scholarly journals They Have the Ability to Say Yes or No: Providers' Perspectives on Veterans' Service Refusal as a Cause of Readmissions

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 362-363
Author(s):  
Nytasia Hicks ◽  
Polly Noel ◽  
Lauren Penney ◽  
Jacqueline Pugh
Keyword(s):  
Patient Autonomy ◽  
Self Care ◽  
Adverse Outcomes ◽  
Cognitive Capacity ◽  
Structured Interviews ◽  
Post Discharge ◽  
Staff Members ◽  
Discharge Care ◽  
Interviewing Techniques

Abstract sService refusal, where patients actively refuse clinicians’ recommendations for additional services needed to achieve safe and full recovery after discharge, is a key but often overlooked cause of readmissions. There is a dearth of literature on the extent of service refusal and providers’ (e.g. clinicians, nurses, social workers) observations regarding how to deal with these situations. As part of a larger, 10 VA site organizational case study of readmission, semi-structured interviews exploring causes of readmission were conducted with 21-41 staff members at each site (n=314). 41 providers identified Veteran service refusal and decision-making as causes of readmission. Providers acknowledged the need to honor patient autonomy/self-determination in decisions while at the same time worrying about potential adverse outcomes. Incongruence between Veterans’ and providers’ perceptions (especially for capacity for self-care), goals, and discharge plans was also cited as a factor in service refusal. Frustration was also raised about initial acceptance of service followed by refusal at time of service delivery. Providers also felt readmissions increased even further when combined with lack of or inadequate caregiving arrangements/family support, lack of cognitive capacity, homelessness, or home care affordability. Findings point to the need for interventions to evaluate congruence between provider and patient assessment of self-care capabilities and provide more in-depth goal setting and motivational interviewing techniques to help patients reach more realistic post-discharge care goals.

scholarly journals Impact of cardiac- and noncardiac-related conditions on adverse outcomes in patients hospitalized with acute myocardial infarction

2019 ◽  
Vol 9 ◽  
pp. 2235042X1985249 ◽  
Author(s):  
Mayra Tisminetzky ◽  
Jerry H Gurwitz ◽  
Ruben Miozzo ◽  
Joel M Gore ◽  
Darleen Lessard ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Revascularization ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Post Discharge ◽  
Discharge Care ◽  
Significant Burden ◽  
Study Population ◽  
The Impact

Background: To examine the impact of cardiac- and noncardiac-related conditions on the risk of hospital complications and 7- and 30-day rehospitalizations in older adult patients with an acute myocardial infarction (AMI). Methods and Results: The study population consisted of 3863 adults aged 65 years and older hospitalized with AMI in Worcester, Massachusetts, during six annual periods between 2001 and 2011. Individuals were categorized into four groups based on the presence of 11 previously diagnosed cardiac and noncardiac conditions. The median age of the study population was 79 years and 49% were men. Twenty-eight percent of patients had two or less cardiac- and no noncardiac-related conditions, 21% had two or less cardiac and one or more noncardiac conditions, 20% had three or more cardiac and no noncardiac conditions, and 31% had three or more cardiac and one or more noncardiac conditions. Individuals who presented with one or more noncardiac-related conditions were less likely to have been prescribed evidence-based medications and/or to have undergone coronary revascularization procedures than patients without any noncardiac condition. After multivariable adjustment, individuals with three or more cardiac and one or more noncardiac conditions were at greatest risk for all adverse outcomes. Conclusions: Older patients hospitalized with AMI carry a significant burden of cardiac- and noncardiac-related conditions. Older adults who presented with multiple cardiac and noncardiac conditions experienced the worse short-term outcomes and treatment strategies should be developed to improve their in-hospital and post-discharge care and outcomes.

scholarly journals Challenges experienced by healthcare workers in managing patients with hearing impairment at a primary health care setting: a descriptive case study

2018 ◽  
Vol 60 (6) ◽  
pp. 39
Author(s):  
S. Orrie ◽  
T. Motsohi
Keyword(s):  
Health Care ◽  
Healthcare Workers ◽  
Health Centre ◽  
Study Data ◽  
Structured Interviews ◽  
Group Discussions ◽  
Descriptive Case Study ◽  
Staff Members ◽  
Qualitative Descriptive

