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Results for “Transitional Care”

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At least 217 records · Page 12Linked to original sources
PubMed1994

Nurse practitioners' effectiveness in NICU.

The effectiveness of Neonatal Nurse Practitioners (NNPs) in a Level III Neonatal Intensive Care Unit (NICU) was evaluated by using a retrospective medical records review. Two groups of infants received care in a Transitional Care Unit (TCU), one by house officers and the second cared for by NNPs. Medical diagnoses, lengths of stay, hospital charges, discharge/transfer disposition and hospital readmissions were studied. No differences were found in DRG codes, discharge disposition, hospital readmission or number of infants transferred from TCU to NICU because of deteriorating condition. Though the infants cared for by the NNPs had significantly lower birth weight and lower gestational age, they averaged 2.4 fewer days in the hospital and $3,491 less in total hospital charges than the group cared for by house officers. This study confirms that NNPs can provide care comparable to house officers in a Level III NICU and be more cost effective.

Efficiency, Organizational↗
PubMed1999

Transition in care: family carers' experience of nursing home placement.

This paper explores families' experience of nursing home placement, which emerged as a significant aspect of a larger hermeneutic phenomenological study of family caring in nursing homes. Hermeneutic analysis of 14 family carers' stories of nursing home placement uncovered five shared meanings: experiencing a loss of control; being disempowered; feeling guilt, sadness and relief simultaneously; possessing a sense of failure; and having to make a forced and negative choice. Discussion of the findings focuses upon the importance of family carer support during the transition period from home care to nursing home care and the subsequent benefits realized as a result of having received such support. Particular emphasis is placed upon how such support assists family carers to begin the process of reconstructing a valued and positive identity through which new possibilities for meaningful caring within a nursing home context can be realized.

Aged↗
PubMed2005

Growing up and moving on. A multicentre UK audit of the transfer of adolescents with juvenile idiopathic arthritis from paediatric to adult centred care.

OBJECTIVE: To assess the provisions made for the transfer of adolescents with juvenile idiopathic arthritis to adult rheumatology clinics in the UK and the impact of a transitional care programme. METHODS: An audit of the documentation of the provisions made for transfer in 10 centres participating in a controlled trial of transitional care. Each centre conducted a retrospective case note audit of the recent patients transferred to adult care before and 12-24 months after the start of the trial. Demographic details, age when transition was first discussed, age at transfer, transitional issues, multidisciplinary team involvement, adolescent self advocacy, and readiness were documented. RESULTS: There were improvements at follow up in documentation of transitional issues, disease specific educational needs, adolescent readiness, and parental needs with the exception of dental care, dietary calcium, and home exercise programmes. The age at which the concept of an independent clinic visit was introduced was lower (mean (SD): 16.8 (1.06) v 15.8 (1.46) years, p = 0.01) but there were no other changes in age related transitional milestones. Significantly more participants had preparatory visits to the adult clinic, had a transition plan, and had joint injections while awake at follow up. CONCLUSIONS: The improvement in documentation suggests that involvement in the research project increased awareness of transitional issues. The difficulty of changing policy into practice was highlighted, with room for improvement, particularly at the paediatric/adult interface. The reasons for this are likely to be multiple, including resources and lack of specific training.

Adolescent↗
PubMed2006

When should young people with chronic rheumatic disease move from paediatric to adult-centred care?

Many young people with childhood-onset diseases, including rheumatic diseases, continue to require medical care into adult life. There are many differences between paediatric and adult health care which can make this change a dramatic and difficult one for young people and their families. Transitional care services aim to equip young people with the appropriate knowledge and skills to cope with this change. This chapter will describe the differences between transition and transfer, and the different perspectives of those involved in the transition process, and will discuss the determinants of a successful transfer. Transition models currently used in practice will also be described, as will the evolving evidence base that is contributing to the further development of transitional care services.

Adolescent↗
PubMed1994

The emerging managed care paradigm: health care in transition.

Defining business objectives is never easy. However, with market reform exceeding any realizable promise of governmental reform, the rapid evolution of health care may seem daunting. The Table presented by the author helps conceptualize where we are and where things seem to be moving. It incorporates issues of interest to the health care business manager, developer, provider, and informed consumer.

Forecasting↗
PubMed1986

A controlled study of transitional day care for non-chronically-ill patients.

The authors randomly assigned 79 inpatients with nonchronic schizophrenia or affective disorder to either an intensive experimental day program called "transitional treatment" or a control treatment--weekly clinically believed to require intensive posthospital treatment to make the transition to the community. Although initially there was a significantly higher dropout rate from the control condition, at the point of discharge from the two programs as well as at 6- and 12-month follow-up there was no difference in outcome. Direct costs for the transitional treatment, however, were much higher.

