Support needs of parents with preterm infants at resource-limited neonatal units in Limpopo province: A qualitative study.

BACKGROUND:  Preterm birth is often unexpected and life-threatening for the baby and/or the mother. When admitted to the hospital, midwives need to provide informational, instrumental, psycho-cultural and emotional support to enhance post-discharge care. OBJECTIVES:  This study aimed to explore and describe the support provided to parents of preterm infants in preparing for post-discharge care. The study was conducted in three district hospitals in the Mopani district, South Africa. METHOD:  A qualitative approach wherein explorative, descriptive and contextual designs were used. A non-probability, convenience sampling was used to select 23 midwives who were working in the maternity unit for at least 2 years. Data were collected through in-depth individual semi-structured interviews until data saturation was reached. The data were analysed through Tesch's open coding method. Trustworthiness was ensured through credibility, transferability and confirmability. Ethical principles adhered to were: informed consent, beneficence, right to self-determination, confidentiality and anonymity. RESULTS:  The findings revealed that parents need informational, instrumental direct supervision, and psycho-cultural and emotional support during preparation for discharge. CONCLUSION:  Parents were unsure of their ability to care for the preterm infants after discharge and manage their own needs. The provision of informational, instrumental, psycho-cultural and emotional support needs would play a vital role in their ability to cope with their parental roles and the relationship with their infant.Contribution: The support provided to parents could build parental confidence and act as an integral part of neonatal follow-up programmes.

Towards reduction of preventable hospital readmission: Older people and family members' views on planned self-management of care at home.

AIMS AND OBJECTIVES: To reduce the likelihood of preventable readmissions, the aim was to investigate how older people (with their family members) managed their chronic health conditions at home following hospital discharge. The objectives explored older people and their family members' perspectives on how discharge plans assisted self-management of their chronic conditions, their recognition of deterioration and when to seek treatment/re-attend hospital. BACKGROUND: Chronic conditions have challenged older adults' self-management, particularly after hospital discharge and can impact on preventable readmission. Few studies have examined patients' and their family members' perspectives on the management of their conditions at home after hospitalisation. DESIGN: A qualitative exploratory design known as Interpretive Description was utilised. METHODS: Purposeful sampling involved 27 community-dwelling older adults; nineteen were discharged patients with one or more chronic health conditions. Eight nominated family members were also recruited to enhance understanding of the older persons' self-management at home. Interviews were undertaken and thematic data analysis followed the COREQ guidelines. RESULTS: Five themes emerged: (1) Post-Discharge Advice; (2) Managing at Home; (3) Recognition and Response to Deterioration; (4) Community Care and Support; and (5) The "Burden" on Others of Post-Discharge Care. CONCLUSION: Older people sought a clear plan for self-management at home prior to discharge. This plan should contain potential signs of deterioration and guidance on future action. We found that support given to older people from family and friends was critical to prevent readmission. In addition, their local General Practitioner and Pharmacist played an essential part in the support of their care. For some, social support services were also important. Nurse telephone follow-up in the week following discharge was mostly absent. However, this strategy would be strongly recommended. RELEVANCE TO CLINICAL PRACTICE: To mitigate against preventable readmission, we recommend the above strategies to assist the older person at home with self-management of their chronic conditions.

Discharge Interventions for First Nations People with Injury or Chronic Conditions: A Protocol for a Systematic Review.

Severe injury and chronic conditions require long-term management by multidisciplinary teams. Appropriate discharge planning ensures ongoing care to mitigate the long-term impact of injuries and chronic conditions. However, First Nations peoples in Australia face ongoing barriers to aftercare. This systematic review will locate and analyse global evidence of discharge interventions that have been implemented to improve aftercare and enhance health outcomes among First Nations people with an injury or chronic condition. A systematic search will be conducted using five databases, Google, and Google scholar. Global studies published in English will be included. We will analyse aftercare interventions implemented and the health outcomes associated. Two independent reviewers will screen and select studies and then extract and analyse the data. Quality appraisal of the included studies will be conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. The proposed study will analyse global evidence on discharge interventions that have been implemented for First Nations people with an injury or chronic conditions and their associated health outcomes. Our findings will guide healthcare quality improvement to ensure Aboriginal and Torres Strait Islander peoples have ongoing access to culturally safe aftercare services.

Evaluation and perceptions of a nursing discharge plan among nurses from different healthcare settings in Spain.

