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Dal Pizzol FLF, O'Rourke HM, Olson J, Baumbusch J, Hunter K. The meaning of preparedness for informal caregivers of older adults: A concept analysis. J Adv Nurs 2024; 80:2308-2324. [PMID: 38041594 DOI: 10.1111/jan.15999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
AIM To examine the concept of preparedness over time in research with informal caregivers of older adults. DESIGN Concept analysis. METHODS Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework. DATA SOURCES Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time. RESULTS The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some 'stressor'; something that prevents them from feeling confident in their preparedness). CONCLUSION The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving. IMPACT This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported. REPORTING METHOD We were unable to locate a reporting method related to this kind of work (concept analysis). PATIENT OR PUBLIC CONTRIBUTION Not applicable as no new data generated.
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Affiliation(s)
- Fernanda L F Dal Pizzol
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah M O'Rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Joanne Olson
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Baumbusch
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathleen Hunter
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
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Klostermann J. Bev Said "No": Learning From Nursing Home Residents About Care Politics in Our Aging Society. THE GERONTOLOGIST 2023; 63:1663-1671. [PMID: 37330624 DOI: 10.1093/geront/gnad069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Indexed: 06/19/2023] Open
Abstract
How do nursing home residents decide when, whether, or how to respond to their own and others' care needs when the need to do is constant? What can we learn from them about care politics in our aging society? Drawing on ethnographic research conducted in three long-term residential care homes in Ontario Canada, this article weaves approaches from the arts, humanities, and interpretive sociology to respond to these questions. Contextualizing nursing home residents' stories of care within broader sociocultural and political contexts, I consider how they develop critical and creative insights, not only about direct care or nursing home life but about moral, philosophical, and culturally significant questions relevant to care provision. As political actors engaged in a "politics of responsibility," they put work into navigating, negotiating, and making sense of their own and others' care needs in under-resourced contexts and in relation to circulating narratives about care, aging, and disability. Exposed to constant demands to care for others, residents' stories highlight the importance of expanding cultural narratives to embrace embodied differences or care needs, to help people to talk about their own needs or limits, and to organize care as a shared, collective responsibility.
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Affiliation(s)
- Janna Klostermann
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
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Saragosa M, Hahn-Goldberg S, Lunsky Y, Cameron JI, Caven I, Bookey-Bassett S, Newman K, Okrainec K. Young carers' perspectives on navigating the healthcare system and co-designing support for their caring roles: a mixed-methods qualitative study. BMJ Open 2023; 13:e075804. [PMID: 38072468 PMCID: PMC10729167 DOI: 10.1136/bmjopen-2023-075804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Despite young carers (YCs) providing regular and significant care that exceeds what would normally be associated with an adult caregiver, we need to learn more about their experience interacting with the healthcare system. The primary study aims were to (1) describe YC experiences in interacting with the healthcare system and (2) identify types of support YC recognise as potentially helpful to their caring role. DESIGN AND SETTING A mixed-methods qualitative study was conducted between March 2022 and August 2022, comprising two phases of (1) semi-structured interviews and focus groups with YCs living in the community to confirm and expand earlier research findings, and (2) a co-design workshop informed by a generative research approach. We used findings from the interviews and focus groups to inform the brainstorming process for identifying potential solutions. RESULTS Eight YCs completed either a focus group or an interview, and four continued the study and participated in the co-design activity with 12 participants. Phase 1 resulted in three overarching themes: (1) navigating the YC role within the healthcare system; (2) being kept out of the loop; and (3) normalising the transition into caregiving. Phase 2 identified two categories: (1) YC-focused supports and (2) raising awareness and building capacity in the healthcare system. CONCLUSION Study findings revealed the critical role that YCs play when supporting their families during pivotal interactions in the healthcare system. Like their older caregiver counterparts, YCs struggle to navigate, coordinate and advocate for their family members while juggling their needs as they transition from adolescence to adulthood. This study provides important preliminary insights into YCs encountering professionals, which can be used to design and implement national support structures.
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Affiliation(s)
- Marianne Saragosa
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- Science of Care Institute, Sinai Health, Toronto, Ontario, Canada
| | - Shoshana Hahn-Goldberg
- OpenLab, University Hospital Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Deptartment of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Isabelle Caven
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Susan Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Karen Okrainec
- Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
- OpenLab, University Hospital Network, Toronto, Ontario, Canada
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Smith TO, Khoury R, Hanson S, Welsh A, Grant K, Clark AB, Ashford PA, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa ML, Lamb S. Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England. BMJ Open 2023; 13:e073611. [PMID: 38070926 PMCID: PMC10729129 DOI: 10.1136/bmjopen-2023-073611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. DESIGN Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. SETTING National Health Service (NHS) providers in five English hospitals. PARTICIPANTS Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. INTERVENTION Usual care: usual NHS care. EXPERIMENTAL usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. RANDOMISATION AND BLINDING Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. MAIN OUTCOME MEASURES Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. RESULTS 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. CONCLUSIONS The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site's ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. TRIAL REGISTRATION NUMBER ISRCTN13270387.
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Affiliation(s)
- Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Kelly Grant
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Damaiyanti M, Amir H, Cahyani DD, Alhidayat NS, Afrianti N, Rahmiati C, Hastuti H, Sari AS, Hidayat R. Improving caregiver preparedness in the care transition of stroke patients: a scoping review. J Med Life 2023; 16:1723-1731. [PMID: 38585525 PMCID: PMC10994610 DOI: 10.25122/jml-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 04/09/2024] Open
Abstract
Stroke is a life-threatening condition caused by the rupture of a brain blood vessel, potentially causing brain damage within minutes, severe disability, and even death. After initial hospitalization and rehabilitation, most stroke survivors return home, relying on their family members as caregivers for activities of daily living and treatments. This scoping review aimed to evaluate caregivers' readiness for transitioning stroke patient care to a home environment. We conducted a comprehensive search on Scopus, PubMed, ScienceDirect, and Google Scholar databases, followed by a secondary search to identify articles based on predefined criteria. A total of 14 articles were synthesized, leading to a series of findings: (1) there is a need to assess and identify caregiver needs, (2) the process needs relevant information, (3) caregivers are involved in the care process until the patients are discharged from the hospital, and (4) there is a need to offer support to caregivers. These results indicate that implementing strategies to enhance caregiver preparedness is crucial for the effective home-based care of stroke survivors.
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Affiliation(s)
- Mukhripah Damaiyanti
- Faculty of Nursing, Universitas Muhammadiyah Kalimantan Timur, Kalimantan Timur, Indonesia
| | - Haeril Amir
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Desy Dwi Cahyani
- Midwifery Department, Poltekkes Kemenkes Malang, Malang, Indonesia
| | | | - Novi Afrianti
- Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
| | - Cut Rahmiati
- Akademi Keperawatan Kesdam Iskandar Muda Banda Aceh, Aceh, Indonesia
| | - Hera Hastuti
- Sekolah Tinggi Ilmu Kesehatan Fatmawati, Jakarta, Indonesia
| | | | - Rahmat Hidayat
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
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Eliassen M, Arntzen C, Nikolaisen M, Gramstad A. Rehabilitation models that support transitions from hospital to home for people with acquired brain injury (ABI): a scoping review. BMC Health Serv Res 2023; 23:814. [PMID: 37525270 PMCID: PMC10388520 DOI: 10.1186/s12913-023-09793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Research shows a lack of continuity in service provision during the transition from hospital to home for people with acquired brain injuries (ABI). There is a need to gather and synthesize knowledge about services that can support strategies for more standardized referral and services supporting this critical transition phase for patients with ABI. We aimed to identify how rehabilitation models that support the transition phase from hospital to home for these patients are described in the research literature and to discuss the content of these models. METHODS We based our review on the "Arksey and O`Malley framework" for scoping reviews. The review considered all study designs, including qualitative and quantitative methodologies. We extracted data of service model descriptions and presented the results in a narrative summary. RESULTS A total of 3975 studies were reviewed, and 73 were included. Five categories were identified: (1) multidisciplinary home-based teams, (2) key coordinators, (3) trained family caregivers or lay health workers, (4) predischarge planning, and (5) self-management programs. In general, the studies lack in-depth professional and contextual descriptions. CONCLUSIONS There is a wide variety of rehabilitation models that support the transition phase from hospital to home for people with ABI. The variety may indicate a lack of consensus of best practices. However, it may also reflect contextual adaptations. This study indicates that health care service research lacks robust and thorough descriptions of contextual features, which may limit the feasibility and transferability to diverse contexts.
