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Background The transition of older persons between care settings is recognised as a particularly critical and vulnerable period (Renom-Guiteras et al. 2014). Appropriate documentation and processes are key in assisting the provision of quality, safe, person-centred care when transferring older persons from residential to acute care settings. This paper reports on the design phase of a national transfer document for older persons. The objective was to inform the development of a draft national transfer document. Methods Development consisted of two phases 1) an integrative review and 2) focus group interviews with stakeholders. The review was guided by Whittemore and Knafl's (2005) integrative review framework. Data from studies using both quantitative and qualitative methodologies were extracted and thematically analysed. Using a qualitative descriptive approach, focus group interviews (n=8) were conducted with a convenience sample of key stakeholders (n=68) to establish their perspectives regarding transfer documents. Data were analysed using content analysis. Results from both phases were integrated to guide the development of the draft document. A multidisciplinary panel of experts in older persons care, reviewed and provided feedback on the draft transfer document. Results Within the review, thirty identified papers focused on transfer documentation between residential and acute care. Results indicated that using a standardised document can potentiate the delivery and acceptance of relevant person-centred information between all parties when transferring an older person between residential and acute care settings. Qualitative interview findings highlighted important aspects for consideration regarding the layout, content and format of future transfer documentation. Following collaboration with the expert panel the transfer document was developed for piloting. Conclusion Consistency and clarity of information is key for a successful transfer of older persons from residential to acute settings. Information needs to be evidence-based, current, and subject to response and change in accordance with best available international practice. [ABSTRACT FROM AUTHOR]

Background There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document. Methods Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085). Results Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated. Conclusion In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer. [ABSTRACT FROM AUTHOR]

Introduction: Supporting the decision-making of those with capacity challenges is a relatively new area of health and social care policy and research. The Assisted Decision-Making (Capacity) Act 2015 has yet to be commenced in Ireland, however codes of practice and educational strategies are in development to support healthcare professionals to practice in accordance with the Act. The overall aim of this research is to develop an educational discussion game (PlayDecide TM) which will encourage healthcare professionals, older people (with and without a diagnosis of dementia) and family caregivers to discuss assisted decision-making (ADM). It is envisaged that this discussion game will support the implementation of the emergent codes of practice. This paper describes a pre-implementation formative evaluation informed by the perspectives of relevant stakeholders in ADM practice. This provides a diagnostic analysis of contextual issues, barriers and enablers influencing the adoption of ADM practice in acute care settings. Methods: The pre-intervention diagnostic activity involved site visits and key informant interviews from within two acute care settings and two day-hospital settings. Data were collected using qualitative interviews and follow-up validation discussion groups. In total, 18 interviews and three validation groups were conducted with family carers and older people with and without a diagnosis of dementia. A further 32 interviews and four validation groups were conducted with healthcare professionals located across the four sites (social workers n=8, SLT/PT/OTs n=8, nurses n=8 and physicians n=8). Reflections were elicited on the following: current practice in relation to decisionmaking; contextual determinants of current practice; and potential barriers/facilitators to enable behavioural change. Results: The qualitative data yielded nuanced descriptions of the following themes: common and accepted ways of engaging in decision-making; favoured modes of communication; areas of tension and cohesion within teams; ideas of how ADM might work; desired behaviour change; ideas on how to implement behaviour change among staff and patients and potential areas of resistance. Discussions: Identification of implementation factors related to organisational culture, interpersonal relationships and governing norms will lead to more targeted and site-specific implementation strategies. This will enhance the likelihood of successful implementation of behaviour change. Conclusions: The findings from the diagnostic analysis will provide real world context-driven narratives and participant issues that will be incorporated into the serious discussion game through a co-design process with key stakeholders, including patients and healthcare professionals. The discussions prompted by the serious game will allow the players to generate ideas about the contextual and cultural adaptations required for successful implementation of ADM policy. Lessons learned: It is essential to identify barriers as well as facilitators prior to implementing any behaviour change interventions. The developmental stage of formative evaluation is the bedrock of successful implementation of change into practice. Limitations: Ethnographic observations of staff/patient interactions were inhibited by local access barriers. Diagnostic activity relied therefore, on first person narrative accounts of decision-making processes rather than direct observations. Suggestions for future research: The findings from the formative evaluation will prompt the development and evaluation of targeted, site- specific behaviour change interventions supporting the adoption of ADM. [ABSTRACT FROM AUTHOR]

To address the lack of research on the information needs of spinal cord injured (SCI) patients and family members in acute care, in order to inform the provision of appropriate information supports. Semi-structured interviews were conducted with seven traumatic SCI patients and six family members. Reflexive thematic analysis was used to analyse and interpret the data. Five themes were generated: (1) "You were lying in limbo and you knew nothing" describes how being situated in non-specialist acute care limited participants' access to information; (2) "You'll never walk again" is not enough describes the need for information about the effects of SCI and the management of secondary conditions; (3) "The delivery was awful" demonstrates the importance of information being explained clearly and empathically; (4) "It was going in one ear and out the other" highlights the need for ongoing conversations with healthcare professionals, as retaining information provided in the early stages post-injury is often difficult; and (5) "Hope" not "false hope" discusses the importance of giving patients and family members hope while simultaneously being realistic about potential recovery. SCI patients and family members had significant unmet information needs in acute care. SCI patients and family members had significant unmet information needs while in acute care. Being in non-specialist acute care significantly limited most participants' access to information. During the acute phase of care, most patients and family members would like to know the patient's recovery prognosis, the impact of SCI on the patient's functional independence, how to manage secondary complications, and what to expect in rehabilitation. As patients and family members often had difficulty absorbing information in the early stages post-injury, information should be continuously repeated, reinforced and clarified. HCPs should promote realistic hope for SCI patients and family members even in the absence of neurological recovery, by focusing on what the patient is still capable of while being honest about their prognosis. [ABSTRACT FROM AUTHOR]

Objectives: Acute hospitals, in particular the emergency department, can be disorienting for people living with dementia. As part of a larger project to improve care for people living with dementia, dementia-inclusive modifications were made to two emergency department bays in a large acute care hospital in Ireland. Modifications to spatial configuration included noise reduction, altered lighting and the addition of an orientation aid and fixed seating for relatives. Method: A mixed methods approach was employed with both service user and service provider perspectives explored (survey of service providers (n = 16) and interviews with family carers (n = 10) at one time point and interviews with service providers (n = 8 and n = 5) and key stakeholders (n = 3) as well as audit data (at two time points) to evaluate the impact of the modifications made to the emergency department. Results: Orientation and navigation within the modified bays were improved though technical issues with the orientation aid were highlighted. Further user information on the functionality of the adjustable lighting would be required to maximise its benefits. This lighting and use of calming colours, together with the addition of noise-reduction bay screens, served to reduce sensory stimulation. The provision of adequate space and seating for family carers was extremely beneficial. The removal of unnecessary equipment and use of new structures to store relevant clinical equipment were other positive changes implemented. A number of challenges in the design development of the modified bays were highlighted, as well as ongoing broader environmental challenges within the emergency department environment. Conclusion: The findings suggest that the modified bays contributed positively to the experience of people living with dementia and their families in the emergency department. [ABSTRACT FROM AUTHOR]

The article offers information on a study which aims to capture the views of nurses on research priorities surrounding acute care for older people in Ireland. The authors of the study used the Delphi approach to gather information in sequential questionnaires. The study reveals several priorities including dignity of the older adult, family involvement and patient safety.