PURPOSE: The exchange of information between different healthcare settings through a nursing discharge plan is essential for safe care. However, the factors contributing to achieving the most efficient exchange have not been well studied. This study aimed to evaluate and explore the perceptions of a nursing discharge plan from the perspective of nurses in different healthcare settings. METHODS: A mixed methods approach comprising a specifically designed ad hoc questionnaire (n = 437) and a focus group session (n = 8). FINDINGS: Overall, 66.1% out of 437 nurses, and especially those working in nursing homes, were satisfied with the nursing discharge plan. Lack of time to complete the report and poor information about both nursing diagnoses and patients' social assessment were identified as problem areas. Some proposals emerged from the focus group: providing sufficient time for its completion, giving the nursing discharge plan a more flexible structure permitting more open-ended responses, requiring more information to be provided about the social and psychological situation of the patients, training nurses to use standardized language to avoid possible misinterpretations, and getting nurses from the different health care settings to work together in designing continuity of care plans. Elderly and low-income patients are found to need greater attention when filling out nursing discharge plans. CONCLUSIONS: The study has revealed key aspects that need to be improved and some recommendations in implementing the nursing discharge plan in our health area. These include that there should be more time provided to complete the NDP, and also specific details regarding the format, structure, content of the information that is communicated, and the prioritization of the patient profile.

Frailty Network in an Acute Care Setting: The New Perspective for Frail Older People.

The incidence of elderly patients who come to the emergency room is progressively increasing. The specialization of the physician units might not be adequate for the evaluation of this complexity. The present study aimed to present a standard procedure, called 'The Geriatric Frailty Network', operating at the Policlinico Gemelli IRCCS Foundation, which is configured specifically for the level II assessment of frail elderly patients. This was a retrospective study in 1191 patients aged over 65, who were evaluated by the Geriatric Frailty Unit directly after emergency department admission for one year. All patients underwent multidimensional geriatric evaluation. Data were collected on demographics, co-morbidity, disease severity, and Clinical Frailty Scale. Among all patients, 723 were discharged directly from the emergency room with early identification of continuity of care path. Globally, 468 patients were hospitalized with an early assessment of frailty that facilitated the discharge process. The geriatric frailty network model aims to assist the emergency room and ward doctor in the prevention of the most common geriatric syndromes and reduce the number of incongruous hospitalizations.

Efecto de una intervención de alta programada sobre los reingresos de pacientes con insuficiencia cardíaca: estudio APRICA / Effect of a planned discharge intervention on readmissions of patients with heart failure APRICA study / Efeito de uma intervenção de alta planejada nas readmissões de pacientes com insuficiência cardíaca estudo APRICA

Introducción. La insuficiencia cardíaca (IC) es una enfermedad con alta incidencia, prevalencia y mortalidad. Es primera causa de hospitalización en mayores de 65 años y 25% de los pacientes que reingresan antes de 30 días. La implementación de varios planes de transición al alta han mostrado beneficios respecto a los reingresos, no habiendo datos al respecto en Uruguay. Se diseñó un estudio para analizar el efecto de un Plan de Alta Programada sobre los reingresos en pacientes internados con IC en un Hospital. Material y métodos. Estudio prospectivo, controlado y randomizado, incluyendo pacientes ingresados en servicios de medicina del Hospital de Clínicas Dr. Manuel Quintela con diagnóstico de IC. Criterios de exclusión: negativa a participar, discapacidad cognitiva, hospitalización d"24 horas o muerte en internación. Se randomizaron dos grupos (intervención y control) con seguimiento a 18 meses. En el grupo intervención se aplicó un plan de alta programada y en el grupo control el criterio de médico tratante. Se registraron reingresos, muerte y calidad de vida a los 3, 6, 9, 12 y 18 meses. Se consideró significativo un valor de p<0,05. Se utilizó la prueba de T- student para muestras independientes. Resultados. Se incluyeron 149 pacientes, 78 en el grupo intervención. Se registraron 19 (24,4%) reingresos en el grupo intervención y 38 (53,5%) en el grupo control (RR 1,85 [IC 1,337-2,583] p<0,05). Ocurrieron 6 muertes en el grupo intervención y 7 en el grupo control (RR: 1,024 [IC 0,926-1,32] p=0,640). La calidad de vida por Test de Minnesota fue 50,98; 49,71 y 49,07 en el grupo intervención a los 3, 6 y 18 meses, respectivamente, y 55,04; 55,32 y 54,91 en el grupo control, con un valor de p no significativo. Conclusiones. La implementación de un Plan de Alta Programada reduce de manera significativa los reingresos por IC. Dado que parece ser una herramienta costo/efectiva para el sistema de salud la misma podría tener un impacto beneficioso en la calidad asistencial del paciente con IC.

