Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore.

INTRODUCTION: Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore. METHOD: Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. RESULTS: Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. DISCUSSION: Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.

The systemic challenges of non-palliative care professionals caring for end-of-life patients: A lived experience study.

OBJECTIVES: The aims of this study are to identify the challenges faced by non-palliative care professionals (NPCPs) in caring for end-of-life patients; determine how these challenges interact with and influence each other systemically; and advance the theories and practices for supporting NPCPs in the provision of quality end-of-life care beyond the boundaries of palliative medicine. METHODS: A constructivist phenomenological research design with an Interpretive-Systemic Framework of inquiry was adopted. Thirty-five physicians, 35 nurses, and 35 Medical Social Workers who play critical roles in caring for end-of-life patients and belonging to the 9 major medical disciplines of Cardiology, Geriatric, Intensive Care Medicine, Internal Medicine, Nephrology, Neurology, Oncology, Respiratory Medicine, and Surgery were recruited through purposive snowball sampling from 3 major public hospitals. RESULTS: Framework analysis revealed 5 themes and 17 subthemes that illuminate the individual, relational, cultural, institutional, and structural challenges that NPCPs faced in rendering end-of-life care. These challenges influence each other within the health-care ecosystem, serving to perpetuate or heighten care obstacles. SIGNIFICANCE OF RESULTS: This is the first known study exploring the systemic challenges of NPCPs spanning 9 major medical disciplines and encompassing 3 professional stakeholders responsible for the care for end-of-life patients, thus ensuring perspective inclusivity across the health-care system. Recommendations that consider the complexity of the interactions between these systemic challenges are presented in detail.

Development and Validation of a Multidimensional Short Version Zarit Burden Interview (ZBI-9) for Caregivers of Persons With Cognitive Impairment.

BACKGROUND: There is a lack of appreciation of the full dimensionality of the original 22-item Zarit Burden Interview (ZBI) in the development of short versions. Existing short versions are premised upon a 1-factor or 2-factor structure or statistical techniques for item selection. Thus, there is a need for ZBI short versions that considers the multidimensional constructs of role strain, personal strain, and worry about performance (WaP) during item selection to provide a more holistic and comprehensive evaluation. PURPOSE: To develop and validate a short version of ZBI through a combined quantitative and qualitative approach that incorporates the validated 4-factor structure of role strain demands; role strain-control; personal strain, and WaP. PATIENTS: We studied 202 caregivers of patients with dementia (84.2%) or mild cognitive impairment (15.8%) attending a memory clinic in Singapore. METHODS: Confirmatory factor analysis and qualitative considerations from expert consensus were used for item selection. Confirmatory factor analysis fit statistics support the 4-factor structure. The 9-item ZBI-9 showed good internal consistency (Cronbach's α=0.87) and convergent validity with anxiety and depression (Pearson correlation: Hospital Anxiety and Depression sub-scales, r≥0.56, P <0.001; ZBI- 22, r=0.95, P <0.001). Using a cut-off score of ≥13, ZBI-9 displayed good discriminatory ability for depressive symptoms (area under curve=0.79, P <0.001; sensitivity=70%, specificity=75%). The ZBI-9 also displayed comparable performance to the 22-item full version and three 12-item short versions. CONCLUSION: The ZBI-9 is a multidimensional short-version assessment tool for caregivers of persons with dementia and mild cognitive impairment that is reliable, valid, and discriminates depressive symptoms.

I see, I learn, I do: Development and evaluation of a video-enhanced nasogastric tube feeding training programme for caregivers.

