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To develop and validate the End-of-Life Care Assessment Tool for Dementia (EoLC-ATD).
A methodological study with multiple phases.
Five sub-studies comprising: a review of 90 validated dementia measures to compile an item bank of advanced dementia symptoms; focus groups with registered nurses on advanced dementia symptom identification and relevance of item bank inclusions; Delphi surveys with dementia experts seeking consensus on the EoLC-ATD constructs and items; pilot testing of the EoLC-ATD; and field testing of the EoLC-ATD in persons with dementia.
The item-bank included 180 symptoms, most of which focus group nurses (n = 17) identified as occurring in advanced dementia. Delphi surveys with dementia experts (n = 31) achieved 70% consensus for 25 of 26 EoLC-ATD items. Pilot testing of the EoLC-ATD by two nurses in eight persons with dementia showed good agreement for six constructs (Cohen's Kappa 0.856–0.927) and 26 items (Cronbach's alpha 77.0). An ‘other sympto’ item was included following RN recommendation. The 27-item EoLC-ATD field tested by 17 nurses in persons with dementia (n = 113) accurately identified advanced dementia symptoms (Cronbach's alpha 77.0, p < 0.001). Mortality at 180 days after baseline EoLC-ATD was significant (p < 0.001, area under the ROC curve p = 0.769).
The EoLC-ATD accurately and reliably identified symptoms of advanced dementia.
The EoLC-ATD provides registered nurses with a single measure of advanced dementia symptoms that will help in identifying symptom-responsive palliative care requirements.
The EoLC-ATD will address the current lack of a validated dementia symptom measure for use by aged care home registered nurses to identify unique palliative and end-of-life care needs according to presenting symptoms in persons living with advanced dementia.
STROBE Statement for cohort and mixed methods studies.
An eight-member Expert Advisory Group, which provided guidance and advice throughout the study, was composed of three carers of persons living with dementia, two dementia care clinicians, a dementia care clinical educator, and two dementia clinician researchers.
To discuss reflexivity for conducting hermeneutic phenomenology and to present the hermeneutic phenomenological circle.
Discussion paper.
We employed data on the lived experience of loneliness of older adults in residential care homes during the COVID-19 pandemic to demonstrate the reflexivity required for hermeneutic phenomenology. We showcased a reflective process grounded in Heidegger's notions of Being and temporality to uncover the context of meaningfulness and its temporal influence on being.
We proposed a hermeneutic phenomenological circle encompassing four relations passing between Being, the interpreter and being. The circle was successfully applied to demonstrate the reflexivity required to conduct hermeneutic phenomenology.
Engaging in reflexivity requires the researcher to develop knowledge about the philosophy of hermeneutic phenomenology. The hermeneutic phenomenological circle facilitates researchers in anchoring their reflections in Being and temporality.
The hermeneutic phenomenological circle serves as a useful tool for researchers/health professionals to learn hermeneutic phenomenology and to facilitate researchers/health professionals at all career stages to engage in reflexivity.
Incontinence-associated dermatitis poses a significant risk for sacral pressure injuries, infection and morbidity in healthcare settings. Despite the availability of best practice guidelines, implementation remains a challenge.
To outline the implementation of a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Services framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries.
This is an empirical research study using mixed methods.
The study, conducted across surgical, medical and critical care wards between June and October 2023, aimed to address knowledge gaps, enhance clinical practice and evaluate the effectiveness of interventions. The implementation strategy included education modules, engagement of staff through focus groups and targeted interventions such as individualised toileting plans and structured skin care regimens. Data collection involved audits, incident reporting and clinician knowledge surveys.
Findings indicate a reduction in hospital-acquired incontinence-associated dermatitis and pressure injuries postimplementation, with observed improvements in clinician knowledge. However, challenges including workload, skill mix and resource limitations were identified as barriers to implementation. The sustainability and scalability of the programme were emphasised, with ongoing monitoring and evaluation essential for long-term success.
This study underscores the importance of evidence-based interventions, interdisciplinary collaboration and leadership support in improving patient outcomes and reducing healthcare costs associated with preventable skin injuries. Further research is needed to assess implementation in community settings and scale up interventions across healthcare networks.
Analysing a hospital-wide programme using the Integrated Promoting Action on Research Implementation in Health Service framework to prevent and manage incontinence-associated dermatitis and improve hospital-acquired pressure injuries, could help identify the challenges for delivering patient-centred care.
No patient or public involvement.
To describe the implementation study, we referred to the StaRI Guideline.
Trial Registration: This intervention study was applied to the whole population and was therefore not a trial and did not require trial registration. The study was considered low risk and the Human Research Ethics Application (HREA) was approved
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