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PubMedDate not supplied

Lessons learned from providing transition services to adolescents with special health care needs.

This article provides insight and information about obstacles adolescents with special health care needs (ASHCNs) face as they progress to adulthood. Descriptions of these challenges are based upon clinical experiences in providing transition services to youth by the service coordinator seen through the Creating Healthy Futures transition clinic. These obstacles were classified as those related to health care, employment, education, independent living, social and recreational skills, and the service system. Information is also provided on the strategies project staff developed to assist youth in dealing with the challenges of the transition obstacles they faced.

Adolescent↗

PubMedDate not supplied

A model of care for childhood cancer survivors that facilitates research.

The majority of children and adolescents diagnosed with cancer will achieve long-term survival after contemporary therapy. Consequent to this success are challenges inherent in coordinating lifelong health care for a group predisposed to a variety of cancer-related complications. With increasing numbers of aging adult survivors of childhood cancer, clinicians now face the additional challenge of studying delayed effects of childhood cancer in the context of organ senescence. Clinicians must also address the transition of survivor health care from the pediatric oncology setting to the adult community. Salient issues influencing health care of long-term childhood cancer survivors are summarized, and a model for monitoring late treatment effects used at a pediatric cancer facility is presented. This model is remarkable for its ability to enhance optimal delivery of long-term survivor care, facilitate the transition of survivor care from the pediatric treatment center to community, providers, and support investigations of late cancer-related morbidity and mortality.

Adolescent↗

PubMed2004

Telehomecare: a comparison of three Canadian models.

The delivery of health care is often segmented into sectors. In Canada, hospital care has traditionally been distinct from community care, and thus the transition of patients across sectors has been challenging. This paper focuses on the systematic development of an integrated model of care for children, for the purpose of smoothing the transition from hospital to home. The new service model uses emerging telecommunications technology to link hospital care providers to patients at home and is termed "telehomecare" (THC). Independent models of THC were developed for three sites across Canada through semistructured interviews and focus groups. Participants included health care providers and administrators from the hospital and community, and patient families. The resulting models were compared using content analysis to determine whether there was a core model of THC that was generalisable across Canada. A core model of THC was identified that includes the use of videoconferencing to enable the integration of hospital- and community-based care to support patients during the initial stages of the transition to home. Each site also articulated unique characteristics in their service model that were related to the nature of their health care delivery system and patient population. This paper describes the core model of transitional care, presents a synopsis of each of the three models, and compares the models. THC provides opportunities to address limitations in the current system and to improve upon equity of access to quality care for children making the transition from hospital to home.

Aftercare↗

PubMed2003

Predictors of institutionalisation in people with dementia.

OBJECTIVE: To identify what patient and carer characteristics influence transition into residential care for people with dementia. METHOD: Longitudinal study of a cohort of people with dementia and their carers in contact with old age psychiatric services in south London. RESULTS: 100 people with dementia and their main family carer were recruited. At six month follow up 22 were in residential care, 63 in the community, 8 had died, and for 7 there were missing data. Between six and 12 months, 7 of the 63 in the community went into residential care, 4 died, and 12 were lost to follow up. The most striking finding is the 20-fold protective effect of having a co-resident carer (odds ratio 0.05, 95% confidence intervals 0.01 to 0.42, p=0.006). Higher ratings of behavioural problems in the person with dementia were also statistically significantly associated with transition into residential care as was the psychological domain of quality of life of the carer. CONCLUSION: These findings powerfully illustrate the pivotal role carried out by carers of people with dementia; interventions directly targeted at helping them to maintain this role would be supported by these data. These data also suggest that strategies directed at improving carer quality of life and at the resolution of behavioural disorder in the person with dementia may also have particular value.

Adult↗

PubMed1997

Family transition through the termination of private duty home care nursing.

Health care professionals prepare families for discharge and for home care, but termination of home care nursing has been approached less methodically. The purpose of this retrospective study was to describe the experience of transition occurring with termination of private duty home nursing care for the families of technology-dependent children. The research question guiding this proposal was: How do families experience the transition from continuous home nursing care through termination of that care? This article will discuss the adjustments and preparations required by termination, families' coping response, their experience of the transition, and suggested interventions.

Adaptation, Psychological↗

PubMed1997

Nursing and health care for an aging society: the case of The Netherlands.

1. Demographic developments in European and western countries are not unique. Nurses should embrace the opportunity to learn from each others' care and research initiatives for the elderly population. 2. Current transitions in health care systems should be seized as an opportunity to further establish and develop the nursing profession, for example, through joining and initiating multidisciplinary initiatives. 3. The aging population is the fastest growing population in a number of countries. The training, recruitment, and retainment of nursing staff are key to continuously provide high quality care for the elderly.

Aged↗

PubMed2002

[Geriatrics at hospitals for acute diseases].

