Empowerment of learning and knowledge: Appreciating professional development for registered nurses in aged residential care

Continued education and professional development ensures nursing competence and contributes positively to quality health outcomes, however it must also include a professional pathway that challenges the contextual confrontations faced by registered nurses within the workplace environment. This is especially relevant for the nursing workforce employed in the Aged Residential Care sector. This research was undertaken in New Zealand and uses Appreciative Inquiry to ‘Appreciate the professional development needs of registered nurses working in the sector’.The findings highlighted the uniqueness of the sector, along with the diversity of the nursing workforce which signals the need for ongoing formal and informal professional development methods. Currently, professional development and learning is not assimilated well into the sector and there remains a void in terms of a professional clinical pathway. This has implications for the future development of professional learning for registered nurses in other sectors. Quality is integral to developing any professional learning, accordingly there must be input from both clinical and education providers. This partnership, between the sector and academia, will integrate learning into the practice area and improve outcomes for residents in aged residential care facilities.     

Characteristics of patients treated for severe hypoglycaemia in emergency care settings – Analysis of routinely collected data

ObjectiveSevere hypoglycaemic events (SHE) commonly require emergency care. This study investigates the presentation of patients with SHE to a single Swiss emergency service, including pre-hospital care with emergency medical services (EMS) and emergency department (ED) presentations.MethodRetrospective analysis of routinely collected data by the EMS and ED during 2014. All adult patients with diabetes type 1 or type 2 with SHE were included in the analysis.Results43 SHE were recorded in 38 patients with diabetes. Mean age of all patients was 65 years (SD ± 17.51), 54% (n = 23) were men, 55.8% (n = 24) were living in a relationship, and 54.8% (n = 23) were diagnosed with type 2 diabetes. Of the 43 episodes, 65% (n = 28) of the presentations used EMS and were then taken to the ED, 28% (n = 12) involved contact with the EMS only, and 7% (n = 3) were seen by the ED but did not use EMS. Patients seen by the EMS only (n = 12) were younger compared to those admitted to ED (n = 28); Md 54 years vs Md 72 years; U = 98; p = .039. The same age difference was similar between patients in the ED setting discharged home (n = 11) and with in-patients (n = 20); Md 61 years vs. Md 79 years; U = 51; p = .013.ConclusionsPeople most likely to suffer a SHE were men, those living with a partner, over 65 years old, and living with type 2 diabetes. Younger patients treated by EMS at home tended to remain at home, in contrast to the older patients who were admitted to hospital. This was also true for the ED where older people in particular became in-patients after such an event. Elderly care specialist brief interventions conveyed by EMS and ED healthcare professionals might be of value to prevent further SHE. Validating these findings in multiple emergency settings is warranted to support the delivery of targeted interventions.     

To both be like a captain and fellow worker of the caring team: the meaning of Nurse Assistants' expectations of Registered Nurses in Swedish residential care homes

Aim.  To describe the expectations of and to illuminate the meaning of the Nurse Assistants' (NA) expectations of Registered Nurses (RN) who are responsible for the care of older people living in residential care homes in Sweden.
Background.  Older people in Sweden who are provided with residential care are extremely frail and incapable of independent living. Therefore, when providing care, RN and NA encounter older people who require a great deal of care. An important precondition for the provision of satisfactory care is to have adequate collaboration between NAs and RNs and their expectations of each other. In this paper, the focus is on the NAs expectations of the RNs.
Method.  The study is based on a qualitative approach and a phenomenological-hermeneutical method. Ten NAs were interviewed and asked to narrate as freely as possible, about their expectations of RNs. The narratives were audio taped and transcribed verbatim. The analytical process includes the following steps; naïve reading, structural analysis, comprehensive understanding and reflection.
Results.  The RNs were expected to take responsibility for being fellow human beings and experts in providing care as well as always available to participate in caring. The RNs were expected to make stand-alone decisions and create a sense of safety for both older people and the NAs and have the courage to work alone and create a safe environment for both the older people and the NAs. The meaning of these expectations was that the RNs are like a captain in providing care, but at the same time, fellow workers.
Conclusion.  When the RNs do not meet the NAs expectations, there is a risk of conflict and therefore also a risk that an unsafe environment being created when caring for older people.     

