1
|
Son D, Tanaka T, Yamaguchi K, Inoue K, Kamimoto M, Lee Y, Hamada T, Taniguchi SI, Koda M. Effects of Using a Video-Sharing Application on Multidisciplinary Staff During Pre-discharge Home Assessment Visits for Elderly Hospitalized Patients. Yonago Acta Med 2023; 66:273-280. [PMID: 37229370 PMCID: PMC10203635 DOI: 10.33160/yam.2023.05.018] [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: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Abstract
Background Pre-discharge home assessment visits for elderly hospitalized patients are conducted by the hospital staff to ensure a smooth transition to home care and are effective in preventing falls and reducing the rehospitalization rates. However, the effect of an application that enables the viewing of videos of the patient's home activities during the pre-discharge visit on the multidisciplinary professionals who provide services to the patient has not yet been fully clarified. Methods Multidisciplinary professionals at 23 facilities located in western Tottori Prefecture who used a video-sharing application (Patto-Mie Net) were invited to be interview participants. Those who agreed were interviewed about the usefulness of the application in their work and its effect on multidisciplinary collaboration. A verbatim transcript was made, and thematic analysis was conducted using the qualitative analysis software NVivo. Results Twenty-eight people participated in the interviews, including nurses, care managers, rehabilitation specialists, care workers, and other social care professions. Fourteen themes and five categories were generated from the analysis: comprehensive information visualization and transferability, identification of changes over time and prognostic prediction, promoting multidisciplinary collaboration, patient and family reality, and disadvantages and concerns. Conclusion The use of an application that allows video-sharing of a patient's home movement status during a pre-discharge visit has revealed a variety of benefits for multiple professionals in hospitals and other facilities. In particular, the results were characterized by the psychological closeness between multiple professionals, promotion of interprofessional communication, and sharing of reality, including the psychosocial background of the patient and family.
Collapse
Affiliation(s)
- Daisuke Son
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8503, Japan
| | - Takeshi Tanaka
- Hino Hospital Association Hino Hospital, Hino-gun, 689-4504, Japan
| | - Koichi Yamaguchi
- Hino Hospital Association Hino Hospital, Hino-gun, 689-4504, Japan
| | - Kazuoki Inoue
- National Health Insurance Daisen Clinic, Saihaku-gun, 689-3314, Japan
| | - Minako Kamimoto
- Tottori Medical Career Support Center, Tottori University Hospital, Yonago, 683-8504, Japan
| | - Young Lee
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8503, Japan
| | - Toshihiro Hamada
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8503, Japan
| | - Shin-Ichi Taniguchi
- Department of Community-based Family Medicine, Faculty of Medicine, Tottori University, Yonago, 683-8503, Japan
| | - Masahiko Koda
- Hino Hospital Association Hino Hospital, Hino-gun, 689-4504, Japan
| |
Collapse
|
2
|
Somerville E, Minor B, Keglovits M, Yan Y, Stark S. Effect of a Novel Transition Program on Disability After Stroke: A Trial Protocol. JAMA Netw Open 2019; 2:e1912356. [PMID: 31577356 PMCID: PMC6777394 DOI: 10.1001/jamanetworkopen.2019.12356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE A gap in care for stroke survivors exists at the point of transition from inpatient rehabilitation to home, when survivors encounter new environmental barriers because of the cognitive and sensorimotor sequelae of stroke. Resolving these barriers and improving independence in the community have the potential to significantly improve stroke survivors' long-term morbidity. OBJECTIVE To investigate the efficacy and safety of a novel enhanced rehabilitation transition program to reduce environmental barriers and improve daily activity performance and community participation among stroke survivors. DESIGN, SETTING, AND PARTICIPANTS This is a phase 2b, single-blind, parallel-group, randomized clinical trial. Participants will be randomized using a 1:1 allocation ratio, stratified by Functional Independence Measure and age, to either attentional control or the intervention. Community Participation Transition After Stroke (COMPASS) is a complex intervention that uses 2 complementary evidence-based interventions: home modifications and strategy training delivered in the home. Community participation after stroke, measured by the Reintegration to Normal Living Index, is the primary outcome. Secondary outcomes include quality of life after stroke, measured by the Stroke Impact Scale, and daily activity performance and magnitude of environmental barriers in the home, both measured by the In-Home Occupational Performance Evaluation. An intention-to-treat analysis will be used. A total of 180 participants, who are 50 years or older, were independent in activities of daily living prior to stroke, and are undergoing inpatient rehabilitation following stroke with a plan to be discharged home, will be included in the study. DISCUSSION Stroke is a leading cause of serious long-term disability in the United States. The COMPASS study is ongoing. To date, 99 participants have been recruited and 77 randomized, with 37 in the treatment group and 40 in the control group. Resumption of previous activities immediately after discharge can improve immediate and long-term community participation. Results from this study will fill a critical gap in stroke rehabilitation evidence by providing important information about the long-term community participation and daily activity performance among stroke survivors as well as environmental barriers in their homes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03485820.
