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Ganefianty A, Songwathana P, Damkliang J. Readiness for hospital discharge perceived by caregivers of patients with traumatic brain injury: A cross-sectional study. BELITUNG NURSING JOURNAL 2024; 10:209-214. [PMID: 38690311 PMCID: PMC11056832 DOI: 10.33546/bnj.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/08/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background There is a growing emphasis on evaluating discharge readiness, particularly for those involved in the care of patients in transition. Caregivers supporting individuals with traumatic brain injury are a specific focus due to the potential impact of adequate discharge preparation on patient recovery and post-discharge outcomes. Objective This research aimed to evaluate the preparedness of caregivers for the discharge of patients with moderate or severe traumatic brain injury from the hospital. Methods This cross-sectional study was carried out in a tertiary hospital in Indonesia from January to April 2023 using the Indonesian adaptation of the Preparedness for Caregiving Scale. The study comprised seventy-four caregivers of individuals with traumatic brain injury, chosen through a purposive sampling approach based on pre-established inclusion and exclusion criteria. Data collection involved a questionnaire covering caregiver information (gender, age, education level, income, and psychological status) and discharge readiness. Descriptive statistics and correlation analyses, employing Pearson and chi-square, were conducted. Results Most caregivers were female (83.8%), spouses of patients (50%), and had a moderate education level (52.7%). The average age of caregivers was 43.7 ± 8.7 years, with an average duration of patient care of 4.22 ± 1.2 days and a monthly income of 220 US dollars. The mean score for readiness for hospital discharge was low (10.08 ± 1.91), indicating that caregivers were not adequately prepared for discharge. Age and education were significant factors (p <0.05) related to hospital discharge readiness. Conclusion This study emphasizes the importance of assessing caregiver readiness for the discharge of patients with traumatic brain injury from the hospital. Findings indicate a concerning trend of inadequate preparedness among caregivers, with factors such as age and education level significantly influencing readiness. The predominance of female caregivers, often spouses of patients, indicates the need for tailored support strategies. Prioritizing caregiver preparation and support, especially by nurses, is crucial for optimizing patient recovery and post-discharge outcomes.
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Affiliation(s)
- Amelia Ganefianty
- Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
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Leland NE, Rouch SA, Prusynski RA, Shore AD, Kaufman H, Hoover LP, Mroz TM, Freburger JK, Saliba D. Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6959. [PMID: 37887697 PMCID: PMC10606322 DOI: 10.3390/ijerph20206959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.
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Affiliation(s)
- Natalie E. Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Stephanie A. Rouch
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
- The Wolff Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Rachel A. Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Amanda D. Shore
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Hannah Kaufman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Lorelei P. Hoover
- Department of Occupational Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA; (S.A.R.); (A.D.S.)
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA; (R.A.P.); (H.K.); (T.M.M.)
| | - Janet K. Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA 15219, USA;
| | - Debra Saliba
- Veterans Affairs (VA) Greater Los Angeles Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, CA 90095, USA;
- Borun Center, University of California, Los Angeles, CA 90095, USA
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Bankole AO, Girdwood T, Leeman J, Womack J, Toles M. Identifying unmet needs of older adults transitioning from home health care to independence at home: A qualitative study. Geriatr Nurs 2023; 51:293-302. [PMID: 37031581 PMCID: PMC10247499 DOI: 10.1016/j.gerinurse.2023.03.015] [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: 12/05/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023]
Abstract
Health care practices to prepare older adults and their family caregivers for transitions from home health care (HHC) to independence at home are rarely studied. The objective of this multiple case study was to describe HHC patient and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. In this qualitative study, data were collected using chart-reviews and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (N=17 pairs). We identified three themes: (1) low patient and caregiver engagement in care planning increased risk for preventable health events after HHC discharge, (2) limited continuity of care restricted patient and caregiver access to community-based services, and (3) gaps in patient and caregiver education influenced independent care of chronic illnesses after discharge. Findings suggest opportunities to improve care practices to prepare older adults and their caregivers for transitions from HHC to independence at home.
