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1
Manogaran, Myuri. "Managing Transitions of Care: An Examination of Parents’ and Providers’ Perspectives on the Transitions of Care of Neonatal Patients from the Neonatal Intensive Care Unit." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/35751.
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Objectives: Transitions of care (ToC) for a high-risk neonatal population, and in some cases inappropriate and early discharge, can have important implications for community and broader population health. As it is a key indicator of the efficiency of the system of health services, the ease of ToC has been a priority for improving care outcomes across all settings in our nation’s healthcare system. Research shows that inappropriate discharges can lead to negative outcomes for patients and their families, health professionals, and the health system. Collaboration amongst the health care professionals, the community, and the patient’s family is needed for an efficient transition. This research examined how interprofessional collaboration (IPC) can act as a catalyst for efficient and effective ToC from a high-risk neonatal unit to care back in the community.
Approach: Twelve infants were observed from their admission on the Neonatal Intensive Care Unit (NICU) until their discharge home. The 12 consisted of four patients discharged directly home, four to another unit within the same hospital, and four to another institution. Stage one involved a document analysis of documents related to ToC policy on the NICU. Stage two involved observation. Stage three involved interviews with healthcare professionals (HCPs) in the hospital and community (n=30) and family members (n=12). Stage four consisted of deliberative workshops with the hospital management and research participants to share the results and obtain their feedback.
Results: Including parents early in the ToC planning process helps parents feel they’re a part of the interprofessional care team, in-charge of their infant’s care and thus better equipped mentally to handle their infant’s ToC. Knowing early on their infant’s discharge plan allows parents the opportunity to ask questions regarding caring for the infant at home or to meet the new healthcare team at the new site (hospital/floor) prior to the transfer. Mechanisms need to be in place to ensure that communication regarding ToC is consistent and clear to and between all HCPs whether in the hospital (e.g. bedside nurse) or in the community (e.g. family doctor). Having a clear understanding of what information should be transferred during a ToC will prevent unnecessary tests and misunderstandings. Increasing HCPs’ knowledge of available community resources will aide in transitioning infants to community care and thus freeing bed space and decreasing unnecessary costs at the hospital (i.e. A feeding and growing baby can be weighed by family doctor or Rapid Response Nurse and not necessarily the neonatologist). A consistent ToC policy across all NICUs would also be beneficial to ensuring a smoother ToC of infants.
Conclusion: It is believed that communication and education in an interprofessional context is critical for more efficient and effective ToC of neonates.
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Bristol, Alycia, and Alycia Bristol. "Family Caregivers' Experiences during Transitions Occurring within an Acute Care Facility." Diss., The University of Arizona, 2016. http://hdl.handle.net/10150/621796.
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Background: Family caregivers represent a critical component in the management of the health of older adults. The inclusion of family caregivers during transitions occurring between hospital and community settings has been previously considered. However, the experience of family caregivers during transitions occurring within the same setting remains unclear. The purpose of this study was to describe the experiences of family caregivers during transitions occurring within an acute care setting. Method: A qualitative description study was conducted. Semi-structured interviews were conducted with 10 family caregivers. Interviews were audio-recorded and occurred in person or over the telephone. Analysis included coding of interview data and the development of overarching themes. Findings: In this study, family caregivers reported the following themes. These themes included: "a lack of central brain during hospitalization," "muddling through transitions alone" and "wariness towards the care delivery system. The environmental influence of the hospital setting influenced family caregivers' view of the care provided by healthcare professionals and the transitions occurring between different units. Furthermore, half of the family caregiver participants (n=5) identified as having a background in healthcare. Healthcare professionals as family caregivers (HCP-FCs) reported unique experiences from other non-healthcare family caregivers. Interviews and field notes from HCP-FC participants were analyzed separately following the same procedures as the larger study. Three themes emerged including, "seeking inclusion," "insider perspectives," and "role struggle." Conclusion: Experiences of HCP-FCs and family caregivers during hospitalization of older adults have the potential to influence perceptions regarding transitional events occurring within acute care settings. Additionally, family caregivers' and HCP-FCs' perceptions of care coordination among healthcare professionals had the potential to negatively influence perceptions of transitions occurring within the acute care setting.
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Campbell, Nancy, and University of Lethbridge School of Health Sciences. "Transitions in death : the lived experience of critical care nurses." Thesis, Lethbridge, Alta. : University of Lethbridge, School of Health Sciences, 2008, 2008. http://hdl.handle.net/10133/653.
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Critical care nurses often face the ordeal of witnessing a patient's death in a tense and stressful environment. Anecdotal stories shared among nurses reveal that unusual experiences often occur at the time of or after a patient's death. This hermeneutic phenomenological study explored the meaning of these experiences for critical care nurses. Using Parse's research method, in-depth interviews were conducted with six critical care nurses who described their experiences at the time of a patient's death as well as during the post-death period. These experiences brought a sense of peace and comfort to each individual as well as reinforced their individual belief patterns about life after death. A distinctive sense of nursing knowing at the time of death was also identified. The findings of this study indicate that the experiences of the phenomenon of death by critical care nurses have a significant impact on each individual and that further research and understanding of this impact is needed.ix, 113 leaves ; 29 cm.
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John, Jaison, Jessie Feathers, Tyler Morgan, Neha Barakam, and Jodi Polaha. "Utility of Incorporating Behavioral Therapy in Transitions of Care Clinics." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/asrf/2020/presentations/14.
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TCC (Transitions of care clinic) is a specialized clinic visit where patients present to their primary clinic after a hospital stay. TCC deploys an interprofessional team to address a gamult of patient concerns. Traditionally, TCC interprofessional team includes a nurse and a doctor. The nurse calls the patient’s house within 2 days to check up on the patient and then they schedule a clinic visit, usually within 7-14 days. However it has been proposed that addition of team members from other disciplines could contribute to better health outcomes for patients seen in TCC. We studied a TCC model with an interprofessional team of not only physicians and nurses but also pharmacists and behavioral therapists for two months. Our aim was to uncover the utility of having a behavioral health team member in TCC visits. This was a prospective study of patients who attended a TCC clinic in a residency setting. An observer collected data on the time the behavioral health provider was in the patient room and the interventions/consultations he/she provided. Data collection is ongoing. We expect to find the following: the percentage of patients within TCC who utilized some form of behavioral therapy in their TCC visits; the percentage of common interventions that were used; average time spent in each visit; average age of patients; and average number of hospitalizations per patient. We expect that these results will demonstrate how behavioral health providers function on interprofessional TCC teams.
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McDonald, Kate. "Transitions to Adulthood for Children with Special Health Care Needs." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/202697.
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Background: Every year in the United States approximately half a million youth with special health care needs (SHCN) turn 18. Little is known about how this population fares during the transition to adulthood. Purpose: To examine transitions to adulthood for young adults with SHCN. Methods: Using data from two national longitudinal surveys: the Panel Study of Income Dynamics and the Survey of Adult Transitions and Health, I built linear and logistic regression models to evaluate the relationship between having a history of SHCN during childhood and key transitional outcomes during young adulthood (e.g., mental health status, educational attainment, employment, financial independence and subjective indicators of adulthood). A second set of logistic models examined associations between hypothesized risk and protective factors during childhood (e.g. family financial burden, care in a medical home and access to adequate insurance) and physical health outcomes during young adulthood for youth with SHCN. Multivariate models were adjusted for key confounders. Results: The majority of youth with a history of SHCN were doing well during the transition to adulthood. That said, compared to young adults without a history of SHCN, young adults with a history of SHCN were in significantly worse mental health (adjusted OR of experiencing a non-specific psychological disorder 3.90, 95% CI 1.78-8.53) and had significantly lower odds of graduating from high school (adjusted OR 0.55, 95% CI 0.32-0.96), attending college (adjusted OR 0.61, 95% CI 0.38-0.96), and receiving financial assistance from their families (adjusted OR 0.56, 95% CI 0.38-0.83). Amongst young adults with a history of SHCN, family financial burden during childhood significantly decreased the odds of being in good physical health during the transition to adulthood. There was limited evidence that receipt of care in a medical home or access to adequate insurance during childhood increased the odds of being in good physical health for young adults with a history of SHCN. Conclusions: These findings have important policy implications for programs serving youth with SHCN. Specifically, mental health and educational services may need to be expanded and more emphasis placed on addressing the non-medical determinants of health, like family financial burden.
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Morgan, Héloïse Dominique. "How children in care cope with transitions : child and adult perspectives." Thesis, University College London (University of London), 2010. http://discovery.ucl.ac.uk/10019948/.
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Holup, Amanda A. "Care Setting of the Last Resort: Care Transitions for Nursing Home Residents Directly Admitted from the Community." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6257.