AIM: We examined the effectiveness of a video-enhanced education package in improving caregiver outcomes (number of steps at first feeding attempt, time to achieve competency and knowledge) compared to the current institutional training approach. DESIGN: Quasi-experiment. METHODS: From August 2016-June 2017, we recruited 112 caregivers in a Singaporean tertiary hospital. We allocated 72 and 40 caregivers to video-enhanced and standard education, respectively. Median values are reported with interquartile ranges (IQR), and analysed using Mann-Whitney U test. RESULTS: Caregivers taught with our video-enhanced package performed a median of 7.0 (IQR = 3.5-7.5) out of eight steps correctly at their first attempt, a 40% increase. There was no change in the median number of training sessions but the 75th percentile dropped to 9.3 from 6.0, a 35% reduction. Post-training knowledge improved from a median of 0.5 (IQR = 0-2.0) to 1.0 (IQR = 0-3.0). The video-enhanced package can improve caregivers' knowledge and accelerate their skill competency.

'24/7' Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest in Caregiving.

The COVID-19 pandemic has exacerbated the difficulties faced by caregivers who have to provide continuous '24/7' care to persons with dementia with minimal formal and informal support. While caregivers have reported heightened levels of caregiving distress and burden during the pandemic, there remains a dearth of research pertaining to their lived experiences of providing continuous care with little respite and the corresponding physical, psychosocial and emotional impacts of caregiving '24/7'. The present study uses data obtained from interviews with dementia caregivers (N = seven) that were collected as part of a larger study on Carer Matters, a hospital-based holistic caregiver support program held during COVID-19, to conduct a secondary thematic analysis. The findings revealed three themes that defined the shared experiences of '24/7' caregivers: (1) A World Overturned, which refers to the increase in caregiving intensity and burden due to the pandemic; (2) Burning on Both Ends, which refers to the impossible balance between caregiving and their personal lives; and (3) At Wits' End, which refers to an overwhelming sense of hopelessness and helplessness over their caregiving situation. These findings highlight the challenges and unsustainability of '24/7' caregiving and the detrimental impact that round-the-clock care wields on caregivers' physical and mental well-being. Implications and recommendations are discussed in accordance with the cultural particularities of the study's Asian context (Singapore), with calls for greater caregiver support to be better integrated into society and the community, especially at the neighborhood and grassroots level, to alleviate caregiving burden and safeguard their well-being.

Applying the RE-AIM framework to evaluate a holistic caregiver-centric hospital-to-home programme: a feasibility study on Carer Matters.

BACKGROUND: Prolonged caregiving of an older adult can cause family caregivers to be overwhelmed, potentially affecting the well-being of both the caregivers and their care-recipients. Carer Matters is a holistic hospital-to-home programme, centred on caregivers' needs as their care-recipients transit from hospital to home. The programme was piloted to support caregivers through caregivers needs assessment, tailored resources, tele-support, training courses, and community support network. This study aimed to examine the feasibility of Carer Matters in a tertiary hospital in Singapore. METHODS: This feasibility study was conducted on the pilot implementation from January to December 2021, during the Covid-19 pandemic. It adopted the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study highlighted quantitative data collected from key process indicators, such as number of caregivers screened, assessed on their needs and provided with assistance. Additionally, qualitative data was collected from in-depth interviews with 51 stakeholders involved in the implementation to examine their perspectives and experiences. These included family caregivers, clinician caregiver support nurses, hospital leaders and community partners. RESULTS: During the pilot, 550 caregivers were enrolled. All caregivers received educational resources when they completed the needs assessment, while 69 of them who reported high burden were given tele-support and 252 attended our caregiver training courses. Despite initial recruitment challenges and obstacles to adoption, stakeholders interviewed found Carer Matters to be effective in providing caregivers with emotional support, knowledge and skills that improved their caregiving abilities, and reduced their sense of isolation and caregiving stress. Among caregivers, the training courses were effective with majority of caregivers agreeing that the courses addressed their needs (99%) and improved their knowledge of the relevant disease conditions (97%). Programme maintenance considered among stakeholders included strategies such as multipronged approach in recruiting caregivers and inviting caregiver advocates to share their experiences. CONCLUSION: This feasibility study highlights that Carer Matters is a valuable component to the ecosystem of support for family caregivers and their care recipients. Carer Matters extends the current patient-centric care model to a more holistic post-discharge continuity of care for both caregivers and their care-recipients, improving and maintaining their overall well-being to better allow transition from hospital-to home. TRIAL REGISTRATION: Feasibility Study of Project Carer Matters for Family Caregivers of Persons with Dementia (NCT number: NCT05205135 ).

