Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description

Abstract

This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities.The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.

Psychometrics of the Physical Resilience Scale in Older Adults Living with Dementia: Proxy Responses

“…Baseline data from the Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT) trial was used for this analysis (Resnick et al, 2022). The study was approved by a University based Institutional Review Board.…”

Optimal Approach for Assessing Evidence of Dementia for Research Studies

“…This study used baseline screening data for eligibility from a randomized clinical trial testing an intervention referred to as Function Focused Care for Acute Care Using the Evidence Integration Triangle (FFC-AC-EIT). The study protocol has been published previously (Resnick et al, 2022). Screening and determination of eligibility was done both prior to and post consent.…”

“…The eligibility for hospitals to participate in the study was based on what was relevant for the intervention activities as described in the protocol paper (Resnick et al, 2022) and included the following criteria: (a) having at least one unit dedicated to general medical patients; (b) identifying two registered nurses to be champions (one for day and one for evening shifts); (c) assuring that hospital staff could access email and websites via a phone, tablet, or computer; and (d) establishing that there was no geriatric program in the hospital for medical patients (e.g., Acute Care for Elders, Hospital for Elder Life Program [HELP]). Participant data was from the first six hospitals in the study.…”

“…Therefore a medical history cannot be used to screen individuals for a dementia diagnosis. The purpose of this study was to describe the findings from a process used for determining dementia in an ongoing National Institute of Aging study (Resnick et al, 2022) and to test the psychometric properties of the proposed measurement model. Specifically, we hypothesized that evidence and severity of dementia would be best conceptualized and established by the measurement model shown in Figure 1: (a) a score of >2 on the AD8 Dementia Screening Interview (Galvin et al, 2005(Galvin et al, , 2006; (b) a score of 9 or greater on the Functional Activities Questionnaire; (c) a score of 0.5 to 2.0 on the Clinical Dementia Rating Scale; and (d) screening positive for dementia based on a score of ≤19 on the Saint Louis University Mental Status Exam Scale for individuals with less than high school education and a score of ≤20 for individuals with at least high school education (Morley & Tumosa, 2002).…”

Delirium Severity and Physical Function in Hospitalized Persons Living With Dementia

“…The study received approval from the Institutional Review Board at the University of Maryland, Baltimore, and has been published. 24 All participants provided written informed consent before data collection.…”