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Since the late 1980s, policymakers have attempted to reduce the institutional bias of their long-term services and supports by investing in more accessible home and community-based services for older adults with long-term care needs and adults with disabilities. To further advance rebalancing discussions, this study examined the resident, facility, and state characteristics associated with the admission of community-dwelling older adults to the nursing home and the subsequent discharge of this population back to community settings. Data from the Minimum Data Set (MDS) 2.0 were used to construct episodes of care for all newly-admitted residents aged 65 and older to any free-standing U.S. nursing home. Several secondary datasets including the Online Survey, Certification, and Reporting Database (OSCAR), LTCFocus.org website, Nursing Home Compare, Nursing Home Data Compendium, and U.S. census estimates were used in the study analyses.
On average, approximately 5.3% of all newly admitted nursing home residents were admitted directly from home with substantial variations across states. Most residents admitted directly from home had limited to extensive dependency in activities of daily living and moderate cognitive impairment. The most common diagnoses on admission included dementia and diabetes. While 31% of residents admitted from home remained in the facility at least 365 days after admission, 32% were discharged to the community, 15% were discharged to the hospital, and 21% died. Most residents admitted from assisted living communities, either remained in the facility or died by the end of the study. Findings from multivariate analyses suggest that resident-level factors, including demographics and health status, influenced the community transition of nursing home residents. Facility characteristics, including ownership, deficiency scores, the ratio of Medicare and Medicaid residents, and urban location were associated with discharge to the community but the effect of these factors differed according to length of stay. The commitment of a state to home and community-based services was also predictive of community discharge. Collectively, findings suggest that resident, facility, and state characteristics influence the community discharge of residents admitted from home or assisted living communities. By understanding the reasons for admission to the nursing home and the factors influencing discharge from the facility, policymakers and administrators can better anticipate and care for community-dwelling older adults with long-term care needs.
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Huyer, Gregory. "Transitions of Care for People with Dementia: Predictive Factors and Health Workforce Implications." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37330.
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As the population ages, policymakers struggle to cope with the increasing demands for home care and institutional long-term care. This thesis project focuses on factors associated with the transition from home to institutional care for people with dementia. Using health administrative data at a population level, we construct a multivariable model that estimates the time between home care initiation after dementia diagnosis and placement in a long-term care home. From the model, we identify protective factors that allow people with dementia to remain at home for longer, with a particular emphasis on the health workforce and the contribution of formal and informal caregivers to delaying the transition from home to institutional care. Together, these results inform policymakers in capacity planning and in determining where investments should be targeted to maintain people with dementia at home, along with the associated health workforce implications.
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McLain, Heather Mae. "Improving Care Transitions in Patients with Heart Failure: An Integrative Literature Review." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5376.
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Heart failure (HF) hospital readmission reductions are linked to nursing interventions that include scheduling a hospital follow-up appointment with the patient's health care provider within a week of discharge. Yet, patients often leave the hospital without an appointment scheduled. The focus of this integrative literature review was on analyzing data that associated follow-up within 7 days with reduced 30-day readmissions. A search of articles using CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, and ProQuest databases resulted in 4,813 articles retrieved using the following search terms: heart failure, readmissions, follow-up appointments, and heart failure guidelines. Scholarly articles selected for inclusion were published between January 1, 2007, and June 30, 2017, in the English language, regarding studies completed in the United States, available online in full text, and specific to patients with HF. The Melnyk Critical Appraisal Guide was used for the appraisal, evaluation, and synthesis of the evidence. The transitional care model served as the theoretical framework for the project. A key finding of the review was that follow-up appointment scheduling within 7 days was associated with a modest reduction in readmissions; more research is needed to produce additional evidence on this topic. Project dissemination may result in positive social change by raising awareness of health disparities and empowering patients and staff to work collaboratively. Through improved communication and follow-up between patients and the interdisciplinary team, patients with HF may be able to experience improved disease management and a reduced number of hospitalizations.
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Hardy, Darla P. "Developing a Clinical Practice Guideline for Improving Communication During Transitions of Care." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6790.
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Transition of care refers to the movement of patients between health care settings; it occurs each time patients move between providers within the same setting or between settings based on the patient's acute or chronic health care needs. Care transition includes the efficient and accurate exchange of information needed to provide high-quality continuity of care. A rural community hospital in in the northeastern region of the United States has a skilled nursing facility and an acute care hospital on one campus. This project focused on the development of a clinical practice guideline (CPG) for the hospital to improve communication during transitions of care. The Iowa model of evidence-based practice informed the development of the guideline. A project team developed the CPG. Five multidisciplinary experts reviewed the CPG using the appraisal of guidelines for research and evaluation (AGREE II) evaluative tool. Results for the 6 domains of the AGREE II tool showed experts' agreement greater than 90% with the guideline as developed. The creation of a CPG to improve communication during care transition could benefit nurses with improved clinical decision making and patients with improved outcomes. The CPG could impact social change by supporting the application of the principles of evidence-based nursing practice, which could result in improved care and patient outcomes.
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Tessier, Nicholas. "Three Studies of Transitions of Young People in Public Care: A Focus on Educational Outcomes." Thesis, Université d'Ottawa / University of Ottawa, 2015. http://hdl.handle.net/10393/32466.
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The educational outcomes of children in care, as they prepare for and eventually complete the transition out of care, have been the subject of a growing body of research. Despite the progress made, no unified theory of risk and protective factors associated with educational outcomes has yet arisen from the longitudinal, cohort, and cross-sectional studies conducted with youth in care. This dissertation presents three papers that examine the effects of risk and protective factors on a range of educational outcome variables. The studies follow the timeline of a young person preparing for transition, moving into supported transitional living, and then eventually exiting care altogether.
Study 1 presents cross-sectional and longitudinal tests of the generalizability of many of the risk and protective factors identified by O’Higgins, Sebba, & Gardner (2014) in their systematic review of predictors of educational achievement among young people living in foster or kinship care. The cross-sectional sample consisted of 3,662 young people aged 12 to 17 years who were residing in out-of-home care in Ontario, Canada. An additional longitudinal sample was composed of a subsample of 962 young people from the cross-sectional sample who had also been assessed 36 months later with the AAR-C2-2010 during year 13 (2013-2014) of the OnLAC project. Supporting evidence for twelve of the twenty factors identified by O’Higgins et al. are revealed in the broad cross-sectional study and for the four factors that were found to predict change in academic success over a longitudinal timeframe suggest we are on the right track. Study 2 uses a lag-as-moderator approach to see if the time between assessments influences the predictive capacity of variables assessed when the young person was in care to predict educational variables evaluated when the youth had completed the transition to support independent living. Results from this thorough methodological study of gap length over six years of OnLAC data are encouraging: 87.5% of the predictors tested for statistical moderation effects by the length of time between assessments were shown to be stable predictors across all gaps (i.e., no moderation by gap length effect). Study 3 presents a pilot 12-month follow-up study conducted with young people at the point of a major transition within or from child welfare services, comparing their characteristics with those of samples from the general population.
When assembled together, the three studies provide a foundation towards the formalizing of a list of risk and protective predictors of educational outcomes (namely, academic success, educational attainment, educational aspirations, and NEET status) originally selected from a systematic review that identified a range of factors to be associated with the educational outcomes of youth in care (O’Higgins, Sebba, and Gardner; 2014). Additionally, this dissertation presents a series of recommendations regarding the management and multiple imputation of missing data and the use of Lag as Moderator statistical methods in child welfare research.
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Logue, Melanie, and Jennifer Drago. "Evaluation of a modified community based care transitions model to reduce costs and improve outcomes." BioMed Central, 2013. http://hdl.handle.net/10150/610029.
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BACKGROUND:The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.METHODS:Focusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.RESULTS:In addition to high levels of patient satisfaction with the care transitions program, participants' confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.CONCLUSIONS:While there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.
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Lage, Daniel E. "Predictors of Potentially Burdensome Transitions of Care for Hospitalized Patients With Advanced Cancer." Thesis, Harvard University, 2017. http://nrs.harvard.edu/urn-3:HUL.InstRepos:32676126.
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Background: Patients with advanced cancer experience frequent hospitalizations and potentially burdensome transitions of care post-discharge that could negatively impact the quality of their end-of-life care. We examined predictors of discharge location for patients with advanced cancer, including patient-reported physical and psychological symptoms, and assessed the relationship between discharge location and survival.
Methods: We prospectively enrolled patients with advanced cancer who experienced an unplanned hospitalization at the Massachusetts General Hospital from September 2014 to March 2016. Upon admission, we assessed patients’ physical symptoms (Edmonton Symptom Assessment System [ESAS]; 0-10) and psychological distress (Patient Health Questionnaire 4 [PHQ-4]; 0-12). The PHQ-4 includes depression and anxiety subscales. We used logistic regression models to identify predictors of discharge to location other than home, including post-acute care (PAC) [skilled nursing facility or long term acute care hospital] or hospice [any setting]. We used Cox proportional hazards models adjusted for clinical variables to assess the relationship between discharge location and survival.