Psychometrics of the Pearlin Mastery Scale among Family Caregivers of Older Adults Who Require Assistance in Activities of Daily Living.

This study examined the psychometric properties of the seven-item mastery scale among 392 family caregivers of care dependent older adults in a tertiary hospital in Singapore. Item response theory (IRT) analysis and confirmatory factor analysis (CFA) were used to assess the scale's psychometric properties. Construct validity was assessed based on correlations between mastery and caregiver burden, depression, and quality of life. Data from the seven-item mastery scale showed acceptable reliability and model fit while IRT analysis showed that response categories were ordered but reflected poor fit for the two positively worded items. Without these two items, responses on the five-item version showed acceptable model fit and had acceptable reliability and high correlation with those on the seven-item version. Item responses on both the seven- and five-item versions show logical correlations with carer self-report on burden, depression, and quality of life. Further psychometric studies of the seven-item mastery scale are warranted. For practical applications such as caregiver screening during hospital admissions, the five-item mastery scale is fit for purpose.

Delivering a holistic hospital-to-home framework to support family caregivers of persons with dementia: Protocol for a feasibility study.

AIM: To evaluate the feasibility of the Carer Matters holistic hospital-to-home framework for family caregivers of people with dementia. BACKGROUND: Family caregivers of persons with dementia face a unique blend of stressors, from behavioural management to navigating the healthcare system. It is important to provide support and assistance to help caregivers cope to enable a sustained capacity for caregiving. This led to our establishment of Carer Matters, the first holistic caregiver-centric hospital-to-home framework of support for caregivers of persons with dementia in Singapore. METHODS: A multimethod study design will be used. We will assess the programme's feasibility and effectiveness using a Theory of Change approach, with findings synthesized using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Our study will involve six inpatient wards of a 1700-bedded acute care hospital over 12 months. Qualitative data will be obtained from interviews of stakeholders-caregivers, healthcare professionals, hospital leaders and community leaders. Quantitative data will be collected from programme logs, surveys and evaluation forms that capture self-reported levels of mastery, anxiety, burden, and depression. Funding has been approved by the Geriatric Education and Research Institute (GERI) Intramural Project Grant (GERI Ref: GERI1626) on May 2020 for this study (£103,659), to be conducted from December 2020 to June 2022. DISCUSSION: The stresses faced by caregivers of persons with dementia are wide and complex, necessitating a multi-faceted caregiver-oriented solution to provide sustained support, empower better management and continued capacity to care. Our study would provide insights on the feasibility and effectiveness of a caregiver-centric support programme stretching from the hospital into the community. IMPACT: These findings will provide a blueprint on how to implement a hospital-to-home patient-caregiver framework and provide policymakers, clinicians, and advocacy groups with critical insights on the potential patient-caregiver-healthcare system outcomes that can be derived.

Light therapy for sleep disturbances in older adults with dementia: a systematic review, meta-analysis and meta-regression.

