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Gustavson AM, Hudson EM, Wisdom JP, Woodward-Abel AB, Hoffman R, Miller MJ, Fink HA, Gaugler JE, Hagedorn HJ. Identifying Patient, Care Partner, and Clinician Needs for Functional Recovery Following Hospitalization When Dementia is Present. J Am Med Dir Assoc 2025; 26:105534. [PMID: 40049580 PMCID: PMC12058380 DOI: 10.1016/j.jamda.2025.105534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/05/2024] [Accepted: 01/23/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVES Persons with dementia are frequently hospitalized, which threatens their ability to return to and live at home. Current post-acute paradigms tend to default to short-term rehabilitation in a nursing home. Still, alternative post-acute care models are crucial for veterans with dementia to recover at home. This study aims to identify the needs of veterans with dementia, care partners, and rehabilitation clinicians in relation to home-based models of care to inform the implementation and adaptation of models to the post-acute context. DESIGN Qualitative study. SETTING AND PARTICIPANTS Participants included veterans with dementia with recent history of hospitalization, care partners, and rehabilitation clinicians. METHODS Semi-structured interviews were conducted across 3 groups (veterans with dementia, care partners, and rehabilitation clinicians) and analyzed using a rapid qualitative approach guided by the Practical, Robust Implementation and Sustainability Model (PRISM). RESULTS Participants included 11 veterans with dementia, 13 care partners, and 23 rehabilitation clinicians. We identified 3 themes from the interviews: (1) collaborative decision making and planning are crucial to high-quality care, (2) follow-through is necessary to ensure needs are met when transitioning from hospital to home, and (3) alternative care options, including technology use, are important when optimizing transitions of care. CONCLUSION AND IMPLICATIONS Alternative options for home care after hospital discharge may enhance patient-and family-centered outcomes. Future research must identify evidence-based models that can be collaboratively adapted or developed to provide effective, safe, and feasible post-acute care to optimize independence in the home and quality of life.
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Affiliation(s)
- Allison M Gustavson
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Veterans Affairs Rehabilitation Research and Development Center for Rehabilitation and Engineering Center for Optimizing Veteran Engagement and Reintegration, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Emily M Hudson
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | | | - Alicia B Woodward-Abel
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Rashelle Hoffman
- Department of Physical Therapy, Creighton University, Omaha, NE, USA
| | - Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Howard A Fink
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Healthcare System, Minneapolis, MN, USA
| | - Joseph E Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Hildi J Hagedorn
- Veterans Affairs Health Services Research and Development, Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
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Joung H, Jones RA. Cancer patient-family caregiver mutuality: A concept analysis. Eur J Oncol Nurs 2025; 76:102891. [PMID: 40378602 DOI: 10.1016/j.ejon.2025.102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 03/24/2025] [Accepted: 04/04/2025] [Indexed: 05/19/2025]
Abstract
PURPOSE Mutuality between cancer patients and family caregivers affects treatment outcomes. Despite increasing recognition of the interdependent relationship between patients and family caregivers, a clear definition of mutuality in dyads is still lacking. This lack of definition challenges developing measurement tools, advancing research, and effectively applying the concept in practice. This concept analysis aims to examine the concept of mutuality between patients and family caregivers' dyads in cancer care. METHODS Walker and Avant's approach was used to define attributes, antecedents, consequences, and empirical referents of mutuality in cancer patient-family caregivers. Literature was searched from PubMed, Web of Science, CINAHL, and Embase. RESULTS While the definition of mutuality varies, it is characterized by interconnection, reciprocity, shared understanding, and adaptability. It originates from antecedents such as cancer diagnosis, existing bonds, effective communication, and supportive environments, leading to improved psychological health, enhanced relationship quality, and better coping strategies. CONCLUSION This study revealed the unique characteristics of mutuality related to cancer trajectory. This underscores the development of standardized tools and the need for cancer-type-specific research to enhance patient and caregiver well-being. Incorporating mutuality's core aspects into clinical practice can offer healthcare providers in-depth insights into cancer care, fostering improved interventions, communication, and collaborative approaches. Additionally, it advocates the need for integration of mutuality into healthcare strategies. It is needed to advance research and education, promoting improved quality of care for patient-family caregiver dyads globally.
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Affiliation(s)
- Hyesong Joung
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
| | - Randy A Jones
- University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA.
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Rababah JA, Al-Hammouri MM, Radaideh A. Health Literacy Profiles of Caregivers of Acute Myocardial Infarction Patients. J Cardiovasc Nurs 2025:00005082-990000000-00277. [PMID: 40133247 DOI: 10.1097/jcn.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
BACKGROUND Health literacy among caregivers of patients with myocardial infarction is a crucial area that is still not fully addressed in research. OBJECTIVE In this study, our aim was to explore the health literacy profiles of caregivers of patients with acute myocardial infarction (AMI). METHODS A cross-sectional design was used, involving 121 caregivers of patients with AMI recruited through convenience sampling. Data were collected using a demographics questionnaire and the Health Literacy Questionnaire. Hierarchical cluster analysis was performed to determine health literacy profiles based on Health Literacy Questionnaire scores and sociodemographic characteristics. RESULTS Six distinct clusters of health literacy profiles emerged from the analysis. Caregivers in cluster 1 exhibited the highest health literacy levels, whereas those in cluster 6 had the lowest health literacy scores with significant difficulties in understanding and using health information. Caregivers' sociodemographic factors such as age, gender, smoking status, and education level played a significant role in determining health literacy profiles. CONCLUSION The study highlights the diverse health literacy profiles among caregivers of patients with AMI, emphasizing the importance of designing tailored interventions to address these differences to improve the health outcomes of caregivers and patients.
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Owokuhaisa J, Wiens MO, Musinguzi P, Rukundo GZ. Transition from Hospital to Home-Based Care for Older Adults in Southwestern Uganda: Informal Caregiver's Experiences. J Multidiscip Healthc 2025; 18:1461-1472. [PMID: 40092221 PMCID: PMC11910931 DOI: 10.2147/jmdh.s495851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 03/06/2025] [Indexed: 03/19/2025] Open
Abstract
Background The transition from hospital-based to home-based care is a complex and challenging process. In most developing countries, patients transfer directly from hospital to home immediately after stabilizing from acute illness. After discharge, all the patient's care needs are taken over by informal caregivers whose experiences and practices may directly or indirectly impact the quality of patient care as well as the outcomes. This study aimed at exploring the experiences of informal caregivers during the hospital to home transition process of older adults. Methods We conducted a qualitative exploratory study that used one-on-one interviews to describe individual experiences of care givers of older adults admitted in a clinical care setting. We interviewed caregivers of older adults with diabetes and of hypertension who were admitted at the inpatient department of internal medicine at Mbarara regional referral hospital (MRRH). All audio recorded interviews were transcribed verbatim by the research assistant in the local dialect and back translated into English the official language spoken in Uganda. The study utilized content analysis approach to analyze 23 interviews conducted. Results Of the 23 participants interviewed, majority were aged between 20 and 40 years and females. Three major themes emerged from the data: informal caregivers' experience during hospitalization, experience during preparation for discharge and experience after discharge. Conclusion Caregiver experience during hospitalization influences their involvement and compliance with the discharge process which in turn affects their ability to deliver quality post discharge care to the patient. Healthcare systems need to put targeted effort and resources in the discharge process and home follow-up visits to improve home-based care by caregivers. Community-based geriatric care centers can bridge the care gap during transition from hospital to home-based care.
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Affiliation(s)
- Judith Owokuhaisa
- Faculty of Medicine, Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Matthew O Wiens
- Institute for Global Health, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pius Musinguzi
- Department of Nursing, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Malhotra C, Murali S, Chaudhry I. Caregivers influence preferred place of death for patients with an advanced cancer. Palliat Support Care 2025; 23:e41. [PMID: 39994924 DOI: 10.1017/s1478951524001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
OBJECTIVES Family caregivers influence realization of home death among advanced cancer patients. However, little is known about the caregiver factors influencing patients' preferred and actual place of death. We aimed to assess caregiver factors associated with both caregivers' and patients' preferred place of death, and the association between their preferred and actual place of death. METHODS From a prospective cohort of 600 patients with stage IV solid malignancy, and 311 caregivers, we analyzed data for 227 patient-caregiver dyads of deceased patients who responded to the question on preferred place of death for patients at least once within the last 3 years before death. We assessed the association of patients' and caregivers' preferred place of death for patients with caregivers' competency, employment, relationship quality with the patient, their relationship with the patient, family support, and the presence of a domestic helper. We controlled for relevant patient factors and utilized the actor-partner interdependence framework for analysis. RESULTS Overall, 67% patients and 74% caregivers preferred a home death for patients during the last 3 years prior to patient's death. Patients whose caregivers reported greater caregiving competency were more likely to prefer a home death (average marginal effect: 0.02; 95% confidence interval, 0.003-0.04). Spousal caregivers were less likely to prefer a home death (-0.10 (-0.19, -0.004)). Caregivers lacking family support were more likely to prefer an institutional death (0.04 (0.002-0.08)). While caregivers' preferences had a marginally significant association with patients' actual place of death (p-value < 0.10), we did not find any association between patients' preferred and actual place of death. SIGNIFICANCE OF RESULTS Caregivers play a crucial role in shaping patients' preferred and actual place of death. Supporting caregivers, particularly spousal caregivers, and enhancing their caregiving competency could potentially help achieve a home death for the patient.