Results: Out of 932 patients, 726 (77.9%) were discharged home, 118 (12.7%) to PAC and 88 (9.4%) to hospice. Compared with patients discharged home, those discharged to PAC or hospice had higher symptom burden, including dyspnea, constipation, low appetite, drowsiness, low wellbeing, fatigue, depression, and anxiety (all p < 0.05). Using logistic regression, patients not discharged home vs. home were more likely to be older (OR 1.03, p<0.0001), live alone (OR 1.95, 95%CI: 1.25-3.02, p<0.003), have impaired mobility (OR 5.08, 95%CI: 3.46-7.45, p<0.0001), longer hospital length-of-stay (OR 1.15, 95%CI: 1.11-1.20, p<0.0001), higher ESAS physical symptoms (OR 1.02, 95%CI: 1.003-1.032, p<0.017), and higher PHQ-4 depression symptoms (OR 1.13, 95%CI: 1.01-1.25, p<0.027). Patients discharged to hospice vs. PAC (reference) were more likely to receive palliative care consultation (OR 4.44, 95% CI: 2.12 to 9.29, p < 0.0001) and have shorter length of stay (OR 0.84, 95% CI: 0.77 to 0.91, p < 0.0001). Compared with patients discharged home, those discharged to PAC had lower survival (HR 1.53, 95% CI 1.22-1.93, p < 0.0001).
Conclusions: Patients with advanced cancer discharged to PAC or hospice have substantial physical and psychological symptom burden and poor physical function, and those discharged to PAC have similar symptom burden and clinical characteristics compared to those discharged to hospice, except for higher rates of palliative care consultation and shorter lengths-of-stay for the hospice group. Patients discharged to PAC also have inferior survival compared with those discharged home. This study has identified a sub-population of patients with advanced cancer discharged to PAC after an unplanned admission, which may benefit from targeted interventions to reduce potentially burdensome care transitions and improve the quality of their end of life care. Future studies should attempt to replicate these findings in a larger, more diverse population, and explore the role of care financing issues and patient preferences in driving post-discharge decision-making at the end of life.
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Sibayan, Juanita. "Family Relational Experiences During Major Transitions with a Chronic Illness." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5266.
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Although health care transitions have received some attention in the literature, few researchers have emphasized family relational experiences and communication during major changes while living with a chronic illness. The purpose of this phenomenological study was to understand the lived experience of parents and their adult children while transitioning from pediatric to adult care of a chronic illness. The bio-psychosocial theory, family systems theory, and attachment theory established the context for this study. A criterion-based sampling technique and snowball sampling were used to recruit 7 parents and 6 of their adult children aged 18 to 30 years who were diagnosed with cystic fibrosis or congenital heart disease, and who had either completed or were in the process of completing the transition from pediatric to adult healthcare. Semi-structured interviews were conducted, and content analysis was used to code and analyze themes that emerged from the experiences of participants. The themes that were identified included that parents were instrumental in maintenance of treatments during high risk periods of adolescence, healthy parent and child relations included collaboration that accommodated autonomy, and that early coaching helped reduce parental anxiety about non-adherence while increasing the self-efficacy of the child. This study contributes to positive social change by informing the design of current procedures to transition young adults with chronic illness by recommending flexibility in negotiations, early education, shadowing between facilities, and incorporating evidence-based practice based on feedback from each family member.
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Hodges, Matthew. "The effect of labor market transitions of the near elderly on access to care." CONNECT TO ELECTRONIC THESIS, 2007. http://dspace.wrlc.org/handle/1961/4132.
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Nambisan, Rohit. "An enterprise architecture evaluation of the Improving Massachusetts Post-Acute Care Transitions (IMPACT) Program." Thesis, Massachusetts Institute of Technology, 2014. http://hdl.handle.net/1721.1/107584.
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Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, School of Engineering, System Design and Management Program, Engineering and Management Program, 2014.Cataloged from PDF version of thesis.
Includes bibliographical references (page 87).
The Post-Acute Care Transfer process is a critical area affecting the quality and safety of patient health care in the US'. While many Post-Acute Care (PAC) centers are Electronic Health Record (EHR) -enabled, a large majority of these centers, such as nursing home and home care, are not set up for exchange of electronic health information. Regardless of EHR capabilities, there are currently no standards for health information transfer between PAC sites. The lack of standard and effective processes to collect and transfer critical patient health information during PAC transitions may be a critical component leading to issues with patient safety and quality during PAC Transitions. Additionally, issues resulting from Post- Acute care transitions (PAC transitions) are implicated as critical drivers for health care utilization in the US (2012 Medicare Chart Book). Funded by an Office of the National Coordinator Health Information Exchange challenge grant, Improving Massachusetts Post-Acute Care Transfers (IMPACT) is an innovative project managed by the Massachusetts eHealth Institute (MeHI) that will improve care transitions to and from post-acute care organizations in Massachusetts through the automation of a new Universal Transfer Form UTF for PAC transitions. Additional technical work includes creation of the Local Area Network Device (LAND) & Surrogate Electronic Environment (SEE) platforms, which together allow long-term care providers to send and receive patient information electronically through the Massachusetts HIway. MeHI is a SDE and recipient of American Recovery and Reinvestment Act (ARRA)/Health Information Technology for Economic and Clinical Health (HITECH) federal funds to create an HIE infrastructure in Massachusetts. MeHI seeks a thorough program evaluation of the IMPACT program. Due to the complex organizational, political, and technological architecture associated with the Post-Acute Care transitions and the interface between LAND & SEE and the HIway, a systems perspective is needed to accurately evaluate and provide recommendations to meet the needs of the program. The following describes the current state assessment for both 2012 and 2013 IMPACT program following the Enterprise Strategic Analysis for Transformation (ESAT) and Enterprise Architecting (EA) methodologies developed out of MIT's Sociotechnical Systems Research Center. Additionally, consideration is given to a future state assessment, which is the ideal set of future state goal derived through a visioning workshop with key stakeholders.
by Rohit Nambisan.
S.M. in Engineering and Management
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Morrow, Ross Dianne. "Healthcare transitions and the aging population a framework to measure the value of rapid rehabilitation /." Orlando, Fla. : University of Central Florida, 2008. http://purl.fcla.edu/fcla/etd/CFE0002130.
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Berube, Kristyn M. "Parents’ Experience of the Transition with their Child from a Pediatric Intensive Care Unit (PICU) to the Hospital Ward: Searching for Comfort Across Transitions." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/23846.
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The pediatric intensive care unit (PICU) has been described as a stressful place for parents of critically ill children. Research to date has examined parents’ needs and stressors with a child in PICU. There is a paucity of research examining the experience for parents of a child who is transferred from the PICU to the hospital ward. Open-ended interviews were conducted with 10 parents within 24-48 hours after transfer from a PICU to a hospital ward at a children’s hospital in Canada to understand this experience. Parents revealed that the experience involved a search for comfort through transitions as expressed through the themes of: ‘being a parent with a critically ill child is exhausting’, ‘being kept in the know’, ‘feeling supported by others’, and ‘being transferred’. The findings from this study can help nurses and other health professionals working with parents to support them through the transition from PICU. Recommendations are made for the inclusion of family-centered care practices to assist parents through transitions.
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Haynes, Helena. "A Doctor of Nursing Practice-Led Transitions of Care Model for Stroke and Transient Ischemic Attack." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/293391.
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Background/Objectives: Gaps in care due to the movement of patients between health settings and/or practitioners, known as transitions of care (TOC), may contribute to second stroke or TIA events. The elements that impact TOC in the stroke/TIA population have not been fully elucidated. The purpose of this study is to identify key elements of a Doctor of Nursing Practice-led TOC model that could be used to develop and evaluate a TOC program for the stroke/TIA population. Design: A descriptive study was performed to 1) identify elements that may affect transitions of care using a stroke database and post-discharge phone surveys and 2) based on information from Aim 1, propose a DNP-led TOC model specific to the stroke/TIA. Setting: An urban primary stroke center in the southwest United States. Participants: All patients in the GWTG®-stroke database from May 1 - December 31st, 2012 and patients who consented at discharge from the stroke unit following a stroke or TIA. Measurements: Patient demographics including: length of stay (LOS), age, race, ethnicity, comorbidities, insurance, discharge status, thirty-day readmission rate, and follow up survey. Results: Patient data (n=276) from GWTG®-stroke database was obtained. Average LOS was 7.81 +/- 11.15 days. The majority of patients were greater than age 65 (59%); 53% relied on Medicare support; those age 50-59 (21%) were most likely to be uninsured (47%). Fifty-one percent were discharged directly home, 48% of those were referred to outpatient rehab services. Two-thirds received rehabilitation services during hospitalization. Eight patients experienced a subsequent hospital readmission; two of those had a repeat stroke event. Although patients reported understanding their discharge instructions, their perception of ongoing care was poor. Conclusion: Key elements of a TOC model specific to the stroke and TIA patient population could include: patient surveillance, comprehensive care planning, follow-up, stroke education and point of contact. Advanced practice nurses have been successful in leading such programs, and a DNP-led model providing continuity of care would support the transition of an effective model into clinical practice.