Collapse
Affiliation(s)
- Emily Somerville
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Brittany Minor
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Marian Keglovits
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Yan Yan
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Susan Stark
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| |
Collapse
|
3
|
Latulippe K, Provencher V, Boivin K, Vincent C, Guay M, Kairy D, Morales E, Pellerin MA, Giroux D. Using an Electronic Tablet to Assess Patients' Home Environment by Videoconferencing Prior to Hospital Discharge: Protocol for a Mixed-Methods Feasibility and Comparative Study. JMIR Res Protoc 2019; 8:e11674. [PMID: 31344677 PMCID: PMC6682277 DOI: 10.2196/11674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023] Open
Abstract
Background Occupational therapists working in hospitals are usually involved in discharge planning to assess patients’ safety and autonomy upon returning home. However, their assessment is usually done at the hospital due to organizational and financial constraints. The lack of visual data about the patients’ home may thus reduce the appropriateness and applicability of the support recommended upon discharge. Although various technological tools such as mobile devices (mobile health) are promising methods for home-based distance assessment, their application in hospital settings may raise several feasibility issues. To our knowledge, their usefulness and added value compared to standard procedure have not been addressed yet in previous studies. Moreover, several feasibility issues need to be explored. Objective This paper aims to (1) document the clinical feasibility of using an electronic tablet to assess the patient's home environment by mobile videoconferencing and (2) explore the added value of using mobile videoconferencing, compared to the standard procedure. Methods A feasibility and comparative study using a mixed-methods (convergent) design is currently undergoing. Six occupational therapists will assess the home environment of their patients in the hospital setting: they will first perform a semistructured interview (a) and then use mobile videoconferencing (b) to compare “a versus a+b.” Interviews with occupational therapists and patients and their caregivers will further explore the advantages and disadvantages of mobile videoconferencing. Two valid tools are used (the Canadian Measure of Occupational Performance and the telehealth responsivity questionnaire). Direct and indirect time is also collected. Results The project was funded in the spring of 2016 and authorized by the ethics committee in February 2017. Enrollment started in April 2017. Five triads (n=4 occupational therapists, n=5 clients, n=5 caregivers) have been recruited until now. The experiment is expected to be completed by April 2019 and analysis of the results by June 2019. Conclusions Mobile videoconferencing may be a familiar and easy solution for visualizing environmental barriers in the home by caregivers and clinicians, thus providing a promising and inexpensive option to promote a safe return home upon hospital discharge, but clinical feasibility and obstacles to the use of mobile videoconferencing must be understood. International Registered Report Identifier (IRRID) DERR1-10.2196/11674
Collapse
Affiliation(s)
- Karine Latulippe
- Center of Excellence on Aging Quebec, Quebec, QC, Canada.,Department of Teaching and Learning Studies, Université Laval, Quebec, QC, Canada
| | - Véronique Provencher
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Research on Aging, Sherbrooke, QC, Canada
| | - Katia Boivin
- CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Claude Vincent
- Department of Rehabilitation, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Manon Guay
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, QC, Canada.,Center for Research on Aging, Sherbrooke, QC, Canada
| | - Dahlia Kairy
- School of Rehabilitation, Université de Montréal, Montréal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Metropolitan Montreal, Montréal, QC, Canada
| | - Ernesto Morales
- Department of Rehabilitation, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Marc-André Pellerin
- CHU de Québec-Université Laval, Quebec, QC, Canada.,Department of Rehabilitation, Université Laval, Quebec, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - Dominique Giroux
- Center of Excellence on Aging Quebec, Quebec, QC, Canada.,Department of Rehabilitation, Université Laval, Quebec, QC, Canada
| |
Collapse
|
4
|
Threapleton K, Newberry K, Sutton G, Worthington E, Drummond A. Virtually home: Feasibility study and pilot randomised controlled trial of a virtual reality intervention to support patient discharge after stroke. Br J Occup Ther 2018. [DOI: 10.1177/0308022617743459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kate Threapleton
- Research Fellow, School of Health Sciences, University of Nottingham, UK
| | - Karen Newberry
- Senior Lecturer in Occupational Therapy, College of Health and Social Care, University of Derby, UK
| | - Greg Sutton
- Learning Technology Developer, Learning Enhancement, University of Derby, UK
| | - Esme Worthington
- Research Fellow, School of Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, University of Nottingham, UK
| |
Collapse
|
5
|
Threapleton K, Newberry K, Sutton G, Worthington E, Drummond A. Virtually home: Exploring the potential of virtual reality to support patient discharge after stroke. Br J Occup Ther 2016. [DOI: 10.1177/0308022616657111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The level of assessment and intervention received by patients prior to discharge varies widely across stroke services in the United Kingdom. This study aimed to explore the potential value of virtual reality in preparing patients for discharge following stroke. Method Semi-structured interviews were carried out with 13 occupational therapists, eight patients with a stroke and four community stroke survivors. Views were sought of the perceived acceptability, potential utility and limitations of a ‘virtual home’ environment for use in pre-discharge education and assessment. Data were analysed thematically. Findings Interviewees found the virtual home to be an acceptable and visual means of facilitating discussions about discharge. It was perceived as valuable in assessing patient insight into safety risks and exploring the implications of installing assistive equipment at home. Limitations were identified relating to specific software issues and the use of virtual reality with patients with cognitive or perceptual impairments. Conclusion The results demonstrate the potential utility of the virtual home within stroke rehabilitation. Patients and therapists engaged with the virtual home and, moreover, made practical suggestions for future development. Feasibility and pilot testing in a clinical setting is required to compare the use of the virtual home with traditional approaches of pre-discharge assessment.
