Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty.

OBJECTIVES: To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN: Mixed-method, pre-post quasi-experimental design. SETTING: A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS: Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. INTERVENTION: Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult's hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. MEASUREMENTS: Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult's hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. RESULTS: Family caregivers' knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult's hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult's surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. CONCLUSION: Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group.

Perceived readiness for hospital discharge in adult medical-surgical patients.

PURPOSE: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients' perceptions of their readiness for hospital discharge. DESIGN: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. SETTING: Midwestern tertiary medical center. SAMPLE: 147 adult medical-surgical patients. METHODS: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. FINDINGS: Living alone, discharge teaching (amount of content received and nurses' skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. CONCLUSIONS: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis' transitions theory as a useful model for conceptualizing and investigating the discharge transition. IMPLICATIONS FOR PRACTICE: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes.

Skeletal pin site care: National Association of Orthopaedic Nurses guidelines for orthopaedic nursing.

A systematic analysis of the research literature on skeletal pin site care was conducted, and the opinions of an expert panel were obtained. Four specific recommendations for skeletal pin site care are offered, with explicit discussions of the level of research support and/or expert panel support for each. Discussion of other pin site care issues is provided, and characteristics of the research base regarding skeletal pin site care are described.

Road to excellence in pain management: research, outcomes and direction (ROAD).

Effective pain management is a critical patient care goal mandated by numerous health care organizations. There remains great opportunity to improve pain management across all sites of care. This article describes an interdisciplinary model for process improvement within an integrated health care system. An outcome-based approach to pain management resulted in the development of four key clinical indicators that are measured across sites, including acute care, long-term, ambulatory, and home care. Early outcome data are presented. Strategies for improving pain management focus on visibility, staff accountability, patient rights, and education.