Care Planning (care + planning)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Care Planning

  • advance care planning
  • health care planning

  • Selected Abstracts

    Report from BSG/BDACDS Winter meeting ,Oral Assessment and Care Planning for the Older Person'

    GERODONTOLOGY, Issue 1 2004
    4th December 200, African Studies, London, School of Oriental

    Standardized Care Planning: Evaluation of ICNP Beta in the Areas of Nutrition and Skin Care in a Practice Setting

    Jan Florin
    PURPOSE To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the International Classification of Nursing Practice (ICNP®). METHODS Standardized care plans were developed based on research in the areas of nutrition and skin care and clinically tested in a 35-bed infectious disease unit at a Swedish university hospital. A convenience sample of 56 computerized and manual patient records were content analyzed and mapped to the terms in ICNP® beta. FINDINGS A total of 1,771 phrases were identified. Approximately 60% of the record content describing nursing phenomena and about one third of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily using the terminology of ICNP® beta. For about 25% of the content describing both nursing phenomena and interventions, no corresponding term was found. The most common deficiencies were focus terms for stating patient perspective or collaboration, nonhuman focus, normal findings, more qualitative judgments, and different expressions for stating duration. Some terms are available in the ICNP beta as a whole, but the organization of axes impedes or restricts the use of terms beyond the ICNP categories. Terms needed to express nursing phenomena could sometimes be found in nursing actions axes. CONCLUSIONS The ICNP® beta needs to be further developed to capture relevant data in nursing care. The axial structure needs to be evaluated, and completeness and granularity of terms need to be addressed further before ICNP beta can be used on a daily basis in the clinical setting. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focuses as well as duration. Empirical studies covering the complexity of information in nursing care are needed. [source]

    The essentials of Advance Care Planning for end-of-life care for older people

    Sarah Yeun-Sim Jeong
    Aims and objectives., The aim of the study was to investigate the phenomenon of Advance Care Planning and the use of Advance Care Directives in residential aged care facilities in Australia. The objectives were to: ,,investigate the implementation process of Advance Care Planning and the use of Advance Care Directives; ,,investigate the outcomes of Advance Care Planning and experiences of people involved in Advance Care Planning and Advance Care Directives, including residents, families and nursing staff. Background., Benefits of Advance Care Planning for older residents are considerable given their degenerative health-breakdown and minimal chance of recovery. To date, the use of Advance Care Planning and Advance Care Directives is limited and models of service delivery and processes are needed to enhance best practice with Advance Care Planning and positive outcomes for older Australians. Design., Case study. Methods., The study conducted using multiple sources of evidence to enrich understanding of the phenomenon of Advance Care Planning. The researcher engaged in data collection over six months involving participant observation, field notes, semi-structured interviews and document analysis. The findings contribute to the limited knowledge of options currently available to older adults and their families in their decision-making about end-of-life care options. Permission to conduct the study., Prior to commencement of the data collection, ethics clearances from the University of Newcastle and the regional Area Health Service were achieved. Permission to access the residential aged care facilities to undertake the study was obtained from the relevant residential aged care facility ethics committees or designated authorities. The researcher undertook several strategies to ensure all the ethical principles were considered and adhered to while conducting the project. Results., The research identified the components and factors involved in the Advance Care Planning process and in attaining desired outcomes. The conceptual framework developed elaborates how Advance Care Planning should be implemented and what may constitute successful implementation of Advance Care Planning in residential aged care facilities. The four main elements (input, throughput, output, feedback), and 20 sub-elements were requisites for nurses to initiate and implement the Advance Care Planning. Conclusion., The essential components for end-of-life care are identified in the implementation processes of Advance Care Planning in residential aged care facilities. The study contributes to greater awareness of the processes needed for ,dying well' and highlights the need to explore experiences of ,successful dying' and the way nurses contribute to these events. Relevance to clinical practice., The case study identified four determinative requisites for successful implementation of Advance Care Planning in aged care facilities: the expert nurse, discussion, education and involvement of a multidisciplinary team. Nurses should take these factors into account and use person-centred approach in formalised processes to encourage participation in plans for end-of-life care. [source]

