Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post-discharge from acute care hospital

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients

BACKGROUND

Neurological conditions produce considerable disease burden.

AIMS

To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden.

METHOD

A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview.

RESULTS

Most patients and caregivers rated quality of life as 'Good'. The patients' physical, psychological and environment domain scores, and caregivers' physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression.

CONCLUSION

A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Using an economic evaluation approach to support specialist nursing services for people with Parkinson's in a regional community

Aim

This study aims to provide economic evidence of the cost‐effectiveness of employing specialist Parkinson's nurses in a regional community in Australia.

Study design

This retrospective study utilized hospital service usage data to compare outcomes for people with Parkinson's disease before and after the employment of a specialist Parkinson's nurse in a regional community.

Methods

A representative sample was drawn from the target population of people with a diagnosis of Parkinson's admitted to a regional hospital over a 4‐year period (2013–2014 and 2016–2017). A multiple regression approach and cost–benefit analysis were used to examine hospital costs related to length of stay based on hospital records. All costs were attributed to resource allocation according to service category and the national funding system. Quantitative data were analysed using Strata Analytics.

Results

Statistical findings demonstrated a reduction in hospital length of stay ranging from 0.37 (AUD$1924) to 0.755 day (AUD$3926) after the establishment of the specialist Parkinson's nurse. The cost–benefit analysis showed a net dollar benefit, or savings in hospital costs, of up to $8600.00 per person over a 3‐year period, as a result of the specialist Parkinson's nurse intervention.

Conclusion

The statistical results show significant cost benefits associated with reduced length of hospital stay following introduction of the specialist Parkinson's nurse. These findings support advocacy for sustainable specialist Parkinson's nurse positions and have the potential to inform and influence policy and systemic changes within the health care system.

Impact

The benefits of embedding specialist nursing services for people with Parkinson's disease in primary health settings include the direct impact on the potential to avoid hospital admissions due to worsening symptoms, improving quality of life for the person with Parkinson's and slowing the trajectory of the disease. Additional benefits are increased access to specialist services and reduced family caregiver burden.

Care of the Patient With Acute Ischemic Stroke (Posthyperacute and Prehospital Discharge): Update to 2009 Comprehensive Nursing Care Scientific Statement: A Scientific Statement From the American Heart Association

In 2009, the American Heart Association/American Stroke Association published a comprehensive scientific statement detailing the nursing care of the patient with an acute ischemic stroke through all phases of hospitalization. The purpose of this statement is to provide an update to the 2009 document by summarizing and incorporating current best practice evidence relevant to the provision of nursing and interprofessional care to patients with ischemic stroke and their families during the acute (posthyperacute phase) inpatient admission phase of recovery. Many of the nursing care elements are informed by nurse-led research to embed best practices in the provision and standard of care for patients with stroke. The writing group comprised members of the Stroke Nursing Committee of the Council on Cardiovascular and Stroke Nursing and the Stroke Council. A literature review was undertaken to examine the best practices in the care of the patient with acute ischemic stroke. The drafts were circulated and reviewed by all committee members. This statement provides a summary of best practices based on available evidence to guide nurses caring for adult patients with acute ischemic stroke in the hospital posthyperacute/intensive care unit. In many instances, however, knowledge gaps exist, demonstrating the need for continued nurse-led research on care of the patient with acute ischemic stroke.