Reablement in a community setting

Abstract

Purpose: When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults. Methods: Ninety-one older adults (80?±?9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310–592?d) using the ADL-Interview (ADL-I). Results: Overall, ADL ability improved significantly over time (p?=?0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p?=?0.042) and were maintained at follow-up 10 months after intervention (p?=?0.674). There were no effects related to age (p?=?0.787) or to whether the older adult had received help previously (p?=?0.120). Conclusion: A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program.

• Implications for Rehabilitation

• Older adults, motivated for obtaining independence within performance of ADL tasks, will potentially benefit from participation in the reablement program.

• Older adults, already receiving home care services, will also have the potential to benefit from participation in the reablement program.

     

Karomed armchairs and cushions in the prevention of pressure ulcers

The clinician providing seating for patients who are unwell, who have poor functional ability or who are at risk of pressure sores, is faced with an increasing choice of products. Making the decision as to which product and associated features to choose can be a difficult task. This article describes the importance of suitable seating provision in patients who are at risk and outlines the Karomed range of armchairs.     

Interface shear and pressure characteristics of wheelchair seat cushions

Pressure ulcer incidence rates have remained constant despite advances in support surface technology. Interface shear stress is recognized as a risk factor for pressure ulcer development and is the focus of many shear reduction technologies incorporated into wheelchair cushions; however, shear reduction has not been quantified in the literature. We evaluated 21 commercial wheelchair seat cushions using a new methodology developed to quantify interface shear stress, interface pressure, and horizontal stiffness. Interface shear stress increased significantly with applied horizontal indenter displacement, while no significant difference was found for interface pressure. Material of construction resulted in significant differences in interface shear stress, interface pressure, and horizontal stiffness. This study shows that the existing International Organization for Standardization (ISO) 16840-2 horizontal stiffness measure provides similar information to the new horizontal stiffness measure. The lack of a relationship between interface shear stress and the overall horizontal stiffness measure, however, suggests that a pressure and shear force sensor should be used with the ISO 16840-2 horizontal stiffness measure to fully quantify a cushion's ability to reduce interface shear stress at the patient's bony prominences.     

Developing a journal club in the community setting

Nurses are required to deliver care based on current evidence, best practice and, where it is available, validated research. A senior staff nurse in an 18-bed community hospital in North Bradford primary care trust identified a gap whereby there were no defined processes to address the lack of evidence-based material, look at new evidence or provide a forum to discuss new ideas. Following a meeting with the trust's research facilitator, the idea of setting up a journal club began to take shape. Funding was obtained via a small grant from the Foundation of Nursing Studies. Various approaches were undertaken to increase attendance, and although the purpose of establishing a journal club within a community setting was clear, the reality was very different. A new approach was eventually found to be successful, and is described here so that it may help other people in similar settings develop and run a journal club.     

Percutaneous dilatational tracheostomy in a community hospital setting

BACKGROUND: Over the past 15 years, many large university hospitals have reported their experience with percutaneous dilatational tracheostomy (PDT). The purposes of this study are to evaluate the safety of PDT in a non-university hospital setting and to compare our results with those published in the literature. METHODS: The study was done by retrospective chart review. RESULTS: Over a 6-year period, 300 PDTs were done in two community hospitals in Tyler, Texas. There was one death and 12 complications. Comparison of our results and those reported in five recently published articles in the literature showed no significant difference in mortality rate, pneumothorax, bleeding, paratracheal placement, dislodgement, or cellulitis. There was a trend toward a significantly lower incidence of paratracheal placement using bronchoscopic guidance. CONCLUSION: Bedside PDT with bronchoscopic guidance can be safely done in a community hospital setting.     

Multidisciplinary approaches to reducing error and risk in a patient care setting

In 1995, a medication error at Boston's Dana-Farber Cancer Institute (DFCI) that received intense media scrutiny, transformed the Institute in many ways. Primarily, patient safety became a major priority that led to Institute-wide organizational learning. As a result, DFCI emerged as a national leader in the patient safety movement. A key factor believed to have contributed to this effort was the use of a multidisciplinary team approach to identifying and preventing errors, with the patient and family members as an integral part of the team. In addition to teamwork, other activities included implementing a new chemotherapy order entry system, transforming the culture to a non-punitive one where staff are encouraged to openly discuss errors and safety issues, and introducing a root cause analysis process for error/near miss investigations. Several guiding principles served as the foundation for the efforts including: 1) systems, not individuals, must be the focus of safety initiatives; 2) organizations must create a non-punitive culture; 3) changes must be hard-wired into systems; and 4) multidisciplinary participation, including patients and families, is critical to success.     