Collapse
Affiliation(s)
- Kate Threapleton
- Research Fellow, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Karen Newberry
- Senior Lecturer in Occupational Therapy, College of Health and Social Care, University of Derby, Derby, UK
| | - Greg Sutton
- Learning Technology Developer, Learning Enhancement, University of Derby, Derby, UK
| | - Esme Worthington
- Research Fellow, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- Professor of Healthcare Research, School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
6
|
Atwal A, Spiliotopoulou G, Stradden J, Fellows V, Anako E, Robinson L, McIntyre A. Factors influencing occupational therapy home visit practice: a qualitative study. Scand J Occup Ther 2013; 21:40-7. [PMID: 24102559 DOI: 10.3109/11038128.2013.821162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Home visits prior to discharge from hospital are an integral part of both occupational therapy practice and the discharge process. However, there is remarkably little understanding as to why they occur in practice and who is thought to best benefit from a home visit. The aims of this research were to explore occupational therapists' perceptions of home visits and to ascertain their clinical reasoning in respect of conducting home visits. Thematic analysis was used to analyse the data. RESULTS The research revealed two different types of home visits: one with the patient and one without the patient. Both types aimed to enhance the discharge process. The key deciding factors for the chosen type of home visit were time issues and available resources. The therapist's justification for a home visit was also associated with the patient's living arrangements, impairments, and level of functioning. Occupational therapists rarely consulted patients about their preferred type of visit. CONCLUSION This study is the first to identify therapists' reasoning between two types of home visits that occur in practice. Future trials are imperative to ascertain which visit is more effective in terms of both patient outcomes and cost effectiveness.
Collapse
Affiliation(s)
- Anita Atwal
- Division of Occupational Therapy, School of Health Sciences and Social Care, Brunel University , Uxbridge , UK
| | | | | | | | | | | | | |
Collapse
|
7
|
Boronowski LE, Shorter CM, Miller WC. Measurement properties of the occupational therapy discharge needs screen. The Canadian Journal of Occupational Therapy 2012; 79:248-56. [PMID: 23210374 DOI: 10.2182/cjot.2012.79.4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pre-discharge home assessments are integral to discharge planning; however, there is no screening tool identifying clients with complex needs. PURPOSE To determine the inter- and intrarater reliability and predictive and concurrent validity of the Occupational Therapy Discharge Needs Screen (OTDNS), a screening tool that identifies clients with more complex discharge needs. METHODS The OTDNS Functional Independence Measure (FIM) and Functional Autonomy Measurement System (SMAF) were administered to 89 participants. FINDINGS Intrarater reliability was ICC = 0.93 (95% CI 0.90 - 0.96) (n = 89). Interrater reliability was ICC = 0.53 (95% CI 0.27- 0.70) (n = 89) with the initial OTDNS instructions, and ICC = 0.91 (95% CI 0.62 - 0.96) (n = 10) with revised OTDNS instructions. The OTDNS had an inverse relationship with the FIM (r = -0.51; p < 0.001) and a positive relationship with the SMAF (r = 0.64; p < 0.001). A score of > 7/28 had a sensitivity = 75% and specificity = 40% when predicting occupational therapy home assessment post-discharge. IMPLICATIONS The OTDNS has potential to contribute to continuity and efficiency of the discharge-planning process.
Collapse
Affiliation(s)
- Linda E Boronowski
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, 4255 Laurel St., Vancouver BC, V5Z 2G9.
| | | | | |
Collapse
|
8
|
Robertson L, Blaga L. Occupational therapy assessments used in acute physical care settings. Scand J Occup Ther 2012; 20:127-35. [DOI: 10.3109/11038128.2012.737369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
9
|
Cutcliffe JR, Links PS, Harder HG, Balderson K, Bergmans Y, Eynan R, Ambreen M, Nisenbaum R. Understanding the risks of recent discharge: the phenomenological lived experiences--“existential angst at the prospect of discharge”. CRISIS 2012; 33:21-9. [PMID: 21940246 DOI: 10.1027/0227-5910/a000096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that people whose mental health problems lead them to require psychiatric hospitalization are at a significantly increased risk of suicide, and that the time immediately following discharge after such hospitalizations is a particularly high-risk time. AIMS This paper reports on phenomenological findings from a federally funded, mixed-methods study that sought to better understand the observed increased risk for suicide following discharge from an inpatient psychiatric service. METHODS A purposive sample of 20 recently discharged former suicidal inpatients was obtained. Data were collected in hermeneutic interviews lasting between 1 h and 2 h and analyzed according to van (1997) interpretation of hermeneutic phenomenology. RESULTS Two key themes, "existential angst at the prospect of discharge" and "trying to survive while living under the proverbial 'sword of Damocles'" were induced. Each of these was comprised of five themes with the first key theme (which is the focus of this paper) encompassing the following: "Feeling scared, anxious, fearful and/or stressed," "Preparedness," "Leaving the place of safety," "Duality and ambivalence," and "Feel like a burden." CONCLUSIONS Early exploration of and reconciling of patients' expectations regarding inpatient care for their suicidality would be empirically based interventions that could diminish the postdischarge risk for further suicide attempts.