Background. Heart failure (HF) is a disease with a high incidence, prevalence and mortality. It is the first cause of hospitalization in people over 65 years and 25% of patients are readmitted within 30 days. The implementation of various discharge transition plans has shown benefits with respect to readmissions, and there is no data in this regard in Uruguay. A study was designed to analyze the effect of a Scheduled Discharge Plan on readmissions in hospitalized patients with HF. Material and methods. Prospective, controlled and randomized study, including patients admitted to the medical services of the Hospital de Clínicas Dr. Manuel Quintela with a diagnosis of HF. Exclusion criteria: refusal to participate, cognitive disability, hospitalization d"24 hours or death in hospital. Two groups (intervention and control) were randomized with 18-month follow-up. In the intervention group, a planned discharge plan was applied and the criterion of treating physician was applied in control. Readmissions, death and quality of life were recorded at 3, 6, 9, 12 and 18 months. A value of p <0.05 was considered significant. The student s T-test was used for independent samples. Results. 149 patients were included, 78 in the intervention group. There were 19 (24.4%) readmissions in the intervention group and 38 (53.5%) in the control group (RR 1.85 [CI 1.337-2.583] p <0.05). There were 6 deaths in the intervention group and 7 in the control group, (RR: 1,024 [CI 0.926-1.32] p = 0.640). The quality of life by Minnesota Test was 50.98; 49.71 and 49.07 in intervention at 3, 6 and 18 months respectively and 55.04; 55.32 and 54.91 in the control group, with a non-significant p value. Conclusions. The implementation of a Scheduled Discharge Plan significantly reduces readmissions for HF. Given that it appears to be a cost/effective tool for the health system, it could have a beneficial impact on the quality of care for patients with HF.

Introdução. A insuficiência cardíaca (IC) é uma doença com alta incidência, prevalência e mortalidade. É a primeira causa de hospitalização em pessoas com mais de 65 anos e 25% dos pacientes são readmitidos em 30 dias. A implementação de vários planos de transição de alta mostrou benefícios no que diz respeito às readmissões, e não há dados a esse respeito no Uruguai. Um estudo foi desenhado para analisar o efeito de um Plano de Alta Planejado nas readmissões em pacientes hospitalizados com IC. Material e métodos. Estudo prospectivo, controlado e randomizado, incluindo pacientes internados nos serviços médicos do Hospital de Clínicas Dr. Manuel Quintela com diagnóstico de IC. Critérios de exclusão: recusa em participar, deficiência cognitiva, internação d"24 horas ou óbito no hospital. Dois grupos foram randomizados (intervenção e controle) com seguimento de 18 meses. No grupo de intervenção, um plano de alta planejado foi aplicado e o critério de médico assistente foi aplicado no controle. Readmissões, óbito e qualidade de vida foram registrados aos 3, 6, 9, 12 e 18 meses. Um valor de p<0,05 foi considerado significativo. O teste T do aluno foi usado para amostras independentes. Resultados. Foram incluídos 149 pacientes, 78 no grupo de intervenção. Houve 19 (24,4%) readmissões no grupo de intervenção e 38 (53,5%) no grupo de controle (RR 1,85 [IC 1,337-2,583] p <0,05). Houve 6 mortes no grupo de intervenção e 7 no grupo controle, (RR: 1,024 [IC 0,926-1,32] p=0,640). A qualidade de vida pelo teste de Minnesotafoi de 50,98; 49,71 e 49,07 na intervenção em 3, 6 e 18 meses, respectivamente, e 55,04; 55,32 e 54,91 no grupo controle, com um valor de p não significativo. Conclusões. A implementação de um Plano de Descarga Planejado reduz significativamente as readmissões para IC. Visto que parece ser uma ferramenta econômica para o sistema de saúde, pode ter um impacto benéfico na qualidade do atendimento aos pacientes com IC.

Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: A Systematic Narrative Review.

BACKGROUND: There is a compelling rationale that effective communication between hospital allied health and primary care practitioners may improve the quality and continuity of patient care. It is not known which methods of communication to use, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health and primary care practitioners. METHODS: Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital-based allied health professionals communicating with community-based primary care practitioners. Risk of bias in the different study designs was appraised using recognized tools and a content analysis conducted of the methodologies used. RESULTS: From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health communicating in some form with primary care practitioners. While none of the included studies specifically investigated the methods or effectiveness of communication between hospital allied health and primary care practitioners, 12 of the 24 studies described processes that addressed components of their discharge communication. Four enablers to effective communication between hospital allied health and primary care practitioners were identified: multidisciplinary care plans, patient and caregiver involvement, health information technology and a designated person for follow up/care management. CONCLUSION: There is currently no "gold standard" method or measure of communication between hospital allied health and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced information technologies to improve collaboration across care settings and facilitate the continuity of integrated people-centered care.