Adolescent↗
PubMed2002

Quality of life of individuals with heart failure: a randomized trial of the effectiveness of two models of hospital-to-home transition.

BACKGROUND: The growing number of patients with congestive heart failure has increased both the pressure on hospital resources and the need for community management of the condition. Improving hospital-to-home transition for this population is a logical step in responding to current practice guidelines' recommendations for coordination and education. Positive outcomes have been reported from trials evaluating multiple interventions, enhanced hospital discharge, and follow-up through the addition of a case management role. The question remains if similar gains could be achieved working with usual hospital and community nurses. METHODS: A 12-week, prospective, randomized controlled trial was conducted of the effect of transitional care on health-related quality of life (disease-specific and generic measures), rates of readmission, and emergency room use. The nurse-led intervention focused on the transition from hospital-to-home and supportive care for self-management 2 weeks after hospital discharge. RESULTS: At 6 weeks after hospital discharge, the overall Minnesota Living with Heart Failure Questionnaire (MLHFQ) score was better among the Transitional Care patients (27.2 +/- 19.1 SD) than among the Usual Care patients (37.5 +/- 20.3 SD; P = 0.002). Similar results were found at 12 weeks postdischarge for the overall MLHFQ and at 6- and 12-weeks postdischarge for the MLHFQ's Physical Dimension and Emotional Dimension subscales. Differences in generic quality life, as assessed by the SF-36 Physical component, Mental Component, and General Health subscales, were not significantly different between the Transition and Usual Care groups. At 12 weeks postdischarge, 31% of the Usual Care patients had been readmitted compared with 23% of the Transitional Care patients (P = 0.26), and 46% of the Usual Care group visited the emergency department compared with 29% in the Transitional Care group (chi2 = 4.86, df 1, P = 0.03). CONCLUSIONS: There were significant improvements in health-related quality of life (HRQL) associated with Transitional Care and less use of emergency rooms.

Adult↗
PubMedDate not supplied

Comparisons of American-Chinese and Taiwanese patients' perceptions of dyspnea and helpful nursing actions during the intensive care unit transition from cardiac surgery.

OBJECTIVE: To compare perceptions by American-Chinese and Taiwanese patients who received ventilatory assistance of acute episodes of dyspnea and the related helpful nursing actions in the intensive care unit (ICU) after cardiac surgery. DESIGN: A descriptive qualitative design. SETTING: Two medical hospitals in northern California and Taiwan. PATIENTS: A purposive sample consisting of 30 adult Chinese patients who experienced acute episodes of dyspnea while receiving assistance from a volume-cycled ventilator following cardiac surgery in the ICU from one study site in the United States (n = 10) and one study site in Taiwan (n = 20). OUTCOME MEASURES: The perceptions, natures, helpful nursing actions, and conceptual definition of the acute episode of dyspnea from the patients' perspective. INTERVENTION: Data were gathered through semi-structured interviews and analyzed by qualitative content analysis. RESULTS: All American-Chinese and Taiwanese subjects experienced physical discomforts, including tightness and congestion in the chest, labored breathing, sweating, palpitations, pain, and loss of vitality. Seventy percent of American-Chinese subjects and 90% of Taiwanese subjects reported having a mortal fear of death during and after the acute episode of dyspnea. The nature of the patients' perceptions of dyspnea revealed in this study can be categorized as unpredictability, sequence, intercorrelation, and exhaustion. Data analysis shows that the acute dyspneic process includes the immediate, following, later, and final transitions. Helpful nursing actions were identified as comforting, companionship, allowing self-concentration, and providing information. CONCLUSION: Both American-Chinese and Taiwanese patients' perceptions of acute episodes of dyspnea and helpful nursing actions were identified and compared. Finally, the conceptual definition of patients' perceptions of acute dyspnea and a conceptual framework for this phenomenon were further tentatively developed to depict and delineate this phenomenon.

Asian↗
PubMed1994

U.S. health care in transition: a response to the Health Security Act of 1993.

Although the President and Mrs. Clinton are to be commended for their courage and commitment in bringing the issue of health care reform to the forefront of national concern, their proposal has "too much regulation and too much government." The author fears that the plan will not work due to its emphasis on global budgeting, price controls, and the regulatory nature of the regional health alliances. He advocates a reform system based on the American values of innovation, entrepreneurship, and the spirit of free enterprise.

Budgets↗