Implementing a high-fidelity simulation program in a community college setting

Despite their relatively high cost, there is heightened interest by faculty in undergraduate nursing programs to implement high-fidelity simulation (HFS) programs. High-fidelity simulators are appealing because they allow students to experience high-risk, low-volume patient problems in a realistic setting. The decision to purchase a simulator is the first step in the process of implementing and maintaining an HFS lab. Knowledge, technical skill, commitment, and considerable time are needed to develop a successful program. The process, as experienced by one community college nursing program, is described.     

Priorities in nursing management of fistulas in a community setting

The aim of this article is to discuss care in the community of patients with a fistula. Areas considered include definition and classification of fistulae, potential causal factors and associated diseases. The article concentrates on enterocutaneous fistulation and the care of patients, but also includes a summary about caring for a patient with an anal fistula. The essential elements of nursing in a community setting are described, and information given on skin care, nutrition, fluids and appliances.     

A comparison of interface pressure readings to wheelchair cushions and positioning: a pilot study.

Occupational therapists are often involved in assessing the seating needs of clients who have quadriplegia. One component of this process involves determining the appropriate use of wheelchair cushions and pressure relieving techniques in the prevention of pressure sores. The purpose of this study was to assess the effect of tilt and recline positioning and various wheelchair cushions on interface pressures at the ischial tuberosities and the sacrum of two subjects with C5 quadriplegia. In addition, interface pressures under bony prominences were assessed in the personal driving position (when the subject enters), neutral, 35 degree tilt, 45 degree tilt, and maximum recline (150 degrees). The results of this study indicate that for the two subjects evaluated, higher average interface pressures at the ischial tuberosities were obtained when using one of the three cushions under scrutiny. Furthermore, the general trend observed with both subjects is a reduction of pressure readings at the ischial tuberosities with tilt and recline positioning (especially with 45 degree tilt and 150 degree recline). The findings of this study are in keeping with previous studies which identified that individual and ongoing assessment is essential in providing the best cushion and pressure relief techniques for individuals.     

Comparison of three wheelchair cushions for effectiveness of pressure relief.

OBJECTIVE: Previous studies have suggested that no single wheelchair pressure-relieving cushion material was optimal for all persons with spinal cord injury (SCI). The purpose of this study was to compare the effectiveness of the short-term pressure-relieving ability of the three most commonly prescribed wheelchair cushions (Roho, Jay, Pindot) for a person with SCI. METHOD: The number of pressure sensors registering at the buttock-cushion interface during wheelchair sitting was measured by the Xsensor Pressure Mapping System after 5 min of sitting. An alternating treatments research design, with an initial baseline and a final treatment phase ending with the most effective cushion for relieving pressure, was used for the clinical evaluation. Measurements were compared using visual inspection and a Wilcoxon signed ranks test. RESULTS: Data analyses indicated that the number of pressure sensors that registered potential harmful levels of pressure at the buttock-cushion interface for the Roho cushion was significantly less than those of the Jay and Pindot cushions. CONCLUSION: The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.     

Student-client relationships in a community health nursing clinical setting

Community-campus partnerships enrich community health nursing curricula in schools of nursing throughout the United States and elsewhere. The York College of Pennsylvania Department of Nursing entered into a collaborative relationship with the local housing authority to provide the nursing component for a nurse-managed Wellness Center that provides a clinical learning site for students in the senior-level community health nursing course. Students work with clients over a seven-week period. Findings after one year indicate that experience in this clinical setting enables students to apply the theoretical concepts of the community health nursing course and learn about the development of the nurse-client relationship.     

Performing breast cancer risk assessments in a community setting

This article describes the implementation of a risk assessment program for women having screening mammography at a community center. The program used the National Cancer Institute's Breast Cancer Risk Assessment Tool to raise awareness in high-risk women. An evidence-based process is essential when implementing changes in clinical practice to overcome challenges and barriers.     

Reducing pressure ulcer incidence in a long-term setting

Selection of appropriate pressure prevention equipment relies on risk assessment and clinical assessment of the resident/patient. Decisions are then made in combination with manufacturer's recommendations, such as interface pressure testing. However, risk assessments can over-predict and laboratory investigations do not necessarily provide an accurate picture of how individual patients will react to pressures from support services. There are few studies on visco-elastic mattresses and their benefits in reducing pressure ulcer incidence. Therefore, a small study was undertaken to review the efficacy of a pressure-reducing visco-elastic foam mattress. For the benefit of the study, a 20-bedded nursing home was provided with 20 visco-elastic mattresses (Pressurease) and 20 pressure-reducing cushions (Mediform Visco). The study aimed to demonstrate a reduction in pressure ulcer prevalence. The study involved 21 residents over a 6-month period. There was a 58.3% prevalence (of Stirling grade 1-2 pressure damage) at trial initiation. The results showed an 85.7% decrease of pressure ulcers within 4 weeks, and an overall decrease of 82.5% over the 6-month period. Comfort levels, scored by residents on a visual analogue scale, demonstrated the Pressurease mattress to be superior to the nursing home standard mattress.