BACKGROUND: Sleep disturbances in older adults with dementia are common. Light therapy may help in regulating their sleep or wake cycle. However, data in the literature on the effectiveness of light therapy for the people with the said condition remain inconclusive. Thus, further research is warranted. OBJECTIVES: This review aims to synthesize the best available evidence on the effectiveness of light therapy in reducing sleep disturbances among older adults with dementia. METHODS: PubMed, Embase, Scopus, CINAHL, Cochrane Library, ALOIS, PsycInfo, Web of Science, ProQuest, OpenGrey, various trial registries and different journals specializing on sleep were searched without limitations on the year of publication. Cochrane's Risk of Bias Tool version 1 and GRADE criteria were used to assess risk of bias and certainty of evidence, respectively. Meta-analysis and meta-regression analyses were conducted using Stata software. RESULTS: A total of 18 randomized controlled trials (RCTs) involving 1012 older persons with dementia were included. The meta-analysis revealed that light therapy significantly reduced night-time awakenings (p = 0.04), enhanced sleep quality (p = 0.01) and increased relative amplitude (p = 0.01) with a small to medium effect (g = 0.26-0.43). Subgroup analyses showed that studies conducted in the Western Pacific region had a larger effect size on sleep duration and efficiency than those conducted in other regions. Univariate random-effects meta-regression revealed that sample size was a significant covariate for the effect size of sleep duration and sleep efficiency. CONCLUSION: This study found that the majority of outcomes had a low level of certainty. Therefore, additional well-designed and large-scale trials must be conducted to achieve a more definitive conclusion.

Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore.

BACKGROUND: Family caregivers' lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes. METHODS: Secondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized. RESULTS: Four caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients' dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity. CONCLUSION: Our findings are useful in providing a framework for: (1) rapid understanding of informal caregivers' varying needs, (2) targeted support in a holistic caregiver-centered manner.

Tenacious team, precarious patient: A phenomenological inquiry into interprofessional collaboration during ICU resuscitations.

AIMS: The study aims to explore the lived experiences of interprofessional collaboration among ICU nurses, doctors, and respiratory therapists in managing resuscitations in the ICUs. DESIGN: Descriptive phenomenological design, underpinned by Husserl's philosophy. METHODS: ICU nurses, doctors and respiratory therapists who have experience in managing resuscitations with the interprofessional team were recruited through purposive sampling from April to December 2019. Sixteen ICU professionals participated in individual, semi-structured, in-depth interviews which were audio recorded, and transcribed verbatim. Findings were analysed using Colaizzi's 7-step analysis. RESULTS: The essence of interprofessional collaboration during resuscitations can be described in four main themes. 'Ruminating about professional boundaries' signifies how ICU professionals acknowledged the roles and boundaries that surrounded their scope of practice during resuscitations. 'Rallying the interprofessional team' illustrates how the interprofessional team rapidly band together amongst the aid and hindrance of contextual enablers and inhibitors. 'Responding to interprofessional conflicts' depicts how intra- and interprofessional tensions can occur during resuscitations that can impact patient safety. 'Reaching collective leadership' proposes enhanced resuscitation care through the collective leadership of the interprofessional team. CONCLUSION: Resuscitations represent a precarious turn of events for the critically ill patient where the interprofessional team undergoes a cyclic sequence of teamwork and conflict while attempting to drive the resuscitation into a positive outcome. As ICU professionals attempt to optimise interprofessional collaboration during resuscitations, findings call for enhanced team training initiatives encompassing the interprofessional team, with an emphasis on collective leadership. IMPACT: ICU professionals experience of interprofessional collaboration during resuscitations is poorly understood. By understanding their lived experience, targeted interventions to improve interprofessional collaboration can be conceptualised and implemented. Findings will set pace for future evaluation research on interprofessional collaboration and patient outcomes during resuscitations.

The hand-brain-heart connection: ICU nurses' experience of managing patient safety during COVID-19.

