Nurse liaison: a strategy for counter-referral

Continuity of care for patients recovering from Covid-19 under the angle of clinical management principles

OBJECTIVE

To analyze the strategies used by nurses at a university hospital to ensure continuity of care at hospital discharge for patients recovered from Covid-19, under the angle of the principles of clinical management.

METHOD

A descriptive study with a qualitative approach, carried out with seven nurses on duty in the medical and gynecology/obstetrics clinics of a university hospital in the Midwest region of the country. The data was processed using IRaMuTeQ software and analyzed using Content Analysis.

RESULTS

The data resulted in five classes by the Descending Hierarchical Classification (DHC), which made up two categories: "Practices developed by nurses for continuity of care in the hospital environment" and "Continuity of care during discharge to the home". The strategies used by the nurses were: daily care systematized in the nursing process and guidance both for preparation and for the day of discharge.

CONCLUSION

The absence of an institutional protocol for safe discharge, as well as the position of nurse coordinator to manage the discharge of patients with Covid-19, can compromise the continuity of care for these patients.

Do nurses participate in end-of-life decision making?

BACKGROUND

To explore how Jordanian nurses participate in the end-of-life (EoL) decision-making process.

METHODS

Interviews with 10 patients and family caregivers, and focus group discussions with seven healthcare professionals (HCPs), were conducted. Interviews were audio-recorded, transcribed and analysed following inductive thematic analysis.

FINDINGS

The participants agreed that nurses are not fully engaged and did not have a direct role in the EoL decision-making process. However, the participants highlighted that 'nurses bridge the gaps in the decision-making process', where nurses act as mediators to facilitate the decision-making process. Lastly, nurses were viewed as 'nurturers and supporters during the journey of the patient's illness'; they were always available to answer their questions, offer help and advise when necessary during palliative referral and throughout the illness.

CONCLUSIONS

Although nurses did not directly participate in EoL decisions, they have several vital contributions that need to be rearranged into structured decisional coaching.

Continuity and coordination of care: conceptual interface and nurses' contributions

This is a theoretical-reflective study, with the objective of discussing the concepts of continuity and coordination of care, its conceptual interface and nurses' actions for its effectiveness in health services, based on international and national scientific publications. The concepts have been studied for decades and, although they are interrelated, they are used in a similar way, indicating a lack of conceptual understanding. The concept of continuity underwent paradigm shifts and began to adopt patients' perspectives. Currently, it involves interpersonal, longitudinal, management and informational domains. Coordination consists of establishing connections between the possible elements involved in care. It is classified as horizontal and vertical and is organized into categories: sequential, parallel and indirect. Nurses stand out through actions aimed at coordination and continuity at different levels of care, which contributes to strengthening a cohesive and people-centered care. The interface between concepts indicates that, in order to achieve integrated and continuous services, continuity and coordination of care need to be interconnected and act together.

Responsible hospital discharge: content validation of nurse's activities

OBJECTIVE

To develop and validate a list of activities to be performed by the nurse at the responsible hospital discharge.

METHOD

Content validation study. The 14 generated items were organized on a Likert scale and submitted to judges' appreciation, using the Delphi Technique. Relevance, explicitness in the statements and the sequential order of execution were evaluated. The consensus for the answers was pre-established at 0.80 and the content validity index was calculated.

RESULTS

Eight professionals participated in the validation of the created list. In Delphi 1, the content validity index ranged from 0.7 (post-discharge contact and home visit scheduling) to 1.0 and in Delphi 2, a range from 0.60 (post-discharge telephone contact) to 1.0.

CONCLUSION

13 of the 14 proposed activities were validated. The created list of activities can contribute to the safe discharge process, the continuity and comprehensiveness of care and, also, to the reduction of readmissions.

Effects of the liaison nurse management on the infectious stroke complications: a randomized controlled trial

Background

Two of the most serious complications after stroke are pneumonia, and urinary tract infection. Liaison nurse, from hospital admission to discharge and then at home helps patients with complicated caring issues stroke. This study investigates the effect of liaison nurse management on the incidence of pneumonia and urinary tract infection in patients with stroke after discharge from the hospital.

