Transitional care and empowerment of the older adult

Older adults with complex comorbidities are at risk for challenges that compromise their post-discharge safety at home. A growing body of evidence suggests that post-hospitalization outcomes for vulnerable elders can be improved by interventions that encourage patient empowerment. The purpose of this pilot project was to determine if an individualized transition intervention would improve patient empowerment 30days after home discharge following an acute illness. Through individualized interaction with an advanced practice nurse, a sample of 25 elder patients was encouraged to acquire the knowledge and confidence to advocate for their needs after discharge from a subacute facility. Pre and post-intervention patient empowerment was measured through the Senior Empowerment and Advocacy in Patient Safety survey. Quantitative data from this study provided evidence to support the benefit of transition care in enhancing patient empowerment. The data generated by this project will add to the existing body of evidence on transitional care.     

Type 2 diabetic patients' experiences of two different educational approaches--a qualitative study

OBJECTIVE: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. METHOD: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. FINDINGS: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance--care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. CONCLUSIONS: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.     

Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Background

During the last decade, the Internet has become increasingly popular and is now an important part of our daily life. When new “Web 2.0” technologies are used in health care, the terms “Health 2.0" or "Medicine 2.0” may be used.

Objective

The objective was to identify unique definitions of Health 2.0/Medicine 2.0 and recurrent topics within the definitions.

Methods

A systematic literature review of electronic databases (PubMed, Scopus, CINAHL) and gray literature on the Internet using the search engines Google, Bing, and Yahoo was performed to find unique definitions of Health 2.0/Medicine 2.0. We assessed all literature, extracted unique definitions, and selected recurrent topics by using the constant comparison method.

Results

We found a total of 1937 articles, 533 in scientific databases and 1404 in the gray literature. We selected 46 unique definitions for further analysis and identified 7 main topics.

Conclusions

Health 2.0/Medicine 2.0 are still developing areas. Many articles concerning this subject were found, primarily on the Internet. However, there is still no general consensus regarding the definition of Health 2.0/Medicine 2.0. We hope that this study will contribute to building the concept of Health 2.0/Medicine 2.0 and facilitate discussion and further research.     

Évolution et enjeux à venir de la pair-aidance dans le champ de la psychiatrie en France

AimsAt a crucial time in its evolution in the field of psychiatry in France — while first experimentations and efforts towards officializing its professionalization are being made — the aim of this paper will be to discuss and raise questions about peer support and the upcoming challenges it may face.MethodA summary of written works related to the integration of peer support in psychiatry highlights not only the ever-growing recognition of this activity both in official texts and in recommendations on the subject of mental health, but also questions related, mainly, to the place accorded to these new professionals within psychiatrist teams. The study of the evolution of the concepts on which peer support is based also offers an insight into its future place within the field of psychiatry.ResultsIf activist movements claiming to adhere to the principle of ‘empowerment’ have experienced, in the course of their history, a process of ‘disempowerment’, it seems probable that peer support in psychiatry will, inevitably, follow a similar evolution.DiscussionThe main challenge is to preserve the vivacity of the initial debate, in spite of both the formalization of interventions made by peer support professionals and of their professionalization.ConclusionAn updated reflection on peer support enables us to study how the concept of the relationship to the other is envisaged nowadays in the psychiatric field.     

Patient safety: a literative review on the impact of nursing empowerment, leadership and collaboration