    Coping With Uncertainties in Advance Care Planning

    Stephen C. Hines
    This essay extends problematic integration theory and related theories of uncertainty management to communication about serious illness and death. These extensions (a) note that theorizing must focus on multiple, interrelated uncertainties rather than a single such uncertainty; (b) explain how communication with others often problematizes efforts to cope with illness-related uncertainties; and (c) identify specific factors that may influence how persons choose to cope with these uncertainties. The essay describes implications for ongoing efforts to improve communication with persons nearing death. Specifically, they point to 5 incorrect assumptions that limit the effectiveness of current efforts to encourage persons to talk about their end-of-life preferences with others in a process referred to as advance care planning and then suggest concrete changes derived from this framework that can improve the advance care planning process and enhance the quality of end-of- life care. [source]

    Staff opinions about the leadership and organisation of municipal dementia care

    L. Albinsson MD
    Abstract The present study describes the opinions of experienced staff providing direct care to patients with dementia in municipal units in Sweden. The focus is mainly on leadership and other organisational factors. A purposeful sample of 31 staff members employed in municipal dementia care in both urban and rural areas in mid-Sweden were selected. Data were collected within a qualitative paradigm using semi-structured interviews which were tape-recorded and analysed using a modified phenomenographical approach. The nearly unanimous opinions of the interviewees indicated that there was a great lack of daily leadership in the units. Thus, few units had clearly formulated goals and few had regular care planning for their residents. Poorly developed teamwork was reported in the care of people with dementia especially regarding doctors, whose visits to the unit were too infrequent and too short, and did not include a direct exchange of information with other staff. In addition, little or no staff education and guidance/supervision was provided on a regular basis. In conclusion, without any unreasonable increase in cost, measures such as introducing clear leadership at the care unit level, concentrating on multi-professional teamwork, and providing education and guidance/supervision to the staff would probably result in better care for patients with dementia and their families. [source]

    From rhetoric to reality: including patient voices in supportive cancer care planning

    Sara K. Tedford Gold PhD
    Abstract Objective, To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co-ordination. Context, In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach, Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In-depth, semi-structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results, The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion, These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. [source]

    Two steps forward, one step back: advance care planning, Australian regulatory frameworks and the Australian Medical Association

    M Parker
    Abstract The Australian Medical Association has recently adopted a policy position concerning advance care planning, which is generally supportive of extending patient self-determination beyond the loss of decision-making capacity. It calls for uniform national legislation for legally enforceable advance health directives (AHD), and statutory protection for practitioners who comply with valid AHD, or who do not comply on several grounds. Analysis of the grounds for non-compliance indicate that they undermine patient autonomy, and aspects of the policy are inconsistent with current common law and statutory regimes that allow an adult to complete a legally binding AHD. The policy therefore threatens the patient self-determination, which it endorses, and places doctors who participate in advance care planning at legal risk. [source]

    Needs and risks of patients in a state-wide inpatient forensic mental health population

    Ariel Segal
    ABSTRACT Routine needs assessments have become mandated requirements for public mental health services. However, the appropriateness of these generic health needs assessments to specialist populations remains questionable. This study sought to assess individual needs assessed using a widely used clinician rated assessment (Health of the Nation Outcome Scales-Secure; HoNOS-Secure), a subjective needs assessment that considers both staff and patient perspectives (Camberwell Assessment of Need-Forensic version; CANFOR), and a measure of risk for general criminal recidivism (Level of Service Inventory: Screening Version; LSI:SV) in a secure forensic mental health service. Results revealed significant positive correlations between staff ratings on HoNOS-Secure, CANFOR total needs, and CANFOR met needs scores, but no significant association between CANFOR ratings or HoNOS-Secure ratings and LSI:SV scores. Although patients and staff reported the same number of needs overall according to CANFOR (7.2 vs. 7.5, P > 0.05), patients reported that more of these needs were unmet (3.1 vs. 2.3, P < 0.05). Differences between staff and patient ratings of need suggest that needs assessments should include patient perspectives to facilitate more collaborative and comprehensive care planning. Divergent perspectives between patients and staff may impair patient engagement in treatment and therefore negatively impact on outcome. Service planning issues and opportunities for future research are discussed. [source]

