Evaluating intentional quality rounding for undergraduate student nurse training during COVID-19

Nursing’s body of knowledge is ever expanding, incorporating new theoretical constructs such as quality and safety and care transitions we now consider central to the domain of nursing, and to nursing clinical education. The purpose of this article is to describe an educational quality improvement project, an alternative clinical learning experience during COVID-19 that enabled the implementation and evaluation of Bachelor of Science in Nursing (BSN) students in an intentional quality rounding process. We designed and implemented a retrospective, observational quality improvement educational project. Programmatic evaluation was used to obtain feedback from 273 pre-licensure students using a 10-item Likert scale evaluation tool in June 2020. Students averaged a 4.33 rating on the evaluation of the intentional quality rounding clinical experience as something they should incorporate into future nursing practice. A critical role for nursing education is the development of innovative teaching strategies and learning experiences that facilitate the student in the translation and application of complex constructs from nursing’s expanding body of knowledge, a task made more difficult by the COVID-19 pandemic.

L’affidamento familiare: le strategie educative elaborate dagli affidatari

Foster care is a condition of welcoming children with families in serious difficulty, legally regulated, aimed at guaranteeing to minors a suitable space for growth, and to families of origin the possibility of overcoming the problems so as to consent the return of the children. It is a challenging educational condition, to be deepened with research. The complexity of the backgrounds of origin and the co-presence of multiple risk factors in fact generate in children and young people in foster care, important difficulties in development, which foster families have to cope with, also with the support of specialists, services and associations. However, the skills that caregivers come to build over the years are valuable, deserving of pedagogical insights, so that good practices of positive parenting can be valued and shared. In this paper we will report the results of a survey, carried out with a national sample of 323 foster families. The study makes it possible to investigate the reasons for the custody prevision, the relationships with families of origin, the difficult life trajectories of the children in foster care (transitions, placements, discontinuities, years of foster care, continuation of relationships after foster care). In this way it is possible to identify the needs highlighted by the minors, the relevant problems that emerge and the promising strategies adopted by the foster families.

Uninterrupted HIV treatment for women: Policies and practices for care transitions during pregnancy and breastfeeding in Côte d’Ivoire, Lesotho and Malawi

Transitions between services for continued antiretroviral treatment (ART) during and after pregnancy are a commonly overlooked aspect of the HIV care cascade, but ineffective transitions can lead to poor health outcomes for women and their children. In this qualitative study, we conducted interviews with 15 key stakeholders from Ministries of Health along with PEPFAR-supported and other in-country non-governmental organizations actively engaged in national programming for adult HIV care and prevention of mother-to-child-transmission of HIV (PMTCT) services in Côte d’Ivoire, Lesotho and Malawi. We aimed to understand perspectives regarding transitions into and out of PMTCT services for continued ART. Thematic analysis revealed that, although transitions of care are necessary and a potential point of loss from ART care in all three countries, there is a lack of clear guidance on transition approach and no formal way of monitoring transition between services. Several opportunities were identified to monitor and strengthen transitions of care for continued ART along the PMTCT cascade.

Systems Barriers to Medication Management During Hospital to Home Transitions of Older Adults With Dementia

The hospital-to-home transition is a high-risk period for medication errors and adverse events for older adults living with dementia. Researchers conducted a qualitative study using semi-structured interviews and participant solicited diaries. Caregivers of adults ages 55 and older were recruited to understand barriers to medication management during hospital to skilled home health care transitions. We used a human factors engineering approach to guide our understanding of systems level barriers. At least two researchers independently coded each transcript using content analysis and the ATLAS.ti software. We interviewed 23 caregivers and identified five barrier types stemming from systems breakdowns related to: (1) knowledge and information, (2) access to and use of resources and tools, (3) caregiver burden, (4) pandemic concerns, and (5) health limitations. Caregivers grappled with receiving overwhelming, insufficient, incorrect, or conflicting information, and had difficulty managing information from different sources. Latinx caregivers encountered language barriers that impeded role and task clarity. Caregivers expressed mistrust in health systems elements and inability to access resources. Caregivers were in need of additional caregiving assistance, financial aid, and tools to manage medications. Balancing multiple medications and responsibilities left caregivers burdened. The health limitations of the older adult and COVID-19 concerns related to reduced access to resources and ability to deliver and receive in person care complicated task management. Altogether these barriers reflect systems level breakdowns impeding task understanding, execution, and overall management. These findings will inform the development of interdisciplinary strategies to ensure safer care transitions.

Developing a Reablement Program Aimed at Preventing Unnecessary Care Transitions After Geriatric Rehabilitation

Patients returning home after geriatric rehabilitation may encounter several challenges related to daily functioning, which only manifest after returned home due to the large difference in environment and amount of support provided in both settings. This study aimed to develop an intervention preventing transitional care. A co-creation design was used, including literature research, observations, interviews, and working groups including a variety of stakeholders (n=13), including care professionals, policymakers of the municipality, client representatives, and an expert in the field of geriatric rehabilitation. Results indicated four main causes for transitional care problems: lack of communication between patients and professionals, coordination and continuity of care, patients’ limited self-management skills, and insufficient preparation. To solve these problems, an intervention was developed consisting of six intervention components aiming to increase self-management during meaningful daily activities, narrow the gap between the rehabilitation and home setting, and enhance communication and coordination.

