Experience of Transitional Care Among Thai-Isan Older Stroke Survivors and Their Family Caregivers.

The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger-Templin-Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period.

The impact of a pilot telehealth coaching intervention to improve caregiver stress and well-being and to increase dietary protein intake of caregivers and their family members with dementia - Interrupted by COVID-19.

The prevalence of dementia is growing as the population and longevity increase. Caregivers of adults with dementia report stress and fatigue and often neglect their health. They also indicate the need for information to address health-related issues, including nutritional problems, of their family members with dementia (FMWD). This study examined the impact of coaching to improve family caregiver (FCG) stress and well-being and to increase the protein intake of both FCGs and their FMWD. All participants received nutrition education including a protein prescription (1.2 g/kg body weight/day) and FCGs received stress-reduction materials. Coached-group randomized participants also received weekly diet coaching and stress-reduction coaching. At baseline and 8 weeks, anthropometrics, a mini-nutritional assessment questionnaire, and diet (protein intake) were assessed in FCGs and FMWD; well-being, fatigue and strain were assessed in FCGs. Repeated two words measures analysis of variance and Fisher's exact tests examined within group and intervention effects. Twenty-five FCGs (13 coached group, 12 not-coached group) and 23 FMWD (12 coached group, 11 not-coached group) completed the study. No significant differences were found between coached and not-coached FCGs and FMWD at baseline. After 8- weeks, FCGs' protein intake significantly increased from 1.00 ± 0.17 to 1.35 ± 0.23 g/kg/body weight in the coached group and from 0.91 ± 0.19 to 1.01 ± 0.33 g/kg/body weight in the not-coached group; there was also an intervention effect (p=.01, η2 = .24). The percentage of FCGs with baseline protein intake less than prescription guidelines and with an end-of-study protein intake meeting/exceeding the prescription significantly differed, with 60% of coached FCGs versus 10% of not coached FCGs meeting the prescription. No intervention effects were shown for protein intake in FMWD or for well-being, fatigue or strain among FCGs. Diet coaching with nutrition education successfully assisted FCGs with improving their protein intake versus nutrition education alone.

Effectiveness of a Per-Meal Protein Prescription and Nutrition Education with versus without Diet Coaching on Dietary Protein Intake and Muscle Health in Middle-Aged Women.

Sufficient dietary protein intake is vital to maintaining muscle health with aging. Yet protein intake among adults is often inadequate. This study's main objective was to examine the impact of nutrition education (NE) and a per-meal protein prescription (PRx) with versus without diet coaching on protein intake. A secondary objective examined its effects on muscle health. Participants included 53 women, age 45-64 years. All participants received NE and PRx; those randomized to coached-group received 10-weeks of diet coaching. Assessments included: protein intake at baseline, weeks 4 and 12 and muscle health (muscle mass, grip strength, five-chair rise test, 4 mgait speed test). The Chi-square test examined percentages of participants meeting PRx between groups. Repeated measures analysis of variance assessed within group and intervention effects on protein intake and muscle health parameters. Protein intake (g/kg body weight) increased (p < 0.001): not-coached (n = 28) 0.8 ± 0.2 to 1.2 ± 0.3 and coached (n = 25) 1.0 ± 0.2 to 1.4 ± 0.3 with no significant difference between groups. A greater percentage of coached-group participants met (p = 0.04) breakfast (72%) and met (p < 0.001) three-meal (76%) PRx versus not-coached participants (25% and 53%, respectively). Participants in both groups exhibited significantly (p < 0.001) improved times for the five-chair rise test and 4 mgait speed test. Diet coaching in conjunction with a PRx and NE should be considered to assist individuals in improving protein intake through self-selection of protein-rich foods.

Family involvement in transitional care from hospital to home and its impact on older patients, families, and health care providers: a mixed methods systematic review protocol.

OBJECTIVE: The goal of this review is to synthesize the available evidence on family involvement in transitional care and its impact on patients' and family caregivers' health as well as health care providers' satisfaction. INTRODUCTION: Involving families in transitional care from hospital to home has been undertaken to improve care quality, patient safety, and well-being. Successful family involvement in care depends on the interaction between the health care system and health care providers. However, family involvement in this process has not yet been systematically examined. This review will examine published quantitative and qualitative studies to create a better understanding of family involvement in transitional care. INCLUSION CRITERIA: This review will consider family involvement in transitional care, encompassing older patients, family caregivers, and health care providers. The quantitative component will compare family involvement interventions with standard care or alternative interventions. Outcomes will be grouped by older patients, family caregivers, and health care providers. For the qualitative component, the subjective experiences of all groups will be explored. METHODS: Eligible quantitative, qualitative, and mixed method studies will be searched in databases and gray literature sources. The review will consider studies from 1989 to the present, published in English or Thai. Study selection, critical appraisal, data extraction, and data synthesis will be undertaken by two independent reviewers following the segregated JBI approach to mixed methods reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020191464.

