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BackgroundPoorly managed pain can lead to substance use disorders, depression, suicide, worsening health, and increased use of health services. Most pain assessments occur in clinical settings away from patients’ natural environments. Advances in smart home technology may allow observation of pain in the home setting. Smart homes recognizing human behaviors may be useful for quantifying functional pain interference, thereby creating new ways of assessing pain and supporting people living with pain. ObjectiveThis study aimed to determine if a smart home can detect pain-related behaviors to perform automated assessment and support intervention for persons with chronic pain. MethodsA multiple methods, secondary data analysis was conducted using historic ambient sensor data and weekly nursing assessment data from 11 independent older adults reporting pain across 1-2 years of smart home monitoring. A qualitative approach was used to interpret sensor-based data of 27 unique pain events to support clinician-guided training of a machine learning model. A periodogram was used to calculate circadian rhythm strength, and a random forest containing 100 trees was employed to train a machine learning model to recognize pain-related behaviors. The model extracted 550 behavioral markers for each sensor-based data segment. These were treated as both a binary classification problem (event, control) and a regression problem. ResultsWe found 13 clinically relevant behaviors, revealing 6 pain-related behavioral qualitative themes. Quantitative results were classified using a clinician-guided random forest technique that yielded a classification accuracy of 0.70, sensitivity of 0.72, specificity of 0.69, area under the receiver operating characteristic curve of 0.756, and area under the precision-recall curve of 0.777 in comparison to using standard anomaly detection techniques without clinician guidance (0.16 accuracy achieved; P

BackgroundVirtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. ObjectiveThe objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. MethodsPeer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. ResultsIn total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. ConclusionsInterventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial RegistrationPROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504

Aim: To explore the health beliefs and health behaviours of older Vietnam‐born people living with chronic disease in Western Australia. Design: This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. Methods: Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. Results: This study included 12 participants. The health perspectives and practices of older Vietnam‐born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self‐blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese‐oriented and Westernized‐orientated practices. Individual factors were also identified as contributing to chronic disease self‐care among participants. Conclusion: This study emphasizes culture played a significant role in shaping the way that older Vietnam‐born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. Implications: A better understanding of the health beliefs and practices of older Vietnam‐born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. Patient and public contribution: This study encompassed the contribution of 12 older Vietnam‐born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants. [ABSTRACT FROM AUTHOR]

To determine and appraise the certainty of fracture liaison service (FLS) in reducing the risk of secondary fragility fractures in older adults aged ≥ 50 years and to examine the nature of the FLS and the roles of various disciplines involved in the delivery of the FLS. Medline, EMBASE, PubMed, CINAHL, SCOPUS, and The Cochrane Library were searched from January 1st, 2010, to May 31st, 2022. Two reviewers independently extracted data. The risk of bias was evaluated using the Newcastle–Ottawa Scale for cohort studies and the PEDro scale for randomized trials, while the GRADE approach established the certainty of the evidence. Thirty-seven studies were identified of which 34 (91.9%) were rated as having a low risk of bias and 22 (59.5%) were meta-analyzed. Clinically important low certainty evidence at 1 year (RR 0.26, CI 0.13 to 0.52, 6 pooled studies) and moderate certainty evidence at ≥ 2 years (RR 0.68, CI 0.55 to 0.83, 13 pooled studies) indicate that the risk of secondary fragility fracture was lower in the FLS intervention compared to the non-FLS intervention. Sensitivity analyses with no observed heterogeneity confirmed these findings. This review found clinically important moderate certainty evidence showing that the risk of secondary fragility fracture was lower in the FLS intervention at ≥ 2 years. More high-quality studies in this field could improve the certainty of the evidence. Review registration: PROSPERO―CRD42021266408. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore factors that influence family caregiver readiness to adopt health smart home technology for their care‐dependent older adult family member. Health smart homes are designed to remotely monitor the health and wellness of community‐dwelling older adults supporting independent living for as long as possible. Accordingly, if the health smart home is deployed into the home of a care‐depended older adult, it can potentially support family caregivers by facilitating workforce participation and give piece of mind to the family caregiver who may not live close to the older adult. However, wider adoption of health smart home technologies into the homes of community‐older adults is low, and little is known about the factors that influence the readiness of family caregivers to adopt smart home technologies for their care‐dependent older adults. Design: A qualitative Descriptive study design was utilized. Methods: Qualitative data were collected between 2019 and 2020 via semi‐structured interviews. Thematic analysis of interviews was completed, and data were organized into themes. Results: Study findings show that caregiver readiness (N = 10) to adopt smart home technology to monitor older adult family members were influenced by five primary themes including a 'big brother effect', 'framing for acceptance', 'data privacy', 'burden' and 'cost.' Conclusion: Family caregivers were open to adopting smart home technology to support the independent living of their older adult family members. However, the readiness of family caregivers was inextricably linked to the older adults' readiness for smart home adoption. The family caregiver's primary concern was on how they could frame the idea of the smart home to overcome what they viewed as hesitancy to adopt in the older adult. The findings suggest that family caregivers endeavour to balance the hesitancy in their older adult family members with the potential benefits of smart home technology. Impact: Family caregivers could benefit if their care‐dependent older adults adopt smart home technology. Recognizing the role of caregivers and their perspectives on using smart home technologies with their care‐dependents is critical to the meaningful design, use and adoption. [ABSTRACT FROM AUTHOR]

