Transition from self-supported to supported living: Older people's experiences

To become dependent on professional support to accomplish the daily activities of life can be considered a turning point, involving a range of challenging changes in life. The purpose of the study was to describe the experiences of older home-dwelling individuals in transition from self-supported to supported living from a lifeworld perspective. Five women and five men were interviewed, and a descriptive phenomenological design was used. The findings showed that an attitude of acceptance was an essential characteristic for this group. An attitude of acceptance comprised: flexibility and tolerance, recognition and hopes, and valuation of self and situation. Finding themselves in a situation they had to submit to, they took an attitude of acceptance. An attitude of acceptance implied acknowledgement of the situation as well as positivity and desires to manage. This attitude may represent a significant potential for improvement. Awareness of this is crucial to support older individuals in a healthy way through the transition process. An attitude of acceptance, however, also implied an acceptance of discontinuity in their lives, renunciations, and denigration of own needs. But this aspect of the acceptance was trivialized by the participants and not equally obvious. Insight into this complexity is vital to avoid ignorance of older individuals’ vulnerability in the transition process

Struggle with a gap between intensive care units and general wards

Nursing critically ill patients includes planning and performing safe discharges from Intensive Care Units (ICU) to the general wards. The aim of this study was to obtain a deeper understanding of the main concern in the ICU transitional process—the care before, during, and after the transfer of ICU patients. Interviews were conducted with 35 Swedish nurses and analysed according to grounded theory. The main concern was the nurses' “struggling with a gap.” The “gap” was caused by differences in the altered level of care and contributed to difficulties for nurses encountering an overlap during the transitional care. The categories: sheltering, seeking organizational intertwining and striving for control are related to the core category and were used to generate a theory. The nurses sought improved collaboration, and employed patient-centred routines. They wanted access to necessary tools; they relayed or questioned their own competence and sought assurance of the patients' ability to be transferred. If the nurses felt a loss of control, lack of intertwining and lack of collaboration, they sheltered their patients and themselves. Intertwining was more difficult to perform, but actually even more important to do. With knowledge about ICU transitional care, collaboration, routines, and with an organization that provides an educational environment, the process could be improved

Eliciting reflections on caring theory in elderly caring practice

Caring theories are the description and conceptualization of the care that is given in caring practise by nurses and other professional caregivers with the aim of verbalizing and communicating caring phenomena. Intermittently, a theory –practice gap is given expression- that theory does not go along with clinical practice in caring

Qualitative theory testing as mixed-method research

While the concept of mixed-methods research is more usually associated with combining quantitative and qualitative approaches, this paper outlines a study that mixed methods by undertaking qualitative theory testing and derivation when examining the relationship between health promotion theory and hospital nursing practice. Thus, it is concerned with relating the metatheoretical aspects of the debate and not with the pragmatic aspects of the research and concomitant methods. A deductive–inductive–deductive design, based on the theory–research–theory strategy of Meleis (1985), tested, revised and developed for nursing established health promotion theory using theory-testing criteria. To complement the methodological mix, the study also used the theory (i.e. a health-promotion taxonomy) as a framework to contextualise the findings rather than generate theory in the way associated with interpretative inquiry. While inconsistent with the traditional view linking theory testing with quantitative, objective epistemology, the process enabled a theoretically robust health-promotion taxonomy to be synthesised and advanced for use in nursing in relation to a paradigm of social thought

The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture

BACKGROUND: The incidence of hip fracture is expected to increase during the coming years, demanding greater resources and improved effectiveness on this group of patients. The aim of the present study was to evaluate the effectiveness of an integrated care pathway (ICP) in patients with an acute fracture of the hip. METHODS: A nonrandomized prospective study comparing a consecutive series of patients treated by the conventional pathway to a newer intervention. 112 independently living patients aged 65 years or older admitted to the hospital with a hip fracture were consecutively selected. Exclusion criteria were pathological fracture and severe cognitive impairment. An ICP was developed with the intention of creating a care path with rapid pre-operative attention, increased continuity and an accelerated training programme based on the individual patient's prerequisites and was used as a guidance for each patient's tailored care in the intervention group (N = 56) The main outcome measure was the length of hospital stay. Secondary outcomes were the amount of time from the emergency room to the ward, to surgery and to first ambulation, as well as in-hospital complications and 30-day readmission rate. RESULTS: The intervention group had a significantly shorter length of hospital stay (12.2 vs. 26.3 days; p < 0.000), a shorter time to first ambulation (41 vs. 49 h; p = 0.01), fewer pressure wounds (8 vs. 19; p = 0.02) and medical complications (5 vs. 14; p = 0.003) than the comparison group. No readmissions occurred within 30 days post-intervention in either group. CONCLUSION: Implementing an ICP for patients with a hip fracture was found to significantly reduce the length of hospital stay and improve the quality of care

