Search Results (1,578)

Aim: This study aims to analyze the self-management needs of patients with interstitial lung disease, clarify the types and characteristics of their needs, and provide a scientific basis for nursing staff to formulate personalized continuing care plans. Method: The Q-methodology was adopted in this study. Semi-structured interviews with 13 patients with ILD and systematic literature retrieval were performed to qualitatively explore and summarize patients’ authentic home self-management needs. The Q-set of representative statement items was further established based on the integrated results of interviews and literature analysis. Subsequently, another 15 patients with ILD were enrolled as the P-set to complete the Q-sort ranking of all statement items. By-person factor analysis was conducted to extract potential self-management demand patterns and refine the typology and core characteristics of patients’ self-management needs. Result: Factor analysis identified four common factors, representing four types of home self-management needs in interstitial lung disease patients. These types differ in symptom management, information preferences, and psychological rehabilitation needs, while sharing core common needs. Conclusions: Patients with interstitial lung diseases have both common and individual self-management needs, with no universal model. Nurses should develop personalized continuing care plans to improve care precision and adaptability. Full article

Urogenital toileting practices for residents in nursing homes (NHs) and their implications for the occurrence of bacteriuria remain largely unknown. Our purpose was to assess urogenital toileting practices in NHs in our region and their association with bacteriuria and urinary culture contamination rates. NHs reported on the direction of urogenital cleaning with respect to the urinary meatus and related practices during resident care over 7 years (2017 to 2023). Linear mixed models were used to relate two urogenital cleaning techniques, with bacteriuria rates (positive urinary cultures per resident over a year) and urinary culture contamination proportions. Of the 111 participating NHs, 33% used a technique involving outward cleaning with respect to the urinary meatus. Of these, 50 institutions had 7-year urinary microbiological data available (10,602 cultures, 13,059 isolates). Escherichia coli (45%) was the most frequently isolated microorganism while 12.4% of all cultures were contaminated (>3 microorganisms). We did not observe any significant association between the cleaning technique and the bacteriuria rates. The technique involving outward cleaning away from the urinary meatus was associated with lower odds of urinary culture contamination (odds ratio = 0.15, 95% CI: 0.05–0.48, p < 0.01). Urogenital cleaning techniques varied across participating institutions. We observed an association with urinary culture contamination, but not with bacteriuria rates. These findings warrant further investigation. Full article

Introduction: As diabetes care becomes increasingly digitalized, stratified, and differentiated, psychosocial vulnerability risks becoming less visible within routine care and documentation. To ensure that differentiated care pathways meaningfully incorporate psychosocial stratification, vulnerability must be identifiable, documented, and revisited as part of routine clinical practice. Aim: The aim of this study is to explore how healthcare professionals identify psychosocial vulnerability in routine diabetes care and how such vulnerability is documented and followed up in the electronic medical record (EMR). Methods: This quality improvement audit with a descriptive analysis component was conducted at Steno Diabetes Center Copenhagen as part of the development of a new differentiated outpatient pathway. Healthcare professionals across disciplines submitted cases of persons with diabetes whom they considered psychosocially vulnerable. Documentation from the preceding six months was reviewed descriptively in order to find patterns of identification, documentation, care planning, and follow-up. Results: A total of 334 referrals representing 275 unique persons with diabetes were submitted. Psychosocial vulnerability extended beyond predefined high-risk categories, as 37% of identified cases did not align with any of the six vulnerability groups described in the Danish VIVE framework. Vulnerability often reflected cumulative everyday-life strain rather than formal diagnoses. While healthcare professionals demonstrated substantial relational attentiveness to psychosocial concerns, this knowledge was not consistently evident in formal documentation. Explicit care plans and longitudinal follow-up were uncommon, and psychosocial concerns were frequently documented as isolated observations rather than as part of structured ongoing care. Conclusions: Psychosocial vulnerability was frequently identified through clinical dialogue and professional judgement and often extended beyond predefined vulnerability categories. The findings highlight the importance of developing shared approaches and a shared understanding of psychosocial vulnerability across professional groups. If psychosocial stratification is to become an operational component of differentiated diabetes care, information about what burdens matter to the person must be identifiable, documented, and carried forward across encounters alongside biomedical information. Full article

