1
|
Ingram L, Pitt R, Shrubsole K. Health professionals' practices and perspectives of post-stroke coordinated discharge planning: a national survey. BRAIN IMPAIR 2024; 25:IB23092. [PMID: 38566295 DOI: 10.1071/ib23092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Background It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals' practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers. Methods A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis. Results Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family . The main perceived barriers were the socio-political context and health professionals' beliefs about capabilities . The main perceived facilitators were health professionals' social/professional role and identity, knowledge, and intentions . The organisation domain was perceived as both a barrier and facilitator to CDP. Conclusion Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.
Collapse
Affiliation(s)
- Lara Ingram
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia; and Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia; and Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia
| |
Collapse
|
2
|
Söderhielm K, Eriksson K, Möller M. Communicative participation in goal-setting meetings for patients with aphasia after stroke. A study using patients' and healthcare professionals' self-ratings. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:342-356. [PMID: 36218168 DOI: 10.1111/1460-6984.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self-rated communicative participation during goal-setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self-rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. METHODS Nine PwA and nine control patients without aphasia rated their experience of communication during a goal-setting meeting. Thirty-eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal-setting meetings. RESULTS The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self-rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. CONCLUSION Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self-ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self-reported experience, since awareness might influence results. WHAT THIS PAPER ADS What is already known on this subject Aphasia is an acquired language disorder that affects patient-provider communication. In stroke rehabilitation, person-centred goal setting is a key component. If healthcare professionals (HCPs) are not able to use adequate communication strategies, a lack of accessible communication can become a barrier to person-centredness. There are evidence-based communication strategies which can be used to overcome this barrier. What this paper adds to existing knowledge This study aimed to investigate communicative participation during goal-setting meetings from the perspective of patients with aphasia and HCPs. To our knowledge, this is the first study where persons with aphasia are asked to rate communicative participation in goal-setting meetings. To broaden the perspective on communication and goal setting, ratings of patients with aphasia are compared to ratings by patients with stroke but no aphasia. The results of this study indicate that there is room for improvement regarding communication during goal-setting meetings. However, asking direct questions on communicative participation to persons with severe aphasia may not be feasible. What are the potential or actual clinical implications of this work? The results of this study imply that both patients with and without aphasia may need more support to be able to express themselves during goal-setting meetings. There also seems to be a need for further education on aphasia and communication strategies among rehabilitation professionals.
Collapse
Affiliation(s)
- Kajsa Söderhielm
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Science & Society (NVS), Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Karin Eriksson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Geriatrics, Pulmonary Disease and Allergology, Gothenburg, Sweden
| | - Marika Möller
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
3
|
Carbone S, Kokorelias KM, Berta W, Law S, Kuluski K. Stakeholder involvement in care transition planning for older adults and the factors guiding their decision-making: a scoping review. BMJ Open 2022; 12:e059446. [PMID: 35697455 PMCID: PMC9196186 DOI: 10.1136/bmjopen-2021-059446] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesise the existing literature on care transition planning from the perspectives of older adults, caregivers and health professionals and to identify the factors that may influence these stakeholders' transition decision-making processes. DESIGN A scoping review guided by Arksey and O'Malley's six-step framework. A comprehensive search strategy was conducted on 7 January 2021 to identify articles in five databases (MEDLINE, Embase, CINAHL Plus, PsycINFO and AgeLine). Records were included when they described care transition planning in an institutional setting from the perspectives of the care triad (older adults, caregivers and health professionals). No date or study design restrictions were imposed. SETTING This review explored care transitions involving older adults from an institutional care setting to any other institutional or non-institutional care setting. Institutional care settings include communal facilities where individuals dwell for short or extended periods of time and have access to healthcare services. PARTICIPANTS Older adults (aged 65 or older), caregivers and health professionals. RESULTS 39 records were included. Stakeholder involvement in transition planning varied across the studies. Transition decisions were largely made by health professionals, with limited or unclear involvement from older adults and caregivers. Seven factors appeared to guide transition planning across the stakeholder groups: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Factors were described at microlevels, mesolevels and macrolevels. CONCLUSIONS This review explored stakeholder involvement in transition planning and identified seven factors that appear to influence transition decision-making. These factors may be useful in advancing the delivery of person and family-centred care by determining how individual-level, group-level and system-level values guide decision-making. Further research is needed to understand how various stakeholder groups balance these factors during transition planning in different health contexts.