Transitions to Long-Term Residential Care Settings

During their life course, many older adults encounter a transition between care settings, for example, a permanent move into long-term residential care. This care transition is a complex and often fragmented process, which is associated with an increased risk of negative health outcomes, rehospitalisation, and even mortality. Therefore, care transitions should be avoided where possible and the process for necessary transitions should be optimised to ensure continuity of care. Transitional care is therefore a key research topic. The TRANS-SENIOR European Joint Doctorate (EJD) network builds capacity for tackling a major challenge facing European long-term care systems: the need to improve care for an increasing number of care-dependent older adults by avoiding unnecessary transitions and optimising necessary care transitions. During this symposium, four presenters from the Netherlands and Switzerland will present different aspects of transitions into long-term residential care. The first speaker presents the results of a co-creation approach in developing an intervention aimed at preventing unnecessary care transitions. The second speaker presents an overview of interventions aiming to improve a transition from home to a nursing home, highlighting the clear mismatch between theory and practice. The third speaker presents the impact of the COVID-19 pandemic on transitions into long-term residential care using an ethnographic study in a long-term residential care facility in Switzerland. The final speaker discusses the results of a recent Delphi study on key factors influencing implementing innovations in transitional care. The discussant will relate previous findings on transitional care with a U.S. perspective.

Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI)

Purpose This study presents the validation of an index that defines and measures a patient-centered approach to quality survivorship care. Methods We conducted a national survey of 1,278 survivors of breast, prostate, and colorectal cancers to identify their priorities for cancer survivorship care. We identified 42 items that were “very important or absolutely essential” to study participants. We then conducted exploratory and confirmatory factor analyses (EFA/CFA) to develop and validate the Patient-Centered Survivorship Care Index (PC-SCI). Results A seven-factor structure was identified based on EFA on a randomly split half sample and then validated by CFA based on the other half sample. The seven factors include: (1) information and support in survivorship (7 items), (2) having a medical home (10 items) (3) patient engagement in care (3 items), (4) care coordination (5 items), (5) insurance navigation (3 items), (6) care transitions from oncologist to primary care (3 items), and (7) prevention and wellness services (5 items). All factors have excellent composite reliabilities (Cronbach’s alpha 0.84-0.94, Coefficient of Omega: 0.81-0.94). Conclusions Providing quality post-treatment care is critical for the long-term health and well-being of survivors. The PC-SCI defines a patient-centered approach to survivorship care to complement clinical practice guidelines. The PC-SCI has acceptable composite reliability, providing the field with a valid instrument of patient-centered survivorship care. The PC-SCI provides cancer centers with a means to guide, measure and monitor the development of their survivorship care to align with patient priorities of care. Trial registration ClinicalTrials.gov ID: NCT02362750, 13 February 2015

Patterns of Intergenerational Care Planning Among Chinese Aging Families in Hong Kong

Care planning before the onset of intensive care needs can increase families’ ability to manage caregiving crises and cope with care transitions. However, future care planning has not been substantially examined in a family context. Drawing on the model of Preparation for Future Care Needs and a family systems perspective, this study investigated patterns of intergenerational care planning across multiple planning domains (awareness, avoidance, information gathering, decision making, and concrete planning) among Chinese intergenerational pairs. Quantitative data of 213 pairs of aging parents and adult children were collected in Hong Kong. Latent Profile Analysis was conducted to examine typological structure underlying care planning patterns. Three patterns were discovered: filial-maximal, dyadic-moderate, and filial-minimal. Profile 1 contained approximately 9.9% of pairs, which demonstrated a relatively higher level of avoidance on considering the need of care preparation and engaged less in concrete planning activities. Profile 2 contained 68.5% of intergenerational pairs that had a moderate preparation level. Profile 3 contained 21.6% of intergenerational pairs that were comparatively active in care planning. The findings also indicated that although older adults across three groups demonstrated a similar level of awareness to prepare for future care, their engagement in the concrete planning activities may be driven by their children’s awareness and preparation toward future care. The findings will enhance professionals’ and service providers’ awareness of diverse care planning patterns among Asian aging families, and inform targeted policies and programmes to alleviate unpreparedness for eldercare through intergenerational care planning which can be more effective than unilateral preparation.

Inter- and Intrastate Variation of Mental Health Requirements for Assisted Living in Seven States

Little is known about states’ approaches to regulating mental health (MH) services in assisted living (AL) settings. Yet, one in nine AL residents are diagnosed with serious mental illness (Hua et al, 2020). This study describes the MH regulatory requirements in AL regulations within Arkansas, Louisiana, New Jersey, New York, Oklahoma, Pennsylvania, and Texas. Using health services regulatory analysis (Smith et al, 2021), we reviewed 2018 regulations for the 45 identified AL licenses within these states sourced from Nexis Uni. We summarize 16 MH requirements related to admission, care transitions, resident assessment, third-party services access, and staff training. Each state explicitly addressed at least one of the identified MH requirements, though few states have consistency across all AL types within a state. The most commonly addressed requirements related to admission limitations, assessment, and transfer to psychiatric units. Understanding these requirements promotes a holistic approach to practices that meet residents' needs.