Methods

This randomized controlled trial was conducted on 80 patients in a hospital in Iran. The intervention group was assessed and developed a caring program by the liaison nurse and the control group received routine care. Two weeks and two months after discharge, the patients were evaluated for the incidence of pneumonia and urinary tract infection. Collected data were analyzed using the Chi-square test. P < 0.05 was considered statistically significant.

Results

The two groups were homogenous in terms of mean age; gender frequently distribution and having urinary catheter. The incidence of pneumonia in intervention and control groups (11.6% vs. 19.2%, P = 0.35) had no statistically significant differences, but there was a significant difference in the incidence of urinary tract infection (0% vs. 24.6%, P < 0.001).

Conclusions

With liaison nurse performance, there was a significant difference in the incidence of urinary tract infection, in two months after discharge from hospital, but the incidence of pneumonia had no statistically significant differences in two groups. Nurse’s evaluation each patient individually according to needs, developing and monitoring the home-based care program, beyond overall education to these patients, could reduce some of complications of a stroke.

Trial registration

This study is retrospectively registered by Iranian Registry of Clinical Trials with decree code: IRCT20170605034330N3 on April 4, 2018.

Continuidade e coordenação do cuidado: interface conceitual e contribuições dos enfermeiros

RESUMO Estudo teórico-reflexivo, com objetivo de discutir os conceitos de continuidade e coordenação do cuidado, sua interface conceitual e ações de enfermeiros para sua efetivação nos serviços de saúde, com base em publicações científicas internacionais e nacionais. Os conceitos são estudados há décadas e, embora sejam inter-relacionados, observa-se sua utilização de maneira semelhante, indicando falta de entendimento conceitual. O conceito de continuidade teve mudanças de paradigma e passou a adotar a perspectiva dos pacientes. Atualmente, envolve domínios interpessoal, longitudinal, gerencial e informacional. Coordenação consiste em estabelecer conexões entre os possíveis elementos envolvidos no cuidado. Classifica-se como horizontal e vertical e está organizada em categorias: sequencial, paralela e indireta. Enfermeiros destacam-se por meio de ações voltadas à coordenação e continuidade nos diferentes níveis de atenção, o que contribui para o fortalecimento do cuidado coeso e centrado nas pessoas. A interface entre conceitos indica que, para o alcance de serviços integrados e contínuos, continuidade e coordenação do cuidado precisam estar interligadas e atuar em conjunto.

Cuidados de transição: análise do conceito na gestão da alta hospitalar

RESUMO Objetivo analisar o conceito Cuidados de Transição no contexto da gestão da alta hospitalar. Método reflexão analítica utilizando-se a análise conceitual de Walker e Avant: seleção do conceito; definição do objetivo, identificação do uso do conceito (busca na literatura e dicionários entre setembro-dezembro/2019 nas bases de dados: PubMed, Biblioteca Virtual em Saúde e SCOPUS. Consideraram-se 77 artigos que contemplaram conceito e outros termos que corroboraram o estudo; para fins metodológicos, 12 estudos possibilitaram a análise); definição dos atributos; descrição de caso modelo; descrição de casos adicionais; definição de antecedentes e consequentes; definição de indicadores empíricos. Resultados os antecedentes cuidados fragmentados e reinternação são comuns ao conceito. Identificaram-se atributos cuidado integrado, colaboração profissional, coordenação, planejamento da alta, comunicação, integração profissional e gerenciamento de casos. Conclusão e implicações para a prática foi oportuno analisar o conceito em conjunto com termos relacionados ao contexto da alta hospitalar. Cuidados de Transição são práticas coordenadas e eficazes para a Continuidade dos Cuidados na transferência do usuário na alta hospitalar; nesse contexto, as Enfermeiras de Ligação são potenciais protagonistas para estar à frente nesse processo de Integração. As especificidades do conceito poderão favorecer a sua compreensão e a construção de conhecimentos que repercutam no cuidado coordenado e contínuo.

Alta hospitalar responsável: validação de conteúdo de atividades do enfermeiro

RESUMO Objetivo: Desenvolver e validar uma lista de atividades a serem realizadas pelo enfermeiro na alta hospitalar responsável. Método: Estudo de validação de conteúdo. Os 14 itens gerados foram organizados em uma escala Likert e submetidos à apreciação de juízes, através da Técnica Delphi. Avaliou-se relevância, clareza nos enunciados e ordem sequencial de execução. O consenso para as respostas foi pré-estabelecido em 0,80 e calculado o índice de validade de conteúdo dos itens. Resultados: Oito profissionais participaram da validação da listagem construída. Na Delphi 1, o índice de validade de conteúdo variou de 0,70 (contato pós alta e agendamento de visita domiciliar) a 1,0 e, na Delphi 2, encontrou-se variação de 0,60 (contato telefônico pós alta) a 1,0. Conclusão: Foram validadas 13 das 14 atividades propostas. A listagem de atividades construída pode contribuir para o processo de alta segura, a continuidade e integralidade do cuidado e, ainda, para a redução das readmissões.

Hospital - primary care articulation in care transition: both sides of the process

OBJECTIVE

To analyze how the articulation between hospital and primary health care related to patient discharge and continuity of care after hospitalization takes place.

METHOD

Qualitative study, using the focus group technique to explore the experience of 21 nurses in hospitals (n = 10) and at primary care (n = 11) in a municipality in the northwest area of the State of São Paulo. Data collection took place between December 2019 and April 2020. Four focus groups were carried out (two in the hospital and two in the health units) and the findings underwent thematic analysis.

RESULTS

The categories identified were: Patient inclusion flow in the responsible discharge planning, Patient/family member/caregiver participation, Care planning, Communication between services, and Challenges in the discharge process. According to reports, the discharge process is centered on bureaucratic aspects with gaps in communication and coordination of care.

CONCLUSION

This research allowed understanding how nurses from different points of health care experience the discharge and (dis)articulation of the team work. The findings can equip managers in the (re)agreement of practices and integration of services to promote continuity of care.

Association between the orientation received during hospitalization and the occurrence of wound healing

OBJECTIVES

to assess whether there is an association between the orientation received during hospitalization and the occurrence of wound healing from the patient's perspective after hospital discharge.

METHODS

concurrent cohort, with 180-day follow-up, held in Dermatology Ward. A total of 62 patients with wounds requiring care after discharge were evaluated between July 2015 and November 2016. Information about the orientation was obtained by phone call between 7 and 10, 60, 120 and 180 days after discharge.

RESULTS

the older the patient, the lower the chance of healing in up to ten days; and the longer the hospitalization, the lower the chance of healing. They received orientation in the high 90.3%, while 87% understood the orientations.

CONCLUSIONS

there was no association between the orientation received during hospitalization and the occurrence of wound healing from the patient's perspective after hospital discharge.

Integration strategies for caring for chronic noncommunicable diseases: a case study

OBJECTIVES

to identify the strategies for integrated care used regarding Chronic Noncommunicable Diseases in a Health District.

METHODS

a case study developed in a district of a municipality in southern Brazil, with 34 participants (coordinators and nursing assistants). Data were collected between August 2016 and June 2017, through interviews, documents and computerized files. To organize the data, the MAXQDA® software was used. Analysis took place using the Integrated Care Network model.

RESULTS

integration strategies were highlighted in the systemic, normative and functional dimensions, such as coordination, district organization, Annual Operating Plan, information system, and user management service.

FINAL CONSIDERATIONS

the district comprises a structure that enables interactions through various tools; among these, coordination represents an effective strategy to enhance care, boost cooperation among professionals and support and manage the district.

Nurse-to-nurse collaboration between nurses caring for older people in hospital and primary health care: A cross-sectional study

AIMS AND OBJECTIVES

To assess the level of nurse-to-nurse collaboration during the transfer of older people between hospital and primary health care and to evaluate the psychometric properties of the newly developed Nurse-to-Nurse Collaboration Between Sectors Instrument.

BACKGROUND

Nurse-to-nurse collaboration is required when older people transfer between hospital and primary health care to enhance the safety and continuity of care to patients. There is a lack of evidence about the nature and level of this collaboration.

DESIGN

A cross-sectional survey design was used. This study adhered to the STROBE checklist.

