Pilot Testing Function Focused Care for Acute Care

产品说明：老年人占住院创伤患者的25%，预计这些比率将增加，到2050年，约40%的创伤患者将是老年人。这些患者通常有多种合并症和生理储备下降，当暴露于急性护理环境和限制运动的医疗和护理干预时，会发生整体身体活动和功能的意外下降。这些人也更有可能在住院时发生感染，压疮和跌倒，并在出院后需要不定期的再住院治疗。由于环境和政策问题，老年创伤患者很少有机会参加体育活动（例如，杂乱的房间，缺乏合适的椅子），患者、家属和健康护理提供者所持有的护理哲学（例如，认为通过限制活动可以防止福尔斯的信念）和患者中的动机因素。为了克服这些挑战，我们开发了创伤恢复功能集中护理（FFC-TR）。FFC- TR的目的是改变护理理念，使护士教授、提示、定位和帮助患者从事身体活动，包括洗澡、穿衣、下床和行走等。功能集中护理（FFC）与向患者提供护理的传统方法形成对比，在传统方法中，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，给病人一个小便池或便盆，而不是帮助病人走到浴室）。FFC活动是个体化的，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; 和（2）初步评估FFC-TR对患者功能、身体表现和总体身体活动的影响，以及住院期间和出院后30天内计划外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到治疗（FFC-TR）或注意力控制[FFC-教育（FFC-艾德）]。FFC-TR干预措施基于社会生态模型和社会认知理论，将由一名研究功能重点护理护士在治疗单位每周工作20小时，为期16个月，并将包括：第一部分护士教育;第二部分环境和政策评估;和第三部分护士的持续培训和激励。组件I包括四个类别：类别1。FFC概述; 2类。患者目标制定;第3类。安全地优化身体活动;和类4。患者动机。FFC-ED仅涉及将护士暴露于组件I。我们将从每家医院招募50名患者，并衡量患者的结局。这项试点工作将有助于确定招募率、混杂因素（如病例组合和人口统计学变量），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，如平均值、标准差和治疗效果和方差估计。

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.