Prescreening cardiothoracic surgical patient population for post acute care services

For the postoperative cardiothoracic patient, the first 2 weeks during recovery is the most difficult time. Initiating discharge planning at the earliest opportunity aids in identifying those patients at risk for functional status disability. The purpose of this study was to examine the results of a pilot preadmission screening program to determine whether cardiothoracic surgical patients could be accurately identified for postoperative needs during preadmission testing.     

Current trends in student retention: A literature review

Associate degree nursing programs must work to find ways to keep students accepted into the nursing programs progressing in the programs. Various factors that have a direct effect on retention rates have been identified, including preadmission testing, English as a Second Language students, cultural diversity, and grade point average/American College Test scores The challenge educators' face is keeping the accepted students enrolled and progressing in the program.     

Characteristics of effective discharge planning programs for the frail elderly

Changes in the health-care system since Prospective Payment began have directly affected the postdischarge needs of the frail elderly. Effective discharge planning programs are critical to meet the posthospital needs of this population. Effective discharge planning is believed to be associated with an increase in patient health status and satisfaction. Both can be met when plans for posthospital services are made in an organized program. Admission assessment and follow-up programs were identified as two characteristics necessary in a formally structured discharge planning program for effective care of frail elders.     

Behavioral Assessment,Analysis, and Support in a Psychiatric Partial Hospitalization Program for Adults with Developmental Disabilities

This article describes the objectives and operations of a behavioral psychology service within a partial hospitalization program for adults with psychiatric disorders and developmental disabilities. Partial hospitalization programs are an effective model of psychiatric service delivery but are not common for patients with mental retardation/mental illness. Phases of intake behavioral assessment, treatment planning and implementation, and discharge are described with an emphasis on functional assessment, data-based accountability, outcome measurement, and positively oriented behavioral support. The article concludes with a discussion of challenges which confront the design and application of behavior analysis procedures within the context of a psychiatric partial hospitalization program.     

The forgotten faces: the lonely journey of powerlessness experienced by elderly single Chinese men with heart disease in Taiwan

The purpose of this study is to explore the content and background context of powerlessness experienced by elderly single Chinese men with heart disease and their coping behaviors during their hospitalization stage. Data were gathered by semi-structured interviews at a leading veterans' hospital in northern Taiwan and analyzed using a qualitative content analysis mode. Twenty-six men who were 65 or older, diagnosed with heart disease, and who lived alone during the preadmission stage were recruited. Eighty-one percent (N = 21) reported that their perceptions of powerlessness occurred either in the preadmission or hospitalization stage or were expected to occur after discharge. Other complaints of powerlessness were attributed to having no choices in appropriate living places during the preadmission stage, having no control over discomfort, being unable to obtain care and companionship from families and friends, failing to get medical information about their disease and options of treatment during hospitalization, or expecting deteriorating health and receiving no assistance during emergencies or in the dying stage after discharge from the hospital.     

Registered nurse students: academic admission and progression

Review of the literature reveals no current studies on predictors of registered nurse success in baccalaureate programs. This retrospective study investigated the relationship between preadmission variables for RNs (grade point average [GPA] in previous course work, year of birth, and number of years of full-time or part-time work prior to admission) and subsequent achievement in a baccalaureate nursing program. Eighty-one RNs, of which 65 completed the program, were the sample for this study. Predictions of success for the study were determined by program completion and final nursing GPA (NGPA). Factor analysis of the variables revealed that RNs who passed all challenge exams had significantly higher mean NGPAs than RNs who did not pass all challenges. Also, RNs who had not received a D in previous course work at the time of enrollment had significantly higher NGPAs than RNs who had received a D. The data found significant in this study can be useful to faculty admission committees in attempting to predict RN success in baccalaureate programs. It can also be helpful in promoting successful outcomes for RNs in generic programs.     

Strategies for lowering attrition rates and raising NCLEX-RN pass rates

This study was designed to determine strategies to raise the NCLEX-RN pass rate and lower the attrition rate in a community college nursing program. Ex-post facto data were collected from 213 former nursing student records. Qualitative data were collected from 10 full-time faculty, 30 new graduates, and 45 directors of associate degree nursing programs in Texas. The findings linked the academic variables of two biology courses and three components of the preadmission test to completion of the nursing program. A relationship was found between one biology course, the science component of the preadmission test, the HESI Exit Examination score, and the nursing skills course to passing the NCLEX-RN. Qualitative data indicated preadmission requirements, campus counselors, remediation, faculty, test-item writing, and teaching method were instrumental in completion of the program and passing the NCLEX-RN.     