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Affiliation(s)
- Marianne Eliassen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway.
| | - Cathrine Arntzen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
- Center for Care Sciences, North, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
| | - Morten Nikolaisen
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
- Center for Care Sciences, North, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
| | - Astrid Gramstad
- Department of Health and Care Sciences, University of Tromsø, The Artic University of Norway, Tromsø, 9037, Norway
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Saragosa M, Kuluski K, Okrainec K, Jeffs L. “Seeing the day-to-day situation”: A grounded theory of how persons living with dementia and their family caregivers experience the hospital to home transition and beyond. J Aging Stud 2023. [DOI: 10.1016/j.jaging.2023.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Patel V, Lindenmeyer A, Gao F, Yeung J. A qualitative study exploring the lived experiences of patients living with mild, moderate and severe frailty, following hip fracture surgery and hospitalisation. PLoS One 2023; 18:e0285980. [PMID: 37200345 DOI: 10.1371/journal.pone.0285980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
It is well recognised that hip fracture surgery is associated with a negative impact on short and long-term post-operative physical health and emotional well-being for patients. Furthermore, these patients are known to be frail with multiple co-morbidities. This study explores how frailty shapes the lived experiences of rehabilitation and recovery for patients who have undergone hip fracture surgery. Semi-structured interviews were conducted with sixteen participants, recently discharged from hospital following hip fracture surgery. Interpretative phenomenological analysis was applied to explore the lived experiences of frail patients and ascertain important themes. Patient experiences were captured in seven overarching themes: 1) the hospital as a place of "safety", 2) placing trust in others, 3) the slow recovery journey impeded by attitude and support, 4) maintaining autonomy and dignity whilst feeling vulnerable, 5) seeking a new normal, 6) loneliness and social isolation and 7) the ageing body. Based on our study findings, we have been able to suggest a number of opportunities to improve support for frailer patients in finding a new routine to their everyday lives, these include on-going physical and psychological support, information and education and a robust pathway for transition of care into the community. A conceptual thematic diagram is presented which helps to understand the experience and the complex needs of frail older people undergoing hip fracture surgery.
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Affiliation(s)
- Vanisha Patel
- Department of Anaesthetics, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Antje Lindenmeyer
- Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Fang Gao
- Birmingham Acute Care Research Centre, Institute of Inflammation and Ageing, University of Birmingham Research Laboratories, Birmingham, United Kingdom
| | - Joyce Yeung
- Warwick Medical School, Warwick Clinical Trials Unit, University of Warwick, Warwick, United Kingdom
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Participating in the Illness Journey: Meanings of Being a Close Relative to an Older Person Recovering from Hip Fracture-A Phenomenological Hermeneutical Study. NURSING REPORTS 2022; 12:733-746. [PMID: 36278766 PMCID: PMC9624350 DOI: 10.3390/nursrep12040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 01/24/2023] Open
Abstract
When an older person suffers an acute event, such as a hip fracture, it influences the whole family. Research shows that while close relatives want to be a part of the older person's life during recovery it is associated with a high perceived level of stress and burden. To provide in-depth knowledge of close relatives' experiences in this situation, the aim of this study was to elucidate meanings of being a close relative to an older person recovering from hip fracture surgery.This study has a qualitative descriptive phenomenological hermeneutical design. Narrative interviews were conducted with ten close relatives. Analysis was conducted using phenomenological hermeneutical interpretation which provided a deeper understanding of the close relatives' lived experiences of their older person's recovery from hip fracture surgery. The structural analysis revealed two themes; "Participating in the illness journey", which was constructed of the subthemes of facing the unimaginable yet expected, encountering healthcare personnel, and noticing recovery and "Putting oneself aside", which was constructed of the subthemes of placing daily life on hold, giving support, and feeling concern and fear.
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11
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Shannon R, Baxter R, Hardicre N, Mills T, Murray J, Lawton R, O'Hara JK. A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home. Health Expect 2022; 25:2796-2806. [PMID: 36056639 DOI: 10.1111/hex.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Partners at Care Transitions (PACTs) intervention was developed to support older people's involvement in hospital to improve outcomes at home. A booklet, question card, record sheet, induction leaflet, and patient-friendly discharge letter support patients to be more involved in their health and wellbeing, medications, activities of daily living and post-discharge care. We aimed to assess intervention acceptability, identify implementation tools, and further develop the intervention. METHODS This was a qualitative formative evaluation involving three wards from one hospital. We recruited 25 patients aged 75 years and older. Ward staff supported intervention delivery. Data were collected in wards and patients' homes, through semi-structured interviews, observation, and documentary analysis. Data were analysed inductively and iteratively with findings sorted according to the research aims. RESULTS Patients and staff felt there was a need for, and understood the purpose of, the PACT intervention. Most patients read the booklet but other components were variably used. Implementation challenges included time, awareness, and balancing intervention benefits against risks. Changes to the intervention and implementation included clarifying the booklet's messages, simplifying the discharge letter to reduce staff burden, and using prompts and handouts to promote awareness. CONCLUSION The PACT intervention offers a promising new way to improve care transitions for older people by supporting patient involvement in their care. After further development of the intervention and implementation package, it will undergo further testing. PATIENT OR PUBLIC CONTRIBUTION This study regularly consulted a panel representing the local patient community, who supported the development of this intervention and its implementation.
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Affiliation(s)
- Rosie Shannon
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Ruth Baxter
- 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
| | - Thomas Mills
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | | | - Jane K O'Hara
- School of Healthcare, University of Leeds, Baines Wing, Leeds, UK
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Giosa JL, Byrne K, Stolee P. Person- and family-centred goal-setting for older adults in Canadian home care: A solution-focused approach. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2445-e2456. [PMID: 34931382 PMCID: PMC9543740 DOI: 10.1111/hsc.13685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 05/13/2023]
Abstract
Goal-setting with older adults in home care is often inhibited by a lack of structure to support person- and family-centred care planning, paternalistic decision-making and task-oriented delivery models. The objective of this research study was to determine how goal-setting practices for older adults could be re-oriented around individuals' self-perceived goals, needs and preferences. Solution-focused semi-structured key informant interviews were conducted with older adult home care clients aged 65 years and older (n = 13) and their family/friend caregivers (n = 12) to explore changes, solutions and strategies for person- and family-centred goal-setting. Participants were recruited through community advertisement in a single region of Ontario, Canada between July and October of 2017. Interviews were conducted in-person and were audio-recorded and transcribed verbatim. Thematic analysis was guided by a multi-step framework method. Four themes emerged from the data: (1) seeing beyond age enables respect and dignity; (2) relational communication involves two-way information sharing; (3) doing 'with' instead of doing 'for' promotes participation and (4) collaboration is easier when older adults and caregivers lead the way. Older adults and caregivers want to be actively engaged in dialogue during care planning to ensure their preferences are included. The findings from this study add the direct perspectives of older adults and their caregivers to literature on solutions to address ageism, improve communication, enhance information sharing and promote collaboration in geriatric care. Next steps for this work could involve testing the changes, solutions and strategies that emerged to determine the effect on person- and family-centred home care delivery.
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Affiliation(s)
- Justine L. Giosa
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- SE Research CentreSE HealthMarkhamOntarioCanada
| | - Kerry Byrne
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
| | - Paul Stolee
- School of Public Health SciencesUniversity of WaterlooWaterlooOntarioCanada
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13
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Kokorelias KM, Gould S, Das Gupta T, Ziegler N, Cass D, Hitzig SL. Implementing patient navigator programmes within a hospital setting in Toronto, Canada: A qualitative interview study. J Health Serv Res Policy 2022; 27:313-320. [PMID: 35593462 DOI: 10.1177/13558196221103662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to identify the organisation and system level barriers and facilitators influencing the implementation of patient navigator programmes in one acute care hospital system in Toronto, Canada. METHODS A qualitative descriptive approach informed by the Consolidated Framework for Implementation Research. Data were collected using in-depth interviews and analysed thematically. RESULTS Thirty-eight individuals participated in interviews (17 community, 21 acute care hospital), including 24 frontline clinicians and 14 programme directors, health care leaders and managers. Implementation of patient navigator programmes was dependent on: (1) a clear consensus on the unique need for patient navigators; (2) champions to promote patient navigation; (3) programme ownership and accountability; (4) external system and organisational landscape and (5) implementation climate. Appropriate mechanisms of communication were found to have impacted each factor as a barrier or facilitator to programme implementation. CONCLUSION Strategies for implementing patient navigator programmes into hospital clinical practice should include incorporating evidence to support the programme, considering mechanisms to enable collaborative communication, and the integration of frameworks to facilitate programme integration into the current practices within the organisation.