METHODS

A sample of 443 nurses (university hospital n = 240, primary health care n = 203) participated in the study from October 2017 to June 2018. Nurses completed the Nurse-to-Nurse Collaboration Between Sectors Instrument (86 items, 7-point Likert-type scale), the Nurse-Nurse Collaboration Scale and the Patient-Centred Competency Scale.

RESULTS

Nurses rated the overall level of nurse-to-nurse collaboration moderately high (mean=4.49, standard deviation=0.83, maximum 7.00). Nurses considered collaboration an important and confidential process, gaining older people's trust in their care. Lower scores were given to the agreement of mutual objectives, policies and guidelines in collaboration, opportunities for job rotation and interacting and networking during the collaboration process. The internal consistency reliability of the newly developed instrument was acceptable.

CONCLUSIONS

Nurses collaborate with competence and confidentiality during the transfer of older people between care settings. However, there is a need for more opportunities to collaborate, to obtain mutual agreement about objectives, policies and practices, and better understand other nurse's roles and responsibilities in collaboration. The reliability and validity of the Nurse-to-Nurse Collaboration Between Sectors Instrument were acceptable though the number and wording of items will be reviewed and further tested.

RELEVANCE TO CLINICAL PRACTICE

Nurses need opportunities to collaborate, and there is a need to develop agreed objectives, practices, roles and responsibilities in this collaboration.

Práticas de enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária

Resumo Objetivo compreender as práticas dos enfermeiros de um hospital universitário na continuidade do cuidado para a atenção primária. Método estudo exploratório, descritivo e qualitativo, realizado entre agosto e novembro de 2019, em hospital universitário no Sul do Brasil, com 21 enfermeiros e a diretora de Enfermagem, aplicando-se, respectivamente, um instrumento on-line na plataforma Survey Monkey e uma entrevista semiestruturada. Os dados coletados foram submetidos à Análise de Conteúdo segundo Minayo. Resultados emergiram três categorias: práticas dos enfermeiros; fortalezas e fragilidades e competências para a continuidade do cuidado. Na admissão e alta, os enfermeiros realizam entrevista e exame físico do paciente. Os pontos positivos foram a comunicação e o conhecimento do contexto familiar da equipe multiprofissional hospitalar e os negativos, a falta de sistema informatizado, a integração dos profissionais do hospital com a atenção primária, o enfermeiro gestor de altas e o protocolo de contrarreferência. A continuidade do cuidado requer, dos enfermeiros, experiência profissional, conhecimento sobre a rede de atenção, habilidades de comunicação, liderança e tomada de decisão. Conclusão e implicações para a prática os enfermeiros compreendem a importância da continuidade do cuidado, entretanto, algumas fragilidades encontradas na instituição dificultam a realização dessas práticas.

PRACTICES OF HOSPITAL NURSES FOR CONTINUITY OF CARE IN PRIMARY CARE: AN EXPLORATORY STUDY

ABSTRACT Objective: to know the practices developed by hospital nurses for continuity of care for Primary Care. Method: this is an exploratory, qualitative research conducted in university hospitals in São Paulo and Curitiba, Brazil. For data collection, a semi-structured interview was conducted with the Director of Nursing and an online questionnaire through open-ended and closed-ended questions, with nurses between August 2018 and July 2019. The analyzes of the interviews were carried out as proposed by Minayo based on in the theoretical framework of continuity of care. Results: the research was conducted at three university hospitals, and one Director of Nursing and 48 nurses participated. From analysis of nurses’ answers, two categories of analysis emerged: identification of post-discharge patients’ care needs and the necessary competencies for continuity of care. Where it was perceived since patients’ admission, nurses’ concern for continuity of post-hospital discharge care, establishing flows together with nurses of the Internal Center for Regulation/Discharge Management Service for the Health Department of the municipality, which forwards to patients’ reference health unit. Conclusion: although nurses are professionals who actively participates in care at various points in the health care network and recognizes the importance of continuing post-discharge care, they remain a fragile point in the care chain, and it is necessary to strengthen this mechanism with Primary Care, optimize home care and avoid hospitalizations.

Care transition of patients with chronic diseases from the discharge of the emergency service to their homes

OBJECTIVE

To evaluate the quality of the care transition for patients with chronic non-communicable diseases discharged from the emergency department to home.

