Patient Care Plans Research Articles

Advance care planning (ACP) in glioblastoma patients: Evaluation of a disease-specific ACP program and impact on outcomes.

The feasibility of implementing an advance care planning (ACP) program in daily clinical practice for glioblastoma patients is unknown. We aimed to evaluate a previously developed disease-specific ACP program, including the optimal timing of initiation and the impact of the program on several patient-, proxy-, and care-related outcomes. The content and design of the ACP program were evaluated, and outcomes including health-related quality of life (HRQoL), anxiety and depression, and satisfaction with care were measured every 3 months over 15 months. Eighteen patient-proxy dyads and two proxies participated in the program. The content and design of the ACP program were rated as sufficient. The preference for the optimal timing of initiation of the ACP program varied widely, however, most of the participants preferred initiation shortly after chemoradiation. Over time, aspects of HRQoL remained stable in our patient population. Similarly, the ACP program did not decrease the levels of anxiety and depression in patients, and a large proportion of proxies reported anxiety and/or depression. The needed level of support for proxies was relatively low throughout the disease course, and the level of feelings of caregiver mastery was relatively high. Overall, patients were satisfied with the provided care over time, whereas proxies were less satisfied in some aspects. The content and design of the developed disease-specific ACP program were rated as satisfactory. Whether the program has an actual impact on patient-, proxy-, and care-related outcomes proxies remain to be investigated.

The perceptions and attitudes of qualified dental therapists towards a diagnostic role in the provision of paediatric dental care.

Objectives This study explored the perceptions and attitudes of qualified UK dental therapists (DTs) to act in a diagnostic role in the dental care of paediatric patients.Methods A mixed methods study. An electronic questionnaire was sent out to the members of associations and closed social networking groups for qualified DTs across the UK. The questionnaire explored the training, clinical experience and working practices of the participants and measured their agreements with applicable statements using Likert scale scores. Semi-structured interviews were also undertaken to explore how UK DTs perceived a diagnostic role for them and what barriers and facilitators they experienced.Results A total of 155 questionnaire responses were returned and 11 interviews conducted. Participants were mostly women (94.8%) with a broad range of working experience, with a mean experience of 9.5 years (± 8.8 standard deviation [SD]) (range: 1-42 years). From the questionnaires, when asked to score agreement on a Likert scale from 0-5, DTs agreed that in a diagnostic role, they could increase access to dentistry for patients and a high proportion were in agreement that they had the knowledge to carry out examination (mean = 4.43 ± 0.87 SD), diagnosis (mean = 4.37 ± 0.90 SD) and care planning for paediatric patients (mean = 2.74 ± 1.32 SD). The interviews yielded three qualitative supra themes: 'working in the UK as a DT today'; 'the perceptions of dental therapists on acting in a diagnostic role in paediatric dental care'; and 'barriers and facilitators to acting in a diagnostic role' and within these, eight major themes were identified.Conclusion Within the limitations of a small sample who were representative of the workforce demographic and educational structures, we found that DTs felt that if they were to act in a diagnostic role, it would improve access to dental services benefitting patients, dentists and the DT profession. DTs identified and explored barriers and facilitators to a diagnostic role. Change is required to overcome these barriers in order to support DTs to act in a front-line diagnostic role.

Nursing Care Plan for Patients with Hajdu-Cheney Syndrome.

Hajdu–Cheney syndrome is a rare genetic disease. Its main features include phenotypic variability, age-dependent progression and the presence of acroosteolysis of the distal phalanges and generalized osteoporosis, which have significant disabling potential. Currently, there is no effective curative treatment, so nursing care is essential to ensure the maintenance of the quality of life of these patients. The main objective of this study was to establish a specific standardized nursing care plan using the NANDA–NIC–NOC taxonomy. The application of a care plan as such would improve the quality of life of patients affected by this rare disease, will contribute to increasing healthcare professionals’ knowledge on this matter and will support future studies on this disease.

Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review.

Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.