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Head, Annabel. "How people with Intellectual Disabilities experience transitions through the Transforming Care programme : a grounded theory study." Thesis, University of Hertfordshire, 2017. http://hdl.handle.net/2299/19457.
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Following the exposure of abuse of people with Intellectual Disabilities (ID) at Winterbourne View, the Government launched the Transforming Care programme, to support people to transition out of hospital into their own home. A literature review revealed limited research into people with IDs experiences of transitioning. The study aimed to explore how transitions through Transforming Care were experienced. Eleven people with ID were interviewed about their experiences, with ten nominating a Key Support Person to be interviewed alongside them on a second occasion. Interviews were analysed using a Social Constructionist Grounded Theory methodology. The model demonstrated that participants experienced transitioning as a highly complex process of managing change. In hospital, how participants were seen by significant others and how they saw themselves resulted in a 'restricted story'. In moving to the community, participants and those around them were able to shift ideas about who they were, allowing for a 'widening out' of their story. Participants discussed seeking a sense of safety in new relationships, managing loss, and going through uncertainty as part of the process of transitioning. The findings of this study demonstrate that transitioning is not a single event, but an ongoing process over time. Clinical implications include ensuring that people with ID feel prepared about their move and the importance of staff understanding peoples' behaviours within a wider context.
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Baldwin, Debra Anne. "Growing up in and out of care : an ethnographic approach to young people's transitions to adulthood." Thesis, University of York, 1998. http://etheses.whiterose.ac.uk/10810/.
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Söderqvist, Åsa. "The (re)construction of home : Unaccompanied children’s and youth’s transition out of care." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ. SALVE (Socialt arbete, Livssammanhang, Välfärd), 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-34617.
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This dissertation focuses on how perceptions of ethnicity and culture become meaningful in relation to the transition from care into independent living, studied from unaccompanied youths’, professionals’, and a methodological perspective. The findings from interviews with unaccompanied youth with experience of leaving care showed that thoughts about their ethnic minority background are constantly present in the young men’s lives. Their stories about preparing to leave care show a continuous attempt to make adjustments in order to fit into the Swedish society (Study I). The results based on interviews with professionals and observations at two residential care units indicated that ‘home’ is sometimes used as a metaphor when describing the residential care units. The home metaphor affected the staff in ways that it sometimes became difficult to separate private and professional matters. The clash between the residential care unit and the desire to create a home environment highlights the issue that programs executed in Sweden for unaccompanied young people were originally not made for them (Study II). Study III emphasised how transnational relationships form the unaccompanied youths view of past, present, and future time. This study highlighted the importance of how the professionals need to understand the unaccompanied children and youth and their situation as flexible (Study III). Finally, methodological reflections about research concerning ethnicity indicated the importance of reflecting on one’s own perceptions, the role as a researcher, and the benefits and limitations these different roles may have in the research process (Study IV). The research was conducted using qualitative methods. The data collection methods entailed interviews with the youth (Study I), individual interviews, focus-groups, and observations with professionals (Study II and III), and discussions based on the data collected for study I-III (Study IV). Altogether, 11 youths (18-22 years) and about 20 professionals at the residential care units participated in the studies. Qualitative content analysis was used to analyse the individual interviews and the focus-groups. All interviews were transcribed verbatim for analysis. The empirical data from observations consisted of notes taken during everyday situations, as well as from short conversations with the professionals. The notes were analysed using qualitative content analysis. The combined results of study I-III were used as empirical data for the analysis in study IV. This dissertation shows that (re)constructing a home is a central part of the care-leaving process for a migrant about to resettle in a new country. The greatest challenge the unaccompanied youth have to conquer during the transition from care to independent living is to fight against exclusion. The main purpose in (re)constructing a home appears to be the same for the youth and the professionals, namely, to reach a sense of safety and belonging. However, different conditions and points of departure may make it hard to agree on details such as what the meaning of belonging actually is, and if it is possible to develop a tailor-made solution. Researching issues of ethnicity comes with the responsibility to avoid reinforcing an ‘us’ versus ‘them’ and, in so doing, reinforce stereotypes.
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Gadoud, Amy Catherine. "A palliative care approach for people with advanced heart failure : recognition of need, transitions in care and impact on patients, family carers and clinicians." Thesis, University of Hull, 2013. http://hydra.hull.ac.uk/resources/hull:10057.
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Background: Despite international and national consensus guidelines, patients with advanced heart failure (HF) have significant unmet palliative care needs. UK policy recommends identification of those requiring palliative care based on prognosis (last year of life). However, HF has an unpredictable course, and clinicians might not discuss a palliative approach for fear of causing alarm and destroying hope. Aim: To explore aspects of a palliative care approach for people with advanced HF: recognition of need, transitions in care and impact on patients, family carers and clinicians. Methods: Mixed method study with integration of findings. Systematic literature review of prognostic variables associated with the last year of life in HF. Analysis of General Practice Research Database (GPRD) records to compare recognition of the need for palliative care between cancer and HF patients. Qualitative semi-structured interviews with patients receiving a palliative approach to care, their carers and clinicians. Findings: GPRD data demonstrated gross inequity between documented recognition of the need for a palliative care approach; HF patients were poorly represented on the palliative care register, and those that were, were registered close to death. Prognostic markers, identified in both the systematic review and GPRD, had limited clinical usefulness for identifying the last year of life. From interview data, clinicians appeared reluctant to discuss a palliative care approach without clear irreversible deterioration of the patient. However, patients welcomed, and some initiated, conversations regarding the change in focus of care. Following such discussion all involved found this approach beneficial, even with subsequent periods of stability or improvement. Other barriers included lack of recognition of symptoms by clinicians and difficulties in delivering proactive care. Conclusions: A palliative care approach before the very end of life is beneficial in this group. A problem-based flexible approach to recognising the need for palliative care, rather than prognosis is recommended.
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St-Jean, Mélanie. "Exploring the Transitions Associated with Aging in Two Northern First Nations Communities." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24204.
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First Nations people have experienced dramatic life changes in a very short period of time. The process of change was not a conscious decision made by First Nations peoples but rather the result of successive stages of European contact and formal colonization by what is now the government of Canada. With such constant changes and the history of assimilation that overshadows the Aboriginal population, it is becoming difficult for Elders to sustain their roles within the family unit and in their community as a whole. This study provides a description of the oral accounts of Elders living in two remote First Nations communities in Northwestern Ontario. I conducted three summers of ethnographic research that involved participant observation of local cultural practices and 12 semi-structured interviews from 2009 to 2011. Guided discussions with Elders about their lives and their relationship to the land provide important insight into local cultural and personal values. Three primary themes emerged from the conversations with the Elders about life during the childhood: the intense physicality of life in the past, the connection between health and local foods and the changing role of Elders. Findings suggest that Elders are eager to transmit their knowledge to provide a healthier lifestyle for future generations. In addition, I provide a description of the current living conditions of Elders in both communities. First Nations Elders, who were once crucial to the survival of a band, are now facing the highest degree of vulnerability and are desperately searching for a new identity that gives them purpose. Meeting with Elders in their homes and at several community events provided insight into their lives and the challenges they are currently facing. These challenges and experiences are hardly one-dimensional, as they each have varying degrees of family support, financial stability and housing conditions. However, the consistent thread in all the cases was the ongoing struggle Elders have faced trying to reconcile traditional perspectives with the growing dominance of contemporary western lifestyle practices.
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Highsmith, McKenzie Calhoun, Jesse Gilreath, Peter Bockhorst, Kathleen White, and Beth Bailey. "Evaluation of an Innovative Transitional Care Clinic in an Interprofessional Teaching Practice." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/ijhse/vol7/iss1/5.
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During transitions of care, great opportunity exists for miscommunication, poor care coordination, adverse events, medication errors and unnecessary healthcare utilization costing billions of dollars annually. An Interprofessional Transitions of Care (IPTC) clinic was developed utilizing a Family Medicine team that included physicians, nurses, a clinical social worker, and a clinical pharmacist. The purpose of this study was to determine if utilization of an IPTC clinic prevented hospital readmission, and to identify factors that predict most benefit from an interprofessional approach to transitions of care. A retrospective chart review of 1,001 patients was completed. A treatment group (TG) of 501 patients were offered IPTC clinic appointments following hospital discharge. A control group (CG) of 500 patients were hospitalized and received traditional follow-up prior to development of the IPTC clinic. Traditional follow-up typically consisted of an automated appointment reminder and a physician office visit. Outcomes assessed included 30-day hospital readmission of TG versus CG, and whether patient characteristics predisposed specific patient groups to attend IPTC appointments or benefit more from IPTC participation. Compared with CG, patients who completed an IPTC appointment were 48% less likely to be readmitted to the hospital within 30 days. Patients with congestive heart failure and cellulitis particularly benefited from IPTC. Telephone contact within two business days of discharge was the greatest predictor of patients attending an IPTC appointment. These results demonstrate that an interprofessional approach to transitions in care effectively addresses this high risk for error and high cost time in the continuum of care.
