Care of patients with leg ulcers: A nursing perspective

Care of patients with leg ulcers is challenging as well as rewarding. Recent advances in scientific knowledge about healing should be incorporated in the nursing care of leg ulcer patients. This article provides an update on the state of the science in the care of leg ulcers in geriatric patients, and focuses on assessment and local care of such ulcers. Ulcer assessment provides the basis for selecting therapies to maximize healing. Wound cleansing and appropriate dressings are essential to good patient outcomes. Furthermore, healing is enhanced when these interventions are combined with strategies that maximize oxygen to the ulcer, promote appropriate levels of activity, optimize perfusion through physiological positioning, and reduce mechanical shear through selection of proper footwear. Care of patients with leg ulcers provides the nurse an opportunity to apply pathophysiology, utilize scientific data, and function as an integral player on the wound care team.     

Persistent Delirium Predicts Greater Mortality

OBJECTIVES: To examine the association between persistent delirium and 1-year mortality in newly admitted post-acute care (PAC) facility patients with delirium who were followed regardless of residence.
DESIGN: Observational cohort study.
SETTING: Eight greater-Boston skilled nursing facilities specializing in PAC.
PARTICIPANTS: Four hundred twelve PAC patients with delirium at admission after an acute hospitalization.
MEASUREMENTS: Assessments were done at baseline and four follow-up times: 2, 4, 12, and 26 weeks. Delirium, defined using the Confusion Assessment Method, was assessed, as were factors used as covariates in analyses: age, sex, comorbidity, functional status, and dementia. The outcome was 1-year mortality determined according to the National Death Index and corroborated using medical record and proxy telephone interview.
RESULTS: Nearly one-third of subjects remained delirious at 6 months. Cumulative 1-year mortality was 39%. Independent of age, sex, comorbidity, functional status, and dementia, subjects with persistent delirium were 2.9 (95% confidence interval=1.9–4.4) times as likely to die during the 1-year follow-up as subjects whose delirium resolved. This association remained strong and significant in groups with and without dementia. Additionally, when delirium resolved, the risk of death diminished thereafter.
CONCLUSION: In patients who were delirious at the time of PAC admission, persistent delirium was a significant independent predictor of 1-year mortality.     

Establishing and sustaining an acute care for elders unit: An incremental journey to success

Acute Care for Elders (ACE) units reduce hospital-associated delirium, functional decline, and lengths of stay. However, establishing and sustaining such units have proven difficult. There are only 43 ACE units among the >3500 hospitals in the United States. This study describes an iterative quality improvement process, which allowed us to establish and sustain an ACE unit care model in a modern academic hospital. This continuous process was centered on implementing the key principles of the ACE unit model of care: patient-centered care assessments, medical care review, specialized prepared environment, early mobilization, physical therapy, and early planning for discharge to home. Quality of care and patient outcomes data for older adults admitted to our ACE unit includes mortality index (observed/expected) consistently <1 (FY22 = 0.86), 30-day readmission rate of <10% (FY22 9.31%), and length of stay index of ~1 (FY22 1.07). We describe how work on our ACE unit has led to hospital-wide initiatives, including dementia-friendly hospital certification. Our hope is that others can use this process to enhance the dissemination of the ACE unit model of care.     

The University of California at Los Angeles Alzheimer's and Dementia Care Program for Comprehensive,Coordinated, Patient‐Centered Care: Preliminary Data

Dementia is a chronic disease that requires medical and social services to provide high‐quality care and prevent complications. As a result of time constraints in practice, lack of systems‐based approaches, and poor integration of community‐based organizations (CBOs), the quality of care for dementia is poorer than that for other diseases that affect older persons. The University of California at Los Angeles (UCLA) Alzheimer's and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient‐centered care for individuals with Alzheimer's disease and other dementias. The goals of the program are to maximize function, independence, and dignity; minimize caregiver strain and burnout; and reduce unnecessary costs. The UCLA ADC program consists of five core components: recruitment and a dementia registry, structured needs assessments of individuals in the registry and their caregivers, creation and implementation of individualized dementia care plans based on needs assessments and input from the primary care physicians, monitoring and revising care plans as needed, and around‐the‐clock access for assistance and advice. The program uses a comanagement model with a nurse practitioner Dementia Care Manager working with primary care physicians and CBOs. Based on the first 150 individuals served, the most common recommendations in the initial care plans were referrals to support groups (73%) and Alzheimer's Association Safe Return (73%), caregiver training (45%), and medication adjustment (41%). The program will be evaluated on its ability to achieve the triple aim of better care for individuals, better health for populations, and lower costs.     

Paediatric resuscitation for nurses working in Ghana: an educational intervention

BRENNAN M.M., FITZPATRICK J.J., MCNULTY S.R., CAMPO T., WELBECK J. & BARNES G. (2013) Paediatric resuscitation for nurses working in Ghana: an educational intervention. International Nursing Review 60 , 136–143 Background: Deficiencies in the paediatric emergency systems of developing countries may contribute to avoidable paediatric mortality. Studies suggest that nurses and doctors may not be educationally prepared to provide immediate paediatric resuscitative care to acutely ill children. The purpose of this study was to determine if a 1‐day World Health Organization (WHO) Emergency Triage and Assessment Treatment (ETAT) Program in paediatric resuscitation would increase Ghanaian nurses' knowledge and self‐efficacy of paediatric resuscitation. Methods: A pre‐experimental, one‐group, pre‐test, post‐test design was used to assess differences in the nurses' knowledge of paediatric resuscitation, and their perceived self‐efficacy of paediatric resuscitation after completing a 1‐day educational intervention in paediatric resuscitation. Forty‐one nurses from a public teaching hospital in Ghana were recruited and participated in the study. Results: Using a paired samples t‐test, there was a statistically significant increase in the nurses' perceived self‐efficacy of paediatric resuscitation in general (P < 0.000), perceived self‐efficacy of bag and mask ventilation (P < 0.000), and knowledge of paediatric resuscitation (P < 0.000). Conclusions: Findings from this study suggest that a 1‐day WHO ETAT Program may increase self‐efficacy of paediatric resuscitation and knowledge of paediatric resuscitation. Clinical Relevance: Policy makers in Ghana need to consider implementing education programmes in paediatric resuscitation for nurses as part of a comprehensive strategy to improve emergency systems and address preventable and avoidable infant and child mortality.