Immersion Experiences About Homelessness and Psychological Processes of Nursing Students: A Pilot Study.

BACKGROUND: Across disciplines, research findings demonstrate that positive exposure to members of stigmatized groups is effective in reducing social stigma. This study explored differences in nursing students' psychological processes about people experiencing homelessness related to a community immersion intervention. METHOD: This descriptive exploratory study examined change from pre- to postintervention. Linguistic inquiry and word count explores affective psychological and social psychological processes of undergraduate and graduate nursing students. RESULTS: Average word use for overall affective and social psychological processes showed significant difference postimmersion intervention. No significant difference was found between affective and social processes postimmersion intervention in relation to nursing students' gender, previous experience with people experiencing homelessness, or previous nursing experience working in an emergency care setting. CONCLUSION: Affective and social psychological processes had significant differences after an immersion event. This supports that a well-designed immersion experience can be effective in both graduate and undergraduate programs and across student characteristics. [J Nurs Educ. 2021;60(4):216-219.].

Choosing coaching frameworks for promoting diet modifications.

Theoretical frameworks have successfully guided researchers in implementing coaching interventions to effect dietary changes in adults for both prevention and management of chronic diseases. Three such frameworks include the Transtheoretical Model (TTM), Social Cognitive Theory (SCT), and the Theory of Integrative Nurse Coaching (TINC). This article introduces each theory, followed by an overview of the coaching interventions used to effect dietary behaviour changes within each theory. A condensed version of Turner's synthesis methodology is used to determine if a conceptual connection exists among the three models/theories. The condensed version includes synthesis preparation, synthesis (comparison of converging and diverging components), synthesis refinement (conceptual connection), and a concluding discussion of all three theories related to nursing practice. This synthesis will inform the focus of interventions that aim to promote dietary changes in adults at risk of developing sarcopenia.

Barriers to primary care: perceptions of older adults utilizing the ED for nonurgent visits.

This purpose of this mixed methods study was to understand access to primary care among older adults who present to an inner city emergency department (ED) for nonurgent care. Questionnaires (N = 62) included demographic, illness characteristics, and health care utilization. Qualitative interviews (N = 20) were conducted. Data was analyzed using descriptive statistics, and qualitative methodology. More than half of the participants were female (60%), African American (57%) and pain was the presenting symptoms among 48% of the participants. Nearly all participants reported barriers to primary care; difficulty with phone systems and staff, and lack of available appointments resulting in an ED visit. Older adults face barriers accessing primary care and as a result, can turn to the ED for their primary care needs. Interventions to improve access for vulnerable older adults might have benefits not only for patient outcomes but also for health policy issues related to cost effective care and overcrowded EDs.

Review of current conceptual models and frameworks to guide transitions of care in older adults.

Older adults are at high risk for gaps in care as they move between health care providers and settings during the course of illness, such as following hospital discharge. These gaps in care may result in unnecessary re-hospitalization and even death. Nurses can assist older adults to achieve successful transitions of care by taking a systematic approach and individualizing care to meet patient and family health literacy, cognitive, and sensory needs. This article reviews trends in transitions of care, models, partnerships, and health literacy. Models described include the Transitional Care Model, Care Transitions Program, Project BOOST (Better Outcomes for Older adults through Safe Transitions), Project RED (Re-engineered Discharge), Chronic Care Model, and INTERACT(II) (Interventions to Reduce Acute Care Transfers). Approaches to transitions of care are discussed, and resources for geriatric nurses are provided.

System issues: challenges to intimate partner violence screening and intervention.

This ethnographic study examines the experiences of health care providers (HCPs) and advocates implementing intimate partner violence (IPV) screening and interventions in their health care organizations. Numerous policies and protocols have been developed to improve the response of HCPs to survivors of IPV. Typically studies have focused on HCPs with little attention to the role of organizations in providing care. The findings from this study highlight that even with IPV programs in place the organizational environment can contribute to suboptimal outcomes. Identified challenges included time constraints, organizational expectations for increased productivity, and dwindling organizational support and services for IPV. With the continuing debate regarding universal screening, this study illuminates the need for clinicians to have a supportive clinical environment and resources for IPV screening and intervention.