EFFECTS OF A NURSING CARE PROGRAM FOCUSED ON BASIC SELF-CARE IN OLDER ACUTE MEDICAL IN-PATIENTS: A RANDOMIZED CONTROLLED TRIAL
Organização e gestão / novas formas de cuidados - Comunicação
Congresso ID: CO024 - Resumo ID: 267
Serviço de Medicina - Centro Hospitalar do Porto; Instituto de Ciências Biomédicas de Abel Salazar
Cecília Rodrigues, Denisa Mendonça, Maria Manuela Martins
Background: Acute illness and hospitalization are frequently associated with the decrease of the independence in basic activities of daily living (BADL) in older patients.
Objective:To test the hypothesis that a Nursing Care Program focused on Basic Self-Care (N_BSC) improves functional outcomes in older acute medical in-patients.
Methods:This was a two-group randomized controlled trial with repeated measures:182 older acute medical patients were randomly allocated to the usual care group(n=91) and intervention group(n=91). N_BSC was inspired by the Eat Walk Engage model and Function-Focused Care philosophy. N_BSC implies promotion of daily walking, plus privileging trips to the toilet by walking (with support devices/people support) and all daytime meals seated (out of bed).To implement N_BSC it was necessary to optimize the physical structure of the service, reorganize the nursing care and train the nurses and nursing assistants.
The main outcome was changes in the number of independent activities of daily living from two weeks before admission (baseline) to discharge. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline. For qualitative variables were calculated frequencies and for continuous variables were calculated statistics of central tendency and dispersion such as means, standard error and median. Normality of continuous variables were checked graphically and through Kolmogorov-Smirnov and Shapiro-Wilk tests. Significant differences in continuous variables between groups were assessed by parametric tests (T-Tests, analysis of variance) or non-parametric tests (Mann–Whitney U, Kruskal-Wallis). Proportions were compared using chi-square test. Significant changes between admission and discharge in basic self-care dependence were analysed using McNemar-Bowker test.
Results:Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, while usual care patients performed independently 1.90 BADL(p<.001). In the usual care group, pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the patients, respectively. In its turn, in the intervention group, pre-admission, in-hospital and overall functional decline occurred in 74.7%, 2.2% and 36.3% of the patients, respectively..
Conclusion: N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.
Objective:To test the hypothesis that a Nursing Care Program focused on Basic Self-Care (N_BSC) improves functional outcomes in older acute medical in-patients.
Methods:This was a two-group randomized controlled trial with repeated measures:182 older acute medical patients were randomly allocated to the usual care group(n=91) and intervention group(n=91). N_BSC was inspired by the Eat Walk Engage model and Function-Focused Care philosophy. N_BSC implies promotion of daily walking, plus privileging trips to the toilet by walking (with support devices/people support) and all daytime meals seated (out of bed).To implement N_BSC it was necessary to optimize the physical structure of the service, reorganize the nursing care and train the nurses and nursing assistants.
The main outcome was changes in the number of independent activities of daily living from two weeks before admission (baseline) to discharge. Differences in scores for BADL between baseline and admission, between admission and discharge, and between baseline and discharge were used to define pre-admission, in-hospital and overall functional decline. For qualitative variables were calculated frequencies and for continuous variables were calculated statistics of central tendency and dispersion such as means, standard error and median. Normality of continuous variables were checked graphically and through Kolmogorov-Smirnov and Shapiro-Wilk tests. Significant differences in continuous variables between groups were assessed by parametric tests (T-Tests, analysis of variance) or non-parametric tests (Mann–Whitney U, Kruskal-Wallis). Proportions were compared using chi-square test. Significant changes between admission and discharge in basic self-care dependence were analysed using McNemar-Bowker test.
Results:Changes from baseline to discharge in the number of independent BADL differ significantly between the intervention and usual care group. Intervention group patients were discharged with a superior functional status than usual care group. On discharge they were able to perform independently 2.93 BADL, while usual care patients performed independently 1.90 BADL(p<.001). In the usual care group, pre-admission, in-hospital and overall functional decline occurred in 78.0%, 4.4% and 63.7% of the patients, respectively. In its turn, in the intervention group, pre-admission, in-hospital and overall functional decline occurred in 74.7%, 2.2% and 36.3% of the patients, respectively..
Conclusion: N_BSC for hospitalized older adults was feasible and program participants were discharged with better functional status than a clinically similar comparison group. N_BSC could be readily adapted for use in other hospitals and warrants further evaluation as a potential new tool for improving outcomes for hospitalized older patients.