Predictors of regular exercise among older residents of long‐term care institutions

The purpose of this study was to apply self‐efficacy theory to explore predictors of regular exercise among older residents of long‐term care institutions. Convenience sampling was used to collect data from 151 older adults residing in three residential care homes in Taiwan. Data collection instruments included a background data sheet, Self Efficacy for Exercise Scale, Outcome Expectations for Exercise Scale and self‐reported regular exercise. Results indicated that older residents who exercised regularly had fewer chronic diseases, better perceived health status and functional status, and higher self‐efficacy expectations and outcome expectations related to exercise. Older residents with a regular exercise habit prior to institutionalization were more likely to engage in regular exercise. Logistic regression analysis indicated past exercise participation and self‐efficacy expectations to be significant positive predictors of regular exercise. To promote regular exercise within this population, these can be potential target areas for interventions. These factors should be targeted in the development and implementation of interventions to promote regular exercise among older residents of long‐term care institutions.     

Long‐term patient outcome 10 years after video‐assisted thoracoscopic surgery lobectomy for non‐small‐cell lung cancer

Introduction: Although there have been many reports associating video‐assisted thoracoscopic surgery (VATS) with improved survival rates in early lung cancer, almost all of the reports have involved short median follow‐ups and been presented at a 5‐year point. Here, we establish the pattern and frequency of recurrences, as well as the long‐term survival rates of patients who have undergone VATS more than 10 years ago. Methods: We retrospectively studied 41 patients who underwent VATS lobectomy for clinical stage I non‐small‐cell lung cancer at Fukuoka University Hospital between November 1994 and December 1999. All patients underwent lobectomy, including a dissection of hilar and mediastinal lymph nodes. Follow‐up consisted of clinical and radiological examinations every 3 months for the first 2 years after the surgery and then once a year thereafter. Results: Of the 41 patients, 31 were diagnosed to be at pathologic stage IA and six at stage IB, while the remaining four were more advanced cases. During the follow‐up period, recurrences were found in five cases (12.2%). Four patients with recurrence died of lung cancer and an additional two died from cancers of other organs. There were other non‐cancer related deaths, largely from respiratory failures. Overall, the 5‐ and 10‐year survival rates after the operation were 79.8% and 68.8%, respectively. Conclusion: Long‐term survival and recurrence rates after a classic VATS lobectomy for lung cancer are favorable compared to the conventional approach.     

Appreciating the ‘person’ in long‐term care

Background. Internationally, approaches to the long‐term care of older people are changing. New models are being developed that aim to de‐institutionalise care settings, maximise opportunities for older people to participate in decision‐making and move from a predominant medical model of care to one that is community orientated. Aims. The aim of this study is to highlight similarities and differences between the different models that exist and explore the implications of these for the role of the registered nurse in long‐term care. Methods. We chose three models for review as these represent a range of views of person centredness, each having distinct roots and focus. The models chosen were as follows: (i) culture change, (ii) person‐centred practice and (iii) relationship‐centred care. Results. The review highlights two key issues – (i) the distinctiveness of different models and frameworks and (ii) different interpretations of ‘person’. Firstly, we identify a disconnection between espoused differences between models and frameworks and the reality of these differences. The evidence also identifies how some models and frameworks adopt a more inclusive conceptualisation of person and personhood and do not define personhood in relation to role (resident, nurse and family member). Conclusions. There is merit in the development of models and frameworks that try to make explicit the different dimensions of person centredness in long‐term care. However, the focus on the development of these, without sufficient attention being paid to evidence of best practices grounded in the concept of personhood, person‐centred care is in danger of losing its original humanistic emphasis. Further, models and frameworks need to take account of the personhood of all persons. Implications for practice. Registered nurses need to have an understanding of the concept of personhood to make sense of the various person‐centred practice frameworks that exist. Without this understanding, there is a danger that the essence of personhood may be lost in the zeal to implement particular models and frameworks.     

Patient‐centeredness in long‐term care of older patients – a structured interview

Aim. The aim of this study was to describe assessments of older people about patient‐centeredness in the long‐term care of Estonian hospitals, and to determine correlations between patients’ assessments and their socio‐demographic characters. Background. Patient‐centeredness increases patients’ satisfaction and enhances their recovery. Still, patients’ opinions are not always taken into account. Method. A cross‐sectional study included 111 older people in long‐term care of 14 Estonian hospitals. Data were collected in 2008 by means of structured interviews. Results. What patients agreed most was that they were given enough opportunity to carry out activities they were capable of performing themselves. Two thirds of participants had not been sufficiently consulted on who would be providing their care. Half of the participants were not given sufficient opportunity to decide what kind of care was needed and how they would receive it. The more assistance patients needed in daily living activities, the less they considered the care as patient‐centred. Conclusions. From the perspective of older people, the patient‐centeredness in Estonian long‐term care is above average. Providing patient‐centred long‐term care in Estonian hospitals deserves more attention. Relevance to clinical practice. Older people should be more involved in decision‐making, especially those who need more assistance in daily living activities.     

Management of Port‐A‐Cath Devices In Long‐Term Acute Care Hospitals

A reliable means of maintaining an intravascular access device (IVAD) is an important aspect of care for a patient in a long‐term acute care (LTAC) setting. Overall, various authors have confirmed that complication rates are lower with use of an IVAD. The key to this success in low complication rates appears to be a team approach to catheter care and management. In our unique practice setting, LTAC, we have over 20 years of experience with IVAD care and management. In an extensive 15‐year retrospective review of the IVAD care, we found very low rates of complications, including infections. This is directly related to a team approach to catheter care, protocol development, employee education, and postoperative management.     

Survived so what? Identifying priorities for research with children and families post‐paediatric intensive care unit

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face‐to‐face, multiple‐stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family‐centred. Children and young people advisors reported priorities that focused on longer‐term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer‐term functional and psycho‐social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors and illuminates differences in proposed priorities between children, young people and adult advisors.     

Long‐Term Care Quality‐of‐Life Scale utility in community home care

This study aimed to test the utility of the Long‐Term Care Quality‐of‐Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality‐of‐Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long‐Term Care Quality‐of‐Life scale to have good test–retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long‐Term Care Quality‐of‐Life and World Health Organization Quality‐of‐Life scales' scores suggesting moderate‐to‐strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long‐Term Care Quality‐of‐Life scale monitoring in home and residential care can identify opportunities for quality‐of‐life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality‐of‐life assessment scale that can be used across care contexts to support evidence‐based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.