The effect of Progressive Muscle Relaxation Technique on sleep quality in total hip arthroplasty patients

Aim: The aim of this study was to investigate the effect of Progressive Muscle Relaxation Technique on sleep quality in patients with total hip arthroplasty. Design: A non-randomized quasi-experimental model was used in this study. Methods: Data were collected using a Personal Information Form and the Turkish translation of the Visual Analog Sleep Scale (VAS Scale). The data was analyzed using percentages and t-test. Results: In comparison with the mean VAS Scale scores between the experimental and the control groups, no significant difference was found between the mean VAS Scale scores of the patients before the surgery and on the night of surgery (p > 0.05). However, a statistically significant difference was found between the mean VAS Scale scores in the first and second postoperative days between groups (p < 0.05). Conclusion: The study found that progressive relaxation exercises improve the quality of sleep. The routine use of progressive relaxation exercises is recommended for patient care plans.

Research progress of clinical intervention and nursing for patients with post-stroke dysphagia.

Post-stroke dysphagia (PSD) is a common and costly complication of stroke and is associated with increased mortality, morbidity, and hospitalization. Although most patients can spontaneously resume swallowing, there are still many patients who do not recover and even die. Despite multiple advances in the acute treatment and secondary prevention of stroke, the effective treatment of PSD remains a neglected area. Studies have shown that repair mechanisms of neurostimulation techniques and increased cortical activity play an important role in the treatment of PSD. In addition, nutritional interventions are also crucial for the treatment of malnutrition in PSD patients. Therefore, this article reviews the effects of the current main clinical treatment methods and nutritional interventions on the treatment and rehabilitation of PSD patients. It also emphasized the necessity of developing an individualized care plan for PSD patients, which is of great significance to promote the clinical treatment, nutritional status, prognosis, and quality of life of PSD patients.

Increasing advance directive completion within the 4R oncology model in breast cancer patients prior to surgery in a racially diverse patient population.

e13511 Background: Advance directives (ADs) are an important part of life care planning in patients with cancer. There is a lack of effective interventions that increase AD rates in breast cancer patients prior to surgery. In this quality improvement project, we implemented a 4R Oncology intervention in a community-based cancer center within an integrated health care system. 4R (Right Info / Care / Patient / Time) is a novel care planning and delivery model, which enables patients and care teams to manage complex time-sensitive care with a multi-modality 4R Care Sequence plan, coupled with follow-up workflows. Methods: Patients with newly diagnosed non-metastatic breast cancer who attended a multidisciplinary clinic and underwent definitive surgery at one facility were included in the study. Patients received usual care from 10/1/19 to 9/30/20 (usual care cohort). From 10/1/20 to 9/30/21 (intervention cohort), patients were provided a 4R Care Sequence, which included AD completion prior to surgery, and those without AD were referred for follow-up with a health educator to discuss AD completion. Demographics, NCCN thermometer distress scores, and AD completion rates were compared between the usual care and intervention cohorts using descriptive statistics. Results: Characteristics of age, gender, race/ethnicity, language interpreter usage, Elixhauser Comorbidity Index, NCCN distress scores > 4, surgery type, tumor grade, ER/PR/HER-2 status were similar between the usual care (N=140) and intervention cohorts (N=141). The intervention improved AD completion rates in a time-sensitive fashion prior to surgery between usual care and intervention cohorts, both in total (15% vs 74%, p<.01), and in 3 of the 5 race/ethnicity groups (Table). AD completion rates increased in patients of all races/ethnicities, but increases were not statistically significant for Hispanic patients, likely due to low numbers of these patients in both cohorts. Patients with higher distress scores completed ADs at similar rates to those with lower distress scores. Conclusions: Delivery of 4R Care Sequences, coupled with a health educator follow-up can significantly increase rates of time-sensitive AD completion, regardless of patients’ distress score. Patients across race/ethnicity groups benefited from the intervention, but further efforts are needed to understand the impact of this intervention in patients who are Hispanic. Through an effective care delivery model, patients can be provided with standardized equitable care. [Table: see text]

