A professional-patient partnership model of discharge planning with elders hospitalized with heart failure.

Despite efforts to improve the discharge planning process and subsequent outcomes, existing mechanisms fail to accurately identify elders' needs for follow-up care. Studies report rehospitalization rates ranging from 12 to 50%. The two aims of this study were to (1) examine the difference in outcomes for elders hospitalized with heart failure and caregivers who participated in a professional-patient partnership model of discharge planning compared to those who received the usual discharge planning and (2) examine differences in costs associated with hospital readmission and use of the emergency room following hospital discharge. A before-and-after nonequivalent control group design was used for this study. Data were collected from the control and the intervention cohorts before discharge and at 2 weeks and 2 months postdischarge. One hundred and fifty-eight patient-caregiver dyads completed both the predischarge and 2-weeks postdischarge interviews; 140 also completed a 2-month follow up. The average age of elders was 73.7 years; the average age of the caregivers was 58.5 years. The findings indicated that elders in the intervention cohort felt more prepared to manage care, reported more continuity of information about care management and services, felt they were in better health, and when readmitted spent fewer days in the hospital than the control cohort. Caregivers in the intervention cohort also reported receiving more information about care management and having a more positive reaction to caregiving 2 weeks postdischarge than the control cohort.     

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.     

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample

The needs of family caregivers of frail elders during the transition from hospital to home: a Taiwanese sample This study explored the needs of family caregivers during the transition from hospital to home. Data from 37 face-to-face interviews with 16 caregivers before discharge and at 2 weeks and 1 month after discharge were subjected to constant comparative analysis. Findings revealed changes in family caregivers' needs during the discharge transition. While preparing to take caregiving responsibility, caregivers reported a need for various types of information. After the discharge, but before home caregiving settled into a pattern, they needed help with caregiving practices. After reaching a pattern for providing family care, caregivers frequently reported needs for continuous emotional support. These findings provide a basis for transitional care services such as discharge planning and home health care services.     

Hip fracture: family caregivers' burden and related factors for older people in Taiwan

Aims. The purpose of this study was to explore the burden experienced by caregivers during the transition from hospital to home. Background. With a growing older population, home‐based care has gradually gained more recognition. Most older people with hip fracture in Taiwan have to be discharged at a relatively early stage. Therefore, the caregiving tasks falls on the families. Methods. A total of 98 older people with hip fracture and their caregivers were interviewed. The sample was selected from three medical centres in Taipei, and questionnaires were collected at one week and one month following hospital discharge. Results. (i) Family caregivers were usually women (63.3%) with spouses being the primary caregivers in most cases (30.6%). About one‐third of caregivers took care of other family members on top of their responsibilities caring for the sick elders at home, and 77.6% shared the care tasks with others. (ii) The caregivers experienced moderate burdens. About 91.8% of caregivers reported ‘I feel sad watching the elder's health deteriorating’, 84.9% reported ‘I must keep an eye on the elder constantly’ and 56.7% reported ‘Taking care of the sick elder at home makes me feel exhausted’. (iii) Caregiver burden and the functional level of older people were adversely correlated. (iv) Caregivers who were unable to access other resources for help and/or had provided care to the older person prior to the fracture resulting in hospitalization experienced a higher burden. Conclusions. These findings should be helpful in the formulation of evidence‐based discharge planning and home health care services. Relevance to clinical practice. Comprehensive discharge planning and developing social support systems for family caregivers to reduce caregivers burden are needed.     

Use of formal community services by elders and their family caregivers 2 weeks following hospital discharge*

Early identification of elders who need care following hospitalization might enhance their health and the health of family members who help them with managing their care. The purpose of this study was to: (a) identify pre-discharge predictors of resource use following hospitalization; (b) describe the formal community services used by elders and their family caregivers during the 2 weeks following hospitalization; and (c) determine whether there is a difference in hospital re-admissions between elders who receive community nursing services compared with those who do not receive any services. The sample consisted of 185 elder/caregiver dyads in which the elders were hospitalized for an acute episode of a chronic condition. Both patients and family caregivers were interviewed before discharge and 2 weeks post-discharge. The findings indicate that pre-discharge functional ability and age are statistically significant predictors of home care services used 2 weeks post-discharge. The findings also suggest that elders who receive visiting nurse services are less likely to be re-admitted to the hospital.     