Collapse
|
10
|
Brown S, Craddock D, Greenyer CH. Medical Patients' Experiences of Inreach Occupational Therapy: Continuity between Hospital and Home. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13418284515875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Reforms in the National Health Service have encouraged a whole system approach. However, coordinated care may be difficult at the interface between acute hospital and community services. Inreach services are community based and the same member of staff provides intervention in hospital and after discharge. This qualitative study aimed to understand medical patients' experiences of inreach occupational therapy. Method: Semi-structured interviews were conducted with a convenience sample of seven older people, following their discharge from a medical inreach occupational therapy service. Thematic analysis was used to explore findings. Findings: Uncertainty was expressed about the role of occupational therapy and about participants not feeling involved in their hospital discharge. There was an appreciation that inreach occupational therapy could aid continuity of care. Some participants considered regular contact with a known health professional to be reassuring on return home, whereas for other participants the principle of accurate information sharing between staff was particularly important at discharge. Conclusion: All participants valued a seamless service between occupational therapy in hospital and at home. The importance of services working across organisational boundaries is emphasised, tailoring the timing of interventions to meet individuals' needs.
Collapse
Affiliation(s)
- Sarah Brown
- Team Leader Occupational Therapist, Southern Health NHS Foundation Trust, Occupational Therapy Service, Queen Alexandra Hospital, Portsmouth
| | - Deborah Craddock
- Director of Programmes for Researcher Development, Faculty of Health Sciences, University of Southampton, Southampton
| | - Corinne Hutt Greenyer
- Lecturer in Occupational Therapy, Faculty of Health Sciences, University of Southampton, Southampton
| |
Collapse
|
11
|
Wilson L, Atwal A, Richards C, McIntyre A. Do occupational therapy pre-discharge home visits affect the longer term outcomes of the discharge process? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2012. [DOI: 10.12968/ijtr.2012.19.6.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lesley Wilson
- Occupational Therapy, Brunel University, Uxbridge Middlesex
| | - Anita Atwal
- Centre for Professional Practice Research and Senior Lecturer in Occupational Therapy at Brunel University, Uxbridge. Middlesex
| | - Chris Richards
- Therapies and Stroke Services, West Middlesex University Hospital NHS Trust, Middlesex; and
| | | |
Collapse
|
12
|
Impact of familiar and unfamiliar settings on cooking task assessments in frail older adults with poor and preserved executive functions. Int Psychogeriatr 2012; 24:775-83. [PMID: 22153134 DOI: 10.1017/s104161021100216x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hospitalized frail older patients are usually assessed for their ability to perform some daily living activities in a clinical setting prior to discharge. However, assessments that take place in this unfamiliar environment might not be as representative of their functional performance as assessments at home. This may be related to a decline in some cognitive components, such as executive functions (EF), which enable one to cope with new environments. This study thus aims to compare cooking task performance in familiar and unfamiliar settings in a population of frail older adults with poor and preserved EF. METHODS Thirty-seven frail older adults were assigned to one of two groups: poor EF or preserved EF. Participants performed two cooking tasks in familiar and unfamiliar settings, using a counterbalanced design. Their performance was assessed with a reliable tool based on observation of motor and process skills (Assessment of Motor and Process Skills). RESULTS Thirty-three participants were retained for analysis. They demonstrated significantly better motor skills (F = 5.536; p = 0.025) and process skills (F = 8.149; p = 0.008) in the familiar setting. The difference between settings was particularly marked for process skills in participants with poor EF (F = 16.920; p < 0.001). CONCLUSIONS This study suggests that a home setting may be preferable for a more accurate assessment of cooking task performance in frail older adults, especially those with poor EF. These findings highlight the risk of underestimating frail older adults' performance when assessed in an unfamiliar setting (e.g. hospital), which could lead to inefficient allocation of home care services.
Collapse
|
13
|
Atwal A, Spiliotopoulou G, Plastow N, McIntyre A, McKay EA. Older Adults' Experiences of Occupational Therapy Predischarge Home Visits: A Systematic Thematic Synthesis of Qualitative Research. Br J Occup Ther 2012. [DOI: 10.4276/030802212x13311219571701] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Occupational therapists in many countries routinely perform predischarge home visits. Although there have been repeated calls to ascertain whether predischarge home visits are clinically and cost effective, there has been a tendency to neglect users' perceptions and experiences of this intervention. Objective: The objective was to conduct a systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits. Method: The search strategy was an electronic database search. Conference proceedings were hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America were contacted. Results: Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria and, from this synthesis, two main themes emerged from the data. The first theme was older adults' perceptions of home visits and the second theme was acceptance of occupational therapy. Conclusion: Only a limited body of research has been conducted. This is surprising given the number of predischarge home visits that are performed. This thematic synthesis of qualitative research has highlighted that insufficient attention has been paid to older adults' perceptions of predischarge home visits.
