Multidisciplinary recording and continuity of care for stroke patients with eating difficulties

Patient-centered discharge summaries to support safety and individual health literacy: a double-blind randomized controlled trial in Austria

BACKGROUND

To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients.

METHODS

In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree).

RESULTS

In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001).

CONCLUSION

With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time.

TRIAL REGISTRATION

First registration 13/11/2020 NCT04628728 at www.

CLINICALTRIALS

gov , Update 15/03/2023.

How are allied health notes used for inpatient care and clinical decision-making? A qualitative exploration of the views of doctors, nurses and allied health professionals

BACKGROUND

Inpatient care is dependent upon the effective transfer of clinical information across multiple professions. However, documented patient clinical information generated by different professions is not always successfully transferred between them. One obstacle to successful information transfer may be the reader's perception of the information, which is framed in a particular professional context, rather than the information per se.

OBJECTIVE

The aim of this research was to investigate how different health professionals perceive allied health documentation and to investigate how clinicians of all experience levels across medicine, nursing and allied health perceive and use allied health notes to inform their decision-making and treatment of patients.

METHOD

The study used a qualitative approach. A total of 53 speech pathologists, nurses, doctors, occupational therapists, dieticians and social workers (8 males; 43 females) from an Australian regional tertiary hospital participated in eleven single discipline focus groups, conducted over 4 months in 2012. Discussions were recorded and transcribed verbatim and coded into themes by content analysis.

FINDINGS

Six themes contributing to the efficacy of clinical information transference emerged from the data: day-to-day care, patient function, discharge and discharge planning, impact of busy workloads, format and structure of allied health documentation and a holistic approach to patient care.

DISCUSSION

Other professions read and used allied health notes albeit with differences in focus and need. Readers searched for specific pieces of information to answer their own questions and professional needs, in a process akin to purposive sampling. Staff used allied health notes to explore specific aspects of patient function but did not obtain a holistic picture.

CONCLUSION

Improving both the relationship between the various health professions and interpretation of other professions' documented clinical information may reduce the frequency of communication errors, thereby improving patient care.

The Minimal Eating Observation Form-II (MEOF-II): cross-cultural validation of the Chinese version for people with stroke

RATIONALE, AIMS AND OBJECTIVES

Eating difficulties are common among patients affected by stroke. A valid, reliable instrument for assessing eating difficulties in people with stroke is needed. The aim of this study was to translate the Minimal Eating Observation Form - version II (MEOF-II) for patients with stroke into Chinese and to comprehensively evaluate its reliability and validity.

METHODS

The scale of the original MEOF-II form was translated into Chinese using the cross-culture translation method, and 125 participants with stroke were assessed. Data were analysed by content validity index, Cronbach's alpha, correlations and exploratory factor analysis (EFA).

RESULTS

Reliability and validity were demonstrated for the scale. A three-factor structure was illustrated by EFA, and construct validity was demonstrated by good convergent and discriminant validity.

CONCLUSIONS

The Chinese version (Ch-MEOF-II) shows good reliability and validity in this study and can be applicable to assess eating difficulties in people with stroke; The Ch-MEOF-II allows the early recognition of eating difficulties and thus provides guidance of proper clinical interventions. For future study, a confirmatory factor analysis may need to confirm the three-factor structure identified in this study. Furthermore, a cross-cultural comparison can be conducted with the availability of the three different validated language versions of the MEOF-II form.

Clinical nursing leaders' perceptions of nutrition quality indicators in Swedish stroke wards: a national survey

AIM

To describe nursing leaders' perceptions of nutrition quality in Swedish stroke wards.

BACKGROUND

A high risk of undernutrition places great demand on nutritional care in stroke wards. Evidence-based guidelines exist, but healthcare professionals have reported low interest in nutritional care. The Donabedian framework of structure, process and outcome is recommended to monitor and improve nutrition quality.

METHOD

Using a descriptive cross-sectional design, a web-based questionnaire regarding nutritional care quality was delivered to eligible participants.

RESULT

Most clinical nursing leaders reported structure indicators, e.g. access to dieticians. Among process indicators, regular assessment of patients' swallowing was most frequently reported in comprehensive stroke wards compared with other stroke wards. Use of outcomes to monitor nutrition quality was not routine. Wards using standard care plans showed significantly better results.

CONCLUSION

Using the structure, process and outcome framework to examine nutrition quality, quality-improvement needs became visible. To provide high-quality nutrition, all three structure, process and outcome components must be addressed.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of care pathways, standard care plans, the Senior Alert registry, as well as systematic use of outcome measures could improve nutrition quality. To assist clinical nursing leaders in managing all aspects of quality, structure, process and outcome can be a valuable framework.

Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Aims and Objectives. This study aimed to investigate barriers for nutrition therapy in the transition between hospital and home and hereby to identify areas for potential improvements. Background. Though the focus on nutritional risk is improving in hospital, there seems to be less effort to maintain or even improve nutritional status after discharge and during the rehabilitation period. Design. Qualitative focus group interviews. Methods. Semistructured focus group interviews with experienced multiprofessional staff from hospital, home care, nursing homes, and general practise. The study was done in the county of Aalborg with about 280.000 inhabitants regarding homecare and general practise as well as Aalborg University Hospital, Denmark. Results. Interviews were generated with 41 professionals from hospital, general practise, and home care. Barriers identified between settings included the following aspects: economic, organisation, and education. The impression of professionals was that few patients are discharged with nutrition therapy, compared to who could benefit from nutrition therapy after discharge. Most often, reasons were a short in-hospital stay and lack of knowledge and interest. Moreover, lack of clinical guidelines throughout all settings, time consumption, lack of transparency regarding economy and workflows, and lack of assistance from experts regarding complicated nutritional problems were identified. Conclusions. Many barriers were found in hospital as well as in the community and general practise. These were most often practical as well as organizational. Improvements of clinical guidelines and instructions and improvement of knowledge and communication at all levels are needed. Relevance to Clinical Practise. This study emphasizes that responsibility needs to be taken for patients whom are still at nutritional risk at discharge, and even before hospitalization. Nurses and doctors in and outside hospital are in need of improved knowledge, standard care plans, and instructions.