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Ingvarsson E, Schildmeijer K, Hagerman H, Lindberg C. "Being the main character but not always involved in one's own care transition" - a qualitative descriptive study of older adults' experiences of being discharged from in-patient care to home. BMC Health Serv Res 2024; 24:571. [PMID: 38698451 PMCID: PMC11067295 DOI: 10.1186/s12913-024-11039-3] [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: 12/20/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The growing number of older adults with chronic diseases challenges already strained healthcare systems. Fragmented systems make transitions between healthcare settings demanding, posing risks during transitions from in-patient care to home. Despite efforts to make healthcare person-centered during care transitions, previous research indicates that these ambitions are not yet achieved. Therefore, there is a need to examine whether recent initiatives have positively influenced older adults' experiences of transitions from in-patient care to home. This study aimed to describe older adults' experiences of being discharged from in-patient care to home. METHODS This study had a qualitative descriptive design. Individual interviews were conducted in January-June 2022 with 17 older Swedish adults with chronic diseases and needing coordinated care transitions from in-patient care to home. Data were analyzed using inductive qualitative content analysis. RESULTS The findings indicate that despite being the supposed main character, the older adult is not always involved in the planning and decision-making of their own care transition, often having poor insight and involvement in, and impact on, these aspects. This leads to an experience of mismatch between actual needs and the expectations of planned support after discharge. CONCLUSIONS The study reveals a notable disparity between the assumed central role of older adults in care transitions and their insight and involvement in planning and decision-making.
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Affiliation(s)
- Emelie Ingvarsson
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
| | - Heidi Hagerman
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
| | - Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1 392 31, Kalmar, Växjö, Sweden
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Uchimura LYT, Figueiró MF, Silva DB, de Paiva LK, Chrispim PPM, Yonekura T. [Evidence of effectiveness of hospital transition care in the elderly: rapid systematic reviewEvidencia de la eficacia de la atención transitoria prestada a las personas mayores después de la hospitalización: revisión sistemática rápida]. Rev Panam Salud Publica 2023; 47:e143. [PMID: 37829577 PMCID: PMC10566530 DOI: 10.26633/rpsp.2023.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/27/2023] [Indexed: 10/14/2023] Open
Abstract
Objective To synthesize the evidence on the effectiveness of hospital transition care in the elderly to support decision-making. Method This rapid systematic review followed the recommendations of the Cochrane Rapid Reviews Methods Group. Studies were selected from the PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) databases using the following criteria: focus on the elderly as population; provision of hospital transition care as intervention; care as usual (non-transition care) as comparator; and effectiveness of the presence vs. absence of transition care as the outcome, with effectiveness defined as improvement in any evaluated parameter. Systematic reviews published in Portuguese, English, or Spanish, with or without meta-analysis, that assessed hospital transition care in elderly individuals were included. Studies lacking a description of the intervention and target population were excluded. Results Of the 207 identified reviews, 18 were included. The studies were conducted in 21 countries, with 10 studies conducted in Europe and one in Brazil. The effectiveness of care for the elderly was demonstrated through increased adherence to medication regimens, reduced adverse events and medication-related errors, improved functional status, reduced falls, and reduced healthcare costs. Conclusions Despite the evidence indicating the effectiveness of hospital transition care, further research is needed to develop more robust indicators of clinical improvement and integration into healthcare systems.
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Affiliation(s)
| | | | - Denila Bueno Silva
- Pesquisadora independenteSão Paulo (SP)BrasilPesquisadora independente, São Paulo (SP), Brasil.
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Winqvist I, Näppä U, Häggström M. Quality of care during rural care transitions: a qualitative study on structural conditions. BMC Nurs 2023; 22:262. [PMID: 37559083 PMCID: PMC10411022 DOI: 10.1186/s12912-023-01423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. METHODS We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care. RESULTS The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. CONCLUSIONS Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.
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Affiliation(s)
- Idun Winqvist
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden.
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden
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Stuck AK, Born S, Stuck AE, Kompis M. Potentially Inadequate Real-Life Speech Levels by Healthcare Professionals during Communication with Older Inpatients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4543. [PMID: 36901552 PMCID: PMC10001886 DOI: 10.3390/ijerph20054543] [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: 11/18/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aim of this study was to investigate real-life speech levels of health professionals during communication with older inpatients in small group settings. METHODS This is a prospective observational study assessing group interactions between geriatric inpatients and health professionals in a geriatric rehabilitation unit of a tertiary university hospital (Bern, Switzerland). We measured speech levels of health professionals during three typical group interactions (discharge planning meeting (n = 21), chair exercise group (n = 5), and memory training group (n = 5)) with older inpatients. Speech levels were measured using the CESVA LF010 (CESVA instruments s.l.u., Barcelona, Spain). A threshold of <60 dBA was defined as a potentially inadequate speech level. RESULTS Overall, mean talk time of recorded sessions was 23.2 (standard deviation 8.3) minutes. The mean proportion of talk time with potentially inadequate speech levels was 61.6% (sd 32.0%). The mean proportion of talk time with potentially inadequate speech levels was significantly higher in chair exercise groups (95.1% (sd 4.6%)) compared to discharge planning meetings (54.8% (sd 32.5%), p = 0.01) and memory training groups (56.3% (sd 25.4%), p = 0.01). CONCLUSIONS Our data show that real-life speech level differs between various types of group settings and suggest potentially inadequate speech levels by healthcare professionals requiring further study.
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Affiliation(s)
- Anna K. Stuck
- Department of Geriatrics, University of Bern, University Hospital Inselspital Bern, 3010 Bern, Switzerland
| | - Stephan Born
- Department of Geriatrics, University of Bern, University Hospital Inselspital Bern, 3010 Bern, Switzerland
| | - Andreas E. Stuck
- Department of Geriatrics, University of Bern, University Hospital Inselspital Bern, 3010 Bern, Switzerland
| | - Martin Kompis
- Department of ENT, Head and Neck Surgery, University of Bern, University Hospital Inselspital Bern, 3010 Bern, Switzerland
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Gaffney HJ, Hamiduzzaman M. Factors that influence older patients’ participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature. PLoS One 2022; 17:e0269840. [PMID: 35759474 PMCID: PMC9236261 DOI: 10.1371/journal.pone.0269840] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Engaging older adults in clinical communication is an essential aspect of high-quality elder care, patient safety and satisfaction in hospitals and GP clinics. However, the factors that influence older adults’ participation during their appointments with health professionals from the older patient’s perspective remain under-investigated.
Objectives
We aimed to fill this knowledge gap by reviewing research articles that have examined older patients’ involvement in clinical communication. In doing so, we hope to assist healthcare professionals and institutions in developing new strategies to improve older patients’ participation and engagement in clinical communication.
Methods
A systematic review of nine databases was conducted for studies reporting identified influences on older patients’ participation in clinical communication published from 2010. These studies were then subjected to thematic analysis for stratification.
Results
Twenty-one articles with a total of 36,797 participants were included and highlighted three major themes that influenced older patients’ participation in the clinical communication. The first theme identified includes accessibility to appointments, support, health information and person-centred care, highlighting that access to appointments, person centred care and health information significantly influences clinical communication participation. Relevant and understandable healthcare information identified that communication factors [i.e. tailored health information, health literacy and patient language barriers, and communication impairments] influences older patients’ participation. Older Patient perceptions of HCP credibility and trustworthiness highlighted how patient’s perceptions of health professionals influence their willingness to participate in clinical communications.