    An Internet-Based Survey of Icelandic Nurses on Their Use of and Attitudes Toward NANDA, NIC, and NOC

    Gyda Bjornsdottir
    PURPOSE To gain understanding of how Icelandic nurses can be supported during a mandated change to the use of NANDA and NIC in clinical documentation practices. METHODS All members of the Icelandic Nurses Association of working age were invited to participate in an Internet-based survey. Each nurse was assigned a unique password mailed to his/her home along with information on how to access the survey Web site. Each nurse could submit answers only once. On submission, data were automatically coded and saved in a database under encrypted numerical identifiers. FINDINGS A total of 463 nurses (18% response rate) participated by submitting answers. The sample was representative of the population in terms of demographic characteristics. Information resources most valued when planning nursing care included text-based progress notes (77%), nursing care plans (52%), doctor's orders (49%), verbal information (48%), and documented nursing diagnoses (37%). Of the participants, 58% said NANDA was used in their workplace; 28% said no standardized nursing documentation was used; 19% reported using NIC always or sometimes when documenting nursing interventions; and 20% never used NIC. NOC use was reported only by researchers. Of the sample, 86% reported that it is important or necessary for nurses to standardize documentation practices; 30% found NANDA useful in education; 56% found it useful for clinical work; 17% for research; and 7% found it not useful at all. Nine percent believed that NANDA diagnoses were not descriptive enough of patients' problems, and 23% found their wording problematic. No statistically significant differences were found between reported use of or attitudes toward NANDA and NIC when comparing nurses who use electronic patient record systems that support NANDA and NIC documentation and those who use paper documentation only. DISCUSSION The sample may have been somewhat biased toward computer use and classification system use for standardized and computerized documentation. However, results indicate that although Icelandic nurses give free-text progress notes and verbal information a higher priority than nursing diagnoses as an information resource for care planning, they have a positive attitude toward NANDA. NANDA and NIC are still used inconsistently in clinical practice, and 28% of participants claimed not to use any form of standardized documentation. CONCLUSIONS In an effort to standardize clinical documentation among nurses, Icelandic health authorities must follow their documentation mandates with educational and technologic support to facilitate the use of NANDA, NIC, and (after its translation) NOC in nursing documentation practices. Electronic patient record system developers must find ways to further facilitate standardized nursing documentation because currently there seems to be no difference between users and nonusers in terms of how they use NANDA and NIC in their documentation practices. [source]

    Applicability of the International Classification of Nursing Practice (ICNP®) in the Areas of Nutrition and Skin Care

    Margareta Ehnfors PhD
    PURPOSE. To evaluate completeness, granularity, multiple axial content, and clinical utility of the beta version of the ICNP® in the context of standardized nursing care planning in a clinical setting. METHODS. An 35-bed acute care ward for infectious diseases at a Swedish university hospital was selected for clinical testing. A convenience sample of 56 patient records with data on nutrition and skin care was analyzed and mapped to the ICNP. FINDINGS. Using the ICNP terminology, 59%-62% of the record content describing nursing phenomena and 30%-44% of the nursing interventions in the areas of nutrition and skin care could be expressed satisfactorily. For about a quarter of the content describing nursing phenomena and interventions, no corresponding ICNP term was found. CONCLUSIONS. The ICNP needs to be further developed to allow representation of the entire range of nursing care. Terms need to be developed to express patient participation and preferences, normal conditions, qualitative dimensions and characteristics, nonhuman focus, and duration. PRACTICE IMPLICATIONS. The practical usefulness of the ICNP needs further testing before conclusions about its clinical benefits can be determined. Search terms: ICNP®, nursing classification, standardized terminology, VIPS [source]

    Burden of stroke in Maori and Pacific peoples of New Zealand

    Valery L. Feigin
    Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health. [source]

    Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol

    Eva Abad-Corpa
    abad-corpa e., carrillo-alcaraz a., royo-morales t., pérez-garcía m.c., rodríguez-mondejar j.j., sáez-soto a. & iniesta-sánchez j. (2010) Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Journal of Advanced Nursing,66(6), 1365,1370. Abstract Title.,Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Aim., To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow-up planning for primary care patients with chronic obstructive pulmonary disease. Background., Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge. Methods., A quasi-experimental design will be adopted, with a control group and pseudo-randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary-level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. Discussion., The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses. [source]

    Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set

    David Dosa MD
    OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items. DESIGN: Retrospective cohort study using MDS and Medicare claims data. SETTING: Free-standing NHs in urban markets in the 48 contiguous U.S. states. PARTICIPANTS: Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721). MEASUREMENTS: Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital. RESULTS: Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors. CONCLUSION: The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH. [source]

    Hospice Usage by Minorities in the Last Year of Life: Results from the National Mortality Followback Survey

    K. Allen Greiner MD
    OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a national cohort and to identify individual characteristics associated with hospice use. DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey (NMFS), a nationally obtained sample using death certificates and interviews with relatives (proxy respondents) to provide mortality, social, and economic data and information about healthcare utilization in the last year of life for 23,000 deceased individuals. SETTING: Hospice care. PARTICIPANTS: Individuals aged 15 and older who died in 1993. Subjects were included in this analysis if they died of nontraumatic causes (N = 11,291). MEASUREMENTS: Hospice use was dichotomized by proxy responses indicating use or nonuse of home or inpatient hospice services. The percentage of individuals using hospice services in the last year of life was calculated. RESULTS: Unadjusted bivariate results found that African Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P < .001) and that those without a living will (LW) (OR = 0.23; P < .001) and without a cancer diagnosis (OR = 0.28; P < .001) were less likely to use hospice. The negative relationship between African Americans and hospice use was unaffected when controlled for sex, education, marital status, existence of a LW, income, and access to health care. Logistic models revealed that presence of a LW diminished the negative relationship between African Americans and hospice use, but the latter remained significant (OR = 0.83; P = .033). A subanalysis of subjects aged 55 and older showed a significant interaction between access to care and race/ethnicity with respect to hospice use (P = .044). Inclusion of income in this multivariable logistic model attenuated the relationship between African-American race/ethnicity and hospice use (OR = 0.77), and the difference between whites and African Americans became only marginally statistically significant (P = .060). CONCLUSION: In the 1993 NMFS, hospice use was negatively associated with African-American race/ethnicity independent of income and access to healthcare. The relationship is not independent of age, insurance type, or history of stroke. For subjects aged 55 and older, access to healthcare may be an important confounder of the negative relationship between African-American race/ethnicity and hospice use. Consistent with previous studies, this analysis found that African Americans were less likely to use LWs than whites. The reduced importance of African-American race/ethnicity on hospice use with the inclusion of presence of a LW in logistic models suggests that similar cultural processes may shape differences between African Americans and whites in advance care planning and hospice use. [source]

    Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management Programs

    Ali Ahmed MD, FACP
    PURPOSE: To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. BACKGROUND: The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1,4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5,7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. METHODS: Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from 1966 to 1999 and other online databases using the following terms and Medical Subject Headings: case management (exp); comprehensive health care (exp); disease management (exp); health services research (exp); home care services (exp); clinical protocols (exp); patient care planning (exp); quality of health care (exp); nurse led clinics; special clinics; and heart failure, congestive (exp). In addition, a manual search of the bibliographies of searched articles was performed to identify articles otherwise missed in the above search. Personal communications were made with three authors to obtain further data on their studies. Using a data abstraction tool, two of the investigators separately abstracted data from the selected articles. Data from the selected studies were combined using the DerSimonian and Laird random effects model and the Mantel-Haenszel-Peto fixed effects model. Meta-Analyst 0.998 software (J. Lau, New England Medical Center, Boston, MA) was used to determine risk ratios (RRs) with 95% confidence intervals (CIs) of mortality and hospitalization for patients receiving care through these specialized programs compared with those receiving usual care. The Cochran Q test was used to test heterogeneity among the studies, and sensitivity analyses were performed to examine the effect of various covariates, such as duration of intervention, and other characteristics of the disease-management programs. RESULTS: The original search resulted in 416 published articles, of which 35 met preliminary selection criteria. Of these, 11 were randomized trials and were selected for the meta-analysis. Studies that were not randomized trials, did not involve heart failure patients or disease-management programs, or had missing outcomes were excluded. Of the 11 studies selected, nine involved specialized follow-up using multidisciplinary teams and the remaining two involved follow-up by primary care physicians and telephone. These studies involved 1,937 heart failure patients with a mean age of 74. The follow-up period ranged from no follow-up (one study) to 1 year (one study). Patients receiving care from specialized heart failure disease-management programs had a 13% lower risk of hospitalization than those receiving usual care (summary RR = 0.87; 95% CI = 0.79,0.96), but the Cochran Q test demonstrated significant heterogeneity among the studies (P = .003). Subgroup analysis of the nine studies using specialized follow-up by a multidisciplinary team showed similar results (summary RR = 0.77, 95% CI = 0.68,0.86; test of heterogeneity, P> .50). Seven of the nine studies did not show any significant association between intervention and reduced hospitalization, but the two studies that used follow up by primary care physicians and telephone failed to show any significant reduction in hospitalization (summary RR = 0.94, 95% CI = 0.75,1.19). In fact, one of the studies demonstrated a higher risk of hospitalization for patients receiving intervention (RR = 1.26, 95% CI = 1.04,1.52). Of the 11 studies, only six reported mortality as an outcome. None of these studies found any association between intervention and mortality (summary RR = 1.15, 95% CI = 0.96,1.37; test of heterogeneity, P> .15). Five of the studies used quality of life or functional status as outcomes, and, of them, only one demonstrated significant positive association. The results of the sensitivity analyses were negative for any significant association with duration of intervention or follow-up or year of study. Eight studies performed cost analyses and seven demonstrated cost-effectiveness of the intervention. CONCLUSIONS: The authors concluded that specialized disease-management programs were cost-effective, and heart failure patients cared for by these programs were more likely to undergo fewer hospitalizations, but the study did not provide any conclusive association between these programs and quality of care or mortality. The authors recommend that disease-management programs involve patient education and specialized follow-up by a multidisciplinary team including home health care. [source]

    Establishing a Case-Finding and Referral System for At-Risk Older Individuals in the Emergency Department Setting: The SIGNET Model

    Lorraine C. Mion PhD
    Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at-risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at-risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000-bed teaching center, a 700-bed county teaching hospital, a 400-bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at-risk older adults are feasible in the ED setting. [source]

    Implementing bedside handover: strategies for change management

    Anne McMurray
    Aims and objectives., To identify factors influencing change in two hospitals that moved from taped and verbal nursing handover to bedside handover. Background., Bedside handover is based on patient-centred care, where patients participate in communicating relevant and timely information for care planning. Patient input reduces care fragmentation, miscommunication-related adverse events, readmissions, duplication of services and enhances satisfaction and continuity of care. Design., Analysing change management was a component of a study aimed at developing a standard operating protocol for bedside handover communication. The research was undertaken in two regional acute care hospitals in two different states of Australia. Method., Data collection included 532 semi-structured observations in six wards in the two hospitals and 34 in-depth interviews conducted with a purposive sample of nursing staff involved in the handovers. Observation and interview data were analysed separately then combined to generate thematic analysis of factors influencing the change process in the transition to bedside handover. Results and conclusion., Themes included embedding the change as part of the big picture, the need to link the project to standardisation initiatives, providing reassurance on safety and quality, smoothing out logistical difficulties and learning to listen. We conclude that change is more likely to be successful when it is part of a broader initiative such as a quality improvement strategy. Relevance to clinical practice., Nurses are generally supportive of quality improvement initiatives, particularly those aimed at standardising care. For successful implementation, change managers should be mindful of clinicians' attitudes, motivation and concerns and their need for reassurance when changing their practice. This is particularly important when change is dramatic, as in moving from verbal handover, conducted in the safety of the nursing office, to bedside handover where there is greater transparency and accountability for the accuracy and appropriateness of communication content and processes. [source]

    A literature review comparing the experiences and emergent needs of adult patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs)