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Affiliation(s)
- Ayomide Okanlawon Bankole
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA.
| | | | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
| | - Jennifer Womack
- Appalachian State University, Beaver College of Health Sciences, Boone, NC, USA
| | - Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
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Kolarczyk E, Witkowska A, Szymiczek M, Młynarska A. The Variables of the Readiness for Discharge from Hospital in Patients after Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1582. [PMID: 36674337 PMCID: PMC9867362 DOI: 10.3390/ijerph20021582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
Discharge after myocardial infarction (MI) reduces the risk of repeated myocardial infarction and stroke and has a positive effect on the patient’s prognosis. An important element of preparation is the assessment of the patient’s readiness for discharge from hospital. This study aimed to evaluate the associations between a patient’s readiness for hospital discharge after MI, their functioning in the chronic illness, and socio-demographic and clinical variables. Methods: This was a cross-sectional, single-center study. The study was conducted among 242 patients who were hospitalized for myocardial infarction after percutaneous coronary intervention (PCI). The Readiness for Hospital Discharge After Myocardial Infarction Scale (RHD-MIS) and the Functioning in Chronic Illness Scale (FCIS) were used. Results: No statistically significant differences were found between socio-demographic and clinical factors and the overall result of the RHD-MIS (p >0.05).There is a positive correlation between hospital discharge readiness and functioning in chronic disease in patients after MI (r = 0.20; p < 0.001). The higher the level of subjective knowledge, the better the functioning in chronic disease (rho = 0.16; p < 0.05), the greater the increase in the sense of influence on the course of the disease (rho = 0.17; p < 0.05) and the greater the decrease in the impact of the disease on the patient’s attitude (rho = 0.23, p < 0.05). Conclusions: The higher the readiness for discharge from hospital, the better the patient’s functioning in the disease and the lower the impact of the disease on the patient.
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Affiliation(s)
- Ewelina Kolarczyk
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Agnieszka Witkowska
- Department of Cardiology, Electrotherapy and Angiology, Scanmed S.A. Racibórz Medical Center, 47-400 Racibórz, Poland
| | - Marek Szymiczek
- Department of Cardiology, Electrotherapy and Angiology, Scanmed S.A. Racibórz Medical Center, 47-400 Racibórz, Poland
| | - Agnieszka Młynarska
- Department of Gerontology and Geriatric Nursing, Faculty of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
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Yamasaki Y, Honda Y, Inoue-Umezaki M, Makieda R, Endo Y, Hanayama K, Sakaue H, Teramoto F. The association between sarcopenia and functional outcomes in patients undergoing convalescent rehabilitation. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:457-463. [PMID: 37940532 DOI: 10.2152/jmi.70.457] [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: 11/10/2023]
Abstract
Sarcopenia is widely believed to be linked to poorer outcomes in inpatient rehabilitation. This study aimed to assess the impact of sarcopenia on functional outcomes and dietary intake during hospitalization in adults undergoing convalescent rehabilitation. We conducted a retrospective cohort analysis at a single rehabilitation institution. The Asian Working Group Consensus Criteria for Sarcopenia was used to diagnose. The Functional Independence Measure (FIM) score was used at hospital discharge to measure the primary functional outcome. Energy and protein intakes during hospitalization were calculated as part of the nutritional assessment. There were 126 patients in the research (median age, 73 yr;54% women). Stroke (n = 73;53.4% sarcopenia) and musculoskeletal disorders (n = 53;56.6% sarcopenia) were among the admission diagnoses. Multiple linear regression analysis revealed that the FIM total score at discharge was modestly associated with sarcopenia only in stroke patients (? = 0.1872, P = 0.09), as well as significantly and independently associated with protein intake during admission only in stroke patients (? = 0.3217, P < 0.05). In hospitalized stroke patients undergoing convalescent therapy, sarcopenia is related to lower functional results. Early identification of sarcopenia and treatment with rehabilitation nutrition should be implemented in this population. J. Med. Invest. 70 : 457-463, August, 2023.