Discharge planning predicting patients' needs.

The elderly are at higher risk for longer and more frequent lengths of hospital stay than other adults. Comprehensive discharge planning programs, including early identification of those at risk, can alter these statistics. Screening inventories to identify patients at risk have been available for many years, but they are not specific to the needs of the elderly. The Blaylock Risk Assessment Screen (BRASS) is administered on admission and identifies patients at risk for prolonged hospital stay and in need of discharge planning resources. The nurse can use the data BRASS provides to improve care outcomes while the patient is in the hospital and in the transition to home care. It shows promise for use as the first phase of a discharge planning program.     

Creating avenues for relative empowerment (CARE): a pilot test of an intervention to improve outcomes of hospitalized elders and family caregivers

The purpose of this pilot study was to evaluate the effectiveness of a family caregiver-focused intervention program (CARE) on the outcomes of hospitalized elders and their family caregivers. A randomized clinical trial was conducted with 49 family caregivers of hospitalized elders in a university medical center in upstate New York. Driven by self-regulation and role theories, the two-phase CARE program consisted of: (a). a mutual agreement consisting of family caregiving activities during hospitalization; and (b). audiotaped information regarding emotional responses and possible complications associated with an elderly patient's hospitalization as well as instructions for effectively participating in the elder's hospital care. The comparison program consisted of information about hospital services and policies. CARE elders had fewer incidents of acute confusion reported by family caregivers during hospitalization and fewer depressive symptoms at 2 weeks and 2 months posthospitalization than did the comparison group. CARE family caregivers participated more in the care of their hospitalized elders and had higher scores on role rewards prior to hospital discharge. Findings from this study support the need for further testing of the CARE intervention with family caregivers to determine its effectiveness on outcomes of hospitalized elders and their family caregivers.     

A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers

Aims. To test the effectiveness of a discharge planning program for dyads of older stroke survivors and their family caregivers in Taiwan. Background. Family caregivers of stroke survivors often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. However, little information could be found on discharge planning programs for caregivers of stroke survivors in Asian families. Design. A randomised experimental design was used to explore the effects of a discharge planning program for 158 dyads of older stroke patients and their family caregivers. Methods. The control group (n = 86 dyads) received only routine hospital discharge planning services and the experimental group (n = 72 dyads) received routine hospital discharge planning services plus the caregiver‐oriented discharge planning program. Outcome variables were measured at baseline, before discharge and one month after hospital discharge. Variables were measured by the Nurse Evaluation of Caregiver Preparation Scale, Preparedness for Caregiving Scale, Caregiver Discharge Needs Satisfaction Scale and Perception of Balance between Competing Needs Scale. Results. Caregivers in the experimental group had significantly better nurse evaluation and self‐evaluation of preparation after the program than before, and greater satisfaction of discharge needs one month after discharge than before discharge. Caregivers in the experimental group had significantly better nurse evaluations and self‐evaluations of preparation and better satisfaction of discharge needs after the program compared with the control group. However, no significant difference was found between caregiver groups in perceived balance of competing needs. Conclusions. This discharge planning program benefited family caregivers of older stroke patients during the transition from hospitalisation to one month after discharge. Relevance to clinical practice. This caregiver‐oriented discharge planning program, with its emphasis on individualised health education and home visits following discharge may improve caregivers’ preparation and the satisfaction of their needs during the discharge transition.     

Predictors of elder and family caregiver satisfaction with discharge planning

Client satisfaction is considered an important outcome measure in a managed care environment faced with escalating health care costs, shortened lengths of hospital stay, and competition among acute care hospitals. With shortened lengths of stay in acute care hospitals, discharge planning has assumed increased importance, particularly for elders who have chronic conditions, such as heart failure, that require follow-up care. Consequently, understanding the predictors of client satisfaction with discharge planning can help hospitals and their nursing staff to tailor services to meet client needs. Previous studies have focused on patient satisfaction with hospital care, with little attention given specifically to satisfaction with discharge planning and to family caregiver satisfaction with discharge planning. The purpose of this study was to determine whether there is a difference between elder and family member satisfaction with discharge planning 2 weeks after hospitalization and what factors predict satisfaction with discharge planning 2 weeks after hospitalization for elders hospitalized with heart failure and their family caregivers. Telephone interviews were conducted with 134 elder/family caregiver dyads 2 weeks after hospitalization. The results indicated that there were no statistically significant differences in discharge planning satisfaction of elders and their family caregivers. Continuity of care and extent to which they felt prepared to manage care following hospitalization were the best predictors of elder's and family caregiver's satisfaction with discharge planning.     