Conclusions and implications
This review demonstrates that there are several factors that contribute to insufficient or no participation of older patients in clinical communication in hospitals and GP clinics. These include accessibility to relevant and understandable health information, and the perceived health professional credibility and trustworthiness. Identifying ways to address these factors may improve patient participation, doctor-patient collaboration and overall health outcomes for older patients.
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Affiliation(s)
- Harry James Gaffney
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- * E-mail:
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Kraun L, De Vliegher K, Vandamme M, Holtzheimer E, Ellen M, van Achterberg T. Older peoples's and informal caregivers' experiences, views, and needs in transitional care decision-making: A systematic review. Int J Nurs Stud 2022; 134:104303. [DOI: 10.1016/j.ijnurstu.2022.104303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/05/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Aerens S, Lepoudre S, Verstappen L, Vanhoucke AL, Malfait S, Van Humbeeck L. Family participation in the care of older hospitalised patients: Patients', family caregivers' and nurses' preferences on family caregivers performing care tasks. Int J Older People Nurs 2021; 17:e12440. [PMID: 34923742 DOI: 10.1111/opn.12440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/04/2021] [Accepted: 12/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND It is estimated that there are 101 million older care-dependent people (60+). This group is expected to double by 2050 due to the ageing of the world's population and the rise in life expectancy. Although people tend to live longer, there is little evidence that they live their later years in better health. In the future, this might put even more stress on an already overburdened acute care health system. Hospitals therefore need to focus on preventive measures to avoid rehospitalisation of older people. Family participation could be part of the solution. OBJECTIVES This study aimed to gain insight into the preferences of family caregivers, patients and nurses towards family caregivers taking up care tasks during hospitalisation, after receiving education. METHODS Data were collected using a cross-sectional survey of nursing staff, family caregivers and older patients in nine wards for older people within three hospitals. Data collection ran from October 2019 till March 2020 using a questionnaire of 25 care tasks with three answer options (perform alone, together with a nurse, do not perform). A consecutive sample of 330 patients and 133 family caregivers (81 dyads could be formed) next to a convenience sample of 67 nurses was obtained. RESULTS Patients (65%) are more prepared to let their family caregiver perform tasks alone than family caregivers (59%) and nurses (52%). Only few patients (3.8%) and family caregivers (13%) prefer the family caregiver to perform a task together with a nurse. The latter answer thus rather dichotomously, while nurses answer more dynamically over the three answer options. Of all family caregivers, 50% indicate willingness and ability to perform tasks on a regular basis. Significant correlations indicate that patients, family caregivers and nurses agree on which care tasks would be more preferable to be performed by a family caregiver. Looking at the dyads, preferences of a patient are not suspected to be more similar with his family caregiver than with a random family caregiver. CONCLUSIONS Patients, FCGs and nurses indicate to be prepared to engage in family participation. Further research needs to concentrate on the different attitudes and perceptions towards performing care tasks through qualitative research and how a successful implementation can be set up. IMPLICATIONS FOR PRACTICE Our study indicates that implementation of family participation in physical care within the hospital could be viable. TRIAL REGISTRATION The study protocol was approved by the ethical committee of the Ghent University Hospital (B670201940430).
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Affiliation(s)
- Sander Aerens
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Shani Lepoudre
- Department of Psychogeriatric Medicine, AZ Damiaan, Ostend, Belgium
| | | | | | - Simon Malfait
- Strategic unit and Nursing Department, Ghent University Hospital, Ghent, Belgium
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Rognan SE, Kälvemark-Sporrong S, Bengtsson KR, Lie HB, Andersson Y, Mowé M, Mathiesen L. Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway. BMJ Open 2021; 11:e044850. [PMID: 34193483 PMCID: PMC8246347 DOI: 10.1136/bmjopen-2020-044850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge. DESIGN This is a qualitative case study. Data collection was done through qualitative observations of patient-HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis. SETTING An internal medicines ward at a university hospital in Norway. PARTICIPANTS Nine patients aged 49-90 years were included close to the day of discharge. RESULTS The analysis revealed the following themes: (1) patient-centred care (PCC), which included 'understanding and involvement in the patient-as-person', 'establishment of a therapeutic alliance', and 'sharing power and responsibility'; and (2) biomedical (conventional) care, including the subthemes 'HCPs in power and control' and 'optimising medical outcomes, following guidelines'. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued. CONCLUSIONS The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.
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Affiliation(s)
- Stine Eidhammer Rognan
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Oslo, Norway
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Sofia Kälvemark-Sporrong
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | | | | | - Yvonne Andersson
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Morten Mowé
- Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, University of Oslo, Oslo, Norway
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Erlang AS, Schjødt K, Linde JKS, Jensen AL. An observational study of older patients' experiences of involvement in discharge planning. Geriatr Nurs 2021; 42:855-862. [PMID: 34090231 DOI: 10.1016/j.gerinurse.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023]
Abstract
The discharge of older patients is complex and healthcare professionals focus more on organizational and coordinating tasks rather than on patient involvement. The study aims to describe older medical patients' experiences of involvement in discharge planning and to identify associations between their experiences of involvement and readmissions. This observational study included 210 older medical inpatients from a Danish university hospital. Data were collected from a questionnaire survey and the patients' medical records. Involvement was measured using the subscales: information, communication, participation, time of discharge, relatives & general impression. Most participants reported receiving the overall information needed before discharge. There was a lack of specific information, regarding medicine and symptoms. Fewer participants reported positively on participation. 23.8% of the participants were readmitted within 30 days. Longer hospitalization, comorbidities and less perceived information were associated with a higher risk of readmission. There were associations between patient involvement and the 30-day readmission rate.
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Affiliation(s)
- Anne Snoghøj Erlang
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark.
| | - Karina Schjødt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Jakob Kau Starup Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Annesofie Lunde Jensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
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Hansen TK, Jensen AL, Damsgaard EM, Rubak TMM, Jensen MEJ, Gregersen M. Involving frail older patients in identifying outcome measures for transitional care-a feasibility study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:36. [PMID: 34082836 PMCID: PMC8173811 DOI: 10.1186/s40900-021-00288-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND During care transitions, the older (75+) patient's agenda can easily be missed. To counteract this, involving patients in shared clinical decision making has proven to be of great value. Likewise, involving patients and other stakeholders as researchers is gaining ground. Patient and public involvement (PPI) in research entails many benefits, for example, by bringing further insight from those with lived experiences of being ill. There are various challenges associated with involving some older patients, for example frailty, cognitive impairment and other chronic illnesses. To the best of our knowledge, there are only a few examples of initiatives involving older patients beyond research participation. The feasibility of involving frail older patients during an ongoing care transition from hospital to primary health care remains unknown. To investigate the feasibility of including older frail patients, their relatives and health care professionals (HCPs) as co-researchers, we established a study with increasingly demanding levels of patient involvement to identify relevant outcome measures for future transitional care research. METHODS The study was a pragmatic, qualitative feasibility study. The involved individuals were frail older patients, their relatives and HCPs. Patients and their relatives were interviewed, while the interviewer made reflective notes. A thematic analysis was made. Relatives and HCPs discussed the themes to identify relevant outcome measures and potentially co-create new patient-reported outcome measures (PROMs) for use in future transitional care studies. The feasibility was evaluated according to six involvement steps. The level of involvement was evaluated using the five-levelled Health Canada Public Involvement Continuum (HCPIC). RESULTS In total, eight patients, five relatives and three HCPs were involved in the study. Patients were involved in discussing care transitions (HCPIC level 3), while some relatives were engaged (HCPIC level 4) in forming PROMs. The partnership level of involvement (HCPIC level 5) was not reached. The thematic analysis and the subsequent theme discussion successfully formed PROMs. The key PROMs were related to care, transparency and the relatives' roles in the transitional care process. CONCLUSIONS When applying a pragmatic involvement approach, frail older patients can be successfully involved in identifying relevant transitional care outcome measures; however, involving these patients as fellow researchers seems infeasible. To maintain involvement, supportive relatives are essential. Useful experiences for future research involvement of this vulnerable group were reported, arguing that patient participation has the potential to become inherent in future geriatric research.