Background: There has been little research on the experiences of healthcare workers (HCWs) with deaf/hearing impaired (HI) clients. Anecdotal evidence suggests that HCWs experience challenges, but little is reported on how they manage these challenges. Interactions with and care of deaf/Deaf and HI patients by clinicians has yielded several questions around communication and assessment strategies, as well as comparative quality of health care for deaf/Deaf and HI clients. This research was intended to further the understanding and knowledge of these aspects of health care of deaf/Deaf and HI clients.Methods: The study design is a qualitative, descriptive case study. Data were collected using semi-structured interviews with individual HCWs and focus-group discussions with groups of participants. Participants were invited staff members at Retreat Community Health Centre (RCHC) in Cape Town. Convenience sampling was used to select participants, and interviews were conducted until saturation was reached. Data were studied and analysed using the phenomenological method.Results: HCWs reported that they serve very few Deaf or HI clients. However, themes of language barriers, resilience, preconceptions, improvisation and innovation, interpreters and recommendations emerged. Difficulties in communication were acknowledged, but HCWs insisted that these barriers are not insurmountable.Discussion and conclusion: A few preconceptions and gaps in knowledge and awareness were revealed. HCWs also tended to rely on escorts and other interpreters. The dominant recommendations are that HCWs should receive training in sign language (SL) and/or that SL interpreters be available at facilities. Despite using words and phrases such as ‘frustrating’ and ‘more effort’, participants’ concluding remarks reiterate that their experiences are positive, suggesting a notable resilience.

scholarly journals Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patricia Jepma ◽  
Corine H. M. Latour ◽  
Iris H. J. ten Barge ◽  
Lotte Verweij ◽  
Ron J. G. Peters ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Transitional Care ◽  
Living Arrangement ◽  
Intervention Group ◽  
Adverse Outcomes ◽  
Cardiac Patients ◽  
Added Value ◽  
Structured Interviews ◽  
Post Discharge ◽  
Care Intervention

Abstract Background Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients’ participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants’ recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients’ needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.

scholarly journals Addressing COVID-19 Barriers to Clinical Trial Enrollment and Implementation in the PHARM-DC Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 104-104
Author(s):  
Joshua Pevnick ◽  
Michelle Keller ◽  
Korey Kennelty ◽  
Michelle Ko ◽  
Logan Murry ◽  
...  
Keyword(s):  
Older Adults ◽  
Adverse Drug Events ◽  
Controlled Trial ◽  
Hospital Readmissions ◽  
Phone Call ◽  
Patient Counseling ◽  
Structured Interviews ◽  
Post Discharge ◽  
Discharge Care ◽  
Study Participants

Abstract Recent hospitalization puts older adults at higher risk of experiencing adverse drug events (ADEs) that are a common cause of hospital readmission. Yet, most ADEs are preventable. The PHARMacist Discharge Care (PHARM-DC) study is a multi-site randomized controlled trial that seeks to evaluate the effect of pharmacist-led peri- and post-discharge interventions on 30-day hospital readmissions among older adults taking ≥10 medications or ≥3 high-risk medications. The PHARM-DC intervention includes pharmacist-led patient counseling, medication reconciliation at discharge, and a follow-up phone call post-discharge. We will highlight study protocol adaptations undertaken during the COVID-19 pandemic to address challenges to enrollment and to minimize risk of COVID-19 exposure for study participants and research personnel. Additionally, we will share insights from focus groups and semi-structured interviews with pharmacist interventionists and pharmacy leaders on barriers and facilitators to implementation due to the pandemic and strategies for future clinical trials to overcome barriers.

