RESUMEN

Myeloproliferative neoplasms (MPNs) are a group of rare chronic progressive blood cancers that vary widely in clinical presentation, yet all patients have a risk of disease progression and thrombotic complications. Diseases include primary myelofibrosis, polycythemia vera, and essential thrombocythemia. With current treatment approaches, most patients live a prolonged life, but many experience a complex of symptoms that negatively influence their functional status and quality of life. Although significant advances have been made in preventing arterial and venous complications while mitigating inflammatory processes, comprehensive palliative care can help address unmet complex physical and psychosocial needs on a long-term basis. This article, created by a multidisciplinary group of providers, offers an overview of MPNs so palliative care clinicians can better support patients with these hematologic cancers.

RESUMEN

This paper uses Ambiguous Loss Theory to explore the anticipatory and ambiguous losses and stressors surrounding the decision to come out as Lesbian, Gay, Bisexual, Transgender or Queer. Purposive sampling was used to administer a survey to 429 individuals who identified as LGBTQ+ about their coming out decisions and experiences. Data were coded and three major themes were developed: (1) the need for psychosocial safety (fear of being disowned, shunned or abandoned); (2) experiences of anxiety, depression, emotional stress, and shame; and (3) the pursuit of authenticity, self-discovery and liberation. Findings from the study indicate that coming out for LGBTQ+ individuals in the twenty first century remains accompanied by challenges and fears, both before and after the process, which significantly affects individuals' health and safety. In the longer term, despite the challenges, stressors and losses identified by participants, most reported that disclosing their sexual orientation had greatly improved their health and mental well-being.

RESUMEN

PURPOSE/OBJECTIVES: Care transitions from one setting to another are vulnerable spaces where patients are susceptible to complications. Health systems, accountable care organizations, and payers recognize that care transition interventions are necessary to reduce unnecessary cost and utilization and improve patient outcomes following a hospitalization. Multiple care transition models exist, with varying degrees of intensity and success. This article describes a quality improvement project for a care transition model that incorporates key elements from the American Case Management Association's Transitions of Care Standards and the Transitional Care Management services as outlined by the Centers for Medicare & Medicaid Services. PRIMARY PRACTICE SETTING: A collaboratively developed care transition model was implemented between a health system population health management office and a primary care organization. FINDINGS/CONCLUSIONS: An effective care transitions model is stronger with collaboration among core members of a patient's care team, including a nurse care manager and a primary care provider. Ongoing quality improvement is necessary to gain efficiencies and effectiveness of such a model. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Care managers are integral in coordinating effective transitions. Care management practice includes transition of care standards that are associated with improved outcomes for patients at high risk for readmission. Interventions inclusive of medication reconciliation, identification and addressing of health-related social needs, review of discharge instructions, and coordinated follow-up are important factors that impact patient outcomes. Patients and their health system care teams benefit from the role of a care manager when there is a collaborative, coordinated, and timely approach to hospital follow-up.

Asunto(s)

RESUMEN

BACKGROUND: Poor dietary intake is common in hospitalised older people. A targeted mealtime intervention is needed to improve nutrition care and dietary intake, especially for those at risk of malnutrition. OBJECTIVES: This quality improvement project designed, implemented and evaluated a mealtime assistance bundle consisting of care measures driven by the hospital nursing team. The aims were to improve the mealtime care process to promote dietary intake of the hospitalised older people and to improve nursing staff's knowledge, attitude and practice in malnutrition. METHODS: This project adopted a pre-post design, targeting older people aged 65 years and above, who were admitted to a general medical unit in a regional hospital in Singapore. A mealtime assistance bundle consisting of seven care measures, using the acronym CANFEED, was implemented for older adults at risk of malnutrition. Outcome measures on the amount of dietary intake during meals through chart reviews and surveys of nursing staff using Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) questionnaire were performed before and after implementation. RESULTS: There were fewer older adults with poor intake in the post-implementation group than the pre-implementation group. Among those at risk of malnutrition, older adults in the post-implementation group had higher average intake of all provided meals as well as the protein-dense main dish. Significant improvements were noted in the total scores rated by the nursing staff in both the Knowledge-Attitude subscale and Practice subscale of the M-KAP questionnaire. CONCLUSIONS: Integrating a nurse-driven mealtime assistance bundle into usual care may have positive outcomes on nutritional intake of hospitalised older people at risk of malnutrition, and on knowledge, attitude and practice of hospital nurses in nutrition care. IMPLICATIONS FOR PRACTICE: Nurses play a critical role in nutrition care for hospitalised older people. Continuing efforts to improve nutritional intake of hospitalised older people should focus on staff education, building a multidisciplinary food-promoting culture and patient, family and community empowerment. More efficient clinical processes incorporating information technology with the EMR to support better nutrition care of the hospitalised older people are needed.