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Affiliation(s)
- Troels Kjærskov Hansen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark.
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark.
| | - Annesofie Lunde Jensen
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | - Tone Maria Mørck Rubak
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
- ResCenPi - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. 'They just came with the medication dispenser'- a qualitative study of elderly service users' involvement and welfare technology in public home care services. BMC Health Serv Res 2021; 21:245. [PMID: 33740974 PMCID: PMC7977566 DOI: 10.1186/s12913-021-06243-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Public home care for the elderly is a key area in relation to improving health care quality. It is an important political goal to increase elderly people's involvement in their care and in the use of welfare technology. The aim of this study was to explore elderly service users' experience of user involvement in the implementation and everyday use of welfare technology in public home care services. METHOD This qualitative study has an explorative and descriptive design. Sixteen interviews of service users were conducted in five different municipalities over a period of six months. The data were analysed using reflexive thematic analysis. RESULTS Service users receiving public home care service are not a homogenous group, and the participants had different wishes and needs as regards user involvement and the use of welfare technology. The analysis led to four main themes: 1) diverse preferences as regards user involvement, 2) individual differences as regards information, knowledge and training, 3) feeling safe and getting help, and 4) a wish to stay at home for as long as possible. CONCLUSION The results indicated that user involvement was only to a limited extent an integral part of public home care services. Participants had varying insight into and interest in welfare technology, which was a challenge for user involvement. User involvement must be facilitated and implemented in a gentle way, highlighting autonomy and collaboration, and with the focus on respect, reciprocity and dialogue.
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Affiliation(s)
- Heidi Snoen Glomsås
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Mariann Fossum
- Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Postboks 509, N-4898, Grimstad, Norway
| | - Kristin Halvorsen
- Faculty of Health Sciences, Institute of Nursing and health promotion, Oslo Metropolitan University, Postbox 4, St. Olavs plass, N-0130, Oslo, Norway
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Pellet J, Weiss M, Zúñiga F, Mabire C. Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol. Pilot Feasibility Stud 2021; 7:71. [PMID: 33731212 PMCID: PMC7968193 DOI: 10.1186/s40814-021-00812-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions. METHODS This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses' teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients' activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission. DISCUSSION The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (ID: NCT04253665 ) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).
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Affiliation(s)
- Joanie Pellet
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Marianne Weiss
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Franziska Zúñiga
- Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Cedric Mabire
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Schjødt K, Erlang AS, Starup-Linde J, Jensen AL. Older hospitalised patients' experience of involvement in discharge planning. Scand J Caring Sci 2021; 36:192-202. [PMID: 33694211 DOI: 10.1111/scs.12977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/19/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Worldwide healthcare policy highlights patient involvement and participation. Older people with chronic diseases and comorbidities are in need of complex healthcare. Even though these issues have been highlighted, there is a need to investigate older patients' perspective on discharge planning in order to ensure quality in the healthcare system. AIM The aim was to explore how older medical patients experience their own involvement in discharge planning from a medical department. METHODOLOGICAL DESIGN A qualitative study using semi-structured interviews with 20 patients aged 60+. Interviews were conducted 1 week after discharge in the patients' homes. ETHICAL APPROVAL The study was approved by the Danish Data Protection Agency, and ethical principles were applied while the study was being conducted. All participants provided informed consent. RESULTS The participants had individual needs and various experiences of being involved in their discharge planning. One main category emerged from the study, "Different levels of rapport," as well as three subcategories, "A lot of information-mostly from healthcare professionals to patients," "The distribution of roles between healthcare professionals and patients" and "The meaning of having relatives." CONCLUSION The participants had various experiences and preferences based on their involvement in discharge planning. In general, older people wished to be involved in discharge planning. Healthcare professionals should thus be aware of the involvement levels of such patients and adjust nursing to these levels during hospitalisation.
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Affiliation(s)
- Karina Schjødt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Snoghøj Erlang
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annesofie Lunde Jensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,ResCenPi - Research Centre for Patient Involvement, Aarhus University & The Central Denmark, Aarhus, Denmark
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14
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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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15
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Casado T, Sousa L, Touza C. Older People's Perspective about Their Participation in Health Care and Social Care Services: A Systematic Review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:878-892. [PMID: 32967580 DOI: 10.1080/01634372.2020.1816591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 06/11/2023]
Abstract
Participation is a right and a key pillar of the active aging paradigm. This systematic review aimed to understand how older people's participation is conceptualized and to detail results regarding older people's perspective about their participation in the context of social and health care services. Twenty-one articles published between 1996 and 2015 were analyzed. The main findings suggested that diverse terminology is used to conceptualize older people's participation; however, all shared a vision of respecting a citizen's autonomy. Older people tend to have a paternalistic perspective although most seek more information and discussion on treatment options. Positive relations with providers enabled negotiation to address individual aspirations, though services tended to be pre-formatted suggesting low levels of adjustment to individual needs and aspirations. Thus, older people and those working with them need training in order to enable participation. In addition, services need to be more flexible to allow users to participate.
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Affiliation(s)
- Tatiana Casado
- Philosophy and Social Work Department, University of the Balearic Islands , Palma de Mallorca, Spain
| | - Liliana Sousa
- Department of Education and Psychology, CINTESIS.ua, University of Aveiro , Aveiro, Portugal
| | - Carmen Touza
- Department of Pedagogy and Specific Didactics, University of the Balearic Islands , Palma de Mallorca, Spain
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16
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Hedqvist AT, Pennbrant S, Karlsson M. Older persons and relatives' experience of coordinated care planning via a video meeting. Nurs Open 2020; 7:2047-2055. [PMID: 33072390 PMCID: PMC7544883 DOI: 10.1002/nop2.600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 07/10/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022] Open
Abstract
Aim The study aimed to describe coordinated care planning via a video meeting from the perspective of older persons and their relatives. Design A qualitative inductive research design was used to describe older persons and relatives’ experience of care planning via video meeting. Methods Eight unstructured interviews were conducted. Purposive sampling resulted in a sample of four older persons and four relatives. The material was analysed by qualitative content analysis. Results The theme being excluded illustrates how the older persons and their relatives experienced care planning via a video meeting as lack of a personal relationship, meaninglessness and lack of participation. The older persons and their relatives had a feeling of being excluded and in an unfamiliar situation. Lack of information about the meeting's structure and content impaired their ability to prepare for it beforehand, which led to uncertainty.
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Affiliation(s)
| | - Sandra Pennbrant
- Department of Health Sciences University West Trollhättan Sweden
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17
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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: 2.0] [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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18
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Olsson A, Berglöv A, Sjölund BM. "Longing to be independent again" - A qualitative study on older adults' experiences of life after hospitalization. Geriatr Nurs 2020; 41:942-948. [PMID: 32709373 DOI: 10.1016/j.gerinurse.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
It is important to support older adults' independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults' experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again" based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults' experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden.
| | | | - Britt-Marie Sjölund
- Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
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19
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Kumlin M, Berg GV, Kvigne K, Hellesø R. Elderly patients with complex health problems in the care trajectory: a qualitative case study. BMC Health Serv Res 2020; 20:595. [PMID: 32600322 PMCID: PMC7325247 DOI: 10.1186/s12913-020-05437-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients' perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. METHODS The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65-91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients' hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken. RESULTS Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory. CONCLUSIONS The patients' considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient's pace in the decision-making process may lead to a more appropriate level of health care in line with the patient's preferences and goals.
