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首页> 外文期刊>International journal of older people nursing >Identifying modifiable factors to improve quality for older adults in hospital: A scoping review
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Identifying modifiable factors to improve quality for older adults in hospital: A scoping review

机译：确定可改善的因素以改善住院老年人的质量：范围界定审查

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Background: Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified. Design: Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology. Method: We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria. Results: A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes. Conclusion: The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care. Implications for practice: Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.
机译：背景：看待住院的传统方法并不总是能识别出医院环境中的因素如何导致残疾。以前对老年人友好型医院的研究提出了老年人与医院环境适应的四个理论方面：社会气候，身体设计，护理系统和过程，政策和程序;但是，尚未确定每个维度的可修改因素。设计：在Arksey和O'Malley的指导下进行的探索性迭代设计（2005年，国际社会研究方法学杂志，第8卷，第19期）界定范围研究方法。方法：我们对与住院社区老年人相关的主要研究进行了范围界定审查。使用关键词搜索术语和标准来识别相关文章，并从符合研究标准的文章中提取可修改因素。结果：共纳入66项研究，并对可修改的因子作图进行评估。我们能够将所有66个研究映射到四个维度。纳入研究的大多数描述了护理系统和过程，很少涉及社会气候，自然设计以及政策和程序。根据四个总体主题，确定了39个潜在可修改因素，并将其映射到理论维度：评估潜在的老年问题;将护理针对特定的临床问题并支持过渡家庭主题。结论：老年人与医院的适应关系有助于我们组织一家老年医院的关键特征，并确定潜在的可改变因素。尽管根据维度进行聚类和组织以帮助理解很直观，但这对交互和层次关系的协同作用知之甚少。我们的研究结果突出了在老年住院患者中进行有效的老年病学护理的重要性，以及需要进一步了解老年人和家庭作为护理单位的重要性。对实践的影响：注册护士具有领导作用，以确保为住院老人提供安全优质的护理。可以在干预措施中发挥领导作用，这些干预措施的重点是确定老年人需要什么和医院环境提供什么之间的适应性。改进的改进因素在注册护士的能力范围内。

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