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Evdokimoff, Merrily Nan. "Testing the Efficacy of a Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults." Thesis, Boston College, 2012. http://hdl.handle.net/2345/2911.
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Thesis advisor: Rosanna DeMarcoAbstract Testing the Efficacy of A Nurse-Led, Patient Self-Management Intervention to Decrease Rehospitalization in Older Adults Merrily Evdokimoff, Ph.D. Rosanna DeMarco, Ph.D., Committee Chair Rehospitalization rates of 20% within 30 days of hospital discharge and 27% within 60 days are one of the highest strains on the federal Medicare budget. The Center for Medicare and Medicaid Services (CMS) has responded by imposing financial disincentives in reimbursement regulations directed to those providers deemed responsible for preventable rehospitalizations. Identifying cost-effective interventions that are appropriate for individuals with chronic illnesses that may be provided within the current home health care system of reimbursement is critical. The purpose of this quasi-scientific intervention study was to test the efficacy of a cost-effective, nurse-led intervention to decrease rehospitalizations of community dwelling older adult Medicare beneficiaries receiving certified home health services following an acute care hospital admission. The intervention was based on Eric Coleman's Care Transition Intervention SM utilizing a personal health record, patient goal setting, and knowledge of "red flags" or changes in condition. Coaching by the home care nurses was added to Coleman's intervention to facilitate support of patient self-management. Three home care agencies, 60 clinicians and 87 patients participated in the study. Findings demonstrated a lower rate of readmission to the hospital in patients receiving the intervention. However, it was not statistically significant. Significant differences were noted between the intervention and the comparison groups including more married or partnered members and higher Case Mix Weight (CMW) or acuity score within the intervention group. Among the rehospitalized participants, provision of a greater number of skilled nursing visits was found. Future replication of the study should include a larger sample and greater time for education of the clinical staff. Inclusion of therapists and productivity adjustments for participating staff during initiation of study is also needed. Further examination of the role of depression in rehospitalization with a larger sample would provide greater understanding of the role depression plays in self-management and rehospitalization
Thesis (PhD) — Boston College, 2012
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Sivananthan, Saskia Nikali. "Diagnosis & disruption : understanding guideline-consistent dementia care and patterns of transitions experienced by individuals with dementia." Thesis, University of British Columbia, 2015. http://hdl.handle.net/2429/52306.
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Introduction Early detection and management, as outlined in dementia guidelines, can improve outcomes and potentially reduce the number of transitions experienced between care-facilities. The objectives of this thesis were to : conduct a critical assessment of the literature on actual versus guideline-consistent dementia care; use population-level data to examine variations in receipt of guideline-consistent dementia care; understand longitudinal patterns of transitions and the factors that contribute to transitions; and assess if receipt of guideline-consistent dementia care and/or high quality primary care are associated with the number of transitions experienced.
Method
Population-level administrative data in British Columbia were used to identify cohorts of individuals newly diagnosed with dementia in 2001/02 and 2009/10. Dementia guidelines were used to characterize clinical care individuals could receive. The proportion of patients diagnosed with dementia in 2009/10 who received guideline-consistent dementia care and the probability that patient characteristics affected the likelihood of receiving each process was assessed. Those diagnosed with dementia in 2001/02 were followed forward 10-years after the first point of diagnosis and points of care when transitions were highest as well as factors that contribute to those transitions were assessed. The association of receipt of guideline-consistent dementia care and/or high quality primary care with the number of transitions experienced in the year of diagnosis was assessed using negative binomial regression.
Results
Older patients were less likely to receive guideline-consistent dementia care. A quarter of the cohort received an antipsychotic or non-recommended benzodiazepine. Individuals living within rural health-authorities or of low income were more likely to receive antipsychotic treatment. Transitions were highest in the year of diagnosis and at end-of-life, driven by acute hospitalizations. Higher morbidity, living within rural health-authorities, and having behavioural symptoms associated with dementia were strongly associated with the number of transitions experienced. Lastly, receipt of guideline-consistent dementia care and high quality primary care, independently, were associated with fewer transitions across care settings.
Conclusion
Patterns of inequality by age and income may signal barriers to guideline-consistent dementia care. The spike in transitions in the year following diagnosis highlights a distressing period for individuals with dementia, but suggests a useful target for interventions.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Coe, Antoinette B. "Identifying Problems during Transitions of Care and Reasons for Emergency Department Utilization in Community-Dwelling Older Adults." VCU Scholars Compass, 2015. http://scholarscompass.vcu.edu/etd/4022.
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A mixed methods approach was used for this study. The setting was a low-income, subsidized housing apartment building for community-dwelling older and younger disabled adults identified as a health care hot spot due to high rates of ambulance use. The study purpose was to identify reasons for ED use and problems during transition from ED to home, predictors of zip code 23220 (health care hot spot) in emergent and non-emergent ED visits, and predictors of total ED costs in community-dwelling older adults living in a health care hot spot. Semi-structured interviews with residents who used the ED, an existing database from an interprofessional care coordination and wellness program for residents, and community-dwelling older adults’ electronic medical record and billing data from 2010-2013 ED visits from an academic medical center were used. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was utilized. A total of 14 interviews were conducted. Themes related to ED use included: high use of ambulance services, timely use of the ED or attempt at self-care, and lack of communication with a health care provider prior to ED visit. Themes related to care transitions were: delay in medication receipt after discharge, lack of a current medication list and personal health record, PCP follow-up instruction, and education on warning signs of a worsening condition. The interprofessional program’s care coordination activities were education, disease monitoring, referral for PCP visit, and discrepancy reconciliation. A total of 7,805 ED visits were included, of which 3,871 were non-emergent and 1,179 were emergent. Common primary ED visit diagnoses were chest pain and abdominal pain. White race, a Charlson Comorbidity Index score of 3, and a total disease count of 10 or more were significant predictors of zip code 23220 in non-emergent ED visits. White race was a significant predictor of zip code 23220 in emergent ED visits. Significant predictors of total ED costs were white or other race, arrival by ambulance, emergent visit type, and year of visit. Pain was a common reason for ED use. Care transition problems related to medication management and follow-up care indicate an area for targeted interventions after ED discharge.
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DeBoe, Joseph Charles, and Joseph Charles DeBoe. "A Needs Assessment for a Private Practice Based Transitional Care Program for Heart Failure." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626308.
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INTRODUCTION: While transitions of care (TOC) programs are known to decrease readmissions for heart failure (HF), significant policy and resource challenges inhibit the implementation of hospital based TOC programs, thus novel models of TOC are urgently needed. The purpose of this study is to evaluate the need and readiness of a private practice based TOC program led by DNP-prepared nurse practitioners.
METHODS: In this descriptive study, cardiology providers from a private practice in the Southwest (N=14) participated in a survey on HF TOC. The practice’s electronic medical records (EMR) database was queried for patient demographic data along with other HF measures (N=3175).
RESULTS: There were 1,827 females (57.5%) and 1,348 males (42.5%) with the mean age being 75.1 years +/-11.1. The 70-79 year age bracket represented 41.0% of all HF patients. The most common ICD-10 code for HF was [I50.32] Chronic Diastolic Congestive Heart Failure (N=986), which translates into 31.0% of the total HF population. Almost 30% of the providers (N=4) acknowledge that they never document their HF readmissions in the practice’s EMR. Nearly 65% percent of respondents “strongly agree,” that HF patients discharged from the hospital require a specific plan of care, while 86% of providers (N=12) either “somewhat agree” to “strongly agree” in the need for a TOC program for HF patients within their cardiology practice. Over 71% (N=10) of the providers “strongly agree” with a DNP-led TOC program for HF.
CONCLUSION: This study provides encouraging results for the future implementation of a cutting edge private cardiology practice based TOC program for HF in Tucson, AZ. The study results clearly indicate the need and readiness for the Tucson-based private practice TOC program for HF. The DNP prepared nurse practitioner is thoroughly prepared to take the lead in designing, implementing and evaluating such a program and this unique role was supported by the practice. Importantly, the results of this study may provide the foundation for future studies examining the effects of private practice based TOC programs for HF.
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Flora, Deanna. "MEDICATION-RELATED PROBLEMS EXPERIENCED BY PATIENTS DURING TRANSITIONS TO ASSISTED LIVING." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2944.
