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.

Public Health Relevance

This study will address the feasibility of Function Focused Care for Trauma Recovery (FFC-TR). Function Focused Care is an approach to care in which nurses acknowledge older adults'physical and cognitive capabilities with regard to engaging in physical activity (bathing, dressing, walking, simple exercise) and integrate physical activity int all care interactions. Our goal in this work is to establish a practical and effective way to prevet immobility, deconditioning and functional impairment in older hospitalized trauma patients and thereby optimize recovery, prevent associated complications and non-elective hospitalizations within 30 days of discharge.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21NR013736-01A1
Application #
8510933
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Mccloskey, Donna J
Project Start
2013-06-01
Project End
2015-05-31
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
1
Fiscal Year
2013
Total Cost
$181,710
Indirect Cost
$56,710
Name
University of Maryland Baltimore
Department
None
Type
Schools of Nursing
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201