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Affiliation(s)
- Chetna Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Shravya Murali
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Isha Chaudhry
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
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Zhang N, Liu Y, Yu X, Tian Z, Liu Y, Li Y, Liu X, Zhu H, Wang L. Positive Coping Style and Family Resilience of Caregivers of COPD Patients: The Chain Mediating Roles of Caregiver Burden and Resilience. J Clin Nurs 2025; 34:554-564. [PMID: 39627971 DOI: 10.1111/jocn.17587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 11/06/2024] [Accepted: 11/21/2024] [Indexed: 01/19/2025]
Abstract
AIMS To investigate the association between positive coping style and family resilience, considering the mediating factors of burden and individual resilience within caregivers of chronic obstructive pulmonary disease (COPD) patients. DESIGN A cross-sectional survey. METHODS A total of, 204 caregivers of COPD patients were recruited using convenient sampling from April 2023 to May 2024 to investigate general information, family resilience, individual resilience, caregiver burden and positive coping styles on caregivers of COPD patients. Influencing factors were primarily identified using Mann-whitney U test and Kruskal-Wallis H test. Spearman correlation analysis was used to explore the correlation between family resilience, positive coping, caregiver burden and resilience. Linear regression was used to analyse the influencing factors of family resilience of caregiver. Structural equation modelling was used to detect the mediating effects of caregiver burden and resilience. REPORTING METHOD The STROBE checklist was followed. RESULTS The family resilience of caregivers was positively correlated with positive coping styles and individual resilience, and negatively correlated with caregiver burden. The family resilience of caregivers increased with the improvement positive coping style and individual resilience, and decreased with the increase of caregiver burden. Caregiver burden and resilience played the chain mediating roles between positive coping style and family resilience. CONCLUSION Family caregivers of COPD patient with higher education levels also have higher family resilience. Higher positive coping style may lead to higher family resilience of caregivers of COPD patients by reducing caregiver burden and promoting resilience. RELEVANCE TO CLINICAL PRACTICE There are individual differences in the level of family resilience of caregivers of COPD patients, and nurses can provide personalised interventions to different family caregivers by understanding their characteristics and needs. Nurses can improve the family resilience of caregivers by guiding them to adopt positive coping styles, reducing burdens and promoting resilience. PATIENT OR PUBLIC CONTRIBUTION This study was conducted with the participation of caregivers of COPD patients who contributed data by completing study questionnaires.
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Affiliation(s)
- Nan Zhang
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yuan Liu
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Xi Yu
- Department of Respiratory and Critical Care, Tianjin First Central Hospital, Tianjin, China
| | - Zheng Tian
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yong Liu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yimiao Li
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Xinyi Liu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Hongyi Zhu
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Lan Wang
- School of Nursing, Tianjin Medical University, Tianjin, China
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Bonus CG, Hatcher D, Northall T, Montayre J. Using a co-design methodological approach to optimize perioperative nursing care for older adult patients from ethnically diverse backgrounds: a study protocol. Int J Qual Stud Health Well-being 2024; 19:2349438. [PMID: 38709958 PMCID: PMC11075656 DOI: 10.1080/17482631.2024.2349438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
This article outlines the use of a co-design methodological approach aimed at optimizing perioperative care experiences for ethnically diverse older adults and their family carers. The research involved three phases. In Phase 1, the foundation was established with the formation of a Core Advisory Group comprising key informants, including health consumers. This initial phase focused on forming relationships and conducting a literature review to inform subsequent stages of the research. Phase 2 progressed to data collection, where a qualitative survey on perioperative experiences was conducted. Semi-structured interviews were held with patients, their family carers, and perioperative staff. Phase 3 advanced the co-design process through a workshop involving patients, family carers, perioperative staff, and key stakeholders. Workshop participants collaborated on potential practice changes, proposing strategies for future clinical implementation. While data analysis and reporting for Phases 2 and 3 are forthcoming, the continued involvement of the Core Advisory Group ensures ongoing consensus-building on health consumer needs. This methodology article adopts a prospective stance, with findings to be presented in subsequent scholarly works. Use of this methodology will help to determine how the use of a co-design approach may impact the development of culturally responsive perioperative nursing care for those from ethnically diverse communities.
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Affiliation(s)
- Charmaine G. Bonus
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Blacktown, NSW, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Tiffany Northall
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
- WHO Collaborating Centre for Community Health Services, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
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Hudon C, Bisson M, Chouinard MC, Moullec G, Del Barrio LR, Angrignon-Girouard É, Pratte MM, Poirier MD. Opportunities of integrated care to improve equity for adults with complex needs: a qualitative study of case management in primary care. BMC PRIMARY CARE 2024; 25:391. [PMID: 39506639 PMCID: PMC11539299 DOI: 10.1186/s12875-024-02643-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 10/28/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs. METHODS A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes. RESULTS Primary care case managers were well-positioned to provide a holistic evaluation of the person's situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals' unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs. CONCLUSIONS Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Pavillon Z10, 3001, 12e Avenue Nord, Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada.
| | - Mathieu Bisson
- Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, 2375 chemin de la Côte Ste-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Maud-Christine Chouinard
- Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, 2375 chemin de la Côte Ste-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Grégory Moullec
- Department of Social and Preventative Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
| | - Lourdes Rodriguez Del Barrio
- Department of Social Work, Université de Montréal, Pavillon Lionel-Groulx, 3150 rue Jean-Brillant, Montreal, Quebec, Canada
| | - Émilie Angrignon-Girouard
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Pavillon Z10, 3001, 12e Avenue Nord, Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - Marie-Mychèle Pratte
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Pavillon Z10, 3001, 12e Avenue Nord, Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - Marie-Dominique Poirier
- Patient Partner, Canada Research Chair in Implementing Integrated Care for People with Complex Needs, Université de Sherbrooke, Sherbrooke, QC, Canada
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Ledford CJW, Cafferty LA, Lee E, Hayes HC, Ede DC, Hodges BP, Whitebloom GC, Walsh DW, Wilkins T. How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study. J Gen Intern Med 2024; 39:2671-2678. [PMID: 38724740 PMCID: PMC11534937 DOI: 10.1007/s11606-024-08785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/22/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. OBJECTIVE This study investigated how social connectedness is associated with patient outcomes in a HaH program. DESIGN The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. PARTICIPANTS The quantitative phase included 100 patients (18 years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. ANALYSIS Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. KEY RESULTS Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. CONCLUSIONS Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.
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Affiliation(s)
| | | | - Eunice Lee
- Medical College of Georgia at Augusta University, Augusta, USA
| | - Hailie C Hayes
- Medical College of Georgia at Augusta University, Augusta, USA
| | - Destine C Ede
- Medical College of Georgia at Augusta University, Augusta, USA
| | | | | | - David W Walsh
- Medical College of Georgia at Augusta University, Augusta, USA
| | - Thad Wilkins
- Medical College of Georgia at Augusta University, Augusta, USA
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Oliver TL, Hetland B, Schmaderer M, Zolty R, Pozehl B. A Feasibility Study of Qualitative Methods Using the Zarit Burden Interview in Heart Failure Caregivers. Appl Nurs Res 2024; 79:151826. [PMID: 39256009 DOI: 10.1016/j.apnr.2024.151826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 06/28/2024] [Accepted: 07/09/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES The primary goal of this study was to identify and understand the burden experienced by informal caregivers of patients with HF at the time of hospital discharge. The researchers aimed to guide future education interventions and promote informal caregiver burden screening. DESIGN The researchers administered the Zarit Burden Interview (ZBI) as a quantitative tool to assess informal caregiver burden. The ZBI is a standardized questionnaire used to measure the extent of burden experienced by informal caregivers. After administering the ZBI, the researchers conducted semi-structured interviews with five informal caregivers of patients with HF. These interviews were guided by probing questions related to ZBI items that were rated with high levels of burden (3 "quite frequently" or 4 "nearly always"). RESULTS The quantitative data showed that the informal caregivers' burden scores on the ZBI ranged from 4 to 41. Male informal caregivers tended to report lower burden scores. The non-spouse informal caregiver had the highest burden score at 41. The qualitative analysis of the interviews revealed several themes related to informal caregiver burden, including fear, patient expectations, patient dependence on caregivers, social isolation, and stressors associated with medication changes after discharge. Despite the qualitative insights into specific burden-related issues, the quantitative analysis of the ZBI scores showed that, on average, informal caregivers reported little to no burden at the time of acute exacerbation of HF in the patient. CONCLUSION The study's findings suggest that while informal caregivers may not report prominent levels of overall burden, they do face specific challenges and stressors, such as social isolation and managing medication changes post-discharge. These findings can inform the development of targeted support and interventions for informal caregivers of patients with HF.
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Affiliation(s)
- Tamara L Oliver
- University of Nebraska Medical Center, Omaha, NE, United States of America; Creighton University, Omaha, NE, United States of America.
| | - Breanna Hetland
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Myra Schmaderer
- University of Nebraska Medical Center, Lincoln, NE, United States of America
| | - Ronald Zolty
- Univeristy of Nebraska Medical Center, Department of Cardiovascular, Omaha, NE, United States of America
| | - Bunny Pozehl
- University of Nebraska Medical Center, Omaha, NE, United States of America
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Manias E, Hughes C, Woodward-Kron R, Ozavci G, Jorm C, Bucknall T. Decision-making about changing medications across transitions of care: Opportunities for enhanced patient and family engagement. Res Social Adm Pharm 2024; 20:520-530. [PMID: 38403571 DOI: 10.1016/j.sapharm.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/19/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Older patients often have complex medication regimens, which change as they move across transitions of care. Engagement of older patients and families in making medication decisions across transitions of care is important for safe and high-quality medication management. AIMS To explore decision-making between health professionals, older patients and families about medication changes across transitions of care, and to examine how patient and family engagement is enacted in the process of decision-making in relation to these medication changes. METHODS A focused ethnographic design was undertaken with semi-structured interviews, observations, and reflective focus groups or interviews. Reflexive thematic analysis was conducted on transcribed data. The study was undertaken at a public teaching acute care hospital and a public teaching community hospital in Australia. RESULTS In all, 182 older patients, 44 family members and 94 health professionals participated. Four themes were conceptualised from the data: different customs and routines, medication challenges, health professional interactions, and patient and family involvement. Environments had differences in their customs and routines, which increased the potential for medication delays or the substitution of unintended medications. Medication challenges included health professionals assuming that patients and families did not need information about regularly prescribed medications. Patients and families were informed about new medications after health professionals had already made decisions to prescribe these medications. Health professionals tended to work in disciplinary silos, and they had views about their role in interacting with patients and families. Patients and families were expected to take the initiative to participate in decision-making about medication changes. CONCLUSIONS Patient movements across transitions of care can create complex and chaotic medication management situations, which lacks transparency, especially for older patients and their families. A greater focus on pre-emptive and planned discussions about medication changes will contribute to improving patient and family involvement in medication decision-making.
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Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia; School of Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Victoria, 3800, Australia.
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, University Road, Belfast, Northern Ireland, BT9 7BL, United Kingdom.
| | - Robyn Woodward-Kron
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia.
| | - Guncag Ozavci
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia.
| | - Christine Jorm
- School of Public Health, The University of Sydney, Castlereagh Street, Camperdown, New South Wales, 2006, Australia.
