Enhancing Dignity for Older Inpatients: The Photograph-Next-to-the-Bed Study.

OBJECTIVES: Older inpatients compromised by illness and cognitive decline may be stripped of physical and cultural identifiers, making them vulnerable to erosion of dignity. This study explored the experiences of patients, carers and clinical staff in response to a simple intervention that could enhance the dignity of care for older inpatients. METHODS: All patients in a rehabilitation ward were encouraged to have a photograph of themselves next to their bed. Of those who participated, focus groups were recruited for patients, family members and staff to explore their reflections. Discussions were transcribed and analyzed using a deductive approach to capture evolving themes relating to patient care. RESULTS: All groups reported that the photograph provided "connection" and means of communication between patients and staff. Staff spoke positively of gaining additional insights into patients' lives. Benefits included enrichment of inter-personal relationships between patients and staff, between staff and families and between patients themselves. CONCLUSIONS: A bedside photograph improved connections between staff, patients and carers, promoting patients' dignity of identity. CLINICAL IMPLICATIONS: Displaying a bedside photograph as a visual reminder of the patient in the pre­illness state helps preservation of an individual's dignity, a core concept in patient­centered care.

The potential for cross-addiction in post-bariatric surgery patients: Considerations for primary care nurse practitioners.

BACKGROUND AND PURPOSE: Possible mental health issues for post-bariatric surgery patients include the development of cross-addictions after the rapid weight loss period. No validated screening tool to assess for possible cross-addictions exists. The main purpose of this study was to develop recommendations for modifying an existing addiction screening tool (the Shorter PROMIS Questionnaire) for use by primary care providers. METHODS: A qualitative descriptive design was used with triangulation of input from the scholarly literature, content experts (CEs), and post-bariatric surgery patients. Three focus groups were conducted with post-bariatric surgery patients (n = 12) with the same questions asked of the CEs (n = 3). Content analysis was used to analyze the transcripts. CONCLUSIONS: The following themes regarding addictions after bariatric surgery were identified through consensus: alcohol, gambling, shopping, exercise, food starving/bingeing, and sexuality/relationships. Dissonant themes included caffeine and tobacco by the post-bariatric surgery patients and prescription/illicit medications by the CEs. IMPLICATIONS FOR PRACTICE: Targeted screening for early identification of problem behaviors by primary care providers may result in appropriate referral to and management by mental health providers, assisting ongoing success of bariatric surgery.

Feasibility and construct validity of a Frailty index for patients with chronic kidney disease.

AIM: To determine whether the frailty status of patients with chronic kidney disease (CKD) can be measured using a Frailty index (FI). METHODS: One hundred and eleven attending a nephrology clinic were approached to complete a one-page questionnaire evaluating cognitive, psychological and functional status. Data were coded as deficits, summed and divided by the total number of deficits considered, to derive an FI-CKD. RESULTS: One hundred and ten (mean age 65.2 years) agreed to participate and assessments took approximately 10 minutes to complete. Mean FI-CKD was 0.25 (SD 0.12). The FI-CKD increased with age at 3% per year, correlated with a modified Fried phenotype (P < 0.001) and increased significantly across CKD stages (P = 0.04). CONCLUSIONS: The FI-CKD is feasible in the outpatient setting and has good construct validity. The greater granularity of a continuous measure has the potential to inform decision-making regarding appropriate interventions for patients at the 'frail' end of the health spectrum.