    Jenny Tagney
    Aims and objectives., This literature review aims to critically appraise any published studies that compare the experiences of patients with permanent pacemakers and those with implantable cardioverter defibrillators. It seeks to identify issues that are similar or unique to one or other group; whether identified needs are being met by current nursing practice and considers how any gaps might be addressed. Background., Increasing numbers of patients are receiving pacemakers and implantable cardioverter defibrillators (ICDs) as indications for devices continue to expand worldwide. Technical follow-up of such patients is well structured. There is an increasing body of knowledge regarding ICD patients' experiences with promising work testing recovery interventions but less seems to be known about pacemaker patients. Design., Systematic review. Methods., Using an integrative approach, electronic searches using comprehensive search terms were supplemented by following reference lists and key journals from 1975,2008. Conclusion., From the direct comparison studies identified, ICD patients who experience shocks are more likely to report lifestyle limitations than pacemaker patients. However, ICD and pacemaker patients share similar outcomes, with both groups reporting increased anxiety and depression. Whilst experiences of ICD patients have been well reported, experiences of patients receiving pacemakers for any reason and pacemakers or ICDs for heart failure (bi-ventricular devices or cardiac resynchronisation therapy , CRT) remain largely unknown. Although psychosocial interventions are suggested for both groups, these have apparently only been tested and reported for ICD patients. Relevance to clinical practice., Nurses internationally encounter increasing numbers of patients with pacemakers and ICDs from primary to tertiary clinical care settings, therefore knowledge of patient experiences relating to such devices and their impact is important to inform care planning. Whilst interventions to assist ICD patients are being tested, further research is required regarding the experiences of patients with contemporary pacemakers to inform care planning and potential nursing support interventions. [source]

    A review of psychosocial needs of breast-cancer patients and their relatives

    Silvia Schmid-Büchi
    Aim., To identify the psychosocial needs of breast-cancer patients and their relatives along with factors affecting these needs and to develop a tentative model to guide further research and need assessments in clinical practice. Background., Women experiencing breast cancer must deal with the diagnosis of a life-threatening illness. Treatment and the recovery process can be demanding for patients and their relatives. Need assessment may help clinicians focus on providing appropriate help. Design., Literature review. Method., Undertaken using electronic databases and specific research terms; 20 articles were identified and analysed. Results., The needs identified by patients involve (1) treatment-related physical and social impairment like fatigue, menopausal symptoms and a changed body image and (2) emotional distress like fear of recurrence, anxiety and depression. Partners need help to protect themselves and the patient from different threats. Women need information to maintain control and manage their illness. Partners want information concerning the patient's condition and both of them about the prognosis and perspectives. There is a lack of knowledge of relatives' needs. Mutual familial support, women's and partners' health and emotional distress may affect the interaction between the patients and their partners. Conclusions., A tentative family-based model to guide further research and clinical support is proposed. Further research is needed to determine precisely which psychosocial factors may influence fulfilment of the patients' and relatives' needs. Relevance to clinical practice., The proposed model may provide a framework for healthcare professionals to evaluate the patients' and relatives' met and unmet needs and the real demand for help, to guide care planning, counselling and education. [source]

    Central venous access for haemodialysis: prospective evaluation of possible complications

    Denise De Andrade PhD
    Aims and objectives., The combination of chronic renal insufficiency and haemodialysis represents a challenge for health professionals. Chronic renal insufficiency patients undergoing haemodialysis treatment through a temporary double-lumen catheter were prospectively studied in order to identify the type and frequency of local and systemic complications. Methods., A six-month period was established with a view to the inclusion of new cases. Data were acquired through interviews, clinical assessment and patient records, and entered into a Microsoft Excel database through a double entry system and exported to the Statistical Package Social Sciences software. Sixty-four patients were evaluated prospectively, of which thirty-eight (59.4%) were men and 35 (54.7%) required catheter insertion for immediate treatment. During the study period, 145 catheters were inserted, ranging from 1 to 7 implants per patient, 29 (45.3%) were single insertions and 127 (87.6%) catheters were inserted into the jugular vein. The catheters were left in place for an average of 30 days. Results., Forty-one (64%) presented inadequate functioning, after about 26 days. A febrile state occurred in 24 (37.5%) patients after 34 days, secretion at the catheter entry site in 27 (42.2% after 26 days and bloodstream infection was encountered in 34(53%) after 34 days. Of the 61 blood culture samples, thirty (49%) were positive for Staphylococcus aureus that was the microorganism most frequently isolated. Conclusion., The findings indicate worrying aspects such as the catheters permanence time, exposing patients to different complications, including infection. Furthermore, inadequate catheter functioning leads to inefficient haemodialysis treatment. Relevance to clinical practice., Knowledge about complications allows for systematic care planning, prevention and control actions. [source]

