RESUMEN
A pilot study was conducted to determine the feasibility of a longitudinal investigation of patients' coping during the early postdischarge period. Recruitment was conducted on a general medical unit and a surgical orthopedic unit. Forty-four participants were recruited with 95% retention. Demographic characteristics plus measures of discharge risk and perceived readiness (expected coping) were collected before discharge. Measures of coping (experienced) and the use of supports and services were collected on the first day postdischarge, the end of the first week, and during weeks 3 and 5. Considerable variability was evident in coping scores, and not all participants exhibited improvement over time. Four patterns of coping were identified: ongoing recovery, initial shock, bumpy road, and progressive decline. Further investigation is required to validate the observed coping patterns. A better understanding of conditions affecting patient coping during the transition from hospital to home will support efforts to reduce unplanned use of acute care services.
Asunto(s)
Adaptación Psicológica , Alta del Paciente/normas , Readmisión del Paciente/estadística & datos numéricos , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Satisfacción del Paciente , Habitaciones de Pacientes/organización & administración , Habitaciones de Pacientes/estadística & datos numéricos , Proyectos PilotoRESUMEN
PURPOSE: Project was undertaken to examine the utility of the Blaylock Risk Assessment Screen (BRASS) in identifying patients who may experience discharge complications as indicated by longer hospital stays or readmission within 30-days of a discharge to home. BACKGROUND: Before measures can be put in place to facilitate discharge planning and to prevent unplanned readmission by recently discharged patients, those at risk of such events must be identified. METHODS: Project involved an analysis of 13-months of administrative data from one tertiary care hospital. Utility of the BRASS was examined in terms of its sensitivity and specificity as well as its positive and negative predictive values. RESULTS: Majority (83%) of hospital discharges were to home. Approximately 7% of patients experienced at least one readmission within 30-days of being discharged to home. Using scores of 10 or higher as an indicator of risk, BRASS exhibited a high degree of specificity suggesting it is useful for 'ruling in' those who have the outcomes-of-interest. However low sensitivity indicates many who experienced the outcomes were incorrectly classified by the BRASS as low risk. The low positive predictive value for 30-day readmission also suggests many who were classified by the BRASS as being 'at risk' were not readmitted. CONCLUSION: The observed rate of 30-day readmission is likely conservative as the analysis involved data from only one acute care facility. One explanation for the low positive predictive value for 30-day readmission is that completion of the BRASS on admission enabled the implementation of preventive measures.
Asunto(s)
Guías como Asunto , Tiempo de Internación/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/normas , Readmisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Medición de Riesgo/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Sensibilidad y Especificidad , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
Feasibility studies play a crucial role in determining whether complex, community-based interventions should be subject to efficacy testing. Reports of such studies often focus on efficacy potential but less often examine other elements of feasibility, such as acceptance by clients and professionals, practicality, and system integration, which are critical to decisions for proceeding with controlled efficacy testing. Although stakeholder partnership in feasibility studies is widely suggested to facilitate the research process, strengthen relevance, and increase knowledge transfer, little is written about how this occurs or its consequences and outcomes. We began to address these gaps in knowledge in a feasibility study of a health intervention for women survivors of intimate partner violence (IPV) conducted in partnership with policy, community and practitioner stakeholders. We employed a mixed-method design, combining a single-group, pre-post intervention study with 52 survivors of IPV, of whom 42 completed data collection, with chart review data and interviews of 18 purposefully sampled participants and all 9 interventionists. We assessed intervention feasibility in terms of acceptability, demand, practicality, implementation, adaptation, integration, and efficacy potential. Our findings demonstrate the scope of knowledge attainable when diverse elements of feasibility are considered, as well as the benefits and challenges of partnership. The implications of diverse perspectives on knowledge transfer are discussed. Our findings show the importance of examining elements of feasibility for complex community-based health interventions as a basis for determining whether controlled intervention efficacy testing is justified and for refining both the intervention and the research design.
Asunto(s)
Mujeres Maltratadas/psicología , Enfermería en Salud Comunitaria/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud , Maltrato Conyugal/terapia , Sobrevivientes/psicología , Salud de la Mujer , Adulto , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Calidad de Vida , Apoyo SocialRESUMEN
To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program.