Asunto(s)

RESUMEN

A long-standing academic-practice partnership was leveraged to facilitate student learning opportunities pertaining to care provision for older adults living with multiple chronic conditions and complex medical problems. Students from a gerontological nursing course in an accelerated baccalaureate nursing program were partnered with gerontology-educated population health nurses in primary care settings. Students observed how population health nurses integrated the Institute for Healthcare Improvement Age-Friendly 4Ms framework into clinical practice as they performed behavioral, psychosocial, and biometric health risks assessments for older adults during their Medicare annual wellness visit. The population health nurses served as role models for professional delivery of age-friendly care including preventative health and wellness care. Student confidence and perception of their understanding of age-friendly and gerontological nursing care improved. Post clinical experience debrief sessions and clinical reflection assignments demonstrated students' admiration of the expansive role and person-centered approach that population health nurses undertake to ensure comprehensive assessment and wellness promotion. Students appreciated the fluidity of population health nurses' conversation regarding the things that matter most to older adults with complex medical conditions.

Asunto(s)

RESUMEN

PURPOSE AND OBJECTIVES: The purpose of this discussion is to review the management and symptomatic burden of patients with myeloproliferative neoplasms (MPNs). Patients with MPNs are at increased risk for thromboembolic events; thus, cardiovascular complications are not uncommon. Professional case managers can coordinate outpatient services with the health care team and assist patients to mitigate cardiovascular complications. PRIMARY PRACTICE SETTING: This discussion is relevant to professional case managers who manage patients with chronic conditions in outpatient settings. FINDINGS/CONCLUSIONS: Professional case managers can intervene for patients with MPNs to improve (a) coordination of scheduled therapeutic phlebotomy procedures, and (b) education about subcutaneous injections and frequent monitoring of laboratory reports. In the outpatient setting, professional case managers can improve health care utilization for patients with MPNs and promote high-quality self-care and symptom management to prevent adverse complications. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: As a member of the outpatient health care team, the professional case manager can serve as a key clinician with comprehensive knowledge of the patient's experience of living with an MPN, their usual state of health and symptoms, and the factors affecting their quality of life. This article explores the role of the professional case manager in the outpatient setting and suggests specific interventions to improve delivery of care and contribute to better self-care management. Professional case managers can assess and validate symptom burden, coordinate and manage routine laboratory testing, support careful medication adjustment, and contribute to improved health outcomes.

Asunto(s)

RESUMEN

Patients suffering from mental illness are often less likely to engage in treatment at an outpatient level. Lack of communication and coordination of care between providers has negative results for the health system and the patient. Improved communication has shown improved satisfaction of providers in health care. Using prior research, an electronic reminder and standardized documentation of communication was added to the health system's electronic health record. The aim of this quality improvement (QI) project was to compare pre-/postintervention communication and satisfaction between emergency department and outpatient psychiatric providers. The QI project was conducted on a convenience sample of 13 outpatient psychiatric providers at a large academic medical center. Using a pre-/postintervention design, QI project data were collected via chart reviews and pre-/postsurveys. The chart review results revealed the communication rate increased significantly from pre (22%) to post (85%), p < .001. The survey results revealed overall satisfaction had statistically significant increase from pre- (Mdn = 3, neutral) to postintervention (Mdn = 5, very satisfied), Z = -2.21, p =.027. The survey results revealed a statistically significant increase in frequency of direct communication from pre- (21%-40%) to postintervention (81%-100%), Z = -2.06, p = .039. The QI project documents an increase in both provider satisfaction and communication post-intervention.

