September 21, 2021

The aim of this study was to examine nurses’ attitudes about the importance of family in nursing care from an international perspective. We used a cross-sectional design. Data were collected online using the Families’ Importance in Nursing Care-Nurses’ Attitudes (FINC-NA) questionnaire from a convenience sample of 740 registered nurses across health care sectors from Sweden, Ontario, Canada, and Hong Kong, China. Mean levels of attitudes were compared across countries using analysis of variance (ANOVA). Multiple regression was used to identify factors associated with nurses’ attitudes and to test for interactions by country. Factors associated with nurse attitudes included country, age, gender, and several practice areas. On average, nurses working in Hong Kong had less positive attitudes compared with Canada and Sweden. The effects of predictors on nurses’ attitudes did not vary by country. Knowledge of nurses’ attitudes could lead to the development of tailored interventions that facilitate nurse-family partnerships in care.

BACKGROUND & AIMS: Overweight and obesity have been consistently reported to carry an increased risk for poorer outcomes in coronavirus disease 2019 (COVID-19) in adults. Existing reports mainly focus on in-hospital and intensive care unit mortality in patient cohorts usually not representative of the population with the highest mortality, i.e. the very old and frail patients. Accordingly, little is known about the risk patterns related to body mass and nutrition in very old patients. Our aim was to assess the relationship between body mass index (BMI), nutritional status and in-geriatric hospital mortality among geriatric patients treated for COVID-19. As a reference, the analyses were performed also in patients treated for other diagnoses than COVID-19. METHODS: We analyzed up to 10,031 geriatric patients with a median age of 83 years of which 1409 (14%) were hospitalized for COVID-19 and 8622 (86%) for other diagnoses in seven geriatric hospitals in the Stockholm region, Sweden during March 2020-January 2021. Data were available in electronic hospital records. The associations between 1) BMI and 2) nutritional status, assessed using the Mini-Nutritional Assessment – Short Form (MNA-SF) scale, and short-term in-geriatric hospital mortality were analyzed using logistic regression. RESULTS: After adjusting for age, sex, comorbidity, polypharmacy, frailty and the wave of the pandemic (first vs. second), underweight defined as BMI<18.5 increased the risk of in-hospital mortality in COVID-19 patients (odds ratio [OR] = 2.30; confidence interval [CI] = 1.17-4.31). Overweight and obesity were not associated with in-hospital mortality. Malnutrition; i.e. MNA-SF 0-7 points, increased the risk of in-hospital mortality in patients treated for COVID-19 (OR = 2.03; CI = 1.16-3.68) and other causes (OR = 6.01; CI = 2.73-15.91). CONCLUSIONS: Our results indicate that obesity is not a risk factor for very old patients with COVID-19, but emphasize the role of underweight and malnutrition for in-hospital mortality in geriatric patients with COVID-19.

BACKGROUND AND PURPOSE: The purpose is to evaluate the construct validity of two generic health measures, the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in residents of long-term care (LTC) facilities, using a convergent/divergent validity approach, with the Functional Independence Measure (FIM), Quality of Life-Alzheimer’s Disease (QOL-AD) and Resident Assessment Instrument (RAI) 2.0 as comparators. METHODS: Health status of 130 residents with dementia residing in one of seven LTC facilities was evaluated by their Healthcare Aides who were their primary care assistants. A priori hypotheses on the magnitude and direction of the correlations were formulated by two clinician/researchers and a researcher familiar with the measures and this population. Predicted and observed correlations were compared. RESULTS: Mean overall HUI2 (0.48, SD 0.16) and HUI3 scores (0.31, SD 0.27) were indicative of severe disability. Of the 208 a priori hypotheses, 39.9% (n = 83) matched the observed correlations, 29.8% were underestimated and 19.7% were overestimated by one category. CONCLUSIONS: Findings support the use of the HUI2 and HUI3 in measuring health-related quality of life in dementia-related research to complement disease-specific measures.

Geriatric malnutrition prevention, detection, and treatment benefit from a multidisciplinary approach, regardless of the care setting. Nutrition care pathways have been created to support multidisciplinary care for hospitals and for transitions and primary care. Conceptual models for supporting nutrition in long-term care emphasize a multidisciplinary approach.

COVID-19 crashed into an already broken system, exposing its many abject vulnerabilities. Of Canada’s confirmed and probable COVID-19 deaths, 85% were in LTC homes— far higher than the comparator countries examined in a recent study by the US department of Health and Human Services (2020). The proximate causes of these disastrous outcomes are now well understood. Governments prioritized infection control in hospitals, returning infected patients to LTC homes and triggering outbreaks (Grant and Ha 2020). There was a failure to provide LTC facilities with adequate personal protective equipment and enforce infection control measures (Loriggio 2021). There was insufficient testing and tracing— even as contract staff itinerated between LTC facilities, trying to earn a living wage on low wages with no sick benefits. As with many aspects of the pandemic, our failure in LTC built on historical inequities and policy failings.