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses are gaining prominence due to their comprehensive approach and biopsychosocial impact. The objective of this study was to synthesise and integrate such interventions for community-dwelling older adults with CHF. Methods: An integrative review was conducted in accordance with the Joanna Briggs Institute protocols and the PRISMA statement, utilising a systematic search across databases including PubMed and Cochrane. Qualitative, quantitative, and mixed-methods studies evaluating non-pharmacological interventions in the home setting were included, whilst those targeting non-specific populations were excluded. Following a rigorous screening process, 12 studies were selected, and their methodological quality was appraised based on study design. Results: The 12 included studies involved a total of 2466 participants and addressed interventions across the domains of education, physical activity, telehealth, and nutrition, with programme durations ranging from 4 weeks to 16 months. Notable improvements were observed in physical capacity, cognitive function, quality of life, and self-care capabilities, alongside potential reductions in hospitalisations reported in some studies. However, considerable methodological variability was identified across the literature. Conclusions: This review synthesises non-pharmacological nursing interventions for older adults with CHF, demonstrating varied benefits across multiple biopsychosocial domains. The findings emphasise the critical need for further research to evaluate the economic viability of these programmes and to adapt interventions to enhance the delivery of community-based care. Full article

Globally, the growth of ageing populations is significant, with more people requiring supported living environments, including residential aged care (RAC). Given the influence of the environment on health outcomes, it is important to consider approaches to evaluate aged care design, including both the built environment and products and technology. With the overarching aim to identify the scope of RAC-built environment and assistive technology design interventions and the way this data is captured methodologically, this review (i) identified methods and measures used to evaluate RAC-built environment and assistive technology design, and examined populations these methods and measures were used with, and (ii) mapped identified approaches to the International Classification of Functioning, Disability and Health (ICF). An a priori review protocol was developed, and a scoping review was then conducted. Eight databases were searched for publications between January 2000 and February 2023, resulting in 81 included studies, which were then mapped to ICF activity, participation and environment domains. Twenty methods and 16 methodologies were identified. Sixty-one articles collected data directly from resident populations, primarily including older adults (n = 52). Forty-nine publications reported on the evaluation of built design, 23 reported on products and technology, and nine reported on both, but with limited inclusion of valued participation as a goal or outcome. While some participatory methods were identified, 25% of the studies did not include consumer perspectives. Analyzing aged care design can identify ways to facilitate, or remove barriers to, healthier spaces and lives in RAC. Use of internationally recognized terminology and an integrative lens on the relationship between technology and environmental design is recommended. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

Background/Objectives: Norway’s ageing population includes many older adults living alone who receive home care and are at increased risk of loneliness. Loneliness is the subjective sense of unmet or imbalanced social needs, shaped by culture and living conditions, and can be social (lack of contact) or emotional (absence of close, trusting relationships). In older people, it often follows partner or role loss or reduced mobility or participation and is associated with emotional pain, lowered self-worth and poorer health and quality of life. This study aimed to explore patients’ experiences of loneliness while living alone and receiving home care. Methods: Twelve older patients (aged 74–98 years) participated in in-depth interviews, which were analysed using phenomenological-hermeneutical analysis in line with Lindseth and Norberg’s recommendations. Results: The results are presented under the following themes: (I) An overwhelming and painful feeling, (II) A presence without connection, and (III) Experiencing a sense of alienation. Conclusions: This study describes complex feelings of loneliness for the majority of participants, often worsened by poor mobility and shrinking social networks. From the patient perspective, good home care goes beyond practical and medical tasks: patients need to be treated as whole persons, with respect and understanding, to alleviate loneliness. Staffing stability, predictable visiting times, time for conversation, and small acts of kindness are central to well-being and the prevention of loneliness. Municipal healthcare should prioritize relationship-building, communication skills, and organizational solutions that enable continuity and flexibility. Focusing on the patient perspective in planning and evaluation will create better targeted interventions and support dignified ageing. Full article

