Nurses’ Perception of Discharging the Medically Complex Pediatric Patient

The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video interpreters when in-person interpreters are not available, and respect for discharge readiness. Recognizing and implementing the appropriate interventions based on nurses’ feedback have the potential to improve quality and patient safety

Readiness for Discharge in Parents of Hospitalized Children

Parental preparation for a child\u27s discharge from the hospital sets the stage for successful transitioning to care and recovery at home. In this study of 135 parents of hospitalized children, the quality of discharge teaching, particularly the nurses\u27 skills in “delivery” of parent teaching, was associated with increased parental readiness for discharge, which was associated with less coping difficulty during the first 3 weeks postdischarge. Parental coping difficulty was predictive of greater utilization of posthospitalization health services. These results validate the role of the skilled nurse as a teacher in promoting positive outcomes at discharge and beyond the hospitalization

A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia in the acute hospital setting

Aim. This paper considers the challenges of delivering effective palliative care to older people with dementia and the possible strategies to overcome barriers to endof-life care in these patients. Background. In UK alone, approximately 100 000 people with dementia die each year and as the number of older people increases, dementia is set to become even more prevalent. Dementia is a progressive terminal illness for which there is currently no cure. Patients dying with dementia have significant health-care needs and in recent years it has been recognised that palliative care should be made available to everyone regardless of diagnosis, as this improves comfort and quality of life. Despite this, patients dying with dementia are often still not given access to palliative care services. Method. A review of English language literature published after 1996 to the present day relating to older people with dementia during the terminal phase of their illness. Results. Twenty-nine articles met inclusion criteria for the review. Most originated from North America and UK and were mostly quantitative in nature. Four key themes were identified: difficulties associated with diagnosing the terminal phase of the illness (prognostication); issues relating to communication; medical interventions; and the appropriateness of palliative care intervention. Conclusions.This review reinforces the importance of providing appropriate palliative care to individuals suffering from end-stage dementia and identifies some of the barriers to extending such specialist palliative care provision. Relevance to practice. There is an urgent need to improve palliative care provision for older people with end-stage dementia and, in addition, more research is required on the needs of patients entering the terminal phase of dementia to assist the allocation of appropriate resources and training to ensure quality and equality in the provision of end-of-life care

Hospital-based alternatives to acute paediatric admission: a systematic review

Objective: To synthesise published evidence of the impacts of introducing hospital-based alternatives to acute paediatric admission. Design: Systematic review of studies of interventions published in English. Patients: Children with acute medical problems referred to hospitals. Interventions: Services provided in a hospital as an alternative to inpatient admission. Main outcome measures: Admission or discharge, unscheduled returns to hospital, satisfaction of parents and general practitioners, effects on health service activity and costs. Results: 25 studies were included: one randomised controlled trial, 23 observational or cross-sectional studies and one qualitative study. Many studies were of uncertain quality or were open to significant potential bias. About 40% of children attending acute assessment units in paediatric departments, and over 60% of those attending acute assessment units in A & E departments, do not require inpatient admission. There is little evidence of serious clinical consequences in children discharged from these units, although up to 7% may subsequently return to hospital. There is some evidence that users are satisfied with these services and that they are associated with reductions in inpatient activity levels and certain hospital costs. Evidence about the impact of urgent outpatient clinics is very limited. Conclusions: Current evidence supports a view that acute paediatric assessment services are a safe, efficient and acceptable alternative to inpatient admission, but this evidence is of limited quantity and quality. Further research is required to confirm that this type of service reorganisation does not disadvantage children and their families, particularly where inpatient services are withdrawn from a hospital

Critical Illness Survivors’ Perceptions of Their Recovery: An Interpretive Phenomenological Inquiry

Surviving critical illness with its physical, cognitive, and psychosocial morbidities is a growing clinical and research challenge and an important public health concern. Currently, there are few interventions for survivors of critical illness after hospital discharge. Potential interventions include rehabilitation services, Intensive Care Unit (ICU) diaries and ICU follow-up clinics, however, most survivors do not have access to these post-hospital interventions. The purpose of this study is to gain a better understanding of how critical illness survivors experience their recovery, interventions they use, and what they perceive as facilitators and barriers to their recovery. A better understanding of these factors, as reported by critical illness survivors, may lead to identification and development of interventions that can be more broadly implemented in the community setting. This multi-site study was guided by interpretive phenomenology, using semi-structured interviews. Purposive sampling was used to identify study participants from six different ICUs. Eighteen participants were recruited for the study. Interpretive phenomenological analysis (IPA) was used to analyze interview transcripts. Six major themes emerged from the interviews; Experiences of Recovery, Self-Managing Recovery, Following Recommendations, Support, Barriers to Recovery, and Unmet Needs. Major findings of this study included participants’ reports of unmet needs of mental health and psychological recovery that were not addressed by healthcare providers. In addition, participants also lacked appropriate knowledge of what to expect during their recovery, which contributed to frustration and anxiety. Findings from this study have implications for nursing practice, education, and research. Nurses are in a unique position to help patients cope with their emotions prior to discharge and provide them with anticipatory guidance once they are discharged. Carefully planned discharge should include a discussion of barriers that critical illness survivors may encounter once they are discharged and also include guidance on how to problem solve those challenges