Effect of hospital discharge plan for children with type 1 diabetes on discharge readiness, discharge education quality, and blood glucose control.

BACKGROUND: Type 1 diabetes is one of the most common chronic diseases in childhood. The number of type 1 diabetes patients in China still ranks fourth in the world. Therefore, children with type 1 diabetes in China are a group that needs attention. The management of type 1 diabetes mellitus (T1DM) involves many aspects of daily life. It is extremely challenging for children and their families. T1DM children have complex medical care needs. Despite the continuous development of therapeutic medicine and treatment technologies, blood glucose control in children with T1DM is still not ideal. They and their parents need to acquire more knowledge and skills before being discharged. AIM: To explore the influence of hospital discharge plan based on parental care needs of children with T1DM on discharge readiness, quality of discharge education and blood glucose control level. METHODS: In total, 102 parents of children with type 1 diabetes were divided into control group and intervention group according to admission time. Fifty cases from February to June 2019 were selected as the control group, and 52 cases from July to October 2019 were selected as the intervention group to implement the discharge plan. The Readiness for Hospital Discharge Scale, Hospital Discharged Education Quality Scale and children's blood glucose metabolism indicators were used to compare the differences in discharge preparation, discharge education quality and blood glucose control between the two groups of children and their parents. RESULTS: On the day of discharge, the two groups of children had the following scores of readiness for discharge: The intervention group score was 225.34 ± 32.47, and the control group score was 208.68 ± 29.31. The P value was 0.007, and the difference was statistically significant. The discharge education quality scores were as follows: The intervention group score was 135.11 ± 19.86, the control group score was 124.13 ± 15.56, the P value was 0.002 and the difference was statistically significant. Three months after discharge, the blood glucose metabolism indicator showed that the glycosylated hemoglobin value of the two groups was (7.45% ± 1.04%), and that of the control group was (8.04% ± 1.27%), P = 0.012. Therefore, the improvement of parents' readiness for discharge, quality of discharge education and blood glucose metabolism indicators (glycosylated hemoglobin, fasting blood glucose and postprandial blood glucose) in the intervention group were better than those in the control group (P < 0.05), and the difference was statistically significant. CONCLUSION: The discharge plan for children with T1DM can help the children and their families realize the transition from hospital care to home self-management and improve the parents' readiness for discharge, thereby improving children's blood glucose control levels.

Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic.

BACKGROUND: Unplanned readmission in the first 30 days after discharge is an important medical problem, although the data on cancer patients is limited. So we planned to evaluate the rates and causes of early readmissions and the predisposing factors. METHODS: Patients hospitalized in Hacettepe University Oncology services between August 2018 and July 2019 were included. The demographic features, tumor stages, regular drugs, last laboratory parameters before discharge, and readmissions in the first 30 days after discharge were recorded. The predisposing features were evaluated with univariate and multivariate analyses. RESULTS: A total of 562 hospitalizations were included. The mean age of the patients was 58.5 ± 14.5 years. Almost 2/3 of the hospitalizations were due to symptom palliation and infections. Eighty-three percent of the patients had advanced disease, and over 60% had an ECOG score of 2 and above. In the first 30 days after discharge, 127 patients were readmitted (22.6%). Advanced stage disease, presence of polypharmacy (5 or more regular drugs), hospitalization setting (emergency department (ED) vs. outpatient clinic), and hypoalbuminemia (< 3 gr/dL) were associated with a statistically significant increase in the risk of readmission. Among these factors, advanced-stage disease (HR: 2.847, 95% CI: 1.375-5.895), hospitalization from ED (HR: 1.832, 95% CI: 1.208-2.777), and polypharmacy (HR: 1.782, 95% CI: 1.173-2.706) remained significant in multivariate analyses. CONCLUSIONS: In this study, 22% of cancer patients had early readmissions. The readmission risk increased in patients with advanced disease, hospitalization from ED, and polypharmacy. The optimal post-discharge plan may reduce readmissions in all oncology patients, with priority for these patient groups.

