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AnteayerInternacionales

COVID‐19 preparedness in aged care: A qualitative study exploring residential aged care facility managers experiences planning for a pandemic

Abstract

Aims and Objectives

The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID-19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise.

Design

An interpretive descriptive study design was employed, and data were collected using semi-structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID-19 response in RACFs.

Methods

RACF clinical managers were invited to discuss their responses to COVID-19 including the management of RACF and staff. Semi-structured interviews explored the COVID-19-related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne's (2008) three-stage process of interpretive description. The COREQ checklist was used in preparing this manuscript.

Results

Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology.

Conclusion

Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world.

Relevance to Clinical Practice

Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID-19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.

Using FRAME Documentation to Achieve RE‐AIM Goals During Iterative, Stakeholder‐Engaged Refinement of a Family Management Intervention for Parents of Preterm Infants

ABSTRACT

Aims

To co-identify adaptations with key stakeholders needed to optimise elements of a video-based intervention (i.e., PREEMIE PROGRESS [PP]), which trains parents in evidence-based family management skills to care for their very preterm infant in the neonatal intensive care unit (NICU).

Design

Descriptive qualitative study oriented with a pragmatic philosophy, informed by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and the framework for reporting adaptations and modifications-expanded (FRAME).

Methods

Semistructured interviews to identify potential adaptations with key stakeholders: family management researchers (n = 5), clinicians (n = 9), technology experts (n = 5) and parents of preterm infants (n = 17). Weekly design team meetings to select and implement high-priority adaptations necessary for the next research phase. Monthly NICU parent partnership meetings to review adaptations and make recommendations for potential adaptations with conflicting data.

Results

Stakeholders (N = 36) suggested 98 potential adaptations: 32 (33.0%) were completed, 8 (8.2%) were abandoned, 5 (5.2%) have work that is ongoing and 52 (53.6%) were tabled for future research phases. Content adaptations (70, 71.4%) were the most frequently suggested adaptation type. Potential adaptations mostly addressed RE-AIM dimensions of effectiveness (43, 43.9%), and implementation (46, 46.9%) and were directed at the parent (i.e., intervention recipient) level (79, 81.4%).

Conclusion

Use of the RE-AIM framework ensured we systematically identified needed adaptations with key stakeholders across a range of dimensions that would improve PP for parents now and in future phases of this research.

Implications for the Profession

Co-identifying potential adaptations with key stakeholders, paired with FRAME documentation, can help nurses prioritise adaptations most appropriate for each phase of implementation.

Impact

Our paper highlights for nurse clinicians and researchers how FRAME documentation of potential adaptations can support stakeholder engagement and a systematic approach to incorporating adaptations throughout all phases of the research process, thereby shortening the evidence to practice gap.

Reporting Method

COREQ guidelines for qualitative reporting.

Patient/Public Contribution

The research team was supported by members of the NICU's Parent Partnership Council (PPC), whose mission is to promote family-centred care improvement projects and research within the NICU. This committee is comprised of nursing, physician, allied health leadership and parents of infants previously hospitalised in the NICU. The NICU PPC met monthly to review conflicting data on potential adaptations and provide recommendations on adaptation decisions.

Exploring Post‐Fall Management Interventions in Long‐Term Care Facilities and Hospitals for Older Adults: A Scoping Review

ABSTRACT

Background

The population is rapidly growing, significantly impacting healthcare settings such as hospitals and long-term care. Falls are a major concern, being a leading cause of hospitalisations and injuries especially among adults aged 60 and above. Despite extensive research on falls prevention and risk factors, there is limited study on effective post-fall management strategies, making it crucial to review and develop interventions to improve care and safety for older adults in healthcare settings.

Aim

To explore the interventions implemented for post-fall management for residents and patients within healthcare settings, including hospitals and long-term care facilities.

Design

A scoping literature review.

Methods

We used the Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). Eligible articles included hospital and long-term care post-fall management interventions. Data were manually extracted by two independent reviewers using the AACTT (Actor, Action, Context, Target and Time) Framework to detail intervention characteristics and guide the data charting process, allowing for thematic analysis and narrative synthesis of key findings.

Data Sources

Medline, CINAHL, PsychINFO and Scopus were searched from inception until 30th September 2024.

Results

Eighteen articles were included. Over half the studies (55.5%) focused on post-fall interventions in LTCFs, testing assessment tools (50%), structured protocols (27.7%), huddles (11.1%) or multifactorial approaches (11.1%), with varied effectiveness. While assessment tools and huddles showed mixed results, structured protocols showed encouraging results with reduced unnecessary hospital transfers and hospitalisations.

Conclusion

This scoping review identified a variety of interventions used after falls in healthcare settings. However, there is inconclusive evidence about the effectiveness of interventions to reduce hospitalisation and injuries. This review identified areas for research that may help to inform post-fall management, including the need for further research into various interventions (e.g., standardised toolkit) to enhance care immediately following a fall.

Patient or Public Contribution

No Patient or Public Contribution.

Implementation of an external female urinary catheter strategy on prevention of skin breakdown in acute care: A quality improvement study

Abstract

Aim(s)

To evaluate the incidence of skin-related complications attributable to incontinence-associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care.

Design

Multicenter quality improvement study.

Methods

Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines.

Results

Three hundred and eighty-one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown.

Conclusion

The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention.

Impact

Significant negative outcomes are associated with UI patients. External female urinary catheters are a non-invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD-related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown.

Patient Contribution

Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care.

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