Cynthia S. Jacelon

Aim: To explore the elements of dignity in interaction and the residents' individual dignity from the viewpoint of staff in long‐term care facilities. Methods: In‐depth interviews were conducted twice with each participant using a hermeneutic phenomenological approach to understand staff experiences and clarify how they understood the meaning of dignity and dignified care. After theme generation, a panel of seven experts reviewed the themes. The previously established framework of the conceptual matrix derived from the residents' perspective was used to verify the applicability of the result. Results: A total of 18 in‐depth interviews were conducted with nine staff who worked at long‐term care facilities. Mean age of participants was 36.8 years (SD = 5.9; range: 25–43); six were female (66.7%). A total of 944 codes were extracted from the interviews, and four themes were generated: “dignity in relation to family members, friends, society, and other residents”; “dignified direct care”; “dignified care by nursing care facilities and the nursing care system”; and “(residents') dignity developed over the life course.” Conclusions: Dignity in interaction and the residents' individual dignity are perceived to be important to care staff. Comparing the elements of dignity extracted from interviews of care staff and those of residents, dignified care is defined by staff with more specific behaviors, responsibilities, and relationships. In long‐term care, “dignity developed over the life course” is a subjective and unique dignity that is not easily influenced by others or the environment and is the background of dignity in interaction.

Background: Social relationships influence health, yet less is known on how social relationships influence self‐care among older people living with multiple long‐term conditions.Objectives: The purpose of this study was to determine how social networks influence therapeutic self‐care behaviours and health among community dwelling older people living with multiple long‐term conditions.Design: Explanatory sequential mixed‐methods.Setting/Sample: Community dwelling older people living in the Northeast United States.Methods: A cross‐sectional sample of eighty‐nine people aged sixty‐five and older participated in telephone surveys. A nested sample of twelve participants completed a follow‐up open‐ended interview. Descriptive statistics, bivariate correlations and regression statistics were used to examine the associations between social network features and functions with the dependent variables of therapeutic self‐care behaviours and health. Qualities that emphasised the contexts of the relationships were integrated in the data analysis.Results: The strength of the social network and level of social support influenced the outcomes of therapeutic self‐care and mental health. Thematic analysis expanded this explanation of self‐care in relation to social network size, psycho‐social support, activation of support, interaction frequency and type.Conclusion: In supporting older people living with multiple long‐term conditions, this nursing research offers new ways to understand close social relationships influence on self‐care in developing systems of care at the community level.Implications for practice: Designing care systems that include small trusted formal and informal caregivers that integrate social network members could improve health outcomes and improve access to supportive resources.

Aim To analyze the concept of patient flow management. Background Patient flow has a significant impact on the provision of patient care. The term “patient flow” is widely used, but the related concept of "patient flow management" has been poorly defined. The ability to differentiate and clarify the term patient flow management has implications on strategies to improve patient flow. Design Rodgers evolutionary method of concept analysis. Data Source Literature published between 2000 and 2021 in the PubMed, CINAHL, and Business Source databases. Review Methods Inductive analysis of the literature was performed to identify the usage and features of the concept. Results Patient flow management is defined as the application of holistic perspectives, dynamic data, and complex considerations of multiple priorities to enable timely, efficient, and high-quality patient care. Patient flow management requires the identification of a patient, care processes, a flow manager, and frontline staff. It has profound consequences on patient, staff, and hospital system outcomes. Conclusions Literature should more carefully delineate between “patient flow” and "patient flow management." Effective patient flow management increases the speed and quality of patient care, improves employee satisfaction, and reduces healthcare costs. Strategies to improve patient flow management should focus on understanding the role and interventions of flow management nurses.

Chronic sleep disturbances reduce physical and mental health and affect over 8 million people age 65 years and older in the United States. There is evidence that use of a wearable Personal Self-Monitoring Device (PSMD) may improve sleep self-management in young adult populations. Feasibility of PSMD use for older individuals has not been explored and was the goal of this study. Persons age 65 years and over with self-reported sleep disturbances were recruited in a local community and were asked to wear a commercial PSMD for a 4-week period. To assess whether such an intervention may be feasible, outcomes included consent rate, study completion rate, data download interpretation, identification of a sleep self-management goal, improved knowledge about sleep, and improved sleep. Twenty-six persons (12 males and 14 females) were recruited over 3 months, out of a total of 33 expressing interest. Mean age=72, SD=4.99. Ninety-two percent of participants completed the study and reported improved awareness of sleep patterns and identified a sleep goal. Total sleep time was M=7 hours 14 minutes, SD=40 minutes; total restful sleep time was M=4 hours 33 minutes, SD=1 hour 22 minutes. In conclusion, sleep self-management with the use of a PSMD is feasible and of interest among persons in the young-old age category (65-74 years). There is potential for the use of PSMD among older people with the goal of improved sleep self-management. Future studies for sleep health self-management and interventions using personal sleep monitoring are recommended.

Aims and objectives: The aim of this research was to explore the processes used by older individuals to self‐manage their health during the first 30 days after being discharged from the hospital. The underlying philosophy for this research was symbolic interactionism. From this perspective, individuals make meaning out of their experiences and act on the basis of those meanings.Background: Little is known about the processes older adults use to adjust to and self‐manage their evolved health status after returning home from the hospital. Few studies have explored this period from the perspective of the older individual living in the situation.Methods: We used case study method to develop a collective, instrumental case to explain the phenomena of older individuals self‐managing their health after hospitalisation. Data included interviews, participant diaries and researcher field notes.Results: The sample included three women who were at least 75 years old, had been hospitalised for at least 24 hr and had been discharged within the week prior to the first interview. Data from the participants were used to create a composite case, Mrs. C. She managed her autonomy, activity, attitude, health and relationships across three phases of posthospitalisation, returning home, adjusting and the evolved normal.Conclusions: This study provides insight into the experience of older individuals during the first 30 days after a stay in a healthcare facility and supports previous research findings regarding hospitalisation and self‐management of chronic health problems.Implications for practice: The findings provide evidence that returning home is a process that usually takes about a month to get into a new routine. Nurses can use this case study to describe some people’s experience after discharge, and to help the older individual to identify friends and family who can provide physical and emotional support during the time immediately after discharge.

Aims and objectives: The purpose of this scoping review of literature is to explore the types of computer‐based systems used for self‐management of chronic disease, the goals and success of these systems, the value added by technology integration and the target audience for these systems.Background: Technology is changing the way health care is provided and the way that individuals manage their health. Individuals with chronic diseases are now able to use computer‐based systems to self‐manage their health. These systems have the ability to remind users of daily activities, and to help them recognise when symptoms are worsening and intervention is indicated. However, there are many questions about the types of systems available, the goals of these systems and the success with which individuals with chronic illness are using them.Design: This is a scoping review in which the Cumulative Index of Nursing and Allied Health Literature, PubMed andIEEEXplore databases were searched. A total of 303 articles were reviewed, 89 articles were read in‐depth and 30 were included in the scoping review. The Substitution, Augmentation, Modification, Redefinition model was used to evaluate the value added by the technology integration.Findings: Research on technology for self‐management was conducted in 13 countries. Data analysis identified five kinds of platforms on which the systems were based, some systems were focused on a specific disease management processes, others were not.Conclusions: For individuals to effectively use systems to maintain maximum wellness, the systems must have a strong component of self‐management and provide the user with meaningful information regarding their health states.Relevance to clinical practice: Clinicians should choose systems for their clients based on the design, components and goals of the systems.