Most older adults desire to be as independent as possible and remain living in their ancestral home as they age. Aging-in-place maximizes the independence of older adults, enhancing their wellbeing and quality of life while decreasing the financial burden of residential care costs. However, due to chronic disease, multimorbidity, and age-related changes, appropriate conditions are required to make aging-in-place possible. Remote monitoring with smart home technologies could provide the infrastructure that enables older adults to remain living independently in their own homes safely. The health-assistive smart home shows great promise, but there are challenges to integrating smart homes on a larger scale. The purpose of this discussion paper is to propose a Design Thinking (DT) process to improve the possibility of integrating a smart home for health monitoring more widely and making it more accessible to all older adults wishing to continue living independently in their ancestral homes. From a nursing perspective, we discuss the necessary stakeholder groups and describe how these stakeholders should engage to accelerate the integration of health smart homes into real-world settings. [ABSTRACT FROM AUTHOR]

The study aimed to determine the knowledge and current practices of Nigerian physiotherapists on the physical activity and exercise training in the rehabilitation of patients with asthma and to determine if any difference exists between novice and expert professionals. This was designed as a cross-sectional study. A total of 311 practicing physiotherapists in Nigeria participated in the study. An electronic questionnaire comprising 34 semi-structured questions with three domains; personal information, knowledge, and current practices, was used to collect data throughout 4-months. Data were analyzed using a pragmatist paradigm. Out of the physiotherapists, 51.8% (n = 161) had postgraduate degrees, 46.9% (n = 146) had bachelor's degrees, and 1.3% (n = 4) had a doctor of physiotherapy degrees. The result also indicates that 45.3% (n = 141) of the physiotherapists had insufficient knowledge about asthma, and 39.5% (n = 123) were not using current clinical practice in the rehabilitation of patients with asthma. The results also indicate that expert physiotherapist has more knowledge and also uses current practices when compared to novice physiotherapist. Even though expert physiotherapists have better knowledge and current practices when compared to the novice physiotherapists, the overall outcomes indicate that Nigerian physiotherapists had insufficient knowledge about asthma and were not using current clinical practice in the rehabilitation of patients with asthma. [ABSTRACT FROM AUTHOR]

