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%，预计这一比例还会增加，到 2050 年，所有创伤患者中约 40% 将是老年人。这些患者通常患有多种合并症，生理储备下降，当暴露于急症护理环境以及限制运动的医疗和护理干预措施时，整体身体活动和功能会无意中下降。这些人在住院时也更有可能出现感染、压疮和跌倒，并在出院后需要计划外的再次住院治疗。由于环境和政策问题（例如，房间杂乱、缺乏合适的椅子）、患者、家人和医疗保健提供者的护理理念（例如，跌倒是可以预防的信念），老年创伤患者几乎没有机会进行身体活动通过限制活动）和患者的动机因素。为了克服这些挑战，我们开发了创伤康复功能聚焦护理 (FFC-TR)。 FFC-TR 的目的是改变护理理念，让护士教导、提示、定位并帮助患者进行身体活动，包括洗澡、穿衣、起床和行走等。功能聚焦护理 (FFC) 与向患者提供的传统护理方法形成鲜明对比，在传统护理方法中，护士和其他护理人员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便盆，而不是帮助患者行走）到浴室）。 FFC 活动是个性化的，因此与所有患者相关，无论诊断或合并症如何。本研究的目的是：（1）建立FFC-TR的可行性； (2) 初步评估FFC-TR对患者功能、身体表现和整体身体活动的影响，以及住院期间和出院后30天内非计划再住院期间不良事件的发生率。为了实现这些目标，两家创伤医院将被随机分配用于治疗（FFC-TR）或注意力控制[FFC-教育（FFC-ED）]。 FFC-TR 干预措施基于社会生态模型和社会认知理论，将由一名以研究功能为重点的护理护士实施，每周在治疗室工作 20 小时，持续 16 个月，其中包括：第一部分护士教育；第二部分环境和政策评估；第三部分：护士的持续培训和激励。组件 I 包括四类：第 1 类：FFC 概述；第 2 课：患者目标制定；第 3 课：安全地优化身体活动；第 4 类：患者动机。 FFC-ED 只涉及让护士接触第一部分。我们将从每家医院招募 50 名患者并评估患者的治疗结果。这项试点工作将有助于确定招募率、病例组合等混杂因素和人口统计学变量，考虑治疗安全性，并为未来的功效分析和更大规模的疗效试验提供必要的数据，例如手段、标准差以及治疗效果和方差的估计。