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Alfred Health, 55 Commercial Road Melbourne, Victoria, 3004, Australia.
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12
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Russell AM, Bonham M, Lovett R, Pack A, Wolf MS, O’Conor R. Characterizing Caregiver Roles and Conflict in Health Management Support to Older People With Multiple Chronic Conditions. J Appl Gerontol 2024; 43:386-395. [PMID: 37982673 PMCID: PMC10922419 DOI: 10.1177/07334648231211456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Caregivers provide critical support for older adults managing multiple chronic conditions (MCCs), but few studies describe the assistance caregivers provide or identify factors influencing their provision of support. We conducted qualitative interviews with 25 caregivers to older adults with MCCs to describe caregivers' roles and identify the factors that influence caregivers' ability to carry out these roles. Transcripts were analyzed using the Framework Method. Caregivers supported the management of MCCs in several ways, including monitoring conditions, communicating with clinicians, and tracking health information. Disagreement, or conflicted relationships, between caregivers and older adults over health and behaviors influenced the provision of support, resulting in less involved and less effective caregivers. Caregivers in conflicted relationships were more challenged by resistance from older adults. Greater agreement, or collaboration, between caregivers and older adults resulted in more involved and effective caregivers. Addressing health-related conflict may enhance caregivers' capacity to support older adults with MCCs.
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Affiliation(s)
- Andrea M. Russell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca Lovett
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allison Pack
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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13
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Savvaides TM, Demetres MR, Aronson KI. Current Landscape and Future Directions of Patient Education in Adults with Interstitial Lung Disease. ATS Sch 2024; 5:184-205. [PMID: 38633514 PMCID: PMC11022645 DOI: 10.34197/ats-scholar.2023-0069re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/21/2023] [Indexed: 04/19/2024] Open
Abstract
Background Understandable, comprehensive, and accessible educational materials for patients with interstitial lung disease (ILD) are lacking. Patients consistently ask for improved access to evidence-based information about ILD. Nonetheless, few research studies focus directly on developing and evaluating interventions to improve patient knowledge. Objective We describe the current landscape of patient education in ILD, identify gaps in current approaches to information delivery, and provide frameworks to address these challenges through novel educational tools. Methods A literature review was conducted in collaboration with a medical librarian (M.R.D.) in April 2022 using Ovid MEDLINE (1946-), Embase (1947-), Cochrane Central (1993-), and CINAHL (1961-). Search terms included "interstitial lung disease," "pulmonary fibrosis," "patient education," and "information seeking behavior" (see the data supplement for full search terms). Reference lists from selected articles were used to identify additional studies. Results Currently, patient education is commonly combined with exercise regimens in pulmonary rehabilitation programs in which benefits of the educational component alone are unclear. Few studies investigate improving knowledge access and acquisition for patients with ILD and their caregivers regarding self-management, oxygen use, and palliative care plans. Online distribution of health information through social media runs the risk of being unregulated and outdated, although it is an avenue of increasing accessibility. Conclusion By expanding access to novel ILD-specific education programs and accounting for social determinants of health that impact healthcare access, patient education has the potential to become more attainable, improving patient-centered outcomes. Further research into optimal development, delivery, and efficacy testing of patient education modalities in ILD is warranted.
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Affiliation(s)
| | - Michelle R. Demetres
- Samuel J. Wood Library & C.V. Starr
Biomedical Information Center, Weill Cornell Medicine, New York, New York
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Guise V, Chambers M, Lyng HB, Haraldseid-Driftland C, Schibevaag L, Fagerdal B, Dombestein H, Ree E, Wiig S. Identifying, categorising, and mapping actors involved in resilience in healthcare: a qualitative stakeholder analysis. BMC Health Serv Res 2024; 24:230. [PMID: 38388408 PMCID: PMC10882781 DOI: 10.1186/s12913-024-10654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Resilience in healthcare is the capacity to adapt to challenges and changes to maintain high-quality care across system levels. While healthcare system stakeholders such as patients, informal carers, healthcare professionals and service managers have all come to be acknowledged as important co-creators of resilient healthcare, our knowledge and understanding of who, how, and in which contexts different stakeholders come to facilitate and support resilience is still lacking. This study addresses gaps in the research by conducting a stakeholder analysis to identify and categorise the stakeholders that are key to facilitating and sustaining resilience in healthcare, and to investigate stakeholder relationships relevant for the enactment of resilient healthcare systems. METHODS The stakeholder analysis was conducted using a sample of 19 empirical research projects. A narrative summary was written for 14 of the projects, based on publicly available material. In addition, 16 individual interviews were undertaken with researchers from the same sample of 19 projects. The 16 interview transcripts and 14 narratives made up the data material of the study. Application of stakeholder analysis methods was done in three steps: a) identification of stakeholders; b) differentiation and categorisation of stakeholders using an interest/influence grid; and c) investigation and mapping of stakeholder relationships using an actor-linkage matrix. RESULTS Identified stakeholders were Patients, Family Carers, Healthcare Professionals, Ward/Unit Managers, Service or Case Managers, Regulatory Investigators, Policy Makers, and Other Service Providers. All identified stakeholders were categorised as either 'Subjects', 'Players', or 'Context Setters' according to their level of interest in and influence on resilient healthcare. Stakeholder relationships were mapped according to the degree and type of contact between the various groups of stakeholders involved in facilitating resilient healthcare, ranging from 'Not linked' to 'Fully linked'. CONCLUSION Family carers and healthcare professionals were found to be the most active groups of stakeholders in the enactment of healthcare system resilience. Patients, managers, and policy makers also contribute to resilience to various degrees. Relationships between stakeholder groups are largely characterised by communication and coordination, in addition to formal collaborations where diverse actors work together to achieve common goals.
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Affiliation(s)
- Veslemøy Guise
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway.
| | - Mary Chambers
- Kingston University & St. George's University of London, London, UK
| | - Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Cecilie Haraldseid-Driftland
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Birte Fagerdal
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Heidi Dombestein
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
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Sawan M, Clough A, Mirzaei A, Widjaja GJ, Schneider C, Jeon YH, Chen T, Hilmer SN, Gnjidic D. The Carer Assessment of MedicaTion Management GuidanCe for People With Dementia at Hospital Discharge (CATCH) Tool: Exploratory Factor Analysis. Alzheimer Dis Assoc Disord 2024; 38:59-64. [PMID: 38300882 DOI: 10.1097/wad.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital discharge (CATCH) tool was developed to examine the carer's experiences of medication management guidance delivery at discharge. This study explored its factor structure, characterized carers' experiences at discharge, and identified predictors of carer preparedness to manage medications at discharge. METHODS A cross-sectional survey of carers across Australia was distributed. Survey responses were analyzed descriptively, and exploratory factor and regression analyses were performed. RESULTS A total of 185 survey responses were completed. Exploratory factor analysis revealed 2 factors in the CATCH tool: (1) shared and supported decision-making in medication management (16 items loading 0.47 to 0.93); 2) provision of medication management guidance that is easy to understand (4 items loading (0.48 to 0.82). Internal consistency was acceptable (Cronbach alpha >0.8). Almost 18% of participants stated that they were not included in decisions about medications for people with dementia. The carer reported that the measure of how guidance is provided was positively related to their confidence in the management of medications postdischarge and satisfaction ( P < 0.05 for both). CONCLUSIONS The CATCH tool can give the patient and carer an opportunity to provide feedback on key elements of medication management guidance delivered at discharge.
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Affiliation(s)
| | | | | | | | | | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | | | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
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Benmessaoud C, Pfisterer KJ, De Leon A, Saragadam A, El-Dassouki N, Young KGM, Lohani R, Xiong T, Pham Q. Design of a Dyadic Digital Health Module for Chronic Disease Shared Care: Development Study. JMIR Hum Factors 2023; 10:e45035. [PMID: 38145480 PMCID: PMC10775044 DOI: 10.2196/45035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/08/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care "Caretown for Medly," which empowers ICs to concurrently expand patients' self-care abilities while acknowledging ICs' eagerness to provide greater support. OBJECTIVE We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly. METHODS We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint's ability to quickly "solve big problems and test new ideas," which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the "KTA Sprint." RESULTS We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care's synergistic benefits. Features were designed for customizability to suit the patient's condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care. CONCLUSIONS These disease-invariant features were designed to address ICs' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads.
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Affiliation(s)
- Camila Benmessaoud
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Kaylen J Pfisterer
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Anjelica De Leon
- Healthcare Human Factors, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Faculty of Media and Arts, Humber College, Toronto, ON, Canada
| | - Ashish Saragadam
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Noor El-Dassouki
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Karen G M Young
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Ting Xiong
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Quynh Pham
- Centre for Digital Therapeutics, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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Saragosa M, Hahn-Goldberg S, Lunsky Y, Cameron JI, Caven I, Bookey-Bassett S, Newman K, Okrainec K. Young carers' perspectives on navigating the healthcare system and co-designing support for their caring roles: a mixed-methods qualitative study. BMJ Open 2023; 13:e075804. [PMID: 38072468 PMCID: PMC10729167 DOI: 10.1136/bmjopen-2023-075804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Despite young carers (YCs) providing regular and significant care that exceeds what would normally be associated with an adult caregiver, we need to learn more about their experience interacting with the healthcare system. The primary study aims were to (1) describe YC experiences in interacting with the healthcare system and (2) identify types of support YC recognise as potentially helpful to their caring role. DESIGN AND SETTING A mixed-methods qualitative study was conducted between March 2022 and August 2022, comprising two phases of (1) semi-structured interviews and focus groups with YCs living in the community to confirm and expand earlier research findings, and (2) a co-design workshop informed by a generative research approach. We used findings from the interviews and focus groups to inform the brainstorming process for identifying potential solutions. RESULTS Eight YCs completed either a focus group or an interview, and four continued the study and participated in the co-design activity with 12 participants. Phase 1 resulted in three overarching themes: (1) navigating the YC role within the healthcare system; (2) being kept out of the loop; and (3) normalising the transition into caregiving. Phase 2 identified two categories: (1) YC-focused supports and (2) raising awareness and building capacity in the healthcare system. CONCLUSION Study findings revealed the critical role that YCs play when supporting their families during pivotal interactions in the healthcare system. Like their older caregiver counterparts, YCs struggle to navigate, coordinate and advocate for their family members while juggling their needs as they transition from adolescence to adulthood. This study provides important preliminary insights into YCs encountering professionals, which can be used to design and implement national support structures.
