scholarly journals Transitional nursing care for older inpatients: a person-centred research programme

2021 ◽  
Vol 11 (1) ◽  
pp. 1-3
Author(s):  
Cédric Mabire ◽  
◽  
Joanie Pellet ◽  
Keyword(s):  
Older Persons ◽  
Nursing Practice ◽  
Transitional Care ◽  
Medication Management ◽  
Research Programme ◽  
Healthcare Services ◽  
Western World ◽  
Levels Of Care ◽  
Transitions Theory ◽  
Hospital To Home

Across the Western world, healthcare services are contending with the challenge of ageing populations. Switzerland is no exception, and faces the need to adapt its healthcare system to the needs of older persons. A disease-oriented approach is ill suited to the varied abilities, preferences and degrees of resilience among older people, and person-centred care is better placed to respond effectively to this situation (Ekman et al., 2013). Our team at the Institute of Higher Education and Research in Healthcare (IUFRS) of the University of Lausanne has developed a research programme to improve the healthcare experiences of older persons during hospitalisation and transition to discharge. We have identified different models and theories that promote a better understanding of the factors that impact on older persons ’lives during these phases and of how to take them into account in nursing practice in order to encourage a person-centred approach. The transition of care from hospital to home is a vulnerable time in the continuum of care for older persons (Arbaje et al., 2014). Transitional care is defined by Coleman and Boult (2003, p 549) as a ‘set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location’. At the theoretical level, Meleis ’transitions theory (2000) provides a perspective for interpreting and planning comprehensive discharge for hospitalised older persons. In designing our research programme, this theory helped us to link the older person’s health problems (conditions of transition) in relation to hospitalisation (nature of transition), discharge preparation (nursing interventions) and the effects on the person (response models) (Mabire et al., 2015). From the transitions theory, Naylor et al. (2017) developed their transitional care model to guide nursing practice during this period. This model includes eight components: Patient engagement Caregiver engagement Complexity and medication management Patient education Caregiver education Patient and caregiver wellbeing Care continuity Accountability

A Qualitative Study of Older Patients’ and Family Caregivers’ Perspectives of Transitional Care From Hospital to Home

2021 ◽  
pp. RTNP-D-20-00067
Author(s):  
İlknur Dolu ◽  
Mehmet İIlkin Naharcı ◽  
Patricia A. Logan ◽  
Piret Paal ◽  
Mojtaba Vaismoradi
Keyword(s):  
Family Caregivers ◽  
Older Patients ◽  
Transitional Care ◽  
Care Program ◽  
Healthcare Services ◽  
Structured Interviews ◽  
High Quality ◽  
Rehabilitation Model ◽  
Hospital To Home ◽  
Discharge From Hospital

Background and PurposeThe need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey.MethodsThematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated.ResultsMain themes were “confused feelings of safety and stress”; “worried about being left alone”; and “disrupted healthcare journey.” The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital.Implications for PracticeA high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge.

scholarly journals A qualitative study of the knowledge-brokering role of middle-level managers in service innovation: managing the translation gap in patient safety for older persons’ care

2014 ◽  
Vol 2 (32) ◽  
pp. 1-118 ◽  
Author(s):  
Graeme Currie ◽  
Nicola Burgess ◽  
Leroy White ◽  
Andy Lockett ◽  
John Gladman ◽  
...  
Keyword(s):  
Patient Safety ◽  
Service Delivery ◽  
Older Persons ◽  
Medication Management ◽  
Research Programme ◽  
Clinical Governance ◽  
Middle Level ◽  
Service Improvement ◽  
Knowledge Brokering ◽  
Lower Status