Screening for Malnutrition Risk and Muscle Mass Depletion Among Gastrointestinal Cancer Patients

ObjectivesIdentify gastrointestinal cancer patients with severe muscle mass depletion and malnutrition risk. Discuss the importance of screening for malnutrition risk, the severity of muscle mass depletion and nutrition care plans for gastrointestinal cancer patients. Explain the health impacts of muscle mass depletion and malnutrition on cancer patients.MethodsOne hundred Jordanian (60 male and 40 female) gastrointestinal (GI) cancer patients diagnosed either with gastric or colorectal cancer were screened for malnutrition risk using the malnutrition universal screening tool (MUST) and for muscle mass depletion using mid upper arm muscle area (MUAMA) and fat free mass index (FFMI). Statistical differences between study subjects by gender and type of gastrointestinal cancer were performed.Results80% of the study subjects have high risk for malnutrition and 60% of them have severe muscle mass depletion. Gastric cancer patients have higher risk of malnutrition compared to colorectal (90.2% vs 72.9%) and for muscle mass depletion by FFMI and MUAMA (70.7% vs 61.0% and 65.8% vs 55.9%) respectively. A statically significant (P ≤ 0.05) differences were found between male and female patients regarding muscle mass depletion by MUAMA and FFMI but not found between gastric and colorectal cancer patients. Although, Chi-square results showed only significant differences in MUAMA and FFMI of females diagnosed with gastric or colorectal cancer.ConclusionsRisks of malnutrition and severe muscle depletion are prevalent among GI cancer patients and nutrition care plans as well as behavioral life-style modifications are urgently needed.Funding SourcesThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Experience of providing nursing care based on Watson's theory to a patient who experienced acute rejection following a kidney transplant

<p>本文描述一位血液透析個案接受腎移植後出現急性排斥之護理經驗，照護期間為2020年1月6日至2020年1月31日。筆者藉由會談、傾聽、觀察、身體評估、病歷查閱等技巧收集資料，確立有急性疼痛、潛在危險性感染、焦慮等健康問題。運用Watson關懷照護理論，與個案建立良好的護病關係，提供個別性護理。針對術後急性疼痛，提供疼痛緩解技巧，如：呼吸控制等，並合併藥物介入，達到疼痛控制；潛在危險性感染風險，著重加強傷口照護，及出院後預防感染居家護理，加上雙重血漿置換後導致白蛋白低於正常值，更運用跨團隊會診營養師，提供高蛋白等營養攝取資訊；當對未來出現不確定，及對不熟悉的治療產生焦慮不安時，除給予治療前詳細介紹外，更運用關懷、聆聽、信仰等，加強其心理與靈性支持，增加個案的自信和希望，使其能以正向態度開始新生活。期望藉由此經驗分享在照護類似個案時，能提供更適切的護理照顧，作為日後臨床照護之參考。</p> <p> </p><p>This study describes the experience of providing nursing care to a hemodialysis patient who experienced acute rejection following a kidney transplant. The period of care lasted from January 6, 2020 to January 21, 2020. Data was collected through conversations, listening sessions, observations, physical assessments, and medical record reviews. The patient was found to be suffering from health problems such as acute pain, a potential risk of infection, and anxiety. Watson’s theory of human caring was applied to establish a strong nurse-patient relationship and to provide personalized nursing care. The patient’s acute postoperative pain was managed and controlled by means of pain alleviation methods such as respiratory control and medication treatment-based interventions. The patient’s potential risk of infection was managed by focusing on the implementation of wound care as well as infection prevention measures at the patient’s home after discharge. Furthermore, since the patient’s albumin level was lower than normal following a double filtration plasmapheresis, a multidisciplinary team was formed, and the patient consulted with a dietician who provided nutritional recommendations such as having a high protein diet. When the patient expressed uncertainty about the future or felt anxious about unfamiliar treatments, the team not only thoroughly described the treatments beforehand, but also enhanced the mental and spiritual support that they provided by expressing concern about, listening to, and placing faith in the patient, with the purpose of boosting the patient’s self-confidence and sense of hope. As a result the patient was able to begin a new life with a positive attitude. This experience is expected to serve as a reference for providing more appropriate nursing care plans for similar patients in clinical settings in the future.</p> <p> </p>

