ABSTRACT
RATIONALE: Discharge planning is a nursing intervention that aims to ensure continuity of care; it consists of several steps of which selecting patients in need of it is the first one. The Blaylock Risk Assessment Screening Score (BRASS) index is a risk screening instrument which can be used early after admission to identify those patients in need of discharge planning. AIM: To test the predictive validity of the BRASS index in screening patients with post-discharge problems. DESIGN: Prospective longitudinal design with prediction instrument measured at admission, and outcomes measured at discharge and 7 and 30 days after discharge. OUTCOME MEASURES: length of stay, discharge destination, status after discharge. INSTRUMENTS: BRASS index, Problems after discharge Questionnaire, Nottingham Health Profile, COOP/WONCA charts. RESEARCH METHOD: 503 elderly patients were screened at admission with the BRASS index. Length of stay and discharge destination were measured at discharge in these same patients. Outcomes after discharge were gathered only in patients who were discharged home and with length of stay of more than 3 days (n=226); outcomes were measured by postal questionnaires at day 7 and day 30 after discharge. RESULTS: patients identified by the BRASS index as high risk are frequently not discharged home and have a longer length of stay. The BRASS scores correlate significantly with the outcome scores after discharge: the higher the BRASS score, the higher the difficulty score after discharge on all domains. However, the sensitivity of the BRASS index is rather low. CONCLUSION: This study demonstrates that the BRASS index is a good predictor instrument for indicating patients who are not discharged home, that the BRASS scores correlate significantly with problems experienced after discharge and that it has high specificity to predict patients with problems after discharge. Clinical use, however, is limited due to the low sensitivity. The BRASS index is a promising case-finding instrument for discharge planning, but needs further development.
Subject(s)
Nursing Assessment/methods , Patient Discharge , Aged , Aged, 80 and over , Analysis of Variance , Female , Humans , Male , Nursing Assessment/statistics & numerical data , Patient Discharge/statistics & numerical data , Prognosis , Reproducibility of Results , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Sensitivity and Specificity , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
1. Ophthalmic patients experience problems after discharge. For instance, most patients reported that they felt insufficiently informed, and some wanted additional help with housekeeping. 2. The most important informational needs are related to the expected recovery time and what the normal recovery signs are. Concerning housekeeping, patients experience most problems with household tasks involving heavy lifting and with shopping. 3. Nurses should address these problems and adapt their practices. For instance, nurses can mail a leaflet containing relevant information to patients before admission, or can institute a post-discharge telephone program to resolve problems.
Subject(s)
Eye Diseases/rehabilitation , Eye Diseases/surgery , Home Nursing , Needs Assessment , Patient Discharge , Self Care , Activities of Daily Living , Aged , Aged, 80 and over , Eye Diseases/nursing , Humans , Patient Education as Topic , Patient Satisfaction , Surveys and QuestionnairesABSTRACT
The problems of elderly people following discharge from hospital is a worldwide focus of nursing attention. Actual and local insight into the nature and extent of post-discharge problems is needed as a base for improving and evaluating discharge planning. Problems following discharge were investigated as the first part of a larger study. Over a 3-month period, 251 elderly people who had been discharged after a hospital stay of more than 3 days, were asked to participate in the study. Half received a postal questionnaire and half were interviewed at home, one week after discharge. There were 145 respondents. The need for information was mentioned by 80% of the patients. Housekeeping tasks also caused most patients some difficulty. Almost 40% of those discharged reported some kind of unmet need.
Subject(s)
Aftercare , Health Services Needs and Demand , Health Services for the Aged , Home Care Services , Patient Discharge , Activities of Daily Living , Adaptation, Psychological , Aged , Aged, 80 and over , Female , Health Status , Humans , Male , NetherlandsABSTRACT
This review-article reports on literature on the effectiveness of validation; and approach used for disoriented elderly. Literature has been searched for by means of several (computerized) indexes and references. By contacting Feil, who developed validation, unpublished articles and reports became available. This search resulted in 13 effect-studies, of which 7 are unpublished, 2 descriptive reports, and 1 research-proposal. The effect-studies have varying designs with different methodological restrictions causing bias. The analysis showed that the quality and therefore the evidential value of the effect-studies is limited. The better the study, the less validation appeared to be effective. It is concluded that the hypothesis, that validation has positive effects on disoriented elderly and their caregivers, has no or minimal scientific basis. Before validation is implemented more and more in Dutch health care, scientific research addressing its effects is indicated.
