressure ulcer rates is desperately needed. As a result, the purpose of this exploratory study was to examine the relationship between staff response time to call lights and the rate for unit-acquired pressure ulcers stage II and greater, in adult in-patient acute care units. We used archived data of one Michigan hospital located in the United States from July 2005 to December 2008 for analyses. The unit of analysis was the patient care unit-month. Pearson product-moment correlation analyses were used. The results showed that a faster staff response time to call lights was found to be associated with a lower percentage of unit-acquired pressure ulcers stage II and greater among surveyed patients. Staff response time is a significant process indicator to predict unit-acquired pressure ulcer rates.

Most frequently observed risk factors for adult inpatient injurious falls in hospitals.

PURPOSE: This exploratory, multihospital, cross-sectional nurse survey identified the adult population group with the most frequently observed risk factors for injurious falls in acute hospital settings. METHODOLOGY: The survey was conducted at 5 nonprofit health systems in the United States. A subset of the survey data from the main study was used in this analysis. The main study was conducted in 2011-2012 and included 560 registered nurses (RNs) from 68 units; it was published in the Journal of Nursing Care Quality in 2013. All the subjects from the main study were included in the present study. Factor analysis was conducted on 81 risk factor frequency items. We identified the group based on the ranking of the mean values for the frequency groups. The risk factor effective preventability items were also analyzed. RESULTS: We identified 24 most frequently observed risk factors and 3 most effectively preventable risk factors, which were all integral to each individual patient. Five of the most frequently observed risk factors were identified as physical-motor factors, 8 were identified as cognition factors, and 4 were demographic characteristics. None of the most frequently observed risk factors were related to medication. The 3 most preventable risk factors were demographic characteristics. For exploratory purposes, 1-way analysis of variance tests were used and show that statistically significant differences were present in the mean scores on some of the frequency scales and effective preventability scales across study health systems, acuity levels of the units, and unit types. CONCLUSION/APPLICATION OF THE STUDY: Perceptions of RNs about the most frequently observed and the most effectively preventable risk factors were mostly inconsistent. Clinical nurse specialists and nursing administrators need to identify frequently observed risk factors on a regular basis. These findings need to be communicated with RN staff in a systematic way to prioritize interventions to prevent injurious falls.

Medication error-related issues in nursing practice.

Professional nurses are more exposed to civil claims for negligence than in the past. Issues related to medication errors, and strategies to decrease them, are addressed.

Frequently observed risk factors for fall-related injuries and effective preventive interventions: a multihospital survey of nurses' perceptions.

There is an urgent need to prioritize the risk factors for injurious falls and effective interventions in nursing practice. Registered nurses perceived that the most frequently observed risk factors were confusion, gait problems, Alzheimer disease, disorientation, and inability to follow safety instructions. The most effective interventions were keeping hospital bed brakes locked, keeping floor surfaces clean/dry, using appropriate footwear for patients, maintaining a call light within reach, and reducing tripping hazards.

How feasible was a bed-height alert system?

This qualitative and descriptive study examined the feasibility of a bed-height alert system as a fall-prevention strategy. The alpha prototype was developed to measure and record bed height, and to remind staff to keep patient beds in the lowest position. This pilot project was conducted in a 52-bed adult acute surgical inpatient care unit of a Michigan community hospital. Qualitative and quantitative information was gathered during semistructured interviews of nursing staff (18 RNs and 13 PCAs; January-April 2011). Descriptive content analysis and descriptive analyses were performed. The overall response rate was 44.9%. The mean values of the feasibility questions are all favorable. Staff's comments also support the view that the alert system would promote patient safety and prevent falls. In short, this system was found to be somewhat useful, feasible, appropriate, and accurate. It has the potential to promote patient safety and prevent bed-associated injurious falls in inpatient care settings.

Nursing staff's awareness of keeping beds in the lowest position to prevent falls and fall injuries in an adult acute surgical inpatient care setting.

High beds are a safety concern. This qualitative study used pre-existing nurse interview data and confirmed nurses' awareness of the importance of keeping patient beds in the lowest position. Lowering the bed helps promote patient safety and prevent falls.