METHOD

A cross-sectional observational and epidemiological study conducted at an emergency department in the South of Brazil with 117 patients and 81 caregivers. The Care Transitions Measure was applied by phone to collect data. A descriptive and analytical statistical analysis was performed.

RESULTS

The quality of the care transition's total score was close to satisfactory (69.5). The "Self-Management Training" factor had the highest score (70.6), while "Understanding medications" had the lowest (68.3). Items related to understanding medications and confidence in carrying out care after discharge obtained lower scores.

CONCLUSIONS

A moderate quality of the care transition was evidenced, as well as the need to adopt strategies to improve the emergency department discharge process and the continuity of the care of patients with chronic diseases.

CONTINUITY OF HOSPITAL DISCHARGE CARE FOR PRIMARY HEALTH CARE: SPANISH PRACTICE

ABSTRACT Objective: to understand discharge plan and the facilities and difficulties for continuity of care in Primary Health Care. Method: a qualitative and exploratory study carried out in Madrid, Barcelona, Murcia, Seville and Granada, with 29 hospital liaison nurses working in university hospitals, between 2016 and 2018. For data collection, an online questionnaire was used with open and closed questions about the profile of nurses; work context; hospital discharge plan; communication between hospital nurses and primary care. All were analyzed based on Thematic Analysis. Results: hospital liaison nurses from Spain draw up a discharge plan at least 48 hours in advance. They offer a Continuity of Care Report, guide patients, families and caregivers to the necessary care after hospital discharge, coordinate consultations and referrals and carry out home visits. Communication with primary care occurs through the computerized system and telephone. Monitoring takes place using indicators and statistical reports. In cases of readmission, nurses are requested and contacted by nurses in primary care. Communication with primary care is among the facilities. Lack of liaison nurses is among the difficulties. Conclusion: hospital liaison nurses from Spain carry out a discharge plan and communicate with primary care. When patients are hospitalized, they are called when there is a need for continuity of care for primary care.

Transitional care from hospital to home for older people: implementation of best practices

ABSTRACT Objective: to assess the conformity of nursing care concerning best evidence in transitional care from hospital to home for older people. Methods: a project to implement best evidence based on the model proposed by the Joanna Briggs Institute in surgical clinic of a university hospital with older people, caregivers or family members, and nurses, between July and August 2019. Eight evidence-based criteria have been audited through interviews, medical records and computerized system, presented in percentages. Results: the highest non-compliance rate found in a baseline audit was absence of continued training on transitional care and hospital discharge plan. Identifying barriers to best practices included educational programs; afterwards, there was an improvement in compliance rates in all the criteria assessed. Final considerations: the criteria based on audited evidence showed an increase in compliance rates with the strategies implemented, contributing to improving transitional care for older people.

Liaison nurse activities at hospital discharge: a strategy for continuity of care

Objective

to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge.

Method

descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories.

Results

among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient’s information to an extra-hospital service.

Conclusion

the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.

The continuity of hospital nursing care for Primary Health Care in Spain

OBJECTIVE

To learn the profile and activities carried out by the Hospital Nurse Liaison for the continuity of care in Primary Health Care in Spain.

METHOD

An exploratory study with a qualitative approach developed in five University Hospitals in Madrid and three in Barcelona, with Hospital Nurse Liaisons who work in Hospitals in Madrid (8) and Barcelona (11). An online questionnaire was applied with open and closed questions for data collection. The data were analyzed by the content analysis technique in the thematic modality.

RESULTS

Nineteen (19) Hospital Nurse Liaisons participated in the study. The liaisons' ages ranged from 26 to 64 years old, the majority were women (94.73%) with experience between 21 and 30 years (52.63%), and had worked in this job between 6 months and 26 years. The Nurse Liasion is required to perform a clinical assessment of the patient prior to discharge and to contact the Nurse in the patient's area of origin by telephone or e-mail. It is necessary to have experience as an educator, to work in a team and have motivation.

CONCLUSION

Nurses in Spain perform care continuity for Primary Health Care, in which their activities encompass the availability of resources and experience in managing the care of complex patients and their families.