Background: Mental health in medical students is well researched, with physiotherapy students receiving less attention even though psychiatry is a recognised specialty within physiotherapy. Objectives: To assess the prevalence and correlates of depression, anxiety and stress among physiotherapy clinical students. Methods: A descriptive cross-sectional study design was employed on 402 physiotherapy clinical students aged 17–40 years using a convenience sampling method. The data were collected using the self-administered 42-items Depression, Anxiety and Stress scale (DASS) and the data were analysed using a Chi-square test and binary logistic regression analysis. Results: The prevalence of depression, anxiety and stress among these students was 79.9%, 85.6% and 81.6%, respectively. The results indicate that financial status and social life influenced depression by 20.6% (odds ratio [OR] [95%] = 1.206 [1.110, 1.311]) and 36% (OR [95%] = 1.360 [1.050, 1.764]), respectively. Fear of repeating a class influenced anxiety by eight times (OR [95%] = 8.330 [6.643, 10.422]). Fear of repeating a class, financial status and academic performance influenced stress by eight times (OR [95%] = 8.360 [6.677, 10.470]), 17.5% (OR [95%] = 1.175 [1.083, 1.275]) and 18.1% (OR [95%] = 1.181 [1.083, 1.276]), respectively. Conclusion: Our study concluded that there was a high prevalence of depression, anxiety and stress among physiotherapy clinical students. These outcomes suggest that more attention needs to be given to improving physiotherapy clinical students' mental health, which will ultimately improve learning outcomes. Clinical implications: The long-term effects of psychological distress could potentially impact students' academic performance. It may also have long-lasting effects after graduation. Therefore, students who are at risk of developing psychological symptoms are needed to be thoroughly examined and then receive early required interventions. [ABSTRACT FROM AUTHOR]

Background: Whilst theoretical grounding is considered important for sound research methodology, consensus on the application of theory in qualitative research remains elusive. Novice researchers may experience challenges in applying theory in qualitative research and these may contribute to the under‐use, over‐reliance or inappropriate application of theory. Practical guidance on how theory can inform and guide the conduct of qualitative research is needed. Purpose: The purpose of this paper was to propose a framework for the application of theory in qualitative research and provide an exemplar. Methods: The Theoretical Application Framework for Qualitative Studies (TAF‐QS) was developed from the synthesis of existing literature and the authors' own experience of the application of theory. Results: The TAF‐QS encourages researchers to articulate which theoretical framework or conceptional framework they are drawing on and how this will be applied by reflecting on the purpose and the context of the study. Conclusion: The TAF‐QS provides support for researchers to explore how theory can be applied and how to achieve this in qualitative research. The use of theory in qualitative research. [ABSTRACT FROM AUTHOR]

Aims: Ageing‐in‐place for older people could be more feasible with the support of smart home technology. Ageing in‐place may maximize the independence of older adults and enhance their well‐being and quality of life, while decreasing the financial burden of residential care costs, and addressing workforce shortages. However, the uptake of smart home technology is very low among older adults. Accordingly, the aim of this study was to explore factors influencing community‐dwelling older adults' readiness to adopt smart home technology. Design: A qualitative exploratory study design was utilized. Methods: Descriptive data were collected between 2019 and 2020 to provide context of sample characteristics for community‐dwelling older adults aged ≥65 years. Qualitative data were collected via semi‐structured interviews and focus groups, to generate an understanding of older adult's perspectives. Thematic analysis of interviews and focus group transcripts was completed. The Elderadopt model was the conceptual framework used in the analysis of the findings. Results: Several factors influenced community‐dwelling older adults' (N = 19) readiness to adopt smart home technology. Five qualitative themes were identified: knowledge, health and safety, independence, security and cost. Conclusion: Community‐dwelling older adults were open to adopting smart home technology to support independence despite some concerns about security and loss of privacy. Opportunities to share information about smart home technology need to be increased to promote awareness and discussion. Impact: Wider adoption of smart home technology globally into the model of aged care can have positive impacts on caregiver burden, clinical workforce, health care utilization and health care economics. Nurses, as the main providers of healthcare in this sector need to be knowledgeable about the options available and be able to provide information and respond to questions know about ageing‐in‐place technologies to best support older adults and their families. [ABSTRACT FROM AUTHOR]

The training of artificial intelligence requires integrating real-world context and mathematical computations. To achieve efficacious smart health artificial intelligence, contextual clinical knowledge serving as ground truth is required. Qualitative methods are well-suited to lend consistent and valid ground truth. In this methods article, we illustrate the use of qualitative descriptive methods for providing ground truth when training an intelligent agent to detect Restless Leg Syndrome. We show how one interdisciplinary, inter-methodological research team used both sensor-based data and the participant's description of their experience with an episode of Restless Leg Syndrome for training the intelligent agent. We make the case for clinicians with qualitative research expertise to be included at the design table to ensure optimal efficacy of smart health artificial intelligence and a positive end-user experience. [ABSTRACT FROM AUTHOR]