对高危人群进行脑卒中社区预防干预的效果评价

目的通过对社区脑卒中高危人群的脑卒中预防干预,探索社区脑卒中综合防治的途径。方法在我院所辖社区居民中,选取符合脑卒中高危人群条件的674例社区居民,经由培训的护士对脑卒中高危人群进行问卷调查及医学体验,实施以健康教育和健康促进为主导的预防脑卒中综合干预。结果干预后高危人群的体质指数、血压、体重、血糖、血脂水平较干预前下降,差异有统计学意义（P〈0.05）：吸烟、饮酒、高脂饮食等不良生活习惯明显改善。结论在社区建立实施健康教育长效机制,全面开展社区预防,对于脑卒中的预防与控制具有极其重要的意义。     

老年尿失禁患者的生存质量调查分析

目的 调查老年尿失禁患者患病情况及其生存质量状况,分析影响老年尿失禁患者生存质量的相关因素.方法 使用尿失禁问卷表和尿失禁生活质量世表(I-QOL),对110名老年尿失禁患者进行调查.结果 老年尿失禁患者的生存质量得分较低,总分平均分为(56.31±12.58)分;I-QOL量表各领域得分其中限制性行为和社交活动受限二者得分较低.年龄因素对老年尿失禁患者生存质量中的限制性行为领域有一定的影响,60～69岁年龄段老年尿失禁患者限制性行为领域得分与70～79岁年龄段和80岁及以上年龄段比较,有统计学意义(P=0.015).教育背景、经济状况、职业、婚姻状况及性别对老年尿失禁患者生存质量无明显影响(P>0.05).不同类型尿失禁患者间比较,混合性尿失禁患者总体生存质量得分最低为(48.66±11.90)分,其次是急迫性尿失禁患者为(56.51±10.00)分,压力性尿失禁患者得分较高为(61.94±11.83)分,二者的得分差异有统计学意义(P<0.01).不同程度尿失禁患者间比较,重度尿失禁患者总体生存质量得分最低,其次是中度尿失禁患者,轻度尿失禁患者得分较高,三者的得分差异有统计学意义(P<0.01).结论 受试老年尿失禁患者总体生存质世较低,主要表现为日常行为和社会交往受限.疾病因素对老年尿失禁患者生存质量的影响较非疾病因素显著.     

老年人生活质量研究进展

介绍了老年人生活质量概念及老年人生活质量常用评估工具,阐述了影响老年人生活质量的因素主要有躯体健康因素、经济因素、社会活动、精神心理因素等。     

Jamar握力器对老年男性的重测信度和测量误差

目的分析Jamar握力器在老年人握力测量时的重测信度和测量误差。方法40位老年志愿者,平均年龄(82.2±8.4)岁。接受间隔1周共2次Jamar握力器测量握力。结果组内相关系数为0.99。测量标准误(SEM、SEM%)为1.18～1.69、4.11%～6.41%;个案最小真实改善程度值(SRD、SRD%)为3.27～4.68、11.39%～17.75%;Bland-Altman分析显示没有系统误差。结论在老年男性中,Jamar握力器具有良好的重测信度与可接受的测量误差。     

End-of-life care for older people in subacute care: A retrospective clinical audit

Background

With an ageing population and chronic illness the leading cause of death, challenges exist in meeting the healthcare needs of older people. For older people, care may be provided in subacute care services where, although the focus is on rehabilitation and optimisation of functioning, many older people will die.

老年人慢性疼痛自我管理策略及有效性的调查研究

目的探讨老年人慢性疼痛的临床特征和自我管理策略及有效性的现状，并分析之间的关系。方法对243名年龄≥65岁慢性疼痛老年人进行系列问卷调查，了解老年人慢性疼痛的临床特征及自我管理策略，并对结果进行分析。结果非麻醉性镇痛药、体育运动、冷热疗法和精神转移活动为4种最常使用的疼痛管理策略，不同年龄组的老年慢性疼痛患者间其所应用的疼痛管理策略比较差异无统计学意义。管理策略的有效性与疼痛强度，疼痛干扰日常生活程度及忧郁程度呈负相关，但与自我效能分数呈正相关。结论老年人愿意尝试各种不同的策略应对慢性疼痛，在今后的老年人慢性疼痛管理培训中应注重体育运动程序的规范化、对抗抑郁并增加自我效能以提高疼痛管理的效果。     

Validation of assistive technology on psychoactive substances for visually impaired people

Purpose: To validate the assistive technology “Drugs: reflection for prevention” to be used with visually impaired people.

Method: Quantitative and quasi-experimental study, contrasting knowledge before and after the use of the assistive technology with 140 visually impaired people in institutes and associations for people with visual impairment. A questionnaire with identification data, a pre-test, a post-test and a questionnaire to assess the assistive technology were applied. Data were described through means and standard deviations, and analyses included the McNemar test, the exact binomial distribution test, and the intraclass correlation coefficient.

Results: Participants were male (65.7%), 84.3% were blind, aged 37.1?years on average and with schooling of 10.1?years on average. There were more correct answers in the post-test (p?<.001). The attributes of the assistive technology were considered adequate: objectives, access, clarity, structure and presentation, relevance and efficacy, and interactivity (p?<.001).

Conclusions: The assistive technology “Drugs: reflection for prevention” was considered valid and reliable to inform visually impaired people about psychoactive substance abuse.

• Implications for rehabilitation

• Created new tool for prevention substance abuse that can be accessed easily.

• Improved information about substance psychoactive for users of the assistive technology.

• Improved quality of life for its users.