Meta-Analysis of Clinical Trials That Evaluate the Effectiveness of Hospital-Initiated Postdischarge Interventions on Hospital Readmission.

Under pressure to avoid readmissions, hospitals are increasingly employing hospital-initiated postdischarge interventions (HiPDI), such as home visits and follow-up phone calls, to help patients after discharge. This study was conducted to assess the effectiveness of HiPDI on reducing hospital readmissions using a systematic review of clinical trials published between 1990 and 2014. We analyzed twenty articles on HiPDI (from 503 reviewed abstracts) containing 7,952 index hospitalizations followed for a median 3 months (range 1-24) after discharge for readmission. The two most common HiPDI included follow-up phone calls (n = 14, 70%) or home visits (n = 11, 55%); eighty-five percent (n = 17) of studies had multiple HiPDI. In meta-analysis, exposure to HiPDI was associated with a lower likelihood of readmission (odds ratio [OR], 0.8 [95% CI, 0.7-0.9]). Patients receiving ≥2 postdischarge home visits or ≥2 follow-up phone calls had the lowest likelihood of readmission (OR, 0.5 [95% CI, 0.4-0.8]). Hospital-initiated postdischarge interventions seem to have an effect on reducing hospital readmissions. Together, multiple home visits and follow-up phone calls may be the most effective HiPDI to reduce hospital readmission.

Implementing primary care in the perianesthesia setting using a relationship-based care model.

As surgical patients pass through the perianesthesia continuum, the nurses they encounter rarely have time to develop a nurse-patient relationship, or identify patient needs and concerns and pass this information along to other providers. In the preprocedural period of the care continuum, however, patients and their families often express information that is important to the patient and should be included in the patient's perioperative plan of care. Three questions were developed and added to the existing preoperative nursing assessment to ascertain the needs and concerns of patients and their families in the presurgical setting. Responses were communicated to the postanesthesia care unit nurse. Through implementation of this simple process, patient needs were better recognized and communicated during recovery from anesthesia. Results suggest that this primary care nursing model, adapted for a perioperative setting, has been overwhelmingly successful in communicating and responding to patients' needs during their surgical experience.

Fall risk assessment and prevention.

Patient falls are a common cause of morbidity and are the leading cause of injury deaths in adults age 65 years and older. Injuries sustained as result of falls in a cancer hospital are often severe, regardless of patient age, due to the nature of the underlying cancer. Falls are a nursing-sensitive indicator and nurses are in a unique position to assess, design, implement, and evaluate programs for fall risk reduction. We analyzed our nursing processes related to falls and fall prevention in conjunction with an evidence-based review, a research study to improve our fall risk-assessment process, and development of a comprehensive fall-reduction program. This article outlines how our institution developed a fall risk assessment for the oncology patient population, and utilized this assessment in a comprehensive nursing approach to fall prevention in both inpatient and outpatient settings.

The meaning of cost for families of children with congenital heart disease.

INTRODUCTION: The purpose of this study was to describe the cost burden of congenital heart disease (CHD) and the associated social impact as experienced by families. METHOD: Qualitative methods were used to collect and interpret data. Semi-structured interviews were conducted with parents of children with various degrees of CHD complexity and socioeconomic status currently admitted for congenital heart surgery at a large tertiary care regional center. RESULTS: The meaning of cost burden as defined by participants resulted in the emergence of two major categories, lifestyle change and uncertainty. Cost was described beyond monetary terms and as a result, data in each category were further clustered into three underlying subcategories labeled financial, emotional, and family burden. The child's disease complexity and parent's socioeconomic status seem to be linked to higher levels of stress experienced in terms of finances, emotional drain, and family member burden. Prenatal diagnosis was noted to trigger early discussion of financial uncertainty, often resulting in altered personal spending prior to birth. DISCUSSION: The cost experienced by parents of children with complex CHD was described as both life-changing and uncertain. Informing families of these types of additional stressors may allow issues of finances to be considered early in the overall preparation of caring for a child with complex CHD.

Identification of barriers to sexual health assessment in oncology nursing practice.

PURPOSE/OBJECTIVES: To explore oncology nurses' attitudes about and knowledge of sexual health. Sexual health is an integral component of quality of life, which is an Oncology Nursing Society research priority. DESIGN: A descriptive, cross-sectional design. SETTING: A National Cancer Institute-designated comprehensive cancer center in the northeastern United States. SAMPLE: A convenience sample of 576 RNs working in acute care, ambulatory, and perioperative services were approached during an annual mandatory training day. METHODS: Attitudes and beliefs about patients' sexual health assessment in nursing practice were evaluated with the Sexual Attitudes and Beliefs Survey and 10 demographic questions. MAIN RESEARCH VARIABLES: Oncology nurses' attitudes and beliefs regarding sexual health assessment of patients. FINDINGS: A statistically significant difference was found in scores based on age and nursing experience, whereby younger and less experienced nurses had higher scores, indicating greater discomfort in discussing sexual health with patients. Statistical significance also was found in scores based on oncology certification and practice setting, whereby oncology certified nurses and outpatient nurses identified fewer attitudinal barriers than noncertified nurses and nurses working in the inpatient setting. CONCLUSIONS: The results suggest that this patient population may not be receiving a complete sexual health assessment. IMPLICATIONS FOR NURSING: Nurses in the sample believed that sexuality was not too private an issue to discuss with their patients and claimed to understand how disease and treatment may affect patients' sexuality. Nurses also believed that their patients should not expect nurses to ask about their sexual concerns and often defer to the physician for any sexually related questions.

