ABSTRACT
Older adults who transition from hospital to cardiac rehabilitation settings often are vulnerable and at risk of experiencing adverse health care outcomes. Given the complexities of transitional care, it is crucial to engage older adults in the clinical decision-making process and to promote their active participation in their medical care. Older adults have unique ways of understanding their participation in the transitional care process. Gaining an in-depth understanding of their specific needs during this process can help inform clinical practice and interventions aiming to improve care for older adults living with cardiovascular disease. Focused ethnography methodology was used to explore the perspectives of older adults and health care providers on patient participation in transitional care from hospital to cardiac rehabilitation. The study also sought to identify and to gain a better and more in-depth understanding of the challenges and opportunities that shape participation for older adults during transitional care from hospital to cardiac rehabilitation. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers from cardiac rehabilitation and cardiology units. Additional methods included document analysis and reflexive journaling. Thematic analysis revealed six themes and fifteen subthemes. Themes included: Follow-up from Healthcare Provides, Interactions with Healthcare Providers, Support from Family Members, Information about Medical Care and Rehabilitation, Decision-Making and Participation, and Healthcare Journey during COVID-19. Older adults reported gaps in follow-up and insufficient spaces or opportunities for participation in decision-making. Healthcare provider's support was reported as essential for a smooth transition, particularly nurses' support. The COVID-19 pandemic was mostly reported as a major barrier for participants, especially in terms of delayed medical procedures and difficult hospitalization experiences. Some participants, particularly those who seek social connection, viewed technology and virtual care negatively. However, virtual care delivery also was reported as a fruitful strategy to engage older adults in their care and to overcome transportation barriers. The results of this study can help inform the implementation of strategies that will engage older adults more actively in their care, as they transition from hospital to cardiac rehabilitation settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
: Employees from a large government agency were abruptly switched to telework for an extended period of time. There was no plan to address potential psychological stressors associated with the disruption of work-family-life balance that emerged as a result of COVID-19. A knowledge gap in how to support employees was apparent from discussions during team and administrative meetings. The project question explored whether the use of stress first-aid (SFA), an educational program, would enable employees to learn self-care strategies to address stressors in a less protected environment. The purpose of this DNP project was to provide a staff education awareness program in SFA to identify early warning signs of stress reactions to avert a stress injury. The scientific evidence supported education awareness training as an effective strategy to address the gap among healthcare professionals. Survey Monkey collected and analyzed 37 surveys. The summative evaluation found most employees were very satisfied with teleworking and very frustrated with the return to in-person office settings. Employees 50 years and older, married without children, with advanced degrees, and with years of work experience were worried and extremely worried about the psychological impact of COVID-19. Recommendations included integrating SFA as a competency, new employee orientation, and a mentoring program. Other recommendations included training for SFA site champions and providing leadership training in disaster management to prepare for the next epidemic or pandemic. The project's positive social change impact may lead to reduced stress by fostering peer and organizational support, addressing stigma, and changing the culture to provide a safe work environment. . (PsycInfo Database Record (c) 2022 APA, all rights reserved)