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.     

Elders' and family members' perspectives in planning for hospital discharge

When elders are unable to participate in discharge planning owing to physical or cognitive impairments, clinicians often work with family members instead. Previous studies on community-dwelling elders and their family members found differences between the elder's and family member's rating of functional status (Rothman, Hedrick, Bulcroft, Hickman, & Rubinstein, 1991). Magaziner, Simonskck, and Kashner (1988) reported that family members who did not live with the elder tended to rate them as less impaired than what the older persons rated themselves. Yet, little is known about the extent to which elders' and family members' perspectives concur with respect to discharge planning. Identifying both discrepancies and areas of agreement is essential in assisting elders and their families in planning for their future needs and evaluating the options available to them. The purpose of this study was to determine the extent to which family members' expectations regarding postdischarge needs agreed with those of elders hospitalized for an acute episode of a chronic illness.     

Cultural and noncultural predictors of health outcomes in Korean daughter and daughter-in-law caregivers

In Western cultures, adverse health effects resulting from providing care for impaired elders is well documented for family caregivers, but little is known about the health of Korean caregivers. This study examined the level of depression and physical health of 120 daughter and daughter-in-law caregivers who cared for cognitively or functionally impaired elderly in Korea. It was hypothesized that cultural factors would have a greater effect on caregivers' health outcomes than noncultural factors, but, contrary to this expectation, the effects of noncultural factors were found to outweigh those of cultural factors. Moreover, the caregivers in this study reported a relatively high level of depression, and more caregivers rated their own health as "poor" than did Western caregivers in previous studies. Family caregiving for the impaired elderly is stressful and negatively affects Korean caregivers' health outcomes regardless of societal values such as filial piety and familism regarding parent care in Korea. Culturally acceptable and sensible support programs may be useful in sustaining long-term care at home by Korean daughter and daughter-in-law caregivers. Further family caregiving studies in the Korean sociocultural context are recommended.     

The competing demands of employment and informal caregiving to disabled elders

The competing demands of work and elder care are the subject of this study. The employment decisions of the informal caregivers of a nationally representative sample of disabled elders were examined using a nested multinomial logit model. Findings from the work accommodation model demonstrated that primary caregivers and those caring for elders with greater care needs are more likely to take unpaid leave, reduce work hours, or rearrange their work schedules to assume elder care responsibilities. Being female, white, and in fair-to-poor health also increased the likelihood of work accommodation. The model predicting employment of a caregiver revealed that the prospect of having to accommodate work to the demands of caregiving keeps some people from work entirely. However, not all caregivers would choose to work in the absence of caregiving responsibilities. After controlling for the probability of work accommodation, need for care, and availability of others to care, it is more likely that younger, white and more highly educated caregivers will be employed. The self-selection of working caregivers observed in this study should be considered when forecasting changes in caregiving costs associated with changes in the labor force participation of caregivers as a result of deliberate policies or social and demographic trends.     

Health-related quality of life and health service use following total hip replacement surgery

AIMS OF THE STUDY: The study investigated health-related quality of life in relation to demographic and clinical factors, and health service use and satisfaction by older total hip replacement (THR) patients following discharge from one Australian Hospital. RATIONALE: Understanding health-related quality of life and patterns of service use during recovery informs caregiving and patient and family education needs for discharge planning and case management. BACKGROUND: Post-discharge, older THR patients have a high rate of health services use. Few valid measures of outcomes link nursing discharge or case management to patient-identified health status or service needs. RESEARCH METHODS: Ward nurses conducted telephone interviews to study self-perceived health-related quality of life using Medical Outcomes Study Short-Form (SF-36) and responses to an accompanying questionnaire on demographics, service use and satisfaction at 1, 2, 4, 8, and 12 weeks postdischarge. SF-36 scores were compared with Australian population norms according to age and gender to determine the relative extent of postdischarge recovery. RESULTS: Psychosocial recovery preceded physical recovery, which steadily improved. Physical component summary scores reached population norms and mental component summary scores exceeded norms by week 1. No differences in quality of life were found by age, but women took longer to recover physically. Those who lived alone did not have lower scores than those with residential support. General practitioners were seen most often; nursing visits were frequent only in weeks 1 and 2, specialist visits occurred at weeks 8 and 12. Allied health, hospital and pathology services were used less often. Most patients were satisfied or very satisfied with all services used. DISCUSSION/CONCLUSIONS: An almost immediate impact on quality of life was evident, probably indicating successful pain alleviation. Service use indicated adequate discharge planning and successful recovery. Having ward nurses as researchers was instrumental to continuity of communication between patients, families and service providers, which suggests increased potential for continuity of care.     