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Affiliation(s)
- Marianne Saragosa
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Science of Care Institute, Sinai Health, Toronto, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- OpenLab, University Hospital Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Deptartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Isabelle Caven
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- OpenLab, University Hospital Network, Toronto, Ontario, Canada
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Kabajaasi O, Trawin J, Derksen B, Komugisha C, Mwaka S, Waiswa P, Nsungwa-Sabiiti J, Ansermino JM, Kissoon N, Duby J, Kenya-Mugisha N, Wiens MO. Transitions from hospital to home: A mixed methods study to evaluate pediatric discharges in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002173. [PMID: 37703267 PMCID: PMC10499195 DOI: 10.1371/journal.pgph.0002173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023]
Abstract
The World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines recognize the importance of discharge planning to ensure continuation of care at home and appropriate follow-up. However, insufficient attention has been paid to post discharge planning in many hospitals contributing to poor implementation. To understand the reasons for suboptimal discharge, we evaluated the pediatric discharge process from hospital admission through the transition to care within the community in Ugandan hospitals. This mixed methods prospective study enrolled 92 study participants in three phases: patient journey mapping for 32 admitted children under-5 years of age with suspected or proven infection, discharge process mapping with 24 pediatric healthcare workers, and focus group discussions with 36 primary caregivers and fathers of discharged children. Data were descriptively and thematically analyzed. We found that the typical discharge process is often not centered around the needs of the child and family. Discharge planning often does not begin until immediately prior to discharge and generally does not include caregiver input. Discharge education and counselling are generally limited, rarely involves the father, and does not focus significantly on post-discharge care or follow-up. Delays in the discharge process itself occur at multiple points, including while awaiting a physical discharge order and then following a discharge order, mainly with billing or transportation issues. Poor peri-discharge care is a significant barrier to optimizing health outcomes among children in Uganda. Process improvements including initiation of early discharge planning, improved communication between healthcare workers and caregivers, as well as an increased focus on post-discharge care, are key to ensuring safe transitions from facility-based care to home-based care among children recovering from severe illness.
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Affiliation(s)
| | - Jessica Trawin
- Institute for Global Health, BC Children’s Hospital and BC Women’s Hospital + Health Centre, Vancouver, British Columbia, Canada
| | - Brooklyn Derksen
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda
| | | | - J. Mark Ansermino
- Institute for Global Health, BC Children’s Hospital, Vancouver, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Niranjan Kissoon
- Institute for Global Health, BC Children’s Hospital and BC Women’s Hospital + Health Centre, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Jessica Duby
- Department of Pediatrics, McGill University, Montreal, Canada
| | | | - Matthew O. Wiens
- Institute for Global Health, BC Children’s Hospital and BC Women’s Hospital + Health Centre, Vancouver, British Columbia, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
- Walimu, Kampala Uganda; Mbarara University of Science and Technology, Mbarara, Uganda
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Bristol AA, Elmore CE, Weiss ME, Barry LA, Iacob E, Johnson EP, Wallace AS. Mixed-methods study examining family carers' perceptions of the relationship between intrahospital transitions and patient readiness for discharge. BMJ Qual Saf 2023; 32:447-456. [PMID: 36100445 PMCID: PMC10512519 DOI: 10.1136/bmjqs-2022-015120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/13/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Intrahospital transitions (IHTs) represent movements of patients during hospitalisation. While transitions are often clinically necessary, such as a transfer from the emergency department to an intensive care unit, transitions may disrupt care coordination, such as discharge planning. Family carers often serve as liaisons between the patient and healthcare professionals. However, carers frequently experience exclusion from care planning during IHTs, potentially decreasing their awareness of patients' clinical status, postdischarge needs and carer preparation. The purpose of this study was to explore family carers' perceptions about IHTs, patient and carer ratings of patient discharge readiness and carer self-perception of preparation to engage in at home care. METHODS Sequential, explanatory mixed-methods study involving retrospective analysis of hospital inpatients from a parent study (1R01HS026248; PI Wallace) for whom patient and family carer Readiness for Hospital Discharge Scale (RHDS) score frequency of IHTs and patient and caregiver characteristics were available. Maximum variation sampling was used to recruit a subsample of carers with diverse backgrounds and experiences for the participation in semistructured interviews to understand their views of how IHTs influenced preparation for discharge. RESULTS Of discharged patients from July 2020 to April 2021, a total of 268 had completed the RHDS and 23 completed the semistructured interviews. Most patients experienced 0-2 IHTs and reported high levels of discharge readiness. During quantitative analysis, no association was found between IHTs and patients' RHDS scores. However, carers' perceptions of patient discharge readiness were negatively associated with increased IHTs. Moreover, non-spouse carers reported lower RHDS scores than spousal carers. During interviews, carers shared barriers experienced during IHTs and discussed the importance of inclusion during discharge care planning. CONCLUSIONS IHTs often represent disruptive events that may influence carers' understanding of patient readiness for discharge to home and, thus, their own preparation for discharge. Further consideration is needed regarding how to support carers during IHT to facilitate high-quality discharge planning.
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Affiliation(s)
- Alycia A Bristol
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Catherine E Elmore
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Marianne E Weiss
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Lisa A Barry
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Eli Iacob
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Erin P Johnson
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Andrea S Wallace
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
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Lee SJC, Lee J, Zhu H, Chen PM, Wahid U, Hamann HA, Bhalla S, Cardenas RC, Natchimuthu VS, Johnson DH, Santini NO, Patel HR, Gerber DE. Assessing Barriers and Facilitators to Lung Cancer Screening: Initial Findings from a Patient Navigation Intervention. Popul Health Manag 2023; 26:177-184. [PMID: 37219548 PMCID: PMC10278031 DOI: 10.1089/pop.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Low-dose computed tomography-based lung cancer screening represents a complex clinical undertaking that could require multiple referrals, appointments, and time-intensive procedures. These steps may pose difficulties and raise concerns among patients, particularly minority, under-, and uninsured populations. The authors implemented patient navigation to identify and address these challenges. They conducted a pragmatic randomized controlled trial of telephone-based navigation for lung cancer screening in an integrated, urban safety-net health care system. Following standardized protocols, bilingual (Spanish and English) navigators educated, motivated, and empowered patients to traverse the health system. Navigators made systematic contact with patients, recording standardized call characteristics in a study-specific database. Call type, duration, and content were recorded. Univariable and multivariable multinomial logistic regression was performed to investigate associations between call characteristics and reported barriers. Among 225 patients (mean age 63 years, 46% female, 70% racial/ethnic minority) assigned navigation, a total of 559 barriers to screening were identified during 806 telephone calls. The most common barrier categories were personal (46%), provider (30%), and practical (17%). System (6%) and psychosocial (1%) barriers were described by English-speaking patients, but not by Spanish-speaking patients. Over the course of the lung cancer screening process, provider-related barriers decreased 80% (P = 0.008). The authors conclude that patients undergoing lung cancer screening frequently report personal and health care provider-related barriers to successful participation. Barrier types may differ among patient populations and over the course of the screening process. Further understanding of these concerns may increase screening uptake and adherence. Clinical Trial Registration number: (NCT02758054).
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Affiliation(s)
- Simon J. Craddock Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hong Zhu
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia M. Chen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Urooj Wahid
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heidi A. Hamann
- Departments of Psychology and Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sheena Bhalla
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rodrigo Catalan Cardenas
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - David H. Johnson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Noel O. Santini
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Himani R. Patel
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David E. Gerber
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
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Sachdeva M, Troup A, Jeffs L, Matelski J, Bell CM, Okrainec K. "I Had Bills to Pay": a Mixed-Methods Study on the Role of Income on Care Transitions in a Public-Payer Healthcare System. J Gen Intern Med 2023; 38:1606-1614. [PMID: 36697926 DOI: 10.1007/s11606-023-08024-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Income disparities may affect patients' care transition home. Evidence among patients who have access to publicly funded healthcare coverage remains limited. OBJECTIVE To evaluate the association between low income and post-discharge health outcomes and explore patient and caregiver perspectives on the role of income disparities. DESIGN Mixed-methods secondary analysis conducted among participants in a double-blind randomized controlled trial. PARTICIPANTS Participants from a multicenter study in Ontario, Canada, were classified as low income if annual self-reported salary was below $29,000 CAD, or between $30,000 and $50,000 CAD and supported ≥ 3 individuals. MAIN MEASURES The associations between low income and the following self-reported outcomes were evaluated using multivariable logistic regression: patient experience, adherence to medications, diet, activity and follow-up, and the aggregate of emergency department (ED) visits, readmission, or death up to 3 months post-discharge. A deductive direct content analysis of patient and caregivers on the role of income-related disparities during care transitions was conducted. KEY RESULTS Individuals had similar odds of reporting high patient experience and adherence to instructions regardless of reported income. Compared to higher income individuals, low-income individuals also had similar odds of ED visits, readmissions, and death within 3 months post-discharge. Low-income individuals were more likely than high-income individuals to report understanding their medications completely (OR 1.9, 95% CI: 1.0-3.4) in fully adjusted regression models. Two themes emerged from 25 interviews which (1) highlight constraints of publicly funded services and costs incurred to patients or their caregivers along with (2) the various ways patients adapt through caregiver support, private services, or prioritizing finances over health. CONCLUSIONS There were few quantitative differences in patient experience, adherence, ED visits, readmissions, and death post-discharge between individuals reporting low versus higher income. Several hidden costs for transportation, medications, and home care were reported however and warrant further research.
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Affiliation(s)
- Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Troup
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute Sinai Health, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Chaim M Bell
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute Sinai Health, Toronto, Ontario, Canada.,Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Karen Okrainec
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University Health Network, Toronto, Ontario, Canada. .,Toronto Western Hospital, 399 Bathurst Street, 8EW-408, Toronto, Ontario, M5T 2S8, Canada.
