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Complex Care (complex + care)
Selected AbstractsNursing Interventions for a Chronically Ill, Nonadherent Teenager With a Psychiatric DiagnosisJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2003Diane Sieben BSN ISSUES AND PURPOSE To describe the complex care of an adolescent with chronic psychiatric and medical problems. CONCLUSIONS The nonadherent, self-abusing, adolescent was empowered to progress developmentally, as well as medically. PRACTICE IMPLICATIONS A planned team approach helped the adolescent become more developmentally appropriate and independent in self-care. The care plan designed by nursing staff included a change in nursing focus, creative problem solving, team nursing, and utilization of multidisciplinary resources. [source] An exploration of best practice in multi-agency working and the experiences of families of children with complex health needs.JOURNAL OF CLINICAL NURSING, Issue 3 2007What works well, what needs to be done to improve practice for the future? Aims and objectives., This Appreciative Inquiry study aimed to explore appreciatively examples of best multi-agency working practice with families (mothers, n = 20; fathers, n = 7; children, n = 1) and people working with children with complex needs (n = 41), to determine what works well, why it has worked well and what best practice in the future could be. Background., The term ,children with complex health needs' encompasses a diverse group of children and this population is increasing. This diverse group of children often requires high levels of physiological, psychological and social care which brings them and their families into therapeutic contact with a wide range of health, social and education professionals and people from other agencies. Design., The study used appreciative interviews, nominal group workshops and consensus workshops to develop a set of 10 ,best practice' guidelines that reflected the views of all participants. Two of these are discussed in detail in this article. All participants were seen as co-researchers whose expert contributions were vital to understanding of what works well and what needs to be done in multi-agency working practice. Results., The study resulted in ,best practice' statements that illuminated ,what works well' in multi-agency working practice that spanned issues including information, decision making, communication, accessibility, collaboration, respect and sharing a common vision. Conclusions., The guidance that results from this study suggests that parents need the opportunity to share and receive support from other parents who understand the lived reality of caring for a child with complex needs. Parents and people from across various agencies need to work together to ensure that the most appropriate person acts in the role of a long-term coordinator, where the family wants this aspect of support. This study adds a multi-disciplinary and appreciatively oriented focus on what works well in complex care. It contributes to an understanding of the value of an Appreciative Inquiry approach within health-care research. Relevance to clinical practice., The guidelines arose from and are grounded in practice and as such they provide clear, workable directions for enhancing practice and for considering what already does work well. [source] Nurse discharge planning in the emergency department: a Toowoomba, Australia, studyJOURNAL OF CLINICAL NURSING, Issue 8 2006Desley Hegney BA Aim., This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives., The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design., The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51·5%) were admitted and 246 (11·5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results., There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5·5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6·17 days per patient in October 2002 to 5·37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as ,frequent flyers'). Conclusions., Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice., It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient. [source] Out-of-area placements in Scotland and people with learning disabilities: a preliminary population studyJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 4 2008M. BROWN bsc (hons) msc pgce phd rgn rnld People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population. [source] Position statement on the role of health care assistants who are involved in direct patient care activities within critical care areasNURSING IN CRITICAL CARE, Issue 1 2003The British Association of Critical Care Nurses Summary ,Intensive care has developed as a speciality since the 1950s, and during this time, there have been major technological advances in health care provision, leading to a rapid expansion of all areas of critical care ,The ongoing problem in recruiting qualified nurses in general has affected, and continues to be a problem for, all aspects of critical care areas ,During the past decade, nursing practice has evolved, as qualified nurses have expanded their own scope of practice to develop a more responsive approach to the complex care needs of the critically ill patient ,The aim of this paper is to present the British Association of Critical Care Nurses (BACCN) position statement on the role of health care assistants involved in direct patient care activities, and to address some of the key work used to inform the development of the position statement [source] Advanced Practice Psychiatric Mental Health Nursing, Finding Our Core: The Therapeutic Relationship in 21st CenturyPERSPECTIVES IN PSYCHIATRIC CARE, Issue 4 2006Suzanne Perraud RN TOPIC.,Increasingly, students from various professional backgrounds are enrolling in Psychiatric Mental Health (PMH) Nursing graduate programs, especially at the post-master's level. Faculty must educate these students to provide increasingly complex care while socializing them as PMH advanced practitioners. PURPOSE.,To present how one online program is addressing these issues by reasserting the centrality of the relationship and by assuring it has at least equal footing with the application of a burgeoning knowledge base of neurobiology of mental illness. SOURCES.,Published literature from nursing and psychology. CONCLUSIONS.,The PMH graduate faculty believes that they have developed strategies to meet this challenge and to help build a PMH workforce that will maintain the centrality of the relationship in PMH practice. [source] | ||||||||||