Pilot Testing Function Focused Care for Acute Care

University Of Maryland Baltimore, Baltimore MD

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Abstract

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.