Consensus statements: ambulatory pediatric oncology nursing practice.

The pre-conference workshop at the 32nd Annual Conference of the Association of Pediatric Hematology/Oncology Nursing, held in September 2008, focused on issues faced by pediatric oncology nurses in the ambulatory setting. The workshop was developed after several years of intense discussions at several forums. Therefore the need for an extended discussion period with ambulatory pediatric oncology nurses across the country to address these concerns was evident. There has been a major shift over the past ten years from inpatient to outpatient treatment in oncology (Chabot & Fox, 2005). This shift has resulted in numerous unique challenges for the pediatric oncology nurse. Challenges include lack of staffing resources for fluctuating patient volume and acuity, telephone triage volume and management, home care patient issues, scheduling systems, patient flow and wait time, and multi-institutional communication. This article reports the results of the APHON workshop which utilized the evidence from adult ambulatory oncology literature and standards and the recommendations of the expert pediatric oncology nurse participants to develop global statements about pediatric oncology ambulatory practice standards. The energy and productivity of the group was evidence of a common theme and demand for attention to the ambulatory nursing staff and practice. The ability to identify common threads and reach consensus with powerful statements of practice supports the continued use of such forums to move practice forward.

Assessing nurses' attitudes toward death and caring for dying patients in a comprehensive cancer center.

PURPOSE/OBJECTIVES: To assess how nurses employed in a comprehensive cancer center feel about death and caring for dying patients and examine any relationships between their attitudes and demographic factors. DESIGN: Descriptive quantitative. SETTING: A 432-bed comprehensive cancer center in New York, NY. SAMPLE: A convenience sample of 355 inpatient and outpatient oncology nurses. METHODS: Voluntary and anonymous completion of the Frommelt Attitude Toward Care of the Dying (FATCOD), the Death Attitude Profile-Revised (DAP-R), and a demographic questionnaire. MAIN RESEARCH VARIABLES: Years of total nursing experience, years employed at the cancer center, previous experience with caring for dying patients, age, gender, and attitudes toward death and caring for dying patients. FINDINGS: Statistically significant relationships were noted among age, nursing experience, previous experience with caring for terminally ill patients, and scores on the FATCOD and DAP-R. Nursing experience and age were the variables most likely to predict nurses' attitudes toward death and caring for dying patients. CONCLUSIONS: RNs with more work experience tended to have more positive attitudes toward death and caring for dying patients. IMPLICATIONS FOR NURSING: Based on the data collected in the study, less experienced oncology nurses will most likely benefit from increased education, training, and exposure to providing and coping effectively with end-of-life care.

Longitudinal study of the prevalence and prognostic implications of oral manifestations in romanian children infected with human immunodeficiency virus type 1.

OBJECTIVE: We evaluated the prevalence and predictive value for human immunodeficiency virus (HIV) disease progression of oral manifestations in Romanian children. METHODS: A nonrandom sample of 238 HIV-infected children was followed prospectively between 1998 and 2001 at the Romanian-American Children's Center in Constanta, Romania. Study subjects underwent comprehensive annual oral examinations. Oral manifestations of interest, demographic data and other selected medical information were recorded at baseline and at each subsequent visit. Descriptive statistics and survival analysis methods were used in the study. A level of statistical significance of alpha = 0.05 was used. RESULTS: The study subjects' mean age was 9.9 +/- 1.2 (SD) years. The most common oral lesions were gingivitis (49%), parotid enlargement (13%) and oral candidiasis (11%). Oral candidiasis was associated with progression to acquired immunodeficiency syndrome or death (whichever occurred first) (log rank P = 0.03) and with death (log rank P < 0.001). Oral hairy leukoplakia also was associated with progression to death (log rank P = 0.001). The risk of dying was 3.43 (95% confidence interval, 1.86-6.34; P < 0.001) for children who had oral candidiasis at baseline and 4.62 (95% confidence interval, 1.67-12.77; P = 0.003) for those who had oral hairy leukoplakia. CONCLUSIONS: Oral manifestations occur commonly among HIV-infected Romanian children. Oral candidiasis and oral hairy leukoplakia were positive predictors of HIV disease progression.