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Affiliation(s)
- Marianne Kumlin
- Inland Norway University of Applied Sciences, Elverum, Norway. .,Innlandet Hospital Trust, Lillehammer, Norway. .,Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Geir Vegar Berg
- Innlandet Hospital Trust, Lillehammer, Norway.,Department of Health Sciences, NTNU, Faculty of Medicine and Health Sciences, Gjøvik, Norway
| | - Kari Kvigne
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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20
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Menezes TMDO, Oliveira ALBD, Santos LB, Freitas RAD, Pedreira LC, Veras SMCB. Hospital transition care for the elderly: an integrative review. Rev Bras Enferm 2020; 72:294-301. [PMID: 31826223 DOI: 10.1590/0034-7167-2018-0286] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/31/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to identify evidence of scientific production on hospital transition care provided to the elderly. METHOD an integrative review, with publications search in the MEDLINE, PubMed, LILACS, BDENF, Index Psychology and SciELO databases, with keywords and Mesh terms: elderly, hospitalization, patient discharge, health of the elderly, and transitional care, between 2013 and 2017 in English, Portuguese and Spanish. The 14 selected articles analysis was carried out through exploratory and critical reading of titles, abstracts and results of the researches. RESULTS transitional care can prevent re-hospitalizations as they enable rehabilitation, promotion and cure of illnesses in the elderly. FINAL CONSIDERATIONS transitional care implies the improvement of the quality of life of the elderly person, requiring skilled health professionals who involve the family through accessible communication.
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21
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22
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Boge RM, Haugen AS, Nilsen RM, Bruvik F, Harthug S. Measuring discharge quality based on elderly patients' experiences with discharge conversation: a cross-sectional study. BMJ Open Qual 2020; 8:e000728. [PMID: 31909210 PMCID: PMC6937014 DOI: 10.1136/bmjoq-2019-000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 11/04/2022] Open
Abstract
Background Discharge conversation is an essential part of preparing patients for the period after hospitalisation. Successful communication during such conversations is associated with improved health outcomes for patients. Objective To investigate the association between discharge conversation and discharge quality assessed by measuring elderly patients’ experiences. Methods In this cross-sectional study, we surveyed all patients ≥65 years who had been discharged from two medical units in two hospitals in Western Norway 30 days prior. We measured patient experiences using two previously validated instruments: The Discharge Care Experiences Survey Modified (DICARES-M) and The Nordic Patient Experiences Questionnaire (NORPEQ). We examined differences in characteristics between patients who reported having a discharge conversation with those who did not, and used regression analyses to examine the associations of the DICARES-M and NORPEQ with the usefulness of discharge conversation. Results Of the 1418 invited patients, 487 (34%) returned the survey. Their mean age was 78.5 years (SD=8.3) and 52% were women. The total sample mean scores for the DICARES-M and NORPEQ were 3.9 (SD=0.7, range: 1.5–5.0) and 4.0 (SD=0.7, range: 2.2–5.0), respectively. Higher DICARES-M and NORPEQ scores were found for patients who reported having a discharge conversation (74%) compared with those who did not (15%), or were unsure (11%) whether they had a conversation (p<0.001). Patients who considered the conversation more useful had significantly higher scores on both the DICARES-M and NORPEQ (p<0.001). Conclusions Reported discharge conversation at the hospital was correlated with positive patient experiences measurements indicating the increased quality of hospital discharge care. The reported usefulness of the conversation had a significant association with discharge care quality.
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Affiliation(s)
- Ranveig Marie Boge
- Department of Clinicial sciences, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
| | - Frøydis Bruvik
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Research, University of Bergen, Bergen, Hordaland, Norway
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23
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Boye LK, Mogensen CB, Mechlenborg T, Waldorff FB, Andersen PT. Older multimorbid patients' experiences on integration of services: a systematic review. BMC Health Serv Res 2019; 19:795. [PMID: 31690308 PMCID: PMC6833141 DOI: 10.1186/s12913-019-4644-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. Methods A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. Inclusion criteria: studies exploring patients’ point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. Results Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. Conclusions Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.
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Affiliation(s)
- Lilian Keene Boye
- University Hospital of Southern Jutland, Kresten Philipsens vej 15, indgang F, 6200, Aabenraa, Denmark. .,Focused Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Emergency Department, University Hospital of Southern Jutland, Jutland, Denmark.
| | - Christian Backer Mogensen
- University Hospital of Southern Jutland, Kresten Philipsens vej 15, indgang F, 6200, Aabenraa, Denmark.,Focused Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Emergency Department, University Hospital of Southern Jutland, Jutland, Denmark
| | - Tine Mechlenborg
- Kong Christian X's Gigthospital, Toldbodgade 3, 6300, Gråsten, Denmark.,Focused Research Unit in Rheumatic, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, 5000, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Research Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700, Esbjerg, Denmark
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24
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Boge RM, Haugen AS, Nilsen RM, Bruvik F, Harthug S. Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey. PLoS One 2019; 14:e0223150. [PMID: 31557232 PMCID: PMC6762102 DOI: 10.1371/journal.pone.0223150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Discharge Care Experiences Survey (DICARES) was previously developed to measure quality of discharge care in elderly patients (≥ 65 years). The objective of this study was to test the factorial validity of responses of the DICARES, and to investigate its association with existing quality indicators. Methods We conducted a cross-sectional study at two hospitals in Bergen, Western Norway. A survey, including DICARES, was sent by postal mail to 1,418 patients 30 days after discharge from hospital. To test the previously identified three-factor structure of the DICARES we applied a first order confirmatory factor analysis with corresponding fit indices and reliability measures. Spearman’s correlation coefficients, and linear regression, was used to investigate the association of DICARES scores with the quality indicators Nordic Patient Experiences Questionnaire and emergency readmission within 30 days. Results A total of 493 (35%) patients completed the survey. The mean age of the respondents was 79 years (SD = 8) and 52% were women. The confirmatory factor analysis showed acceptable fit. Cronbach’s α between items within factors was 0.82 (Coping after discharge), 0.71 (Adherence to treatment), and 0.66 (Participation in discharge planning). DICARES was moderately correlated with the Nordic Patient Experiences Questionnaire (rho = 0.49, P < 0.001). DICARES overall score was higher in patients with no readmissions compared to those who were emergency readmitted within 30 days (P < 0.001), indicating that more positive experiences were associated with fewer readmissions. Conclusions DICARES appears to be a feasible instrument for measuring quality of discharge care in elderly patients (≥ 65 years). This brief questionnaire seems to be sensitive with regard to readmission, and independent of comorbidity. Further studies of patients’ experiences are warranted to identify elements that impact on discharge care in other patient groups.