Should I stay or should I go? Customers’ reactions faced with the deterioration of a business relationship

2016 ◽  
Vol 31 (1) ◽  
pp. 47-58 ◽  
Author(s):  
David Vidal ◽  
Hervé Fenneteau ◽  
Gilles Paché
Keyword(s):  
Degradation Process ◽  
Response Strategy ◽  
Business Relationship ◽  
Structured Interviews ◽  
Content Type ◽  
Staff Members ◽  
Response Strategies ◽  
Customer Commitment ◽  
Business Sectors

Purpose – This paper aims to develop a framework helping managers to understand reactions, adopting the supplier perspective, and starting from the idea that the outcome of the degradation process is mainly determined by customers’ reactions. Inter-organisational relationships are sometimes subject to degradation. When incidents arise, and relationship attractiveness decreases, its evolution becomes uncertain. Design/methodology/approach – A case study carried out with a large French industrial company (FabIndus) specialised in the production of supplies destined to a large variety of business sectors. In all, 26 semi-structured interviews were conducted with staff members of FabIndus and clients’ representatives identified as having recently been confronted with deterioration in their relationship. Findings – The paper finds that customers’ reactions vary according to the nature of the business relationship and the customer commitment when degradation begins. Using two types of commitment and the exit–voice–loyalty–neglect model, it is possible to identify four types of reactions in the situation of the deterioration of a relationship. For each one of the reactions, the paper defines the response strategy that suppliers may take on. Originality/value – The paper underlines the importance of a segmented view of business behaviours faced with the deterioration of a relationship. This can be helpful to elaborate differentiated response strategies, to avoid mutual misunderstandings.

scholarly journals Protocol for a prospective, longitudinal mixed-methods case study: supporting a Model of Care for Healthier Adolescents (The MoCHA study)

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e025098 ◽  
Author(s):  
Claire Hayes ◽  
Victoria J Palmer ◽  
Magenta Simmons ◽  
Bridget Hamilton ◽  
Christine Simons ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Depressive Symptomatology ◽  
Emotional Dysregulation ◽  
Self Report ◽  
Structured Interviews ◽  
Post Discharge ◽  
Mixed Methods Case Study ◽  
Distress Scale ◽  
Prospective Longitudinal

IntroductionImproving mental healthcare for adolescents is a global policy priority. Despite demands for community-based services, many adolescents require more intensive interventions, such as an inpatient admission. This is typically at a point of crisis, often accompanied by intense emotional dysregulation, impairment of coping function and impulsivity. However, limited evidence exists on how best to support this group while they are in inpatient care, aside from pharmacological treatments which have a limited role in adolescents. Little is known about the models of care (MoC) offered in inpatient units, whether adolescents perceive these as helpful and the perspectives of caregivers and clinicians. Here, we describe a protocol which aims to explore and evaluate an inpatient MoC.Methods and analysisWe designed a longitudinal, mixed-methods, case study. The population consists of adolescents, caregivers and clinicians at a single inpatient unit in Melbourne, Australia. Standardised outcome measures, including semi- structured interviews, will be administered to adolescents at three time-points, T1 (admission), T2 (discharge) and T3 (6 months post discharge). Caregivers will also be interviewed at T1, T2 and T3. Clinicians will be interviewed once. The measures include: Life Problems Inventory, Quick Inventory of Depressive Symptomatology, Kessler Psychological Distress Scale and the Youth Self-Report. Health of the Nation Outcome Scales for Children and Adolescents will be collected at T1 and T2. Quantitative analysis will include descriptive statistics and paired t-tests summarising adolescents admitted to the unit, clinical characteristics and longitudinal data on symptomatology. Qualitative data will be analysed using both thematic and trajectory analysis. Data collection began in May 2017 and will cease with T3 interviews by October 2018.Ethics and dissemination

scholarly journals Implementing post-discharge care following acute kidney injury in England: a single-centre qualitative evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e036077 ◽  
Author(s):  
Rebecca Elvey ◽  
Susan J Howard ◽  
Anne-Marie Martindale ◽  
Thomas Blakeman
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Transitions Of Care ◽  
Clinical Expertise ◽  
Structured Interviews ◽  
Post Discharge ◽  
Factors Influencing ◽  
Discharge Care ◽  
Discharge Summaries

