ABSTRACT
The Respiratory Coordinated Care Program (RCCP) based at St George Hospital, is a specialised community program designed to assist people with advanced COPD (DRG groupings E65A/E65B) to live optimally well at home. The aim of the program is to reduce hospital admission rates, readmission rates, and hospital length of stay (LOS). Additional components of RCCP include a Pulmonary Rehabilitation program and an early discharge service. An improvement in patient outcomes over subsequent years 1998-2006, is demonstrated when compared to the national peer DRG with regards to LOS, readmission rates and hospital admissions per patient per year, pre and post recruitment to the RCCP. The chronic long term component of the RCCP shows that the mean LOS and the number of hospital admissions was significantly lower when compared to the national DRG average. Since its inception, the RCCP has consistently demonstrated a cost effective reduction in hospital admission rates, LOS and reduced readmission.
Subject(s)
Community Health Nursing/organization & administration , Home Care Services, Hospital-Based/organization & administration , Patient Care Team/organization & administration , Pulmonary Disease, Chronic Obstructive/prevention & control , Pulmonary Medicine/organization & administration , Respiratory Therapy , Aged , Continuity of Patient Care/organization & administration , Cost-Benefit Analysis , Female , House Calls , Humans , Length of Stay/statistics & numerical data , Male , New South Wales , Nurse Clinicians/organization & administration , Nursing Evaluation Research , Outcome Assessment, Health Care , Patient Admission/statistics & numerical data , Patient Satisfaction , Program Evaluation , Pulmonary Disease, Chronic Obstructive/psychologyABSTRACT
Nurses lack a comprehensive body of scientific knowledge to guide the palliative care of patients with nonmalignant conditions. Current knowledge and practice reveal that nurses in many instances are not well prepared to deal with death and dying. Focus groups were used in an exploratory study to examine the perceptions of palliative care among cardiorespiratory nurses (n = 35). Content analysis was used to reveal themes in the data. Four major themes were found: (1) searching for structure and meaning in the dying experience of patients with chronic disease, (2) lack of a treatment plan and a lack of planning and negotiation, (3) discomfort in dealing with death and dying, and (4) lack of awareness of palliative care philosophies and resources. The information derived from this sample of cardiorespiratory nurses represents a complex interplay between personal, professional, and organizational perspectives on the role of palliative care in cardiorespiratory disease. The results of the study suggest a need for nurses to be equipped on both an intellectual and a practical level about the concept of palliative care in nonmalignant disease.
Subject(s)
Critical Care , Health Knowledge, Attitudes, Practice , Heart Diseases/nursing , Lung Diseases/nursing , Palliative Care , Chronic Disease , Focus Groups , Humans , Patient Care Planning , Philosophy, NursingABSTRACT
Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.