Differences in plans for living at home between temporary residents of a health-care facility for the elderly and their family caregivers in Japan

Aim: Older residents in Japan requiring rehabilitation often reside in health‐care facilities for the elderly (HCFE) prior to being discharged to home. The return home can be very stressful for both the elder and family caregiver. The purpose of this study was to clarify the differences in plans for home life between the residents of a HCFE who were scheduled for discharge home and their family caregivers. Method: Semistructured interviews were conducted with eight pairs of elders and caregivers. Results: Differences were seen in several areas, including dietary preferences, recognition of the elder’s independence, preconceptions or not knowing about the elder’s pleasurable activities, and the way of care. Conclusions: Differences with regard to enjoyable activities for the elderly arose from a lack of understanding of the lives of the elderly on the part of their families.     

Family Caregiving in Cases of Hip Fracture

The growing incidence and cost and the serious nature of hip fracture in the elderly require a closer examination of the family's role in the rehabilitation process and how it can be assisted in that role. In this prospective study, 57 family caregivers provided information before the hospital discharge of the patient with hip fracture and at 2, 8, and 14 weeks postdischarge. They were asked about caregiving demands and problems, caregiver mood, expectations about recovery, and advice to future caregivers. A brief follow-up was conducted at 6 months. The care recipients were all women and had been living at home before injury. The postdischarge location of the patient (e.g., in a residence shared with the caregiver, in a different residence, or in a nursing home) was a major factor in the types of caregiving activities but not in total demand. Nonspouses cited the most problems. Mood distress did not change over time. Caregivers appeared to have unrealistic expectations about the length of the recovery period; by 14 weeks, 36% judged the care recipient's mobility to be worse than expected, and 20% felt that the patient had more pain than expected. The most frequent advice to future caregivers was to have patience and to give encouragement.     

Components of a proper hospital discharge for elders

SIGNIFICANCE: Effective discharge planning is a vital link in continuity of care for elders. Previous studies identify problems with planning for elders' discharge from the hospital and problems elders encounter managing care post-discharge. However, little attention has been given to identifying effective discharge planning processes. Explicating the components of effective discharge planning is critical to replicate the process in other health care settings and predict post-discharge outcomes. PURPOSE: The purpose of this study was to identify the components of effective discharge planning for elders and factors that impede planning. METHODS: Ethical approvals were obtained from the University and National Health Service (NHS) Trust. Qualitative methods were used and data were collected from two wards in a 78-bed geriatric rehabilitation hospital that was part of a National Health Service Trust serving Southwest London. Data included semi-structured interviews and documents related to discharge planning, care delivery, and community resources. A total of 24 semi-structured interviews were conducted with health care professionals who were part of the hospital's multidisciplinary team, those affiliated with the Community Trust that provided aftercare, elders, and family carers. RESULTS: Participants consistently used the term "proper discharge" when referring to effective discharge planning. The multidisciplinary team comprised a vital context for a proper discharge. The findings indicated that three circles of communication were central in a four stage discharge process. Different circles of communication were key at different stages. CONCLUSIONS: The findings provide insights for educating nurses about effective planning practices and examining the global significance of impediments to a proper hospital discharge.     