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Affiliation(s)
- Kristina M Kokorelias
- Post-doctoral Fellow, St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada
| | - Sarah Gould
- Research Analyst, Post-doctoral Fellow, St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tracey Das Gupta
- Director of Interprofessional Practice, 71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Naomi Ziegler
- Vice President, Client Services, SPRINT Senior Care, Toronto, ON, Canada
| | - Dan Cass
- Executive Vice President and Chief Medical Executive, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sander L Hitzig
- Scientist and Program Director, St John's Rehab Research Program, Sunnybrook Health Sciences Centre, 574553Sunnybrook Research Institute, Toronto, ON, Canada
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‘Is my journey destination home?’ Exploring the experiences of older adults who undertake a transition care programme: a qualitative study. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Transition care programmes (TCP) provide older adults with goal-oriented rehabilitation after hospitalisation. However, limited research has focused on understanding older adults' experiences when undertaking TCP. Using a phenomenological approach, we explored the lived experience of older adults undertaking a TCP at a transition care facility in Australia. A purposive sample (N = 33 participants: 16 older adults, four family members and 13 staff) was recruited. Semi-structured interviews were undertaken at three time-points during admission and inductive thematic analysis was utilised. Older adults reflected on their TCP experiences through an emotional lens through which they deliberated, ‘is my destination home?’ Fear of losing independence and uncertainty about their discharge destination strongly influenced older adults' perspectives regarding their TCP experience. Emotional responses, both positive and negative, were influenced by expectations prior to admission, level of family support and staff behaviour. Staff and family concurred that many older adults were confused about their admission to the facility and initially were unprepared to engage in the rehabilitation provided. Older adults experienced TCP as a time of great uncertainty and feared the unknown when discharged from hospital to transition care. They expressed grief at the loss of existing life roles and anxiety about the possibility of being unable to return home. Health professionals need to inform and tailor rehabilitation for older adults to better support this transient time of life.
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Alselami S, Butcher HK. A Unitary Caring Theory Perspective of Family Caregiving for Patients Hospitalized With a Stroke in Saudi Arabia. Nurs Sci Q 2022; 35:191-202. [PMID: 35392716 DOI: 10.1177/08943184211070608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to gain a deeper understanding of the experience of Saudi informal family caregivers of hospitalized patients who have experienced a stroke. In-depth, face-to-face, semistructured interviews of five family caregivers using open-ended questions were conducted in a major hospital in Saudi Arabia. The interviews were recorded, transcribed verbatim, and analyzed using the unitary-caring hermeneutic phenomenological research method. Data analysis revealed six major essences that were synthesized into one statement reflecting the essence of caring for a family member with a stroke in Saudi Arabia: Living with the uncertainty of ambiguity amid feeling distressed with worries and fears replete with unfulfilled desires while yearning for compassionate caring and overcoming uncertainties through connections and faith honoring abiding commitments. As a means to transform the findings into theory and language of the nursing discipline, the essences were then interpreted within the theory of unitary caring.
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Affiliation(s)
- Seham Alselami
- Faculty member, King Saud bin Abdul-Aziz University for Health Sciences, College of Nursing, Jeddah, Saudi Arabia
| | - Howard K Butcher
- Professor, Director of PhD Program, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Hudon C, Aubrey-Bassler K, Chouinard MC, Doucet S, Dubois MF, Karam M, Luke A, Moullec G, Pluye P, Tzenov A, Ouadfel S, Lambert M, Angrignon-Girouard É, Schwarz C, Howse D, MacLeod KK, Gaudreau A, Sabourin V. Better understanding care transitions of adults with complex health and social care needs: a study protocol. BMC Health Serv Res 2022; 22:206. [PMID: 35168628 PMCID: PMC8848684 DOI: 10.1186/s12913-022-07588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adults with chronic conditions who also suffer from mental health comorbidities and/or social vulnerability require services from many providers across different sectors. They may have complex health and social care needs and experience poorer health indicators and high mortality rates while generating considerable costs to the health and social services system. In response, the literature has stressed the need for a collaborative approach amongst providers to facilitate the care transition process. A better understanding of care transitions is the next step towards the improvement of integrated care models. The aim of the study is to better understand care transitions of adults with complex health and social care needs across community, primary care, and hospital settings, combining the experiences of patients and their families, providers, and health managers. Methods/design We will conduct a two-phase mixed methods multiple case study (quantitative and qualitative). We will work with six cases in three Canadian provinces, each case being the actual care transitions across community, primary care, and hospital settings. Adult patients with complex needs will be identified by having visited the emergency department at least three times over the previous 12 months. To ensure they have complex needs, they will be invited to complete INTERMED Self-Assessment and invited to enroll if positive. For the quantitative phase, data will be obtained through questionnaires and multi-level regression analyses will be conducted. For the qualitative phase, semi-structured interviews and focus groups will be conducted with patients, family members, care providers, and managers, and thematic analysis will be performed. Quantitative and qualitative results will be compared and then merged. Discussion This study is one of the first to examine care transitions of adults with complex needs by adopting a comprehensive vision of care transitions and bringing together the experiences of patients and family members, providers, and health managers. By using an integrated knowledge translation approach with key knowledge users, the study’s findings have the potential to inform the optimization of integrated care, to positively impact the health of adults with complex needs, and reduce the economic burden to the health and social care systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07588-0.
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Affiliation(s)
- Catherine Hudon
- Département de Médecine de Famille et Médecine d'urgence, Université de Sherbrooke (UdeS), Pavillon Z7-local 3007, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland (MUN), St-John's, NL, Canada
| | | | - Shelley Doucet
- Department of Nursing and Health Sciences, University of New-Brunswick (UNB), Fredericton, NB, Canada
| | - Marie-France Dubois
- Département des sciences de la santé communautaire, UdeS, Sherbrooke, QC, Canada
| | - Marlène Karam
- Faculté des sciences infirmières, Université de Montréal (UdeM), Montreal, QC, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New-Brunswick (UNB), Fredericton, NB, Canada
| | - Grégory Moullec
- École de santé publique, Département de médecine sociale et préventive, UdeM, Montreal, QC, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Amanda Tzenov
- Department of Family Medicine, MUN, St-John's, NL, Canada
| | - Sarah Ouadfel
- Département de Médecine de Famille et Médecine d'urgence, Université de Sherbrooke (UdeS), Pavillon Z7-local 3007, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mireille Lambert
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, QC, Canada
| | - Émilie Angrignon-Girouard
- Département de Médecine de Famille et Médecine d'urgence, Université de Sherbrooke (UdeS), Pavillon Z7-local 3007, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Charlotte Schwarz
- Department of Nursing and Health Sciences, University of New-Brunswick (UNB), Fredericton, NB, Canada
| | - Dana Howse
- Primary Healthcare Research Unit, Memorial University of Newfoundland (MUN), St-John's, NL, Canada
| | - Krystal Kehoe MacLeod
- Postdoctoral Fellow, Department of Nursing and Health Sciences, UNB, Fredericton, NB, Canada
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McNeil H, McMurray J, Byrne K, Grindrod K, Stolee P. Engagement of older adults in regional health innovation: The ECOTECH concept mapping project. SAGE Open Med 2022; 10:20503121211073333. [PMID: 35083046 PMCID: PMC8785349 DOI: 10.1177/20503121211073333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Regional health innovation ecosystems can activate collaboration and support planning, self-management and development and commercialization of innovations. We sought to understand how older adults and their caregivers can be meaningfully engaged in regional health innovation ecosystems focused on health and aging–related technology innovation. Methods: A six-phase concept mapping technique gathered data over six time points across Canada. Brainstorming conducted online and in person identified engagement ideas. Statements were sorted by similarity and rated by participants on importance and feasibility. Qualitative approaches and multidimensional scaling, hierarchical cluster analysis, descriptive statistics and t tests were used for analysis. Results: Sixty-two unique ideas were assembled into a seven-cluster framework of priorities for engagement in regional health innovation ecosystems including public forums, co-production and partnerships, engagement, linkage and exchange, developing cultural capacity, advocacy and investment in the ecosystem. Conclusions: This study identified a framework of priorities for directions and strategies for older adult and caregiver engagement in regional health innovation ecosystems. Next steps include collaborations to develop regional health innovation ecosystems that actively engage older adults and their caregivers in health and aging–related technology innovation.