ObjectivesWe sought to understand the factors influencing the implementation of a primary care intervention to improve post-discharge care following acute kidney injury (AKI).DesignQualitative study using semi-structured interviews and thematic analysis.SettingGeneral practices in one Clinical Commissioning Group area in England.ParticipantsA total of 18 healthcare staff took part in interviews. Participants were practice pharmacists, general practitioners, practice managers and administrators involved in implementing the intervention.ResultsWe identified three main factors influencing implementation: differentiation of the new intervention from other practice work; development of skill mix and communication across organisations. Overall, post-AKI processes of care were deemed straightforward to embed into existing practice. However, it was also important to separate the intervention from other work in general practice. Dedicating staff time to proactively identify AKI on discharge summaries and to coordinate the provision of care enabled implementation of the intervention. The post-AKI intervention provided an opportunity for practice pharmacists to expand their primary care role. Working in a new setting also brought challenges; time to develop trusting relationships including an understanding of boundaries of clinical expertise influenced pharmacists’ roles. Unclear and inconsistent information on discharge summaries contributed to concerns about additional work in primary care.ConclusionsThe research highlights challenges around post-discharge management in the primary care context. Coordination and communication were key factors for improving follow-up care following AKI. Further consideration is required to understand patient experiences of the interface between secondary and primary care. The issues pertaining to discharge care following AKI are relevant to practitioners and commissioners as they work to improve transitions of care for vulnerable patient populations.

The Indonesian National Scientific Repository: A Case Study of Research Data Sharing

2020 ◽  
Vol 49 (1) ◽  
pp. 14-25
Author(s):  
Deka Anggawira ◽  
Nina Mayesti
Keyword(s):  
Data Sharing ◽  
Data Access ◽  
Scientific Data ◽  
Research Data ◽  
Case Study Method ◽  
Structured Interviews ◽  
Staff Members ◽  
Institutional Goals ◽  
Development Teams

AbstractThis study discusses the sharing of research data through the Repositori Ilmiah Nasional, the Indonesian national scientific repository, which is managed by the Center for Scientific Data and Documentation, Indonesian Institute of Sciences (Pusat Dokumentasi dan Informasi Ilmiah, Lembaga Ilmu Pengetahuan Indonesia, known by the abbreviation PDDI-LIPI). The purpose of this study is to describe the process of research data sharing and identify supporting factors and obstacles faced in that process. This study uses a qualitative approach, with a case study method. Data collection techniques included field observations and observations on the repository system; semi-structured interviews with several informants, including researchers as well as development and librarian teams; and, analysis of policy documents and guidelines. Through these investigations, we discovered that while the Center has developed a new DataVerse repository system to enable research data sharing, there are still several issues that impede the repository from meeting institutional goals for increased data access. There is a need for additional training and socialization of researchers, to encourage and motivate them to share their research data through this service. Additionally, staff members need to gain competence in the management and curation of data. Researchers and librarians involved in research data sharing activities still face various obstacles in the areas of policy, service visibility, and promotion. This research is expected to increase the awareness of researchers, librarians, and repository development teams about each other’s needs and to aid them in collaborating with each other to optimize the sharing of research of data through the repository.

FOSTERING STUDENTS’ EXPERIENCES IN ENGLISH WRITING WITH MICROBLOGGING IN TWITTER

2019 ◽  
Vol 13 (2) ◽  
pp. 113
Author(s):  
Pham Thi Thu Hien
Keyword(s):  
Qualitative Research ◽  
Language Learning ◽  
Research Design ◽  
Research Methodology ◽  
Learning Tools ◽  
Structured Interviews ◽  
English Writing ◽  
Qualitative Research Methodology

Twitter and Microblogging are two separate entities but completes each other. Both of them can be used as language learning tools and their potential has been proved by several scholars. This study tries to examine students’ experiences in integrating microblogging with twitter. It is also study about the beneficial roles of microblogging with Twitter in language learning, its relation to writing, and its appropriateness in language learning. This study employs a qualitative research methodology, and case study as its research design. Semi-structured interviews and questionnaires were employed in this study to find out about participants' views about microblogging and Twitter. From this study, it can be concluded that the participants of the study underwent various experiences during the implementation of microblogging with Twitter. They also felt that microblogging with Twitter at some point advantages them to systematically arrange their ideas, and allows them to choose appropriate diction of their ideas. They also stated that Twitter can be an appropriate means in language learning, especially in English writing<em>.</em>