Espiritualidade e religiosidade na abordagem a pacientes sob cuidados paliativos

Abstract The development of the care plan for patients under palliative care must be unique and comprehensive, seeking to meet, as far as possible, the patient’s needs. Within this plan, the spiritual and religious axis stands out. To analyze the importance of this type of approach, we carried out an integrative review study. The articles analyzed should answer the guiding question “what does the literature say about spirituality and religiosity in the approach to patients under palliative care?”. The sample comprised 15 articles that show the multidisciplinary nature of the theme and point out the benefits of combining the spiritual and religious axis with care plans. We observed, however, that some practices and religious aspects can negatively influence the individual and the professional team feels unprepared to address and develop this issue with its patients.

Utilizing an innovative digital collaboration tool to impact shared decision making, health equity and trust with a focus on advance care planning for patients with metastatic breast cancer.

e24123 Background: Advance care planning (ACP) has been associated with improved quality of life, increased use of hospice and palliative care, and less use of extreme treatments close to death. These conversations often do not occur and documentation rates of ACP in oncology patients have been as low as 10%, with rates of documentation increasing between 30-40% in intervention studies. The present study aimed to examine the effectiveness of an online Advance Care Appointment Companion (ACAC) collaboration tool to improve communication and elevate trust between MBC patients and their oncologist and increase completion rates of ACP documents. Methods: Data were collected from 48 patients with mean age of 66.9 years (SD = 6.97) with MBC during their medical oncology appointments (Time 1) and three months later (Time 2) at the Koontz Center for Advanced Breast Cancer. At Time 1, patients were enrolled on the ACAC platform and then completed questions in the clinic or at home about completion status of a healthcare directive and durable power of attorney (DPOA) for healthcare, comfort in discussing ACP with their care team and loved ones, and goals of care at end of life. A summary of these responses with a provider prompt script was securely sent to the oncologist prior to each appointment and used to discuss ACP over the three-month study period. Descriptive statistics, t-tests, McNemar-Bowker and McNemar’s tests were conducted to examine changes in rates of ACP document completion, patient reported levels of comfort in discussing ACP, and quality of life preferences. Results: The study included a diverse sample of female MBC patients including 79% White, 19% Black/African American, 2% Mixed Race; 6% less than a high school degree, 17% high school or GED, 19% some college, and 58% associate’s degree or above. Results showed a significant increase in completion of a healthcare directive (Time 1 = 10.4%, Time 2 = 37.5%, p < .01) and DPOA (Time 1 = 31.5%, Time 2 = 56.3%, p < .01) and improved comfort discussing ACP with their care team (p < .01) and loved ones (p < .01) from baseline to follow-up. Significantly more patients reported that they would not want CPR (p < .05) at follow-up and all of these patients had reported that they were unsure at baseline. On average, ACP conversations during medical appointment took 5 minutes to discuss. Conclusions: Results show that the ACAC is an inclusive solution which provides equitable access to patients. This tool facilitates enhanced patient provider communication and assists patients with MBC in finalizing decisions regarding their goals of care, leading to increased completion and proper submission of ACP documentation. Future research should examine how the ACAC can decrease financial toxicity, utilize internal resources, and address social determinants of health.

Improving Students' Knowledge and Skills Through a Tele-ICU Clinical Rotation.