Risk factors for chronic insomnia following hospitalization

AIM: This paper reports a study whose purpose was to determine whether there is an increase in the incidence of chronic insomnia following hospitalization and, if so, to identify patients at risk. BACKGROUND: The consequences of difficulty sleeping in hospital have received scant attention from clinicians or researchers. Implicit in this lack of interest is the assumption that difficulty in sleeping is a transient reaction to hospitalization that will resolve on discharge, an assumption not empirically supported. It has been argued that in susceptible people this type of temporary disruption to sleep can be the catalyst for the development of chronic insomnia. METHOD: Established sleep and depression rating instruments were used to monitor the sleep of 57 cardiac and 29 orthopaedic patients after elective surgery (n = 86), recruited through a hospital preadmission clinic. RESULTS: Preadmission chronic insomnia of 10% was consistent with general population prevalence estimates of 6-12%. Three months after discharge the incidence had almost doubled to 19%. Sixty-one per cent of this variance could be explained by hyperarousal, sleep hygiene issues, and dysfunctional cognitions about sleep. Depression was found to be a salient predictor but not an independent risk factor. Age, sex, and hospital-related data, such as score for difficulty sleeping in hospital, proved to be statistically insignificant. CONCLUSIONS: The results support the role of hyperarousal and dysfunctional sleep attitudes and behaviours as stronger predictors of chronic insomnia than patient demographics or environmental issues. Given that most of the patients were ambivalent about how they slept in hospital, with high satisfaction (71%) in the presence of significant disruption (63%), preadmission sleep education given to these patients prior to admission potentially contributed to the development of more realistic expectations of the quality of in-hospital sleep.     

Benefits of Preoperative Education for Adult Elective Surgery Patients

Patient education is a major concern for perioperative nurses in an ambulatory surgery setting. It has proven difficult to develop formal preoperative teaching programs in this environment, but research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience.Typical patient education consists of pamphlets that are given to the patient before surgery and verbal instructions from the physicians and nurses on the day of surgery. Ideally, preoperative patient education should begin in the surgeon's office, continue through preadmission testing, and be completed at admission. Having a well-designed preoperative education program enables perioperative nurses in ambulatory surgery centers to provide a thoughtful approach to perioperative teaching in a limited time. AORN J 90 (September 2009) 381-387. © AORN, Inc, 2009.     

Discharge planning in an acute hospital.

To improve discharge planning on an acute medical ward, a nursing "team system" was initiated with clear delineation of responsibility for discharge planning. The head nurse supervised the nurses' actions and supported their communication with attending physicians. To assess the efficacy of this approach, chart reviews and interviews of 60 consecutive patients were performed before and after the implementation of the plan. A plan was labeled adequate if the following criteria were met: all treatable diagnoses were recognized; appropriate treatment regimens were instituted for each diagnosis; the patient's abilities were sufficient for him to function in the proposed environment; and plans were made for follow-up care. Patient knowledge was stated to be adequate if the patient was aware of his diagnosis, treatment regimen and plans for follow-up care. In addition, the patient was questioned concerning his satisfaction with the plans for further care. Seventy-five percent of the patients admitted to this ward required discharge planning. Of those requiring discharge planning, the plan was judged adequate in 55% prior to the program change and in 83% following that change. Eighty percent of the patients required some teaching during their hospital stay. Of these, by the time of discharge, knowledge was adequate in 53% prior to the program change and 51% subsequent to the change. Initially 68% of the patients were very satisfied with the discharge plans but this figure rose to 86% following the program change.     

Car seat challenges: where are we in implementation of these programs?

