Knowing the Patient: Understanding Readmission Reasons in Complex Heart Failure.

BACKGROUND: Heart failure (HF) is a complex problem characterized by frequent hospitalizations and high 30-day readmission rates. Researchers studying HF readmission report that patients and clinicians have different perspectives on readmission and preventability when unadjusted for disease severity. OBJECTIVE: The aim of this study was to gather patient, caregiver, nurse, and physician subjective reason(s) for 30-day HF readmission and perceptions of preventability with contextual factors to evaluate differences. METHODS: A convergent, parallel, mixed-methods design was used with interviews and chart reviews to evaluate contextual factors from the current and index hospital stay. Adults readmitted within 30 days of a previous inpatient stay with a coded HF diagnosis were enrolled and interviewed, followed by interviews with associated caregivers, attending physicians, and assigned nurses. RESULTS: Interviews were conducted with patients (n = 44), caregivers (n = 6), physicians (n = 24), and nurses (n = 44). Readmissions were emergent/urgent (95%) and occurred within 14.9 days (SD, 8.1; 2-28 days) on average after discharge. Index stay coding revealed that most patients (73%) had a high severity of illness (73%) and risk of mortality (68%). Heart failure stage was inconsistently documented. Patients reported acute symptomatic reasons, with only 32% describing readmission as preventable. Physicians reported diagnostic reasons, 38% of which were preventable. Nurses reported behavioral reasons, with 59% being preventable. Patient/clinician agreement on readmission reason was low (30%). CONCLUSIONS: Patient/clinician perspectives on readmission varied among the patients with complex HF. Care planning based on HF stage and other contextual factors is needed to ensure a shared understanding of disease severity and a tailored symptom management approach to prevent readmission.

Theory-Driven Evaluation of a Multisite Nursing Professional Practice Model.

Evaluation of the professional practice model is an expectation in Magnet-designated facilities. Few evaluations of practice models are theory driven. A multisite, theory-driven model evaluation was conducted that included input from a variety of sources resulting in a comprehensive revision of the model.

Best Fit Orientation: An Innovative Strategy to Onboard Newly Licensed Nurses.

The premature turnover of newly licensed registered nurses is a costly problem prompting leaders to consider new orientation approaches. This article describes the "Best Fit Orientation"-an innovative approach for onboarding newly licensed registered nurses. It features centralized hiring, individualized orientation on diverse units, and realistic job preview tenets promoting self-evaluation, change management, relationship building, and "best fit" unit selection. Positive evaluations, high retention, and minimal added costs make this program very attractive.