Collapse
Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| |
Collapse
|
4
|
Suivi des patients traités par AVK : intérêt d’un relais pharmaceutique entre l’hôpital et la ville. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:45-53. [DOI: 10.1016/j.pharma.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/19/2022]
|
5
|
Olsson M, Carlström E, Marklund B, Helldin L, Hjärthag F. Assessment of Distress and Quality of Life: A Comparison of Self-Assessments by Outpatients with a Schizopsychotic Illness and the Clinical Judgment of Nurses. Arch Psychiatr Nurs 2015; 29:284-9. [PMID: 26397430 DOI: 10.1016/j.apnu.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 04/29/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate how self-assessments of perceived distress and quality of life in patients with schizopsychotic illness are associated with nurse assessments of symptoms, function and life situation. Data were obtained through interviews that used evidence-based rating and visual analogue self-rating scales. Descriptive statistics, correlation and regression analyses were used to process the data. The results demonstrated that the patient self-ratings did not correlate with the nurse assessments, and the perceived distress was not affected by remission status. The findings indicate that patient self-assessments are not a sufficient basis for decisions regarding appropriate treatment interventions.
Collapse
Affiliation(s)
- Maivor Olsson
- Department of Psychiatry, NU-Hospital Organisation, Trollhättan, Sweden; Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Eric Carlström
- Academy of Sahlgrenska, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Nursing, Health and Culture, University West, Trollhättan, Sweden.
| | - Bertil Marklund
- Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Primary Health Care Research Development and Education Centre, Vänersborg, County Administration of West Sweden, Sweden.
| | - Lars Helldin
- Department of Psychiatry, NU-Hospital Organisation, Trollhättan, Sweden; Department of Psychology, Karlstad University, Karlstad, Sweden.
| | - Fredrik Hjärthag
- Department of Psychology, Karlstad University, Karlstad, Sweden.
| |
Collapse
|
6
|
Older people and decision-making following acute stroke in China: ‘hiding’ as a barrier to active involvement. AGEING & SOCIETY 2015. [DOI: 10.1017/s0144686x15000549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACTDecision-making among older patients with stroke, their families and professionals has been extensively studied in a Western context, but there has been little prior work in China. The study reported here explored how decision-making took place between older people with stroke, their family carers and professionals in an acute care context in mainland China using a constructivist grounded theory approach. Data were collected through semi-structured interviews, participant observation and documentary analysis. Constant comparative analysis of the data was carried out. This paper focuses on the key social process of ‘hiding’ and its dynamic relationship with the core category ‘keeping the peace’. In order to meet the traditional Chinese cultural value of ‘maintaining harmony’, both family carers and professionals hid essential information from older stroke survivors who, as a consequence, were effectively precluded from playing an active role in major decisions. In understanding ‘hiding’, the paper draws upon both Chinese cultural values and ‘awareness context theory’ and in so doing questions the relevance to the Chinese context of key Western notions such as involvement in health-care decision-making. A better understanding of the experiences of decision-making processes between older people with stroke, their family carers and professionals in China will help professionals to provide the best possible support and care whilst promoting informed decision-making amongst all concerned.
Collapse
|
7
|
Gabrielsson-Järhult F, Nilsen P. On the threshold: older people's concerns about needs after discharge from hospital. Scand J Caring Sci 2015; 30:135-44. [DOI: 10.1111/scs.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Per Nilsen
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| |
Collapse
|
8
|
Stans SEA, Dalemans R, de Witte L, Beurskens A. Challenges in the communication between 'communication vulnerable' people and their social environment: an exploratory qualitative study. PATIENT EDUCATION AND COUNSELING 2013; 92:302-312. [PMID: 23809168 DOI: 10.1016/j.pec.2013.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Communication vulnerable people are often unable to communicate effectively within their social environment, hindering client-centered care and participation in daily life. This study aims to explore the experiences of communication and the factors that influence this in long term care settings. METHODS A qualitative study using the critical incident method. Communication vulnerable clients and people within their immediate environment were interviewed about their communication experiences. RESULTS Thirty-nine individuals in three settings participated in the interviews, of which 14 were clients. Specific challenges in communication were presented in different relationships. The main influencing factors in the communication between clients and professionals were: effort put into improving the communication, knowledge of the professional, augmentative and alternative communication, time for communication and the influence and power of the client. CONCLUSION Communication vulnerable people and people within their immediate environment face daily challenges in communicating with each other. In particular, communication among clients, can be very difficult. Augmentative and alternative communication tools are only rarely used. PRACTICE IMPLICATIONS Professionals need to develop adequate knowledge and skills to improve their communication. Also, more attention should be focussed on use of AAC, communication between professionals and family members, and support in the communication among clients.