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Affiliation(s)
- Heather McNeil
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, Brantford, ON, Canada
| | - Josephine McMurray
- Lazaridis School of Business and Economics/Health Studies, Wilfrid Laurier University, Brantford, ON, Canada
| | - Kerry Byrne
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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18
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Ariza-Vega P, Prieto-Moreno R, Castillo-Pérez H, Martínez-Ruiz V, Romero-Ayuso D, Ashe MC. Family Caregivers' Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture. J Clin Med 2021; 10:jcm10245850. [PMID: 34945145 PMCID: PMC8708159 DOI: 10.3390/jcm10245850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023] Open
Abstract
Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
| | - Rafael Prieto-Moreno
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
- Correspondence:
| | | | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain;
- Center for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
| | - Dulce Romero-Ayuso
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
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Smith T, Clark L, Khoury R, Man MS, Hanson S, Welsh A, Clark A, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa M, Lamb SE. A feasibility study to assess the design of a multicentre randomized controlled trial of the clinical and cost-effectiveness of a caregiving intervention for people following hip fracture surgery. Bone Jt Open 2021; 2:909-920. [PMID: 34753296 PMCID: PMC8636304 DOI: 10.1302/2633-1462.211.bjo-2021-0136] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. Methods This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals. Discussion A multicentre recruitment approach will provide greater external validity across population characteristics in England. The mixed-methods approach will permit in-depth examination of the intervention and trial design parameters. The findings will inform whether and how a definitive trial may be undertaken to test the effectiveness of this caregiver intervention for patients after hip fracture surgery. Cite this article: Bone Jt Open 2021;2(11):909–920.
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Affiliation(s)
- Toby Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lucy Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mei-See Man
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Klaus Pfeiffer
- Department of Geriatric Rehabilitation, Robert-Bosch-Krankenhaus GmbH, Stuttgart, Germany
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Flinders University, Adelaide, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,University of Oxford, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK.,University of Exeter, Exeter, UK
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Fox MT, Sidani S, Butler JI, Skinner MW, Macdonald M, Durocher E, Hunter KF, Wagg A, Weeks LE, MacLeod A, Dahlke S. Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol. Implement Sci Commun 2021; 2:81. [PMID: 34294145 PMCID: PMC8295643 DOI: 10.1186/s43058-021-00179-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities. METHODS In this multimethod study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15-20 people with dementia and 15-20 family-caregivers in each province will rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions' acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will (1) rate the acceptability of the interventions and (2) participate in semi-structured focus group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8-10 healthcare providers per focus group) will be held for a total of 8-12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings. DISCUSSION Findings will (1) include a set of acceptable interventions for rural transitional care that promote older patients' functioning and family-caregivers' ability to support patients' functioning, (2) identify resources needed to incorporate the interventions into rural transitional care, and (3) provide high-quality evidence to inform new transitional care practices and policies and guide future research.
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Affiliation(s)
- Mary T. Fox
- School of Nursing, Faculty of Health, York University Centre for Aging Research and Education, York University, HNES suite 343, 4700 Keele St, Toronto, Ontario M3J 1P3 Canada
| | - Souraya Sidani
- School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - Jeffrey I. Butler
- School of Nursing, York University Centre for Aging Research and Education, Faculty of Health, York University, HNES suite 343, 4700 Keele Street, Toronto, Ontario M3J 1P3 Canada
| | - Mark W. Skinner
- Trent School of the Environment, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2 Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Room 130, Forrest Bldg., PO Box 15000, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Evelyne Durocher
- School of Rehabilitation Science, Institute of Applied Health Sciences, Faculty of Health Sciences, McMaster University, Room 428, 1400 Main St. W, Hamilton, Ontario L8S 1C7 Canada
| | - Kathleen F. Hunter
- Faculty of Nursing, University of Alberta, 5-293 Edmonton Clinic Health Academy 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, 1-198 Clinical Sciences Building, Edmonton, Canada
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Room G30, Forrest Bldg. PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Ann MacLeod
- Trent/Fleming School of Nursing, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2 Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
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Abrams LR, Hoffman GJ. Skilled Nursing Facilities Modify the Relationship Between Depressive Symptoms and Hospital Readmissions but Not Health Outcomes Among Older Adults. J Aging Health 2021; 33:817-827. [PMID: 33929271 DOI: 10.1177/08982643211013127] [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: 11/17/2022]
Abstract
Objectives: Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. Methods: This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000-2014). Results: Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day hospital readmissions (OR = 0.95, p = 0.029) but did not prevent 30-day falls, 1-year falls, or 1-year mortality associated with depressive symptoms. Discussion: Depressive symptoms were associated with discharges to SNFs, but SNFs do not appear to address depressive symptoms to enhance functioning and survival.
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Affiliation(s)
- Leah R Abrams
- Harvard Center for Population and Development Studies, 1857Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
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22
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Ariza-Vega P, Castillo-Pérez H, Ortiz-Piña M, Ziden L, Palomino-Vidal J, Ashe MC. The Journey of Recovery: Caregivers' Perspectives From a Hip Fracture Telerehabilitation Clinical Trial. Phys Ther 2021; 101:6044311. [PMID: 33351931 DOI: 10.1093/ptj/pzaa220] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/12/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective was to explore family caregivers' perspectives of the recovery process of older adults with hip fracture and describe experiences from caregivers who: (1) used the online intervention, or (2) received home-based care provided by the Andalusian Public Health Care System. METHODS This was an exploratory secondary study with informal family caregivers who had an older adult family member with hip fracture enrolled in a novel telerehabilitation (telerehab) clinical trial. Forty-four caregivers of older adults with hip fracture were interviewed at 6 to 9 months after their family member's hip fracture. RESULTS Caregivers shared concerns of family members' survival and recovery; they recounted increased stress and anxiety due to the uncertainty of new tasks associated with providing care and the impact on their lifestyle. Although most caregivers were satisfied with the health care received, they made suggestions for better organization of hospital discharge and requests for home support. The main reasons why caregivers and their family member chose the telerehab program were to enhance recovery after fracture, gain knowledge for managing at home, and because of the convenience of completing the exercises at home. There were more family caregivers in the control group who expressed a high level of stress and anxiety, and they also requested more social and health services compared with caregivers whose family member received telerehab. CONCLUSION Family caregivers are an essential component of recovery after hip fracture by providing emotional and physical support. However, future clinical interventions should evaluate person-centered interventions to mitigate possible stress and anxiety experienced by family caregivers. IMPACT Family caregivers' perspectives are necessary in the co-design of management strategies for older adults after hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Biohealth Research Institute, Granada, Spain.,Department of Physiotherapy, PA-HELP "Physical Activity for HEaLth Promotion" research group, University of Granada, Granada, Spain
| | | | - Mariana Ortiz-Piña
- Department of Physiotherapy, PA-HELP "Physical Activity for HEaLth Promotion" research group, University of Granada, Granada, Spain
| | - Lena Ziden
- Department of Health and Rehabilitation, The Sahlgrenska University Hospital, Gothenberg, Sweden; and Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | | | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
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Cohen C, Pereira F, Kampel T, Bélanger L. Integration of family caregivers in delirium prevention care for hospitalized older adults: A case study analysis. J Adv Nurs 2020; 77:318-330. [PMID: 33078872 DOI: 10.1111/jan.14593] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/16/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
AIM To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care. DESIGN Multiple case study. METHODS The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 - April 2018 through various instruments, including semi-structured interviews and family caregiver logs. Within- and across-case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore-Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272). RESULTS Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care. CONCLUSION The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further. IMPACT Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient- and family-centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.