Caring for the frail elderly at home: toward a theoretical explanation of the dynamics of poor quality family caregiving

Using the grounded theory approach, 39 family caregivers were theoretically sampled using newspaper advertising to explore their perceptions of providing home care for frail elders and to generate a theoretical model that describes the dynamics of good quality and poor quality family caregiving; explains the relationships among certain contextual and perceptual variables and the behaviors exchanged by elders and caregivers; and identifies points where interventions by nurses could be effective. The model consists of five constructs that were identified from the data and were staged within the framework provided by symbolic interactionism and social exchange theory. The five constructs and two related driving forces provide a partial explanation for the quality of family caregiving and a beginning explanation for the phenomenon of elder abuse.     

The association of collaboration between family caregivers and nurses in the hospital and their preparedness for caregiving at home

Family caregivers of an older person who was recently hospitalized often feel unprepared for their new or expanded tasks. Quality and continuity of care for older people is expected to improve when nurses collaborate with family caregivers as partners in care. The aim of this study was to explore the unique contribution of collaboration between family caregivers of older patients and hospital nurses as a possible predictor for preparedness of caregiving after hospital discharge. With a cross sectional design, a postal survey was sent to 777 family caregivers of home-dwelling hospitalized patients (≥70 years). Regression analyses were used to test the association between collaboration and preparedness for caregiving. In total, 506 (68%) family caregivers responded of whom 281 (38%) were eligible. Their mean (SD) age was 65 (13) and 71% were female. Family caregivers’ level of collaboration with nurses was significantly associated with their preparedness for caregiving.     

Utility of the life course perspective in research with Mexican American caregivers of older adults

Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.     

基于PubMed数据库出院计划研究热点文献计量学分析

目的 检索出院计划的相关文献,分析当前的研究现状及研究热点。方法 检索美国国立图书馆PubMed数据库2008—2019年收录的出院计划相关文献,使用Bicomb、gCLUTO等软件对主题词等进行聚类分析,结合文献评阅出院计划的研究现状和研究热点。结果 共纳入文献1 578篇,获得高频主题词36个,聚类分析得到6组聚类效果较好的研究热点：家庭照顾者在出院计划中的研究;提高医疗服务质量的研究;出院计划在脑卒中患者中的研究;出院计划与连续性护理的研究;出院计划在老年患者中的研究和出院计划在预防患者再入院中的作用。结论 当前出院计划的研究处于快速发展阶段,热点主要集中在出院计划在老年患者、脑卒中患者的研究等方面,其他方向的出院计划研究也值得国内外护理人员深入开展。     

Abuse of aging caregivers: test of a nursing intervention

Although most women find it difficult to provide care to an older family member, some women face additional challenges and health risks because the care recipient is abusive or aggressive toward them. This study tested a 12-week psychoeducative nursing intervention intended to decrease the frequency and intensity of physical and verbal/psychological aggression toward older caregiving wives and daughters by care recipients and improve selected abuse-related outcomes. The intervention, which focused on pattern identification, advocacy counseling, reframing of the caregiving situation, and nonconfrontational caregiving strategies, was individualized and highly interactive with emphasis placed on mutual problem solving and mutual planning. Subjects included women older than 50 who provided care to elders older than 55. Subjects were randomly assigned to group (intervention, N = 38; control, N = 45) and data collectors were "blinded" to group assignment. Findings indicated the intervention significantly reduced frequency of verbal/psychological aggression, and feelings of anger for caregivers providing care to fathers or husbands. It was not effective for caregivers providing care to mothers, and it did not reduce burden. Implications for nursing include raising awareness about the special vulnerabilities of older caregivers, providing provocative new information about the gender-based power dynamics in caregiving situations and underscoring the need for nurses to assume a stronger leadership role in building science with regard to family caregiving.     

Discharge planning and home care for low-birth-weight infants.

This article presents a review of discharge planning and home follow-up for low-birth-weight infants. The scope of the problem of low birth weight and postdischarge health status of low-birth-weight infants are presented in overview. Discharge planning and home care are detailed for healthy low-birth-weight infants and for low-birth-weight infants requiring various levels of technologic support in the home. Emphasis is on comprehensive discharge planning and home follow-up to facilitate continuity and quality of postdischarge care. Nursing's role is critical to the discharge planning and the postdischarge care process.