Using patient-reported measures to drive change in healthcare: the experience of the digital, continuous and systematic PREMs observatory in Italy

BACKGROUND: The use of Patient Reported Experience Measures (PREMs) has great potential in healthcare service improvement, but a limited use. This paper presents an empirical case of PREMs innovation in Italy, to foster patient data use up to the ward level, by keeping strengths and addressing weaknesses of previous PREMs survey experiences. The paper reports key lessons learned in this ongoing experience of action research, directly involving practitioners. METHODS: The aim of this paper is to present the results of an ongoing action research, encompassing the innovation of PREMs collection, reporting and use, currently adopted by 21 hospitals of two Italian regions. The continuous and systematic PREMs collection has been implemented between 2017 and 2019 and includes: a continuous web-based administration, using web-services; an augmented and positive questionnaire matching standard closed-ended questions with narrative sections; the inclusion and benchmarking of patient data within a shared performance evaluation system; public disclosure of aggregated anonymized data; a multi-level and real-time web-platform for reporting PREMs to professionals. The action research was carried out with practitioners in a real-life and complex context. The authors used multiple data sources and methods: observations, feedback of practitioners, collected during several workshops and meetings, and analysis of preliminary data on the survey implementation. RESULTS: A continuous and systematic PREMs observatory was developed and adopted in two Italian regions. PREMs participation and response rates tend to increase over time, reaching stable percentages after the first months. Narrative feedback provide a 'positive narration' of episodes and behaviours that made the difference to patients and can inform quality improvement actions. Real-time reporting of quantitative and qualitative data is enabling a gratifying process of service improvement and people management at all the hospitals' levels. CONCLUSIONS: The PREMs presented in this paper has been recognized by healthcare professionals and managers as a strategic and positive tool for improving an actual use of PREMs at system and ward levels, by measuring and highlighting positive deviances, such as compassionate behaviours

Peer Support for Addiction in the Inpatient Setting

Background: In 2006 the Institute of Medicine reported that combined mental illness and substance use disorder was the second leading cause of disability and death in women and the highest cause in men. More recent data obtained from the 2016 National Survey on Drug Use and Health (Ahrnsbratz et al 2016) indicates in 2016 only one in ten of the people who need treatment, receive it. At Cambridge Health Alliance’s Everett Hospital, the site of this pilot project, opioid overdose and acute alcohol intoxication comprise one in every ten visits in the Emergency Department. In January of 2018, CHA partnered with North Suffolk Mental Health to embed two Recovery Coaches in the Emergency Room and Inpatient setting to support and engagement and navigation into treatment for patients presenting to the hospital with addiction. Aims: The aim of this study is to describe Year One of the Recovery Coach pilot project, with recommendations for improvement to inform further program growth. Method: The population of patients who worked with a Recovery Coach in Year One is described in terms of demographic information, insurance status and ACO attribution. Semi-structured interviews of patients, Recovery coaches, staff, providers, and administrators were conducted to extract qualitative themes among the stakeholders. Results: The average patient is described as a 44-year-old, white, low-income, English-speaking male living in a surrounding community with Alcohol use Disorder. Themes emerging from interviews indicate positive support for the program from all stakeholder perspectives. Strong themes of value in patient engagement, Recovery Coach empowerment, and influence on staff and provider work satisfaction emerge, as well as several areas of opportunity for program improvement. Conclusions: The findings of this study provide valuable stakeholder input that will improve the program and inform its expansion. The findings should not be generalized to other programs, as the CHA inpatient-based Recovery Coach model is different than other programs described in the literature. However, this study may be of interest to another hospital planning to develop an inpatient-based model

Pediatric Intensive Care Hospitalization: Sibling Experience

Prior research on the impact of pediatric intensive care unit (PICU) hospitalization on families have been predominantly focused on the parents, yet siblings who visit the ill child in the PICU environment remain understudied. The aim of this study was to describe the experiences of 9- to 17-year-old siblings of acutely critically ill or injured children. A generic qualitative approach using one-to-one interviews, observations, and clinician notes was used to gain an understanding of the experience of siblings who visited the PICU. Qualitative analytic methods were used to analyze the data. The findings from 16 siblings (mean age 6.3 years) indicated that visiting their critically ill sister or brother in the PICU can be emotionally distressing. Three major themes and nine subthemes were identified from the data. Predominant sibling stressors include: Pre-illness stressors, ICU environment, parent stressors, appearance of ill child, and uncertainty. Siblings coped by distraction, praying, reflecting on their bond with the ill child, and accepting support from close friends, family members, and the community. Sibling physical, emotional, and social health were impacted. Siblings experienced fear, worry, and hope while visiting their critically ill sister or brother in the PICU. Future research should fully incorporate the sibling perspective when designing interventions to mitigate the effects of PICU visitation on healthy children