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Affiliation(s)
- Christine Cohen
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
| | - Thomas Kampel
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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24
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Sun W, Ashtarieh B, Zou P. The safety challenges of therapeutic self-care and informal caregiving in home care: A qualitative descriptive study. Geriatr Nurs 2020; 42:491-501. [PMID: 32807555 DOI: 10.1016/j.gerinurse.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
With an increasing number of older people who require homecare services, clients must develop a therapeutic self-care ability in order to manage their health safely in their homes. Therapeutic self-care is the ability to take medications as prescribed, and to recognize and manage symptoms that may be experienced, such as pain. This qualitative research study utilized one-on-one, in-depth, semi-structured interviews with the clients and their informal caregivers recruited from one homecare agency in Ontario, Canada. The goal of the interviews was to gain a better understanding of the relationship between client's therapeutic self-care ability and homecare safety outcomes, and the role of self-care and caregiving activities in supporting homecare safety in relation to chronic disease management. A total of fifteen older homecare clients (over the age of 65) and fifteen informal caregivers were interviewed in their homes. Qualitative description was the methodological approach used to guide the research study. Thematic analyses of the qualitative interview data revealed that homecare clients and their informal caregivers are struggling with multiple aspects of safety challenges. The study findings provided insight into safety problems related to therapeutic self-care at home, and this knowledge is vital to policy formulation related to the role of healthcare professionals in improving client's therapeutic self-care ability to reduce safety related risks and burden for older homecare recipients. Protocol Reference and REB approval (#27223) was obtained from University of Toronto Research Ethics Board.
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Affiliation(s)
- Winnie Sun
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto M5T 1P8 ON, Canada.
| | - Bahar Ashtarieh
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa L1H 7K4 ON, Canada.
| | - Ping Zou
- School of Nursing, Nipissing University, 750 Dundas Street West, Room 209, Toronto M6J 3S3 ON, Canada.
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25
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Ponnala S, Block L, Lingg AJ, Kind AJ, Werner NE. Conceptualizing caregiving activities for persons with dementia (PwD) through a patient work lens. APPLIED ERGONOMICS 2020; 85:103070. [PMID: 32174358 PMCID: PMC7098392 DOI: 10.1016/j.apergo.2020.103070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/03/2020] [Accepted: 01/29/2020] [Indexed: 05/18/2023]
Abstract
Informal caregivers are an integral part of care delivery for persons with dementia (PwD). Informal caregivers take part in a wide range of care activities both individually and collaboratively with other caregivers. Caregiving often involves high demands in the face of limited resources, which can lead to stress, burden, and burnout. To support caregivers, we need to conceptualize caregiving activities they perform, and the networks and roles through which they perform work. We performed a directed content analysis on interview data from twenty caregivers and applied a human factors approach to characterize informal caregiving work. Our results revealed 1) nuances in caregiving roles, 2) differences in caregiving networks, and 3) 13 categories of caregiving activities characterized by time commitments; physical, cognitive and socio-behavioral demands; and varying network dependencies. These findings can be applied in future studies to evaluate the needs of caregiving networks and how to better support them.
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Affiliation(s)
- Siddarth Ponnala
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA
| | - Laura Block
- School of Nursing, University of Wisconsin - Madison, USA
| | - Aloysius J Lingg
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA
| | - Amy J Kind
- School of Medicine, Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin - Madison, Health Services and Care Research Program, USA; School of Medicine and Public Health, University of Wisconsin - Madison, VA Geriatrics Research Education and Clinical Center, Madison VA Hospital, USA
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, University of Wisconsin - Madison, USA.
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26
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Luchsinger JS, Jones J, McFarland AK, Kissler K. Examining nurse/patient relationships in care coordination: A qualitative metasynthesis. Appl Nurs Res 2019; 49:41-49. [DOI: 10.1016/j.apnr.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/15/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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28
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Smith TO, Pearson M, Pfeiffer K, Crotty M, Lamb SE. Caregiver Interventions for Adults Discharged from the Hospital: Systematic Review and Meta-Analysis. J Am Geriatr Soc 2019; 67:1960-1969. [PMID: 31350918 DOI: 10.1111/jgs.16048] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To review the evidence evaluating the effectiveness of informal caregiver interventions to facilitate the recovery of older people discharged from the hospital. DESIGN Systematic review and meta-analysis. SETTING Hospital and community. METHODS Published and unpublished randomized and nonrandomized controlled trials assessing the effectiveness of informal caregiver interventions to support the recovery of older people discharged from the hospital were identified (to March 2019). The primary outcome was patient health-related quality of life (HRQOL). Secondary outcomes included patient function, caregiver burden, caregiver HRQOL, psychological distress, adverse events, and health resource use. Studies were critically appraised and meta-analyzed. PARTICIPANTS Adults who had been admitted to the hospital. RESULTS A total of 23 studies were eligible (4695 participants). The indication for hospital admission was stroke in 21 trials (91%). Interventions consisted of training and/or skills-based programs, with or without home visits/telephone follow-up. Caregiver interventions for patients following stroke may provide no benefit for patient HRQOL at 12 months (standardized mean difference = .29; 95% confidence interval = -.12 to .69; low-quality evidence). Caregiver interventions demonstrated benefit for caregiver burden and both patient and caregiver anxiety at 12 months. No consistent effect was found on functional outcomes, depression, HRQOL, adverse events, or health resource use measures. CONCLUSIONS Informal caregivers who receive training to facilitate the recovery of older people discharged from the hospital following stroke may have a lower burden and reduced anxiety at 12 months compared with those who do not. However, the evidence was moderate to low quality. Further study is warranted to explore whether caregiver interventions can be modified for nonstroke populations such as those with hip fracture. J Am Geriatr Soc 67:1960-1969, 2019.
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Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Matthew Pearson
- Physiotherapy Outpatients Department, Dynamic Health, Cambridgeshire Community Services NHS Trust, Huntingdon, United Kingdom
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Maria Crotty
- Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
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29
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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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30
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Asif M, Cadel L, Kuluski K, Everall AC, Guilcher SJT. Patient and caregiver experiences on care transitions for adults with a hip fracture: a scoping review. Disabil Rehabil 2019; 42:3549-3558. [PMID: 31081400 DOI: 10.1080/09638288.2019.1595181] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The purpose of this scoping review was to explore the literature on experiences and perspectives of patients with hip fractures and their caregivers during transitions in care.Methods: Seven databases were searched for studies published between 1 January 2000 and 3 July 2018. Grey literature was also searched.Results: Eleven articles met the inclusion criteria. The scoping review found that patients and caregivers encounter several challenges during care transitions including the following: lack of information sharing, role confusion and disorganized discharge planning. Common suggestions reported in the literature for improving care transitions were: increasing written communication, offering a patient representative role, using technology for knowledge dissemination and increasing geriatrician involvement.Conclusions: The results of this scoping review provide a useful foundation from which to build strategies to address challenges such as lack of information sharing, role confusion and disorganized discharge planning experienced by patients and caregivers during care transitions. Further research needs to explore the development of strategies to promote patient-centered care especially during discharge from an acute care facility.Implications for rehabilitationEncourage health care providers to collaborate with patients with hip fracture and caregivers on decision-making about rehabilitation and recovery goals, discharge planning and safe patient transfer.Assess the needs of patients with hip fracture and caregivers before, during and after a care transition to deliver patient and family-centered care across multiple care settings.Provide patients with hip fracture and caregivers standardized information-exchange tools to increase timely, accurate exchange of information during care transitions.Encourage formal discussions about roles and responsibilities in the transitions in care process among patients with hip fracture, caregivers and health care providers.