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Cerdan de las Heras J, Andersen SL, Matthies S, Sandreva TV, Johannesen CK, Nielsen TL, Fuglebjerg N, Catalan-Matamoros D, Hansen DG, Fischer TK. Hospitalisation at Home of Patients with COVID-19: A Qualitative Study of User Experiences. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1287. [PMID: 36674043 PMCID: PMC9858642 DOI: 10.3390/ijerph20021287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Hospitalisation at Home (HaH) is a new model providing hospital-level care at home as a substitute for traditional care. Biometric monitoring and digital communication are crucial, but little is known about user perspectives. We aim to explore how in-patients with severe COVID-19 infection and clinicians engage with and experience communication and self-monitoring activities following the HaH model. A qualitative study based on semi-structured interviews of patients and clinicians participating in the early development phase of HaH were conducted. We interviewed eight clinicians and six patients. Five themes emerged from clinicians: (1) staff fear and concerns, (2) workflow, (3) virtual closeness, (4) patient relatives, and (5) future HaH models; four themes emerged from patients: (1) transition to home, (2) joint responsibility, (3) acceptability of technologies, and (4) relatives. Despite technical problems, both patients and clinicians were enthusiastic about the conceptual HaH idea. If appropriately introduced, treatment based on self-monitoring and remote communication was perceived acceptable for the patients; however, obtaining vitals at night was an overwhelming challenge. HaH is generally acceptable, perceived patient-centred, influencing routine clinical workflow, role and job satisfaction. Therefore, it calls for educational programs including more perspective than issues related to technical devices.
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Affiliation(s)
- Jose Cerdan de las Heras
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Signe Lindgård Andersen
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Sophie Matthies
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | | | - Caroline Klint Johannesen
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Virology and Microbiological Special Diagnostics, Statens Serum Institut, 2300 Copenhagen, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | - Natascha Fuglebjerg
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
| | | | - Dorte Gilså Hansen
- Institute of Public Health, Research Unit of General Practice, University of Southern Denmark, 5230 Odense, Denmark
| | - Thea K. Fischer
- Department of Clinical Research, Copenhagen University Hospital—North Zealand, 3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
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Fox MT, Butler JI, Sidani S, Alzghoul MM, Skinner M, Amell T, Ferguson-Paré M. Family caregivers' perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study. PLoS One 2022; 17:e0279187. [PMID: 36534678 PMCID: PMC9762580 DOI: 10.1371/journal.pone.0279187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is a critical need for hospital-to-home transitional care interventions to prepare family caregivers for patients' post-discharge care in rural communities. Four evidence-based interventions (named discharge planning, treatments, warning signs, and physical activity) have the potential to meet this need but family caregivers' perspectives on the acceptability of the interventions have not been examined. This gap is significant because unacceptable interventions are unlikely to be used or used as designed, thereby undermining outcome achievement. Accordingly, this study examined the perceived acceptability of the four interventions to rural family caregivers. MATERIALS AND METHODS A multi-method descriptive design was used. The quantitative method entailed the administration of an established scale to assess the interventions' perceived acceptability to family caregivers. The qualitative method involved semi-structured interviews to explore family caregivers' perceived acceptability of the interventions in greater depth, including acceptable and unacceptable aspects, in the context of their own transitional care experience. Participants were the family caregivers of a relative who had been discharged home in a rural community from an acute care hospital in Ontario, Canada. RESULTS The purposive sample included 16 participants who were mostly middle-aged women (n = 14; 87.5%) caring for a parent (n = 9; 56.3%) at high risk for hospital readmission. The mean scores on the acceptability measure were 3 or higher for all interventions, indicating that, on average, the four interventions were perceived as acceptable. In terms of acceptable aspects, four themes were identified: the interventions: 1) involve family caregivers and proactively prepare them for discharge, 2) provide clear, written, and detailed guidance, 3) place the onus on healthcare providers to initiate communication, and 4) ensure post-discharge follow-up. In terms of unacceptable aspects, one theme was identified: the physical activity intervention would be challenging to implement. DISCUSSION The findings support implementing the four interventions in practice throughout the hospital-to-home transition. Healthcare providers should assess family caregivers' comfort in participating in the physical activity intervention and tailor their role accordingly.
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Affiliation(s)
- Mary T. Fox
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Jeffrey I. Butler
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Souraya Sidani
- Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - Manal M. Alzghoul
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | - Mark Skinner
- Trent School of the Environment, Peterborough, Ontario, Canada
- Trent Centre for Aging & Society, Peterborough, Ontario, Canada
| | - Travis Amell
- School of Nursing, York University, Toronto, Ontario, Canada
- Hospice of Waterloo Region, Waterloo, Ontario, Canada
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Anderson TS, Marcantonio ER, McCarthy EP, Ngo L, Schonberg MA, Herzig SJ. Association of Diagnosed Dementia with Post-discharge Mortality and Readmission Among Hospitalized Medicare Beneficiaries. J Gen Intern Med 2022; 37:4062-4070. [PMID: 35415794 PMCID: PMC9708999 DOI: 10.1007/s11606-022-07549-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with dementia are frequently hospitalized and may face barriers in post-discharge care. OBJECTIVE To determine whether patients with dementia have an increased risk of adverse outcomes following discharge. DESIGN Retrospective cohort study. SUBJECTS Medicare beneficiaries hospitalized in 2016. MAIN MEASURES Co-primary outcomes were mortality and readmission within 30 days of discharge. Multivariable logistic regression models were estimated to assess the risk of each outcome for patients with and without dementia accounting for demographics, comorbidities, frailty, hospitalization factors, and disposition. KEY RESULTS The cohort included 1,089,109 hospitalizations of which 211,698 (19.3%) were of patients with diagnosed dementia (median (IQR) age 83 (76-89); 61.5% female) and 886,411 were of patients without dementia (median (IQR) age 76 (79-83); 55.0% female). At 30 days following discharge, 5.7% of patients with dementia had died compared to 3.1% of patients without dementia (adjusted odds ratio (aOR) 1.21; 95% CI 1.17 to 1.24). At 30 days following discharge, 17.7% of patients with dementia had been readmitted compared to 13.1% of patients without dementia (aOR 1.02; CI 1.002 to 1.04). Dementia was associated with an increased odds of readmission among patients discharged to the community (aOR 1.07, CI 1.05 to 1.09) but a decreased odds of readmission among patients discharge to nursing facilities (aOR 0.93, CI 0.90 to 0.95). Patients with dementia who were discharged to the community were more likely to be readmitted than those discharged to nursing facilities (18.9% vs 16.0%), and, when readmitted, were more likely to die during the readmission (20.7% vs 4.4%). CONCLUSIONS Diagnosed dementia was associated with a substantially increased risk of mortality and a modestly increased risk of readmission within 30 days of discharge. Patients with dementia discharged to the community had particularly elevated risk of adverse outcomes indicating possible gaps in post-discharge services and caregiver support.
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Affiliation(s)
- Timothy S Anderson
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Edward R Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA
- Harvard Medical School, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ellen P McCarthy
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA
- Harvard Medical School, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Long Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA
- Harvard Medical School, Boston, MA, USA
| | - Mara A Schonberg
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA
- Harvard Medical School, Boston, MA, USA
| | - Shoshana J Herzig
- Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02446, USA
- Harvard Medical School, Boston, MA, USA
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Raising the bar for patient experience during care transitions in Canada: A repeated cross-sectional survey evaluating a patient-oriented discharge summary at Ontario hospitals. PLoS One 2022; 17:e0268418. [PMID: 36194600 PMCID: PMC9531793 DOI: 10.1371/journal.pone.0268418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient experience when transitioning home from hospital is an important quality metric linked to improved patient outcomes. We evaluated the impact of a hospital-based care transition intervention, patient-oriented discharge summary (PODS), on patient experience across Ontario acute care hospitals. METHODS We used a repeated cross-sectional study design to compare yearly positive (top-box) responses to four questions centered on discharge communication from the Canadian Patient Experience Survey (2016-2020) among three hospital cohorts with various levels of PODS implementation. Generalized Estimating Equations using a binomial likelihood accounting for site level clustering was used to assess continuous linear time trends among cohorts and cohort differences during the post-implementation period. This research had oversight from a public advisory group of patient and caregiver partners from across the province. RESULTS 512,288 individual responses were included. Compared to non-implementation hospitals, hospitals with full implementation (>50% discharges) reported higher odds for having discussed the help needed when leaving hospital (OR = 1.18, 95% CI = 1.02-1.37) and having received information in writing about what symptoms to look out for (OR = 1.44, 95% = 1.17-1.78) post-implementation. The linear time trend was also significant when comparing hospitals with full versus no implementation for having received information in writing about what symptoms to look out for (OR = 1.05, 95% CI = 1.01-1.09). INTERPRETATION PODS implementation was associated with higher odds of positive patient experience, particularly for questions focused on discharge planning. Further efforts should center on discharge management, specifically: understanding of medications and what to do if worried once home.
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Fenton A, Stevens S, Cost Z, Bickford J, Kohut M, Jacobs EA, Hutchinson RN. Patients' and caregivers' experiences of hospitalization under COVID-19 visitation restrictions. J Hosp Med 2022; 17:819-826. [PMID: 35920080 PMCID: PMC9538139 DOI: 10.1002/jhm.12924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals did not allow caregiver visitation. Little is known about how caregivers' absence affected patients' care. OBJECTIVE This study aimed to describe visitation restrictions' impact on patients and their caregivers experiences. DESIGN We used a sequential explanatory mixed-methods study design. First, we randomly selected 200 adult patients with cancer or heart failure hospitalized before (n = 100) and during visitor restrictions (n = 100) and abstracted data from the electronic medical record on communication between medical teams and caregivers and the topics discussed. Results from the quantitative analysis guided our thematic analysis of semi-structured interviews conducted with a subsample of patients hospitalized during visitor restrictions and their caregivers to understand the impact of visitor restrictions on their experiences. RESULTS Compared to prerestrictions, caregivers under visitation restrictions communicated less frequently with the medical team (29% vs. 37% of hospitalized days; p = .04), fewer received discharge counseling (37% vs. 52%; p = .04), and disproportionately more had no contact with the medical team (36% vs. 17%; p < .01). Video conferencing was documented for caregivers of only five patients. Qualitative analysis revealed that both caregivers and patients experienced emotional distress, increased conflict, and decreased perception of quality of care because of visitation restrictions. CONCLUSIONS Hospital visitor restrictions significantly reduced caregivers' communication with patients' medical team, causing caregivers and patients emotional distress. Protocols that facilitate communication between caregivers and care teams may benefit caregivers who cannot be physically present at care facilities, including distance caregivers.