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Affiliation(s)
- Ranveig Marie Boge
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Frøydis Bruvik
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Bergen, Norway
| | - Stig Harthug
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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25
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Murray J, Hardicre N, Birks Y, O'Hara J, Lawton R. How older people enact care involvement during transition from hospital to home: A systematic review and model. Health Expect 2019; 22:883-893. [PMID: 31301114 PMCID: PMC6803411 DOI: 10.1111/hex.12930] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/02/2019] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Current models of patient‐enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to ‘reach‐in’ to complex health‐care systems. Objective To develop a dynamic and interactional model of patient‐enacted involvement in care. Search strategy Electronic search strategy run in five databases and adapted to run in an Internet search engine supplemented with searching of reference lists and forward citations. Inclusion criteria Qualitative empirical published reports of older people's experiences of care transitions from hospital to home. Data extraction and synthesis Reported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding leads to the development of a new framework and thereafter a model representing changing states of involvement. Main results Patients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health‐care professionals as they attempt to resolve health‐ and well‐being‐related goals. ‘Non‐involvement’, ‘information‐acting’, ‘challenging and chasing’ and ‘autonomous‐acting’ were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion leads patients to act autonomously, creating the potential to cause harm. Discussion and conclusion The model suggests that involvement is highly challenging for older people during care transitions. Going forward, interventions which seek to support patient involvement should attempt to address the dynamic states of involvement and their mediating factors.
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Affiliation(s)
- Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Natasha Hardicre
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Jane O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK.,Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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26
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Holmqvist KL, James I. Patient participation in municipal elderly care from the perspective of nurses and occupational therapists. Nurs Open 2019; 6:1171-1179. [PMID: 31367443 PMCID: PMC6650693 DOI: 10.1002/nop2.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/01/2019] [Accepted: 05/07/2019] [Indexed: 11/05/2022] Open
Abstract
AIM The aim of this study was to describe how nurses and occupational therapists in municipal care of older people define and implement patient participation in their daily work. DESIGN This study had a cross-sectional design. Data were collected using an online questionnaire. METHODS The questionnaire had both closed and open-ended questions. One-hundred and fourteen nurses and occupational therapists responded. Data were analysed with descriptive statistics and thematic analysis. RESULTS Two main themes were identified as follows: "The professionals' perspective at the centre - Patient participation to enhance compliance" and "The patients' perspective at the centre - Patient participation as an ongoing process." The themes covered a continuum. On one extreme, patient participation was equated with making the patient comply with what the professionals wanted to do. On the other extreme, all power was transferred to the patient. The first theme was restricted to the decision-making process. The second theme covered the entire care or, rehabilitation, process.
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Affiliation(s)
- Kajsa Lidström Holmqvist
- Faculty of Medicine and Health, University Health Care Research CenterÖrebro UniversityÖrebroSweden
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
| | - Inger James
- Faculty of Medicine and Health, School of Health SciencesÖrebro UniversityÖrebroSweden
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27
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons' experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary. BMC Health Serv Res 2019; 19:224. [PMID: 30975144 PMCID: PMC6460679 DOI: 10.1186/s12913-019-4035-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background Researchers have shown that hospitalisation can decrease older persons’ ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons’ experiences adapting to daily life at home after hospital discharge. Methods A metasummary of qualitative findings using Sandelowski and Barroso’s method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. Results Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. Conclusions The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4035-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Elderly patients' (≥65 years) experiences associated with discharge; Development, validity and reliability of the Discharge Care Experiences Survey. PLoS One 2018; 13:e0206904. [PMID: 30403738 PMCID: PMC6221326 DOI: 10.1371/journal.pone.0206904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A review of the literature reveals a lack of validated instruments that particularly measure quality in the hospital discharge process. This study aims to develop and validate a survey instrument feasible for measuring quality (≥65 years) related to the discharge process based on elderly patients' experiences. METHODS Construction of the Discharge Care Patient Experience Survey (DICARES) was based on 16 items identified by literature reviews. Intraclass correlation for test-retest was applied to assess consistency of the survey. Explorative factors analysis was applied to identify and validate the factor structures of the DICARES. Cronbach's α was used to assess internal reliability. To evaluate the external validity of the final DICARES questionnaire the patients' scores were correlated with scores obtained from the three other questionnaires; the Nordic Patient Experiences Questionnaire, the 12-Item Short-Form Health Survey and Subjective Health Complaints. The DICARES association with readmissions was examined. RESULTS A total of 270 patients responded (64.4%). The mean age of participants was 77.1 years and 57.8% were men. The exploratory factor analysis resulted in a 10-item instrument consisting of three factors explaining 63.5% of the total variance. The Cronbach's α were satisfactory (≥70). Overall intraclass correlation was 0.76. A moderate Spearman correlation (rho = 0.54, p <0.01) was found between the total mean DICARES score and total mean score of the Nordic Patient Experiences Questionnaire. The total mean DICARES score was inversely associated with the quality indicator based on readmissions (OR 0.62, CI 95: 0.41-0.95, p = 0.028). CONCLUSION We have developed a 10-item questionnaire consisting of three factors which may be a feasible instrument for measuring quality of the discharge process in elderly patients. Further testing in a wider population should be carried out before implementation in health care settings.
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Durocher E, Kinsella EA, Gibson BE, Rappolt S, Ells C. Engaging older adults in discharge planning: case studies illuminating approaches adopted by family members that promote relational autonomy. Disabil Rehabil 2018; 41:3005-3015. [PMID: 30298744 DOI: 10.1080/09638288.2018.1483430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Discharge decisions have significant implications for older adults and their involved family members. Evidence of older adult and family members' engagement in discharge decision-making, however, varies widely. Some recent work shows assumed associations between ageing, diminished participation in healthcare decision-making and increased reliance on family members. Other research suggests that family members adopt strategies to promote older adults' participation in decision-making. Relational autonomy theory suggests that individuals have differing levels of autonomy and that individuals' agency can be supported (or marginalized) by others.Purpose: Using three case studies, we examine traditional and relational conceptions of autonomy and explore how relational approaches could inform healthcare practice.Methods: Taking a critical feminist bioethics perspective, we present a secondary analysis of three microethnographic case studies focused on discharge planning with older adults in one Canadian inpatient rehabilitation setting. The data consist of observations of discharge planning family conferences and semi-structured interviews with older adults and family members.Results: Tensions between older adults' wishes to return home and their diminished participation in discharge decisions, and family members' assumption of a primary role in discharge decision-making and their wish for the older adult to move to a supported setting were apparent. To reconcile these tensions, the older adults' family members in these cases employed strategies to promote older adults' participation in decision-making that were consistent with relational autonomy theory.Conclusion and implications for practice: The analysis suggests that older adults' participation in discharge decision-making processes could be better promoted through relational approaches.Implications for rehabilitation • Adopting an approach guided by relational autonomy might better enable patients to participate in decision-making than would an approach guided by traditional conceptions of autonomy. • Rehabilitation professionals could seek assistance from family members and guide them toward collaborative partnerships. • A range of strategies may be employed to customize relational approaches to enhance autonomy: • having several different conversations with patients to enable multiple chances to contribute knowledge and views; • involving family members or taking the time to explain information several different times and in diverse manners; • showing patients videos or photos of discharge locations; • exploring a breadth of potential discharge options; • accompanying patients to visit different options in person; and • getting patients in touch with individuals who have made similar choices. • It is recognized that taking a relational approach might be time-consuming and that practice contexts may not be conducive to such practice.