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Affiliation(s)
- Maliha Asif
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Ariza-Vega P, Ortiz-Piña M, Mora-Traverso M, Martín-Martín L, Salazar-Graván S, Ashe MC. Development and Evaluation of a Post-Hip Fracture Instructional Workshop for Caregivers. J Geriatr Phys Ther 2019; 43:128-136. [PMID: 30913137 DOI: 10.1519/jpt.0000000000000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post-hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. METHODS This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. RESULTS AND DISCUSSION We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. CONCLUSIONS Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital of Granada, Granada, Spain; Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain; and PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Susana Salazar-Graván
- Orthopaedic Surgery and Traumatology Service, Health Campus Hospital, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada; and Centre for Hip Health and Mobility, Vancouver, Canada
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Perceptions Managing Functional Needs Among Older Adults Receiving Post-Acute Home Health Care. Res Gerontol Nurs 2019; 12:174-183. [PMID: 30901481 DOI: 10.3928/19404921-20190319-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/15/2019] [Indexed: 11/20/2022]
Abstract
Caregivers play important roles in managing the physical functioning (PF) needs of older adults transitioning home after a hospitalization. Training and support of caregivers in the post-acute home health care (HHC) setting should incorporate caregivers' perspectives. To explore caregivers' experiences managing PF needs in the post-acute HHC setting, semi-structured telephone interviews of 20 caregivers were conducted. Conventional content analysis revealed patient-, caregiving task-, caregiver-, and home environment-related themes consistent with the Theory of Dependent Care. Caregivers highlighted the dynamics and contributors of PF needs for older patients in the post-acute HHC setting and depicted the enormity of caregiving tasks needed to manage older patients' PF needs. Caregivers also described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. Findings from this research can guide nursing efforts to target caregiver training and support during this critical care transition. [Res Gerontol Nurs. 2019; 12(4):174-183.].
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A Framework for Supporting Post-acute Care Transitions of Older Patients With Hip Fracture. J Am Med Dir Assoc 2019; 20:414-419.e1. [PMID: 30852166 DOI: 10.1016/j.jamda.2019.01.147] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Improving care transitions is of critical importance for older patients, especially those with complex care needs. Our study examined the "Transitions of Care" (ToC) of complex, post-acute older adults at multiple time points. The objective of this article is to identify domains relevant to health care transitions of post-acute older patients with hip fracture so as to inform future ToC interventions. DESIGN Here we conducted a framework-based synthesis of the 12 peer-reviewed manuscripts that were published from our multisite, ethnographic study. SETTING AND PARTICIPANTS All 12 manuscripts were based on 1 study, described here. Data were collected in multiple regions, in acute and sub-acute care wards, rehabilitation programs, home care agencies, long-term care and assisted living facilities, and patients' private homes. We completed 51 interviews with 23 postoperative hip fracture patients aged ≥65 years, 24 interviews with 19 family caregivers, and 96 interviews with 92 health care providers. Interviews with patients, family caregivers, and health care providers were conducted at each transition point for a total of 171 individual interviews. RESULTS Taken together, our framework analysis of the 12 manuscripts identified 8 themes related to ToC. Two themes, patient complexity and system constraints, are contextual factors that tend to impede ToC and may be less amenable to change. The remaining 6 themes, patient involvement and choice, family caregiver roles, strong relationships, coordination of roles, documentation, and information sharing, have the potential to support and improve ToC. CONCLUSIONS AND IMPLICATIONS With comprehensive data from a range of stakeholders, collected at multiple transition points along the health care continuum, in our final 6 themes we identify potential points of intervention for clinicians and teams seeking to improve ToC for older complex patients.
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Provencher V, D’Amours M, Viscogliosi C, Guay M, Giroux D, Dubé V, Delli-Colli N, Corriveau H, Egan M. Risks Perceived by Frail Male Patients, Family Caregivers and Clinicians in Hospital: Do they Change after Discharge? A Multiple Case Study. Int J Integr Care 2019; 19:4. [PMID: 30804726 PMCID: PMC6384319 DOI: 10.5334/ijic.4166] [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: 03/29/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Up to 40% of hospitalised seniors are frail and most want to return home after discharge. Inaccurate estimation of risks in the hospital may lead to inadequate support at home. This study aimed to document convergences and divergences between risks and support needs identified before hospital discharge and perceived at home post-discharge. METHODS This research used a multiple case study design. Three cases were recruited, each involving a hospitalised frail patient aged 70+, the main family caregiver and most of the clinicians who assessed the patient before and after hospital discharge. Thirty-two semi-structured interviews were conducted and their transcripts analysed using a qualitative thematic analysis approach. RESULTS Among risks raised by participants, falls were the only one with total inter-participant/inter-time/inter-case convergence. In all cases, all participants mentioned, before and after discharge, home adaptations and use of technical aids to mitigate this risk. However, clinicians recommended professional services while patients and family caregivers preferred to rely on family members and their own coping strategies. CONCLUSION The divergences identified for most risks and support needs between users and clinicians, before and after discharge, provide new insights into a comprehensive and patient-centred risk assessment process to plan hospital discharge for frail elderly.
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Affiliation(s)
- Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Centre on Aging, Québec, CA
| | | | - Chantal Viscogliosi
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Centre on Aging, Québec, CA
| | - Manon Guay
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Centre on Aging, Québec, CA
| | - Dominique Giroux
- Department of Rehabilitation, Faculty of Medicine, Université Laval and Centre of Excellence on Aging, Québec, CA
| | - Véronique Dubé
- Research Centre, Centre hospitalier de l’Université de Montréal (CRCHUM), Québec, CA
| | - Nathalie Delli-Colli
- School of Social Work, Faculty of Arts, Humanities and Social Sciences, Université de Sherbrooke and Research Centre on Aging, Québec, CA
| | - Hélène Corriveau
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke and Research Centre on Aging, Québec, CA
| | - Mary Egan
- School of Rehabilitation, Faculty of Health Sciences, University of Ottawa, Ontario, CA
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Takahashi PY, Finnie DM, Quigg SM, Borkenhagen LS, Kumbamu A, Kimeu AK, Griffin JM. Understanding experiences of patients and family caregivers in the Mayo Clinic Care Transitions program: a qualitative study. Clin Interv Aging 2018; 14:17-25. [PMID: 30587950 PMCID: PMC6304078 DOI: 10.2147/cia.s183893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Care transitions programs are increasingly used to improve care and reduce re-admission of patients after hospitalization. To learn from the experience of patients who have participated in the Mayo Clinic Care Transitions (MCCT) program and to understand the patient experience, we sought perspectives of patients, caregivers, and providers who worked with participants of the MCCT program. Methods Investigators interviewed 17 patients and nine of their caregivers about their experience with the MCCT program. Eight health care providers described provider experiences with the MCCT program. Data from semistructured interviews were audio recorded, transcribed, and evaluated through content analysis. Inductive coding methods were used to elicit themes about patient experience with the MCCT program. Results Patients, caregivers, and providers emphasized that the MCCT program prevented hospitalizations and contributed to the health and quality of life of participants. All three stakeholder groups emphasized the value of the home visit and provision of the visit on a patient’s “home turf” as central to the program. Patients appreciated speaking to a provider without the stress and exertion of a trip to the clinic. Caregivers appreciated improved communication provided in the home visit and felt that home visits gave them peace of mind. Patients, caregivers, and providers also identified the need for improved phone triage and communication. Conclusion Patients, caregivers, and providers acknowledged the care transitions problem and emphasized the benefits of seeing patients on their home turf rather than in an office visit. This qualitative study of patient, caregiver, and provider experiences further validates the importance of the MCCT program.
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Affiliation(s)
- Paul Y Takahashi
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Dawn M Finnie
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Stephanie M Quigg
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Lynn S Borkenhagen
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Ashok Kumbamu
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ashley K Kimeu
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Joan M Griffin
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
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Uhrenfeldt L, Fegran L, Aagaard H, Ludvigsen MS. Significant others' experience of hospitalized patients' transfer to home: A systematic review and meta-synthesis. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2018; 139:1-9. [PMID: 30477973 DOI: 10.1016/j.zefq.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant others are individuals representing family members or neighbors, friends, colleagues or members of the same household, who act as relatives or surrogates. Significant others play an important role when patients are transferred or discharged after hospitalization. OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available evidence exploring significant others' experiences of the discharge or transfer of adult patients after hospitalization. METHODS A qualitative comprehensive systematic review and meta aggregation. TYPES OF PARTICIPANTS Participants of this review are the 'significant other(s); persons who are important or influential to the patient's life. PHENOMENA OF INTEREST How the significant others' experience hospitalized patients' transitions and the psychosocial and existential issues during transfer from hospital to home. CONTEXT Studies that investigate the organizational culture during hospitalization. TYPES OF STUDIES Studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. SEARCH STRATEGY The search aimed at finding published and unpublished studies in English, German, Danish, Swedish and Norwegian, and was unrestricted by time. Eleven electronic databases and eleven websites were searched. CRITICAL APPRAISAL Methodological validity of the qualitative papers was assessed independently by two reviewers using the standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS Qualitative research findings were synthesized. RESULTS A total of 189 findings from twelve studies were aggregated into three categories. An aggregated finding was generated based on the primary studies: SOs existential strength is linked to preparations for the discharge including care planning meeting(s) and learning-by-doing care activities led by health care providers during hospitalizations. CONCLUSIONS The studies in this review provided useful and credible statements from caregivers' voices that are not previously aggregated nor presented. The findings enlighten both positive and burdensome experiences in the everyday life of caring for a significant other after discharge.