Asunto(s)

RESUMEN

This quality improvement (QI) project evaluates a comprehensive, patient-centered plan to reduce the emergency department (ED) revisit rate by improving outpatient follow-up after initial ED visits. Patients with low-acuity complaints discharged from the ED are often instructed to schedule a follow-up appointment with their primary care team or a specialty service after leaving the ED. In this QI project, patients either had a follow-up visit scheduled at the time of ED discharge or received a phone call within 2 days of discharge to schedule outpatient follow-up visit. The number of ED visits per patient was significantly reduced following implementation of scheduling at the time of ED discharge.

Asunto(s)

RESUMEN

Polycythemia vera (PV) is a rare progressive myelo-proliferative cancer with significant symptom burden. Patients with PV often experience symptoms that adversely affect quality of life, work productivity, and functional status. Oncology nurses are well suited to assess for symptom burden and to provide educational interventions that support patients and their families.

Asunto(s)

RESUMEN

A group of rare hematologic cancers, myeloproliferative neoplasms (MPNs) evolve when bone marrow dysfunction causes overproduction of one or more blood cell types. This article explores the diagnosis, treatment, and nursing care of patients diagnosed with one of three classic MPNs: essential thrombocythemia, polycythemia vera, and primary myelofibrosis.

Asunto(s)

RESUMEN

Sickle cell disease (SCD) is a severe chronic disease that leads to premature mortality caused by serious complications of the disease such as acute chest syndrome, stroke, and sepsis. Patients presenting to the emergency department (ED) with pain due to vaso-occlusive crisis (VOC) are at a higher risk for complications, making it imperative that emergency nurses, nurse practitioners, and physicians are knowledgeable about SCD and understand the other associated complications besides VOC. Because of the complexity of disease and misperceptions about SCD among ED nurses, physicians, and nurse practitioners, a quality improvement (QI) framework for treatment of adults with SCD in EDs was developed. The Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS) is a research-based QI framework consisting of 7 distinct algorithms that serve to guide all ED team members in assessment and management of the complexity of care that patients with SCD require.

Asunto(s)

RESUMEN

Chronic conditions and age-related changes place older adults at increased risk for skin breakdown and damage to skin integrity, leading to poor outcomes that may impact quality of life. Although we cannot stop skin from aging, home care clinicians are in the best position to mitigate further skin problems and influence healthier outcomes for patients with skin issues. Home healthcare clinicians can improve skin health and well-being for older adults by incorporating simple but thorough systematic skin assessments at every visit. This includes identifying the patient's personal skin care practices and preferences. Home healthcare clinicians can intervene and address excessive moisture or extreme dryness of skin, use available resources for best practices in wound care, and educate about sun protection.

Asunto(s)

RESUMEN

Each day, nurses care for patients from diverse cultures and backgrounds, including those who self-identify as lesbian, gay, bisexual, transgender, or queer. To facilitate productive health partnerships, nurses need to be aware of a patient's sexual orientation, gender identity, and expression. Prelicensure nursing students employed cultural humility with the use of a video and a guided discussion. The purpose of this article is to describe teaching strategies that can be used by other nurse educators.

RESUMEN

Assuring home care staff competencies through simulation has the potential to improve care transitions and clinical outcomes. Recreating a home environment can be used for orientation of home care staff and to meet other learning needs. Lessons learned from the use of simulation in a geriatric nursing course in a prelicensure program can be used to prepare clinicians for transitioning patients across care settings. With simulation, learners can identify challenges in patient safety, pain management, and management of patients' cognitive decline as well as learn how to communicate with patients, family members, and the healthcare team. Simulation, as an interactive pedagogy, provides opportunities for learners to practice assessment, monitoring, and patient care in a controlled, safe, risk-free environment. Following participation in a simulation, learners are given the opportunity to reflect on ways to improve patient care when transitioning from acute to home care settings. Simulations described in this article can be used for orientation of staff to a home healthcare agency because they allow clinicians to hone the skills necessary for patient care in the home. Staff educators can also use simulation to validate staff competencies in caring for patients at home.

Asunto(s)

RESUMEN

BACKGROUND: Alcohol misuse is prevalent among college students and negatively affects their health, relationships, and academics. Alcohol misuse screening for this age group is advised but often overlooked. OBJECTIVE: The aim of this study was to implement an evidence-based alcohol screening tool, the Alcohol Use Disorders Identification Test-Consumption, at a southern university health clinic. METHODS: This quality improvement project used a preintervention/postintervention, mixed-methods design. A survey containing the Alcohol Use Disorders Identification Test-Consumption screening tool is used to identify students with alcohol misuse who are then offered education and follow-up. Students who were found to misuse alcohol were retested 1 month later. Qualitative comments were also gathered about the success of the project. RESULTS: Alcohol misuse at this location is high and usually missed during the student health encounter. Screening and identification of alcohol misuse were increased. The follow-up survey showed a reduced number of students misusing alcohol. CONCLUSION: Alcohol screening and treatment in a university health setting may result in decreased alcohol-related problems. The potential to improve student outcomes at other colleges and universities should be considered.