Evaluación del Plan de Alta por enfermería en el hospital San José, Popayán 2017 / Evaluation of the effectiveness of hospital discharge planning at San José hospital, Popayán 2017

Resumen Introducción: Durante el alta hospitalaria es importante que el enfermero identifique los cuidados que requiere el paciente, permitiéndole guiar intervenciones mediante el plan de alta que fomenta el autocuidado, enfocado a necesidades específicas de cada persona, para prevenir complicaciones y disminuir reingresos. Objetivo: Evaluar la ejecución del plan de alta por los profesionales de enfermería en los servicios de medicina interna y quirúrgicas del Hospital San José, Popayán durante el año 2017. Materiales y métodos : Estudio de tipo cuantitativo, diseño descriptivo y transversal. La población conformada por los enfermeros de los servicios de medicina interna y quirúrgicas del Hospital San José y pacientes con alta programada de 24 horas o menos antes del egreso hospitalario. Resultados: La información se recolectó por medio de un instrumento de valoración realizado a participantes que cumplen con criterios de inclusión. El 94,7% de los pacientes tenían egreso programado, de estos 58,6% recibieron indicaciones en las últimas 48 horas sobre los cuidados en casa y el 100% manifestaron entender las recomendaciones brindadas por el enfermero. Respecto al profesional de enfermería el 100% refiere no conocer alguna metodología para elaborar el plan de alta y el 80% no conoce si en la institución existe un procedimiento de egreso y seguimiento al paciente. Conclusiones: El plan de alta es un proceso que no se encuentra estandarizado y por lo tanto no es evaluado en la institución, el personal de Enfermería se limita a brindar educación sobre las indicaciones médicas de egreso y no sobre un plan de alta propio de Enfermería.

Abstract: Introduction: When the patients are going to be discharged from the hospital, the nurses must execute the discharge plan based on their specific needs. It is essential to promote self-care in patients to prevent future medical complications and readmissions. Objective: To evaluate the implementation of the discharge plan by the nursing professionals in the internal medicine and surgical services at the San José hospital in Popayán, Colombia, in 2017. Materials and methods: This quantitative study has a descriptive and transversal design. The research population is composed of nurses from the internal medicine and surgical services from the San José Hospital and patients that are going to be discharged from the clinic in 24 hours or less. Results: The information was collected by using an instrument that was designed for the participants to confirm if they fit the inclusion criteria. According to collected data, 94.7% of the patients had scheduled discharges, 58.6% of them had received indications in the last 48 hours before the discharge on how the self-care routines must be followed at home. Additionally, 100% of people said they understood the recommendations given by the nurses. Finally, 100% of the nursing professionals claimed that they did not know any methodology to prepare the discharge plan, and about 80% of them did not know about the existence of a patient's exit procedure and patient's medical follow-up in the institution. Conclusions: The patient discharge plan is not standardized, so it is not evaluated in the institution. The nursing staff is focused only on explaining the medical indications, but they are not focused on creating their discharge plans.

Guía para un Plan de egreso en personas con secuelas por Enfermedad Vascular Cerebral / Discharge plan guides for persons with Cerebrovascular Disease Sequelae / Guia para um Plano de egresso em pessoas com sequelas por Doenças Vasculares Cerebrais

Resumen Introducción: Las personas que sufren un Evento Vascular Cerebral (EVC), generalmente quedan incapacitadas para la realización de sus actividades básicas, lo que conlleva a una dependencia. Por consiguiente, es importante la elaboración de un plan de egreso con amplia información sobre los cuidados que facilite al profesional de enfermería brindar educación para la salud, dirigida a familiares y enfermos sobre el cuidado en el hogar tras un EVC. Métodos: El procedimiento utilizado para esta propuesta constó de tres fases, en las cuales se realizó una revisión de la literatura, una delimitación con base en el tema central, para finalmente, elaborar el plan de egreso que aquí se presenta. Resultados: En la primera fase se analizaron 39 estudios, 16 de tipo cualitativo, 11 cuantitativos, ocho Guías de práctica clínica, tres mixtos y dos tesis; posteriormente, en la segunda fase se estableció la delimitación del tema con base en el criterio de evidencia científica y los diagnósticos enfermeros de la NANDA, y finalmente; en la tercera fase, se prescribieron las principales intervenciones de cuidado a implementar tras el egreso de pacientes con EVC. Discusión y conclusiones: El plan de egreso forma parte del cuidado integral y humanizado, requiere llevarse a cabo de forma habitual para facilitar el diálogo sobre las incertidumbres, dudas y angustias presentes, frecuentemente, en el cuidador primario y enfermo tras su egreso. A su vez, las guías de cuidado contribuyen a establecer el plan de egreso al enfermo, con el propósito de disminuir los reingresos hospitalarios, prevenir complicaciones y mejorar su calidad de vida, además de poder seguir innovando la práctica clínica de enfermería.

