Transitional care for older adults with chronic illness: A qualitative inquiry.

BACKGROUND: Improved public health strategies and medical advancements have expanded older adults' survival after acute insults from chronic diseases. The resultant increase in disability and care requirements among older adults is significant. However, transitional care interventions to support the efficient transition from acute care settings to home are primitive in developing countries like India. OBJECTIVE: This qualitative survey aimed to estimate the transitional care requirements of older adults with chronic illness discharged from acute care facilities. METHODS: Descriptive phenomenological approach was utilised for this qualitative study. The older adult-family caregiver dyads fulfilling the inclusion criteria were interviewed until the achievement of information saturation. The transcribed narratives between the researcher, older adults and their caregivers were thematically analysed. Consolidated Criteria for Reporting Qualitative Research (COREQ) served as the framework for reporting this research. RESULTS: Thirteen older adult-caregiver dyads participated in the semi-structured interview, which yielded six themes. Older adults have a hidden self with characteristics ranging between a continuum of 'insistence' to 'giving up'. Caregiver attributes identified from this inquiry were exhaustion, engagement and empowerment. The remaining four themes which constitute the framework for the 'transitional care progression' model include 'complications are mature when identified among older adults', 'medication knowledge is proportionate with its compliance', 'ignorance of supportive care increases caregiver burden' and 'deficient follow-up practices compromise health'. CONCLUSIONS: Transitional care for older adults with chronic illness is premature in developing countries. However, the needs of older adults with chronic disease and their caregivers evolved from the present study align with global perspectives. Themes generated from the current qualitative interview, blended with evidence-based interventions, yielded the transitional care progression model, which serves as the only available framework for implementing transitional care in the region. IMPLICATIONS FOR PRACTICE: Future research to establish the feasibility and validity of the 'transitional care progression model' is forecasted. The model requires inclusion within the healthcare curriculum. Professional nurses prepared to implement coordinated transitional care pathways are recommended.

Lived Experience of Adult Female Cancer Survivors to Discover Common Protective Resilience Factors to Cope with Cancer Experience and to Identify Potential Barriers to Resilience.

Objectives: Primary objective - Phase I: The primary objective of this study was as follows: (1) To identify common protective resilient factors that enabled the adult female cancer survivors to cope with the cancer experience. (2) To identify potential barriers to the resilience of adult female cancer survivors. Secondary objective - Phase II: The secondary objective of this study was to develop and validate a resilience tool for cancer survivorship. Material and Methods: A mixed approach using sequential exploratory design was used in the study. A qualitative approach using phenomenology design was used in the first phase followed by a quantitative approach in the second phase. In the first phase, in-depth interviews were conducted until data saturation with 14 female breast cancer survivors chosen by purposive and maximum variation sampling methods based on inclusion criteria. The researcher used Colaizzi's data analysis framework to analyse the transcripts. Findings were configured as protective resilience factors and barriers to resilience. Based on the analysis of the qualitative phase, the researcher developed a 35-item resilience tool for cancer survivorship. Content validity, criterion validity and reliability of the newly developed instrument were assessed. Results: In the qualitative phase, the mean age of the participants was 57.07 years and the mean age at diagnosis was 55.5 years. The majority 11 (78.57%) of them were homemakers. All 14 (100%) of them had undergone surgery. The majority 11 (78.57%) of them had all three modes of therapy, that is, surgery, chemotherapy and radiation therapy. The categories of themes identified are presented under two main headings, that is, protective resilience factors and barriers to resilience. The theme categories identified under protective resilience factors were personal, social, spiritual, physical, economic and psychological factors. The barriers to resilience identified were lack of awareness, medical/biological barriers, social, financial and psychological barriers. The developed resilience tool had a content validity index of 0.98, a criterion validity of 0.67, internal consistency of 0.88 and stability of 0.99 at a 95% confidence interval. Principle component analysis (PCA) was used to validate the domains. PCA of protective resilience factors (Q1-Q23) and barriers to resilience (Q24-Q35) had Eigenvalues of 7.65 and 4.49, respectively. The resilience tool for cancer survivorship was found to have good construct validity. Conclusion: The present study has identified the protective resilience factors and barriers to resilience among adult female cancer survivors. The developed resilience tool for cancer survivorship was found to have good validity and reliability. It will be useful for nurses and all other healthcare professionals to assess the resilience needs of cancer survivors and to provide need-based quality cancer care.

Nursing organisation during COVID-19: experiences of an unaided, not-for-profit quaternary care teaching hospital in India.

India reported its index case of coronavirus disease 2019 (COVID-19) in January 2020 and since then there has been an alarming rise in cases. In response to the worsening pandemic and the challenge presented by COVID-19 for hospitals in the public sector, the Government of India asked the country's private hospitals to reserve a percentage of their beds for COVID-19 patients. This article describes how nursing services at the Christian Medical College, Vellore - an unaided, not-for-profit quaternary care teaching hospital in Tamil Nadu, India - addressed various challenges to ensure a sustained, high-quality nursing care response to increased patient load. The main challenges included changing COVID-19 policies, ensuring the hospital was prepared to care for COVID-19 patients, and ensuring the availability of nurses. The article demonstrates how proactive planning, empowered involvement of nursing leaders and collaborative efforts resulted in deployment and training of 1,400 nurses, and ensured coordinated care for more than 10,000 patients with COVID-19.

Older adults with chronic illness - Caregiver burden in the Asian context: A systematic review.