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Medication reconciliation is a systematic and comprehensive review of medication regimens during care transitions aiming to prevent adverse drug events. Poorly executed transitions negatively impact patient welfare and cause financial burden. Medication-related problems (MRPs) experienced during transitions to an assisted living facility (ALF) were evaluated. Data was collected from pharmacy records for transitions to an ALF over three months, including demographics, medications, potentially inappropriate medications, and MRPs. MRPs were categorized and summarized using descriptive statistics. Forty-five patients (71% female) experienced 59 transitions. Average age was 85.6 years. Median length of stay away from the ALF was three days. There were averages of 18.3 pre-transition medications, 12.5 medications in the discharge orders and/or upon ALF admission, and 15.9 final medications. 979 MRPs were identified, mostly no indication documented, followed by underuse, overuse, and non-adherence. Many of the identified MRPs are potentially preventable. Interventions are needed to reduce MRPs during ALF transitions.
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Darwishi, Mahboba, and Huda Mussa. "Närståendes upplevelser av att vårda en anhörig i livets slutskede i hemmet : En litteraturöversikt." Thesis, Ersta Sköndal högskola, Institutionen för vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-4745.
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Bakgrund: Enligt World Health Organization's (WHO) definition är palliativ vård en helhetsvård av patienten och dennes närstående genom ett professionellt sammansatt vårdteam. Palliativ vård är ett område där närståendes roll blir speciellt viktigt och hela familjen drabbas när en i familjen får en svår sjukdom. Många med svår sjukdom önskar att få vård i hemmet vid livets slutskede. När en person vårdas i hemmet är det ofta den närstående som tar vårdarrollen i hemmet och tar ansvaret över sin anhöriges vård. Närståendes engagemang i vården av deras anhörig kan påverka dem fysisk och psykiskt. Syfte: Syftet var att beskriva närståendes upplevelser av att vårda en anhörig i livets slutskede i hemmet. Metod: Metoden var en litteraturöversikt som baserades på elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna togs fram via databaserna CINAHL complete with full text och Medline. Resultat: Resultatet visade att närstående kände ett ansvar att vårda sin anhörige. Ansvarstagandet påverkade närståendes egen hälsa och deras dagliga liv. Jobb och hobby begränsades då fokus lades på den anhöriges behov. Att se sin anhörig bli försämrade i livets slutskede upplevdes särskilt svårt. Stöd från familj, vänner och sjukvårdpersonal underlättade att hantera vårdandet. Dock upplevde närstående otillräckligt stöd av hälso- och sjukvården när det gäller information, vägledning och förberedelse för vårdarrollen. Diskussion: Resultatet diskuterades mot Meleis transitons teori, relaterad till att de närstående genomgår en transition när de vårdar en sjuk anhörig. Vidare diskuterades vilken roll sjuksköterskan har för att hjälpa närstående att genomgå en hälsosam transition.Background: The World Health Organization (WHO) defines palliative care as a total care of the patient and their relatives, provided by a multi professional healthcare team. Palliative care is an area where the next of kin's role is particularly important because when a family member suffers from an illness it affects the whole family. Many people with serious illness wish to be cared for at home at the end of life. When a person is cared for at home, often the next of kins take the caring role and the responsibility over their relative's care. The next of kins involvement in the care of their loved one can affect them physically and mentally. Aim: To describe the next-of-kin's experiences of caring for a loved one at the end of life at home. Method: The literature review was based on eleven scholarly articles with a qualitative approach. Articles were gathered through database search in CINAHL complete with full text and Medline. Results: The result showed that the next of kins experienced a responsibility to care for their loved one. Taking responsibility influenced the caregivers own health and social activities. Work and hobbies were limited since focus was on their loved one's needs. To witness the deterioration of their loved one at the end of life was perceived particularly difficult. Support from the family, friends and health care professionals facilitated them to manage the care giving. However, the next of kin experienced insufficient support by healthcare when it came to information, guidance and preparedness for the caregiver role. Discussions: The result was discussed in relation to Meleis transition theory, because the next of kins were seen to go through a transition when they were caring for an ill loved one. Furthermore, the nurse's role was discussed with a focus on how to help the next of kin to undergo a healthy transition.
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Hillring, Sanna, and Emma Ljudén. "Sjuksköterskans möjlighet att ge god palliativ omvårdnad inom slutenvården. En litteraturöversikt." Thesis, Högskolan Dalarna, Omvårdnad, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:du-29467.
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Bakgrund: Dagens sjukvård är oftast inriktad på att bota och därför kan palliativ omvårdnad vara utmanande för sjuksköterskan som är ovan att arbeta nära döden. Sjuksköterskan har ett ansvar för att en god omvårdnad ska uppnås, även i palliativa situationer. Behovet av palliativ omvårdnad förväntas även öka vilket innebär att det är av vikt att studera hur sjuksköterskan kan ge en god palliativ omvårdnad till patienter som befinner sig i övergång från botande till palliativ vård. Syfte: Att beskriva faktorer som möjliggör att sjuksköterskan kan ge en god omvårdnad till patienter som befinner sig i övergång från botande till palliativ vård i livets slutskede inom slutenvården. Metod: En litteraturöversikt som bygger på 14 vetenskapliga artiklar som söktes fram via databaserna Pubmed, Cinahl samt PsycINFO. Resultat: Vikten av att identifiera och diagnostisera döendet hade betydelse för möjliggörandet av en god palliativ omvårdnad då det ansågs vara betydande för att palliativ vård påbörjades. Ett välfungerande samarbete i teamet hade också betydelse för att kommunikationen var god inom vårdprocessen. Sjuksköterskans attityder till palliativ vård samt hens relation med patienten var även de betydande faktorer för att möjliggöra en god omvårdnad till palliativa patienter. Slutsats: Resultatet visar att en god kommunikation i teamet är av stor vikt för att kunna leverera bra palliativ vård. Faktorer som visade sig underlätta kommunikationen var att vårdlaget arbetar mot gemensamma mål och vårdplaner samt att dessa dokumenterades för att öka kontinuiteten. Det har kunnat påvisats att undervisning om palliativ vård kan göra skillnad och på så sätt säkra att patienten får en bättre vård.Background: Today's healthcare is usually cure focused and therefore palliative nursing can be challenging for a nurse who is new to work close to death. The nurse has a responsibility in achieving good nursing care, including palliative situations. The need of pallitaive care is expected to rise which means there is a great importance in studying how the nurse can provide good care for patients transitioning from curative to palliative care. Aim: To describe factors that enable the nurse to provide good care to patients who are in transition from curative to palliative care in the end stage of life in the inpatient care. Method: A literature review based on 14 scientific articles who were found at Pubmed, Cinahl and PsycINFO. Results: The importance of identifying and diagnosing dying was important for enabling a good palliative care as it was considered to be significant in order to start palliative care. A well-functioning team-based collaboration also had significance to enable a good communication in the care process. The nurse's attitudes to palliative care and their relationship with the patient were also important factors for enabling good care for palliative patients. Conclusion: The result shows that good communication within the team were of great importance to deliver quality care in a palliative situation. To enable good communication the team should have a common goal, set up goals of care, and be sure to document those in order to maintain continuity. It has been shown that palliative education in the workplace can make a difference so that the patient gets better care.
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Fernandez, Mary Elizabeth Poteet. "A survey study of entry transition practices used by teachers of infants and toddlers." Thesis, University of North Texas, 2004. https://digital.library.unt.edu/ark:/67531/metadc4710/.
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This study identified transition practices used by teachers and/or primary caregivers of infants and toddlers when entering child care programs across Dallas , TX . Participants completed the Program Entry Transition Practices Survey regarding their use of transition practices in fall 2003 and perceived barriers to entry transition practices. Results show frequency tallies, percentages of use for each transition practice, and the mean number of practices used for the entire sample and with the sample split according to participants from profit and non-profit programs. Results were also organized into four subscales based on the type of practice used. Results supported the hypothesis that teachers and caregivers would report more transition practices occurring after beginning care and directed towards a group than those occurring before beginning care and directed towards an individual. In response to the broader research question regarding barriers: Teachers and caregivers from profit and non-profit centers reported similar barriers to implementing transition practices.
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Hyde-Dryden, Georgia. "Overcoming by degrees : exploring care leavers' experiences of higher education in England." Thesis, Loughborough University, 2013. https://dspace.lboro.ac.uk/2134/12260.
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Existing research has shown that care leavers are one of the most disadvantaged groups in society and are at particular risk of experiencing negative long-term outcomes including unemployment, homelessness and mental health problems. This thesis makes a contribution to knowledge in this area by focusing upon a group of care leavers about whom very little is currently known: care leavers in higher education. These are young people who despite the odds, have succeeded educationally and are overcoming their early disadvantage to make a successful transition from care into adulthood. This thesis uses Bourdieu's theory on transformation and reproduction in society and the concepts of capital, field and habitus to explore care leavers' experiences of higher education. It considers how the support available to care leavers from their local authorities and higher education institutions has developed since Jackson and colleagues (2005) Going to University from Care study first highlighted deficits in the level of support provided to care leavers. This thesis also compares the experiences of care leavers with students from other disadvantaged backgrounds to understand where care leavers have specific support needs as a result of not being supported at university by their birth parents. Finally, this thesis considers the impact of the Buttle UK Quality Mark, developed in response to the findings of Jackson and colleagues (2005) and awarded to universities demonstrating a commitment to supporting care leavers.