RICHARDSON A. & STORR J. (2010) Patient safety: a literative review on the impact of nursing empowerment, leadership and collaboration. International Nursing Review 57 , 12–21 Background: Nurses are ideally placed to drive the safety and quality agenda within health care because of their unique proximity to patients. There have been some attempts to look at the links between nursing care and quality outcomes, but relatively little on the connection between nursing and patient safety. Therefore, exploring the evidence on this issue was indicated, excluding links to nurse staffing and environment. Aims: The aim of this study was to identify to what extent and in what way nursing leadership, collaboration and empowerment can have a demonstrable impact on patient safety. Methods: A search of electronic databases was undertaken from 1998 to 2008. One thousand seven hundred eighty‐eight titles and abstracts were retrieved, and the full text of 65 relevant papers was obtained and reviewed. Data extraction was undertaken if papers met the following inclusion criteria: a measure of impact from a study or audit, patient safety and nursing focused, and identified one of the following issues (leadership, advocacy, interdisciplinary working, empowerment and collaboration). Eleven papers were selected and critically reviewed. Finding: Of the 11 papers, 7 were undertaken in the USA, 2 in Canada, 1 in the UK and 1 in Iceland. Selected papers comprised of one systematic review, one cohort study, four qualitative studies, three cross‐sectional studies, one survey and an evaluation. The quality of papers was variable and provided limited evidence of impact or effectiveness in terms of nurses directly influencing patient safety. Conclusion: Gaps currently exist in relation to knowledge on the extent and nature of the role of nurses in patient safety improvement. Considerable work is required before comprehensive solutions can be further developed. Huge potential exists for improvement through nursing empowerment, leadership and the development of tools to strengthen and support nurses' influential role in the quality and safety movement; therefore, the need for investment into well‐designed research studies to address these gaps is obvious, required and timely.     

Empoderamiento y Dermatología

The term empowerment refers to any process that facilitates behavioral changes and encourages responsibility and making informed choices. The concept has been applied mainly to help patients with chronic conditions achieve therapeutic goals. The aim of the approach in health care is to enhance self-caring and self-efficacy. The term derives from the English verb to empower meaning “to give (someone) the authority or power to do something” or “to make an individual or a group stronger or more powerful”. One of the responsibilities of health professionals is to improve patients’ knowledge and their ability to choose between the different alternatives available to them so that they can act accordingly. In this article, we review the various definitions of the term empowerment, the tools used to measure patient empowerment, the implications of the concept for the management of chronic disease, and its use in dermatological conditions.     

Measuring empowerment among people living with HIV: a systematic review of available measures and their properties

A systematic review was conducted to identify and appraise measures of empowerment used in peer-reviewed research with people living with HIV. Thirty articles reporting on 12 scales were identified via keyword and citation searches of electronic databases and hand searching of reference lists. The instruments captured a wide range of constructs, including self-efficacy, perceived knowledge/information seeking, self-management behaviours, belief in an active patient role and tolerance of uncertainty. While the majority of instruments were focused exclusively on self-efficacy to manage HIV, the Patient Activation Measure (PAM-13 and PAM-22) and the Health Empowerment Inventory were broader in scope. Most of the identified measures had acceptable construct validity, however there were insufficient data to determine the reliability or responsiveness of many of the scales. The findings highlight the need for a more concrete definition of empowerment and for further validation of existing measures with people living with HIV.     

Understanding how different mechanism of life coaching offered to young adults with type 1 diabetes can improve their ability to see opportunities and overcome barriers

ObjectiveThe purpose of this study was to gain a greater understanding of the potential mechanisms of life coaching in relation to young people with Type 1 diabetes (T1DM); including how it influences their motivation and their ability to see opportunities and overcome barriers.MethodsWithin the theoretical framework of realistic evaluation theory this qualitative study was conducted at three different hospitals where a total of 10 young adults with T1DM were coached as a supplement to their usual care at the hospital. Data were collected through semi-structured interviews and a focus group interview.ResultsThe findings showed that the young adults obtained a better self-awareness, and analyse of the coaching sessions point at several separate coaching mechanisms that seem to improve the young adults’ sense of well-being and personal empowerment in relation to their diabetes.ConclusionLife coaching could be an important supplement to more traditional diabetes follow-up in the specialized health care system.Practice implicationsThe results of this study imply that the capacity to deliver life coaching to young adults with T1DM can have broad implications for supporting them in obtaining better regulated diabetes and living a better daily life.