Pilot Testing Function Focused Care for Acute Care

针对急性护理的试点测试功能重点护理

基本信息

批准号：
8510933
负责人：
BARBARA RESNICK
金额：
$ 18.17万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8510933
关键词：
Accounting Activities of Daily Living Acute Address Admission activity Adverse event Antibiotics Attention Bathing Beds Belief Care given by nurses Caregivers Caring Case Mixes Cognitive Comorbidity Cues Data Decubitus ulcer Development Diagnosis Education Educational process of instructing Elderly Environment Environmental Policy Equilibrium Exercise Exposure to Fall prevention Family Family health status Future Goals Health Personnel Healthcare Height Hospitalization Hospitals Hour Incidence Individual Infection Intervention Intravenous Measures Medical Mentors Modeling Motivation Movement Nurses Nursing Education Nursing Homes Outcome Patient Care Patients Performance Philosophy Physical Function Physical activity Physiological Positioning Attribute Recovery Recruitment Activity Rehabilitation therapy Research Resources Rest Safety Sterile coverings Testing Time Training Trauma Trauma recovery Walking Work base efficacy trial experience falls flexibility functional decline functional disability improved improved functioning member mortality nursing intervention older patient prevent programs public health relevance rehabilitation service sedentary social social cognitive theory trauma units treatment effect

项目摘要

DESCRIPTION: Older adults account for 25% of hospitalized trauma patients and these rates are anticipated to increase so that by 2050 approximately 40% of all trauma patients will be older adults. These patients generally have multiple comorbidities and decreased physiologic reserve and when exposed to acute care environments and medical and nursing interventions that restrict movement an unintentional decline in overall physical activity and function occurs. These individuals are also more likely to develop infections, pressure ulcers and fall when hospitalized and require unscheduled rehospitalizations post discharge. Older trauma patients have little opportunity to engage in physical activity because of environmental and policy issues (e.g., cluttered rooms, lack of appropriate chairs), philosophies of care held by patients, familie, and health care providers (e.g., beliefs that falls are prevented by restricting mobility) and motivational factors among patients. To overcome these challenges we developed Function Focused Care for Trauma Recovery (FFC-TR). The purpose of FFC- TR is to change care philosophies such that nurses teach, cue, position and help patients engage in physical activity including such things as bathing, dressing, getting out of bed and walking. Function focused care (FFC) contrasts with traditional approaches to care provided to patients in which nurses, and other caregivers, perform tasks for older patients or limit the amount of activity they might perform (e.g., giving patients a urinal or bedpan versus helping patients walk to the bathroom). FFC activities are individualized and are therefore relevant for all patients regardless of diagnoses or comorbidities. The aims of this study are to: (1) Establish the feasibility of FFC-TR; and (2) Evaluate, in a preliminary fashion, the impact of FFC-TR on patients' function, physical performance and overall physical activity, and incidence of adverse events during hospitalization and unscheduled rehospitalizations within 30 days of discharge. To achieve these aims, two trauma hospitals will be randomly allocated to treatment (FFC-TR) or attention control [FFC-Education (FFC- ED)]. The FFC-TR intervention, which is based on a social ecological model and social cognitive theory, will be implemented by a Research Function Focused Care Nurse working on treatment units 20 hours a week for 16 months and will include: Component I Education of Nurses; Component II Environmental and Policy Assessments; and Component III Ongoing Training and Motivation of Nurses. Component I includes four classes: Class 1. Overview of FFC; Class 2. Patient Goal Development; Class 3. Optimizing Physical Activity Safely; and Class 4. Patient Motivation. FFC-ED involves exposing nurses to Component I only. We will recruit 50 patients from each hospital and measure patient outcomes. This pilot work will help establish recruitment rates, confounders such as case mix and demographic variables consider treatment safety and provide the necessary data such as means, standard deviations and estimation of treatment effects and variance for future power analyses and a larger efficacy trial.

描述：老年人占住院创伤患者的25％，预计这些率将增加，因此到2050年，大约40％的创伤患者将成为老年人。这些患者通常具有多种合并症和生理储备的减少，并且在暴露于急性护理环境以及医疗和护理干预措施时，限制了运动的整体体育锻炼和功能无意下降。这些人也更有可能出现感染，压力溃疡和住院时会下降，并且需要在出院后进行外部的重新住院。由于环境和政策问题（例如，混乱的房间，缺乏适当的主席），患者，家族和卫生保健提供者（例如，通过限制移动能力限制移动能力来预防掉落的信念）以及患者之间的激励因素，年龄较大的创伤患者几乎没有机会进行体育锻炼。为了克服这些挑战，我们开发了以创伤恢复（FFC-TR）为重点的护理。 FFCTR的目的是改变护理理念，例如护士教，提示，位置和帮助患者进行体育锻炼，包括诸如沐浴，穿衣，起床和步行之类的事情。以功能为中心的护理（FFC）与为护士和其他护理人员的患者提供的传统护理方法形成鲜明对比，或者为老年患者执行任务，或限制他们可能执行的活动量（例如，为患者提供小便池或卧室，而不是帮助患者步行去洗手间）。 FFC活动是个性化的，因此与所有患者有关，无论诊断或合并症如何。这项研究的目的是：（1）确定FFC-TR的可行性；（2）以初步的方式评估FFC-TR对患者功能，身体表现和整体体育锻炼的影响以及住院期间不良事件的发生率和出院后30天内未定规划的重新介绍化。为了实现这些目的，将两家创伤医院随机分配给治疗（FFC-TR）或注意力控制[FFC-dedecation（FFC- ED）]。 FFC-TR干预基于社会生态模型和社会认知理论，将由研究功能的护理护士每周工作20个小时，持续16个月，其中包括：护士的组成部分；组件II环境和政策评估；和组件III正在进行的培训和护士的动机。组件i包括四个类：FFC的概述1级； 2级。患者目标发展； 3级。安全优化体育锻炼；和4级。患者动机。 FFC-ED涉及将护士暴露于组件I。我们将从每家医院招募50名患者，并衡量患者的预后。这项试点工作将有助于建立招聘率，案例混合和人口统计学变量等混淆者考虑治疗安全，并提供必要的数据，例如均值，标准偏差以及治疗效果的估计以及未来功能分析的方差以及更大的效力试验。