BACKGROUND: COVID-19 has challenged critical care nursing through increased critical care service utilization. This may have a profound impact on intensive care unit (ICU) nurses' ability to maintain patient safety. However, the experiences of ICU nurses in managing patient safety during an infectious disease outbreak remains unexplored. AIMS AND OBJECTIVES: To explore ICU nurses' narratives in managing patient safety in the outbreak ICUs during the COVID-19 pandemic. DESIGN: A narrative inquiry design. METHODS: A purposive sample of 18 registered nurses who practiced in the outbreak ICUs during the COVID-19 pandemic were recruited between June and August 2020. Individual semi-structured interviews were conducted, transcribed verbatim, and narratively analysed. RESULTS: Findings reviewed an overarching anatomy-specific storyline of a 'hand-brain-heart' connection that describes nurses' experience with managing patient safety during the COVID-19 pandemic. Firstly, stories on 'the hands of clinical practice' revealed how critical care nursing is practiced and adapted by ICU nurses during the pandemic. In particular, ICU nurses banded together to safeguard patient safety by practicing critical care nursing with mastery. Secondly, stories on 'the brain of psychosocial wellness' highlights the tumultuous impact of COVID-19 on the nurses' psychosocial well-being and how nurses demonstrated resilience to continually uphold patient safety during the pandemic. Lastly, stories on 'the heart of nursing' drew upon the nurses' intrinsic professional nursing identity and values to safeguard patient safety. Specific patient tales further boosted the nurses' commitment to render safe nursing care during the pandemic. CONCLUSIONS: Through their stories, ICU nurses reported how they continually seek to uphold patient safety through clinical competence, resilience, and heightened nursing identity. RELEVANCE TO CLINICAL PRACTICE: ICU nurses require sustainable clinical resources and references such as clinical instructors, as well as visible psychosocial support channels, for ICU nurses to continue to uphold patient safety during COVID-19.

The early stages of caregiving: A qualitative study into the caregiving experiences of Asian family caregivers of persons with newly-diagnosed dementia.

In Asian societies, the responsibility of caring for persons with dementia often falls upon an immediate family member. However, little attention has been paid to the early stages of caregiving, as well as their transition into a more experienced caregiver. Thus, a qualitative descriptive study involving a purposive sample of 11 main family caregivers of a person with newly diagnosed dementia was recruited from a tertiary hospital in Singapore. Three themes emerged from the data analysis: (1) Suspicions to seeking confirmation of dementia, (2) Grappling with dementia diagnosis, and (3) Making adjustments for the future. Areas of needs and support identified during the early caregiving journey suggest the need for caregivers to be prepared for the practical and emotional challenges. Unique to the Asian culture, our findings put forth the advocacy of engaging persons with dementia in the discussions of their long-term care and options.

'From Expert to Novice', Perceptions of General Ward Nurses on Deployment to Outbreak Intensive Care Units during the COVID-19 Pandemic: A Qualitative Descriptive Study.

AIMS AND OBJECTIVES: This study aimed to explore the perceived preparedness and psychosocial well-being of general ward nurses prior to their deployment into the outbreak intensive care units (ICUs) during the COVID-19 pandemic. BACKGROUND: With the surge in COVID-19 cases requiring ICU care, non-ICU nurses maybe deployed into the ICUs. Having experienced through SARS, hospitals in Singapore instituted upskilling programs to secure general ward nurses' competency in providing critical care nursing. However, no studies have explored the perceptions of general ward nurses on deployment into the ICUs during the COVID-19 pandemic. DESIGN: Qualitative descriptive study. METHODS: The study was conducted at Singapore's epicentre of COVID-19 management. Five focus groups were conducted following purposive sampling of 30 general ward nurses identified for outbreak ICU deployment. Focus groups were audio-recorded, transcribed verbatim and data thematically analysed. This study was conducted and reported in accordance with the COREQ checklist. RESULTS: Three salient themes arose, exemplifying the transition from clinical experts in the general wards to practising novices in the outbreak ICUs. Firstly, 'Into the deep end of the pool' described general ward nurses' feelings of anxiety and stress associated with higher exposure risk and expanded responsibilities to nurse critically ill patients. Secondly, 'Preparing for "war"' illustrated deployed nurses' need for clear communication and essential critical care nursing training. Lastly, 'Call of duty' affirmed the nurses' personal and professional commitment to embrace this transition into the ICUs, and their desire for greater psychosocial support. CONCLUSION: The study findings highlight that though general ward nurses perceived their impending ICU deployment positively, they require ongoing support to facilitate a smoother transition. RELEVANCE TO CLINICAL PRACTICE: Findings provided an evidence base to improve the preparedness of general ward nurses deployed into the ICUs during the COVID-19 pandemic within key areas of training, information dissemination and psychosocial resilience.