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Morris, Emilee. "“Accomplishing something important:” exploring how parents of two-year-old children perceive the transition between child care classrooms." Thesis, Kansas State University, 2015. http://hdl.handle.net/2097/35743.
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Master of ScienceSchool of Family Studies and Human Services
Bronwyn Fees
For young children and their families, transitions between classrooms are a normative part of the child care experience, yet these types of transitions are seldom studied. In the United States, there are approximately 144,000 child care centers for children birth to five years of age (Child Care Aware, 2014). Nearly 60% of infants and toddlers participate in some form of nonparental child care arrangement (Iruka & Carver, 2006). In particular, how parents experience their child’s transitions between classrooms within child care centers is not well understood. Children aged birth to three years face challenges when separating from trusted caregivers and forming new relationships. This study explored the unfolding of perceptions of five families as their children turned two-years-old and moved between a one-year-old to a two-year-old classroom in the same child care setting. Drawing from a systems approach, the parental perception of the transition was examined in relation to their children’s experience. Structured interviews took place with families before, during, and after their children’s transition to the new classroom. Mothers were interviewed in four out of the five cases, and one couple chose to participate in the interviews together. Families reported unique concerns such as worry regarding the child’s adjustment or concern about how the child would be accepted in the new peer environment, based on certain factors of influence including past experiences with transitions and the temperament and behavior of their child in the child care setting. However, parents regarded the transition positively due to the perceived benefits of a classroom with older peers and advanced learning opportunities. Parents expressed this positive viewpoint to their children through conversations. Interviews suggested that the way parents perceived the transition was closely connected to the child’s behaviors in the new environment as well as the quality of relationships formed with the teachers and peers. The findings indicate the importance of individualizing the transition experience for families, remaining mindful of the family system during the transition, and implementing strategies to support the relationship building process. Keywords: qualitative, transitions, two-year-old, early childhood education, parents
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Brumm, Susan D. "Readmissions, Telehealth, and a Handoff to Primary Care in Veterans with Diabetes." Xavier University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1524395520207456.
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Crawford, H., and Jean Croce Hemphill. "Bridging the Gap in Care Transitions by Implementing an Electronic Homeless Resource Toolkit for Case Management Personnel: Hospital to Community." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/7574.
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Palmeirinha, Carla Susana Gomes Lopes. "Transição da Pessoa com Doença Oncológica Avançada de Oncologia para Cuidados Paliativos: O Papel do Enfermeiro Especialista em Enfermagem de Saúde Mental e Psiquiátrica." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2019. http://hdl.handle.net/10400.26/28850.
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Mestrado em Enfermagem, Área de Especialização: Enfermagem de Saúde Mental e PsiquiátricaEste relatório de estágio procura estruturar o percurso desenvolvido durante o 2º Estágio do 2º Mestrado em Associação de Enfermagem de Saúde Mental e Psiquiátrica e assim demonstrar a aquisição das Competências Especificas do Enfermeiro Especialista em Enfermagem de Saúde Mental e Competências de Mestre. Grande parte das pessoas com doença oncológica avançada não têm acesso de forma sistemática às intervenções de Cuidados Paliativos. Foi utilizada a metodologia de projeto para dar resposta ao problema identificado: “A transição da pessoa com doença avançada para CP é muitas vezes realizada de forma abrupta e sem preparação gradual”. Ao longo do trabalho foi evidenciado o papel do Enfermeiro Especialista em Enfermagem de Saúde Mental e Psiquiátrica como uma mais valia nesta transição pois, além das competências de avaliação das necessidades em saúde mental, só ele poderá intervir com cuidados psicoterapêuticos, sócio-terapêuticos, psicossociais e psicoeducacionais permitindo assim promover a melhoria da qualidade dos cuidados de saúde.
This report seeks to structure the course developed during the 2nd Stage of the 2nd Master's degree in Nursing Association of Mental and Psychiatric Health and thus demonstrate the acquisition of Specific Competencies of Nurse Specialist in Mental Health Nursing and Master Competencies. Most people with advanced oncologic disease do not have systematic access to Palliative Care interventions. The Project Methodology was used to respond to the identified problem: "The transition of the person with advanced disease to Palliative Care is often performed abruptly and without gradual preparation". Throughout this study, the role of the Nurse Specializing in Mental and Psychiatric Health Nursing was evidenced as an asset in this transition because, in addition to the competencies of assessing mental health needs, he alone can intervene with psychotherapeutic, socio-therapeutic, psychosocial and psychoeducational care, thus promoting the improvement of the quality of health care.
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Stover, Annisa Leachman. "Patient Safety: Improving Medication Reconciliation Accuracy for Long-Term Care Residents." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2693.
Full textAbstract:
Patient Safety: Improving Medication Reconciliation Accuracy
for Long-Term Care Residents
by
Annisa L. Stover
MSN, Southern University, 2008
BSN, Our Lady of the Lake College, 2005
Project Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Nursing Practice
Walden University
August 2016
During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them is during hospital or long-term care admission. Guided by Rosswurm and Larrabee's model for change, Rogers' diffusion of innovation, and the Multi-Center Medication Reconciliation Quality Improvement toolkit, a 6-member interdisciplinary team composed of nurses, pharmacists, and institutional stakeholders was mobilized to develop policy and practice guidelines as well as secondary documentation necessary to implement and evaluate a quality improvement initiative to address medication reconciliation. Current evidence was explored and used to develop policy and practice guidelines for medication reconciliation, then submitted to 4 scholars, including 2 practice experts, a nurse administrator, and a specialist in pharmacy, to validate content. Scholarly validation supported the premise that the developed products would be beneficial in the accurate documentation of medication reconciliation. Scholarly feedback was evaluated by comparing to current best practices for medication reconciliation. Implementation, education, and evaluation plans were developed to guide operationalization of policy and practice guidelines. This project may positively affect social change by fostering a new practice policy, practice guidelines, and supporting documents to manage medication reconciliation of long-term care residents transitioning to acute care settings, thereby improving medication safety at transitions of care for vulnerable populations.
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Padilla, Liza L. "Transitioning with an Ostomy: The Experience of Patients with Cancer Following Hospital Discharge." Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/24291.
Full textAbstract:
The study aim was to describe the lived experience of patients with an ostomy due to cancer following hospital discharge, using a Heideggerian phenomenological lens. Colaizzi’s (1978) process guided a thematic analysis of nine unstructured interviews. The overall essence of patients’ transition experience was Adjusting to a New Way of Living. Four major themes emerged, Some Things are Different, Always on my Mind, Moving Towards Independence, and I’m Not Alone. Results suggest that the transition involves: adjusting to the ostomy and cancer; financial implications; changes in self, physical being, lifestyle, and social aspects of life; and psychological acceptance and preparation for the unexpected. Home care nurses and patients’ support network facilitated meeting their comprehensive care needs; while cancer treatments, the role of the significant other in the loss of privacy, funding inconsistencies, and temporary ostomy status were barriers. Patients need a comprehensive care approach to better facilitate the transition process.
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Baxter, Jennifer Anne, and Jennifer Baxter@aifs gov au. "The Employment of Partnered Mothers in Australia, 1981 to 2001." The Australian National University. Research School of Social Sciences, 2005. http://thesis.anu.edu.au./public/adt-ANU20070716.112159.
Full textAbstract:
The employment rate of young partnered women and partnered mothers increased considerably over the 1980s, while there was less change in the 1990s. This thesis explores these changes, with a focus on partnered mothers with young children. The objectives are to describe what the changes in female employment were, and to analyse why they might have occurred.
¶
The analyses were primarily quantitative, although they were put into context with extensive reviews of Australian and, where relevant, international literature. The primary source of data was Australian Bureau of Statistics (ABS) Census data. Other data used included those from the ABS Child Care Surveys, Negotiating the Life Course Survey and the National Social Science Survey.
¶
Many changes in maternal employment were identified. The most notable change was the increase in the number and proportion of partnered mothers working part- time hours. Job characteristics also changed, with these women in full-time or part- time jobs more likely to be working in higher skilled professional and para- professional jobs in 2001, compared to 1981. For partnered mothers with a child aged less than one, the proportion working increased, but there was also evidence that more women were making use of maternity leave.