Almost half of adults who occupy hospital beds are > = 65 years; this proportion is expected to increase as the population ages. Hospitalization can magnify age-related physiologic changes and increase morbidity. The outcome of hospitalization appears to be poorer with increasing age; outcome is better in patients hospitalized for elective procedures (e.g., joint replacement) than in those hospitalized for serious conditions (e.g., multisystem organ failure). About 75% of persons > = 75 who are functionally independent when admitted to hospitals from their homes are not functionally independent when discharged. Even when an illness is treatable or appears uncomplicated, patients may not return to prehospitalized functional status. A particularly successful model is Acute Care for the Elderly (ACE) intervention, a program of patient-centered care designed to prevent dysfunction. Hospitalization is necessary only when the patient cannot receive appropriate treatment in any other environment. The health care practitioner should promptly identify patients who can benefit from medical care in another environment (e.g., at home). Acute hospital care should only be of sufficient duration to allow successful transition to home care, a skilled nursing facility, or an outpatient rehabilitation program.

Acute Disease↗

PubMed1996

Advancing nursing practice: acute care nurse practitioners meet challenges at and beyond the health care horizon.

Preparation of advanced practice nurses (APNs) with acute care skills relevant to today's health care environment is a challenge faced by nurse educators, care providers, professional organizations, and regulatory agencies. The acute care nurse practitioner (ACNP) is prepared to provide multidimensional, risk-appropriate management of medically vulnerable patients with serious illness in a variety of settings. ACNPs conduct comprehensive health assessments, order and interpret diagnostic tests, diagnose and manage health problems and disease-related symptoms, prescribe and evaluate drugs and treatments, and coordinate care during setting transitions. Working independently and collaboratively the ACNP enhances access to care and quality of care for patients and families through cost-effective, outcome-oriented practice. This article describes health care market factors fostering ACNP practice, ACNP practice domain, the University of Washington ACNP program, and collaborative contributions from educators, care providers, professional organizations, and regulatory groups needed to implement the role.

Acute Disease↗

PubMed2004

Transitioning the young adult with congenital heart disease for life-long medical care.

Guidelines for the successful orchestration of transitioning of the adolescent and young and older adult patient with congenital heart disease to a health care system appropriate for their long-term congenital heart disease care and counseling appear necessary to improve patient and family confidence, education, therapy, life quality, and survival outcomes. Schema for care organization and delivery for adult patients with congenital heart disease remain primitive and largely unimplemented. The presence of a strong central care oversight organization and the establishment of a multi-institutional database to assist in assessment of care outcomes and guidelines appears requisite to these needs and for the establishment of transitioning guidelines for these patients as they assume a greater and deeper shared control of their futures with their caregivers.

Adolescent↗

PubMed1997

Understanding the transition to community living after discharge from an acute care hospital: an exploratory study.

OBJECTIVES: This study was conducted to obtain patients' experiences in making the transition from an acute care hospital to their homes in the community. METHOD: Data were gathered through group and telephone interviews with a volunteer sample of 27 discharged patients. Analysis involved two stages: categorization of shared themes and interpretation of individual occupational experiences. RESULTS: Informants described their experiences of transition in terms that were analytically categorized as Perceived Self-Efficacy, Resources, Dimensions of Occupation, and Environmental Constraints and Opportunities. Analysis of individual patient transcripts suggests the presence of an hierarchical ordering of desired occupations. CONCLUSION: Understanding patients' perceptions of enabling and disabling experiences has implications for predischarge and postdischarge practice in occupational therapy.

Activities of Daily Living↗

PubMed2003

Care not cure: dialogues at the transition.

Physicians and patients find it hard to communicate when treatment fails to cure or control cancer. Communication barriers include fear of "giving up," losing the medical team, and discussing death. The quality of physician-patient communication affects important outcomes including patient distress, coping, and quality of life, and physician burnout. Communication skills that can be taught, learned, and maintained for physicians at all levels of training, and effective educational programs have been described. Research on communication skills training should focus on the best method of delivery, the "dose-response" effect, and how to measure success of training in complex health care environments.

Adaptation, Psychological↗

PubMedDate not supplied

Creating clinical opportunities in a managed care environment.

The Continuum of Care clinical experience was developed to provide future nurses with practice in a managed care environment. Students see how the critical care patient's needs change during the recovery process and assist the patient with the transition to self-care at home. Patient and student evaluations indicate the experience increases students' understanding of the role of the nurse in managed care while facilitating patients' transition to the self-care environment.

Clinical Competence↗

PubMed2005

Difficulties in patient management associated with the transition period.

