Taking action to close the research/practice divide

In this paper we focus at the level of individual project to explore aspects of the nexus between research and practice. Using a research project that sought to explore and understand care transitions for older people as the vehicle for our discussion, we examine how the process by which a research project itself is thought about, conceptualized, developed and conducted influences knowledge translation and ways to get research into practice, and conversely practice into research. Processes and strategies we engaged in throughout this research project to promote the transfer of knowledge both among and between researchers, practitioners and the wider practice community are highlighted.     

Sexuality, health care and the older person: an overview of the literature

Abstract.  This paper reviews recent literature around sexuality, health care and the older person. The construction of sexuality and the importance of sexuality to older people are discussed, as is sexual diversity in old age, and sexuality and health. Also discussed are the myths and stereotypes associated with this topic, and the medical, social, healthcare, and institutional barriers to sexuality and sexual health in later life.     

Delirium and older people: what are the constraints to best practice in acute care?

An Australian research team conducted a six‐month acute care pilot study in a medical ward of a large hospital in New South Wales. Aim. To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Method and design. Participatory action research (PAR) was selected as the best approach for involving ward staff to make sustainable clinical practice decisions. The PAR group comprised research academics and eight clinicians from the ward. Thirteen PAR sessions were held over 5 months. Clinicians described care of patients with delirium. Stories were analysed to identify constraints to best practice. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Relevance to clinical practice. The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department; routine ward activities were not conducive to provision of rest and sleep; assisting with the patient’s orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Clinicians perceived that management driven by length of a patient’s stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. A larger study is being planned across a variety of settings.     

Connecting what we do with what we know: building a community of research and practice

How to think about, develop, maintain and optimize connections between research and practice remains a vexed and contested area in the increasingly complex multidisciplinary and inter-professional practice that constitutes contemporary healthcare and service delivery. A body of literature challenging linear and passive notions of research uptake has emerged which views research uptake as a dynamic, contextualized and active process. This paper explores the development of a successful and exciting community of research and practice involving a university and an aged care organization in Australia. The community of research and practice is premised on dynamic, contextual and active interaction between research and practice; where the categories of research and practice are not mutually exclusive or static; and where community is more than just a structure to facilitate collaborative research projects. It is proposed that the idea of a community of research and practice is a useful one in terms of seeking to better understand and provide strategies for knowledge translation between researchers and practitioners and those who are both.     

Best practice interventions to improve the management of older people in acute care settings: a literature review

AIM: This paper is a report of a literature review of experimental evidence describing interventions to manage the older adult in the acute care hospital setting. BACKGROUND: Older people are increasingly being cared for in a system largely geared towards acute care. This approach is often inadequate to meet the needs of older patients with chronic and complex conditions. In response to these challenges, evidence-based interventions are required to improve health outcomes. METHOD: The MEDLINE and CINAHL databases and the Internet were searched using the keywords elderly, older, geriatric and aged care. Studies published between 1985 and 2006 were included if they reported, in English, a controlled trial of an intervention designed to improve the management of older adults in the acute care setting. The findings were synthesized using the method of a modified integrative literature review. FINDINGS: Only 26 controlled trials met the inclusion criteria. The following elements of interventions appear critical in providing optimal health outcomes for older people admitted to acute care: (1) a team approach to care delivery either directly in a designated unit for older patients or indirectly using gerontological expertise in a consultancy model; (2) targeted assessment techniques to prevent complications; (3) an increased emphasis on discharge planning and (4) enhanced communication between care providers across the care continuum. CONCLUSION: A multidisciplinary team approach, using gerontological expertise, in acute care settings is recommended to improve the care of older patients. Care delivery should occur in a specially designed unit, with communication strategies that emphasize discharge planning.     

The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research

AimThis study aims to discuss how narrative pedagogy of improving the positive attitude toward older people among nursing students and increasing students’ willingness to practice older people's care.BackgroundConsidering the progress of population aging, the requirement for nursing manpower in older people care is on the rise. However, related studies have demonstrated that nursing students generally have a negative attitude toward older people, which affects students’ willingness to engage in older people's care in the future.DesignThis study applied mixed method research design. For the quantitative study design, we have adopted a quasi-experimental study, pretest-posttest design.MethodsThe study adopted purposive sampling. A total of 87 nursing students in two classes of five-year junior college program in northern Taiwan were selected as the study subjects. The students were randomly allocated into an experimental group of 43 subjects and a control group of 44 subjects. The experimental group received narrative pedagogy of geriatric care course for 18 weeks with 2 h per week, the control group received general lectures. This study was conducted between October 2019 and February 2020. The quantitative data were collected using the structured questionnaire. The qualitative data were collected by individual interviews and students’ reflective writing.ResultsThe average scores of the older people's attitude (F=4.60, p < 0.05) and the willingness to care for the older people (F=4.19, p < 0.05) in the experimental group increased significantly, reaching a statistically significant level. According to the adjusted post-test score averages of the two groups, under the control of the pre-test, the Older Adults Attitude Scale (64.02 >60.22) and the post-test of the Older Adults Care Willingness Scale (11.63 >9.93) in the experimental group were significantly higher than those in the control group. In the qualitative analysis, four themes were emerged, which were negative stereotypes about the older people, myth-breaking for prejudice against the older people, new older people impression for replacement and rethinking for older people care.ConclusionNarrative pedagogy is an effective teaching method, which can improve nursing students' older people's positive attitudes and increase students’ willingness to practice older people's care.     

Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people

mccormack b., dewing j., breslin l., coyne-nevin a., kennedy k., manning m., peelo-kilroe l., tobin c. & slater p. (2010) Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing 5 , 93–107 Aim. To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. Design. The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the ‘Person-Centred Nursing Index’. Findings. Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses’ perceptions of caring, indicating a shift from a dominant focus on ‘technical’ aspects of care, to one where ‘intimate’ aspects of care were more highly valued. Relevance to clinical practice. The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships.     

Using action research in nursing practice with older people: democratizing knowledge

Aim. This paper reports on an action research study which raised some questions about the processes of developing a sense of shared ownership in action research in a research environment which does not always have the appropriate mechanisms to support and sustain action research. Background. Action research has gained popularity in nursing and healthcare research, offering a way of developing practice‐based knowledge, which can assist in changing practice and democratizing inquiry. Methods. There are other organizational constraints on action research which arise at different levels, and which also require discussion. These can be issues about communication and ownership at a practice level and issues of funding and project management procedures. This paper reports on a study in which these issues came to the fore, and offers some thoughts on how they can affect the processes of action research. Conclusion. While the principles of action research appear to offer much towards the development of a practice‐rooted body of knowledge for nursing, unless some of the issues of ownership are resolved, it is unlikely to move beyond academic rhetoric. Relevance to clinical practice. If nursing is to engage in action research, this must be done critically and reflectively and careful attention paid to developing an inclusive and collaborative approach to knowledge and practice development. Furthermore, to develop in nursing and health care research, it must find ways to meet the requirements of funding bodies.     

Factors influencing older patients' participation in care: a review of the literature

lyttle d.j. & ryan a. (2010) Factors influencing older patients’ participation in care: a review of the literature. International Journal of Older People Nursing 5 , 274–282
doi: 10.1111/j.1748-3743.2010.00245.x Background. Over the past 10 years, there has been an increase in the literature promoting patient involvement in health care at all levels of the decision-making process. Aim. To review the literature on factors influencing patient participation in care with a particular focus on the perspective of older people. Method. Various search engines were used to conduct the review and articles were identified through the following databases; CINAHL, CSA ILLUMINA, Science Direct, Blackwell Synergy, the Cochrane Library, OVID, SAGE, AHMED, BNI and MEDLINE. Research studies ranging from 2000–2007 were selected for inclusion on the basis that they investigated patient participation and/or older peoples’ involvement in health care. Findings. Seven key themes emerged from the literature: the concept of participation, the need for older people to be involved, autonomy and empowerment, patients’ expectations, benefits of participation, factors influencing participation and precursors to participation. Conclusions. Although patient participation has received considerable attention in the literature, this review highlights the dearth of research from the perspective of older people. There is a general consensus that preference for participation should be assessed and not assumed, and the review offers a sobering reminder that participation should not be achieved at the expense of patient autonomy and choice. Relevance to practice. Quality care and the most productive use of resources are dependent on the public’s engagement with health service providers. However, despite being central to contemporary nursing practice, this review suggests that the reality is not matched by the rhetoric. Future initiatives should focus on supporting nurses and other healthcare professionals to develop the competencies required to facilitate greater participation by older people who wish to become more involved in their care.     

The meaning of good and bad care in the community care: older people's lived experiences

In spite of a considerable body of research in the past decades on what does or does not constitute good care for older people, there are still few studies addressing this question in which older people narrate their experiences of being dependent on community care. This study was therefore carried out aiming to explore older people's lived experiences of what good and bad care meant to them, when it was offered by community care services. Nineteen older persons in three Swedish communities participated in the study, which used a phenomenological–hermeneutic approach. Data were collected through unstructured interviews and Colaizzi's framework was utilized in the analysis of the data.
The key theme arising from the analysis was that of being encountered as a human being by caregivers who, through the provision of safe and secure care, provide opportunities for living life as usual. When any of these circumstances are lacking, bad care will be the consequence. As the general intention in society is to ensure good quality of care to older people as well as others, the findings in our study should have important implications for providers of community care for older people.     

Research use in the care of older people: a survey among healthcare staff

Background. Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community‐based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design. The overall aim of this cross‐sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method. Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results. Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions. Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice. There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence‐based practice that involves the EN/NA group.     

Models of mental health care for older adults: a review of the literature

Aim.  This paper reviews literature that draws on models of mental health care for older adults.
Background.  It is predicted that as a consequence of the aging of the population the incidence of mental health disorders, common in older populations, will also rise. Many such disorders can be successfully managed if detected early. Assessment and management requires collaboration between health professionals who are skilled and educated in the management of older adults with mental illness and the use of models of care appropriate to this population.
Results.  The paucity of research in this area is demonstrated.
Conclusion.  The need for mental health nurses to challenge current models of mental health care for older adults is identified so that they take on an expanded and developed specialist role in care of older adults with mental illness.     

Supportive care for older people with frailty in hospital: An integrative review

BackgroundGrowing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care.AimTo identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation.DesignAn integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term ‘supportive care’. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken.Data sourcesLiterature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n = 52) were integrated using synthesis of themes.ResultsRelevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings.ConclusionThe findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.