Collapse
Affiliation(s)
- Anita Atwal
- Senior Lecturer in Occupational Therapy, Director of the Centre for Professional Practice Research, School of Health Sciences and Social Care, Brunel University, London
| | - Georgia Spiliotopoulou
- Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, London
| | - Nicola Plastow
- Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, London
| | - Anne McIntyre
- Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, London
| | - Elizabeth A McKay
- Reader and Director of Occupational Therapy, School of Health Sciences and Social Care, Brunel University, London
| |
Collapse
|
14
|
Atwal A, Luke A, Plastow N. Evaluation of Occupational Therapy Pre-Discharge Home Visit Information Leaflets for Older Adults. Br J Occup Ther 2011. [DOI: 10.4276/030802211x13125646370889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose: This study evaluated the use, quality and readability levels of occupational therapists' pre-discharge home visit information leaflets. Method: One hundred and twelve surveys were sent via email to occupational therapists working with older people. The International Patient Decision Aids Standards and the SMOG Readability Formula were used to analyse five occupational therapy home visit leaflets, supplied by the 11 occupational therapists who responded to the survey. Results: The five leaflets had low scores in relation to providing unbiased and detailed information. In addition, the reading level of the information leaflets was, on average, four grades higher than the recommended level. Conclusion: Therapists need to ensure that the information within home visit leaflets is relevant, evidence based, and targeted at the correct readability level.
Collapse
Affiliation(s)
- Anita Atwal
- Senior Lecturer in Occupational Therapy, Director of the Centre for Professional Practice Research, School of Health Sciences and Social Care, Brunel University, West London
| | - Alexandra Luke
- Head of Clinical Pathways — Neurosciences, Maudsley Hospital, London
| | - Nicola Plastow
- Lecturer in Occupational Therapy, School of Health Sciences and Social Care, Brunel University, West London
| |
Collapse
|
15
|
Ericsson I, Malmberg B, Langworth S, Haglund A, Almborg AH. KUD - a scale for clinical evaluation of moderate-to-severe dementia. J Clin Nurs 2011; 20:1542-52. [DOI: 10.1111/j.1365-2702.2010.03619.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
16
|
Lannin NA, Clemson L, McCluskey A. Survey of current pre-discharge home visiting practices of occupational therapists. Aust Occup Ther J 2011; 58:172-7. [PMID: 21599682 DOI: 10.1111/j.1440-1630.2010.00911.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM Discharge planning frequently involves occupational therapy pre-discharge home visiting as one component of intervention. Pre-discharge home visits aim to maximise a person's functional performance within the context of their home and community environment, bridging the transition between hospital and home. The aim of this study was to describe the pre-discharge home visiting practices of occupational therapy departments. METHODS This descriptive study used a postal survey which was sent to occupational therapists in 215 public and privately funded hospitals in New South Wales, Australia. The survey enquired about the number of pre-discharge home visits completed per month, who went on visits and time spent on visits. Descriptive statistics were used in analyses. RESULTS Surveys were returned by occupational therapists from 53 departments, representing a response rate of 25%. Respondents estimated that they conducted approximately 13 pre-discharge home visits per month (range: 1-60). Visits were estimated to take an average of 1 hour and 20 minutes (excluding travel time). Approximately one-quarter of respondents felt that there was pressure to reduce the number of pre-discharge home visits conducted. Using their local hospital records, nine hospital departments estimated that the number of home visits completed per month had reduced by 50% compared with the number of home visits five years previously. DISCUSSION Findings suggest a wide variation in current pre-discharge home visiting practice. There is a need for well-designed clinical trials that investigate the effectiveness of these costly and time-consuming visits on functional performance.
Collapse
Affiliation(s)
- Natasha A Lannin
- Rehabilitation Studies Unit, Sydney Medical School, Faculty of Health Sciences, The University of Sydney, Ryde, New South Wales, Australia.
| | | | | |
Collapse
|
17
|
Fitzgerald LR, Bauer M, Koch SH, King SJ. Hospital discharge: recommendations for performance improvement for family carers of people with dementia. AUST HEALTH REV 2011; 35:364-70. [DOI: 10.1071/ah09811] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Accepted: 10/19/2010] [Indexed: 11/23/2022]
Abstract
Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. Objective. To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. Results. Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. Conclusion and recommendations. Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer’s needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers. What is known about the topic? The literature shows discharge planning can increase in patient and caregiver satisfaction, reduce post-discharge anxiety, reduce unplanned readmissions and reduce post-discharge complications and mortality. To be effective, discharge planning requires interdisciplinary collaboration; yet for people with a dementia there are insufficient system processes to support discharge planning, routine breakdowns in communication between patient, family caregivers and health professionals and inadequate admission and aftercare plans. There is little known about the discharge planning as it effects the family carer’s of people with dementia. What does this paper add? This research provides evidence of the family carer’s experience of metropolitan and rural hospital discharge as it relates to planning, preparation and support. It investigates how well the discharge planning process met the needs of the family carer and what improvements are required if hospital discharge planning is to be more effective. The research identifies a range of initiatives that hospital and health professionals can implement to improve current discharge practices for family carers of people with dementia. What are the implications for practitioners? This report makes recommendations for changes to hospital health systems and the discharge practices of health professionals. Hospitals need to develop policy, process and procedure that take into account family carer’s needs, develop key performance indicators that measure discharge planning practices, and adopt best practice activities that include such items as early engagement of the primary carer’s, the identification of a liaison health professional and implementation of a policy that requires family carers to be involved in and notified of an impending discharge. It is recommended that health professionals be educated on the needs of family carers as it relates to communication and consultation. The primary carer is involved in discussions and decisions about in-hospital and post-hospital treatment regimes and is in agreement with, and competent in, post-discharge treatments, therapies and support services.
