Purpose Comprehensive geriatric assessment (CGA) is a widely used approach in geriatric care and involves multidisciplinary assessments focused on determining a frail elderly persons medical, psychological and functional capability to develop an integrated plan for treatment. The purpose of this paper is to describe and scrutinize the CGA implementation process at six acute geriatric departments in three county councils and to study the outcome by the documentation in the patient medical records, and the staff perceptions using CGA. Design/methodology/approach The paper describes the implementation process stages. Outcome measures were based on patient medical records reviews at baseline and follow-ups at year 1 and year 2. Staff perceptions of using CGA were gathered by a questionnaire at the second follow-up. Findings The implementation had not yet reached sustainability so the implementation process must continue. Results show that documentation on the different areas increased in year 1, as well as the use of standardized assessment tools. However, results from the reviews for year 2 showed some decrease. Staff considered CGA to have high value for the geriatric patient but pointed out the need for continuing education. Originality/value Successful strategies for this implementation were strong support from the managers, small seminars, CGA rounds, good introduction routines for new staff and the use of reminders such as pocket-sized focus cards. A high staff turnover occurred during the study, which probably had a significant negative impact on the results.

Aim: The objective of this study was to examine young adults healthcare utilisation and its possible association with health literacy. Background: Many countries struggle with insufficient accessibility at emergency departments (EDs) and primary healthcare centres (PHCs). Young adults, aged 20-29 years old, account for a substantial number of unnecessary doctor visits where health literacy could be an explanatory factor. Method: This study incorporated a combined retrospective and cross-sectional study design with analysis of registry data, including all registered outpatient doctor visits between 2004 and 2014 (n = 1 086 432), and strategic sample questionnaire data (n = 207), focusing on socio-demographics, symptoms and information-seeking behaviour. Mean differences between first-year and last-year doctor visits for each age group were calculated using registry data. Fischers exact test was applied to questionnaire data to analyse group differences between ED and PHC visitors as well as between patients with sufficient health literacy and insufficient health literacy. Binary logistic regression was used to investigate covariation. Findings: Healthcare utilisation has increased among young adults during the past decade, however, not comparatively more than for other age groups. ED patients (n = 49) compared to PHC patients (n = 158) were more likely to seek treatment for gastrointestinal symptoms (P = 0.001), had shorter duration of symptoms (P = 0.001) and sought care more often on the recommendation of a healthcare professional (P = 0.001). Insufficient/problematic health literacy among young adults was associated with having lower reliance on the healthcare system (P = 0.03) and with a greater likelihood of seeking treatment for psychiatric symptoms (P = 0.002). Conclusion: Young adults do not account for the increase in healthcare utilisation during the last decade to a greater extent than other age groups. Young adults reliance on the healthcare system is associated with health literacy, an indicator potentially important for consideration when studying health literacy and its relationship to more effective use of healthcare services.

Aim:

To describe self-rated health in relation to lifestyle and illnesses and to identify risk factors for ill health such as pressure ulcers, falls and malnutrition among 75-year-old participants in a new clinical routine involving health assessment followed by tailored one-to-one health promotion at preventive clinic visits to a nurse at primary health care centres (PHCC).

Background:

There is a rapidly growing ageing population worldwide. It is central to health policy to promote active and healthy ageing. Preventive clinic visits to a nurse in primary health care were introduced as a new clinical intervention in a region in Sweden to improve the quality of health for the older adults.

Design:

A quantitative cross-sectional population-based study.

Methods:

The sample consisted of 306 individuals in six primary health care centres in Sweden aged 75 years who attended preventive clinic visits to a nurse. Data were collected from March 2014 to May 2015 during structured conversations with a nurse based on self-administered questionnaires, clinical examinations, risk assessments and after the clinic visit existing register data were collected by the researcher.

Findings:

Participants experienced good self-rated health despite being overweight and having chronic illnesses. Daily exercise such as walking and housework was more common than aerobic physical training. The majority had no problems with mobility but reported anxiety, pain and discomfort and had increased risk of falls.

Conclusion:

It is important to encourage the older adults to live actively and independently for as long as possible. The healthy older adults may benefit from the clinical intervention described here to support the individual’s ability to maintain control over their health. Such supportive assessments might help the healthy older adult to achieve active ageing, reducing morbidity and preventing functional decline.

Introduction

The aim of this study was to evaluate participants’ and managers’ experience of the design and content of an education programme. The Knowledge to Action (KTA) framework was applied to identify the steps of knowledge creation and action in the education programme.

Methods

Data were collected from 18 participants representing two groups: participants in the intervention and supervisors and managers. Two focus groups took place: two with participants in the intervention (4 and 3 in each) and one with eleven managers.

Results

All steps in the KTA framework were identified and discussed from several aspects. The importance of selecting projects that were relevant and added value in their clinics was mentioned by all participants. The participants also mentioned that after the education, they had further understanding and increased skills in how to be active and perform continuous improvement projects. The step in the KTA process regarding how to adapt knowledge to local context was not discussed explicitly by the participants or managers.

