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International Journal of Palliative... Jul 2021Health workers are likely to document patients' care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care.
BACKGROUND
Health workers are likely to document patients' care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care.
AIM
To assess nurses' and clinicians' documentation practices when using a new patients' continuation case sheet (PCCS) and explore nurses' and clinicians' experiences regarding the documentation of patients' information in the new PCCS. The purpose of introducing the PCCS was to improve the continuity of care for patients attending clinics at which they were unlikely to consistently see the same clinician or nurse.
METHOD
This was a mixed-methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients in a hospice and palliative care programme. Data were collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face, audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician and four palliative care nurse specialists. Thematic analysis was used.
RESULTS
Patients' biogeographic information was missing in 5% to 10% case notes. Spiritual and psychosocial issues were not documented in 42.6% of patients' case notes and vital signs, in 49.2%. The poorest documentation practices were observed in the past medical history part of the PCCS, noted in 40%-63% of the 100 case notes included in this study. Four themes emerged from interviews with clinicians and nurses: (1) what remains unclear and challenges; (2) comparing the past with the present; (3) experiential thoughts, and; (4) transition and adapting to change.
CONCLUSION
The PCCS seems to be a comprehensive and simple tool that can be used to document patients' information at subsequent visits. To increase its reliability and validity, clinicians and nurses need training on how to use it. Clinicians and nurses need to prioritise accurate and complete documentation of patient care in the PCCS to ensure quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalisable findings.
Topics: Continuity of Patient Care; Cross-Sectional Studies; Documentation; Hospice Care; Humans; Nurses; Palliative Care; Physicians; Reproducibility of Results; Retrospective Studies
PubMed: 34292773
DOI: 10.12968/ijpn.2021.27.5.227 -
Intensive & Critical Care Nursing Apr 2021Improving care of critically ill patients requires using an interprofessional care model and care standardisation.
BACKGROUND
Improving care of critically ill patients requires using an interprofessional care model and care standardisation.
OBJECTIVES
Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration.
METHODS
Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration.
RESULTS
Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001).
CONCLUSION
This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.
Topics: Critical Care; Humans; Intensive Care Units; Patient Care; Patient Care Team; Teaching Rounds
PubMed: 33262010
DOI: 10.1016/j.iccn.2020.102974 -
International Journal of Nursing Studies Nov 2019The process of moving patients from a hospital to a home or another care setting, also called transitional care, can lead to unwanted complications and negative... (Review)
Review
BACKGROUND
The process of moving patients from a hospital to a home or another care setting, also called transitional care, can lead to unwanted complications and negative outcomes. The term "transitional care" involves a wide range of conditions and services to ensure the continuity of care and prevention of unwanted consequences in vulnerable individuals, who are affected by any changes in care settings or caregivers.
OBJECTIVES
The purpose of this concept analysis is to clarify the concept of transitional care by considering its application in different studies and its changes over time.
DESIGN
A concept analysis.
DATA SOURCES
Literature from 2008 to 2018 were sought using Medline, PubMed, Google Scholar and Cochrane databases with terms "transitional care", "transitional care" OR "care transitions", "transitional care" AND "nursing", "transitional care" AND "discharge planning".
REVIEW METHODS
Rodgers' evolutionary concept analysis method was used to clarify the antecedents, attributes and consequences.
RESULTS
The 46 eligible articles were fully studied and findings were categorized into antecedents, attributes and consequences. Transitional care antecedents were classified into three categories: patient/family/caregivers related factors, factors related to hospital system (inpatient care), and social factors. The defining attributes include patient-oriented transitional care, transitional care with a hospital-based approach and transitional care with a community-based approach. Consequences categorized into patient-related consequences, family/caregiver-related consequences, and hospital-related consequences.
CONCLUSION
The results of the analysis of the transitional care concept have shown that this concept is not limited to care provided by nurses at discharge, and that its proper implementation requires considering many factors including the status of patients and their families, different members of the healthcare team, and environmental and social conditions and facilities. A proper understanding of transitional care not only specifies the role of care providers, but also creates a basis for designing an evidence based care program.
Topics: Humans; Patient Transfer; Transitional Care; United States
PubMed: 31442782
DOI: 10.1016/j.ijnurstu.2019.103387 -
Current Opinion in Anaesthesiology Aug 2020The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic... (Review)
Review
PURPOSE OF REVIEW
The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required.
RECENT FINDINGS
Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation.
SUMMARY
Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.
Topics: Age Factors; Aged; Ambulatory Care Facilities; Anesthesia; Anesthesiologists; Anesthesiology; Anesthetics; Drug-Related Side Effects and Adverse Reactions; Humans; Patient Care; Patient Safety
PubMed: 32618686
DOI: 10.1097/ACO.0000000000000883 -
Anaesthesia Jun 2024
Topics: Humans; Appointments and Schedules; Ambulatory Surgical Procedures; Patient Care; Efficiency, Organizational
PubMed: 38489835
DOI: 10.1111/anae.16282 -
AORN Journal Mar 2020
Topics: Efficiency, Organizational; Humans; Inventions; Patient Care; Quality Improvement
PubMed: 32128763
DOI: 10.1002/aorn.12993 -
The Surgical Clinics of North America Oct 2019Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive... (Review)
Review
Palliative care is an interdisciplinary field that focuses on optimizing quality of life for patients with serious, life-limiting illnesses and includes aggressive management of pain and symptoms; psychological, social, and spiritual support; and discussions of advance care planning, including treatment decision making and complex care coordination. Early palliative care is associated with increased quality of life, decreased symptom burden, decreased health care expenditures, and improved caregiver outcomes. This article discusses integrating interdisciplinary palliative care into surgical practice, and some current models of using and expanding palliative care skill sets in surgery, including training initiatives for both physicians and nurses.
Topics: Chronic Disease; Humans; Palliative Care; Patient Care Team; Perioperative Care; Quality of Life; Terminal Care
PubMed: 31446910
DOI: 10.1016/j.suc.2019.05.004 -
Annals of Hematology Mar 2021While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and... (Review)
Review
While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.
Topics: Continuity of Patient Care; Delivery of Health Care, Integrated; Hematologic Neoplasms; Humans; Interdisciplinary Communication; Medical Oncology; Palliative Care; Patient Care Team; Referral and Consultation
PubMed: 33388859
DOI: 10.1007/s00277-020-04386-8 -
The American Journal of Hospice &... Feb 2021The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates...
BACKGROUND
The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians.
OBJECTIVE
The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals.
DESIGN
Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index.
SETTINGS/PARTICIPANTS
Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school.
RESULTS
Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family ( < .001), time with family and friends ( = .002), being at peace with God ( < .001), dying at home ( = .004), feeling that life was meaningful ( < .001), living as long as possible ( < .001), and resolving conflicts ( < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year.
CONCLUSIONS
Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
Topics: Goals; Hospice Care; Hospices; Humans; Intergenerational Relations; New York; Patient Care Planning; Perception; Students, Medical; Terminal Care
PubMed: 32588649
DOI: 10.1177/1049909120934737 -
British Journal of Nursing (Mark Allen... Aug 2019
Topics: Evidence-Based Practice; Health Care Costs; Humans; Patient Care; State Medicine; United Kingdom; Wounds and Injuries
PubMed: 31393757
DOI: 10.12968/bjon.2019.28.15.S4