Application of a marketing concept to patient-centered care: co-producing health with heart failure patients.

Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.

A study of Family Councils in nursing homes.

UNLABELLED: Families can remain actively involved in the care of their residents by participating in a Family Council within the nursing home (NH). A Family Council is an independent, self-determining group of NH residents' families and friends and often includes a nursing facility liaison. PROBLEM: Less than half of NHs has an active council. PURPOSE: To determine the presence, characteristics, and impact of Family Councils. METHOD: A descriptive study was conducted. Mailed surveys to NH administrators and personal interviews of Family Council members were included in this study. The survey was mailed to administrators in all 60 licensed NHs in a metropolitan county in the southwestern United States. RESULTS: Sixteen NH administrators responded, with 12 (75%) of the 16 reporting the presence of an active Family Council. Three administrators provided the name of a member of their facility's Family Council who were interviewed by telephone. Both the survey and personal interview results supported the positive effect of active Family Councils to provide mutual support, empower its members, and advocate change to improve the residents' quality of life.

Hospital discharge of older adults. How nurses can ease the transition.

When an older adult is discharged from the hospital, she or he should have an individualized, comprehensive discharge plan to help prevent unnecessary complications and rehospitalization. But the large number of older adults who are hospitalized and their typically greater needs can make creating such a plan a challenge for clinicians. Clear communication among hospital personnel, patients, family members, case managers, and community caregivers (such as home health care nurses and long-term care staff) is essential. In examining effective discharge planning for this population, this article examines five discharge models.

Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?

Relocation stress syndrome is a nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness, and loneliness. It usually occurs in older adults shortly after moving from a private residence to a nursing home or assisted-living facility. The primary purpose of this study was to validate the symptoms of relocation stress syndrome. Eight nursing home residents and 8 assisted-living facility residents were interviewed 2 to 10 weeks after admission, when symptoms of relocation stress syndrome are most likely to appear. Results of this study indicate that the incidence of relocation stress syndrome may be overestimated. More accurate diagnosis and treatment of depression in older adults is needed.

Educational needs of employed family caregivers of older adults: Evaluation of a workplace project.

Family members provide 80% of care for older adults in the United States. Many family caregivers are employed either full or part time. For employed caregivers, personal health, job performance, and the ability to advance their career are affected by the weight of their caregiving responsibilities. Some find it necessary to quit their jobs. Employed caregivers report a need for caregiving information; however, they seldom think of their workplace as a valuable resource. Results of the second of a 3-phase research and service project are discussed. Based on a needs assessment completed by employees of a large institution, educational sessions were offered during 3 consecutive months. Thirty-five employees attended 1 or more sessions. The sessions were evaluated highly on a 5-point Likert-type scale for usefulness of information, quality of presentation, and value of session. Sharing project results with the employing institution's human resources department yielded commitment to integrate caregiver education and referral into a newly organized work-life program. When properly managed, such workplace programs can provide needed assistance to employed caregivers. A nurse working with older adults is an ideal provider to initiate and manage this kind of program.

Teaching older adults to self-manage medications: preventing adverse drug reactions.

Older adults use more prescription and OTC medications than any other age group. Because their medication regimens often are complicated by many medications and different doses, times, and administration methods, older adults are at high risk for medication mismanagement. The most common errors associated with medication mismanagement include mixing OTC and prescription medications, discontinuing prescriptions, taking wrong dosages, using incorrect techniques, and consuming inappropriate foods with specific medications. Both human and environmental factors contribute to medication mismanagement among older adults. Human factors include faulty communication between the health care provider and the patient; the patient's lack of knowledge; ADRs; alcohol-drug interactions; use of OTC medications and herbal products; cognitive, sensory, and motor impairments; and polypharmacy. Environmental factors include high cost of prescribed medications, improper medication storage, and absence of clearly marked expiration dates. Nurses need to take advantage of both formal and informal teaching opportunities in all settings to prepare a patient for medication self-management. Teaching should be individualized and based on a thorough assessment of the patient's abilities to administer medication safely and the specific medication regimen. By involving older adults as active partners in their health care, many errors and medication-related health problems can be prevented. New technologies and devices have the potential for improving the patient's self-management of medications. The role of nurses in educating older adults and their families about proper medication management is vital.

Functional status in older women following hip fracture.

BACKGROUND: Women aged 65 years and over are at high risk for a fractured hip because of osteoporosis. One of the devastating effects of a fracture is the loss of ability to live independently. AIM: The major aim of this study was to describe the functional status, or ability to perform activities of daily living, of women aged 65 years and older who had experienced a fractured hip in the recent past and to explore possible differences in selected variables (e.g. age and length of rehabilitation) for those who were fully performing activities of daily living at least 6 months after fracture and those who were not. DESIGN: Following Institutional Review Board approval, data were collected from 23 Caucasian women ranging from 65 to 95 years of age (M = 82, SD = 6.83) who had experienced fractured hips related to a fall in the recent past (6 months to 4 years). All were living independently prior to their fractures. Three Registered Nurses, in a structured interview, collected the data using a Demographic Data Form, an Osteoporosis Risk Factor Checklist, the Katz Index of Independence in Activities of Daily Living, and the Lawton Instrumental Activities of Daily Living Scales. RESULTS: Nine of the participants reported prior fractures, suggesting that this could have been a risk factor for this group. Eighteen achieved the maximum independence score of six on the Katz Index of Independence in Activities of Daily Living; help with bathing was required by the other five. Of the Instrumental Activities of Daily Living, those requiring physical activity for home maintenance were the most problematic. Ability to perform Instrumental Activities of Daily Living was significantly related to ability to perform the activities required to live independently. CONCLUSIONS: Results suggest that achieving a functional level that will support independence is possible for older women who were residing independently prior to a hip fracture.