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PubMed2001

The everlasting trial of strength and patience': transitions in home care nursing as narrated by patients and family members.

The aim of this study was to describe and interpret patients' and their family members' lived experiences of caring at home. Twelve tape-recorded narratives, with seven patients and five family members, were interpreted in accordance with a phenomenological-hermeneutic method inspired by Ricoeur. The findings revealed life situations where natural caring was changed into patient-care-giver relations and the home became a public room. The patients had to deal with decreased abilities and the family members with adjusting to caring needs. The changes in the life situations were interpreted as long lasting and trying transitions. Implications for nursing and further research are proposed.

Activities of Daily Living↗
PubMedDate not supplied

From limbo to legitimacy: a theoretical model of the transition to the primary care nurse practitioner role.

The initial transitional year of professional practice is thought to provide the critical foundation on which new professionals build their expertise. The purpose of this study was to describe the experiences of new nurse practitioner graduates during their first year of primary care practice. Thirty-five persons were interviewed alone or in focus groups at approximately 1, 6, and 12 months after graduation. Grounded theory methodology guided the data collection and analysis. A theoretical model was constructed that represents the transition to the primary care nurse practitioner role. This model consists of a process called From Limbo to Legitimacy, which encompasses four major categories: Laying the Foundation, Launching, Meeting the Challenge, and Broadening the Perspective. Each category contains a set of subcategories that detail the multiple aspects of the experience. This model highlights both the distress and the accomplishments of the initial year of advanced practice.

Adult↗
PubMed2004

'Making the move': relatives' experiences of the transition to a care home.

Despite a growing awareness of the significance of helping a relative to relocate to a care home as a key phase in the caregiving career, relatively few studies in the UK have explored this experience in depth. The research on which the present paper is based sought to better understand experiences of nursing home placement from the viewpoint of relatives. The study was informed by a constructivist perspective. Data were collected in 37 semi-structured interviews involving 48 people who had assisted a close relative to move into a nursing home. Data analysis revealed three phases of the transition from the relatives' perspective: 'making the best of it'; 'making the move'; and 'making it better'. The relatives' experiences across these phases were understood in terms of five continua, reflecting the extent to which they felt they were: operating 'under pressure' or not; 'working together' or 'working alone'; 'supported' or 'unsupported', both practically and emotionally; 'in the know' or 'working in the dark'; and 'in control of events' or not. This paper reports on the findings which relate to the second phase of the transition, 'making the move', which relates to experiences around the time of relocation to the care home environment. The findings suggest that health and social care practitioners have enormous potential to influence relatives' experiences of nursing home entry. Experiences are enhanced if family carers perceive that they are able to work in partnership with care staff in order to ease the transition for the older person.

Adaptation, Psychological↗
PubMed1995

Staff perception of their roles during the transition of psychiatric care into the community.

The objective of this study was to investigate the staff's experiences involved in the processes of the transition of 20 non-demented long-stay psychiatric patients. Staff members expressed satisfaction from working outside the hospital. They believed that the patients' condition and their quality of life had improved and that they were likely to achieve successful resettlement after a lengthy process of rehabilitation. However, staff members considered that their roles were demanding and involved a lot of domestic activities. They recommended gradual and slow preparation for the patients, and an educational programme for the public as well as appropriate preparation and continuing professional support for staff.

Adult↗
PubMed2002

Experiencing "change" from within: situating the transition to primary health care in a remote Australian context.

The transition to primary health care (PHC) is often described in an idealized manner, which either ignores or obscures the experiences associated with its implementation at the local level. By adopting an anthropological perspective, this article highlights some of these experiences and the context within which they occur for one health care organisation in remote Western Australia. It specifically focuses on problems associated with economic rationalism, managerialism, and the inherently fragmented character of health service organisations. Such issues must be allowed to inform idealized PHC models in order to make them more applicable and attuned to local needs and realities.

Efficiency, Organizational↗
PubMed2005

Addressing transition to adult health care for adolescents with special health care needs.

OBJECTIVE: To determine the factors associated with addressing the transition from pediatric to adult-oriented health care among US adolescents with special health care needs. METHODS: Data for 4332 adolescents, 14 to 17 years of age, from the 2000-2001 National Survey of Children With Special Health Care Needs were used. The adequacy of transition services was determined by parent self-report. Explanatory variables, including parental education, family poverty status, race/ethnicity, measures of the severity and complexity of conditions, health insurance status, having a personal doctor, and the quality of the parent's relationship with the adolescent's doctor, were entered into a regression model. RESULTS: Overall, 50.2% of parents reported that they had discussed transition issues with their adolescent's doctor and 16.4% had discussed and developed a plan for addressing those needs. In a multivariate regression analysis, correlates of the adequacy of transition services included older age, female gender, complexity of health care needs, and higher quality of the parent-doctor relationship. CONCLUSIONS: Among adolescents with special health care needs, those who were older and those with more complicated needs were more likely to have addressed the transition from a pediatric to adult-oriented system of care. Furthermore, this analysis demonstrated a strong association between a high-quality parent-provider relationship and the extent to which transition issues were addressed. The importance of transition services for adolescents with less complex needs and the overall impact of health care transition services were not assessed in this study and remain important questions for future investigations.

Adolescent↗
PubMed1993

Patient care information systems and physicians: the transition from technology icon to health care instrument.

We have discussed several important transitions now occurring in PCIS that promise to improve the utility and availability of these systems for the average physician. Charles Babbage developed the first computers as "thinking machines" so that we may extend our ability to grapple with more and more complex problems. If current trends continue, we will finally witness the evolution of patient care computing from information icons of the few to clinical instruments improving the quality of medical decision making and care for all patients.

Attitude to Computers↗
PubMed2002

Beyond the golden hour: avoiding the pitfalls from resuscitation to critical care.

The transition from resuscitation bay to intensive care unit is wrought with potential problems that can significantly affect patient outcome. Among these are hypothermia, injudicious fluid management, hypocarbia, incorrect drug dosing, and incomplete evaluation. Based on a comprehension of the ongoing pathophysiology associated with injury, steps can be taken to ensure that this process positions the patient on the beginning of the path to recovery and not further into the spiral of worsening organ system dysfunction.

Child↗
PubMed1986

[Group health care].

The transition from individual to group health care entails a response to multidisciplinary scientific systems, the enlistment of community participation, and an effort to make the professionals aware of the need to work as a team. The author points to the need to change the information system so that the professional-to-be will acquire a mentality and method of work appropriate for group care. In the architecture of service facilities structural changes must also be provided for the care of groups rather than individuals. In short, the change entails a review of all the elements of care.

Community Health Services↗
PubMed1998

From assurance to insurance in Russian health care: the problematic transition.

OBJECTIVES: Given the declining health status of the Russian population and the negative social impact of ongoing economic reforms, it is important to understand the nature and scope of Russia's innovations in health care financing. METHODS: Data on Russian health care and its financing were gathered from Russian newspapers and journals. US government agency reports, recent press accounts, and the authors' observations and interviews in Russia. RESULTS: The 1991 statutory basis for the Russian mandatory medical insurance system replaced the traditional, state-funded medical care system with a regional system principally reliant on an enterprise-based with-holding tax plus supplementation by local government and, to a minor extent, federal funds. The regional agent for distribution and management of these funds is a series of Territorial Health Insurance Funds. Implementation thus far has been highly uneven among territories. CONCLUSIONS: An insurance model patterned after the Western example may not be the optimal solution to Russia's current health financing problems. Given the chaotic nature of political and economic reform, Russia may simply not be ready for market-based medical insurance.

Health Care Reform↗