Development and evaluation of an electronic nursing documentation system

Background Nursing documentation is a critical aspect of the nursing care workflow. There is a varying degree in how detailed nursing reports are described in scientific literature and care practice, and no uniform structured documentation is provided. This study aimed to describe the process of designing and evaluating the content of an electronic clinical nursing documentation system (ECNDS) to provide consistent and unified reporting in this context. Methods A four-step sequential methodological approach was utilized. The Minimum Data Set (MDS) development process consisted of two phases, as follows: First, a literature review was performed to attain an exhaustive overview of the relevant elements of nursing and map the available evidence underpinning the development of the MDS. Then, the data included from the literature review were analyzed using a two-round Delphi study with content validation by an expert panel. Afterward, the ECNDS was developed according to the finalized MDS, and eventually, its performance was evaluated by involving the end-users. Results The proposed MDS was divided into administrative and clinical sections; including nursing assessment and the nursing diagnosis process. Then, a web-based system with modular and layered architecture was developed based on the derived MDS. Finally, to evaluate the developed system, a survey of 150 registered nurses (RNs) was conducted to identify the positive and negative impacts of the system. Conclusions The developed system is suitable for the documentation of patient care in nursing care plans within a legal, ethical, and professional framework. However, nurses need further training in documenting patient care according to the nursing process, and in using the standard reporting templates to increase patient safety and improve documentation.

Feasibility of a Palliative Care Intervention Utilizing Community Health Workers to Facilitate Delivery of Home-based Palliative Care in India

Objectives: The purpose of this study was to evaluate the feasibility of a home-based palliative care program delivered by community health workers (CHW) in rural areas outside of Kolkata, India. The specific aims were to assess CHWs’ ability to implement the intervention protocol and maintain records of care, to characterize patient problems and CHW activities to assist patients, and to assess change in patient pain scores over the course of the intervention. Materials and Methods: Four CHWs were hired to facilitate delivery of home-based palliative care services. CHWs were trained using the Worldwide Hospice and Palliative Care Alliance’s Palliative Care Toolkit. CHWs provided care for patients for 3-months, making regular home visits to monitor health, making and implementing care plans, and referring patients back to the cancer center team for serious problems. Results: Eleven patients enrolled in the intervention, with ten of these patients participating in the intervention and one patient passing away before starting the intervention. All ten participants reported physical pain, for which CHWs commonly recommended additional or higher dose medication and/or instructed patients how to take medication properly. For two patients, pain levels decreased between baseline and end of study, while pain scores did not decrease for the remaining patients. Other symptoms for which CHWs provided care included gastro-intestinal, bleeding, and respiratory problems. Conclusion: The study findings suggest that utilization of CHWs to provide palliative care in low-resource settings may be a feasible approach for expanding access to palliative care. CHWs were able to carry out the study visit protocol and assess and document patient problems and their activities to assist. They were also able to alleviate many common problems patients experienced with simple suggestions or referrals. However, most patients did not see a decrease in pain levels and more emphasis was needed on the emotional aspects of palliative care, and so CHWs may require additional training on provision of pain management and emotional support services.

Health Literacy and Patient -Reported Outcomes

Modern healthcare needs to identify parameters for high-quality care. Quality improvement is the key for advancing in healthcare, and the new assessment tool shifts from a disease-centered outcome to a patient-centered outcome. Clinical outcome such as morbidity and mortality are directly connected and interdependent from patient-reported outcomes: well-informed patients who decide with their healthcare provider what treatment is best for them have better outcomes and higher patient satisfaction rates. These subjective data collected by rigorous, meaningful, and scientific methods and presented in a utilizable format can be used to create care objectives towards which both the surgeon and their patient can travel. Time has come to carry patient-centered outcomes from research into decision making and daily care plans. This chapter outlines a focus beyond life-prolonging therapy, aiming to minimize the negative effects of treatment, optimize quality of life, and align medical decisions with patient expectations.

