ABSTRACT
Aims and objectives
To examine activity, experiences, and outcomes of a 4-bed Close Observation Pod model
of multidisciplinary care for patients, carers, and staff. This model provides additional
surveillance by an assistant in nursing to support vulnerable older patients with
cognitive or physical impairments at risk of hospital-acquired complications.
Design
Concurrent mixed method design.
Methods
Data collection concluded in 2018 and entailed: (1) A retrospective cohort study of
12 months of patient outcome data; (2) Semi-structured interviews with manifest content
analysis to describe the experiences of patients, carers, and staff, and (3) Cross-observational
study with behavioural mapping to observe physical, social, and cognitive activity.
Results
Patients admitted to a 4-bed Close Observation Pod had significantly lower odds of
falls than the control group; but were more than four times as likely to experience
other adverse complications (pneumonia, delirium, pressure injuries, medical emergency
team, personal threat) than those in the control group. The 4-bed Pod resulted in
qualitatively perceived benefits of socialisation and monitoring for safety, but challenges
of privacy, noise, staffing characteristics, and conflicting expectations. Patients
were observed to have high levels of sedentary behaviour, spending on average only
34.7% of the observed time engaging in physical (18%), cognitive (5%), or social activity
(15%).
Conclusion
Complex older patients provided with a close observation model of multidisciplinary
care, where additional surveillance is provided by an assistant in nursing, were observed
to experience lower odds of falls but higher rates of other potentially preventable
complications, and high levels of sedentary behaviour.
Keywords
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References
- Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.The Journal of Nursing Administration. 2012; 42: S10-S16https://doi.org/10.1097/01.NNA.0000420390.87789.67
Australian Institute of Health and Welfare (2018). Australia’s Health. No. 16 AUS 221. Available from: 〈https://www.aihw.gov.au/getmedia/6bc8a4f7-c251-4ac4-9c05-140a473efd7b/aihw-aus-221-chapter-3-3.pdf.aspx〉.
- 'Failure to Maintain': a theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital.International Journal of Nursing Studies. 2016; 63: 146-161https://doi.org/10.1016/j.ijnurstu.2016.08.001
- The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study.BMC Health Services Research. 2015; 1591https://doi.org/10.1186/s12913-015-0743-1
- Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study.BMJ Open. 2013; 3https://doi.org/10.1136/bmjopen-2013-002770
- Core domains for research on hospital inactivity in acutely Ill older adults: a Delphi consensus study.Archives of Physical Medicine and Rehabilitation. 2021; 102: 664-674https://doi.org/10.1016/j.apmr.2020.10.136
- Why hospital design matters: a narrative review of built environments research relevant to stroke care.International Journal of Stroke. 2022; 17: 370-377https://doi.org/10.1177/17474930211042485
- Nursing staff perceptions of physical function in hospitalized older adults.Applied Nursing Research. 2011; 24: 215-222https://doi.org/10.1016/j.apnr.2010.01.001
- Nursing associates: will they become a cheap substitute for nurses?.The Guardian: Australia Edition. 2018; 7 (Available from:)
- Hospital nurse staffing models and patient and staff-related outcomes-an epic EPOC systematic review.JBI Evidence Implementation. 2011; 9 (326)
- Unlocking Skills in Hospitals: Better Jobs, More Care.Grattan Institute, 2014
- Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment.Journal of Clinical Nursing. 2018; 27: 3768-3779https://doi.org/10.1111/jocn.14632
- Management of delirium in medicine: experience of a Close Observation Unit.Australasian Journal on Ageing. 2013; 32: 60-63https://doi.org/10.1111/ajag.12007
- Hospital outcomes of older people with cognitive impairment: an integrative review.International Journal of Geriatric Psychiatry. 2018; 33: 1177-1197https://doi.org/10.1002/gps.4919
