scholarly journals 22 Coping with Medicines After Hospital Discharge; the Invisible Work of Older Patients and Their Care-Givers

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
J Tomlinson ◽  
H Smith ◽  
J Silcock ◽  
K Karban ◽  
B Fylan
Keyword(s):  
Older Patients ◽  
Structured Interviews ◽  
Medicines Management ◽  
Post Discharge ◽  
General Internal ◽  
Care Givers ◽  
Invisible Work ◽  
Ethical Approval ◽  
Discharge From Hospital ◽  
The Invisible

Abstract Introduction Older patients often experience medication-related problems following discharge from hospital. These can be categorised as issues with obtaining medication, taking medication, medication effects or problems with communication or care co-ordination (Nicosia et al., Journal of General Internal Medicine, 2019, https://doi.org/10.1007/s11606-019-05463-z). The aim of this study was to explore older adults’ experiences of post-discharge medicines management, including the strategies they use to safely manage their changed medicines. Methods Following ethical approval, patients aged 75 and above, with a change in their long term medicines, were recruited during admission to one of two hospitals in Yorkshire. Semi-structured interviews took place with the participants in their own homes, approximately two weeks after discharge. Interviews were audio recorded and transcribed. Data were analysed using the Framework method. Results Twenty-seven patients (mean age 85 years; 6 males) consented to be interviewed. They described multiple self-management and safety strategies used to support medicines management in the early post-discharge phase. The work done included adaptations (to routines, the home environment and action plans), scaffolding (where patients and their care-givers support the primary care system by providing additional documentation or prompts to ensure medicines were supplied on time and were correct) and error avoidance (seeking information, performing checks and balances). Conclusion Older patients experience gaps in their post-discharge medicines-related care which they had to bridge through implementing their own strategies or by enlisting support from others. This study shines a spotlight on to the invisible work that patients have to do in order to make post-discharge medicines management fit for purpose. Further work should consider those patients who are not able to carry out these tasks or who do not have any care-givers available for support and how this potential gap in care can be addressed.

Caring for elder patients: Mutual vulnerabilities in professional ethics

2017 ◽  
Vol 25 (8) ◽  
pp. 1004-1016 ◽  
Author(s):  
Karin Nordström ◽  
Tenzin Wangmo
Keyword(s):  
Nursing Staff ◽  
Professional Ethics ◽  
Older Patients ◽  
Professional Relationships ◽  
Structured Interviews ◽  
Continuous Training ◽  
Elder Patients ◽  
Central Switzerland ◽  
Ethical Approval ◽  
Ethics Commission

Background: Neglect and abuse of elders in care institutions is a recurring issue in the media. Elders in care institutions are vulnerable due to their physical, cognitive, and verbal limitations. Such vulnerabilities may make them more susceptible to mistreatment by caregivers on whom they are heavily dependent. Objectives: The goal was to understand caregivers’ concerns about ensuring correct and proper treatment, as well as their experiences with neglect and abuse of older patients. This article examines resources and challenges of professional ethics within the care setting. Research design: A study was conducted to explore the quality of care provided to older patients in nursing homes, geriatrics institutions, and ambulant care in the northwest region of Switzerland. Participants and research context: A total of 23 semi-structured interviews were conducted with nursing staff of varying experience levels. Ethical considerations: Ethical approval was granted by the competent regional ethics commission, Ethikkomission Nordwest-und Zentralschweiz EKNZ [Ethics Commission Northwest and Central Switzerland] (2014-015). Findings: Three themes emerged from our data analysis: professional identity, professional context, and professional relationships. Our findings indicate mutual vulnerabilities within these three themes, characterizing the interactions between nursing staff and older patients. Study participants believe that incidences of error, neglect, and abuse are consequences of their own vulnerability since they are not able to meet the demands of an overstraining work situation. Discussion: Different aspects of this mutual vulnerability are described and critically discussed as challenges for professional ethics. Conclusion: Early education, continuous training as well as better management and response from the institution are necessary to maintain professionalism while handling mutual vulnerabilities.

scholarly journals Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

2020 ◽  
Author(s):  
Daisy Kolk ◽  
Anton F. Kruiswijk ◽  
Janet L. MacNeil-Vroomen ◽  
Milan L. Ridderikhof ◽  
Bianca M. Buurman
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Older Patients ◽  
Structured Interviews ◽  
Post Discharge ◽  
Qualitative Interview Study ◽  
Before And After ◽  
Ed Visits ◽  
The Relationship

Abstract Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

Technology supported rehabilitation for patients of critical illness caused by COVID-19: a protocol for a mixed-methods feasibility study

2020 ◽  
Vol 27 (10) ◽  
pp. 1-9 ◽  
Author(s):  
Ana-Carolina Gonçalves ◽  
Todd Leckie ◽  
Alexander Hunter ◽  
Daniel Fitzpatrick ◽  
Alan Richardson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Critical Illness ◽  
Feasibility Study ◽  
Activity Levels ◽  
Structured Interviews ◽  
Post Discharge ◽  
Use Of Technology ◽  
Recovery Experiences ◽  
Study Population ◽  
Discharge From Hospital

Background/Aims The COVID-19 pandemic has created the need for research on how to effectively rehabilitate patients who have been discharged from an intensive care unit. This study is a protocol for a mixed methods feasibility study addressing the research questions: 1) what are the needs of patients who have survived COVID-19? 2) is the use of technology feasible to support their recovery? Methods A multicentre, technology supported, rehabilitation intervention for survivors of critical illness caused by COVID-19 will be assessed. Survivors in the study population will be offered a smartwatch to monitor their activity levels and will have biopsychosocial outcome measures monitored at three time points: discharge from hospital, 2–3 months post discharge and 1 year post discharge. Semi-structured interviews will be conducted across eight hospital sites with survivors, their relatives and professionals to understand their recovery experiences. Conclusions Designed by frontline clinicians, this protocol outlines a feasibility study that will provide new knowledge on the process of recovery of critical illness caused by COVID-19.

