Joan Norris

Exploring Care Transitions From Patient, Caregiver, and Health-Care Provider Perspectives

Care transitions involve coordination of patient care across multiple care settings. Many problems occur during care transitions resulting in negative patient outcomes and unnecessary readmissions. The purpose of this study was to describe the experience of care transitions from patient, caregiver, and health-care provider perspectives in a single metropolitan Midwest city. A qualitative descriptive design was used to solicit patients’, caregivers’, and health-care providers’ perceptions of care transitions, their role within the process, barriers to effective care transitions, and strategies to overcome these barriers. Five themes emerged: preplanned admissions are ideal; lack of needed patient information upon admission; multiple services are needed in preparing patients for discharge; rushed or delayed discharges lead to patient misunderstanding; and difficulties in following aftercare instructions. Findings illustrated provider difficulty in meeting multiple care needs, and the need for patient-centered care to achieve positive outcomes associated with quality measures, reduced readmissions, and care transitions.

The Omaha System: a model for describing practice.

Diverse data and information are becoming increasingly important to clinicians, administrators, and educators as they work in rapidly changing settings. A number of classification systems or vocabularies have been developed that offer structure for client records and clinical information systems. Such structure is needed to generate reliable, valid, and useful data. The research-based Omaha System is one such classification system. It consists of nursing diagnoses/client problems, interventions, and client outcomes. The Omaha System is being used in many settings, including home care, nursing centers, colleges of nursing, and school health programs.

A Grounded Theory of Reimaging

Several cross-sectional, qualitative studies suggest that physical alterations in appearance or functioning have the potential to influence self-esteem. There have been no studies describing the process of adapting to body image disruption. A grounded theory of reimaging is proposed, based on the experiences of 28 participants who had experienced significant weight change, loss or paralysis of body parts, ostomies, scarring from burns or trauma, or surgical reconstruction. Participants were interviewed at 3, 6, 12, and 18 months following the physical alteration. Three phases, action processes, influencing factors, and outcomes, of reimaging are described.

Divorcing and Building a New Life

The purpose of this study was to provide a qualitative description of womens experiences of divorcing and building a new life. Interviews with 10 divorced women were conducted, transcribed, and analyzed using the constant comparative method. Four phases were identified in the process of divorcing and building a new life: the emotional divorce, making the decision, pulling apart, and moving beyond. Feelings and coping strategies reported by the participants are described.

Five Families Living With Hereditary Breast and Ovarian Cancer Risk

This qualitative study explores the communication and decision-making strategies of five families with hereditary breast and ovarian cancer (HBOC) risk.Investigators asked female carriers of BRCA1 and BRCA2 genetic mutations to recall early knowledge and experiences concerning cancer risk.Husbands and children (aged 15-25 years) of women with HBOC risk also were interviewed on knowledge, experiences, and expectations for future decisions regarding their risk.Themes derived from the interviews suggested a need for additional studies of families with HBOC risk to address how family history and other factors influence decision making.Nurses should assess patients and their families for issues with body image and adjustment after cancer treatment and offer appropriate support.In addition, parents should be advised on when and how to tell children about their potential risk and support their testing and health-promotion decisions.

Nursing Education Application of a Computerized Nursing Expert System

Nurse educators are required to be knowledgeable about a wide variety of complex health care problems in order to provide quality education. At the same time, they are given a multitude of other responsibilities such as participating in scholarly activity, advising students, maintaining an active role in nursing practice, and performing community service. These educators must find innovative ways to present current lectures while at the same time meeting their other obligations. The use of Creighton Online Multiple Modular Expert System (COMMES), a computerized decision support consultant, was evaluated as a technique for faculty use in developing and organizing new lecture content. The study found that COMMES was beneficial as a systematic prompt for lecture content, as a tool for organizing content, and as a means to verify completeness of lecture material.

Commentary on Grabbing the rice straw.

The authors began by refuting a myth that Asians are healthier than other population groups born in the United States. A study by Frisbie, Cho, and Hummer (2001) was based on national health survey data from 1992 to 1995 and contrasted self-reports of new Asian and Pacific Island immigrants to their U.S.-born co-ethnics on health, days in bed because of illness, and number of activity limitations. Results supported the expectation that although immigrants did have health advantages on arrival, these advantages were lost over a period of 5, 10, or more years. These results supported the study’s hypotheses that new immigrants tend to be selectively more robust and healthier than native-born populations but acculturation over time to U.S. lifestyles (e.g., diets and lower activity levels, exposure to smoking, alcohol, and drugs) leads to declines in health over time. The authors also reported that immigrant groups do vary widely. Pacific Islanders with high rates of obesity were less healthy than other Asian populations, and different immigrant streams can vary on health: with more highly educated and skilled Asian populations appearing to be healthier than later arriving Asian refugee populations. Ma (1999) completed a field study, interviewing Chinese immigrants (n = 75) of various ages and socioeconomic status and a group of Western and traditional Chinese health professionals (n = 30). Chinese immigrants described their patterns of health-seeking behaviors over the prior 2 years as: using home remedies and self-treatment (94%), going to both Western and traditional Chinese clinics in the United States (45%), traveling to China or Taiwan for care (32%), going to traditional Chinese clinics in the United States (25%), going to Western medicine clinics in the United States (21%),