BackgroundBrokering of evidence into service delivery is crucial for patient safety. We study knowledge brokering by ‘hybrid’ middle-level managers (H-MLMs), who hold responsibility for clinical service delivery as well as a managerial role, in the context of falls, medication management and transition, in care of older people.ObjectivesGenerate insight into processes and structures for brokering of patient safety knowledge (PSK) by H-MLMs.DesignWe utilise mixed methods: semistructured interviews, social network analysis, observation, documentary analysis, tracer studies and focus groups.SettingNHS East and NHS West Midlands.ParticipantsOne hundred and twenty-seven H-MLMs, senior managers and professionals, in three hospitals, and external producers of PSK.Main outcome measuresWhich H-MLMs broker what PSK, and why? (1) How do H-MLMs broker PSK? (2) What are contextual features for H-MLM knowledge brokering? (3) How can H-MLMs be enabled to broker PSK more effectively in older persons’ care?ResultsHealth-care organisations fail to leverage PSK for service improvement. Attempts by H-MLMs to broker PSK downwards or upwards are framed by policy directives and professional/managerial hierarchy. External performance targets and incentives compel H-MLMs in clinical governance to focus upon compliance. This diverts attention from pulling knowledge downwards, or upwards, for service improvement. Lower-status H-MLMs, closer to service delivery, struggle to push endogenous knowledge upwards, because they lack professional and managerial legitimacy. There is a difference between how PSK is brokered within ranks of nurses and doctors, due to differences in hierarchal characteristics. Rather than a ‘broker chain’ upwards and downwards, a ‘broken chain’ ensues, which constrains learning and service improvement.ConclusionsClinical governance is decoupled from service delivery. Brokering knowledge for service improvement is a ‘peopled’ activity in which H-MLMs are central. Intervention needs to mediate interprofessional and intraprofessional hierarchy, which, combined with compliance pressures, engender a ‘broken’ chain for applying PSK for service improvement, rather than a ‘brokering’ chain. Lower-status H-MLMs need to have their legitimacy and disposition enhanced to broker knowledge for service improvement. More informal ‘social mechanisms’ are required to complement clinical governance for development of a brokering chain. More research is needed to (1) examine why some H-MLMs are more disposed and able than others to broker PSK for service improvement, and (2) understand how knowledge brokering might be enhanced so that exogenous and endogenous knowledge is better fused for service improvement.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e037999
Author(s):  
Martina Rimmele ◽  
Jenny Wirth ◽  
Sabine Britting ◽  
Thomas Gehr ◽  
Margit Hermann ◽  
...  
Keyword(s):  
Older Patients ◽  
Transitional Care ◽  
Intervention Group ◽  
Care Quality ◽  
Care Plan ◽  
Control Group ◽  
Care Services ◽  
Continuous Care ◽  
Hospital To Home ◽  
Randomised Controlled

IntroductionIn Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home.Methods and analysesRandomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient’s symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated.Ethics and disseminationEthics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community.Trial registrationClinicalTrials.gov identifier: NCT03513159.

Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions

2021 ◽  
pp. 108482232110021
Author(s):  
Alireza Nikbakht Nasrabadi ◽  
Leila Mardanian Dehkordi ◽  
Fariba Taleghani
Keyword(s):  
Patient Safety ◽  
Data Collection ◽  
Continuity Of Care ◽  
Chronic Conditions ◽  
Transitional Care ◽  
Major Elements ◽  
Study Data ◽  
Multiple Chronic Conditions ◽  
University Hospitals ◽  
Levels Of Care

Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.

Enhancing family nursing practice in schools: School nurses’ perspectives on illness beliefs and family nursing practice skills when caring for children with attention-deficit hyperactivity disorder or asthma – A cross-sectional study

2021 ◽  
pp. 205715852110096
Author(s):  
Erla Kolbrun Svavarsdottir ◽  
Gudny Bergthora Tryggvadottir ◽  
Margret Gisladottir ◽  
Ragnheidur Osk Erlendsdottir
Keyword(s):  
Nursing Practice ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
School Nurses ◽  
Illness Beliefs ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hyperactivity Disorder ◽  
Family Nursing ◽  
Practice Skills

An increasing number of children attend schools with chronic illnesses/disorders that require managing and comprehensive healthcare from school nurses during the day. Collaboration between school nurses, the school-aged child with attention-deficit hyperactivity disorder (ADHD) or asthma, and their families is needed when coordinating/managing chronic health problems in the school setting. However, involving families in the assessment and care planning processes can be challenging. The aim of this study was to survey the illness beliefs of school nurses and their perceptions of their family nursing practice skills when offering healthcare services to children with ADHD or asthma in schools. A cross-sectional study was used for a sample of 82 school nurses. The manuscript was prepared following STROBE guidelines. Results indicated that the school nurses perceived themselves to be more confident and to have better knowledge and skill in family nursing practice when offering healthcare services to families of children with ADHD in comparison to asthma.

