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ABSTRACT: AIM: To report a concept analysis of oral hygiene care. BACKGROUND: Oral hygiene care, as it is provided to older patients in hospital and long-term care settings by nurses and their delegates, has the potential to contribute to the oral health of patients while preventing aspiration pneumonia as well as periodontitis, which itself has been associated with several systemic diseases. However, the state of oral cleanliness in such patients tends to be poor and despite the existence of guidelines, nursing care practices may be inadequate and not reflective of recent advances in knowledge. DESIGN: Concept analysis. DATA SOURCES: A search of electronic databases (2002-2012), use of internet search engines, and hand searching yielded an international data set of 66 research studies, reviews, and practice guidelines. REVIEW METHODS: The concept analysis method of Walker and Avant was used to explore the concept of oral hygiene care in the context of frail older patients. RESULTS: Oral hygiene care involves approaches informed by knowing the patient, inspecting the oral cavity, removing plaque, cleansing the oral tissues, decontaminating the oral cavity, using fluoride products and maintaining oral tissue moisture. Those attributes, along with their antecedents and consequences, form a conceptual framework from which a middle-range theory of nurse-administered oral hygiene care is derived that could be tested, evaluated, modified, and translated into practice. CONCLUSIONS: Clarity around the concept of oral hygiene care as a nursing intervention could enable nurses to impact oral health outcomes and possibly prevent systemic diseases in older patients.
Journal of Advanced Nursing 02/2013; · 1.48 Impact Factor
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Sharon Kaasalainen,
Kevin Brazil,
Noori Akhtar-Danesh, Esther Coker,
Jenny Ploeg,
Faith Donald,
Ruth Martin-Misener,
Alba DiCenso,
Thomas Hadjistavropoulos,
Lisa Dolovich,
Alexandra Papaioannou
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ABSTRACT: To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents.
A controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data.
Four LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group.
Data were collected from 200 LTC residents; 99 for the intervention and 101 for the control group.
Implementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities.
Resident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews.
Pain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol.
These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents.
Journal of the American Medical Directors Association 06/2012; 13(7):664.e1-8. · 4.64 Impact Factor
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Sharon Kaasalainen,
Kevin Brazil, Esther Coker,
Jenny Ploeg,
Ruth Martin-Misener,
Faith Donald,
Alba DiCenso,
Thomas Hadjistavropoulos,
Lisa Dolovich,
Alexandra Papaioannou,
Anna Emili,
Tim Burns
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ABSTRACT: The study purposes were twofold: (1) to explore barriers to pain management and those associated with implementing a pain management program in long-term care (LTC); and (2) to develop an interprofessional approach to improve pain management in LTC.
A case study approach included both qualitative and quantitative components. We collected data at two LTC sites using seven focus groups for the licensed nurses, unregulated care providers and physicians, and 10 interviews with other health care provider groups, administration, and residents. We reviewed documents and administered a short survey to study participants to assess perceptions of barriers to pain management.
The findings revealed barriers to effective LTC pain management at the resident/family, health care provider, and system levels. We then developed a six-tiered model with proposed interventions to address these barriers.
This model can guide the development of innovative approaches to improving pain management in LTC settings.
Canadian journal on aging = La revue canadienne du vieillissement 12/2010; 29(4):503-17. · 0.92 Impact Factor
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ABSTRACT: Nurses' perceptions of barriers preventing optimal pain management in older adults on acute medical units and the extent to which they perceived they had adopted four evidence-based practices related to pain assessment and management were often incongruent with actual practice. Eliciting reports of pain, offering pro re nata pain relief regularly, utilizing pain assessment tools in patients with cognitive impairment, redesigning documentation tools and processes, making nonpharmacological alternatives accessible, and helping patients and families manage side effects would target the 12 barriers having the biggest impact.
Applied nursing research: ANR 08/2010; 23(3):139-46. · 0.87 Impact Factor
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Esther Coker
Evidence-based nursing 05/2009; 12(2):57.
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ABSTRACT: Persistent pain is a significant problem for older hospitalized adults and their health care team. A better understanding of the approach to pain management in the clinical setting will provide guidance for the development of improvements in clinical management. The purpose of this study was to determine the prevalence of pain and to examine the current state of pain assessment and management in older adults on the six acute medical units of an academic health sciences centre. Findings revealed that 70% of older patients were in pain, nurses had limited awareness of their patients' pain, documentation of pain assessment and management was lacking, and pain was under-treated. Utilization of practice guidelines related to management of persistent pain in older adults in acute care settings is recommended, and an approach to their implementation, including identifying and overcoming the barriers to such best practices, is warranted.
Perspectives (Gerontological Nursing Association (Canada)) 02/2008; 32(1):5-12.