Collapse
|
18
|
Barras S, Grimmer-Somers K, May E. Consensus on 'core/essential' and 'ideal world' criteria of a pre-discharge occupational therapy home assessment. J Eval Clin Pract 2010; 16:1295-300. [PMID: 20738478 DOI: 10.1111/j.1365-2753.2009.01331.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES There are no standard criteria for an occupational therapy (OT) home assessment for patients about to be discharged from an acute rehabilitation facility. This has implications for benchmarking, quality improvement and research. The aim of this paper is to establish 'core/essential' and 'ideal world' elements of OT home assessments for patients about to be discharged from acute rehabilitation settings. METHODS A piloted open-ended questionnaire initiated a Delphi study involving knowledgeable OTs working in Australian public and private acute rehabilitation settings. 'Core/essential' and 'ideal world' elements of OT home assessments were confirmed when 70% agreement was reached. RESULTS Of 242 facilities in two Australian states, 110 were invited to participate, and 81 OTs from 84 facilities did so. Four Delphi rounds were required to reach consensus on 30 'core/essential' and 25 'ideal world' elements. CONCLUSION Standard use of 'core/essential' pre-discharge home assessment elements should improve standards of care and the quality of discharge planning. OTs should consider including 'ideal world' criteria in pre-discharge assessments to optimize recently ill patients' community independence.
Collapse
Affiliation(s)
- Sarah Barras
- University of South Australia, Adelaide, South Australia, Australia
| | | | | |
Collapse
|
19
|
Elliott C, Frith J, Newton J. Occupational Therapy in Chronic Liver Disease: A Preliminary Study to Explore the Views of Occupational Therapists and Physicians Working in Acute Medical Settings. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12682330090451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic liver disease (CLD) is on the increase worldwide. Occupational therapists are well placed to address many of the symptoms associated with CLD; however, there is a dearth of literature to support this or to define the current working practice of occupational therapists in this clinical area. This study used questionnaires and mixed methodological analysis to describe both the current working practice of occupational therapists in CLD and the perceptions of the occupational therapist's role by physicians referring patients with CLD to occupational therapy. Thematic analysis of the structured data demonstrated an appropriate understanding of, and referral to, occupational therapy in the context of safe discharge from hospital and the provision of equipment. Cross-sectional analysis revealed a homogeneous approach to current occupational therapy working practice in CLD which, although expedient, lacks emphasis on the treatment of the symptoms experienced by this client group.
Collapse
Affiliation(s)
- Chris Elliott
- Institute for Ageing and Health, Newcastle University
| | - James Frith
- Institute for Ageing and Health, Newcastle University
| | - Julia Newton
- Institute for Ageing and Health, Newcastle University
| |
Collapse
|
20
|
Home and Clinical Assessments of Instrumental Activities of Daily Living: What Could Explain the Difference between Settings in Frail Older Adults, If Any? Br J Occup Ther 2009. [DOI: 10.1177/030802260907200803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Older patients are usually assessed by occupational therapists in hospital before going home. However, for many frail older adults, this assessment in an unfamiliar environment might not be as representative of their functional abilities as an assessment at home. The aim of this literature review was to determine if differences exist between home and clinical instrumental activities of daily living (IADL) assessments of frail older adults and identify factors that might explain those differences, if any. Method: The sources of the review data were Medline, CINAHL, AMED, PsycINFO, Embase and Current Content from 1988 to 2008. As few relevant studies concerning frail people were found, the search was extended to mixed-age and older adult populations. Ten articles were retained. Main findings: The results suggest differences in IADL assessment between settings for older adults without dementia. Some factors, such as familiarity with the environment and coping skills, might explain those differences. Based on this review, similar results might be expected with frail older people. Implications for practice: Given the dearth of literature on this topic, further research is needed to compare home and clinical assessments and measure relevant factors in a frail population. Helping occupational therapists to identify frail patients, who may show different abilities in unfamiliar settings, could mean more appropriate services after discharge from hospital.
Collapse
|
21
|
Abstracts. Br J Occup Ther 2009. [DOI: 10.1177/03080226090728s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
22
|
Borthwick R, Newbronner L, Stuttard L. 'Out of Hospital': a scoping study of services for carers of people being discharged from hospital. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:335-349. [PMID: 19175427 DOI: 10.1111/j.1365-2524.2008.00831.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Successive government policies have highlighted the need to inform and involve carers fully in the hospital discharge process. However, some research suggests that many carers feel insufficiently involved and unsupported in this process. This paper summarises a scoping review to identify what the UK literature tells us about the service provision for carers, and its effectiveness, around the time of hospital discharge of the care recipient, and also describes a mapping exercise of the work currently being done by Princess Royal Trust for Carers Centres in England to support carers around the time of hospital discharge. The restriction to UK literature was dictated by the nature of the project; a modest review carried out for a UK-based voluntary sector organization. Fifty-three documents were reviewed, of which 19 papers (representing 17 studies) were reporting on primary research. As only five of these studies actually involved an intervention, it appears there is very little research from the UK which evaluates specific interventions to support carers around the time of hospital discharge of the care recipient. While the mapping exercise showed that in some areas there are services and/or initiatives in place which have been designed to improve the process of discharge for carers, in many places there is still a gap between what policy and research suggest should happen and what actually happens to carers at this time. Even where services and initiatives to support carers through the discharge process exist, there is only limited evidence from research or evaluation to demonstrate their impact on the carer's experience. Further research, both quantitative and qualitative, is required to address these areas and enable commissioners, providers and carers' organizations to work together towards a service in which patients and carers alike receive the support and help they need at this significant time of transition.