Programs with several paths to the Doctor of Nursing Practice (DNP) face significant difficulties in preparing clinical scholars who can transform healthcare. While Post‐Baccalaureate to DNP (BSN‐DNP) programs are fulfilling the Institute of Medicine's mandate for seamless academic progression, several factors need to be considered for students' successful program completion. These factors include: (1) the students' stage of cognitive development for strategic thinking (metacognition); (2) students' tendency to underestimate the rigors of doctoral educational requirements; and (3) faculty challenges in helping students to acquire skills needed to complete the DNP project. The purpose of this paper is to describe learner‐centered approaches to enhance analytic preparation of BSN‐DNP students. [ABSTRACT FROM AUTHOR]

Hospitalized older adults who do not receive sufficient mobility are more likely to sustain negative health outcomes, including higher rates of mortality and institutionalization. Accordingly, the purpose of the current secondary data analysis was to examine the nurse-promoted mobility of hospitalized older adults and the association between nurses' barriers and nurse-promoted mobility. In addition, the relationship among patient severity of illness, proxy levels for function, and nurse-promoted mobility was examined. The final study sample included 61 nurses working in medical units caring for a total of 77 older adults. Findings suggest nurse knowledge gaps and attitude barriers could potentially influence the type and frequency of mobility they promote in older patients. A relationship was found between older patients with impaired mobility using assistive devices for mobility at home, and those at high risk for falls and nurses promoting more sedentary activity (e.g., chair sitting, walking in the room). Interestingly, nurses promoted significantly more sedentary mobility for patients with physical therapy orders. [ABSTRACT FROM AUTHOR]

The purpose of the current study was to examine nurses' barriers, including knowledge, attitude, and external barriers, to promoting physical activity in hospitalized older adults. Differences between the perceptions of barriers based on nurses' experience were also examined. A behavioral framework classifying nurse knowledge, nurse attitude, and external barriers was used for the study. Eighty-five nurses were recruited from two community-based hospitals in the Pacific Northwest. The findings suggest that nurses with varying levels of experience perceive a variety of barriers to promoting mobility in hospitalized older adults. Nurses with <5 years of experience perceived that they may lack knowledge and training to safely mobilize hospitalized patients and make appropriate referrals to therapists. Nurses' attitudes revealed that they collectively viewed the promotion of mobility as a priority, but novice nurses did not. Further, some nurses deferred the responsibility to promote mobility to other disciplines. [ABSTRACT FROM AUTHOR]

The Smart Home designed to extend older adults independence is emerging as a clinical solution to the growing ageing population. Nurses will and should play a key role in the development and application of Smart Home technology. Accordingly, conceptual frameworks are needed for nurse scientists who are collaborating with multidisciplinary research teams in developing an intelligent Smart Home that assists with managing older adults' health. We present a conceptual framework that is grounded in critical realism and pragmatism, informing a unique mixed methodological approach to generating, analyzing, and contextualizing sensor data for clinician‐based machine learning. This framework can guide nurse scientists in knowledge construction as they participate in multidisciplinary health‐assistive Smart Home and artificial intelligence research. In this paper, we review philosophical underpinnings and explicate how this framework can guide nurse scientists collaborating with engineers to develop intelligent health‐assistive Smart Homes. It is critical that clinical nursing knowledge is integrated into Smart Home and artificial intelligence features. A conceptual framework and practical method will provide needed structure for knowledge construction by nurse scientists. [ABSTRACT FROM AUTHOR]

Objectives: This scoping review (a) describes programs to improve mobility in hospitalized adults and (b) determines the methods used to measure mobility. Method: The Joanna Briggs Institute Methodology for Scoping Reviews was used to conduct this review. Results: Our findings suggest that using a multidisciplinary approach may be the most effective way to promote mobility in hospitalized older adults. Most studies did not articulate how physical activity was measured, indicating that more research is needed. Discussion: The literature shows that implementation of protocols designed to improve the early and regular implementation of physical mobility activities improves the health outcomes of hospitalized older people. Costs associated with healthcare utilization are also reduced, including hospital length of stay. Mobility programs that quantified mobility through validated measurement tools or accelerometers are the most promising as they provide feedback that reinforces progress of the patient and the expected benefits of early mobility. [ABSTRACT FROM AUTHOR]