Premature infants and infants with special needs are being discharged home at smaller weights and earlier postconceptional ages. This presents a challenge to safely transporting these infants in car seats. Car seat technology has not kept abreast of advances experienced in neonatal medical technology. Several studies have demonstrated that preterm infants are at risk for apnea, bradycardia, and oxygen desaturations while being transported in traditional car seats. The American Academy of Pediatrics issued policy statements recommending that all infants less than 37 weeks of gestational age be monitored in a car seat safety test prior to discharge. This article reviews current literature on implementing car seat safety testing in hospitals and the results of a research survey of newborn nursery and neonatal intensive care units across the United States to evaluate the status of these facilities in implementing car seat safety testing programs. The results show that many level II and level III units have begun to implement car seat safety programs despite the lack of literature and guidelines available on how to develop a program. Although most programs monitored the same criteria, there were variations in length of testing, which infants were tested, and recommendations for the infants who failed the testing.     

Public Health Nursing Interventions to Improve the Use of a Health Service: Using a Pilot Study to Guide Research

This article demonstrates how a pilot study can provide useful direction for a research project. In planning a study to improve the use of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for Medicaid-eligible children, we tested our research methods and interventions (mailed pamphlets, telephone calls, home visits) on a small scale (N = 100) prior to implementing a large-scale (N greater than 2000) project. The issues and obstacles included obtaining cooperation from many agencies involved in administering the Medicaid program, addressing informed consent, assessing feasibility of methods for random sampling and random assignment, identifying sources of Medicaid data, designing and assessing validity and reliability of research tools, and testing the feasibility of implementing interventions in the field. Our experience may be particularly helpful for public health nurses who plan to investigate approaches to improve the use of services in federally mandated health programs where cooperation from federal, state, and local agencies is required.     

Characteristics of patients referred for discharge planning from a geriatric ward at a national university hospital in Japan: Implications for improving hospital programs

Abstract The purpose of the present study was to identify the characteristics of patients from a geriatric ward who were referred for discharge planning support, a service provided by the first multidisciplinary department for discharge planning among the national university hospitals in Japan. From October 1997 to May 1999, 335 patients were discharged; 23 patients (6.9%) were referred. The referred patients were older and more frequently diagnosed with malignancy, dementia and respiratory infection. In addition, they had lower activities of daily living (ADL) and instrumental ADL scores. Those characteristics, which may be related to the longer hospital stay and lower rate of returning home of the referred patients, can be assessed early in hospitalization to identify patients at risk for difficult discharge planning. It is important to identify patients who need earlier intervention by formalized discharge planning so that the current situation of overly long hospitalization in Japan will improve.     

Early intervention in severe head injury: long-term benefits of a formalized program.

With traumatic brain injuries numbering more than two million per year, health professionals are faced with the challenges of restoring and maximizing quality of life. This study quantifies the benefits of a formalized head injury program, including the concept of trauma rehabilitation, defined as early, aggressive rehabilitation during acute hospitalization. Thirty-eight severely head injured patients received treatment at the same rehabilitation facility. Twenty-one of these patients received acute care services at ten different hospitals without formalized traumatic brain injury programs, and 17 received services at a hospital with a formalized early intervention program. Comparison of outcome data for the two programs revealed that patients in the formalized program had comas and rehabilitation stays approximately one third the length of patients in nonformalized programs (18.9 vs 53.8 days and 106.5 vs 239.5 days, respectively). Mean cognitive levels at discharge from the acute hospitals (5.6 vs 4.0) and the rehabilitation facility (7.4 vs 6.7) were significantly higher for the formalized program, and they facilitated a significantly higher percentage of discharges to home vs extended care facility (94% vs 57%).     

Evaluation of a Presurgical Group Program Given at Two Different Times

This study was designed to test the outcomes of a preoperative teaching program for cholecystectomy patients and to determine the appropriate time to offer the program. The hypotheses were: (a) Patients in a preadmission program will recover better than those in a program given the eve of surgery, and (b) patients in the control group will have a poorer recovery than those in the two experimental groups. The outcomes measured were state-anxiety, ventilatory function, well-being, pain, functional ability, analgesics, and length of hospitalization. There were no significant differences between the three groups except in state-anxiety the eve of surgery which was higher in the control than in the two experimental groups. State-anxiety the eve of surgery and trait-anxiety were the most important variables affecting outcomes. There was a positive and significant linear relationship between pre- and postoperative state-anxiety.     

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.