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Affiliation(s)
- Lisbeth Uhrenfeldt
- Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Aalborg University, Aalborg, Denmark; Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Liv Fegran
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Hanne Aagaard
- Lovisenberg Diaconal University College, Oslo, Norway; Section for Nursing, Aarhus University, Aarhus, Denmark
| | - Mette Spliid Ludvigsen
- Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Aalborg University, Aalborg, Denmark; Randers Regional Hospital, Randers and Department of Clinical medicine, Aarhus University, Aarhus, Denmark
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Moral-Fernández L, Frías-Osuna A, Moreno-Cámara S, Palomino-Moral PA, Del-Pino-Casado R. The start of caring for an elderly dependent family member: a qualitative metasynthesis. BMC Geriatr 2018; 18:228. [PMID: 30253750 PMCID: PMC6157059 DOI: 10.1186/s12877-018-0922-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The family often takes care of an elderly person who suddenly becomes dependent. This greatly affects different aspects of the caregivers' lives. The aim of this study is to explore the initial experiences, during the first year of care, of persons who suddenly become caregivers for elderly dependent relatives. METHODS A search in CINAHL, PsycINFO, WOS, Medline, and Scopus and a metasynthesis of qualitative research were conducted including 19 articles. RESULTS Three categories were developed to explain the process of becoming a caregiver 'taking on the role' (life changes, uncertainty and confusion, and acceptance or resistance); 'beginning to realise' (new needs, impact, and appraisal); and 'implementing strategies' (seeking help and self-learning, reordering family and social relationships, solving problems, and devising strategies to decrease negative emotions and stress). CONCLUSIONS The synthesis provides a comprehensive understanding of the experience of becoming a caregiver in order to help health-care professionals to adapt care plans to this situation.
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Affiliation(s)
- Lourdes Moral-Fernández
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Antonio Frías-Osuna
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Sara Moreno-Cámara
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Pedro A. Palomino-Moral
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
| | - Rafael Del-Pino-Casado
- Department of Nursing, School of Health Sciences, University of Jaén, Campus Las Lagunillas, s/n, 23071 Jaén, Spain
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Behm L, Björkman E, Ahlström G. Mental health and reactions to caregiving among next of kin of older people (65+) with multi-morbidity discharged home after hospitalization. Scand J Caring Sci 2018; 32:1458-1467. [PMID: 30092125 DOI: 10.1111/scs.12592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Older people with multi-morbidity are major users of healthcare and are often discharged from hospital with ongoing care needs. This care is frequently provided by informal caregivers and the time immediately after discharge is challenging for caregivers with new and/or additional tasks, resulting in anxiety and stress. AIM This study aimed to describe mental health, with particular reference to anxiety and depression and reactions to caregiving, and to investigate any associations between the two, in next of kin of older people with multi-morbidity after hospitalisation. It also aimed to explore the association between the demographic characteristics of the study group and mental health and reactions to caregiving. METHODS This was a cross-sectional questionnaire study using the Hospital Anxiety and Depression Scale and the Caregiver Reaction Assessment. The study group consisted of 345 next of kin of older people (65+) with multi-morbidity discharged home from 13 medical wards in Sweden. Data were analysed using descriptive and analytical statistics. To identify whether reactions to caregiving and next of kin characteristics were associated with anxiety and depression, a univariate logistic regression analysis was performed. RESULTS More than one quarter of respondents showed severe anxiety and nearly one in 10 had severe depressive symptoms. The frequencies of anxiety and depression increased significantly with increased negative reactions to caregiving and decreased significantly with positive reactions to caregiving. Regarding caregiving reactions, the scores were highest for the positive domain Caregiver esteem, followed by the negative domain Impact on health. Women scored significantly higher than men on Impact on health and spouses scored highest for Impact on schedule and Caregiver esteem. CONCLUSIONS Nurses and other healthcare professionals may need to provide additional support to informal caregivers before and after discharging older people with significant care needs from hospital. This might include person-centred information, education and training.
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Affiliation(s)
- Lina Behm
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Eva Björkman
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
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Arbaje AI, Hughes A, Werner N, Carl K, Hohl D, Jones K, Bowles KH, Chan K, Leff B, Gurses AP. Information management goals and process failures during home visits for middle-aged and older adults receiving skilled home healthcare services after hospital discharge: a multisite, qualitative study. BMJ Qual Saf 2018; 28:111-120. [PMID: 30018114 DOI: 10.1136/bmjqs-2018-008163] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Middle-aged and older adults requiring skilled home healthcare ('home health') services following hospital discharge are at high risk of experiencing suboptimal outcomes. Information management (IM) needed to organise and communicate care plans is critical to ensure safety. Little is known about IM during this transition. OBJECTIVES (1) Describe the current IM process (activity goals, subactivities, information required, information sources/targets and modes of communication) from home health providers' perspectives and (2) Identify IM-related process failures. METHODS Multisite qualitative study. We performed semistructured interviews and direct observations with 33 home health administrative staff, 46 home health providers, 60 middle-aged and older adults, and 40 informal caregivers during the preadmission process and initial home visit. Data were analysed to generate themes and information flow diagrams. RESULTS We identified four IM goals during the preadmission process: prepare referral document and inform agency; verify insurance; contact adult and review case to schedule visit. We identified four IM goals during the initial home visit: assess appropriateness and obtain consent; manage expectations; ensure safety and develop contingency plans. We identified IM-related process failures associated with each goal: home health providers and adults with too much information (information overload); home health providers without complete information (information underload); home health coordinators needing information from many places (information scatter); adults' and informal caregivers' mismatched expectations regarding home health services (information conflict) and home health providers encountering inaccurate information (erroneous information). CONCLUSIONS IM for hospital-to-home health transitions is complex, yet key for patient safety. Organisational infrastructure is needed to support IM. Future clinical workflows and health information technology should be designed to mitigate IM-related process failures to facilitate safer hospital-to-home health transitions.
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Affiliation(s)
- Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Clinical Investigation, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashley Hughes
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicole Werner
- Department of Industrial and Systems Engineering, University Of Wisconsin Colleges, Madison, Wisconsin, USA.,Department of Geriatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kimberly Carl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland, USA
| | - Kate Jones
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Kathryn H Bowles
- Biobehavioral Health Science Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Home Care Policy and Research, Visiting Nurse Services of New York, New York, New York, USA
| | - Kitty Chan
- MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Ayse P Gurses
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abstract
Purpose
The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements.
Design/methodology/approach
A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared.
Findings
Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors.
Originality/value
This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole.
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Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. AUST HEALTH REV 2017; 41:144-150. [PMID: 27333204 DOI: 10.1071/ah16054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Affiliation(s)
- Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Michele Foster
- School of Social Work and Human Services, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
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Hainstock T, Cloutier D, Penning M. From home to 'home': Mapping the caregiver journey in the transition from home care into residential care. J Aging Stud 2017; 43:32-39. [PMID: 29173512 DOI: 10.1016/j.jaging.2017.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Abstract
Family caregivers play a pivotal role in supporting the functional independence and quality of life of older relatives, often taking on a wide variety of care-related activities over the course of their caregiving journey. These activities help family members to remain in the community and age-in-place for as long as possible. However, when needs exceed family capacities to provide care, the older family member may need to transition from one care environment to another (e.g., home care to nursing home care), or one level of care to another (from less intense to more intensive services). Drawing upon qualitative interview data collected in a populous health region in British Columbia, Canada, this study explores the roles and responsibilities of family caregivers for family members making the care transition from home care to residential care. A thematic analysis of the interview transcripts resulted in the development of a conceptual framework to characterize the "Caregiver Journey" as a process that could be divided into at least three phases: 1) Precursors to transition - recognizing frailty in family members and caregivers prior to transition; 2) Preparing to transition into residential nursing home care (RC) and 3) Post-transition: Finding a new balance - where caregivers adjust and adapt to new caregiving responsibilities. Our analyses revealed that the second phase is the most complex involving a consideration of the various activities, and roles that family caregivers take on to prepare for the care transition including: information gathering, advocacy and system navigation. We conclude that there is a need for family caregivers to be better supported during care transitions; notably through ongoing and enhanced investments in strategies to support caregiver communication and education.