INTRODUCTION: Upsurge in life expectancy, filial responsibility of caring, and healthcare advances have increased the older adult population in Asia. The last decade has witnessed nuclear families' proliferation in Asia, leaving family caregivers with more accountability and responsibility. This review explores the pattern of caregiver burden among caregivers of older adults with chronic illness in Asia. METHODS: PRISMA guidelines serves as the framework for this systematic review. Studies from selected databases assessed caregivers' physical state, psychological dysfunction, and or burden as an outcome measure. The Newcastle - Ottawa Quality Assessment Scale appraised the quality of the selected studies. RESULTS: The review included 12 research articles. Caregivers consistently report mild to a moderate burden. Care recipient with functional dependency, comorbidities, memory, and sleep impairments, escalate caregiver burden. Caregiver variables intensifying burden were advancing age, male gender, spouse as a care recipient, longer care provision duration, and no assistance. CONCLUSION: Optimal levels of emotional well-being, significant family/social support, and self-preparedness among caregivers are grounds for their empowerment. PRACTICAL IMPLICATIONS: A paradigm shift from 'caregiver burden' to 'caregiver resilience' is advocated. Routine screening, preventive measures (skill-building and psychosocial empowerment), and restorative services (respite care and problem-based home visiting) for caregivers are forecasted.

Achieving Continuous Improvement in CSSD Management through Performance Measurements using User Satisfaction Surveys and Interventions.

Introduction: The objective of the study was to achieve continuous improvement in Central Sterile Supply Department (CSSD) management through performance measurements using user satisfaction surveys and interventions. Methods: A brainstorming session was conducted with the multidisciplinary process improvement team in 2012 on the reasons for dissatisfaction with CSSD services. A baseline survey questionnaire was prepared to assess levels of dissatisfaction for key indicators and to establish target benchmarks for improvement. Charge nurses in the wards were chosen as respondents. The report was presented by the Quality Management Cell (QMC) to the steering committee in the presence of the CSSD managers. Solutions and support were offered to the team for improvement. Similar surveys were conducted in 2014, 2016, 2017, 2018, and 2019 to understand the impact of the changes implemented. Results: The overall satisfaction of the respondents with the CSSD services increased from 54% in 2012 to 89% in 2019, which is statistically significant (95% Cl: -0.56 to -0.25) with p-value < 0.001. Conclusion: This exercise helped to build a strong team and create a culture of openness in the CSSD. Improvement measures were data driven and other departments like Radiology and Laundry were motivated to embrace the idea of understanding their user perceptions. This study demonstrates the effectiveness of internal user satisfaction surveys as a valuable tool for continuous quality improvement. This exercise proved beyond doubt that regular monitoring improves quality of services.

Effectiveness of prehemodialysis preparatory program on improving coping among chronic kidney disease patients.

Diagnosis of chronic kidney disease (CKD) and initiation of dialysis treatment is reported to be stressful for patients. It is essential that patients use effective coping strategies to deal with these stressors, since ineffective coping could have several adverse effects on various treatment-related as well as personal aspects of life, thereby lowering the quality of life in these patients. The study used a quasi-experimental design. The study population comprised 100 adult patients with Stage 3 and Stage 4 CKD whose glomerular filtration rate was deteriorating and required to undergo hemodialysis (HD) treatment. Carver's Brief Cope Scale was used to assess coping strategies used. The study was carried out in a tertiary care hospital in Bengaluru, India. Patients in the intervention group received pre-HD preparatory program and those in the control group received standard care. Postassessment for coping strategies used was carried out two weeks after the delivery of intervention. Highly significant statistical differences were observed in the use of certain adaptive coping strategies among the experimental group as compared to the control group after implementation of pre-HD preparatory program. These adaptive coping strategies included self-distraction (P = 0.011), active coping (P = 0.000), planning (P = 0.026), acceptance (P = 0.001), and religion (P = 0.005). The intervention was not found to be significant in reducing use of maladaptive coping strategies (P = 0.095). In India, 61%-66% of patients who present to nephrologists are already in end-stage renal disease. These patients hardly receive any organized education that would prepare them to understand their disease and enable them to manage it to the best of their abilities. An ongoing patient education and counseling program led by trained nurse educator will help patients cope effectively with the diagnosis of CKD and its treatment.

Diet and Physical Activity Among Women in Urban and Rural Areas in South India: A Community Based Comparative Survey.

INTRODUCTION: Noncommunicable diseases (NCDs) such as diabetes, hypertension, and heart diseases are increasing in India. There is a clear need to study risk factors for NCDs in various population groups in the country. MATERIALS AND METHODS: This community based cross-sectional survey was conducted to study the diet and physical activity of women in urban and rural areas in Vellore district. Dietary data was collected using 24-h dietary recall and physical activity was collected using the International Physical Activity Questionnaire (IPAQ). Sociodemographic variables were collected to assess the risk factors for unfavorable diet and physical activity. RESULTS: The odds of the rural women engaging in high physical activity are 3.61 times greater than urban women (95% confidence interval (CI) = 2.36-5.54). The odds of the urban women consuming a high calorie diet are 1.923 times that of the rural women (95% CI = 1.282-2.857). The odds of the urban women being overweight/obese are 5.555 times than that of the urban women (95% CI = 3.333-10). Women who were housewives and not doing household work were significantly less physically active, took higher calorie diet, and were more overweight and obese compared to women who were involved in active household work. CONCLUSIONS: Urban women had unfavorable diet and physical activity levels compared to rural women. They also had higher levels of overweight and obesity. There is a need for targeted NCD prevention interventions among urban women.