In the course of their education, respiratory therapy students participate in clinical rotations, which are essential to their education. Recently, the number of clinical sites has decreased as some have been eliminated. During the COVID-19 pandemic, schools were challenged to find hospitals to accommodate students due to the risk of infection. Tele-ICU has emerged as a means for staff therapists to assess and monitor patients via remote monitoring systems. We hypothesized that a clinical rotation at a tele-ICU would strengthen students' knowledge of mechanical ventilation, telemedicine, and COVID-19. In this study, students completed clinical rotations in a tele-ICU. Students spent two 4-h clinical rotations rounding on 320 ICU beds at 5 hospitals. Under the supervision of experienced therapists, students performed remote patient-ventilator assessments, including review and interpretation of ventilator waveforms, patient-ventilator interaction, arterial blood gases, and chest x-rays. Students completed pre- and post-rotation surveys assessing their confidence managing mechanical ventilation, experience with telemedicine, ARDS, and patients with COVID-19. Mean self-confidence in mechanical ventilation (P = .001), assessing waveforms (P = .001), and knowledge of ARDS increased after the clinical rotation (P = .001). Similarly, reported knowledge related to spontaneous breathing trial protocols (P = .009), lung-protective ventilation (P = .002), patient care planning (P = .001), and use of Excel spreadsheets (P = .002) increased from the beginning to the end of the clinical rotation. Student confidence in interprofessional communication increased from 85 [69-98] to 95 [78-100]; P = .03). Overall, the largest change was students' ability to assess patients with COVID-19 (pre-rotation 50.0 [11.5-65.7], post-rotation 80.0 [58.5-100]; P = .001). Qualitative results revealed overwhelmingly positive results for both students and preceptors. Students' confidence in assessing patients via remote monitoring increased in a tele-ICU clinical rotation. Self-assessed knowledge related to COVID-19 also increased to statistical significance.

Research progress of advance care planning for patients with advanced cancer

Research progress of advance care planning for patients with advanced cancer

Oncologist phenotypes and associations with response to a machine learning-based intervention to increase advance care planning: Secondary analysis of a randomized clinical trial.

While health systems have implemented multifaceted interventions to improve physician and patient communication in serious illnesses such as cancer, clinicians vary in their response to these initiatives. In this secondary analysis of a randomized trial, we identified phenotypes of oncology clinicians based on practice pattern and demographic data, then evaluated associations between such phenotypes and response to a machine learning (ML)-based intervention to prompt earlier advance care planning (ACP) for patients with cancer. Between June and November 2019, we conducted a pragmatic randomized controlled trial testing the impact of text message prompts to 78 oncology clinicians at 9 oncology practices to perform ACP conversations among patients with cancer at high risk of 180-day mortality, identified using a ML prognostic algorithm. All practices began in the pre-intervention group, which received weekly emails about ACP performance only; practices were sequentially randomized to receive the intervention at 4-week intervals in a stepped-wedge design. We used latent profile analysis (LPA) to identify oncologist phenotypes based on 11 baseline demographic and practice pattern variables identified using EHR and internal administrative sources. Difference-in-differences analyses assessed associations between oncologist phenotype and the outcome of change in ACP conversation rate, before and during the intervention period. Primary analyses were adjusted for patients' sex, age, race, insurance status, marital status, and Charlson comorbidity index. The sample consisted of 2695 patients with a mean age of 64.9 years, of whom 72% were White, 20% were Black, and 52% were male. 78 oncology clinicians (42 oncologists, 36 advanced practice providers) were included. Three oncologist phenotypes were identified: Class 1 (n = 9) composed primarily of high-volume generalist oncologists, Class 2 (n = 5) comprised primarily of low-volume specialist oncologists; and 3) Class 3 (n = 28), composed primarily of high-volume specialist oncologists. Compared with class 1 and class 3, class 2 had lower mean clinic days per week (1.6 vs 2.5 [class 3] vs 4.4 [class 1]) a higher percentage of new patients per week (35% vs 21% vs 18%), higher baseline ACP rates (3.9% vs 1.6% vs 0.8%), and lower baseline rates of chemotherapy within 14 days of death (1.4% vs 6.5% vs 7.1%). Overall, ACP rates were 3.6% in the pre-intervention wedges and 15.2% in intervention wedges (11.6 percentage-point difference). Compared to class 3, oncologists in class 1 (adjusted percentage-point difference-in-differences 3.6, 95% CI 1.0 to 6.1, p = 0.006) and class 2 (adjusted percentage-point difference-in-differences 12.3, 95% confidence interval [CI] 4.3 to 20.3, p = 0.003) had greater response to the intervention. Patient volume and time availability may be associated with oncologists' response to interventions to increase ACP. Future interventions to prompt ACP should prioritize making time available for such conversations between oncologists and their patients.