Relationship between family functionality and the quality of life of the elderly

ABSTRACT Objective: To analyze the correlation between family functionality and the quality of life of the elderly. Method: Sectional and correlational study conducted with 692 Brazilian elderly between July and October 2020. The elderly filled three instruments: biosociodemographic, family APGAR and WHOQOL-Old. The tests Kruskal-Wallis, Pearson correlation, and linear regression analyzed the data. The study considered a 95% confidence interval (p < 0.05) for all analyses. Results: The elderly with mild and severe family dysfunction presented worse quality of life when compared to the elderly with a functional family. All facets of quality of life correlated positively with family functionality. Conclusion: Family functionality is positively correlated with the quality of life of the elderly, therefore requiring the inclusion of the family in health care plans to identify potential family stressors early and plan interventions to solve the problems raised.

Frailty and sociodemographic and health factors, and social support network in the brazilian elderly: A longitudinal study

ABSTRACT Objective: To identify and analyze the sociodemographic and health factors and the social support network of the elderly associated with frailty in the assessments carried out between 2007/2008 and 2018. Methods: This is a longitudinal study with elderly people aged ≥65 years living in the community. The instruments used were those for Demographic Profile, the Mini Mental State Examination, the Functional Independence Measure, Lawton and Brody Scale, Geriatric Depression Scale, Minimum Relationship Map for the Elderly, and Edmonton Frail Scale. Descriptive analysis and linear regression were used, all tests with p < 0.05. Results: Of the 189 elderly in the study period (2007/2008–2018), most were 80 years old and over, with an average of 82.31 years old; they were women, with no partner, who lived with other family members and were retired. In the final analysis, regardless of age and sex, a decrease in functional independence, an increase in depressive symptoms, an increase in the number of self-reported illnesses, and an increase in the frailty score were observed. Conclusion: The factors that were associated with the increase in frailty of the elderly during the study period were age, female sex, and no partner. The health team, which includes nurses, shall be aware of changes and develop care plans to prevent or avoid their progression.

A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination tools

Introduction & importance Children with traumatic brain injury (TBI) report unmet needs several years after their injury and may require long-term care. However, this chronic health condition is often only treated and monitored in the short-term. Care for young persons with TBI often relies on parents to manage their child's complex care network. Effective care coordination can close these gaps and facilitate continuity of care for children with TBI. The purpose of this scoping review was to develop a better understanding of tools that improve care coordination for Children with Special Health Care Needs (CSHCN). This, in turn, can inform care for children with TBI. Methods A scoping review was conducted following the PRISMA framework and methodology. OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination tools used with CSHCN. Results 21 articles met the criteria for inclusion in the review, and 6 major categories of care coordination tools were identified: telehealth, online health records and tools, care plans, inpatient discharge protocols, family training, and reminders. Discussion Studies examining telehealth, online tools, care plans, and family training care coordination interventions for CSHCN have shown positive outcomes and would be relevant strategies to improve the care of children with TBI. Future prospective research should investigate these tools to explore whether they might improve communication, reduce unmet needs, increase service access, and improve long-term outcomes for children with TBI.

Challenges and chances for local health and social care integration – Lessons from Greater Manchester, England

PurposeSustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.Design/methodology/approachDocumentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.FindingsThe study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.Research limitations/implicationsThe findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.Originality/valueThis study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.

Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review

Attention-deficit/hyperactivity disorder is one of the most common comorbidities in individuals with autism spectrum disorder. However, the clinical implications of the co-occurrence of these two disorders are still poorly understood. Based on a preregistered protocol (PROSPERO CRD42020193880), this systematic review identified 34 articles, published between January 1, 2014, and September 1, 2020, on cognitive, adaptive/social, and behavioral manifestations in children and adolescents with a diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder (ASD+). The majority of available studies found a tendency toward a significant poorer cognitive performance in individuals with ASD+ compared with those with autism spectrum disorder alone (ASD−). The analysis of social/adaptive processes suggested that ASD+ is associated with lower functioning in comparison with ASD−. Finally, individuals with ASD+ were more likely to develop emotional/behavioral difficulties, in particular externalizing problems. Although some studies did not find differences among the two groups, overall co-occurring ASD+ may constitute a distinctive phenotype with a greater likelihood of cognitive, adaptive dysfunction, and mental health symptoms compared with ASD−. These results may inform the setting up and implementation of care pathways for individuals with attention-deficit/hyperactivity disorder and autism spectrum disorder. Lay abstract This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.