Asunto(s)
Complicaciones de la Diabetes/terapia , Manejo de la Enfermedad , Servicios de Atención de Salud a Domicilio , Cuidados de Enfermería en el Hogar/métodos , Cicatrización de Heridas , Heridas y Lesiones/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Conducta Cooperativa , Complicaciones de la Diabetes/enfermería , Enfermería Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Derivación y Consulta/organización & administración , Salud Rural , Heridas y Lesiones/complicaciones , Heridas y Lesiones/enfermería , Adulto JovenRESUMEN
Wuest's (1998, 2001) caregiving theory was tested with 282 women self-identified as caregivers of family members with dementia to examine how quality of past relationship within caregiving dyads and sense of obligation to care affected their health outcomes and health promotion over 9 months, using latent growth curve analysis. The model explained 62% of the variance in women's health (Time 4). Health was affected positively by past relationship and negatively by obligation. Health promotion was positively affected by health (Time 1) and by obligation. Change observed in health promotion was nonlinear and positively affected health (Time 4). Findings suggest past relationship and obligation to care predict health outcomes for caregivers and that interventions to increase caregivers' health promotion may improve health outcomes.
Asunto(s)
Cuidadores/psicología , Demencia/enfermería , Promoción de la Salud/métodos , Estado de Salud , Salud de la Mujer , Actividades Cotidianas , Adaptación Psicológica , Adulto , Anciano , Actitud Frente a la Salud , Demencia/psicología , Femenino , Humanos , Persona de Mediana Edad , Modelos Psicológicos , Análisis Multivariante , Análisis de Regresión , Autoimagen , Adulto JovenRESUMEN
Caregiving by family members, particularly women, is a societal expectation that is intensifying in the context of an aging population and health care restructuring. Our program of caregiving research spans two decades, moving from inductive theory development using grounded theory methods to deductive theory testing. In this article, we reflect on the serendipitous development of this program of research methodologically and conceptually. We summarize the key conceptual contributions that the program has made to caregiving knowledge, particularly with respect to the past relationship between care recipient and caregiver, obligation to care, caregiver agency, and relationships between caregivers and the health care system.
Asunto(s)
Enfermedad de Alzheimer/psicología , Cuidadores/psicología , Investigación sobre Servicios de Salud/métodos , Evaluación de Programas y Proyectos de Salud , Teoría Psicológica , Relaciones Familiares , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Modelos Psicológicos , Desarrollo de Programa , Investigación Cualitativa , Salud de la MujerRESUMEN
INTRODUCTION: Although the provision of inpatient care is not typically associated with emergency nursing, it is the new reality in many departments. Given the number of admitted patients boarded in the emergency department for part or all of their hospital stay, it is important to know who these patients are. The purpose of this analysis was to determine whether the occurrence of ED boarding could be predicted by factors specific to the type and timing of the ED visit or whether patient characteristics also affected these decisions. METHODS: A retrospective review of administrative data for a 1-year period was conducted. Chi-square and logistic regression analyses were used to determine whether the likelihood of being boarded for more than 2 hours could be predicted by factors specific to the type of visit (ie, triage level and admission type) and timing of the visit (ie, time of day and day of week) or whether patient characteristics (ie, sex and age group) also played a role. RESULTS: Slightly more than half of patients remained in the emergency department for more than 2 hours following receipt of an admission order. Results suggest the likelihood of boarding was highest for those who were medical admissions and admitted on a weekday or during the night shift. Even after accounting for these factors, patient characteristics improved the ability to predict ED boarding. Female patients and those 65 years of age or older were more likely to be boarded. CONCLUSIONS: Findings suggest that in addition to their usual responsibilities, emergency nurses are providing care to a group of inpatients who tend to have high medical and nursing care needs.