Abstract Introduction: Persons who suffer a stroke generally are not able to carry out their basic activities and thus become dependent. Because of this, designing discharge plans based on wide-scope information facilitating nursing staff provide healthcare education to victims of stroke and their families is of paramount importance. Methods: In the proposal three stages were considered: a literature review; a main topic delimitation; and a discharge plan, herein featured. Results: In the first stage, 39 studies were analyzed: 16 qualitative; 11 quantitative; 8 clinical practice guides; 3 mixed methods; and 2 dissertations. In the second stage, the main theme was established based on the scientific criteria and the NANDA nursing diagnostics. In the third stage, the main cerebrovascular disease care interventions were prescribed. Discussion and conclusions: The integral discharge plan requires being regularly carried out in order to foster dialogues on related uncertainties, doubts, and anxieties. These care guides can contribute to the establishment of discharge plans aimed at reducing hospital readmissions, preventing complications, and improving the quality of life of these patients.

Resumo Introdução: As pessoas que sofrem um Evento Vascular Cerebral (EVC), geralmente, ficam incapacitadas para a realização de suas atividades básicas, isto, envolve uma dependência, por isso é importante a elaboração de um plano de egresso com vasta informação sobre os cuidados, que facilite no profissional de enfermagem proporcionar educação para a saúde, dirigida a familiares e doentes sobre o cuidado no lar trás um EVC. Métodos: O procedimento utilizado para esta proposta consistiu três fases, nas quais, se realizou uma revisão da literatura, uma delimitação com base no tema central, para finalmente, elaborar o plano de egresso que aqui se apresenta. Resultados: Na primeira fase se analisaram 39 estudos, 16 de tipo qualitativo, 11 quantitativos, oito Guias de prática clínica, três mistos e duas teses; posteriormente, na segunda fase se estabeleceu a delimitação do tema com base no critério de evidencia científica e dos diagnósticos enfermeiros da NANDA, e finalmente; na terceira fase, prescreveram-se as principais intervenções de cuidado a implementar trás o egresso de pacientes com EVC. Discussão e conclusões: O plano de egresso forma parte do cuidado integral e humanizado, requer ser feito de forma habitual, para facilitar o diálogo sobre as incertezas, dúvidas e angústias presentes, frequentemente, no cuidador primário e o doente trás seu egresso. As guias de cuidado contribuem a estabelecer o plano de egresso para o doente, com o propósito, de diminuir os reingressos hospitalários, prevenir complicações e melhorar sua qualidade de vida, além de poder seguir inovando a prática clínica de enfermagem.

Longing to get back on track: Patients' experiences and supportive care needs after lung cancer surgery.

AIMS AND OBJECTIVES: This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs. BACKGROUND: Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital. DESIGN: This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ). METHODS: The information about 14 patients' experiences was collected from semi-structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis. RESULTS: The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle. CONCLUSIONS: The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning. RELEVANCE TO CLINICAL PRACTICE: Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.

Opioid prescribing in orthopaedic and neurosurgical specialties in a tertiary hospital: a retrospective audit of hospital discharge data.

BACKGROUND: To understand patterns of opioid prescribing on discharge in the orthopaedic and neurosurgical wards of a tertiary metropolitan hospital. METHODS: A retrospective audit of medical records and discharge summaries for all orthopaedic and neurosurgical patients admitted for at least 2 days on two surgical wards over a 6-month period between 1 January and 30 June 2017. RESULTS: A combined total of 355 patients (281 orthopaedic and 74 neurosurgical patients) were included in the audit. Approximately 82% were discharged on opioids. Of patients discharged on opioids, 71.4% of the orthopaedic group and 73.8% of the neurosurgical group were discharged on combinations of two or more opioids (immediate release together with slow release). Around 65% of the sample discharged on opioids was opioid naïve on admission. About 32.5% of the orthopaedic patients and 68.9% of the neurosurgical patients were discharged on a combination of opioid and other pharmacotherapy that could potentiate the central nervous system depressant effect of the opioids. Only 6.9% of orthopaedic patients and 11.5% of the neurosurgical patients had discharge summaries that included any reference to opioid management after discharge. CONCLUSION: Orthopaedic and neurosurgical units had high opioid prescribing rates on discharge from hospital. This highlights the need for clear communication of the intended medication management plan post-discharge in order to minimize inappropriate and ongoing use of opioids post-surgery.

Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study.

AIMS: We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. METHODS AND RESULTS: We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). CONCLUSIONS: A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence.

Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study.

BACKGROUND: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety. METHODS: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status. RESULT: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57]. CONCLUSION: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study. TRIAL REGISTRATION: Clinical Trials ID: NCT02773914. Registered 16 May 2016.

A prospective study of the clinical content of palliative medicine interdisciplinary team meetings.

Structured interprofessional communication should improve the structure and clarity of the plan of care. The interdisciplinary team meeting (IDTM) is an opportunity for shared information on patients' and family care needs. We report a prospective observations study of palliative medicine IDTM, which recorded the clinical issues discussed. One hundred and forty-five disparate clinical items were identified for 59 patients and were discussed by the IDTM in about 240 minutes. By content analysis and research meeting consensus, they were grouped into 9 agreed interdisciplinary themes. The 9 themes were then subjected to biostatistical analysis and 3 communication clusters identified. Themes consisted of 3 major communication clusters: (1) clinical services, (2) psychosocial, and (3) care plan. Two themes (information exchange and clinical transitions) did not cluster. The IDTM identified patient care need, reported concerns, and supported collaboration in proactive patient care plans. Future research projects with more patients and a large number of meetings can confirm our findings. This should also examine specific contributions by professional discipline.

The effects of discharge plan on stress, anxiety and depression in patients undergoing percutaneous transluminal coronary angioplasty: a randomized controlled trial.

BACKGROUND: Angioplasty is one of the most common methods for treating coronary artery diseases. However, a large number of those undergoing this treatment face psychological problems that negatively affect the quality of their life and recovery. We aimed to determine the effects of discharge planning on stress, anxiety, and depression in patients undergone percutaneous transluminal coronary angioplasty (PTCA). METHODS: In this randomized controlled trial, 80 candidates for PTCA during January to April 2013 were randomly assigned to equal experimental and control groups. The patients in the experimental group participated in two training sessions before and after the procedure and an informative booklet was used for their training. These patients were followed by phone during the two weeks after discharge. The depression anxiety stress scale (DASS-21) was completed by all subjects upon admission, at discharge, and one month after discharge. Data were analyzed using SPSS software, version 18. t test was used as appropriated. RESULTS: The experimental group showed a statistically significant decrease in their stress, anxiety and depression a month after receiving the planned discharge (P<0.001). Although scores of stress (P=0.696), anxiety (P=0.110), depression (P=0.073) of the experimental group did not differ significantly on the day of discharge, the decrease was considerable compared with that of the control group. CONCLUSION: Using a planned discharge program in patients undergoing PTCA lowered their stress, anxiety, and depression. TRIAL REGISTRATION NUMBER: IRCT201302182812N12.

Seguimiento al plan de egreso hospitalario con uso de tecnologías de la información y la comunicación (teléfono fijo-móvil y/o mensajes de texto) a cuidadores familiares de niños con enfermedad crónica en el Institutode Ortopedia Infantil Roosevelt / Acompanhamento ao plano de saída hospitalaria com utilização das tecnologias da informação e comunicação (telefone fixo-móvel e/ou mensagens de texto) os cuidadores familiares de crianças com doença crônica, no Instituto de Ortopedia Infantil Roosevelt / Follow to hospital discharge plan with use of information and/or communication technology (mobile home telephone and text messages) to caregiver of children with chronic disease in the Instituto de Ortopedia Infantil Roosevelt

El artículo describe el soporte social dado a los cuidadores familiares de niños con enfermedad crónica mediante el uso de tecnologías de la información y la comunicación (teléfono fijo-móvil y/o mensajes de texto) en el seguimiento al plan de egreso. El estudio contó con la participación de nueve cuidadores familiares de niños con enfermedad crónica entre los seis meses y los diez años que asistieron al Instituto de Ortopedia Infantil Roosevelt. A cada uno de ellos se le realizó un seguimiento telefónico, para el cual fue necesario el diseño e implementación de una guía titulada Cuido cuidándome. Después del seguimiento telefónico, a cinco cuidadores se les realizó una entrevista semiestructurada. A partir de este proceso se obtuvieron cinco categorías: reconocimiento de la tecnología de la información y la comunicación (teléfono y/o mensajes de texto) en el seguimiento al plan de egreso, apoyo social, otros medios para recibir soporte social, utilidad de las tecnologías de la información y la comunicación y reconocimiento de la situación como cuidador. Se concluyó que se lograron identificar las dimensiones del soporte social significativas para el cuidador; en este caso, la interacción personal y la guía, ya que ellos reconocen en la información, la educación suministrada y el apoyo emocional herramientasque les facilitan su afrontamiento a la situación de salud, el cuidado en el hogar y el seguimiento al plan de egreso realizado por la enfermera. En cuanto a la tecnología de lainformación y comunicación utilizada, se evidencia que el teléfono, a pesar de no ser una tecnología innovadora, facilita en gran medida dar continuidad a los cuidados de enfermeríaen el hogar a partir del plan de egreso establecido para cada paciente y su cuidador...