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Affiliation(s)
- Evelyne Durocher
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Elizabeth Anne Kinsella
- School of Occupational Therapy & Occupational Science Field, Western University, London, Canada.,Department of Women?s Studies and Feminist Research, Western University, London, Canada
| | - Barbara E Gibson
- Department of Physical Therapy, University of Toronto, Toronto, Canada.,Bloorview Research Institute, Toronto, Canada
| | - Susan Rappolt
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Carolyn Ells
- Department of Medicine, Biomedical Ethics Unit, McGill University, Montreal, Canada
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Kvæl LAH, Debesay J, Langaas A, Bye A, Bergland A. A Concept Analysis of Patient Participation in Intermediate Care. PATIENT EDUCATION AND COUNSELING 2018; 101:1337-1350. [PMID: 29551564 DOI: 10.1016/j.pec.2018.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/01/2018] [Accepted: 03/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Although the concept of patient participation has been discussed for a number of years, there is still no clear definition of what constitutes the multidimensional concept, and the application of the concept in an intermediate care (IC) context lacks clarity. Therefore this paper seeks to identify and explore the attributes of the concept, to elaborate ways of understanding the concept of patient participation for geriatric patients in the context of IC. METHODS Walker and Avant's model of Concept analysis [1] based on a literature review. RESULTS Patient participation in the context of IC can be defined as a dynamic process emphasizing the person as a whole, focusing on the establishment of multiple alliances that facilitate individualized information and knowledge exchange, and ensuring a reciprocal engagement in activities within flexible and interactive/dynamic organizational structures. CONCLUSION Patient participation in IC means involving patients and their relatives in holistic interdisciplinary collaborative decision-making. The results highlight the complexity of patient participation and contribute to a greater understanding of the influence of organizational structure and management. PRACTICAL IMPLICATIONS The present study may provide a practical framework for researchers, policy makers and health professionals to facilitate patient participation in IC services.
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Affiliation(s)
- Linda Aimée Hartford Kvæl
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway.
| | - Jonas Debesay
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Anne Langaas
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
| | - Asta Bye
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway; Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Astrid Bergland
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
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Høy B, Ludvigsen MS. Older adults' experiences of patient involvement in transitional care: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:860-866. [PMID: 29634511 DOI: 10.11124/jbisrir-2017-003440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify and synthesize older adult's experiences of patient involvement in transitional care between hospital and home. The purpose is to build theory to inform future research and clinical practice.The review will specifically address the following research questions.
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Affiliation(s)
- Bente Høy
- Independent Senior Researcher
- Randers Regional Hospital, Randers, Denmark
| | - Mette Spliid Ludvigsen
- Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence
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Redley B, McTier L, Botti M, Hutchinson A, Newnham H, Campbell D, Bucknall T. Patient participation in inpatient ward rounds on acute inpatient medical wards: a descriptive study. BMJ Qual Saf 2018; 28:15-23. [PMID: 29475980 PMCID: PMC6860730 DOI: 10.1136/bmjqs-2017-007292] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/26/2017] [Accepted: 01/28/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Meaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs. OBJECTIVE Describe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services. METHODS Naturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience sampling, a stratified sample of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing diverse participation preferences: active control where the patient makes decisions; shared control where the patient prefers to make decisions jointly with clinicians; and passive control where the patient prefers clinicians make decisions. RESULTS Of the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients' participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds; and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity, that contributed to patient participation or non-participation in ward rounds. CONCLUSIONS Participation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
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Affiliation(s)
- Bernice Redley
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research- MonashHealth Partnership, Monash Health, Clayton, Victoria, Australia
| | - Lauren McTier
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Epworth HealthCare, Richmond, Victoria, Australia
| | - Alison Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research- MonashHealth Partnership, Monash Health, Clayton, Victoria, Australia
| | - Harvey Newnham
- General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Donald Campbell
- General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research-Alfred Partnership, Alfred Health, Melbourne, Victoria, Australia
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Sykes S, Baillie L, Thomas B, Scotter J, Martin F. Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation. Int J Integr Care 2017; 17:3. [PMID: 29588636 PMCID: PMC5853909 DOI: 10.5334/ijic.3055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/11/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. THEORY AND METHODS The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n = 49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n = 44) and post (n = 47) course and interviews (n = 9) 2-5 months later. RESULTS Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. CONCLUSIONS AND DISCUSSION An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home.
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Affiliation(s)
- Susie Sykes
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Lesley Baillie
- School of Health, Wellbeing and Social Care, Open University, Walton Hall, Milton Keynes, MK7 6AA, GB
| | - Beth Thomas
- Simulation and Interactive Learning (SaIL) Centre, Guy’s and St Thomas’ NHS Foundation Trust, GB
| | - Judy Scotter
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Fiona Martin
- Clever Together, 2 Primrose Street, London, EC2A 2EX, GB
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Johannessen AK, Tveiten S, Werner A. User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions. Scand J Caring Sci 2017; 32:815-823. [PMID: 28833351 DOI: 10.1111/scs.12512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 07/05/2017] [Indexed: 12/01/2022]
Abstract
User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short-time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street-level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision-makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.
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Affiliation(s)
- Anne-Kari Johannessen
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Sidsel Tveiten
- Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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Macmillan TH. Hospital discharge: lost opportunities to promote or maintain older people’s mental health. QUALITY IN AGEING AND OLDER ADULTS 2016. [DOI: 10.1108/qaoa-06-2015-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore the impact of hospital discharge on the wider wellbeing of older people, drawing out implications this can have on mental health.
Design/methodology/approach
This paper is based on research from the Healthwatch England Special Inquiry into hospital discharge. The paper focuses on the experiences of 1,300 older people, with the majority of the research being undertaken by the local Healthwatch network. The 58 local Healthwatch who submitted evidence on the experiences of older people as part of the inquiry were autonomous in how they were able to carry out the research, with results being analysed through use of a qualitative framework.
Findings
Older people often felt they were not ready for discharge due to not feeling involved in planning of their discharge, being discharged without the information they need and having difficulties accessing aftercare support. This paper examines the impact these issues can have on the mental health and wellbeing of older people, their carers and specifically patients with dementia both during and after discharge from hospital. Through examination of these issues the discharge process can be viewed from the perspective of the individual, and start to conceptualise where the hospital discharge process could further support older people’s mental health and wellbeing.
Research limitations/implications
This paper examines these issues in detail through case studies collected regarding older people, and exposes the impact poor discharge can have on physical and mental wellbeing for older patients. The paper presents a number of issues which have implications for policy and practice in both health and social care, and the integration of the two services.
Originality/value
This is the first Special Inquiry conducted by Healthwatch England in conjunction with the local Healthwatch network and presents a large scale piece of research led by the experiences of older people.
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Nyborg I, Kvigne K, Danbolt LJ, Kirkevold M. Ambiguous participation in older hospitalized patients: gaining influence through active and passive approaches-a qualitative study. BMC Nurs 2016; 15:50. [PMID: 27563281 PMCID: PMC4997666 DOI: 10.1186/s12912-016-0171-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 08/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Patient participation is required by law in Norway and in several western countries. Current participation ideology is based on individualism, which may conflict with the older generation’s commonly held values of solidarity and community. Hence, different values and ideologies may come in conflict when older patients receive treatment and rehabilitation in geriatric wards. Participation is a guiding principle in rehabilitation. Criteria for admission of older patients to geriatric wards are complex health problems, acute illness and/or acute physical and/or cognitive functional failure. The ideal is an active and engaged patient. The aim of the study was to describe the difficulties experienced by older patients on acute geriatric wards when involving themselves with their own treatment and care. Methods In this qualitative study older patients were interviewed during hospitalization in geriatric wards and asked to tell about their experiences with participation. Data analysis was conducted using a phenomenological hermeneutic method. Results The patients experienced difficulties in participating in decisions and care. They linked their difficulties to their own diminishing capabilities, and cited the ward’s busy schedule as a reason for abstaining from participation. However, despite their reservations, they did participate in decisions in different ways. Their participatory practices appeared ambiguous and they employed various strategies to put themselves in a position of influence. The most important of these involved their relatives. The patients delegated to family the tasks of seeking, receiving and giving information to the nurses and the staff, and, to some extent, for the dialogues with hospital staff about their needs and plan of care. The family appeared to accept the responsibility willingly. Conclusions The patients addressed their difficulties by authorizing family members to act and participate on their behalf. This underlines the family’s important role in patient participation and the role that nurses and other staff must play in collaborating with the patient and their family to facilitate participation independently of the patients’ performances of participation.