Abstract TP419: Shared Medical Appointments: Supporting Stroke Care Transitions Through Improved Knowledge and Peer Support

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kathleen Burns ◽  
Karen S Theodore
Keyword(s):  
Risk Factors ◽  
Transitional Care ◽  
Care Transitions ◽  
Individual Risk ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Shared Medical Appointments ◽  
Complex Needs ◽  
Improved Outcomes ◽  
Hospital To Home

Background: Stroke patients have complex needs and are at high risk for complications, making transitional care critical to achieving improved outcomes. Although shared medical appointments (SMAs) are known to improve outcomes for other patient populations, evidence supporting SMA benefit for stroke patient transition from hospital to home is lacking. This study’s purpose was to examine feasibility of participation, patient satisfaction and understanding of key stroke topics following a transitional stroke SMA. Methods: Inclusion criteria for this study included: age 18 years or older, hospitalized for stroke/TIA, and planned discharge to home. Individuals with deficits impairing group participation were excluded. Eligible patients were educated on and invited to attend a SMA occurring 1-2weeks after hospital discharge. The SMA included a private exam and interactive group session to address key stroke topics: 1) medication compliance 2) individual risk factors, 3) secondary prevention, 4) signs of stroke and 5) actions for signs of stroke. Following the SMA, participants completed a two-part survey seeking a) a yes/no response to assess increased understanding of stroke topics, and b) level of agreement on satisfaction with the SMA format. Responses were analyzed using descriptive statistics. Results: While 15 patients agreed to participate prior to discharge, only eight attended the SMA. Attendees were primarily male (75%) with an ischemic stroke diagnosis (63%). The majority who did not attend were female (71%) and without family present during in-hospital education and invitation (86%). Age, stroke severity and stroke risk factors for both groups were otherwise similar. All participants reported an increased understanding of all stroke topics and 95% were satisfied with the SMA. Conclusion: Findings support use of SMAs for stroke patients transitioning from hospital to home. Reinforcing key stroke topics in a peer supported environment may increase understanding and compliance, leading to improved outcomes. Additional research is warranted to explore barriers to SMA participation.

scholarly journals EMERGING MODELS OF CARE: THE IMPACT OF PHARMACIST-LED MEDICATION MANAGEMENT IN A TRANSITIONAL CARE PROGRAM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S708-S708
Author(s):  
Ebony Andrews ◽  
Travonia Brown-Hughes ◽  
Ronald Lyon ◽  
Shanea D Parker ◽  
Brad Lazernick
Keyword(s):  
Transitional Care ◽  
Medication Management ◽  
Hospital Readmissions ◽  
Care Transitions ◽  
Patient Activation ◽  
Care Program ◽  
Transition Process ◽  
Models Of Care ◽  
Care Transition ◽  
The Impact

Abstract Transitional care programs have emerged as successful models of care in which to reduce cost and improve health outcomes. However, few transitional care models have directly incorporated the expertise of the pharmacist as an integral member of the care coordination team. Therein lies an inherent limitation of many community-based transitional care programs, the underutilization of pharmacist during all stages of the care transition process. In 2013, the Hampton Roads Care Transitions Project (HRCTP), a partnership between Senior Services of Southeastern Virginia Area Agency on Aging in Norfolk, VA and Hampton University School of Pharmacy, was established. The goal of the HRCTP is to provide medication management services to reduce preventable hospital readmissions for adults 60 years of age and older with targeted diagnoses. Pharmacists work in collaboration with social workers who act as HRCTP care transition coaches. Between May 2017- October 2018, 678 patients were enrolled in the HRCTP. The hospital readmission rate among patients with targeted diagnoses was reduced by 55.3% with an absolute percentage point reduction of 9.9% and estimated savings amount per avoided readmission of $14,400. Patients who participated in the HRCTP showed a 14% increase in the Patient Activation Assessment indicating an improvement in self-managing efficacy. 93% of patients/caregivers indicated they felt more confident in their ability to manage their health, and 91% expressed satisfaction with the program. The program has proven effective in assisting seniors to remain in their home, reducing hospitalizations, promoting health, increasing patient satisfaction, and reducing healthcare cost.

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

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