The European Society for Paediatric Endocrinology (ESPE) held a consensus workshop in Manchester, UK, in December 2003 to discuss issues relating to the care of growth hormone (GH)-treated patients in the transition from paediatric to adult life. Aspects under consideration included the definition of transition, the process of delivery of transitional care, the exact need to reassess pituitary status after completion of growth and puberty in teenagers who have received GH treatment during childhood, the most appropriate biochemical definition of severe GH deficiency (GHD) in the transitional period, and the factors influencing both the decision to reinstitute treatment and also the timing and dosage schedule when GH treatment is reinstituted.

Adolescent↗

PubMedDate not supplied

Themes of rural health and aging from a program of research.

The culture and diversity of rural life and limitations of rural health systems to meet the changing health needs of an aging population lead to problems of obtaining appropriate care in rural America. In a program of nursing research involving three ethnographic studies in rural Colorado, transitions of older adults across differing levels of heath care were explored. The sample totaled 425 participants, of whom 25% were Hispanic. Five major themes emerged: circles of formal and informal care; integration of faith, spirituality, and family with health status; crisis nature of health care transitions; nursing homes as a housing option; and changing spirit of traditional rural nursing. Recommendations for providers included making their practices congruent with rural culture, being fully informed of available resources, facilitating acceptable health care decisions, and integrating physical, mental, and spiritual health care for elders and their families.

Aged↗

PubMedDate not supplied

[Pregnant adolescents in a transition phase: a nursing focus on caring-researching].

The objective of this study is to understand the change women go through in their daily life, considering the transition during adolescence and maternity. It aims at understanding the existential meaning of the pregnant adolescent, facing transition, as a located phenomenon, in the simultaneity of life events. Data were collected through the discourse of eight pregnant adolescents who answered a phenomenological interview guided by the question: "What is it to be a pregnant adolescent undergoing transition, as a located phenomenon, in the simultaneity of life events?" The comprehensive analysis of the reports was based on the Heideggerian hermeneutics. It showed that pregnant adolescent experience this transitional moment with fear, fragility and ambiguous feelings of pleasure and suffering, according to the meanings attributed to their experiences.

Adolescent↗

PubMed1997

Physicians' attitudes toward managed care: assessment and potential effects on practice behaviors.

This study was designed to identify the key components of physicians' attitudes toward managed care and develop a tool to assess these components. We developed a questionnaire based on physicians' reactions to managed care, as reflected in the published literature. We mailed this questionnaire to a sample of 753 community physicians in the greater Sacramento area. A factor analysis of these data (n = 315) identified five unifactorial scales, which we labeled managed care quality, need to adapt to managed care, cost-containment effectiveness of managed care, personal knowledge of managed care, and inevitability of managed care. Physicians were most negative about the quality of managed care and most in agreement about the need to adapt to it. Correlations among these five scales, while statistically significant, were modest in size, suggesting that these physicians were quite discriminating in their evaluations. In comparison with medical/surgical specialists, primary care physicians rated the quality of managed care, their knowledge of it, and the inevitability of a national transition to managed care more positively. These measures predicted the physicians' intentions to alter their medical behaviors to comply with managed care practices.

Attitude of Health Personnel↗

PubMed2002

The effect of acarbose on the colonic transit time of elderly long-term care patients with type 2 diabetes mellitus.

BACKGROUND: Constipation is common in elderly patients with diabetes mellitus (DM); its prevalence is estimated as up to 60% among patients with diabetic neuropathy. Acarbose, an alpha-glucosidase inhibitor, has a beneficial role in controlling DM, although one of its side effects is diarrhea. This study evaluates the efficacy of acarbose in improving constipation using transit time (TT) studies in elderly long-term care (LTC) patients. METHODS: Twenty-eight patients with type 2 DM and constipation were recruited for the study. TT was measured by radiopaque markers and was calculated separately for the four segments of the colon (ascending, transverse, descending, and rectosigmoid) and for the total colonic transit time (CTT). Segmental TT and CTT were evaluated in each patient before and after 1 week, and again after 4 weeks of treatment with acarbose. RESULTS: The mean baseline CTT measured in patients was 202 plus minus 136 hours. After 1 and 4 weeks of acarbose treatment, the baseline CTT significantly decreased to 149 plus minus 107 hours and 161 plus minus 97 hours, respectively (p <.002). For each segment studied, the TT was shortened, but it reached significance for the ascending and transverse colon only (p <.02 and p <.03, respectively). The effect of diet composition was examined. The amount of fiber consumed correlated with shortened CTT, while fat tended to be in negative correlation with TT. CONCLUSIONS: Acarbose therapy reduced the extremely prolonged CTT in LTC diabetic persons with constipation. The drug could be useful in relieving constipation in these patients, in addition to its beneficial effect in the control of diabetes.

Acarbose↗

PubMed2001

Child care in Slovenia: an example of a successful transition.

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full-time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971-1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in-kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three-quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three-quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.

Child Day Care Centers↗