    ,The real stuff': implications for nursing of assessing and measuring a terminally ill person's quality of life

    BN(Ed), Merilyn Annells Dip AppSc
    ,,Two quality of life (QoL) assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL) questionnaires, were trialled within district nursing palliative care to test usefulness and feasibility for holistic intervention selection, individualized palliative care planning, and measurement of the quality of dying. ,,The specific focus of this paper is to discuss the less tangible outcomes of the trial, which illuminate the partly ,hidden' value and nature of clinical nursing. ,,These outcomes include awareness that the use of such tools may: by actual administration of the tool be, in and of itself, a therapeutic nursing action; focus on ,the real stuff' from the client's perspective, that which matters most to the terminally ill client, but may not be classically considered as prompting nursing intervention; and facilitate ,the real stuff' of nursing, perhaps known but not usually articulated by nurses, and which usually does not feature on care plans nor in time allocation schedules. [source]

    Coping With Uncertainties in Advance Care Planning

    Stephen C. Hines
    This essay extends problematic integration theory and related theories of uncertainty management to communication about serious illness and death. These extensions (a) note that theorizing must focus on multiple, interrelated uncertainties rather than a single such uncertainty; (b) explain how communication with others often problematizes efforts to cope with illness-related uncertainties; and (c) identify specific factors that may influence how persons choose to cope with these uncertainties. The essay describes implications for ongoing efforts to improve communication with persons nearing death. Specifically, they point to 5 incorrect assumptions that limit the effectiveness of current efforts to encourage persons to talk about their end-of-life preferences with others in a process referred to as advance care planning and then suggest concrete changes derived from this framework that can improve the advance care planning process and enhance the quality of end-of- life care. [source]

    Assessment of anger coping skills in individuals with intellectual disabilities

    P. Willner
    Abstract Recent controlled studies have supported the effectiveness of anger management training for people with intellectual disabilities (IDs). This report describes an evaluation instrument designed to assess their usage of specific anger coping skills. The Profile of Anger Coping Skills (PACS) is designed for completion by a staff member or carer. Three situations are first elicited in which a client frequently displays anger. The respondent then rates each situation for the extent to which the client deploys each of eight behavioural and cognitive coping skills. In a preliminary reliability study, 20 users of a day service for people with IDs were rated independently by two staff members, with one of them completing the assessment on two separate occasions: the PACS showed good test,retest reliability and lower, but still acceptable, interrater reliability. The PACS was subsequently used, in a different day service, as part of the assessment pack administered before and after a 12-week anger management group, with a parallel assessment of an untreated control group. The treated group showed substantial decreases in measures of anger, which were maintained at 6-month follow-up. Increases in PACS-rated anger coping skills were also seen in all participants in the anger management group, but not in the control group. There were differences in the extent to which different coping skills were acquired by the treated group, and there were also individual differences in the profile of specific skills acquired. It is concluded that the PACS is a reliable instrument for assessing anger coping skills, particularly when used repeatedly with the same informant. It provides information that is useful for both individual care planning and the design of future anger management programmes. [source]

    Evidence-based practice: implications and concerns

    BEd (Hons), PETER NOLAN BA (Hons)
    Aims, The aim of this paper was to undertake a brief critical appraisal of evidence-based practice (EBP) as it is currently perceived in health care settings. Background, The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people's preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. Methods, After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. Results, The nature, strengths and limitations of evidence-based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. Conclusions, Evidence-based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management, In order for evidence-based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek. [source]

    Participation in arranging continuing health care packages: experiences and aspirations of service users

