Mette Geil Kollerup

Improving visiting nurses’ post-hospital medication management: A participatory approach

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.,Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.,The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.,The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.,Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.,This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

Assessing Basic Needs in Frail Older Persons Calls for Aesthetic Nursing Skills - An Ethnographic Approach

Background: Despite research on caring for older persons’ basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated if they are suffering from chronic diseases and complex functional impairments. A starting point for an exploration of this complexity is the identification of frail older persons’ basic needs Aim: To explore the challenges in nursing assessment of basic needs when the older persons’ frailty also implies impressive and expressive difficulties. Method: We used Spradley’s theory of participant observation. Data were collected from three older persons’ individual assessment meeting, followed by individual interviews with the nurse. Field notes and transcribed dialogues from the assessment meetings and interviews were analyzed systematically in four steps. Findings: Very limited input from the frail older persons characterizes the assessment. The nurses gave ample time and listened patiently to the older persons’ voices to understand his or her limited verbal and nonverbal expressions. Using different types of questions, answers, body language and interpretations the nurses ensured that they had heard correctly and understood the older persons’ remarks and answers. This revealed two themes: Patiently eliciting the older person’s voice, and Empathic listening piecing fragments together to form an understanding. Conclusion: When patient age and frailty implies impressive and expressive challenges, the nursing assessment of basic needs requires well developed nursing skills to create a facilitating setting that involves the frail older person. The nurse elicits patiently the older person’s voice, and listens empathically to piece fragments together to form an understanding. Using imagination and improvisation trying out different solutions, the aesthetic nursing skills are seen prominent though related to the empiric-, ethic-, and personalskills. This enabled the nurses in enhancing the frail older persons’ participation and helped to maintain dignity despite impairment and limited input.