ABSTRACT
Delirium, a life-threatening complication for hospitalized older adults associated with adverse outcomes, is often underrecognized and underreported. The purpose of the current study was to analyze delirium documentation for hospitalized older adults. Charts of 34 patients, aged 71 and older with documented delirium and referral to a Hospital Elder Life Program, were reviewed. With the exception of International Classification of Diseases-9 coding, delirium was only mentioned in 12 (35.3%) charts, although descriptors potentially indicative of delirium were usually recorded. Of these, the most frequently recorded were confusion (94.1%), mental status change (70.6%), and disorientation (61.8%). When nurses charted delirium descriptors, only 5.9% of their notes included physician referral. Physician responses were to order diagnostic tests and medications, usually antipsychotic or benzodiazepine agents. Of 28 patients requiring transfer to another facility after discharge, delirium was mentioned in only one transfer note. Commonly used delirium descriptors can be used for the development of natural language processing tools for clinical decision support. [Journal of Gerontological Nursing, 43(3), 32-40.].
Subject(s)
Delirium/diagnosis , Delirium/nursing , Documentation/methods , Geriatric Nursing/methods , Nursing Assessment/methods , Patient Admission , Aged , Aged, 80 and over , Delirium/therapy , Female , Geriatric Assessment , Hospitalization , Hospitals, Community , Humans , Male , Needs Assessment , Retrospective Studies , Treatment Outcome , United StatesABSTRACT
Hospitals want to hire baccalaureate nurses. Even if there were sufficient numbers of baccalaureate nurses to fill hospital vacancies, however, it is unclear how long these nurses stay at the "bedside." Until the profession can ascertain how many baccalaureate nurses stay in hospital nursing, simply preparing enough of them will not suffice. Because no published studies were identified that examined either how long baccalaureate nurses stay in hospital nursing or these nurses' reasons for leaving hospital nursing, we undertook a pilot study of our own baccalaureate graduates. Specifically, this comparative descriptive pilot study examined baccalaureate nurses' average number of years in hospital nursing and their reasons for leaving or intending to leave hospital nursing. Three hundred ninety graduates responded. Forty percent had left hospital nursing after an average of 6.4 years, with a median of 5 years. Just over 56% were still practicing hospital nursing, and of these, 81.8% were staff RNs, 26.9% of whom intended to leave hospital nursing in the next 3-5 years. Nurses who intended to leave were less satisfied in their jobs (P < .0001) than those who did not intend to leave. They were also more likely to disagree that RNs played a participatory role in hospital affairs (P = .048), that there were adequate staffing and resources (P = .041), and that RN-physician relationships were collegial (P = .048). The most frequent reasons for intent to leave were the following: to advance education or to take new positions (43%), stress/burnout, long hours, and lack of administrative support/respect (21%, respectively). Only 17% cited poor pay/benefits as a reason for intent to leave. Respondents who had already left hospital nursing cited similar reasons. Dissatisfaction with the practice environment results in baccalaureate nurses leaving hospital nursing at a time when there is a critical shortage of nurses in all practice settings, but especially hospitals. Considering the accumulating evidence of superior patient outcomes in hospitals well staffed by baccalaureate nurses, it is critical to identify and implement solutions to ensure that adequate numbers of experienced, baccalaureate nurses stay at the bedside.
Subject(s)
Nursing Staff, Hospital , Education, Nursing , Humans , Job Satisfaction , Nursing Staff, Hospital/psychology , Pilot ProjectsABSTRACT
Elders with heart failure are at high risk for poor postdischarge outcomes such as rehospitalizations, emergency department use, and unscheduled physician visits. This study was conducted to determine if sociodemographic characteristics would aid in identifying high-risk individuals.
Subject(s)
Heart Failure/therapy , Hospitalization , Aged , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Male , Multivariate Analysis , Office Visits/statistics & numerical data , Patient Readmission/statistics & numerical data , Pennsylvania , Regression Analysis , Risk Factors , Socioeconomic Factors , Treatment OutcomeABSTRACT
Heart failure (HF) affects more than one million older Americans. As the population ages, the incidence of HF will increase. The purpose of this study was to identify variables that profile elders hospitalized with HF who are at high risk for poor postdischarge outcomes. A total of 103 patients were enrolled in the study. A low serum sodium and a fair or poor self-reported health status predicted all-cause readmission. A low serum sodium predicted HF-related readmissions. Four or more HF symptoms and index admission to an urban hospital predicted physician office visits. Admission to a community hospital predicted emergency department visits, and the number of coexisting medical conditions indicated an increased risk for an emergency department visit. The findings indicate that it is possible to profile hospitalized elders with HF who are at risk for poor postdischarge outcomes.