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Affiliation(s)
- Yuki Yamasaki
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Yui Honda
- Department of Nutrition, Kawasaki Medical School Hospital, Okayama, Japan
| | - Mami Inoue-Umezaki
- Department of Nutrition, Kawasaki Medical School Hospital, Okayama, Japan
| | - Ryoko Makieda
- Department of Nutrition, Kawasaki Medical School Hospital, Okayama, Japan
| | - Yoko Endo
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama, Japan
- Department of Nutrition, Kawasaki Medical School Hospital, Okayama, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical School, Okayama, Japan
| | - Hiroshi Sakaue
- Department of Nutrition and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Fusako Teramoto
- Department of Clinical Nutrition, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama, Japan
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Combination of High Energy Intake and Intensive Rehabilitation Is Associated with the Most Favorable Functional Recovery in Acute Stroke Patients with Sarcopenia. Nutrients 2022; 14:nu14224740. [PMID: 36432427 PMCID: PMC9694182 DOI: 10.3390/nu14224740] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Energy intake and rehabilitation time individually contribute to the improvement of activities of daily living (ADL). This study aimed to investigate the additive effect of energy intake and rehabilitation time on ADL improvement in acute stroke patients with sarcopenia. The study included 140 patients (mean age 82.6 years, 67 men) with stroke. Energy intake during the first week of hospitalization was classified as “Sufficiency” or “Shortage” based on the reported cutoff value and rehabilitation time was classified as “Long” or “Short” based on the median. The study participants were categorized into four groups based on the combination of energy intake and rehabilitation time. The primary outcome was the gain of functional independence measure (FIM) motor during hospitalization. The secondary outcomes were length of stay and home discharge rates. Multivariate analysis was performed with primary/secondary outcomes as the dependent variable, and the effect of each group on the outcome was examined. Multivariate analysis showed that “long rehabilitation time and sufficient energy intake” (β = 0.391, p < 0.001) was independently associated with the gain of FIM motor items. The combination of high energy intake and sufficient rehabilitation time was associated with ADL improvement in acute stroke patients with sarcopenia.
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-de Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons. Sci Rep 2022; 12:10854. [PMID: 35760829 PMCID: PMC9237047 DOI: 10.1038/s41598-022-14502-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia, 31. C.P., 39340, Suances, Cantabria, Spain.,Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain
| | - Ana Fernández-Feito
- Departamento de Medicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Avda. Julián Clavería s/n C.P., 33006, Oviedo, Principado de Asturias, Spain. .,Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avda del Hospital Universitario, s/n. C.P., 33011, Oviedo, Principado de Asturias, Spain.
| | - David Cantarero
- Departamento de Economía, Universidad de Cantabria, Avda. de los Castros s/n C.P., 39005, Santander, Cantabria, Spain.,IDIVAL, Research Group of Health Economics and Health Services Management-Research Institute Marqués de Valdecilla C/ Cardenal Herrera Oria s/n., 39011, Santander, Cantabria, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - Joaquín Cayón-de Las Cuevas
- Departamento de Derecho Privado, Universidad de Cantabria, Avda. de los Castros s/n. C.P.,, 39005, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
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Knox S, Haas A, Downer B, Ottenbacher KJ. Association of Dementia Severity and Caregiver Support With Early Discharge From Home Health. Am J Alzheimers Dis Other Demen 2022; 37:15333175221129384. [PMID: 36242532 PMCID: PMC10581099 DOI: 10.1177/15333175221129384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The objective of this study was to examine the relationship between dementia severity and early discharge from home health. METHODS This was a retrospective study of 100% national Medicare home health da ta files (2016-2017). Multilevel logistic regression was used to study the relationship of dementia severity, caregiver support, and medication assistance with early discharge from home health. RESULTS The final cohort consisted of 91 302 Medicare beneficiaries with an ADRD diagnosis. A pattern of early discharge rates across dementia severity levels was not demonstrated. The relative risk for early discharge was lower for individuals who needed assistance with medication and for those with unmet caregiver needs. DISCUSSION The findings of this study do not support the hypothesis that dementia severity contributes to early discharge from home health. Further research is needed to fully understand key factors contributing to early discharge from home health.
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Affiliation(s)
- Sara Knox
- Medical University of South Carolina, Charleston, SC, USA
| | - Allen Haas
- University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- University of Texas Medical Branch, Galveston, TX, USA
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