Review question/objective: The objective of the review is to synthesize evidence regarding the experiences of unpaid caregivers of community-dwelling adults with dementia. Specifically, the review question is: What are the experiences and perceptions of unpaid caregivers providing care for community-dwelling adults with dementia?
Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities.
The purpose of this article was to examine the adequacy of the 5 rights (5 R's) for nurses and for including patients in medication administration while considering patient safety. Patient safety related to medication adverse events will be discussed; the 5 R's will be examined and critiqued and the importance of patient-centered care and patient participation in care will be presented. A path forward is offered based on the expressive-collaborative model. Suggestions for introduction of the model are outlined, and implications for practice, research, and education are discussed.Nurses have been guided by the 5 R's of medication administration in both education and practice for many decades. Many have found the 5 R's to be lacking and proceeded to propose the addition of a variety of rights from right indication to the rights of nurses to have legible orders and timely access to information. Patients are no longer passive recipients of care and are choosing to play increasingly greater roles in the process of care.In a collaborative patient-centered environment, an expressive-collaborative model of approaching systems of care is needed. In this model, individuals negotiate with one another to find out what people need to know and to strategize on the means to acquiring the necessary information. Providers are no longer expected to be all knowing.Medication administration is no longer simply the 5 R's. Medication administration is a process with many interconnected players including patients. We need to collaboratively restructure medication use in this era in which all involved in the process share the responsibility for a safe medication use system.
Abstract Background As of March 2021, three SARS-CoV-2 variants of concern (VOC) have been identified (B.1.1.7, B.1.351 and P.1) and been detected in over 111 countries. Despite their widespread circulation, little is known about their transmission characteristics. There is a need to understand current evidence on VOCs before practice and policy decisions can be made. This study aimed to map the evidence related to the transmission characteristics of three VOCs. Methods A rapid scoping review approach was used. Seven databases were searched on February 21, 2021 for terms related to VOCs, transmission, public health and health systems. A grey literature search was conducted on February 26, 2021. Title/abstracts were screened independently by one reviewer, while full texts were screened in duplicate. Data were extracted using a standardized form which was co-developed with infectious disease experts. A second data extractor verified the results. Studies were included if they reported on at least one of the VOCs and transmissibility. Animal studies and modeling studies were excluded. The final report was reviewed by content experts. Results Of the 1796 articles and 67 grey literature sources retrieved, 16 papers and 7 grey sources were included. Included studies used a wide range of designs and methods. The majority (n=20) reported on B.1.1.7. Risk of transmission, reported in 15 studies, was 45-71% higher for B.1.1.7 compared to non-VOCs, while R 0 was 75-78% higher and the reported R t ranged from 1.1-2.8. There was insufficient evidence on the transmission risk of B.1.35.1 and P.1. Twelve studies discussed the mechanism of transmission of VOCs. Evidence suggests an increase in viral load among VOCs based on cycle threshold values, and possible immune evasion due to increased ACE2 binding capacity of VOCs. However, findings should be interpreted with caution due to the variability in study designs and methods. Conclusion VOCs appear to be more transmissible than non-VOCs, however the mechanism of transmission is unclear. With majority of studies focusing on the B.1.1.7 VOC, more research is needed to build upon these preliminary findings. It is recommended that decision-makers continue to monitor VOCs and emerging evidence on this topic to inform public health policy.
Home support workers (HSWs) encounter unique safety issues in their provision of home care. These issues raise ethical concerns, affecting the care workers provide to seniors and other recipients. This paper is derived from a subproject of a larger Canada-wide study, Safety at Home: A Pan-Canadian Home Care Safety Study, released in June 2013 by the Canadian Patient Safety Institute. Semi-structured, face-to-face, audiotaped interviews were conducted with providers, clients and informal caregivers in British Columbia, Manitoba and New Brunswick to better understand their perceptions of patient safety in home care. Using the BC data only, we then compared our findings to findings of other BC studies focusing on safety in home care that were conducted over the past decade. Through our interviews and comparative analyses it became clear that HSWs experienced significant inequities in providing home care. Utilizing a model depicting concerns of and for HSWs developed by Craven and colleagues (2012), we were able to illustrate the physical, spatial, interpersonal and temporal concerns set in the context of system design that emphasized the ethical dilemmas of HSWs in home care. Our data suggested the necessity of adding a fifth domain, organizational (system design). In this paper, we issue a call for stronger advocacy for home care and improved collaboration and resource equity between institutional care and community care.
The authors carried out an environmental scan to support nurse leaders as they develop registered nurse prescribing regulation and education in Canada, and to highlight important areas for further knowledge development.
Objectives The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found. Methods This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009–2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada. Results The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients’ decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation. Conclusions Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as ‘informal’ caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.
The objective of this review is to explore and synthesize evidence regarding the advanced practice nursing roles in Arab countries in the Eastern Mediterranean region.Many countries have witnessed an increase in the number and types of advanced practice nursing roles. The literature has documented many positive patient outcomes associated with care provided by advanced practice nurses. The International Council of Nurses claims that advanced practice nursing is country-sensitive. Despite the availability of international literature that explores advanced practice nursing roles globally, little attention has been given to advanced practice nursing roles in Arab countries in the Eastern Mediterranean region.This review will consider studies related to advanced practice nursing roles, such as the historical development, role title, regulations, entry level education, role implementation, and outcomes, in Arab countries in the Eastern Mediterranean region.A comprehensive systematic search will be completed for both published and non-published literature using CINAHL (EBSCO), PubMed (NLM), PsycINFO, Embase (Elsevier), Nursing and Allied Health (ProQuest), Scopus (Elsevier), and websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses' Nurse Practitioner/Advanced Practice Nursing Network, World Health Organization regional office for the Eastern Mediterranean, and nursing associations and ministries of health in Arab countries. The search will include literature published in Arabic and English, from the inception of databases to present.
Objectives The four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC. Design A rapid scoping review. Data sources On 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos’ L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication. Eligibility criteria Studies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included. Data extraction and synthesis Titles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Results Of the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC. Conclusions The increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.