Objective: This study aimed to evaluate the risk of medical device-related pressure injury (MDRPI) development among patients exposed to medical devices and to assess the clinical utility of the Medical Device-Related Pressure Injury Risk Assessment Scale (MDRPIS). Methods: This clinical assessment study included 132 patients receiving care in intensive care, palliative care, and home-care units. The MDRPIS total score ranges from 8 to 27, with scores of 8–12 indicating high risk, 13–21 indicating moderate risk, and 22–27 indicating low risk. The scale was used to assess MDRPI risk associated with life-sustaining medical devices. Its psychometric performance was evaluated through analyses of internal consistency, criterion validity against the Braden Scale, and diagnostic accuracy using receiver operating characteristic (ROC) analysis. Results: The MDRPIS demonstrated strong discriminative ability for identifying patients at risk of MDRPI, with an area under the curve (AUC) of 0.822. A cut-off score of ≤16 was identified as the optimal threshold for detecting high-risk patients. Patients with MDRPIS scores of 16 or lower had a significantly higher incidence of MDRPI than those classified as low risk (p < 0.001). Respiratory support devices, particularly non-invasive ventilation (NIV)/continuous positive airway pressure (CPAP) masks and tracheostomy flanges or securement devices, were identified as the most significant risk factors for injury development. The highest incidence of MDRPI was observed among patients in intensive care units, followed by those in palliative care and home-care settings, indicating a statistically significant concentration of device-related risk in high-acuity care environments (p < 0.05). Conclusions: Clinical settings, particularly intensive care and palliative care units, should incorporate the MDRPIS into routine risk assessment protocols to facilitate targeted preventive interventions, including prophylactic dressings and advanced fixation techniques for patients using high-risk devices such as NIV masks and tracheostomy securement systems. The systematic implementation of the MDRPIS may support more effective allocation of nursing resources and enhance patient safety by enabling the early identification and prevention of avoidable device-related pressure injuries. Furthermore, the findings indicate that an MDRPIS score of 16 or below represents a clinically meaningful threshold for initiating preventive interventions. Full article

Background/Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent among nursing home residents and represent a major clinical and care-related challenge. These symptoms are frequently associated with increased psychotropic drug use despite limited efficacy and important safety concerns. This study aimed to evaluate longitudinal changes in BPSD and psychotropic drug use following implementation of the “Los Filabres” protocol, a structured person-centered non-pharmacological intervention, in nursing home residents with dementia. Methods: A single-arm longitudinal pre–post observational study was conducted in five nursing homes in Andalusia, Spain, including 204 residents with dementia or cognitive impairment. After staff training, the intervention was implemented over 12 months. Outcomes were assessed at baseline (T0), 6 months (T1) and 12 months (T2) using the Neuropsychiatric Inventory (NPI), including symptom frequency, severity, clinical relevance, and caregiver-related distress. Psychotropic drug use was analyzed according to the Anatomical Therapeutic Chemical classification system. Statistical analyses included Friedman and Cochran’s Q tests, with effect sizes estimated using Cohen’s d and h. The observational nature of the study implies that observed changes may be subject to limitations such as Hawthorne effects. Results: Significant reductions were observed across all global NPI dimensions over time (p < 0.001), including symptom frequency, severity, clinical relevance, and caregiver-related distress. The proportion of participants with at least one clinically relevant symptom decreased from 93.1% at baseline to 35.8% at 12 months (p < 0.001). Significant longitudinal reductions were also observed in psychotropic drug use, with the mean number of psychotropic drugs per participant decreasing from 2.38 to 1.57 (p < 0.001). Reductions were observed in anxiolytic and antipsychotic use, as well as in as-needed prescriptions. Conclusions: The “Los Filabres” protocol was associated with significant longitudinal reductions in BPSD and psychotropic drug use in nursing home residents with dementia. These findings suggest that structured person-centered non-pharmacological interventions based on the identification of unmet needs may help support dementia care and more individualized pharmacological management in long-term care settings. These findings should be interpreted cautiously due to the observational pre–post design and absence of a control group. Full article