Starting a peripartum pelvic floor disorder clinic: what to expect in the first thirty-six months.

Subspecialty peripartum pelvic floor disorder (PFD) clinics provide care to a unique patient population. We aim to describe the experiences of such a clinic in the first 36 months after its establishment. This is a descriptive case series of all women who presented to a subspecialty PFD clinic at an academic medical center over 36 months (January 2018-December 2020). Patient characteristics, referral patterns, and care plans will be described. Four hundred eighty-three women presented for care. Women were a mean age of 31.0 ± 4.2 years, most were primiparous (404, 83.6%), and over half (279, 57.8%) had a spontaneous vaginal delivery. Three hundred eighteen women (66.9%) had obstetric anal sphincter injury (OASI), which was also the primary referral indication in 313 (64.8%). Most consultations were from an obstetrician (246, 51.3%), and the median time from delivery to evaluation was 17 days (IQR 11.0-34.0). The majority of women had one additional follow-up visit (330, 68.3%). One hundred forty-one (29.9%) women underwent minor office procedures, and 26 (5.4%) underwent surgery. The number of referrals sequentially increased from year 1 (59, 12.2%) to year 3 (215, 44.5%). The 36-month experiences in our growing subspecialty peripartum PFD clinic demonstrate both sustainability and feasibility of this new service line, with consistent clinical growth over time and 483 new consultations, 2/3 of which were for OASI and the other 1/3 for a variety of peripartum pelvic floor indications. Our data outline a model for care, including timeline for follow-up, treatments administered, and number of interventions, both office and surgical.

Overcoming End of Life Discussion Hesitancy in Advance Care Planning for Patients with Advanced Cancer and Their Caregivers (RP309)

Overcoming End of Life Discussion Hesitancy in Advance Care Planning for Patients with Advanced Cancer and Their Caregivers (RP309)

Ovarian sclerosing stromal tumour in a 39-year-old lady- A case report and review of the literature

One of the rarest ovarian sex cord-stromal tumour is Sclerosing Stromal Tumour (SST). It commonly presents as lower abdominal pain and tenderness, with or without a mass, and/or abnormal menses. As the clinical presentation and imaging are like borderline or malignant epithelial tumours and sex cord-stromal tumours, accurate preoperative clinical diagnosis can be a challenge and the diagnosis is usually made following postoperative histopathologic examination. Understanding the clinicopathological characteristics of this tumour is vital for accurate preoperative diagnosis, which can be essential for planning of care and treatment for patients. Along with a review of the current literature, we present a case of a young female with SST. This patient presented with prolonged menstrual bleeding. She underwent total abdominal hysterectomy with right salpingo-oophorectomy and left salpingectomy. The histopathological examination revealed the salient features of SST like cellular heterogeneity, hemangiopericytoma (HPC) like vascular structures, and a pseudo lobular architecture with cellular nodules separated by hypocellular, oedematous, and collagenous stroma, hence confirming the diagnosis. This case highlights the importance of considering SST as a differential diagnosis, in young patients with ovarian mass having the morphological and histopathological characteristics, despite its rarity in occurrence.

Impact of COVID-19 Measures on Discharge Planning and Continuity of Integrated Care in the Community for Older Patients in Singapore.

