Conectar
To explore why and how staff use alarms for falls prevention in hospital and their alignment to person-centred practice.
Qualitative interpretive design.
One hundred focus groups and 25 interviews across 10 health services were completed between October 2022 and September 2024. Participants included nurses (n = 451), allied health (n = 82), and fall prevention managers (n = 18). The Framework Method guided initial data familiarisation and analysis and led to the Person-Centred Practice Framework being identified as a useful framework.
Themes generated: (1) Understaffed, under-resourced, under pressure, (2) Alarm impact on stress and workload, (3) Negotiating patient safety and patient preference, (4) Engaging family as a resource, (5) Sharing responsibility for alarms and falls prevention, and (6) Navigating ambiguity and fearing consequences.
Staff feel compelled to use alarms despite problems associated with their use and challenges to person-centred practice. Drivers of alarm use were feeling under-resourced and fearing liability if patients fell. Staff want clearer organisational guidance in alarm use but also want the freedom to use their own clinical reasoning.
Hospitals worldwide are working to identify effective strategies for preventing falls. However, research has yet to adequately explore the perspectives of frontline nurses and allied health staff regarding the use of mobilisation alarms—a critical gap when evaluating their impact and effectiveness. This study's six key themes provide insights into why alarms are so widely used despite the limited evidence supporting their effectiveness.
Consolidated Criteria for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
Australian New Zealand Clinical Trials Registry ACTRN12621000823875.
To review current evidence on the implementation and impact of virtual nursing care in long-term aged care.
An integrative rapid literature review.
Medline, CINAHL, Web of Science, Embase, Ageline and Scopus.
The review included studies involving virtual care interventions provided by nurses (or by a multidisciplinary team including nurses) to older people in residential aged care that reported health outcomes or stakeholder experiences. Consistent with PRISMA guidelines, databases were systematically searched in July and August 2024, focusing on literature published since 2014. Studies were screened in Covidence by three team members, with conflicts resolved by additional reviewers. Studies not involving nurses or not set in aged care were excluded.
The search identified 13 studies, which included quantitative, qualitative and mixed-method approaches, conducted in both Australian and international settings, as well as in rural and metropolitan locations. Nurses were often involved as part of an existing virtual care programme, typically located in a hospital setting. The training and credentials of nurses delivering VN varied in terms of specialisation and advanced practice. The model of care in general was ad hoc, though in some cases there were regular, scheduled VN consultations. The time requirements for onsite staff and nurses were not well articulated in any of the studies, and information on the funding models used was also lacking.
There is some evidence that VN interventions in aged care may improve communication, enhance person-centred care and reduce emergency department presentations and hospitalisations.
Rigorous, ongoing evaluation of VN interventions is required to ensure their appropriate application in residential aged care.
To estimate the direction and magnitude of socioeconomic inequalities in outcome, experience and care among adults consulting for a musculoskeletal pain condition.
Multicentre, prospective observational cohort with repeated measures at three waves (baseline, 3 months and 6 months after index consultation).
30 general practices in North Staffordshire and Stoke-on-Trent, England.
1875 consecutive, eligible, consenting patients, aged 18 years and over, presenting with a relevant SNOMED CT-coded musculoskeletal pain condition between September 2021 and July 2022.
Standard care.
Primary outcome was patient-reported pain and function using the Musculoskeletal Health Questionnaire (MSK-HQ score, 0–56). Secondary outcomes were patient experience (overall dissatisfaction with consultation experience, dichotomised) and an indicator of care received (opioid prescription within 14 days of index consultation). Using multilevel models, we examined inequalities in primary and secondary outcomes by area deprivation (Index of Multiple Deprivation derived from patient residential postcode), before and after adjusting for sociodemographic and survey administration variables, clinical case-mix and selected practice-level covariates.
Compared with patients from the least deprived neighbourhoods, patients from the most deprived neighbourhoods had significantly poorer MSK-HQ scores at baseline (mean 22.6 (SD 10.4) vs 27.6 (10.1)). At 6 months, the inequality gap in MSK-HQ score widened (difference in mean score after adjustment for all covariates: 1.94; 95% CI: –0.70 to 4.58). Opioid prescription was more common for patients living in the most deprived neighbourhoods (30% vs 19%; fully adjusted OR: 0.69; 95% CI: 0.44 to 1.08). Only 6% of patients overall reported being dissatisfied with their consultation. Analysis of multiply imputed data produced a similar pattern of findings to complete-case analysis.
Substantial inequalities in the chronicity, severity and complexity of musculoskeletal pain problems are already present at the time of accessing care. Inequalities in pain and function do not reduce after accessing care and may even widen slightly.
ISRCTN18132064; Results.
To identify and characterise the approaches and instruments used in recent literature to measure the prevalence of restrictive care practices in adult mental health inpatient units. Additionally, it sought to summarise the reported psychometric properties, including reliability and validity of these measures.
A systematic review of recent litratures was conducted using Scopus, MEDLINE, CINAHL, PsycINFO, Web of Science and Embase databases to identify studies published from 1 January 2010 to 11 October 2023. A total of 128 studies measuring the use of restrictive care practices were included. Data on measurement methods were extracted from each study and summarised to compare how consistently these practices have been measured across studies and how authors consistently reported the reliability and validity of these measurment approaches. All findings were reported following the PRISMA 2020 checklist.
There were significant variations in how the prevalence of restrictive care practices was measured, and the reliability and validity of these measurements were unclear for most studies. Only 11 studies reported inter/intra-rater reliability. Key variations were observed in data sources utilised, how and by whom the data were collected, the timing and total duration of data collection during patient admission, how and by whom data were extracted from secondary sources, measurement instruments and the reported reliability and validity of measures.
Methodological inconsistencies about the measurements approaches of restricitve care practices would introduduce potential random and/or systematic biases on the reported data which may obscure the the true prevalance these practices. This hinder the ability to acurately assess the effectiveness of reduction strategies and understand the naturally occuring practices. Establishing a standardised set of reliable measures is crucial for enabling valid comparisons for the rates of restricitve car epractice use across settings and countries, which could enhance the ongoing monitoring and reduction of these practices.
The absence of standardised defintions and measurement approaches for restrictive care practices challenges the global effort to reduce their use. Without reliable and common measures, clinicians and researchers often face challenges in documening RCP incidents accurately, compromising efforts to improve care quality and support a recovery-oriented approach. Such measurment errors would mislead decission-maker which would furhter contribute to the inconsistency the the implementation of these practices.
No patient or public contribution.
PROSPERO: CRD:42022335167; https://www.crd.york.ac.uk/prospero/export_details_pdf.php
There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised.
This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates.
Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates.
A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I 2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions.
There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations.
Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities.
This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study.
The protocol for this review has been registered to PROSPERO: CRD42022335167.
FreshRSS 