Background: Patients with severe chronic anemia often require frequent blood transfusions. Many are elderly with comorbidities and limited mobility, making regular hospital visits burdensome. In some cases, patients may receive transfusions despite hemoglobin levels being above the clinical threshold due to logistical challenges, leading to unnecessary exposure to risks, inefficient use of blood units, and resource strain. This study aims to evaluate the use of point-of-care (POC) hemoglobin measurements under controlled outpatient clinic conditions, as an initial step toward potential future home-based monitoring by the patients or their caregivers, with the goal of optimizing transfusion timing, aiming to reduce unnecessary hospital visits while maintaining patient safety. Methods: A total of 127 patients from a hemato-oncology outpatient clinic at Carmel Medical Center were evaluated using a nurse-operated POC device to sample capillary blood, with 236 paired measurements concurrently analyzed via venous blood in the laboratory. Demographic and clinical data were assessed to evaluate factors associated with agreement between POC and laboratory measurements. Statistical analysis included Bland–Altman plots and Pearson correlation coefficients. Results: The POC device showed a moderate correlation with laboratory results (r = 0.73, p < 0.001), with a mean difference of 1.20 g/dL (SD = 1.94 g/dL) but wide limits of agreement (−3.20 to 5.50 g/dL). No significant differences were observed across demographic or clinical subgroups. Notably, all 156 paired measurements with POC-measured hemoglobin >7 g/dL were confirmed by laboratory testing. Conclusions: Although POC hemoglobin devices are not suitable as standalone tools for routine monitoring of chronic anemia, the high negative predictive value observed at the 7 g/dL threshold suggests that they may be useful for ruling out severe anemia. If validated in larger multicenter and home-use studies, POC Hb devices might contribute to reducing unnecessary hospital visits and transfusions. Full article

Background/Objectives: Polypharmacy is common in elderly nursing home residents (NHR), due to the high prevalence of chronic diseases. This practice increases the risk of clinically significant drug–drug interactions (DDIs) with serious consequences for patient health and safety. The objective of this study was to evaluate the prevalence of DDIs using the UpToDate Drug–Drug Interaction Checker, potentially inappropriate medication (PIM, as defined by the STOPP-START criteria), and their association with major clinical outcomes. Methods: Demographic data, clinical history and detailed medication records of 275 patients from Romania were collected. Potentially inappropriate medications were identified using 16 selected criteria from the 2023 STOPP/START guidelines. Statistical analysis was performed using GraphPad, R, and Python, involving Chi-squared and Fisher’s exact tests with Benjamini–Hochberg correction, linear regression, and drug-interaction network analysis to characterise interaction frequency and severity. Results: Detailed medical histories over the past year were available for 76 patients. The mean number of drugs prescribed was 9.61 ± 4.47 drugs, with an average of 10.68 ± 10.54 potential interactions per patient. The primary clinical outcome was associated with not respecting certain STOPP-START recommendations (p < 0.01). Overall, 33.1% of NHRs utilised herbal supplements, resulting in a total of 76 potential herb–drug interactions. Conclusions: The results suggest a potential impact of DDIs on clinical outcomes, underscoring the need for further studies to clarify causality. The use of STOPP/START recommendations and deprescribing could lead to better tolerability and smaller drug-related burden in the institutionalised, elderly population. Full article

Background: Virtual reality (VR) is a promising technology for the relief of physical and psychosocial burdens. We found that individualised VR videos were well tolerated and accepted and seemed to have a stronger effect on well-being and emotional connection than standardised VR in cancer inpatients under palliative care. For implementation, it is important to actively involve patients, as their input helps to ensure that the VR intervention meets their needs, thus making it more likely to be accepted and effective in practice, while balancing the needs of healthcare professionals. Aim: Exploration of patients’ and healthcare professionals’ perspectives on best practice VR intervention implementation. Design: Workshop-based 360° focus group using a strengths–weaknesses–opportunities–threats (SWOT) model and deductive/inductive qualitative analysis with a ‘framework’ approach. Setting/participants: The focus group took place at the National Centre for Tumour Therapy of a German university hospital. Participants were a local doctor (1) and nurses (3) with VR experience, the cooperating patient advisory board of the study (2), and members of a regional self-help group (3). Results: Eighteen subthemes were identified in the SWOT model. While there was agreement on the ‘strength of distraction’ and ‘opportunities of individualised VR’, concerns remained regarding data protection when using private VR content. There was an argument about gatekeeping by relatives worried about mental distress in patients immersing in home or family VR scenes. In contrast, many ideas were discussed regarding how to overcome rejectionist staff attitudes. However, the high organisational time and staff deployment were addressed as major weaknesses. Conclusions: Involving patient stakeholders and healthcare professionals in the planning of the implementation strategy revealed several issues that require attention. In particular, information needs to be provided not only to patients but also to relatives and hospital staff, alongside ensuring data protection and adequate staffing. Trial registration: Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11 July 2023. Full article