Introduction:The COVID-19 pandemic affects the process of care transition for patients with underlying chronic conditions. This study aims to explore the impact of the pandemic measures on discharge planning and continuum of care for vulnerable older patients from multi-stakeholder perspectives.Methods:We conducted focus group discussions and individual interviews with healthcare workers, community partners, government officials and family caregivers in Singapore. All interviews were audio-recorded, transcribed verbatim and thematically analysed.Results:A total of 53 individuals participated in the study. Discharge planning and care continuity in the community were affected primarily by the limited step-down care options and remote assessment of discharge needs. Participants felt a need to revisit the decision of ‘essential’ community services through engagement of all stakeholders to enhance care community.To improve better care transition, participants suggested the need for clearer communication of guidelines, improved intersectoral collaboration, shared responsibility of patient care through community engagement and employment of novel models of care.Conclusion:The pandemic measures generated challenges of safe discharge of patients and care continuity in the community. Findings shed light on the need to proactively assess care pathways and catalyse novel models to improve care transition beyond the pandemic.

Making remote measurement technology work in multiple sclerosis, epilepsy and depression: survey of healthcare professionals

BackgroundEpilepsy, multiple sclerosis (MS) and depression are long term, central nervous system disorders which have a significant impact on everyday life. Evaluating symptoms of these conditions is problematic and typically involves repeated visits to a clinic. Remote measurement technology (RMT), consisting of smartphone apps and wearables, may offer a way to improve upon existing methods of managing these conditions. The present study aimed to establish the practical requirements that would enable clinical integration of data from patients’ RMT, according to healthcare professionals.MethodsThis paper reports findings from an online survey of 1006 healthcare professionals currently working in the care of people with epilepsy, MS or depression. The survey included questions on types of data considered useful, how often data should be collected, the value of RMT data, preferred methods of accessing the data, benefits and challenges to RMT implementation, impact of RMT data on clinical practice, and requirement for technical support. The survey was presented on the JISC online surveys platform.ResultsAmong this sample of 1006 healthcare professionals, respondents were positive about the benefits of RMT, with 73.2% indicating their service would be likely or highly likely to benefit from the implementation of RMT in patient care plans. The data from patients’ RMT devices should be made available to all nursing and medical team members and could be reviewed between consultations where flagged by the system. However, results suggest it is also likely that RMT data would be reviewed in preparation for and during a consultation with a patient. Time to review information is likely to be one of the greatest barriers to successful implementation of RMT in clinical practice.ConclusionsWhile further work would be required to quantify the benefits of RMT in clinical practice, the findings from this survey suggest that a wide array of clinical team members treating epilepsy, MS and depression would find benefit from RMT data in the care of their patients. Findings presented could inform the implementation of RMT and other digital interventions in the clinical management of a range of neurological and mental health conditions.

NANDA International nursing diagnoses in the coping/stress tolerance domain and their linkages to Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions in the pre-hospital emergency care.

AimTo determine the prevalence of NANDA International nursing diagnoses in the coping/stress tolerance domain and their linkages to Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions in the pre‐hospital emergency care setting.DesignRetrospective descriptive study of electronic record review.MethodsEight thousand three hundred three episodes recorded during the year 2019 were recovered from the electronic health records of a public emergency care agency. The prevalence of NANDA International nursing diagnosis, Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions was determined. A cross‐tabulation analysis was performed to determine the linkages. Data were accessed in November 2020.ResultsNANDA International nursing diagnoses Anxiety (00146) and Fear (00148) represented more than 90% of the diagnoses recorded in the domain. Anxiety level (1211) and emotional support (5270) were the most recorded Nursing Outcomes Classification outcomes and Nursing Interventions Classification interventions, with almost 20% and 5% of total records, respectively. The linkage between nursing diagnosis Anxiety (00146), outcome Anxiety level (1211) and intervention Anxiety reduction (5820) was the most recorded with slightly more than 3% of the total.ConclusionEight different NANDA International nursing diagnoses in the coping/stress tolerance domain were recorded. Nursing Outcomes Classification outcomes were selected aimed mainly at psychological well‐being and Nursing Interventions Classification interventions to support coping. In general, linkages were aimed to provide emotional support, physical well‐being, information, education and safety.ImpactThis study showed that pre‐hospital emergency care nurses diagnose and treat human responses in the coping/stress tolerance domain. Expert consensus‐based linkages may be complemented by the results of this study, increasing the levels of evidence of both individualized and standardized care plans for critical patients assisted by pre‐hospital emergency care nurses.