¶
Coinciding with these changes were a number of compositional changes, as women of succeeding birth cohorts were more educated, and more likely to delay marriage and childbearing. Attitudinal change was also evident, as people became more accepting of working wives. Attitudes to working mothers with young children changed less, with a strong preference for mothers to be at home when their children were young. Also over this period, there were many changes in infrastructure, policy and the labour market generally that had impacts on female employment opportunities and conditions. These changes are explored in detail, and their relationship to employment change examined.
¶
Because there were so many changes in these factors occurring over this period, the exact causes of employment change were difficult to identify. Also, an analysis of employment change is complicated because the causality of certain effects does not run in only one direction there are more complex links between education, childbearing and employment that should be accounted for in explaining changes over time. Similarly, changes in supply of labour are difficult to disentangle from changes in demand for labour.
¶
Compositional changes were certainly important in explaining the growth in the proportion working, especially for younger women. These women were not only more highly educated in 2001, they were less likely to have children. For working mothers, the effect of increased education levels could be seen in the greater numbers working in higher status occupations.
¶
The analyses of infrastructure and policy change, particularly that of changes in income support and child care provision which were covered in some detail, did suggest that certain aspects of these broader changes were associated with changes in employment, at least for some sections of the population. Income support changes may have enabled more mothers, particularly those in low-income households, to stay at home with young children. This might be part of the reason for the slower growth in female employment in the 1990s, as payments to single-income families increased.
¶
The increased availability of formal child care was likely to have enabled more mothers to work, although the use of informal care, and parental-care only also grew over the 1980s and 1990s. The cost of care continues to be prohibitive for some families.
¶
Increases in part-time work continued even when the overall rate of employment slowed down. Changes in industrial relations, through award restructuring and the introduction of enterprise bargaining, were associated with an increased availability of part-time jobs. This sustained use of part-time work was congruent with the employment preferences of working mothers with young children. Also, the evidence presented shows that part-time work has grown in higher status as well as lower status jobs.
¶
Overall, while it was not possible to identify the exact causes of employment change, the compositional (education and childbearing changes in particular), attitudinal and broader infrastructure/policy changes were no doubt related.
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Tollman, Stephen M. "Closing the gap : applying health and socio-demographic surveillance to complex health transitions in South and sub-Saharan Africa." Doctoral thesis, Umeå : Epidemology and Public Health Sciences, Departmet of Public Health and Clinical Medicine, Umeå University, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1909.
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Nedelcu, Cristina. "The Impact of Pre-Adoption Stress on the Romanian Adoptees' Transitions to Adulthood and Adult Attachment: Perspectives of the Adoptees and the Adoptive Parents." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1539610709123468.
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Blanchette, Julia Elisabeth PhD RN CDE. "Financial Stress Factors, Psychological Factors and Self-Management Outcomes in Emerging Adults with Type 1 Diabetes." Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1575539367731274.
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Carlisle, MaKaila, and Kiana R. Johnson. "Outcomes of Tennessee youth as they age out of fostercare." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/5.
Full textAbstract:
As youth in foster care mature into adulthood, they face enormous challenges (Jaudes, 2012). They lose help and support as they change into their independent live style. A lot of youth do not get the proper help they need. For example research supports that 47 percent of youth aged out of the system had health insurance coverage. One study reported that 40% of foster care youth endorsed some type of maltreatment while in foster care (Salazar,Keller, & Courtney, 2011). Yet, services that address the unique ongoing mental healthcare needs of foster care youth are not systematically required, and only a fraction of foster care youth who evidence clinically significant psychiatric symptoms receive mental health care (Burns et al., 2004; Valdez, 2015). Youth like this need someone to help them with their mental state when entering the transition to adulthood. A benefit they lack is support from family, or a mentor. In this research study, we examine what happens to the children who aged out of the foster care system, and how they continue with their life now that they are on their own. We will present the prevalence of services utilized, and outcomes experienced pertaining to the transition from being in state custody from state and national fostercare
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Schreiner, Nathanial J. "Treatment Burden in Adults Living with Multiple Chronic Conditions Transitioning from a Skilled Nursing Facility to Home." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1491933628119571.
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Fylan, Beth. "Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
Full textAbstract:
Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentship
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Fylan, Gwynn Elizabeth Margaret Mary. "Medicines management after hospital discharge : patients' personal and professional networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
Full textAbstract:
Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
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Urban, Rachel L. "Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom." Thesis, University of Bradford, 2014. http://hdl.handle.net/10454/7288.
Full textAbstract:
Medication safety and improving communication at care transitions are an
international priority. There is vast evidence on the scale of error associated
with medicines reconciliation and some evidence of successful interventions to
improve reconciliation. However, there is insufficient evidence on the factors
that contribute towards medication error at transitions, or the roles of those
involved. This thesis examined current UK medicines reconciliation practice
within primary and secondary care, and the role of HCPs and patients. Using a
mixed-method, multi-centre design, the type and severity of discrepancies at
admission to hospital were established and staff undertaking medicines
reconciliation across secondary and primary care were observed, using
evidence-informed framework, based on a narrative literature review.
The overall processes used to reconcile medicines were similar; however, there
was considerable inter and intra-organisational variation within primary and
secondary care practice. Patients were not routinely involved in discussions
about their medication, despite their capacity to do so. Various human factors
in reconciliation-related errors were apparent; predominantly inadequate
communication, individual factors e.g. variation in approach by HCP, and
patient factors e.g. lack of capacity. Areas of good practice which could reduce
medicines reconciliation-related errors/discrepancies were identified. There is a
need for increased consistency and standardisation of medicines reconciliationrelated
policy, procedures and documentation, alongside communication
optimisation. This could be achieved through a standardised definition and
taxonomy of error, the development of a medicines reconciliation quality
assessment framework, increased undergraduate and post-graduate education,
improved patient engagement, better utilisation of information technology and
improved safety culture.
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Barros, Carolina F. Pombo de. "Keeping head above water: social presence in the transitions of brasilian women to motherhood. Comparing experiences in Brazil, Portugal and Sweden." Doctoral thesis, Universidade de Évora, 2017. http://hdl.handle.net/10174/21167.
Full textAbstract:
Keeping head above water: social presence in the transitions of Brazilian women to motherhood. Com-paring experiences in Brazil, France, Portugal and Sweden
The main objective of this thesis was characterizing and analysing social presence in the transition(s) of Brazilian women from privileged classes to motherhood, in Brazil, France, Portugal and Sweden, in recent years. As a final goal, it intended to contribute to de-construct the hegemonic model of ―good motherhood‖ in Brazil, which is established from the experiences of middle-class white Brazilian wom-en. As methodological strategy, it focused on Brazilian mothers‘ experiences of presences, using Com-puter-Mediated Communication and three methods in parallel: a documentary research on official re-ports of perinatal health and family policies, biographical interviews and recording of daily diaries, artic-ulated through a phenomenological perspective. Therefore, in my fieldwork I searched, in a spiral drift-ing, how certain moral rhetorics associated to gender, class and racial norms are reproduced by privi-leged mothers in maternal transitions. Beyond of this process of reproducing hegemonic representation of motherhood, I also found generating hesitations and ethical enactment among these women towards marginalized mothers such as racialized, single and poor ones. Finally, this thesis discusses how care ethics raise from daily parental relationships and how improving responsive social presence is quite significant for the promotion of such ethics beyond of feminine care work; SUMÁRIO:
Com a cabeça fora d‘água: a presença social em torno da transição de mulheres brasileiras para a maternidade. Comparação de experiências no Brasil, na França, em Portugal e na Suécia.
O principal objetivo desta tese foi caracterizar e analisar a presença social na(s) transição(ões) das mulheres brasileiras de classes privilegiadas para a maternidade, no Brasil, na França, em Portugal e na Suécia, nos últimos anos. Como objetivo final, este trabalho pretende contribuir para desconstruir o modelo hegemônico de ―boa maternidade‖ no Brasil, que é estabelecido a partir das experiências de mulheres brancas da classe média. Como estratégia metodológica, o estudo foi focado em analisar as experiências de presença das mães brasileiras, através de Comunicação Mediada por Computador e três métodos em paralelo: uma pesquisa documental em relatórios oficiais de políticas de saúde perinatal e em políticas familiares, entrevistas biográficas e gravação de diários, articulados através de uma perspectiva fenomenológica. Por isso, em meu trabalho de campo eu procurei, numa deriva em espiral, como certas retóricas morais associadas às normas de gênero, classe e raça são reproduzidas por mães privilegiadas no cotidiano durante as transições maternas. Além deste processo de reprodução da representação hegemônica da maternidade, eu também encontrei hesitações criativas e enação ética entre as mulheres em relação à mães marginalizados, tais como as mães Afro-descendentes, solteiras e pobres. Finalmente, esta tese discute como a ética do cuidado emerge a partir de relações parentais e como melhorar a responsividade da presença social é bastante significativo para a promoção de tal ética para além do trabalho de cuidado exercido pelas mulheres.