Pilot Testing Function Focused Care for Acute Care

描述：老年人占住院创伤患者的25%，预计这一比例将增加，到2050年，大约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无意下降。这些人在住院期间也更容易发生感染、压疮和跌倒，并且在出院后需要重新住院。由于环境和政策问题（例如，杂乱的房间，缺乏合适的椅子），患者、家属和卫生保健提供者所持有的护理理念（例如，认为通过限制活动可以防止跌倒）以及患者的动机因素，老年创伤患者很少有机会从事体育活动。为了克服这些挑战，我们开发了以功能为重点的创伤恢复护理（FFC-TR）。FFC- TR的目的是改变护理理念，使护士教导、提示、定位和帮助患者进行身体活动，包括洗澡、穿衣、下床和散步。功能重点护理（FFC）与传统的护理方法形成对比，在传统的护理方法中，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，给患者一个小便池或便盆，而不是帮助患者走到浴室）。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；

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.