Background/Objectives: Loneliness is a major public health concern in later life and may be especially prevalent among older adults living in nursing homes. Evidence from Spain remains limited regarding modifiable correlates of different loneliness dimensions. This study aimed to describe social and existential loneliness among nursing home residents and examine their associations with sociodemographic, institutional, functional, and psychosocial factors. Methods: We conducted a cross-sectional study in Spanish nursing homes using face-to-face structured interviews with residents aged ≥65 years (n = 139). Social loneliness was assessed with the ESTE-II scale and existential loneliness with the existential loneliness subscale of the ESTE-R. Functional dependence was measured with the Barthel Index. Health literacy, locus of control, institutional variables, and suicidality-related items were also collected. Spearman correlations and multiple linear regression models with BCa bootstrapped 95% confidence intervals (5000 resamples) were used. Results: Social and existential loneliness were moderately correlated (ρ = 0.481, p < 0.001). Greater activity engagement was independently associated with lower social (B = −1.105, p < 0.001) and existential loneliness (B = −0.732, p = 0.029). Receiving visits regularly was associated with lower social loneliness (B = −4.083, p = 0.002), but not existential loneliness. Greater functional independence was associated with lower existential loneliness (B = −0.044, p = 0.023). Conclusions: Activity engagement was a consistent correlate across loneliness dimensions, whereas regular visits were mainly related to social loneliness and functional independence to existential loneliness. These findings support feasible long-term care strategies focused on meaningful activities, relational contact, and functional support. Full article

Background: Long-term care facility (LTCF) residents are highly susceptible to healthcare-associated infections, and prevention is challenging given frailty, dementia, communal living, and resource constraints. Environmental surface and air contamination contribute to transmission. Novel no-touch automated disinfection technologies have been studied in hospitals, but evidence specific to LTCFs is scarce. This scoping review summarizes recent LTCF-focused interventions, their effectiveness, and implementation considerations. Methods: This scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched PubMed, Medline, Embase, CINAHL, and Scopus for observational or experimental studies evaluating environmental disinfection in LTCFs/nursing homes, excluding body decolonization, non-LTCF settings, and reviews/protocols. Two reviewers independently screened and extracted data via Covidence. This review has been registered on OSF (Open Science Framework). Results: Of 1491 records, 7 studies met the inclusion criteria (6 from the USA, 1 from Australia): one cluster randomized trial, one interrupted time series studies, three prospective observational studies, and two pre–post designs. Interventions included physical methods (HVAC-integrated UV/UVGI, continuous UVGI) and chemical approaches (dry hydrogen peroxide, room fogging plus chlorine dioxide wipes, hydrogen peroxide wipes). Outcomes were heterogeneous (surface SARS-CoV-2 RNA, COVID-19 attack/case rates, airborne/surface microbial loads, and one clinical endpoint—acute respiratory illness). Several studies reported reductions in environmental or airborne bioburden; however, UV-based studies did not demonstrate statistically significant reductions in clinical infections. Certainty was limited by small numbers, non-randomized designs, and diverse outcome measures. Conclusions: No-touch automated disinfection methods appear promising as supplements to standard infection prevention control bundles for reducing environmental contamination in LTCFs. Nevertheless, consistent clinical benefits are unproven. Rigorous, LTCF-tailored, adequately powered trials with standardized clinical and environmental outcomes, plus implementation and cost-effectiveness evaluations, are needed. Full article

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable. Full article