摘要:

This article describes the contributions to knowledge development and clinical practice during the past decade resulting from testing and refining a transitional care model with hospitalized elders by a multidisciplinary research team. A major goal of this research program has been to improve the postdischarge outcomes of older adults admitted to hospitals for an acute exacerbation of a chronic cardiovascular illness. In addition to demonstrating positive outcomes for elders while reducing costs, findings from the testing of the transitional care model have advanced knowledge of important patient and caregiver issues including the effects of the model of elders with medical versus surgical conditions, the profile of elders at risk for poor outcomes, predictors of caregiver burden, the unique needs of elders and the contributions of advanced practice nurses in meeting these needs, and decision making regarding home care referrals.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Continuity of patient care is a tenet of professional nursing practice regardless of setting. Communication between providers about patients is fundamental to continuity. As the role of hospitals in health care is constrained, care is now commonly delivered to patients during an episode of illness by multiple agencies. Continuity of care now assumes full communication between providers about patients' conditions and needs. Research provides evidence about the dynamics of patient care communication: more lean (background and medical) than rich (nursing care and psychosocial) data are communicated; structured, written formats transmit more information than informal channels of communication; and organizational and patient characteristics would appear to affect communication about patients. Knowledge about the communication dynamics of patient care may assist providers in designing strategies to attain the basic goals of continuity of care.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Standardization and computerization of medical documentation has provided a method to describe patient care by naming and linking patients' needs with nursing interventions. This study used a standardized nursing classification system to describe the types and frequency of problems experienced by elders hospitalized and discharged to home and the interventions used by staff nurses and advanced practice nurses (APNs) as they provided acute care and discharge planning for these cardiac patients. The patients' hospital records and the APN logs were content analyzed and then coded using the Problem Classification Scheme and Intervention Scheme of the Omaha System. Patients experienced an average of 8.6 problems that required a total of 7,000 interventions in all four Omaha System intervention categories. The results provided a description of the most frequent problems experienced by the patients linked with the most common nursing interventions. The nature, complexity, and prevalence of patient problems and the importance of communication across settings are evident. In addition, the study findings increase understanding of the contribution of nurses to the care of hospitalized elders as they make the transition from hospital to home.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Implantable cardioverter defibrillators (ICD) are highly effective in the identification and termination of malignant ventricular tachycardia and fibrillation. It is anticipated that the number of patients receiving this device will increase because of major advancements in technology and the results of prospective controlled clinical trials. Major life changes occur after implantation of the device. Continued research is needed to identify concerns and needs of patients with ICDs and their families. Specific interventions must be tested to determine efficacy. Nurses must be able to provide education and psychologic support to assist patients in their successful transition to home.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Elderly patients with heart failure present a tremendous challenge to the current health care system. Decreased length of hospital stay for patients with increased numbers of comorbid conditions and complex medication regimens contribute to a revolving door of rehospitalizations. Using a transitional care model designed to decrease rehospitalizations, advanced practice nurses (APNs) in an ongoing clinical trial provide discharge planning in the acute care setting with home follow-up by the same APN for a 3-month period. This article reviews three case studies to provide a view of the complex and challenging situations in which elders with heart failure live and the care provided by APNs using the transitional care model to guide their practice. Social, economic, and emotional factors overlay the illness in each of these cases. The APNs, with advanced knowledge of cardiac disease and research-based management, help the patients and their caregivers to prioritize information and take the appropriate actions, while coping with the complexity of their conditions and the challenges they face. Keeping these patients from returning to the hospital provides evidence of the success of this transitional model of care.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Family members of postsurgical patients are, by necessity, taking on the caregiving role sooner without any specified resources to help them. The input of these caregivers is essential so nurses can understand their concerns, needs, and struggles and develop strategies to support the caregivers in their caregiving role. This study was designed to increase nursing knowledge regarding the experiences of being a caregiver of a cardiac surgery patient during the immediate postdischarge period. The qualitative research method of interpretative description, first described by Thorne, Kirkham, and MacDonald-Emes in 1997 guided the study. In-depth interviews were held with eight spousal caregivers. Findings revealed that the experience was molded by caregivers' past participation as a caregiver, as well as caregivers' and care recipients' outlook on life, their interpersonal relationship, and their expectations. Caregivers engaged in the process of caregiving that involved being vigilant and monitoring the care recipient's recovery, implementing strategies to assist the recovery process, and taking on a role to provide care and seek help as required. The encounter with caregiving affected all realms of caregivers' lives, and they experienced feelings of stress, vulnerability, and having to put their lives on hold; these feelings were often compounded by uncertainty.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Client satisfaction is considered an important outcome measure in a managed care environment faced with escalating health care costs, shortened lengths of hospital stay, and competition among acute care hospitals. With shortened lengths of stay in acute care hospitals, discharge planning has assumed increased importance, particularly for elders who have chronic conditions, such as heart failure, that require follow-up care. Consequently, understanding the predictors of client satisfaction with discharge planning can help hospitals and their nursing staff to tailor services to meet client needs. Previous studies have focused on patient satisfaction with hospital care, with little attention given specifically to satisfaction with discharge planning and to family caregiver satisfaction with discharge planning. The purpose of this study was to determine whether there is a difference between elder and family member satisfaction with discharge planning 2 weeks after hospitalization and what factors predict satisfaction with discharge planning 2 weeks after hospitalization for elders hospitalized with heart failure and their family caregivers. Telephone interviews were conducted with 134 elder/family caregiver dyads 2 weeks after hospitalization. The results indicated that there were no statistically significant differences in discharge planning satisfaction of elders and their family caregivers. Continuity of care and extent to which they felt prepared to manage care following hospitalization were the best predictors of elder's and family caregiver's satisfaction with discharge planning.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID