Dagrunn Nåden Dyrstad

A review of the literature on patient participation in transitions of the elderly

Patient participation is highlighted in healthcare policy documents as an important area to address in order to improve and secure healthcare quality. The literature on healthcare quality and safety furthermore reveals that transitional care carries a risk of adverse events. Elderly persons with co-morbidities are in need of treatment and healthcare from several care professionals and are transferred between different care levels. Patient-centered care, shared decision-making and user involvement are concepts of care that incorporate patient participation and the patients’ experiences with care. Even though these care concepts are highlighted in healthcare policy documents, limited knowledge exists about their use in transitions, and therefore points to a need for a review of the existing literature. The purpose of the paper is to give an overview of studies including patient participation as applied in transitional care of the elderly. The methodology used is a literature review searching electronic databases. Results show that participation from elderly in discharge planning and decision-making was low, although patients wanted to participate. Some tools were successfully implemented, but several did not stimulate patient participation. The paper has documented that improvements in quality of transitional care of elderly is called for, but has not been well explored in the research literature and a need for future research is revealed. Clinical practice should take into consideration implementing tools to support patient participation to improve the quality of transitional care of the elderly.

Quality and safety in transitional care of the elderly: the study protocol of a case study research design (phase 1)

Introduction Although international studies have documented that patients’ transitions between care providers are associated with the risk of adverse events and uncoordinated care, research directed towards the quality and safety of transitional care between primary and secondary health and care services, especially for the elderly receiving care from multiple healthcare providers due to complex health problems, is lacking. This study investigates how different aspects of transitional care can explain the quality and safety of elderly healthcare services in Norway. The overall aim of the study was to explore different aspects of transitional care of the elderly, in different contexts and how they might explain the quality and safety of care. Methods and analysis The study applies a case study design. Two cases are chosen: one city-based hospital and one rural hospital with associated nursing homes and home-based nursing services. Admission and discharge to/from hospital to/from nursing homes or home-based nursing services constitute the main focal areas of the study, including the patient, next-of-kin and the professional perspective. The qualitative methods employed include participant observation, individual interviews and document analysis. To ensure trustworthiness in the data analysis, we will apply analyst triangulation and member checks. A total impression of the data material will first be created in a systematic text condensation approach. Second, the qualitative data analysis will involve in-depth analyses of two specific themes: the risk perspective and the patient perspective in transitional care. Ethics and dissemination The study is approved by the Norwegian Regional Committees for Medical and Health Research Ethics. The study is based on informed written consent, and informants can withdraw from the study at any point in time. Interview and observation data material will be managed confidentially. Results It will be disseminated at research conferences, in peer-reviewed journals and through public presentations to people outside the academic community.

Factors that influence user satisfaction: tracheotomised home mechanical ventilation users' experiences.

AIMS AND OBJECTIVES To describe the self-reported life situation of users totally dependent on home mechanical ventilation (HMV) after tracheotomy and to identify factors associated with user satisfaction. BACKGROUND HMV users are a small but growing group in society and among the most vulnerable individuals with chronic disabilities. The participants in the present study belong to an even more susceptible minority of this group, as they require round the clock ventilation at home through a tracheostomy, implying the need for continuous care. Their testimonies are important for the generation of new knowledge. DESIGN A qualitative design using interviews. METHODS Individual interviews were conducted with six participants and analysed by qualitative content analysis. RESULTS The main theme that emerged different individual needs require a range of approaches was based on three sub-themes: (1) Tailored information (2) Sensitivity in decision-making and (3) Building trust and confidence. Information was perceived as crucial and participants described different experiences of receiving optimal information to not receiving information at all. Successful collaboration was perceived when the user was given the opportunity to participate in decision-making about her/his treatment and care, where to live and how to organise daily life. Trust and confidence in the caregivers were important. CONCLUSION The participants highlighted the need for strategies to improve satisfaction. Their experiences varied depending on age, where they lived, who they encountered in the healthcare system and the level of family support. Our findings suggest that patients who perceive themselves as well informed at an early stage are more satisfied with treatment, decisions about their tracheotomy and their life situation. RELEVANCE TO CLINICAL PRACTICE There is a lack of knowledge among healthcare providers, thus tailored, high competence and guidelines are required.

Quality and safety in the transitional care of the elderly (phase 2): the study protocol of a quasi-experimental intervention study for a cross-level educational programme

Introduction Transitional care and patient handover are important areas to ensure quality and safety in elderly healthcare services. Previous studies showed that healthcare professionals have little knowledge of the setting they are transferring patients to and a limited understanding of roles and functions; these constitute barriers to effective communication and shared care responsibilities across levels of care. Aim The main objective is to implement a cross-level education-based intervention programme with healthcare professionals aimed at (1) increasing professionals’ awareness and competencies about quality and safety in the transitional care of the elderly; (2) creating a discussion platform for knowledge exchange and learning across levels and units of care and (3) improving patient safety culture, in particular, in transitional care. Methods and analysis A quasi-experimental control group study design with an intervention group and a control group; this includes a pretest, post-test and 1-year follow-up test assessment of patient safety culture. Qualitative data will be collected during the intervention programme and between the measurements. The study design will be beneficial for addressing the effects of the cross-level educational intervention programme on reports of patient safety culture and for addressing the feasibility of the intervention measures. Ethics and dissemination The study has been approved by the Regional Committees for Medical and Health Research Ethics in Norway, Ref. No. 2011/1978. The study is based on informed written consent; informants can withdraw from the study at any point in time. The results will be disseminated at research conferences, in peer review journals and through public presentations outside the scientific community.

Older patients’ participation in hospital admissions through the emergency department: an interview study of healthcare professionals

BackgroundPatient participation is an important aspect of healthcare quality and may be one way to improve the quality of transitional care for older patients. Research reveals minimal awareness about patient participation in hospital admissions. Hospital admissions require attention to individuals’ specific needs beyond patient frailty, and to involve patients and their families in shared decision-making. The aim of this study was to identify factors influencing patient participation by exploring healthcare professionals’ views on patient participation during the hospital admission of older patients through the emergency department (ED).MethodsThe study used a qualitative and descriptive design with face-to-face interviews. A total of 27 interviews were conducted with 15 healthcare professionals from one hospital and 12 from another. The data were analyzed using systematic text condensation.ResultsHealthcare professionals thought that patient participation in hospital admissions was influenced by five main factors: 1) routine treatment and care during hospital admission, and in particular certain procedures such as medical examinations; 2) the frail and thankful older patients, and the overall picture of their medical needs; 3) hospital resources, such as available staff and beds; 4) healthcare professionals’ attitude towards finding out about older patients’ experiences; and 5) the presence of a supportive and demanding next of kin acting as an advocate for the patient.ConclusionsPatient participation in hospital admissions of older patients is dependent on the way the service is organized, the patients’ condition, hospital resources, healthcare professionals’ attitudes, and support from patients’ next of kin. Some of the participants had high expectations of themselves and actively involved patients, but others did not find patient participation relevant in the emergency department. Some used crowded wards as a reason not to engage older patients in their own care.

Norwegian nursing students’ evaluation of vSim® for Nursing

BackgroundvSim® for Nursing is the first web-based platform linked to the nursing education curriculum. It is an American simulation tool, developed in 2014 through a collaboration between Wolters Kluwer Health, Laerdal Medical and the National League for Nursing. To our knowledge, no studies have evaluated vSim® for Nursing from the nursing students’ perspective in Norway. The aim of the study was to evaluate second year Norwegian nursing students’ experiences with the virtual clinical simulation scenario in surgical nursing from vSim® for Nursing.MethodsA descriptive and a convergent mixed method design was utilised. The method comprised a 7-item questionnaire with five open-ended questions. Sixty-five nursing students participated in the study.ResultsThe majority of Norwegian nursing students evaluated the virtual clinical scenario in surgical nursing from vSim® for Nursing useful, realistic and educational in preparing for clinical placement in surgical care. However, a small portion of the nursing students had trouble understanding and navigating the American vSim® for Nursing program.ConclusionsIntroducing virtual simulation tools into the nursing education encompasses faculty and student preparation, guidance from faculty members during the simulation session and support for students who are facing difficulties with the simulation program.

Studying Complex Care Transitions from a Qualitative Perspective

In this chapter, Laugaland et al. present key methodological challenges and lessons learned when studying complex care transitions from a qualitative perspective. Although these challenges are common to many other research designs, they are especially important to consider for researchers in the design and conduct of qualitative research studies aiming to developing in-depth descriptive and analytical understandings of care transitions. The challenges described in this chapter are structured according to recruitment and retention of the elderly and issues concerning data collection.

The Role of Next of Kin in Care Transitions

In this chapter, Dyrstad and Storm draw attention to the important role that next of kin play in care transitions, especially for vulnerable or older patients. The chapter describes the legal responsibility of healthcare professionals to involve next of kin and then discusses theories of relevance to the understanding of the next of kin’s role in transitional care. The chapter uses relevant literature and empirical examples to provide new understandings and proposes a conceptual model for the role of next of kin in care transitions. Lastly, the chapter offers suggestions about the next of kin’s role from the healthcare professionals’ perspective.