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Affiliation(s)
- Anny Fenton
- Division of Population SciencesDana Farber Cancer InstituteBostonMassachusettsUSA
| | - Sandra Stevens
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
| | - Zachary Cost
- Tufts University School of MedicineBostonMassachusettsUSA
| | - Jaime Bickford
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
| | - Michael Kohut
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
| | - Elizabeth A. Jacobs
- Tufts University School of MedicineBostonMassachusettsUSA
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
| | - Rebecca N. Hutchinson
- Maine Medical CenterDivision of Palliative MedicinePortlandMaineUSA
- Tufts University School of MedicineBostonMassachusettsUSA
- MaineHealth Center for Interdisciplinary Population Health ResearchPortlandMaineUSA
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Gettel CJ, Serina PT, Uzamere I, Hernandez‐Bigos K, Venkatesh AK, Cohen AB, Monin JK, Feder SL, Fried TR, Hwang U. Emergency department care transition barriers: A qualitative study of care partners of older adults with cognitive impairment. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12355. [PMID: 36204349 PMCID: PMC9518973 DOI: 10.1002/trc2.12355] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner-completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi-structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners' mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner-reported outcome measures as well as ED discharge care transition interventions targeting care partners.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale School of MedicineNew HavenConnecticutUSA
| | - Peter T. Serina
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ivie Uzamere
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Kizzy Hernandez‐Bigos
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Arjun K. Venkatesh
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Center for Outcomes Research and EvaluationYale School of MedicineNew HavenConnecticutUSA
| | - Andrew B. Cohen
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Joan K. Monin
- Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Shelli L. Feder
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
- Yale University School of NursingOrangeConnecticutUSA
| | - Terri R. Fried
- Section of GeriatricsDepartment of Internal MedicineYale School of MedicineNew HavenConnecticutUSA
- VA Connecticut Healthcare SystemWest HavenConnecticutUSA
| | - Ula Hwang
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Geriatrics ResearchEducation and Clinical CenterJames J. Peters VA Medical CenterBronxNew YorkUSA
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Allen J, Lobchuk M, Livingston PM, Layton N, Hutchinson AM. Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study. Health Expect 2022; 25:2876-2892. [PMID: 36069335 DOI: 10.1111/hex.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. METHODS A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. FINDINGS All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. DISCUSSION Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. CONCLUSIONS Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. PUBLIC CONTRIBUTION This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.
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Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Michelle Lobchuk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia M Livingston
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living Research Centre, Peninsula Campus, Monash University, Frankston, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Bonus CG, Northall T, Hatcher D, Montayre J. Experiences of perioperative care among ethnically diverse older adult patients: An integrative review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Topham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag 2022; 27:181-193. [PMID: 35617533 PMCID: PMC9177052 DOI: 10.1097/ncm.0000000000000563] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes. METHODS We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy. RESULTS Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps. CONCLUSION The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes. IMPLICATIONS FOR CASE MANAGEMENT This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
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Affiliation(s)
- Emily Wahlquist Topham
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Alycia Bristol
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Brenda Luther
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Catherine E Elmore
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Erin Johnson
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Andrea S Wallace
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
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Hashemlu L, Esmaeili R, Bahramnezhad F, Rohani C. The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study. ARYA ATHEROSCLEROSIS 2022; 18:1-10. [PMID: 36817345 PMCID: PMC9937671 DOI: 10.48305/arya.2022.24350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 02/24/2023]
Abstract
BACKGROUND Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran. METHODS The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software. RESULTS The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were "family caregiver's unmet needs" (with 5 subcategories), "Empowering Informal Caregivers" (with 3 subcategories), and "access to a standard home healthcare system" (with 7 subcategories). CONCLUSION Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients' hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.
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Affiliation(s)
- Leila Hashemlu
- PhD Student in Nursing, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Esmaeili
- Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Roghayeh Esmaeili; Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and
Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran;
| | - Fatemeh Bahramnezhad
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery AND Department of Spiritual Health, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Affiliated Researcher, Department of Health Care Sciences, Palliative Care Center, Marie Cederschiöld Högskola, Campus Ersta, Stockholm, Sweden AND Associate Professor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Pedrosa R, Ferreira Ó, Baixinho CL. Rehabilitation Nurse’s Perspective on Transitional Care: An Online Focus Group. J Pers Med 2022; 12:jpm12040582. [PMID: 35455698 PMCID: PMC9025548 DOI: 10.3390/jpm12040582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
The increasing incidence of chronic and dependence leads to the need for hospitalization and adaptation in the process of returning home, as well as transition between care levels to ensure continuity of care. The World Health Organization has been warning about this problem since 2016, and consider reorganizing the care model as one of the solutions. The present study aimed to analyse the nurses’ perspective on transitional care for dependent people with rehabilitation care needs after hospital discharge. Methods: A focus group was developed with the participation of Rehabilitation Nurses from the hospital and community context, and content analysis was defined a posteriori. Results: From the content analysis emerged four related categories: promotion of continuity of care, nurse of advanced practice as a care manager, capacitation of the person and caregiver, and promotion of the care coordination. Conclusions: The present study allowed the strategies identification that minimize fragmentation risk of care and promote the person participation in transitional care. Ensuring transitional care is imperative to increase the quality of care, the satisfaction of professionals, clients, and the development of a system of sustainable health.
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Affiliation(s)
- Rita Pedrosa
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Correspondence:
| | - Óscar Ferreira
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal
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Pedrosa ARC, Ferreira ÓR, Baixinho CRSL. Transitional rehabilitation care and patient care continuity as an advanced nursing practice. Rev Bras Enferm 2022; 75:e20210399. [DOI: 10.1590/0034-7167-2021-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the needs and facilitating and hindering elements related to transitional rehabilitation care. Methods: Integrative literature review oriented toward answering the question “What nursing interventions guarantee transitional rehabilitation care to dependent adult or elderly people when they return home after hospitalization?”. Results: The patients did not participate much in the planning of hospital discharge and decision-making when they had to return home. Informal caretakers reported that professionals showed detachment during hospitalization and delayed guiding instructions. Health professionals mentioned lack of time to offer this care modality as a difficulty. Final considerations: Ensuring training, follow-up, and coordination between care levels is essential. Care integration can reduce hospital stay and the impact of post-discharge complications. Transitional care contributes to a sustainable health system, higher care quality, and client satisfaction.
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Affiliation(s)
- Ana Rita Cardoso Pedrosa
- Hospital de Vila Franca de Xira, Portugal; Inovação e Desenvolvimento em Enfermagem de Lisboa, Portugal
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Sawan MJ, Jeon YH, Bond C, Hilmer SN, Chen TF, Wennekers D, Gnjidic D. Caregivers' experiences of medication management advice for people living with dementia at discharge. J Eval Clin Pract 2021; 27:1252-1261. [PMID: 33586327 DOI: 10.1111/jep.13551] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Caregivers of people living with dementia play an essential role in managing medications across transitions of care. Adequate caregiver medication management guidance at hospital discharge is important to ensure optimal outcomes from medication use. This qualitative study explores the experiences and perspectives of caregivers about the medication management guidance provided at hospital discharge. METHODS A qualitative approach using semi-structured, telephone interviews was conducted with 31 caregivers of people with dementia across Australia. Purposive sampling was used to ensure maximum variation of diverse experiences and perspectives. RESULTS Caregivers' experiences of medication guidance for people with dementia at discharge were described in three themes including: (a) inadequate information about medication management at discharge; (b) limited caregiver engagement in medication management decisions; and (c) difficulties ensuring medication supply post discharge. Most participants indicated they would like to be included in discussions at discharge. However, participation was influenced by caregivers being overwhelmed by discharge processes; proactively seeking information on medication-related harm; and belief in advocacy as part of their caregiver role. Caregivers reported they would like to receive a tailored medication list for people with dementia which included information on medications that may impact on the patient's cognition, and for hospital staff to communicate with both the community pharmacist and primary care physician, to improve co-ordination post transition. DISCUSSION In our study of caregivers of people with dementia, we identified key recommendations to facilitate regular participation of people living with dementia and their caregiver around medication guidance at discharge.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christine Bond
- School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Faculty of Medicine and Health, Royal North Shore Hospital and Northern Clinical School, St Leonards, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Sperber NR, Shapiro A, Boucher NA, Decosimo KP, Shepherd-Banigan M, Whitfield C, Hastings SN, Van Houtven CH. Developing a person-centered, population based measure of "home time": Perspectives of older patients and unpaid caregivers. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2021; 9:100591. [PMID: 34688200 PMCID: PMC10442891 DOI: 10.1016/j.hjdsi.2021.100591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/20/2022]
Abstract
Measuring "home time," number of days not in facility-based care, with medical claims is a promising approach to assess person-centered outcomes on a population level. Generally, spending more time at home matches long-term care preferences and improves quality of life. However, existing "home time" measures have not incorporated key stakeholder perspectives. We sought to understand how patients and family caregivers value time spent in diverse facility-based health care settings (Emergency Department, Nursing Home, Post-Acute Care/Skilled Nursing, Inpatient Hospital) to help determine whether various settings have different effects on quality of life and thus merit different weighting in a "home time" measure. We conducted three focus groups among patients and family caregivers within the U.S. Veterans Health Care System. We identified themes pertaining to patients' quality of life in each of the four facility-based care settings. Discussions about both emergency department and post-acute/skilled nursing care reflected loss of personal control, counterbalanced by temporary stay. Inpatient hospital care evoked discussion about greater loss of personal control due to the intensity of care. Nursing homes ultimately signified decline. These findings illuminate differences in quality of life across health-care settings and help justify the need for different weights in a measure of "home time."