Collapse
Affiliation(s)
- Steffy E A Stans
- Zuyd University of Applied Sciences, Faculty of Health, Heerlen, The Netherlands.
| | | | | | | |
Collapse
|
9
|
Berglund H, Wilhelmson K, Blomberg S, Dunér A, Kjellgren K, Hasson H. Older people's views of quality of care: a randomised controlled study of continuum of care. J Clin Nurs 2013; 22:2934-44. [PMID: 23808647 DOI: 10.1111/jocn.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To analyse frail older people's views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older people's own homes. BACKGROUND Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older people's views of quality of care. DESIGN Randomised controlled study. METHODS Items based on a validated questionnaire were used in face-to-face interviews to assess older people's views of quality of care at three, six and 12 months after baseline. RESULTS Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p ≤ 0·005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12 months (p < 0·03). CONCLUSIONS The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older people's own homes, case management and interprofessional teamwork. RELEVANCE TO CLINICAL PRACTICE The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.
Collapse
Affiliation(s)
- Helene Berglund
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Vårdalinstitutet, The Swedish Institute for Health Sciences, Lund, Sweden
| | | | | | | | | | | |
Collapse
|
10
|
Donnelly SM, Carter-Anand J, Cahill S, Gilligan R, Mehigan B, O’Neill D. Multiprofessional Views on Older Patients’ Participation in Care Planning Meetings in a Hospital Context. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/09503153.2013.786695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Olsson M, Larsson LG, Flensner G, Bäck-Pettersson S. The impact of concordant communication in outpatient care planning - nurses' perspective. J Nurs Manag 2013; 20:748-57. [PMID: 22967293 DOI: 10.1111/j.1365-2834.2012.01479.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To elucidate registered nurses' experiences of coordinated care planning in outpatient care. BACKGROUND Coordinated care planning has been studied from the perspectives of both patients and nurses in inpatient care, but it is deficient in outpatient care. METHOD Qualitative content analysis of interviews with 10 registered nurses participating in two focus groups. RESULTS An overall theme was identified: creating concordant communication in relation to patient and health-care providers. The result is based on four categories and nine subcategories. CONCLUSIONS Nurses need extraordinary communication skills to reach concordance in outpatient care planning. In addition to involving and supporting the patients and next of kin in the decision-making process, the outcome of the nursing process must be understood by colleagues and members of other professions and health-care providers (non-nursing). IMPLICATIONS FOR NURSING MANAGEMENT An effective outpatient care-planning process requires that care managers understand the impact of communicating, transferring information and reaching consensus with other health-care providers, actively supporting employees in the outpatient care-planning process and contributing to the development of common goals and policy documents across organisational boundaries.
Collapse
Affiliation(s)
- Maivor Olsson
- Department of Psychiatry, NU-Hospital Organisation, Trollhättan, Sweden.
| | | | | | | |
Collapse
|
12
|
Thompson J, Mckeever M. The impact of stroke aphasia on health and well-being and appropriate nursing interventions: an exploration using the Theory of Human Scale Development. J Clin Nurs 2012; 23:410-20. [DOI: 10.1111/j.1365-2702.2012.04237.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Care planning at home: a way to increase the influence of older people? Int J Integr Care 2012; 12:e134. [PMID: 23593048 PMCID: PMC3601533 DOI: 10.5334/ijic.817] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/25/2012] [Accepted: 06/20/2012] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. METHODS Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. RESULTS Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. CONCLUSION Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.
Collapse
|
14
|
Siouta E, Broström A, Hedberg B. Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals. Eur J Cardiovasc Nurs 2012; 12:47-55. [DOI: 10.1177/1474515111430894] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eleni Siouta
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
| | - Anders Broström
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Sweden
| | - Berith Hedberg
- Department of Nursing Science, School of Health Sciences, Jönköping University, Sweden
- Ryhov County Hospital, 55185 Jönköping, Sweden
| |
Collapse
|
15
|
Yeung SM, Wong FKY, Mok E. Holistic concerns of Chinese stroke survivors during hospitalization and in transition to home. J Adv Nurs 2011; 67:2394-405. [DOI: 10.1111/j.1365-2648.2011.05673.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|