Health literacy and patient activation among adults with chronic diseases in Singapore: A cross-sectional study.

AIMS: Increased patient activation levels can improve health outcomes. Hence, this study aims to examine the relationships between sociodemographic variables and domain-specific health literacies with patient activation. DESIGN: A cross-sectional design. METHODS: 200 outpatient adults with chronic diseases completed a survey that assessed their domain-specific health literacy and patient activation levels. Univariate and multivariate analysis of the variables were conducted on patient activation with 95% confidence interval (CI). RESULTS: Multiple linear regression analyses observed a positive linear relationship between the following domain-specific health literacy variables-"actively manage my health" (p < .0001, 95% CI: 0.89-2.29), "understanding health information" (p = .008, 95% CI: 0.28-1.85), and "finding good health information" (p = .02, 95% CI 0.13-1.51) with patient activation. The other sociodemographic and clinical variables were not statistically significant. Increased focus from healthcare professionals is needed on helping patients better find and understand health information and encouraging them to actively manage their health; elements which would raise their activation levels.

Effectiveness of skin cleanser and protectant regimen on incontinence-associated dermatitis outcomes in acute care patients: A cluster randomised trial.

Skin cleansers and protectants protect skin from incontinent matter to reduce the risk of incontinence-associated dermatitis (IAD), but their effectiveness treating established IAD in the tropics is unknown. We conducted an open-label cluster randomised trial to compare the effectiveness of a combined regimen of (1) specialised skin cleansers with disposable body wipes and (2) either an acrylic terpolymer (T1) or zinc oxide (T2) skin protectant against disposable body wipes and zinc oxide protectant (control) in promoting IAD healing and reducing the risk of deterioration. Eighty-four patients were recruited in a tertiary hospital in Singapore between April 2019 and January 2020 (T1: n = 23; T2: n = 37; Control: n = 24). Although not statistically significant, patients treated with T1 and T2 were 1.5 times as likely to experience IAD healing within seven days compared with the control (P = .66). Healing was more pronounced in participants with skin loss treated with T1 or T2. No treatment was superior in preventing IAD deterioration, the prevalence of which remained small (8%-14%). While skin cleaning and protectants reduced the overall risk of skin deterioration, the addition of skin cleansers enhanced IAD healing within a short period, an important consideration for future research examining IAD treatment in acute care.

Effectiveness of simulated patients in geriatric education: A scoping review.

BACKGROUND: Global healthcare systems are adapting to meet the demands of an aging population. It is essential to prepare our healthcare workers on complex and unique issues in the treatment of older adults. Past studies have shown that simulated patients are a valuable teaching tool in training current and prospective healthcare professionals. Few studies have examined its use in the geriatric context. OBJECTIVES: This scoping review presents the effectiveness of simulated patients in healthcare education for geriatric care and eldercare purposes among current and prospective healthcare professionals. DATA SOURCES: Search on CINAHL, Cochrane, ScienceDirect and Medline were completed on studies published between January 2009 to January 2020. A manual hand searching of reference lists for relevant articles was also conducted. REVIEW METHODS: This scoping review follows the methods of Arksey and O-Malley to synthesize the literature on simulated patients in the teaching of geriatric care to current and prospective healthcare professionals. Inclusion criteria were, primary studies, with full-text articles, and in English. RESULTS: Fifteen articles were included in this review. These articles were of wide variation by study design, settings, populations. Four broad themes were identified from existing literature: (i) improvement in geriatric knowledge, (ii) improvement in technical and non-technical skills, (iii) greater confidence in clinical and non-clinical skills, and (iv) learners' perception towards simulation as a learning pedagogy. CONCLUSION: Simulated patients may have potential in improving geriatric education. Students generally enjoyed the learning methodology, finding it engaging and easy to learn by practising. Future studies could consider engaging simulated patients in the teaching pedagogy of geriatric teaching for current or prospective healthcare professionals.