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Affiliation(s)
- Taylor Hainstock
- Institute on Aging & Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8P 2Y2, Canada
| | - Denise Cloutier
- Institute on Aging & Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8P 2Y2, Canada; Department of Geography, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Margaret Penning
- Institute on Aging & Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8P 2Y2, Canada; Department of Sociology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada
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Abstract
Purpose
Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues.
Design/methodology/approach
Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes.
Findings
The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs.
Originality/value
The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
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Jeffs L, Kuluski K, Law M, Saragosa M, Espin S, Ferris E, Merkley J, Dusek B, Kastner M, Bell CM. Identifying Effective Nurse-Led Care Transition Interventions for Older Adults With Complex Needs Using a Structured Expert Panel. Worldviews Evid Based Nurs 2017; 14:136-144. [DOI: 10.1111/wvn.12196] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital Volunteer Association Chair in Nursing Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital, Associate Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Kerry Kuluski
- Research Scientist, Sinai Health System; Lunenfeld-Tanenbaum Research Institute; Toronto ON Canada
| | - Madelyn Law
- Associate Professor; Brock University; St. Catherines ON Canada
| | | | - Sherry Espin
- Associate Professor; Ryerson University; Toronto ON Canada
| | - Ella Ferris
- Former Executive Vice-President-Programs; Chief Nursing Executive, and Chief Health Disciplines Executive; St. Michael's Hospital Toronto ON Canada
| | - Jane Merkley
- Executive Vice President Patient Care; Quality and Chief Nurse Executive Sinai Health System; Toronto ON Canada
| | - Brenda Dusek
- Former Program Manager; Registered Nurses’ Association of Ontario; Toronto ON Canada
| | - Monika Kastner
- Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
| | - Chaim M. Bell
- Clinician Scientist; Sinai Health System; Toronto ON Canada
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Jeffs L, Saragosa M, Law MP, Kuluski K, Espin S, Merkley J. The role of caregivers in interfacility care transitions: a qualitative study. Patient Prefer Adherence 2017; 11:1443-1450. [PMID: 28860727 PMCID: PMC5572948 DOI: 10.2147/ppa.s136058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- Correspondence: Lianne Jeffs, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Room 720, 209 Victoria Street, Toronto, ON M5B 1T8, Canada, Tel +1 416 864 6060 ext 77644, Email
| | - Marianne Saragosa
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
| | - Madelyn P Law
- Department of Health Science, Brock University, St Catharines
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, ON, Canada
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Saletti-Cuesta L, Tutton E, Langstaff D, Willett K. Understanding informal carers' experiences of caring for older people with a hip fracture: a systematic review of qualitative studies. Disabil Rehabil 2016; 40:740-750. [PMID: 27976920 DOI: 10.1080/09638288.2016.1262467] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice. METHOD Meta-ethnography was used to inform the review, and 21 studies were included. FINDINGS The analysis identified a core theme of "engaging in care: struggling through", as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown. CONCLUSIONS The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.
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Affiliation(s)
- Lorena Saletti-Cuesta
- a Culture and Society Research and Study Centre, National Scientific and Technical Research Council. (CIECS-CONICET-UNC), Córdoba , Argentina
| | - Elizabeth Tutton
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,c Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick , Warwick , UK
| | - Debbie Langstaff
- d Trauma Unit , John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust , Oxford , UK
| | - Keith Willett
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,e Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science , University of Oxford , Oxford , UK
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Rustad EC, Seiger Cronfalk B, Furnes B, Dysvik E. Next of kin's experiences of information and responsibility during their older relatives’ care transitions from hospital to municipal health care. J Clin Nurs 2016; 26:964-974. [DOI: 10.1111/jocn.13511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
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
- Department of Clinical Medicine; Helse Fonna Local Health Authority; Haugesund Norway
| | - Berit Seiger Cronfalk
- Palliative Research Center; Ersta Sklöndal University College; Stockholm Sweden
- Faculty of Health and Caring Sciences; Stord Haugesund University College; Haugesund Norway
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Bodil Furnes
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
| | - Elin Dysvik
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
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Saletti-Cuesta L, Tutton E, Langstaff D, Willett K. Understanding patient and relative/carer experience of hip fracture in acute care: A qualitative study protocol. Int J Orthop Trauma Nurs 2016; 25:36-41. [PMID: 28274778 DOI: 10.1016/j.ijotn.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND This paper presents a qualitative study protocol focusing on older peoples' experience of recovery in acute care following hip fracture and also the experiences of their family or informal carers. There is limited evidence regarding older people and their relatives'/carers' experiences of recovery in acute care. AIM The study had two research questions. First what is the experience of older people who have suffered a fractured hip and secondly what is the relatives'/carers' experience of being alongside a person who has suffered a fractured hip? METHODS The methodology chosen is phenomenology using the methods of interviewing and participant observation. It is planned to recruit a purposive sample of up to 40 patients including those with memory loss who have suffered a fractured hip, and up to 30 of their relative/carers, and up to 20 staff may choose to take part in the observation sessions. Analysis will be through drawing out units of meaning, bringing them together to form categories and themes of experience. CONCLUSION This study will extend knowledge by exploring what is important to patients and their relatives/carers in the early phase of recovery. Practice based principles that can be integrated into the hip fracture pathway and enhance future care will be developed from the study findings.
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Affiliation(s)
- Lorena Saletti-Cuesta
- Culture and Society Research and Study Centre, National Scientific and Technical Research Council (CIECS-CONICET-UNC), Cordola, Argentina
| | - Elizabeth Tutton
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals, NHS Foundation Trust, UK; RCN Research Institute, Warwick Medical School, University of Warwick, West Midlands, CV4 8UW, UK.
| | - Debbie Langstaff
- Trauma Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Keith Willett
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals, NHS Foundation Trust, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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50
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Sefcik JS, Nock RH, Flores EJ, Chase JAD, Bradway C, Potashnik S, Bowles KH. Patient Preferences for Information on Post-Acute Care Services. Res Gerontol Nurs 2016; 9:175-82. [PMID: 26815304 PMCID: PMC4955661 DOI: 10.3928/19404921-20160120-01] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/04/2015] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to explore what hospitalized patients would like to know about post-acute care (PAC) services to ultimately help them make an informed decision when offered PAC options. Thirty hospitalized adults 55 and older in a Northeastern U.S. academic medical center participated in a qualitative descriptive study with conventional content analysis as the analytical technique. Three themes emerged: (a) receiving practical information about the services, (b) understanding "how it relates to me," and (c) having opportunities to understand PAC options. Study findings inform clinicians what information should be included when discussing PAC options with older adults. Improving the quality of discharge planning discussions may better inform patient decision making and, as a result, increase the numbers of patients who accept a plan of care that supports recovery, meets their needs, and results in improved quality of life and fewer readmissions. [Res Gerontol Nurs. 2016; 9(4):175-182.].
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Affiliation(s)
- Justine S. Sefcik
- F31NR015693, University of Pennsylvania School of Nursing, Philadelphia, PA,
| | - Rebecca H. Nock
- T32NR009356, Center for Integrative Science in Aging and, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA,
| | - Emilia J. Flores
- Center for Integrative Science in Aging and, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA,
| | - Jo-Ana D. Chase
- University of Missouri Sinclair School of Nursing, S343 Sinclair School of Nursing, Columbia, MO, 65211
- T32NR009356, University of Pennsylvania School of Nursing, Philadelphia, PA,
| | - Christine Bradway
- CISA/Dept of Biobehavioral Health Sciences University of Pennsylvania School of Nursing Philadelphia, PA
| | - Sheryl Potashnik
- Decision Support: Optimizing Post-Acute Referrals and Effect on Patient Outcomes, University of Pennsylvania School of Nursing, Philadelphia, PA,
| | - Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Vice President for Research and Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York, Claire M. Fagin School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104
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