Discussion

Education in research methods and performing improvement projects to develop the clinic creates a more positive attitude to working with continuous improvement. The participant’s self-esteem and knowledge increased regarding how to work with improvements. It is important to have the manager’s support to perform a project. Emphasis was on knowledge inquiry and synthesis and presenting the results with or without possible solutions. The participants and managers talked about barriers and knowledge use more generally and at an organizational level. This means that the participants did not gain the last bit of nowledge needed to put the action into practice. This implies that the problem regarding lack of implementation skills in health care might remain.

PURPOSE:

To examine the effects of using standardized terminologies in nursing.

METHODS:

A systematic literature research was conducted in June 2015 going back to January 2007. A modified narrative synthesis was used as the structure for the analysis.

RESULTS:

Twenty-three articles were included. Three themes were identified: enable evaluation of nursing-sensitive outcome indicators, enable calculation of resource consumption, and characterize nursing care.

CONCLUSIONS:

The studies included in the analysis described evidence for usefulness rather than effect. In all the studies, standardized nursing terminology was found to be essential for measuring, clarifying, and understanding nursing care.

IMPLICATIONS FOR NURSING PRACTICE:

The use of standardized terminologies could be advantageous. However, there are shortcomings in nursing documentation and the use of standardized nursing terminologies that obstruct evaluation of nursing care

Documentation in the patient record must be systematic and rigorous. However, each health care profession documents parts of the electronic health record (EHR) separately. This system can lead to double documentation. The aim of the study was to describe the amount of double documentation in health records for in-patients. A retrospective descriptive review of 30 records for in-patients diagnosed with hip fracture was conducted. Double documentation occurred on all records reviewed during the stay in hospital and in or between all professions reviewed. In total, 822 instances of double documentation were found. The EHRs available today are not designed to monitor processes. Instead, they follow each health profession, which can lead to double documentation. It would be desirable to develop an EHR from a process perspective and not a record per profession.

Optimal mobility is fundamental for healthy ageing and quality of life. This study is part of a cross-sectional population-based study of 85-year-old people residing in Linköping municipality, Sweden. The purpose was to describe 85-year-old peoples' health-related quality of life (HRQoL) in relation to mobility and fall risk while adjusting for gender and body mass index. Data collection included a postal questionnaire, a home visit and a reception visit. HRQoL was assessed with EQ-5D-3L, mobility with the Timed Up and Go test (TUG) and fall risk with the Downton Fall Risk Index (DFRI). All those who completed the DFRI, TUG and EQ-5D-3L were included in the present study (N = 327). Lower HRQoL was associated with longer time taken to complete TUG and higher fall risk in both genders but not with body mass index. Women had higher risk of falling, took a longer time to complete TUG and reported less physical activity compared with men. Health-care professionals should address mobility capacity and fall risk in order to maintain quality of life in elderly people. This is of utmost importance, especially for elderly women because impaired mobility, high risk of falling and occurrence of pain are common among women, and related to lower HRQoL.

Health care staff are obliged to help patients participate in their care. Previous research has shown that information and relationships with staff are important factors for patients to feel involved. The aim of the study was to describe patients’ experiences of participation during hospitalization for hip fracture. Eleven patients being treated for hip fracture were included and data were collected using interviews. Analysis of the data was carried out through qualitative content analysis. The results illustrate that the experiences of participation are governed by the patient’s personal circumstances, needs and wishes and are affected by how responsive the staff are to these. Patients’ experience of participation is also affected by having to adapt to the health care organization and structure. To pursue individualized care, staff need to start from patient preferences and it is a challenge to adapt care to both the individual and the organization. By paying attention to patient preferences, the staff have a greater opportunity to implement changes in health care that will benefit a large patient population. This can lead to patients gaining better functional capacity and quality of life.

Background: Patient records should both transfer and create knowledge about patients and their health care. A standardized care plan could be a way to implement evidence-based care directly in practice and improve the documentation in patient records. The aim of this study is to investigate and compare the development and implementation process of a standardized care plan in hospital and primary health care. A further aim is to evaluate the effects on the quality of documentation and the care given in two contexts. Methods and Analysis: Realistic evaluation will be used as a framework to investigate the implementation process. According to this framework, possible contexts, mechanisms, and outcomes in the study will be considered. The study will be performed in two contexts: an orthopedic clinic and primary health care centers. In both contexts, the two key mechanisms will be the same: the implementation process will be driven by internal facilitators (practitioners at the units) and the process will be guided by the Rules and Regulations for interoperability in the Health and Social Care specification, “National information structure for standardized care plans”. Two outcomes of the study will be studied: to investigate the development and implementation process by an evaluation of fidelity and to evaluate how a standardized care plan affects the quality of documentation and the use of evidence-based care. Discussion: Implementation of the SCP will probably meet the same resistance as implementation of guidelines. Documentation of care is an important but resource-consuming requirement in health care, a more standardized method of documenting is requested by health professionals. This project can provide insight into the complex process of developing and implement an SCP in different contexts, which will be useful in further implementation processes.