The transition experience of rural older persons with advanced cancer and their families: a grounded theory study

BACKGROUND: Transitions often occur suddenly and can be traumatic to both patients with advanced disease and their families. The purpose of this study was to explore the transition experience of older rural persons with advanced cancer and their families from the perspective of palliative home care patients, bereaved family caregivers, and health care professionals. The specific aims were to: (1) describe the experience of significant transitions experienced by older rural persons who were receiving palliative home care and their families and (2) develop a substantive theory of transitions in this population. METHODS: Using a grounded theory approach, 27 open-ended individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved family caregivers. Four focus group interviews were conducted with 12 palliative care health care professionals. All interviews were transcribed verbatim, coded, and analyzed using Charmaz\u27s constructivist grounded theory approach. RESULTS: Within a rural context of isolation, lack of information and limited accessibility to services, and values of individuality and community connectedness, older rural palliative patients and their families experienced multiple complex transitions in environment, roles/relationships, activities of daily living, and physical and mental health. Transitions disrupted the lives of palliative patients and their caregivers, resulting in distress and uncertainty. Rural palliative patients and their families adapted to transitions through the processes of Navigating Unknown Waters . This tentative theory includes processes of coming to terms with their situation, connecting, and redefining normal. Timely communication, provision of information and support networks facilitated the processes. CONCLUSION: The emerging theory provides a foundation for future research. Significant transitions identified in this study may serve as a focus for improving delivery of palliative and end of life care in rural areas. Improved understanding of the transitions experienced by advanced cancer palliative care patients and their families, as well as the psychological processes involved in adapting to the transitions, will help health care providers address the unique needs of this vulnerable population

A mixed methods study of hope, transitions, and quality of life in family caregivers of persons with Alzheimer's disease

<p>Abstract</p> <p>Background</p> <p>Several research studies have reported the poor quality of life of family caregivers of persons with Alzheimer's disease (AD). However, factors that influence their quality of life have not been clearly defined. The purpose of this study was to examine factors associated with the quality of life of these caregivers such as demographic variables, their transition experience, and hope. A secondary aim was to explore the transition experience of family caregivers of persons with AD.</p> <p>Methods</p> <p>A cross-sectional triangulation data transformation model mixed method design (Quant +Qual) was utilized to address the purpose of the study. Eighty family caregivers of persons with AD completed a survey with quantitative measures [demographic variables, Herth Hope Index (HHI-hope), World Health Organization Quality of Life -BREF (WHOQOL-BREF)] and a qualitative survey about their transitions experience. The qualitative data (transition open ended- survey) was converted to quantitative data using content analysis. Variables significant at the p < 0.10 level in the univariate analysis were entered in the multivariate generalized linear model used to determine significant factors associated with quality of life.</p> <p>Results</p> <p>Subjects with higher hope scores (p < 0.0001) (Factor 1: temporality and future-cognitive-temporary dimension of hope) and who dealt with their transitions by actively seeking out knowledge and assistance (p = 0.02) had higher overall quality of life scores. HHI scores were associated with overall quality of life and for each of the four quality of life domains (physical psychosocial, relationships, and environment).</p> <p>Conclusions</p> <p>Hope played a significant role in the subjects' perceptions of overall quality of life as well as the 4 quality of life domains. This underscores the need to develop ways to foster hope in family caregivers. Moreover, the active engagement of families in seeking information and help, as a way to deal with their transitions, suggests encouraging this engagement is important. The findings of this study also suggest many directions for future research, such as increasing our understanding of the processes of transitions for this population.</p