    S. Abbott ba(hons), ma(econ)
    Aims, This paper examines patients' and carers' experiences of receiving community health services, and considers the degree of patients' participation in the management of their continuing care. Background, Care management, advocated for many years as a way of ensuring appropriate and coordinated care, emphasizes the involvement of patients and carers in care planning. Evidence suggests that such involvement is unusual. Methods, Semi-structured interviews were carried out with 99 continuing health care patients and/or their carers. Findings, A few informants had willingly chosen to be active in arranging and coordinating their care, and a few others, who did not take an active role, were very satisfied with the services which they received. The majority, however, were not satisfied, feeling unclear about how their needs had been assessed and how services had been arranged. They were mostly disappointed by the absence of information and by the lack of regular contact with NHS and/or Social Services personnel. Some had felt compelled to become proactive in order to ensure that the care provided was adequate. Conclusions, Community nurses are valued by patients, and are well placed to be care managers. However, less qualified staff are also able to offer the regular support and information which patients want and value. [source]

    Can the introduction of a quality of life tool affect individual professional practice and the quality of care planning in a community mental health team?

    N. MURPHY rmn dip he bsc (hons) msc pgchepr
    Accessible summary ,,Audit should not be restricted to one form of methodology and should embrace mixing methods of data collection. ,,Use of a quality of life tool allows users more of a voice, enhancing the partnership with service providers and presenting an alternate view of risk. ,,Implementation of any change to practice needs to address local level barriers and engage the service providers in the process, therefore, avoiding the common perception of being given more work without negotiation and feelings of alienation. Abstract This practice development paper demonstrates the scope for creativity in mixing audit and methods of investigation. It details the evolution of Quality of Life (QOL) perspectives and relates them to the practice of care planning. The process proved enlightening and affirming to practitioners and engaged them in considering value-based practice (recovery-orientated) from the perspective of the client. It was clear that subtle changes to care planning emerged, and the goal of giving responsibility for self determining issues was addressed. [source]

    The Politics of Recognition in Culturally Appropriate Care

    Over the last 20 years, the concept of culturally appropriate health care has been gradually gaining popularity in medicine and public health. In calling for health care that is culturally appropriate, minority groups seek political recognition of often racialized constructions of cultural difference as they intervene in health care planning and organization. Based on interview narratives from people involved in community organizing to establish a federally funded community health center in a mid-size New England city, I chart the emergence of a language of "culturally appropriate health care" in language used to justify the need for a health center. An identity model of recognition underlies the call for ethnic resemblance between patient and provider seen in many culturally appropriate care programs. I contrast this model of health care with earlier calls for community access and control by activists in the 1970s and explore the practical and theoretical implications of each approach. [source]

    Advanced care planning in ALS

    MUSCLE AND NERVE, Issue 6 2002
    Walter G. Bradley DM
    No abstract is available for this article. [source]

    Gender differences in the factors related to physical activity among adults with diabetes

    CCRNArticle first published online: 25 MAR 200, Ramesh B. Navuluri MSC(AGRI)
    Abstract A descriptive correlational study was conducted to determine the gender differences in the relationship between health-related hardiness, patient attitude toward compliance, and self-care adherence to physical activity among 155 adults with diabetes. The two subcomponents of health-related hardiness, control and commitment/challenge, were included as separate variables. The correlations between commitment/challenge and self-care adherence to physical activity, and between total health-related hardiness and self-care adherence to physical activity, were significant among men (n = 52). The correlation between patient attitude toward compliance and self-care adherence to physical activity was significant among women (n = 103). Clinically, when compliance with self-care adherence to physical activity is the goal, a male patient may need hardiness instructions, while a female patient may need interventions to promote attitude toward compliance. Future research may include studying the relationships between other self-care practices such as diet management, medication compliance, and glucose monitoring and the variables of health-related hardiness and patient attitude toward compliance, which may help health-care professionals in appropriate care planning aimed at promoting self-management of diabetes. [source]

    Implementing cancer survivorship care planning: workshop summary.

    PSYCHO-ONCOLOGY, Issue 11 2007
    2007., Institute of Medicine, National Academies Press, Washington
    No abstract is available for this article. [source]