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Affiliation(s)
- Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA.
| | - Abigail Shapiro
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA
| | - Nathan A Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke University, Sanford School of Public Policy, Durham, NC, USA; Duke University, Margolis Center for Health Policy, Durham, NC, USA; Duke University School of Medicine, Center for the Study of Aging, Durham, NC, USA; Duke University School of Medicine, Department of Medicine, Division of Geriatrics, Durham, NC, USA
| | - Kasey P Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA
| | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke University, Margolis Center for Health Policy, Durham, NC, USA
| | - Chelsea Whitfield
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke University School of Medicine, Center for the Study of Aging, Durham, NC, USA; Duke University School of Medicine, Department of Medicine, Division of Geriatrics, Durham, NC, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System; 508 Fulton Street (152), Durham, NC, 27705, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke University, Margolis Center for Health Policy, Durham, NC, USA
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Norcott A, Chan CL, Nyquist L, Bynum JP, Min L, Fetters MD, DeJonckheere M. Behaviours of older adults and caregivers preparing for elective surgery: a virtually conducted mixed-methods research protocol to improve surgical outcomes. BMJ Open 2021; 11:e048299. [PMID: 34663655 PMCID: PMC8524274 DOI: 10.1136/bmjopen-2020-048299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Older adults (age ≥65 years) are pursuing increasingly complex, elective surgeries; and, are at higher risk for intraoperative and postoperative complications. Patients and their caregivers frequently struggle with the postoperative recovery process at home, which may contribute to complications. We aim to identify opportunities to intervene during the preoperative period to improve postoperative outcomes by understanding the preparatory behaviours of older adults and their caregivers before a complex, elective surgery. METHODS AND ANALYSIS As a result of the COVID-19 pandemic, we will conduct this study via telephone and videoconferencing. Using a multiphase mixed-methods research design, we will collect data on 10-15 patient-caregiver dyads from a pool of older adults (across a spectrum of cognitive abilities) scheduled for an elective colorectal surgery between 1 July 2020 and 30 May 2021. We will collect quantitative and qualitative data before (T1, T2) and after (T3, T4) surgery. Preoperatively, participants will each complete a cognitive assessment and a semi-structured qualitative interview that focuses on their preparatory behaviours (T1). They will then answer questionnaires about mood, self-efficacy and home environment (T2). Three weeks following hospital discharge, participants will complete another qualitative interview focusing on a comparison of preoperative and postoperative preparedness (T3). Researchers will also collect information about the patient's medical conditions, the postoperative complications and healthcare utilisation from the patient's chart 30 days following discharge (T4). We will code and conduct thematic analysis of the qualitative data to identify salient themes. Quantitative data will be analysed using basic descriptive statistics to characterise the participants. We will integrate the qualitative and quantitative findings using results from the quantitative scales to group participants and with use of joint display analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Michigan IRB. Study findings will be disseminated through peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Alexandra Norcott
- Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chiao-Li Chan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Linda Nyquist
- Institute of Gerontology, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P Bynum
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Lillian Min
- Geriatric Research, Education, and Clinical Center (GRECC), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa DeJonckheere
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Dichman C, Wagner MK, Joshi VL, Bernild C. Feeling responsible but unsupported: How relatives of out-of-hospital cardiac arrest survivors experience the transition from hospital to daily life - A focus group study. Nurs Open 2021; 8:2520-2527. [PMID: 33638939 PMCID: PMC8363397 DOI: 10.1002/nop2.779] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/26/2020] [Accepted: 01/21/2021] [Indexed: 12/17/2022] Open
Abstract
AIM To generate knowledge about how relatives of out-of-hospital cardiac arrest survivors experience the transition between hospital and daily life. The research question was "how do relatives of out-of-hospital cardiac arrest survivors experience collaboration and communication with healthcare professionals, and what is emphasized as important in the transition from hospital to daily life". DESIGN Qualitative design. METHODS Six semi-structured focus group interviews were conducted with 23 relatives of out-of-hospital cardiac arrest survivors who participated in a residential rehabilitation course. Data was collected between November 2018 and March 2019. Transcripts were analysed using a phenomenological hermeneutic approach. RESULTS The analysis generated three themes "a necessary presence," "communication with healthcare professionals on the cardiac ward" and "the abrupt disappearance of the system." Relatives of out-of-hospital cardiac arrest survivors feel a great responsibility when coping and adjusting to their new life. In the transition to daily life, a focus on systematic involvement and collaboration with relatives should be an essential part of the post-cardiac arrest pathway.
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Affiliation(s)
- Camilla Dichman
- Department of CardiologyThe Heart CentreCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Mette Kirstine Wagner
- Department of CardiologyThe Heart CentreCopenhagen University Hospital RigshospitaletCopenhagenDenmark
| | - Vicky L. Joshi
- REHPAThe Danish Knowledge Centre for Rehabilitation and Palliative CareDepartment of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Camilla Bernild
- Department of CardiologyThe Heart CentreCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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Health Literacy, Health Confidence, and Simulation: A Novel Approach to Patient Education to Reduce Readmissions. Prof Case Manag 2021; 26:138-149. [PMID: 33784721 DOI: 10.1097/ncm.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bagnasco A, Rosa F, Dasso N, Aleo G, Catania G, Zanini M, Rocco G, Turci C, Ghirotto L, Hayter M, Sasso L. Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences. J Clin Nurs 2021; 30:2246-2257. [PMID: 33350526 DOI: 10.1111/jocn.15613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. BACKGROUND The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. DESIGN Phenomenology. METHODS This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. RESULTS Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. CONCLUSIONS Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.
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Affiliation(s)
| | - Francesca Rosa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicoletta Dasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gennaro Rocco
- National Social Security Council (ENPAPI, Roma, Italy
| | - Carlo Turci
- Ordine Professioni Infermieristiche di Roma, Roma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Emilia, Italy
| | - Mark Hayter
- School of Health & Social Work, University of Hull, Hull, UK
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Tool development to improve medication information transfer to patients during transitions of care: A participatory action research and design thinking methodology approach. Res Social Adm Pharm 2021; 18:2170-2177. [PMID: 33926826 DOI: 10.1016/j.sapharm.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Medication changes during transitions of care is a recognized challenge that has been linked to adverse events. The delivery of medication instructions during transition from hospital to home is a priority area for improvement. OBJECTIVE The goals of this work were to 1) understand the current experiences of patients and families; and 2) co-design tools to improve medication information transfer during transitions of care together with patients, families, and providers. METHODS A participatory action approach, using mixed methods within a design thinking framework was used. Participants were chosen from patient groups at higher risk of adverse events, guided by extreme user design, which posits that needs of extreme users can also fit the majority. Providers, patients and family (users) were interviewed to understand current experiences with medication information transfer during transitions of care and to solicit input on potential elements to inform tool design. Users were engaged in iterative creation of prototypes. RESULTS A total of 116 patients, family caregivers, and providers were engaged throughout this project. Findings highlighted challenges currently experienced, strengthening the case for tools that engage the patient and family in medication information transfer. Important information included why medications were prescribed, how to take them, side effects, and an explanation of the role of community pharmacists. Displaying information in a grid format was preferred. Two tools were prototyped: (1) A Medication Whiteboard for engaging patients and families in creating their medication routine, and (2) A Patient Oriented Medication List for providing medication instructions and as a reference once patients are home. CONCLUSIONS Through the use of mixed methods within a design thinking framework, the team was able to understand the challenges and design prototypes of tools that both engage patients and families in developing their medication routine and improve medication information transfer during transitions of care.
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Checa C, Medina-Perucha L, Muñoz MÁ, Verdú-Rotellar JM, Berenguera A. Living with advanced heart failure: A qualitative study. PLoS One 2020; 15:e0243974. [PMID: 33315935 PMCID: PMC7735582 DOI: 10.1371/journal.pone.0243974] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/01/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Information about how patients with advanced heart failure (HF) live and cope with their disease remains scarce. The objective of this study was to explore, from phenomenological and holistic perspectives, the experiences of patients suffering from advanced HF, attended at home in the primary care setting in 2018. Materials and methods Qualitative study conducted in 4 primary healthcare centers in Barcelona (Spain). Twelve in-depth interviews were conducted in advanced HF patients, aged over 65 and visited regularly at home. We developed a purposeful sampling, accounting for variability in gender, age, and socioeconomic level. Leventhal’s framework was used to analyze the interviews. Results Participants received insufficient and contradictory information about HF. They talked about their cognitive representation and claimed a better communication with healthcare professionals. Due to their advanced age, subjects considered their daily living limitations to be normal rather than as a consequence of HF. Gender differences in emotional representation were clearly observed. Women considered themselves the keystone of correct family “functioning” and thought that they were not useful if they could not correspond to gendered societal expectations. Cognitive coping strategies included specific diets, taking medication, and registering weight and blood pressure. Nevertheless, they perceived the locus of control as external and felt unable to manage HF progression. Their emotional coping strategies included some activities at home such as watching television and reading. Social support was perceived crucial to the whole process. Conclusions Locus of control in advanced HF was perceived as external. Healthcare professionals should adapt emotional health interventions in patients with advanced HF based on a gender perspective. Social support was found to be crucial in facing the disease. Patients reported poor communication with healthcare professionals.
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Affiliation(s)
- Caterina Checa
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Healthcare Centre Dreta de l’Eixample, Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
- * E-mail:
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Miguel-Ángel Muñoz
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut Català de la Salut, Barcelona, Spain
| | - José María Verdú-Rotellar
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut Català de la Salut, Barcelona, Spain
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Guilcher SJT, Maunula L, Cadel L, Everall AC, Li J, Kuluski K. Caregiving for older adults with hip fractures: Exploring the perspectives of caregivers, providers and decision-makers in Ontario, Canada. Arch Gerontol Geriatr 2020; 93:104321. [PMID: 33359957 DOI: 10.1016/j.archger.2020.104321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Caregivers play an important role in providing physical, emotional and social support to individuals with hip fracture. This study sought to explore perceptions of caregiving for older adults with hip fractures by comparing experiences of caregivers, providers and decision-makers. METHODS Semi-structured interviews were conducted both in-person and by telephone with caregivers, providers and decision-makers (n=32) from one rural and one urban hospital selected from two health regions in Ontario, Canada. Interviews were audio-recorded and transcribed verbatim. The data were coded descriptively and interpretively, and compared within and across participants types. RESULTS Three main themes reflected tensions between caregivers and providers/decision-makers. Firstly, differing expectations of caregiver roles were identified. Several caregivers wanted more participation in the decision-making process but often felt excluded, while others expressed feeling stressed due to the expectations placed on them. Conversely, providers and decision-makers often described caregivers needing to strike a balance between providing supportive care while avoiding becoming too involved. Secondly, different expectations of what the healthcare system and providers could provide, with tensions particularly around timing of discharge were noted. Finally, there were differing perceptions of information needs. Providers spoke about the importance of providing education to caregivers and perceived themselves to be providing appropriate education. However, caregivers often described poor communication and not having a clear understanding of next steps and the care plan. CONCLUSION Managing and tailoring expectations, improving communication (e.g., content, timing) and the consistency of information shared with caregivers from different providers could facilitate more positive caregiving experiences and interactions.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6.
| | - Laena Maunula
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada, L5B 1B8
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, M5SM2
| | - Joyce Li
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6
| | - Kerry Kuluski
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada, M5T 3M6; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada, L5B 1B8
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Weeks LE, Barber B, MacDougall ES, Macdonald M, Martin-Misener R, Warner G. An exploration of Canadian transitional care programs for older adults. Healthc Manage Forum 2020; 34:163-168. [PMID: 33272058 PMCID: PMC8079793 DOI: 10.1177/0840470420974040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transitional care programs are effective for improving patient outcomes upon discharge from acute care services and reducing the burden of healthcare costs; however, little is known about the types of transitional care programs for older adults across Canada. This exploratory study gathered an in-depth understanding of Canadian transitional care programs and described how each program functions to support older adults and family/friend caregivers. Nine key informants were interviewed about the development of transitional care programs within four Canadian provincial regions including Atlantic, Central, Prairie, and West Coast. Key facilitators and barriers influencing the development and long-term success of transitional care programs included program scope, program structure, continuity of care, funding, and health system infrastructure. Future research is required to identify how a broad range of transitional care programs operate and to disseminate knowledge with health leaders and decision-makers to ensure transitional care programs are embedded as essential health system services.