The article presents the results of an investigative process undertaken as part of the research group hotbed of Nursing Chronic-Patient Care of Universidad Nacional de Colombia at Instituto de Ortopedia Infantil Roosevelt (IOIR) during the first half of 2010. This was a qualitative and descriptive research aiming to describe the social support for family caregivers of children with chronic illness through the use of telephone (fixed-mobile) and / or text messages in the follow-up discharge plan. This was achieved through the development and implementation of a tool that facilitated providing social support and strengthening the care from caregivers through monitoring at home. The study involved the participation of nine caregivers of children with chronic disease from six months to ten years attending this medical institution. Each of these subjects underwenttelephone follow-up, which was necessary for the design and implementation of a guide entitled Cuido Cuidándome. It was intended to address different aspects of social support; including different ways to allow the caregiver recognize the importance of their role. After telephone follow-up, five of the nine caregivers participating in the research underwent semi-structured interviews. These interviews were recorded and later transcribed for content analysis and comparison with literature. From this process, five categories were drawn up: recognition of Information and communication technology (telephone or text messaging) following-up the exit plan, social support, other means for receiving social support, utility of information and communication technology, and recognition of the situation as a caregiver. It was successfully identified that there are significant dimensions of social support for the caregiver. In this case, personal interaction and guidance were meaningful because the information, the education and the emotional support provided by means of the ICT’s were tools to facilitate...

O objetivo do artigo é descrever o apoio social para familiares de crianças com doenças crónicas com o uso de telefone (fixo-móvel) e/ou mensagens de texto no plano de acompanhamento quitação. Isto foi conseguido através do desenvolvimento e implementação de uma ferramenta que facilitou a prestar apoio social e fortalecer o atendimento dos cuidadores através do acompanhamento em casa. O estudo envolveu a participação de nove cuidadores de crianças com doença crônica a partir de 6 meses a 10 anos, para assistir a este hospital público. Cada um destes indivíduos foram submetidos a um acompanhamento telefônico, o que era necessário para a concepção e implementação de um guia intitulado Cuido cuidándome, que visava abordar diferentes aspectos do suporte social, incluindo temas diferentes para permitir que o cuidador reconhecer a importância do seu papel. Após a entrevista por telefone seguimento, foram submetidos a semi-estruturada 5 de 9 cuidadores participam da pesquisa, as entrevistas foram gravadas e posteriormente transcritas para análise de conteúdo e comparação com a literatura a partir deste processo tenho 5 categorias: Reconhecimento de Tecnologia da Informação e comunicação (telefone ou mensagens de texto) em seguir o plano de saída, o apoio social, outros meios para receber apoio social, a utilidade das tecnologias da informação e comunicação e reconhecimento da situação de um cuidador. Depois de rever o que concluiu com êxito identificadas dimensões significativas de apoio social para o cuidador, neste caso a interação pessoal e orientação, como as que foram reconhecidas na educação, informação e apoio emocional ferramentas que facilitarão o seu enfrentamento com a situação de saúde, atendimento domiciliar e acompanhamento do plano de quitação por parte do enfermeiro. Como a tecnologia da informação e comunicação usado é prova de que o telefone apesar de não ser uma tecnologia inovadora facilita muito a continuidade dos cuidados de enfermagem...

El plan de alta: Una herramienta para el cuidado integral y la recuperación de la persona enferma / Discharge plan: a tool for the integral care and the recovery of the sick person

El presente artículo propone los aspectos que deben tenerse en cuenta al realizar el Plan de Alta para un enfermo, agrupándolos por medio de una nemotecnia que, a la vez que facilita su memorización, refleja un cuidado integral. Reafirma la autonomía de la persona enferma y tiene en cuenta a los cuidadores cuando se trata de personas que no pueden asumir total o parcialmente su auto-cuidado

The present paper highlights the aspects that must be considered at the time of drawing up the patient discharge plan. This is done by grouping the aspects according to a mnemonic, which not only facilitates its memorization, but also reflects a well-rounded care. The proposed plan strengthens the autonomy of the ill person, but it also considers the caretakers in situations dealing with people who cannot assume total or partially responsibility of their self-care