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Servicio de Urgencia en Hospital/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ocupación de Camas , Distribución de Chi-Cuadrado , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nuevo Brunswick , Investigación en Administración de Enfermería , Admisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Adulto JovenRESUMEN
Research on acute care reentry by recently discharged inpatients has generally focused on hospital readmissions, with less attention given to presentations to the emergency department (ED). This omission results in underestimation of the extent of reentry and its impact on ED patient volumes and flow. This project involved an analysis of administrative data to examine the rate of ED presentations by recently discharged inpatients using 3 time metrics-within 0-3 days, 0-7 days, and 0-30 days of discharge. Descriptive-correlational analyses were conducted to examine the rates of reentry and ability to predict ED presentations using patient demographic (age and sex) and clinical profile (length of hospital stay and day of presentation). Approximately 12% of hospital discharges to home involved patients who presented to the ED within 30 days, and almost half occurred within the first week. Results of multivariable analyses suggest that the influences of ED presentations differ depending on the time metric examined. Emergency department presentations within 3 and 7 days of discharge compared with 30 days were not predicted by patient age or sex but were more likely to involve those with shorter hospital stays. A weekend presentation was also more likely among case patients presenting within 3 days of discharge. Only about one third of ED presentations resulted in readmission. Emergency department presentations are an important component of acute care reentry. Establishment of a common reentry metric for ED presentations would facilitate efforts to determine the impact of these events. Emergency nurses working in advanced practice roles are ideally positioned to assume a leadership role in addressing the needs of recently discharged inpatients who present to the ED. By reviewing these cases and collaborating with the inpatient unit staff, it may be possible to identify strategies for augmenting discharge planning and the provision of transitional care.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nuevo Brunswick , Factores Sexuales , Factores de TiempoRESUMEN
We examined the effect of telephone follow-up on surgical orthopedic patients' postdischarge recovery. The sample consisted of 438 patients randomly assigned to receive routine care with or without telephone follow-up 24 to 72 hours after discharge (intervention). During the intervention, the nurse caller assessed each patient's status, identified problems, and provided needed follow-up care. Structured telephone interviews were conducted with all participants during the third week after their discharge. Key outcomes were self-reports of problems, progress, and unanticipated contact with the health care system. The primary self-reported problems were mood changes, constipation, pain, and swelling. Women and younger participants tended to report more problems. Availability of help was positively associated with progress. Although telephone follow-up did not affect the first two outcomes, it was associated with increased occurrence of health care contacts, as was living farther from the hospital. The study findings highlight the need to clearly explicate the requirements and outcomes for nurse-initiated telephone follow-up programs.
Asunto(s)
Continuidad de la Atención al Paciente , Enfermería Ortopédica/métodos , Procedimientos Ortopédicos/enfermería , Enfermería Perioperatoria/métodos , Teléfono , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Alta del Paciente , Satisfacción del Paciente , Recuperación de la FunciónRESUMEN
It has been reported that the outcomes of care are affected not only by the educational preparation and experience of the practitioner but also by the parameters of his or her practice. Given differences that exist internationally in the enactment of the emergency nurse practitioner (ENP) role, a synthesis of research articles was conducted to examine the educational preparation and experience of ENPs, the role(s) they assume as determined by their patient population, and the outcomes used to evaluate their practice. The synthesis was informed by Sidani and Irvine's (1999) conceptual framework for evaluating the nurse practitioner role in acute care settings. The synthesis included 43 research articles, which were retrieved following a search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) bibliographic database. Approximately 60% of the articles were descriptive or qualitative studies, whereas only 7% were randomized controlled trials. Findings suggest that although many outcomes of care have been evaluated, no outcomes have been evaluated consistently and many are not specific to the intervention or actions of nurse practitioners. In addition, few research articles provide information on the educational preparation and experience of the ENPs or the parameters of their practice. Such information is needed to explain the variability observed in the outcomes achieved and to build a body of evidence supporting the role of nurse practitioners in the emergency department.
Asunto(s)
Competencia Clínica , Enfermería de Urgencia/educación , Internacionalidad , Enfermeras Practicantes/educación , Rol de la Enfermera , Evaluación Educacional , Escolaridad , HumanosRESUMEN
People who access the emergency department for less urgent health problems have been described as inappropriate users of the health-care system.Yet little is known about the factors precipitating such use and how these differ based on location of the emergency department. In this descriptive-correlational study guided by Andersen's Model of Health Services Use, 1612 people who presented to an emergency department with a less urgent health problem were interviewed. Analysis revealed rural/urban differences in the characteristics of patients, nature of the problems, actions taken, and factors precipitating the visit. Despite its popularity, the predictive capabilities of Andersen's model were limited in explaining use of self-treatment or willingness to wait for treatment. The findings show that an emergency department's roles and functions vary according to its location. Such insights provide direction for developing services that respond to the needs of people with less urgent health problems that are cognizant of geographic location.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Servicios Urbanos de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Motivación , Evaluación de Necesidades , Nuevo Brunswick , Investigación Metodológica en Enfermería , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Características de la Residencia , Autocuidado/métodos , Autocuidado/psicología , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.
Asunto(s)
Manejo del Dolor , Dimensión del Dolor/métodos , Manejo de la Enfermedad , Humanos , Índice de Severidad de la EnfermedadRESUMEN
The social expectation that women will care for family members persists despite evidence that many women have difficult or abusive past relationships with their parents and partners. Little is known about how past relationship influences the health of women caring for adult family members. On the basis of earlier grounded theory research, we tested the theory that past relationship and obligation predict health outcomes and health promotion in 236 women caregivers of adult family members. Structural equation modeling demonstrated support for the theory, with 56% of the variance in health outcomes and 11% of the variance in health promotion accounted for by the model.