Asunto(s)

RESUMEN

PURPOSE AND OBJECTIVES: The purpose of this discussion is to review the barriers to care for patients with sickle cell disease (SCD). Chronic pain and the perception of addiction, implicit bias, frequent hospitalizations and emergency department visits, clinician and patient knowledge deficits, and SCD stigma all impede the ability to provide evidence-based care for patients with SCD. Case managers can coordinate and advocate for appropriate care that improves patient outcomes. PRIMARY PRACTICE SETTING: This discussion is relevant to case managers working with patients with SCD in the clinic, hospital, and emergency department. FINDINGS/CONCLUSIONS: Case managers can serve an important advocacy role and intervene to improve the coordination of services and efficient use of resources. This will lead to improved quality of life and optimal health care utilization for persons with SCD. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: As a constant member of the health care team, the case manager may be the only health care team member who has a broad knowledge of the patient's experience of acute and chronic pain, usual state of health, social behavioral health needs, and how these factors may affect both inpatient and outpatient health care use and health outcomes. This article explores the barriers to care and suggests specific interventions within the role of the case manager that can improve care delivered and ultimately contribute to improved patient outcomes. Specifically, these interventions can improve communication among members of the health care team. Case manager interventions can guide coordination, prevent hospital readmissions, reduce health care utilization, and contribute to overall improved patient quality of life and health outcomes.

Asunto(s)

RESUMEN

The purpose of this article is to describe an innovative method to help home care clinicians better communicate with older adults experiencing normal physiologic changes that impact their ability to communicate effectively. Developmental changes such as hearing, speech, vision, and cognition profoundly impede an older adult's ability to communicate with others, potentially undermining the quality of care delivered. The use of trigger films as an educational intervention can assist home care clinicians to improve communication with their patients. Trigger films are 2- to 4-minute video clips that end abruptly, encouraging learners to analyze clinical situations in a safe environment, such as a staff conference room. Trigger films are easy to make with the use of a smart phone and two staff members portraying the role of home care clinician and patient. Allowing discussion after viewing the trigger film places clinicians in an active learning role, thus fostering the sharing of ideas and best practice. Addressing age-related barriers to communication with this modality serves to improve patient interaction and healthcare outcomes. The use of trigger films is another tool that empowers the clinician to provide improved care for patients with communication deficits.

Asunto(s)

RESUMEN

Sickle cell disease (SCD) is a complex multisystem debilitating disease. Despite its complexity, health care providers who are not SCD experts receive little formal education on SCD. An open-access, educational website, "Emergency Department Sickle Cell Disease: Crisis Management and Beyond," was created to provide education about SCD to emergency department (ED) providers who are not SCD experts but who provide care for patients with SCD. Electronic surveys were used to conduct a formal evaluation of the accuracy and relevance of the website's content, as well as the effectiveness of the education modules in improving knowledge among health care providers. The evaluation consisted of (1) individual module pre- and post-knowledge assessment, (2) content validity assessment of educational modules, (3) overall website content assessment, and (4) overall website assessment (Health on the Net core principles). A convenient sample of ED providers, accelerated bachelor of science in nursing students, SCD experts, and website experts completed the anonymous surveys. Descriptive statistics and paired t tests were used to compare mean difference in post- minus pre-knowledge test scores. Knowledge scores statistically improved for nursing students (p value less than 0.0001). Emergency department providers showed a mean improvement of 3.2 points on the eight-item knowledge assessment. Both SCD experts and ED providers agreed that the module content was clear and easy to understand, accurate, comprehensive, relevant, and met module objectives. Participants agreed that the website was clear, easy to navigate, and visually appealing. Website experts stated that the website met much of the Health on the Net criteria. The website is a useful resource for providers and nursing students, especially those who serve or plan to serve in EDs.

Asunto(s)