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Affiliation(s)
- Ingrid Nyborg
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway ; Innlandet Hospital Trust, Kyrre Grepps gate 11, N- 2819 Gjøvik, Norway
| | - Kari Kvigne
- Hedmark University of Applied Sciences, Department of Nursing, P.O Box 400, N-2418 Elverum, Norway ; Nord University, Department of Nursing and Health, Sandnessjøen, Norway
| | - Lars Johan Danbolt
- Norwegian School of Theology, Majorstuen, P.O. Box 5144, N-0302 Oslo, Norway ; Director of The Center for the Psychology of Religion, Innlandet Hospital Trust, P.O. Box 68, N-2312 Ottestad, Norway
| | - Marit Kirkevold
- Institute of Health and Society, University of Oslo, Blindern, P.O. Box 1130, NO-0318 Oslo, Norway
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Abstract
ABSTRACTReturning home or moving to a more supportive setting upon discharge from inpatient health-care services can have a tremendous impact on the lives of older adults and their families. Institutional concerns with patient safety and expedience can overshadow health-care professionals' commitments to collaborative discharge planning. In light of many competing demands and agendas, it can be unclear what is driving discharge-planning processes and outcomes. This paper presents the results of a study examining discharge planning in an older adult rehabilitation unit in a Canadian urban setting. Using microethnographic case studies, we explored the perspectives of older adults, family members and health-care professionals. Drawing on concepts of relational autonomy to guide the analysis, we found that discourses of ageing-as-decline, beliefs privileging health-care professionals' expertise and conventions guiding discharge planning intersected to marginalise older adult patients in discharge-planning decision making. Discharge planning in the research setting was driven by norms of ‘protecting physical safety’ at the expense of older adults’ self-declared interests and values. Such practices resulted in frequent recommendations of 24-hour care, which have significant personal, social and financial implications for older adults and their families, and ultimately might undermine clients' or health-care systems' aims. The analysis revealed social, political and institutional biases that diminish the rights and autonomy of older adults.
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Gabay G. Exploring perceived control and self-rated health in re-admissions among younger adults: A retrospective study. PATIENT EDUCATION AND COUNSELING 2016; 99:800-806. [PMID: 26626068 DOI: 10.1016/j.pec.2015.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Although health promotion calls for patient empowerment, it is not integrated in reducing re-admissions. This study examines the link among patient perceived control, self-rated health and fewer hospital re-admissions. METHODS An empirical explorative retrospective cross-sectional study with 208 respondents aged 40-65 with poor health and identical health plans. All measures hold good psychometric properties. RESULTS Self-rated health was strongly related to fewer re-admissions. Perceived control moderated the relationship between self-rated health and fewer re-admissions. Perceived control and self-rated health, together, contributed 5.2% to the variance in re-admissions. CONCLUSION Perceived control and perceived health status each explained a different share of the variance of re-admissions. Together, these perceptions reduced re-admissions by .40. Patient-clinician communication upon discharge may be a new direction to reduce re-admissions, improve delivery of care and promote health. PRACTICE IMPLICATIONS To reduce re-admissions, managements need to invest in restructuring the patient discharge process. A physician-patient dialogue shaping patient perceptions about their health status, perceived room for health improvement, and available internal and external resources may make a difference. Findings stress the need to allocate more time and resources for discharge communication processes and for physician training on psycho-social skills that may empower patients upon discharge.
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Affiliation(s)
- Gillie Gabay
- Head of Systemic Organizational Development, School of Behavioral Studies, College of Management Academic Studies, 7 Rabin Boulevard, Rishon Letzion 91750, Israel.
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Algilani S, James I, Kihlgren A. Experiencing Participation in Health Care: “Through the Eyes of Older Adults”. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.61007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients' needs and preferences during care transition, professionals must understand their experiences. OBJECTIVE The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services. METHODS The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals' experiences during care transition. RESULTS Two complementary themes emerged during the analysis: "Participation depends on being invited to plan the care transition" and "Managing continuity of care represents a complex and challenging process". DISCUSSION Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important resources, which illustrate the importance of making their voice heard. Older patients are therefore likely to benefit from more intensive support. A tailored, patient-centered follow-up of each patient is suggested to ensure that patient preferences and continuity of care to adhere to the new situation.
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Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway
- Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway
- Correspondence: Else Cathrine Rustad, Stord/Haugesund University College, Klingenbergvegen 8, N-5414 Stord, Norway, Email
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Seiger Cronfalk
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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Dyrstad DN, Testad I, Storm M. Older patients' participation in hospital admissions through the emergency department: an interview study of healthcare professionals. BMC Health Serv Res 2015; 15:475. [PMID: 26486306 PMCID: PMC4617984 DOI: 10.1186/s12913-015-1136-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patient participation is an important aspect of healthcare quality and may be one way to improve the quality of transitional care for older patients. Research reveals minimal awareness about patient participation in hospital admissions. Hospital admissions require attention to individuals' specific needs beyond patient frailty, and to involve patients and their families in shared decision-making. The aim of this study was to identify factors influencing patient participation by exploring healthcare professionals' views on patient participation during the hospital admission of older patients through the emergency department (ED). METHODS The study used a qualitative and descriptive design with face-to-face interviews. A total of 27 interviews were conducted with 15 healthcare professionals from one hospital and 12 from another. The data were analyzed using systematic text condensation. RESULTS Healthcare professionals thought that patient participation in hospital admissions was influenced by five main factors: 1) routine treatment and care during hospital admission, and in particular certain procedures such as medical examinations; 2) the frail and thankful older patients, and the overall picture of their medical needs; 3) hospital resources, such as available staff and beds; 4) healthcare professionals' attitude towards finding out about older patients' experiences; and 5) the presence of a supportive and demanding next of kin acting as an advocate for the patient. CONCLUSIONS Patient participation in hospital admissions of older patients is dependent on the way the service is organized, the patients' condition, hospital resources, healthcare professionals' attitudes, and support from patients' next of kin. Some of the participants had high expectations of themselves and actively involved patients, but others did not find patient participation relevant in the emergency department. Some used crowded wards as a reason not to engage older patients in their own care.
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Affiliation(s)
- Dagrunn Nåden Dyrstad
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
| | - Ingelin Testad
- Centre for Age-Related Medicine, SESAM, Stavanger University Hospital, Stavanger, Norway.
| | - Marianne Storm
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
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Vat M, Common C, Laizner AM, Borduas C, Maheu C. Reasons for returning to the emergency department following discharge from an internal medicine unit: perspectives of patients and the liaison nurse clinician. J Clin Nurs 2015; 24:3605-14. [PMID: 26467172 DOI: 10.1111/jocn.13011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To understand the patients' reasons for returning to the emergency department soon after their discharge from an internal medicine unit and to compare these reasons with the liaison nurse clinician's risk assessment tools used for discharge planning. BACKGROUND Returns to the emergency departments soon after discharge from the hospital are a recurrent problem. Factors precipitating readmission to hospital have been analysed through the lens of health care providers, but few studies have explored the patients' perspectives on their reasons for returning to the emergency departments. DESIGN A qualitative, descriptive study. METHODS Semi-structured interviews were conducted with a convenience sample of eight patients recruited from a major teaching hospital in Montreal, Canada. Three different data sources were triangulated: patients' perspectives obtained through interviews and data from the tools used by the liaison nurse clinician, the Bounceback Probability Legend and the LACE Index Scoring Tool. RESULTS Most patients attributed their return to the emergency department on being discharged too soon, feeling weak at discharge, having limited help at home with managing chronic illnesses and insufficient discharge instructions. participants' reasons for returning differed from those predicted by the liaison nurse clinician's evaluation using the risk assessment tools of each participant's risk of return. CONCLUSIONS This study highlights patients' frailty upon discharge from the hospital and their informational need on their health condition and their support need to rely on during convalescence at home. Patient's readiness and concerns were not integrated as part of the liaison nurse clinician's evaluation tools for discharge planning. This led to discrepancies between the perspectives of the patients and the liaison nurse clinician about discharge planning. RELEVANCE TO CLINICAL PRACTICE Health care professionals should evaluate patients' understanding of their illness, their readiness for self-management and work collaboratively with patients to assess concerns before discharge, so that appropriate support can be mobilised to prevent readmission.
