1,720,978 research outputs found
Multimorbidity in older adults living with and beyond cancer
No full textPurpose of review: the current review draws attention to the need for longer term management of multiple conditions in older adults with cancer.Recent findings: older people living with and beyond cancer are more likely than younger people to have higher prevalence of multimorbidity leading to an overall increase in illness and treatment burdens, limiting health-related quality of life (QoL), and capacity to self-manage. Older age presents a higher risk of cancer treatment side-effects and development or progression of other conditions, leading to worsening health, long-lasting functional problems, and social isolation. Although many prioritize functional independence and continuance of valued activities over survival, older people living with multimorbidity are more likely to experience poor physical functioning during and beyond cancer treatment.Summary: cancer treatment decisions and survivorship plans should be developed in the context of other conditions and in line with the individual's priorities for continued QoL. More research is needed to guide service development and clinical practice in this important area.<br/
Understanding the cultural environment of the outpatient care setting for patients with dementia receiving cancer treatment: a qualitative study
No full textIntroduction: people with dementia have poorer cancer outcomes than those without, and experience inequalities in access to, and quality of, care. Outpatient environments, where radiotherapy, chemotherapy and immunotherapy cancer treatments typically take place, have largely been excluded from research. This study was conducted to understand provision of treatment and support and experiences of care for people with dementia undergoing cancer treatment in the outpatient setting. Materials and methods: using observation, interviews and document analysis, data were collected to scrutinise the cultural environment of ambulatory care, comprising the physical fabric of the care setting; interactions, behaviours and perceptions of those in the care setting; and the organizational, clinical and interactional processes involved in care delivery. The study was conducted in the outpatient oncology departments of two large teaching hospitals in England between January 2019-July 2021. Results: data were gathered from a wide range of sources, including 15 hours of observation, and interviews with patients (n=2), caregivers (n=7) and staff (n=20). Evidence from this study suggests the cultural environment of the outpatient care setting reflects and supports the standardised processing of people for cancer treatment. Dementia introduces a wider set of care requirements not catered for by this standardised treatment model and associated processes. Data showed the needs of patients with dementia could be addressed most effectively when individualised, as opposed to standardised care, was offered.Conclusion: there is work to be done in outpatient cancer services to ensure responsiveness to individual patient need. This could be achieved by having an established way (or ways) of eliciting needs, preferences and expectations, a belief that a person’s needs and expectations are legitimate, and that effort should be made to address them, with the ability to accommodate these needs and expectations.Patient or public contribution: patients and caregivers were involved in the study design and development of study materials including the interview topic guide. They also assisted with discussion and clarification of study findings.<br/
137 Discharge decision-making for Older People in the Acute Medical Unit - an Ethnographic Study
No full textDischarge decision making for older people. A review of the literature using a qualitative synthesis
No full textMaking health care responsive to the needs of older people
No full textThis commentary highlights the importance of health system responsiveness to older people living with complex health needs. Age-related changes and associated morbidity can present barriers to identifying an individual’s health needs, expectations, values and preferences, and so sufficient time, skill and resource is required to inform the development of a tailored plan for each individual. A focus on responsiveness moves thinking beyond the responsibilities of the individual clinician in the single encounter, and allows us to identify elements of the wider system that may constrain how well the clinician is able to respond. Setting the goal of responsive health care requires us to assess the suitability of wider health system features and processes for meeting the diverse needs of individual people throughout their journey, and the extent to which the system can adapt dynamically as needs change. Standardised approaches to care prescribed across organisations (such as time-based targets or routinised approaches to inpatient nursing care) are likely to result in low responsiveness as individual complexity grows, disadvantaging patients with needs that do not fit the prescribed approach. Responsiveness is high when individual practitioners and clinical teams have the resources, decentralised authority, flexibility and autonomy to provide the care required. Building a more responsive health system requires a greater understanding of how these conditions can be achieved
Interventions for older people having cancer treatment: a scoping review
No full textObjectivesThere is currently no overview of supportive interventions developed for older people having cancer treatment. The aims and objectives, methods, and outcomes of interest of existing supportive interventions have not been evaluated. To understand how health services might meet the needs of older people undergoing cancer treatment, a scoping review was undertaken to identify and characterise supportive interventions developed for this patient group.Materials and methodsThis scoping review examined supportive interventions (services, programs, tools or policies) applied during diagnosis or treatment that address physical, psychological, social or spiritual needs of older patients. A systematic search of the following electronic databases was undertaken August–October 2017 (updated March 2019): AMED; CINAHL; EMBASE; Medline; PsychINFO.ResultsSixty-two papers met the inclusion criteria. The review established that existing interventions to support older people having treatment for cancer are diverse in aim, and the evaluation methodology and outcome measure selection vary considerably. The interventions rarely target complex issues such as multimorbidity, frailty, or the impact of other geriatric syndromes in addition to cancer.ConclusionWe suggest that future research should focus on patient populations with complex needs, including addressing comorbidity and age-associated conditions such as dementia
Creating Learning Environments for Compassionate Care (CLECC): The implementation and evaluation of a sustainable team-based workplace learning intervention
No full textDevelopment and validation of a methodology to measure the time taken by hospital nurses to make vital signs observations
No full textBACKGROUND: Several time and motion studies have sought to quantify the nursing work involved in observing patients' vital signs. However, none of these studies offered a validated methodology that can be replicated. This is reflected in the high variation between these studies in the mean times for measuring and recording observations. AIM: To describe the development and inter-rater reliability of a methodology for observing the nursing time and workload involved in measuring and recording patients' vital signs. DISCUSSION: The authors developed a methodology that used the quality of interactions (QI) tool ( Bridges et al 2018 ) to measure and record the start and finish times of the rounds of nurses observing vital signs and individual observations clustered in rounds. Two raters concurrently documented their observations of nurses undertaking patient observations in a simulated setting. The tool and associated documentation were found to be easy to use, and there was a high level of agreement in measurements by different observers. CONCLUSION: The authors' methodology can be used to reliably measure the time involved in taking vital signs. IMPLICATIONS FOR PRACTICE: Using the QI tool may increase precision when timing and classifying nursing activities concerning observing vital signs. The authors anticipate that it could be adapted effectively to measure several other nursing activities and so support researchers interested in capturing different aspects of nurses' work.</p
Research that supports nursing teams: learning opportunities for team members
No full textThis article, the second in a four-part series about using research evidence to support nursing teams, discusses the learning opportunities generated from four studies that followed the two Francis inquiries into care failings at Mid Staffordshire NHS Foundation Trust. We discuss how four different interventions, directly or indirectly use learning to enable nursing teams to optimise care in acute hospital settings. We argue that the profound impact of the Covid-19 pandemic may have overshadowed the need for measures to support nursing staff learning at a time when care quality is more important than ever.<br/
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