Transitions between skilled home health and hospice for persons living with dementia: a systematic review of literature.

BACKGROUND: In the United States (US), nearly one third of skilled home health (HH) patients and nearly one half of hospice patients have diagnoses of Alzheimer's disease and related dementias (ADRD), conditions often characterized by a slow decline in cognition and function. Many persons living with dementia (PLWDs) are cared for at home yet may transition between care settings such as skilled HH or hospice, potentially leading to fragmented and poorer care. The purpose of this systematic review was to examine literature pertaining to (I) care transitions for PLWD who are enrolled in skilled HH and hospice in the US, and (II) specifically, care transitions between skilled HH and hospice for PLWD. METHODS: We conducted a systematic review. From March to November 16, 2023, we searched CINAHL, PsychInfo (EBSCO version), and PubMed databases inputting keywords and index terms related to HH, care transition, hospice, and dementia. Articles were included if they were peer-reviewed, primary research studies that were published between 2017-2023 and addressed care transitions for PLWD enrolled in US skilled HH and hospice or transitions between the two settings. We evaluated the quality of each article and extracted relevant data. We described studies by setting while analyzing for similarities and differences between them. RESULTS: Of 230 studies, 14 met our inclusion criteria. We found that PLWD are at higher risk for early, unsuccessful discharge from-and readmission to-skilled HH; and PLWD are at higher risk for being discharged alive from hospice. Only one study pertained to care transitions for PLWD between skilled HH and hospice. CONCLUSIONS: We included only studies set in the US, as skilled HH and hospice may differ in policy and practice in other countries, which limits our findings. Future work should explore assessment approaches specific to PLWD that lead to higher quality of coordination of care to, from, and between skilled HH and hospice.

Lateral incivility, nursing students, and the academic environment: A modified epidemiological triangle.

The traditional epidemiological triangle identifies an infectious disease causing agent, a susceptible host to house the agent, and an environment conducive to the agent's proliferation and sustenance. Social epidemiology expands this basic triangle to address health determinants, social inequities, and heath disparities related to and encountered by vulnerable populations. A group is considered vulnerable if it is susceptible to poor physical, psychological, spiritual, social, or emotional health, attack, and censure or criticism. Nursing students fulfill these criteria for vulnerability. Lateral student-to-student incivility as the disease causing agent, nursing students as the susceptible hosts, and the academic and clinical learning environments reflect a modified epidemiological triangle. Nursing students experience physical, social, and emotional problems from experiencing and witnessing incivility. Students replicate modeled incivility behaviors. Learning may be negatively compromised. Oppressed group behavior is presented as one cause of lateral incivility. The transmission of incivility behaviors as the disease causing agent can be interrupted through civility education offered to nursing student hosts and a no tolerance stance against incivility in the academic learning environment. Cognitive Rehearsal is an evidence-based strategy to teach nursing students how to confront incivility victimization.