Collapse
|
23
|
Bauer M, Fitzgerald L, Haesler E, Manfrin M. Hospital discharge planning for frail older people and their family. Are we delivering best practice? A review of the evidence. J Clin Nurs 2009; 18:2539-46. [PMID: 19374695 DOI: 10.1111/j.1365-2702.2008.02685.x] [Citation(s) in RCA: 211] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This paper examined the available evidence concerning hospital discharge practices for frail older people and their family caregivers and what practices were most beneficial for this group. BACKGROUND Hospital discharge practices are placing an increasing burden of care on the family caregiver. Discharge planning and execution is significant for older patients where inadequate practices can be linked to adverse outcomes and an increased risk of readmission. DESIGN Literature review. METHODS A review of English language literature published after 1995 on hospital discharge of frail older people and family carer's experiences. Results. Numerous factors impact on the hospital discharge planning of the frail older person and their family carer's that when categorised focus on the role that discharge planning plays in bridging the gap between the care provided in hospital and the care needed in the community, its potential to reduce the length of hospital stay, the impact of the discharge process on family carer's and the need for a coordinated health professional approach that includes dissemination of information, clear communication and active support. CONCLUSION The current evidence indicates that hospital discharge planning for frail older people can be improved if interventions address family inclusion and education, communication between health care workers and family, interdisciplinary communication and ongoing support after discharge. Interventions should commence well before discharge. Relevance to clinical practice. An awareness of how the execution of the hospital discharge plan is perceived by the principal family carer of a frail older person, will allow nurses and others involved with the discharge process to better reconcile the family caregivers' needs and expectations with the discharge process offered by their facility. The research shows there is a direct correlation between the quality of discharge planning and readmission to hospital.
Collapse
Affiliation(s)
- Michael Bauer
- Division of Nursing and Midwifery/Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Vic., Australia
| | | | | | | |
Collapse
|
24
|
Harris S, James E, Snow P. Predischarge occupational therapy home assessment visits: Towards an evidence base. Aust Occup Ther J 2008; 55:85-95. [DOI: 10.1111/j.1440-1630.2007.00684.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Hibberd J. The home‐visiting process for older people in the in‐patient intermediate care services. QUALITY IN AGEING AND OLDER ADULTS 2008. [DOI: 10.1108/14717794200800003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
26
|
Atwal A, McIntyre A, Craik C, Hunt J. Occupational Therapists' Perceptions of Predischarge Home Assessments with Older Adults in Acute Care. Br J Occup Ther 2008. [DOI: 10.1177/030802260807100203] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Predischarge occupational therapy home assessments are routinely performed with older adults in Europe, Australia and North America. Their primary aim is to facilitate a timely and safe discharge from hospital. However, there is a lack of published research on this topic, especially studies exploring occupational therapists' perceptions of home assessments. The paper aims to redress this by describing occupational therapists' perceptions of predischarge occupational therapy home assessments with older adults in acute care. All occupational therapists who undertook home assessments in an acute care hospital with older adults during the duration of the study period were invited to complete a reflective diary. In total, 15 reflective diaries were completed by six therapists. The data were analysed using thematic content analysis. The findings suggest that home assessments were carried out because of mobility or environmental concerns. Satisfaction and dissatisfaction with the outcome of the home assessment were related to the incidents that occurred during the assessment. Some of the occupational therapists' anxieties were related to the older adults' level of functioning or ill health, and the older adults' own concerns did have an impact upon the therapists' expectations of the home assessment process.
Collapse
Affiliation(s)
- Anita Atwal
- Brunel University, Uxbridge, Middlesex
- Hounslow Primary Care Trust, West Middlesex University Hospital, Isleworth, Middlesex
| | | | | | - Jacki Hunt
- Hounslow Primary Care Trust, West Middlesex University Hospital, Isleworth, Middlesex
| |
Collapse
|
27
|
Huby G, Brook JH, Thompson A, Tierney A. Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization. J Interprof Care 2007; 21:55-67. [PMID: 17365374 DOI: 10.1080/13561820601035020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' "participation" in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of "decision-making" and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
Collapse
Affiliation(s)
- Guro Huby
- Centre for Integrated Healthcare Research, School of Health in Social Sciences, University of Edinburgh, UK.