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ABSTRACT: The purpose of this study is to explore attitudes and beliefs that affect decisions about prescribing and administering pain medications in older adults who live in long-term care (LTC), with a particular emphasis on those with cognitive impairment. At each of the four participating LTC facilities, data were gathered from three separate groups of health care professionals: physicians, registered nurses, and registered practical nurses. Based on grounded theory, a model was developed that highlighted critical decision points for nurses and physicians regarding pain management. The major themes that emerged from the data concerned pain assessment (lack of recognition of pain, uncertainty about the accuracy of pain assessment and diagnosis) and treatment (reluctance to use opioids, working to individualize pain treatments, issues relating to physician trust of the nurse on prescribing patterns). These findings may facilitate the development of innovative approaches to pain management in LTC settings.
Western Journal of Nursing Research 09/2007; 29(5):561-80; discussion 581-8. · 1.19 Impact Factor
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Esther Coker
Evidence-Based Nursing 11/2006; 9(4):122.
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Sharon Kaasalainen,
Pam Baxter,
Lori Schindel Martin,
Dawn Prentice,
Sue Rivers,
Allison D'Hondt,
Jenny Ploeg, Esther Coker,
Maureen Montemuro,
Jennifer Hammers,
Erica Roberts
Perspectives (Gerontological Nursing Association (Canada)) 02/2006; 30(1):4-10.
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Esther Coker
Evidence-Based Nursing 08/2004; 7(3):92.
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ABSTRACT: The British STRATIFY tool was previously developed to predict falls in hospital. Although the tool has several strengths, certain limitations exist which may not allow generalizability to a Canadian setting. Thus, we tested the STRATIFY tool with some modification and re-weighting of items in Canadian hospitals.
This was a prospective validation cohort study in four acute care medical units of two teaching hospitals in Hamilton, Ontario. In total, 620 patients over the age of 65 years admitted during a 6-month period. Five patient characteristics found to be risk factors for falls in the British STRATIFY study were tested for predictive validity. The characteristics included history of falls, mental impairment, visual impairment, toileting, and dependency in transfers and mobility. Multivariate logistic regression was used to obtain optimal weights for the construction of a risk score. A receiver-operating characteristic curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk.
Inter-rater reliability for the weighted risk score indicated very good agreement (inter-class correlation coefficient = 0.78). History of falls, mental impairment, toileting difficulties, and dependency in transfer / mobility significantly predicted fallers. In the multivariate model, mental status was a significant predictor (P < 0.001) while history of falls and transfer / mobility difficulties approached significance (P = 0.089 and P = 0.077 respectively). The logistic regression model led to weights for a risk score on a 30-point scale. A risk score of 9 or more gave a sensitivity of 91% and specificity of 60% for predicting who would fall.
Good predictive validity for identifying fallers was achieved in a Canadian setting using a simple-to-obtain risk score that can easily be incorporated into practice.
BMC Medicine 01/2004; 2:1. · 6.03 Impact Factor
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ABSTRACT: Abstract
Background
The British STRATIFY tool was previously developed to predict falls in hospital. Although the tool has several strengths, certain limitations exist which may not allow generalizability to a Canadian setting. Thus, we tested the STRATIFY tool with some modification and re-weighting of items in Canadian hospitals.
Methods
This was a prospective validation cohort study in four acute care medical units of two teaching hospitals in Hamilton, Ontario. In total, 620 patients over the age of 65 years admitted during a 6-month period. Five patient characteristics found to be risk factors for falls in the British STRATIFY study were tested for predictive validity. The characteristics included history of falls, mental impairment, visual impairment, toileting, and dependency in transfers and mobility. Multivariate logistic regression was used to obtain optimal weights for the construction of a risk score. A receiver-operating characteristic curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk.
Results
Inter-rater reliability for the weighted risk score indicated very good agreement (inter-class correlation coefficient = 0.78). History of falls, mental impairment, toileting difficulties, and dependency in transfer / mobility significantly predicted fallers. In the multivariate model, mental status was a significant predictor (P < 0.001) while history of falls and transfer / mobility difficulties approached significance (P = 0.089 and P = 0.077 respectively). The logistic regression model led to weights for a risk score on a 30-point scale. A risk score of 9 or more gave a sensitivity of 91% and specificity of 60% for predicting who would fall.
Conclusion
Good predictive validity for identifying fallers was achieved in a Canadian setting using a simple-to-obtain risk score that can easily be incorporated into practice.
BMC Medicine. 01/2004;
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Esther Coker
Evidence-Based Nursing 08/2003; 6(3):93.
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ABSTRACT: Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.
Journal of Professional Nursing 21(6):372-9. · 0.89 Impact Factor
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ABSTRACT: Accurate prediction of fall-prone hospitalized older adults may be integral to reducing falls. The STRATIFY, a simple 5-point falls prediction tool, was prospectively validated on a Geriatric Assessment and Rehabilitation Unit as a one-time initial predictor of patients likely to fall. Sensitivity and specificity were lower than in the original British study. Introducing risk assessments validated elsewhere on a patient care unit or on a hospital-wide scale requires caution.
Outcomes management 7(1):8-14; quiz 15-6.