Topik-Topik Komunikasi Dakwah Dalam Mesej Akidah Kepada Masyarakat Orang Asli di Selangor

Sains Insani ◽  
2018 ◽  
Vol 3 (2) ◽  
pp. 15-21
Author(s):  
Zulkefli Aini ◽  
Abdul Ghafar Don ◽  
Ahmad Irdha Mokhtar ◽  
Nur Uswah Ahmad Fauzi
Keyword(s):  
Qualitative Study ◽  
Study Design ◽  
Verbal Feedback ◽  
Structured Interviews ◽  
Orang Asli ◽  
Case Study Design ◽  
Beliefs And Practice ◽  
Islamic Faith ◽  
Selection Of

One of the factors that can affect a person's behavior is a communication message. In the context of the da`wah, preachers who involved actively in da`wah communication with the Orang Asli should be able to ensure that the message conveyed can be understood by the target group. In addition, the selection of the correct messages of da`wah based on the foremost priority simplify the process of sharing information between the preachers and the Orang Asli. Accordingly, this article aims to identify specific topics of Islamic faith (akidah) submitted by the Orang Asli in the process of da`wah communication and to identify verbal feedback given by the preachers to the Orang Asli of the topics. This qualitative study using case study design and data was collected through semi-structured interviews. Interviews involving nine preachers were active in da`wah activity to the Orang Asli community in Selangor. Data were analyzed thematically according to the specified objectives. The study found that the topics frequently raised by the Orang Asli is concerned about belief in Allah, belief in Malaikat, and belief in Qada' and Qadar. The topics may be found within the framework of worldview in their beliefs and practice of ancient traditions. Therefore, the preachers gave verbal feedback on these topics is based on a clear and precise sample corresponding to the level of their thinking. The emphasis on these topics is very important to strengthen and purify the faith of the community.Keywords: Communication; Message; Preacher; Indigenous community Abstrak: Elemen mesej dalam komunikasi merupakan salah satu faktor yang dapat memberi kesan terhadap perubahan tingkah laku seseorang. Dalam konteks dakwah, pendakwah yang terlibat dalam proses komunikasi dakwah dengan Orang Asli seharusnya berkebolehan memastikan kandungan mesej yang disampaikan boleh difahami oleh sasaran dakwahnya. Di samping itu, pemilihan mesej dakwah yang betul mengikut keutamaan memudahkan proses perkongsian maklumat antara pendakwah dengan Orang Asli. Sehubungan dengan itu, artikel ini bertujuan untuk mengenalpasti topik-topik tertentu dalam mesej akidah yang dikemukakan oleh masyarakat Orang Asli kepada pendakwah dan mengenalpasti maklum balas lisan yang diberikan oleh pendakwah kepada Orang Asli terhadap topik tersebut. Kajian kualitatif ini menggunakan reka bentuk kajian kes dengan pengumpulan data melalui temu bual separa struktur. Temu bual melibatkan sembilan orang pendakwah yang aktif dalam aktiviti dakwah masyarakat Orang Asli di Selangor. Data kajian dianalisis secara tematik mengikut objektif yang ditentukan. Kajian ini mendapati bahawa topik-topik yang sering dikemukan oleh Orang Asli kepada pendakwah dalam penyampaian mesej akidah ialah berkenaan tentang keimanan kepada Allah SWT, keimanan kepada malaikat, dan keimanan kepada qada’ dan qadar. Topik-topik berkenaan didapati berada dalam kerangka worldview kepercayaan dan amalan tradisi mereka. Sehubungan dengan itu, pendakwah memberikan maklum balas lisan terhadap topik-topik tersebut adalah berdasarkan keterangan yang jelas dan contoh yang tepat bersesuaian dengan tahap pemikiran mereka. Penekanan terhadap topik-topik tersebut merupakan perkara yang penting dalam rangka mengukuhkan dan memurnikan akidah masyarakat Orang Asli.Kata kunci: Komunikasi; Mesej; Pendakwah; Komuniti Orang Asli

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