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Affiliation(s)
- Lori E Weeks
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brittany Barber
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Marilyn Macdonald
- School of Nursing, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Grace Warner
- School of Occupational Therapy, 3688Dalhousie University, Halifax, Nova Scotia, Canada
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Graven LJ, Boel-Studt S, Buck HG, Abbott L, Grant JS. Heart Failure Caregiver Self-Care: A Latent Class Analysis. Clin Nurs Res 2020; 30:625-635. [PMID: 33218254 DOI: 10.1177/1054773820973121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about heart failure (HF) caregiver self-care. This article reports a secondary analysis of data from a cross-sectional, descriptive study involving 530 HF caregivers. A three-step latent class mixture model identified HF caregiver classes at risk for poor self-care and examined the relationship between the identified self-care classes and caregiver burden and depression. Caregivers completed online surveys on self-care, caregiver burden, depression, problem-solving, social support, and family function. Caregivers were 41.39 (±10.38) years old, 78.3% Caucasian, and 50.9% men. Three classes of HF caregivers (24% Low-Risk, 24.9% Moderate-Risk, 51.1% High-Risk) were identified. High-Risk caregivers had the worst self-care and the lowest levels of social support, problem-solving, and family function. Moderate-Risk caregivers were the most experienced and had the best self-care yet had the most comorbidities. High-Risk caregivers reported more caregiver burden and depression. "At-risk" caregivers may benefit from self-care and support programs, but more research is needed.
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Affiliation(s)
- Lucinda J Graven
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - Shamra Boel-Studt
- Florida State University College of Social Work, Tallahassee FL, USA
| | - Harleah G Buck
- Csomay Center for Gerontological Excellence, University of Iowa College of Nursing, Iowa City, IA, USA
| | - Laurie Abbott
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - Joan S Grant
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
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'There was no preamble': Comparing the Transition from Hospital to Home in Different Care Settings. Can J Aging 2020; 40:282-292. [PMID: 33190652 DOI: 10.1017/s0714980820000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers' optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients' previous experiences, needs, and care expectations.
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Ferreira BADS, Gomes TJB, Baixinho CRSL, Ferreira ÓMR. Transitional care to caregivers of dependent older people: an integrative literature review. Rev Bras Enferm 2020; 73:e20200394. [PMID: 33175000 DOI: 10.1590/0034-7167-2020-0394] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the needs of caregivers of dependent older people related to self-care in the transition from hospital to home. METHODS Integrative literature review that followed a predefined protocol, carried out from March to May 2019 in the platforms EBSCO, B-On, Scopus, Web of Science, and Joanna Briggs Institute. Descriptors and eligibility criteria were defined for the bibliographic sample, which was ten articles. The search was limited to articles published between 2015 and 2019 to guarantee evidence topicality. RESULTS The needs of caregivers related to transitional care can be grouped into five categories: needs in the transition into the role of caregiver; needs related to self-care of caregivers themselves; health needs; economic needs; and social and collective needs. FINAL CONSIDERATIONS The work developed by nurses regarding transitional care of caregivers must have two focuses: managing care provided to dependent older people and managing the needs of caregivers and the care offered to them.
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Pellet J, Weiss M, Rapin J, Jaques C, Mabire C. Nursing discharge teaching for hospitalized older people: A rapid realist review. J Adv Nurs 2020; 76:2885-2896. [DOI: 10.1111/jan.14511] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/20/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare‐IUFRSUniversity of LausanneLausanne University Hospital Lausanne Switzerland
| | - Marianne Weiss
- Marquette University College of Nursing Milwaukee WI USA
| | - Joachim Rapin
- Faculty of Nursing University of Montreal Montreal Quebec Canada
- Lausanne University Hospital Lausanne Switzerland
| | - Cecile Jaques
- Medical Library Lausanne University Hospital and University of Lausanne Lausanne Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare‐IUFRSUniversity of LausanneLausanne University Hospital Lausanne Switzerland
- Lausanne University Hospital Lausanne Switzerland
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Hill L, Prager Geller T, Baruah R, Beattie JM, Boyne J, de Stoutz N, Di Stolfo G, Lambrinou E, Skibelund AK, Uchmanowicz I, Rutten FH, Čelutkienė J, Piepoli MF, Jankowska EA, Chioncel O, Ben Gal T, Seferovic PM, Ruschitzka F, Coats AJS, Strömberg A, Jaarsma T. Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper. Eur J Heart Fail 2020; 22:2327-2339. [PMID: 32892431 DOI: 10.1002/ejhf.1994] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/18/2022] Open
Abstract
The Heart Failure Association of the European Society of Cardiology has published a previous position paper and various guidelines over the past decade recognizing the value of palliative care for those affected by this burdensome condition. Integrating palliative care into evidence-based heart failure management remains challenging for many professionals, as it includes the identification of palliative care needs, symptom control, adjustment of drug and device therapy, advance care planning, family and informal caregiver support, and trying to ensure a 'good death'. This new position paper aims to provide day-to-day practical clinical guidance on these topics, supporting the coordinated provision of palliation strategies as goals of care fluctuate along the heart failure disease trajectory. The specific components of palliative care for symptom alleviation, spiritual and psychosocial support, and the appropriate modification of guideline-directed treatment protocols, including drug deprescription and device deactivation, are described for the chronic, crisis and terminal phases of heart failure.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Tal Prager Geller
- Palliative Care Ward at Dorot Health Centre, Heart Failure Unit at Rabin Medical Center, Netanya, Israel
| | - Resham Baruah
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - James M Beattie
- Cicely Saunders Institute, King's College London, London, UK
| | - Josiane Boyne
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | | | - Izabella Uchmanowicz
- Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, University Hospital, Wroclaw, Poland
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Massimo Francesco Piepoli
- Heart Failure Unit, Cardiology, Guglielmo da Saliceto Hospital, Piacenza, Italy.,University of Parma, Parma, Italy
| | - Ewa A Jankowska
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania.,University of Medicine Carol Davila, Bucharest, Romania
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Petar M Seferovic
- Cardiology Department, Clinical Centre Serbia, Medical School Belgrade, Belgrade, Serbia
| | - Frank Ruschitzka
- Clinic for Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Hattangadi N, Kurdyak P, Solomon R, Soklaridis S. Goals of care or goals of life? A qualitative study of clinicians' and patients' experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS). BMC Health Serv Res 2020; 20:687. [PMID: 32709233 PMCID: PMC7379793 DOI: 10.1186/s12913-020-05541-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background Recognizing the need for improved communication with patients at the point of hospital discharge, a group of clinicians, patients, and designers in Toronto, Canada collaborated to develop a standardized tool known as the Patient-Oriented Discharge Summary (PODS). Although quantitative results suggest PODS helps mitigate gaps in knowledge, a qualitative inquiry from the clinician and patient perspective of psychiatric hospital discharge using PODS has not been widely explored. Our aim was to explore clinicians’ and patients’ experiences with PODS. Methods We used a qualitative thematic analysis to explore clinicians’ (n = 10) and patients’ (n = 6) experiences with PODS. We used convenience sampling to identify and invite potential participants at the Center for Addiction and Mental Health in Toronto, Canada to participate in semi-structured interviews between February 2019 and September 2019. Data were analyzed using a thematic analysis approach to develop descriptive themes. Results Emerging themes from the data between clinicians and patients were both different and complementary. Clinicians described PODS using the concept of “goals of care.” They relayed their experiences with PODS as a discrete event and emphasized its role in meeting their “goals of care” for discharge planning. Patients provided more of a “goals of life” perspective on recovery. They characterized PODS as only one facet of their recovery journey and not necessarily as a discrete or memorable event. Patients focused on their outcomes post-discharge and situated their experiences with PODS through its relation to their overall recovery. Conclusions PODS was experienced differently by clinicians and patients. Clinicians experienced PODS as helpful in orienting them to the fulfillment of goals of care. Patients did not experience PODS as a particularly memorable intervention. Due to the information advantage that clinicians have about PODS, it is not surprising that clinicians and patients experienced the PODS differently. This study expanded our understanding of hospital discharge from clinicians and patients perspectives, and suggests that there are additional areas that need improvement.
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Affiliation(s)
- Nayantara Hattangadi
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada
| | - Paul Kurdyak
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada
| | - Rachel Solomon
- The Hospital for Sick Children, Toronto, ON, M5S 1S2, Canada
| | - Sophie Soklaridis
- Center for Addiction and Mental Health, 33 Russell Street, 2nd floor, room 2059, Toronto, ON, Canada.
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Kitko L, McIlvennan CK, Bidwell JT, Dionne-Odom JN, Dunlay SM, Lewis LM, Meadows G, Sattler EL, Schulz R, Strömberg A. Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e864-e878. [DOI: 10.1161/cir.0000000000000768] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF—tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient’s symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.
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