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Affiliation(s)
- Molywan Vat
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Carol Common
- MUHC - adult sites, McGill University Health Centre, Montreal, QC, Canada
| | - Andrea Maria Laizner
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,MUHC Research Institute, Montreal, QC, Canada
| | - Coralie Borduas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Christine Maheu
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
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Andreasen J, Lund H, Aadahl M, Sørensen EE. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital. Int J Qual Stud Health Well-being 2015; 10:27370. [PMID: 26037333 PMCID: PMC4452652 DOI: 10.3402/qhw.v10.27370] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. METHODS The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. RESULTS Four main categories were identified: "The system," "Keeping a social life," "Being in everyday life," and "Handling everyday life." These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. CONCLUSION AND DISCUSSION Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.
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Affiliation(s)
- Jane Andreasen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark;
| | - Hans Lund
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Centre for Knowledge Based Practice, Bergen University College, Bergen, Norway
| | - Mette Aadahl
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup Hospital, Glostrup, Denmark
| | - Erik E Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Gabrielsson-Järhult F, Nilsen P. On the threshold: older people's concerns about needs after discharge from hospital. Scand J Caring Sci 2015; 30:135-44. [DOI: 10.1111/scs.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Per Nilsen
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Dyrstad DN, Laugaland KA, Storm M. An observational study of older patients' participation in hospital admission and discharge--exploring patient and next of kin perspectives. J Clin Nurs 2015; 24:1693-706. [PMID: 25727777 DOI: 10.1111/jocn.12773] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore older patients' participation during hospital admission and discharge. BACKGROUND Patient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa. DESIGN This study adopts a participant observational research design. METHODS Participant observations of 41 older patients (over 75 years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes. RESULTS Varying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision-making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients' health conditions and preferences also influence participation. CONCLUSIONS Several issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient's preferences and their capacity to participate. RELEVANCE TO CLINICAL PRACTICE Study findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients' participation in hospital admission and discharge.
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Affiliation(s)
- Dagrunn N Dyrstad
- Department of Health Studies, Faculty of social Sciences, University of Stavanger, Stavanger, Norway.,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | | | - Marianne Storm
- Department of Health Studies, Faculty of social Sciences, University of Stavanger, Stavanger, Norway
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Hvalvik S, Dale B. The Transition from Hospital to Home: Older People’s Experiences. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojn.2015.57066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bångsbo A, Dunér A, Lidén E. Patient participation in discharge planning conference. Int J Integr Care 2014; 14:e030. [PMID: 25411572 PMCID: PMC4236306 DOI: 10.5334/ijic.1543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/02/2014] [Accepted: 10/09/2014] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION There is a need for individualized discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by Harré & van Langenhove. METHODS The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008-2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings. RESULTS Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning. CONCLUSIONS The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation.
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Affiliation(s)
- Angela Bångsbo
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dunér
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Eva Lidén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bragstad LK, Kirkevold M, Foss C. The indispensable intermediaries: a qualitative study of informal caregivers' struggle to achieve influence at and after hospital discharge. BMC Health Serv Res 2014; 14:331. [PMID: 25078610 PMCID: PMC4119054 DOI: 10.1186/1472-6963-14-331] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 07/22/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The care policy and organization of the care sector is shifting to accommodate projected demographic changes and to ensure a sustainable model of health care provision in the future. Adult children and spouses are often the first to assume care giving responsibilities for older adults when declining function results in increased care needs. By introducing policies tailored to enabling family members to combine gainful employment with providing care for older relatives, the sustainability of the future care for older individuals in Norway is more explicitly placed on the family and informal caregivers than previously. Care recipients and informal caregivers are expected to take an active consumer role and participate in the care decision-making process. This paper aims to describe the informal caregivers' experiences of influencing decision-making at and after hospital discharge for home-bound older relatives. METHODS This paper reports findings from a follow-up study with an exploratory qualitative design. Qualitative telephone interviews were conducted with 19 informal caregivers of older individuals discharged from hospital in Norway. An inductive thematic content analysis was undertaken. RESULTS Informal caregivers take on comprehensive all-consuming roles as intermediaries between the care recipient and the health care services. In essence, the informal caregivers take the role of the active participant on behalf of their older relative. They describe extensive efforts struggling to establish dialogues with the "gatekeepers" of the health care services. Achieving the goal of the best possible care for the care recipient seem to depend on the informal caregivers having the resources to choose appropriate strategies for gaining influence over decisions. CONCLUSIONS The care recipients' extensive frailty and increasing dependence on their families coupled with the complexity of health care services contribute to the perception of the informal caregivers' indispensable role as intermediaries. These findings accentuate the need to further discuss how frail older individuals and their informal caregivers can be supported and enabled to participate in decision-making regarding care arrangements that meet the care recipient's needs.
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Affiliation(s)
- Line Kildal Bragstad
- Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, NO-0318 Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, NO-0318 Oslo, Norway
| | - Christina Foss
- Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, NO-0318 Oslo, Norway
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Quality in transitional care of the elderly: Key challenges and relevant improvement measures. Int J Integr Care 2014; 14:e013. [PMID: 24868196 PMCID: PMC4027895 DOI: 10.5334/ijic.1194] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 03/21/2014] [Accepted: 03/25/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. Results Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Conclusion Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.
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Kolovos P, Kaitelidou D, Lemonidou C, Sachlas A, Sourtzi P. Patient Participation in Decision Making During Nursing Care in Greece--A Comparative Study. Nurs Forum 2014; 50:147-57. [PMID: 24620895 DOI: 10.1111/nuf.12089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe patient participation in decision making during nursing care from patients' and nursing staff' perspectives. METHODS The sample consisted of medical and surgical patients (n = 300) and the nursing staff (n = 118) working in the respective wards in three general hospitals. A questionnaire was used for the study; data were collected from April 2009 to September 2010. Data were analyzed by an exploratory factor analysis. RESULTS Patient participation was recorded at a medium level during nursing care, although it was rated as important from both patients and nursing staff. Exploratory factor analysis revealed the factor structure for the planning and implementation of the nursing care. Providers and receivers of nursing care perceived participation in a similar way. Interpersonal interaction was supported from older and less educated patients, as well as from university-educated nurses. Patient participation was greater in practical aspects of care and limited in technical medical issues and supportive services. CONCLUSIONS Patient participation, although moderate, was evident during nursing care in hospital settings. Paternalism in the decision-making process was the dominant trend, whereas interpersonal interaction between the parties was recognized as a prerequisite for planning nursing care.
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Affiliation(s)
- Petros Kolovos
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | - Daphne Kaitelidou
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrysoula Lemonidou
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panayota Sourtzi
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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