- Nurses’ perspectives on how operational leaders influence function-focused care for hospitalised older people.Journal of Nursing Management. 2016; 24: 1119-1129https://doi.org/10.1111/jonm.12421
- Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?.Collegian. 2021; 28: 482-488https://doi.org/10.1016/j.colegn.2020.12.004
- Task engagement and the consistency of pedagogical controls: an ecological study of differently structured classroom settings.Curriculum Inquiry. 1978; 8: 3-36https://doi.org/10.1080/03626784.1978.11075556
- Nurse staffing, nursing assistants and hospital mortality: retrospective longitudinal cohort study.BMJ Qual Saf. 2019; 28 (Epub 2018 Dec 4. PMID: 30514780; PMCID: PMC6716358): 609-617https://doi.org/10.1136/bmjqs-2018-008043
- Supporting general hospital staff to provide dementia sensitive care: a realist evaluation.International Journal of Nursing Studies. 2019; 96: 61-71https://doi.org/10.1016/j.ijnurstu.2018.10.004
- Perspectives: the Nurse Associate: an asset to supplement the NHS workforce or a cheaper substitute for the registered nurse?.Journal of Research in Nursing. 2016; 21: 483-486https://doi.org/10.1177/1744987116656737
- Nursing perspectives on reducing sedentary behaviour in sub‐acute hospital settings: a mixed methods study.Journal of Clinical Nursing. 2021; 31: 1348-1361https://doi.org/10.1111/jocn.15994
- Applied Logistic Regression. 2nd edn. John Wiley & Sons, Inc, 2000
Independent Hospital Pricing Authority (2020). Pricing and funding for safety and quality – Risk adjustment model for hospital acquired complications. Available from: 〈https://www.ihpa.gov.au/sites/default/files/publications/pricing_and_funding_for_safety_and_quality-hacs.pdf〉.
- Towards human-centred general hospitals: the potential of dementia-friendly design.Architectural Science Review. 2021; 8: 1-9https://doi.org/10.1080/00038628.2021.1933889
- Content analysis: review of methods and their applications in nutrition education.Journal of Nutrition Education and Behavior. 2002; 34: 224-230https://doi.org/10.1016/S1499-4046(06)60097-3
- One size fits all? Mixed methods evaluation of the impact of 100% single-room accommodation on staff and patient experience, safety and costs.BMJ Quality and Safety. 2016; 25: 241-256https://doi.org/10.1136/bmjqs-2015-004265
- Impact of the design of the built environment on people with dementia: an evidence-based review.HERD: Health Environments Research & Design Journal. 2014; 8: 127-157https://doi.org/10.1177/193758671400800111
- Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals.The Lancet. 2021; 397: 1905-1913https://doi.org/10.1016/S0140-6736(21)00768-6
- Healthcare assistants used as ‘nurses on the cheap’.Nursing Times. 2016;
- Delegation practices between registered nurses and nursing assistive personnel.Journal of Nursing Management. 2010; 18: 157-165https://doi.org/10.1111/j.1365-2834.2010.01062.x
- A comparison of nursing tasks undertaken by regulated nurses and nursing support workers: a work sampling study.Journal of Advanced Nursing. 2017; 73: 1421-1432https://doi.org/10.1111/jan.13224
- Where have all the nurses gone?.Australian Journal of Advanced Nursing. 2008; 26: 95-101
- Nurse staffing models in acute care: a descriptive study.Nursing Open. 2019; 6: 1218-1229https://doi.org/10.1002/nop2.321
- Evaluation of a partnership model of care delivery involving registered nurses and unlicensed assistive personnel.Canadian Journal of Nursing Leadership. 1999; 12: 4-20https://doi.org/10.12927/cjnl.1999.19073
- The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: an analysis of administrative health data.International Journal of Nursing Studies. 2016; 63: 189-200https://doi.org/10.1016/j.ijnurstu.2016.09.008
- Datasets to support workforce planning in nursing: a scoping review.Collegian. 2021; 282021
- One to one specialling and sitters in acute care hospitals: a scoping review.International Journal of Nursing Studies. 2018; 84: 61-77https://doi.org/10.1016/j.ijnurstu.2018.04.018
Article info
Publication history
Published online: March 02, 2023
Accepted:
December 28,
2022
Received in revised form:
September 21,
2022
Received:
March 6,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australian College of Nursing Ltd. Published by Elsevier Ltd.