| | | | | | | |
Collapse
|
28
|
Mistiaen P, Francke AL, Poot E. Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review. BMC Health Serv Res 2007; 7:47. [PMID: 17408472 PMCID: PMC1853085 DOI: 10.1186/1472-6963-7-47] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 04/04/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients encounter a variety of problems after discharge from hospital and many discharge (planning and support) interventions have been developed and studied. These primary studies have already been synthesized in several literature reviews with conflicting conclusions. We therefore set out a systematic review of the reviews examining discharge interventions. The objective was to synthesize the evidence presented in literature on the effectiveness of interventions aimed to reduce post-discharge problems in adults discharged home from an acute general care hospital. METHODS A comprehensive search of seventeen literature databases and twenty-five websites was performed for the period 1994-2004 to find relevant reviews. A three-stage inclusion process consisting of initial sifting, checking full-text papers on inclusion criteria, and methodological assessment, was performed independently by two reviewers. Data on effects were synthesized by use of narrative and tabular methods. RESULTS Fifteen systematic reviews met our inclusion criteria. All reviews had to deal with considerable heterogeneity in interventions, populations and outcomes, making synthesizing and pooling difficult. Although a statistical significant effect was occasionally found, most review authors reached no firm conclusions that the discharge interventions they studied were effective. We found limited evidence that some interventions may improve knowledge of patients, may help in keeping patients at home or may reduce readmissions to hospital. Interventions that combine discharge planning and discharge support tend to lead to the greatest effects. There is little evidence that discharge interventions have an impact on length of stay, discharge destination or dependency at discharge. We found no evidence that discharge interventions have a positive impact on the physical status of patients after discharge, on health care use after discharge, or on costs. CONCLUSION Based on fifteen high quality systematic reviews, there is some evidence that some interventions may have a positive impact, particularly those with educational components and those that combine pre-discharge and post-discharge interventions. However, on the whole there is only limited summarized evidence that discharge planning and discharge support interventions have a positive impact on patient status at hospital discharge, on patient functioning after discharge, on health care use after discharge, or on costs.
Collapse
Affiliation(s)
- Patriek Mistiaen
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, the Netherlands
| | - Else Poot
- The Netherlands Centre of Excellence in Nursing (LEVV), P.O. Box 3135, 3502 GC Utrecht, the Netherlands
| |
Collapse
|
29
|
Feasibility and results of a randomised pilot-study of pre-discharge occupational therapy home visits. BMC Health Serv Res 2007; 7:42. [PMID: 17355644 PMCID: PMC1832184 DOI: 10.1186/1472-6963-7-42] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/14/2007] [Indexed: 12/13/2022] Open
Abstract
Background Pre-discharge home visits aim to maximise independence in the community. These visits involve assessment of a person in their own home prior to discharge from hospital, typically by an occupational therapist. The therapist may provide equipment, adapt the home environment and/or provide education. The aims of this study were to investigate the feasibility of a randomised controlled trial in a clinical setting and the effect of pre-discharge home visits on functional performance in older people undergoing rehabilitation. Methods Ten patients participating in an inpatient rehabilitation program were randomly assigned to receive either a pre-discharge home visit (intervention), or standard practice in-hospital assessment and education (control), both conducted by an occupational therapist. The pre-discharge home visit involved assessment of the older person's function and environment, and education, and took an average of 1.5 hours. The hospital-based interview took an average of 40 minutes. Outcome data were collected by a blinded assessor at 0, 2, 4, 8 and 12 weeks. Outcomes included performance of activities of daily living, reintegration to community living, quality of life, readmission and fall rates. Results Recruitment of 10 participants was slow and took three months. Observed performance of functional abilities did not differ between groups due to the small sample size. Difference in activities of daily living participation, as recorded by the Nottingham Extended Activities of Daily Living scale, was statistically significant but wide confidence intervals and low statistical power limit interpretation of results. Conclusion Evaluation of pre-discharge home visits by occupational therapists in a rehabilitation setting is feasible, but a more effective recruitment strategy for a main study is favored by application of a multi-centre setting.
Collapse
|
30
|
Efraimsson E, Sandman PO, Rasmussen BH. "They were talking about me"--elderly women's experiences of taking part in a discharge planning conference. Scand J Caring Sci 2006; 20:68-78. [PMID: 16489962 DOI: 10.1111/j.1471-6712.2006.00382.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Discharge planning procedures needs improving to make transition to care settings in the community smooth, safe and secure. Research about discharge planning that involves a patient perspective is limited. The intention of this study was to focus on the patients' (elderly women) experiences of taking part in discharge planning conferences (DPCs) to deepen our understanding of the meaning of facing "the world of the institution" from a life-world perspective. AIM This study aims at describing elderly women's experience of taking part in a DPC as they are about to be discharged from hospital. METHODOLOGICAL DESIGN To illuminate the phenomenon from a life-world perspective, an interview study was chosen. Eight follow-up interviews with seven elderly women were carried out. The interviews were analysed using a qualitative content analysis methodology. FINDINGS The interpretation of data was that the women's future was as in suspense as they got ill or were hit by accidents. The analysis revealed four themes that reflected the women's experiences of taking part in the DPCs: Being affiliated; Being in focus, Standing outside; and finally Being unprepared. STUDY LIMITATIONS AND CONCLUSION: The limitations of the study are related to: selection of participants; participation in the interview was connected to a video recording study; gap in time between participation in the DPC and the interview. The findings are still seen as trustworthy as the experiences expressed by the participating women in data are to be seen as a contribution to an emerging understanding of the meaning of the phenomenon from a life world perspective. The findings make clear that the institutional world easily and without much resistance from the patients transgresses the border of their life worlds. This awakes a need to reconsider how a caring perspective can be established in practice.
Collapse
Affiliation(s)
- Eva Efraimsson
- School of Health Sciences, University College of Borås, Allégatan 1, S-501 90 Borås, Sweden.
| | | | | |
Collapse
|
31
|
Barras S. A systematic and critical review of the literature: The effectiveness of Occupational Therapy Home Assessment on a range of outcome measures. Aust Occup Ther J 2005. [DOI: 10.1111/j.1440-1630.2005.00496.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|