Patient Activation and its Predictors in Hospitalized Older Adults in Singapore.

BACKGROUND: Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AIMS: To explore patient activation and its predictors in hospitalized older adults in Singapore. METHODS: Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. RESULTS: 300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (ß=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care. CONCLUSION: Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.

Effect of an evidence-based poster on the knowledge of delirium and its prevention in student nurses: A quasi-experimental study.

BACKGROUND: A major barrier to nurses adopting evidence-based practice (EBP) has been the limited awareness of evidence underpinning clinical practice, often due to poor access and understanding of the literature base. To address this, we piloted the development of educational posters summarizing the evidence base around clinical practices to see if they help nurses better understand the rationale behind their care. Our first poster focused on the evidence supporting the management of delirium in older persons, specifically delirium identification and its prevention. OBJECTIVE: To examine the effect of an evidence-based poster education on the delirium knowledge of student nurses. DESIGN: A prospective two-armed quasi-experimental study. METHODS: 188 student nurses were recruited in December 2017. Participants were alternated to receive either an evidence-based poster education session or a reflective education session as a control. Both groups were assessed on their general knowledge on delirium, knowledge on delirium detection and knowledge on delirium prevention. This was conducted both before exposure to either the intervention or control, and one week after exposure. Unpaired t-tests with 95% confidence intervals (CI) were applied to compare the mean change in pre-test and post-test delirium knowledge. We used the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist to report our methods and findings. RESULTS: Students in the poster education group reported greater improvements in mean scores of delirium identification (Mean increase = 1.0, p = 0.007, 95% CI: 0.3-1.6), delirium prevention (Mean increase = 1.6, p < 0.001, 9% CI: 1.0-2.2) and overall delirium knowledge (Mean increase = 2.7, p < 0.001, 95% CI: 1.5-3.8) than students in the control. CONCLUSION: Summarised research evidence within a poster format can increase student nurses' access to the evidence base. This has shown to increase their knowledge to guide their clinical practice. IMPACT STATEMENT: Exposure to poster summaries of research evidence underpinning delirium care increases student nurses' clinical knowledge of delirium identification and prevention.

Enrolled nurses' perceptions of providing nutritional care to hospitalised older people in Singapore's acute care setting: A qualitative descriptive study.

BACKGROUND: Malnutrition is a growing challenge in health care as its prevalence among hospitalised older people is expected to intensify alongside the rapidly ageing world's population. Singapore's nursing framework adopts enrolled nurses as the main providers to nutritional care, where nutritional care is a process of screening, assessment, intervention, continuous monitoring and documentation. This is the first Asian study conducted on enrolled nurses' perceptions of nutritional care. OBJECTIVE: To explore enrolled nurses' perceptions of providing nutritional care to hospitalised older people in Singapore's acute care setting. METHODS: This is a qualitative descriptive study. Individual face-to-face semi-structured interviews using an interview guide were conducted with 15 enrolled nurses from September 2017 to January 2018. The collected data were analysed using content analysis. RESULTS: Four main categories were identified as follows: (1) The role of enrolled nurses in the provision of nutritional care, (2) Perceived enablers in nutritional care, (3) Perceived challenges in nutritional care and (4) Proposed strategies to improve nutritional care. CONCLUSION: This study provided insights to the perceived roles of enrolled nurses in nutritional care. It also outlined the enablers and challenges faced by the enrolled nurses and their suggestions to improve nutritional care provision. One critical finding was the need to better engage families and domestic helpers in nutritional care of older people. IMPLICATIONS FOR PRACTICE: To optimise nutritional care delivery, healthcare institutions should explore ways to engage and involve families and domestic helpers during older patients' mealtimes. Nurses could also educate older people, their families and domestic helpers on the importance of nutritional care during hospitalisation.