A Qualitative Study of Older Patients’ and Family Caregivers’ Perspectives of Transitional Care From Hospital to Home

2021 ◽  
pp. RTNP-D-20-00067
Author(s):  
İlknur Dolu ◽  
Mehmet İIlkin Naharcı ◽  
Patricia A. Logan ◽  
Piret Paal ◽  
Mojtaba Vaismoradi
Keyword(s):  
Family Caregivers ◽  
Older Patients ◽  
Transitional Care ◽  
Care Program ◽  
Healthcare Services ◽  
Structured Interviews ◽  
High Quality ◽  
Rehabilitation Model ◽  
Hospital To Home ◽  
Discharge From Hospital

Background and PurposeThe need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey.MethodsThematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated.ResultsMain themes were “confused feelings of safety and stress”; “worried about being left alone”; and “disrupted healthcare journey.” The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital.Implications for PracticeA high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge.

scholarly journals The role of older patients’ goals in GP decision-making about medicines: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kristie Rebecca Weir ◽  
Vasi Naganathan ◽  
Stacy M. Carter ◽  
Chun Wah Michael Tam ◽  
Kirsten McCaffery ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Older People ◽  
Older Patients ◽  
Geographic Location ◽  
Future Research ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Medicines Management ◽  
Lower Priority

Abstract Background To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients’ overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs’ perspectives on the importance of discussing patients’ goals and preferences, and the role patient preferences play in medicines management and prioritisation. Methods Semi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. Results The results showed that most GPs recognised some value in understanding older patients’ goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients’ goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients’ goals in medicines decisions: 1) goals and preferences considered lower priority – ‘Directive’; 2) goals seen as central – ‘Goal-oriented’; 3) goals and preferences considered but not explicitly elicited – ‘Tacit’. Conclusions This study explores how GPs differ in their approach to eliciting patients’ goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients’ goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.

A labour of love? The invisible work of caring teachers during Covid-19

2021 ◽  
pp. 1-17
Author(s):  
Ana María Rio Poncela ◽  
L. Romero Gutierrez ◽  
D. D. Bermúdez ◽  
M. Estellés
Keyword(s):  
Caring Teachers ◽  
Invisible Work ◽  
The Invisible

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service

2021 ◽  
pp. 136749352110147
Author(s):  
Elizabeth M. Forster ◽  
Catherine Kotzur ◽  
Julianne Richards ◽  
John Gilmour
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Nurse Practitioner ◽  
Parental Support ◽  
Transition Period ◽  
Short Form ◽  
Acute Pain Service ◽  
Cross Sectional Survey ◽  
Post Discharge ◽  
Discharge From Hospital

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child’s pain management and perceptions of support from the NpAPS. Parents completed the Parents’ Postoperative Pain Measure–Short Form (PPPM-SF) and factors affecting parents’ participation in children’s pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

scholarly journals Structure and processes of emergency observation units with a geriatric focus: a scoping review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pieter Heeren ◽  
Annabelle Hendrikx ◽  
Janne Ceyssens ◽  
Els Devriendt ◽  
Mieke Deschodt ◽  
...  
Keyword(s):  
Scoping Review ◽  
Emergency Care ◽  
Older Patients ◽  
Clinical Care ◽  
Care Needs ◽  
Post Discharge ◽  
Care Services ◽  
Observation Units ◽  
Primary Care Services ◽  
Healthcare Professions

Abstract Background Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs. Methods The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies. Results Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies. Conclusion This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.

scholarly journals Longitudinal Study of Music Therapy’s Effectiveness for Premature Infants and Their Caregivers (LongSTEP): Feasibility Study With a Norwegian Cohort

2021 ◽  
Author(s):  
Claire M Ghetti ◽  
Bente Johanne Vederhus ◽  
Tora Söderström Gaden ◽  
Annette K Brenner ◽  
Łucja Bieleninik ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Feasibility Study ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Perinatal Period ◽  
First Year ◽  
Structured Interviews ◽  
Post Discharge ◽  
Critical Realist ◽  
Musical Interaction

Abstract Premature infants and their parents experience significant stress during the perinatal period. Music therapy (MT) may support maternal–infant bonding during this critical period, but studies measuring impact across the infant’s first year are lacking. This nonrandomized feasibility study used quantitative and qualitative methods within a critical realist perspective to evaluate the feasibility, acceptability, and suitability of the treatment arm of the Longitudinal Study of music Therapy’s Effectiveness for Premature infants and their caregivers (LongSTEP) (NCT03564184) trial with a Norwegian cohort (N = 3). Families were offered MT emphasizing parent-led infant-directed singing during neonatal intensive care unit (NICU) hospitalization and across 3 months post-discharge. We used inductive thematic analysis of semi-structured interviews with parents at discharge from NICU and at 3 months and analyzed quantitative variables descriptively. Findings indicate that: (1) parents of premature infants are willing to participate in MT research where parental voice is a main means of musical interaction; (2) parents are generally willing to engage in MT in NICU and post-discharge phases, finding it particularly interesting to note infant responsiveness and interaction over time; (3) parents seek information about the aims and specific processes involved in MT; (4) the selected self-reports are reasonable to complete; and (5) the Postpartum Bonding Questionnaire appears to be a suitable measure of impaired maternal–infant bonding. Parents reported that they were able to transfer resources honed during MT to parent–infant interactions outside MT and recognized parental voice as a central means of building relation with their infants. Results inform the implementation of a subsequent multinational trial that will address an important gap in knowledge.

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