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The Journal of Nursing Administration Dec 2023This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered...
This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.
Topics: Humans; Patient Participation; Aftercare; Patient Discharge; Surveys and Questionnaires; Patient-Centered Care
PubMed: 37983606
DOI: 10.1097/NNA.0000000000001364 -
Addiction (Abingdon, England) Dec 2023
Topics: Humans; Addiction Medicine; Artificial Intelligence; Patient Care
PubMed: 37735091
DOI: 10.1111/add.16341 -
Medizinische Klinik, Intensivmedizin... May 2024Effective handoffs in the intensive care unit (ICU) are key to patient safety. (Review)
Review
BACKGROUND
Effective handoffs in the intensive care unit (ICU) are key to patient safety.
PURPOSE
This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement.
MATERIALS AND METHODS
Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived.
RESULTS
The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety.
CONCLUSION
Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.
Topics: Humans; Patient Handoff; Intensive Care Units; Patient Safety; Germany; Checklist; Interdisciplinary Communication; Medical Errors; Patient Care Team; Critical Care
PubMed: 38498181
DOI: 10.1007/s00063-024-01127-x -
Emergency Nurse : the Journal of the... Oct 2023Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice...
Overcrowding in the emergency department (ED) is a significant issue and often leads to nursing care being delivered in areas not intended for clinical use, a practice commonly referred to as 'corridor care'. Delivering care in non-clinical areas negatively affects patient safety and poses unique professional challenges for emergency nurses while also reducing their well-being. To end - or at least reduce - corridor care, system-level interventions are needed. In the meantime, there are practical solutions that can be implemented at an individual and departmental level to mitigate some of the risks associated with it. This article discusses a pragmatic approach to patient care, and explores opportunities for nurses to mitigate risks and enhance safety and efficiency, in overcrowded EDs.
Topics: Humans; Emergency Service, Hospital; Patient Care; Nursing Care; Emergency Nursing
PubMed: 37818625
DOI: 10.7748/en.2023.e2187 -
BMJ Supportive & Palliative Care Dec 2023Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and...
BACKGROUND
Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood.
OBJECTIVES
To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care.
METHODS
A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text.
RESULTS
After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers.
CONCLUSIONS
Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
Topics: Humans; Palliative Care; Caregivers; Decision Making; Terminal Care; Hospice Care
PubMed: 35318213
DOI: 10.1136/bmjspcare-2022-003525 -
Nursing Standard (Royal College of... Nov 2023Providing person-centred care that takes into account each patient's individual needs and priorities is crucial at the end of life. Nurses need to be aware of the main...
Providing person-centred care that takes into account each patient's individual needs and priorities is crucial at the end of life. Nurses need to be aware of the main aspects of person-centred care, such as supporting shared decision-making, developing therapeutic nurse-patient relationships, and considering the patient's physical, psychological, social and spiritual needs. This article discusses the concept of person-centred care in the context of providing end of life care to patients and their families. It explains the benefits and barriers to providing person-centred end of life care, and outlines some of the areas that nurses and other healthcare professionals need to consider to promote effective care.
Topics: Humans; Hospice Care; Palliative Care; Terminal Care; Patient-Centered Care; Death
PubMed: 37743829
DOI: 10.7748/ns.2023.e12171 -
Quality Management in Health CareContinuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have...
BACKGROUND AND OBJECTIVES
Continuity of care is an integral aspect of high-quality patient care in primary care settings. In the Department of Family Medicine at Mayo Clinic, providers have multiple responsibilities in addition to clinical duties or panel management time (PMT). These competing time demands limit providers' clinical availability. One way to mitigate the impact on patient access and care continuity is to create provider care teams to collectively share the responsibility of meeting patients' needs.
METHODS
This study presents a descriptive characterization of patient care continuity based on provider types and PMT. Care continuity was measured by the percentage of patient a ppointments s een by a provider in their o wn c are t eam (ASOCT) with the aim of reducing the variability of provider care team continuity. The prediction method is iteratively developed to illustrate the importance of the individual independent components. An optimization model is then used to determine optimal provider mix in a team.
RESULTS
The ASOCT percentage in current practice among care teams ranges from 46% to 68% and the per team number of MDs varies from 1 to 5 while the number of nurse practitioners and physician assistants (NP/PAs) ranges from 0 to 6. The proposed methods result in the optimal provider assignment, which has an ASOCT percentage consistently at 62% for all care teams and 3 or 4 physicians (MDs) and NP/PAs in each care team.
CONCLUSIONS
The predictive model combined with assignment optimization generates a more consistent ASOCT percentage, provider mix, and provider count for each care team.
Topics: Humans; Family Practice; Continuity of Patient Care; Patient Care Team; Physicians; Nurse Practitioners
PubMed: 36940371
DOI: 10.1097/QMH.0000000000000392 -
Critical Care Nurse Dec 2023
Topics: Humans; Patient Care; Telemedicine
PubMed: 38035615
DOI: 10.4037/ccn2023741 -
Journal of the American Medical... Dec 2023Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better... (Review)
Review
OBJECTIVES
Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better outcomes at the end of life (EOL), such as avoidance of unwanted interventions or death in hospital. The timing of these discussions varies, and it is possible that their influence on EOL outcomes depends on their timing. This study synthesized current evidence concerning the timing of goals of care (GOC) discussions in NHs and its impact on EOL outcomes.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
Adult populations in NH settings.
METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Embase, and Cumulative Index of Nursing and Allied Health from January 2000 to September 2022. We included studies that examined timing of GOC discussions in NHs, were peer-reviewed, and published in English. Quality of the studies was assessed using the Newcastle-Ottawa Scale.
RESULTS
Screening of 1930 abstracts yielded 149 papers that were evaluated for eligibility. Of the 18 articles, representing 16 distinct studies that met review criteria, 12 evaluated the timing of advance directives. There was variation in the timing of GOC discussions and compared with discussions that occurred within a month of death, earlier discussions (eg, at the time of facility admission) were associated with lower rates of hospitalization at the EOL and lower health care costs.
CONCLUSIONS AND IMPLICATIONS
The timing of GOC discussions in NHs varies and evidence suggests that late discussions are associated with poorer EOL outcomes. The benefits of goal-concordant care may be enhanced by earlier and more frequent discussions. Future studies should examine the optimal timing for GOC discussions in the NH population.
Topics: Humans; Nursing Homes; Advance Directives; Hospitalization; Patient Care Planning; Terminal Care
PubMed: 37918815
DOI: 10.1016/j.jamda.2023.09.024 -
The American Journal of Nursing Sep 2023Navigating record-high, ongoing shortages.
Navigating record-high, ongoing shortages.
Topics: Humans; Patient Care; Pharmaceutical Preparations
PubMed: 37615460
DOI: 10.1097/01.NAJ.0000978120.58096.04