Care Practices Research Articles

Barriers to healthy transitions between nursing homes and emergency departments

This study identifies barriers to healthy transitions between nursing homes and emergency departments by exploring current practices in both primary care (out-of-hours primary care and nursing homes) and specialist healthcare (ambulance services and emergency departments) organizations from the perspectives of healthcare professionals. The objective is to highlight areas where improvements to these transitions are most needed. NH residents frequently use acute healthcare services. Many have complex healthcare needs, requiring coordination across multiple providers and different healthcare settings. Transitions theory by Afaf Meleis inspired this study and helped identify barriers to healthy transitions between nursing homes and emergency departments. Eighteen qualitative interviews were conducted with healthcare professionals from nursing homes, ambulance services, out-of-hours primary care, and emergency departments. Three themes were identified from the interviews: 1: staff burden, 2: discontinuity of care, and 3: transitions taking a toll on the well-being of residents. This study identifies critical areas needed to improve transitions between nursing homes and emergency departments. Many of the barriers to healthy transitions are systemic, suggesting that micro, meso, and macro-level efforts are needed.

Survivorship preparedness and activation among survivors of lymphoma.

Taking an active role in managing post-treatment care has emerged as a key aspect of promoting a successful transition into survivorship and is associated with better patient outcomes. In this study, we focus on two key aspects of active self-management, activation and preparedness. Activation was defined as understanding one's role in the care process and having the knowledge, skill, and confidence to take on a role in managing self-care. Preparedness was defined as the extent to which individuals perceived they had sufficient information about what to expect after cancer treatments are completed. The study goal was to characterize survivorship preparedness and activation among lymphoma survivors within 5years of treatment completion in New Jersey and examine the association of sociodemographic, medical, care transition experiences, practical concerns, and psychosocial factors with activation and preparedness. One hundred and one Hodgkin lymphoma or non-Hodgkin lymphoma survivors who had completed treatment within 5years completed a survey of survivorship care experiences (response rate = 34.12%). Approximately 60% of survivors reported high activation, with similar percentages for higher preparedness. Less activated survivors were significantly (p < .05) younger, married, resided in a more deprived geographic area, and reported more fatigue and information needs. Less activated survivors reported recalling that their providers were significantly (p < .05) less likely to discuss long-term side effects, psychosocial needs, risk-reducing lifestyle recommendations, and how to manage other medical concerns. Fewer care transition practices were most strongly associated with lower preparedness. A significant proportion were not activated for survivorship, and both activation and preparedness were strongly associated with providers' survivorship transition practices. Implementing programs to foster more activation and preparedness for lymphoma survivorship care would benefit from education about recommended follow-up care and healthy lifestyle practices. Providers should routinely ask about their patients' confidence and preparedness for survivorship and provide referrals for appropriate care as needed.

The mediating effects of minority stress experiences on cannabis consumption among 2SLGBTQ+ youth

Introduction Data suggest there are within-group variations in cannabis consumption among sexually diverse individuals. However, less is known about specific sexual orientations, such as Two-Spirit, asexual, pansexual, and queer (2SAPQ+), when compared with lesbian, gay, and bisexual people, as they often are not given an option to indicate their identities on surveys, leading them to be grouped with bisexuals. This study aimed to compare the relationship between LG and 2SAPBQ+ (including bisexual) identification and routine cannabis use, and whether it was mediated by minority stress. Methods Data were collected across two time points from 851 Two-Spirit, lesbian, gay, bisexual, queer, and questioning (2SLGBTQ+) youth participants. Structural equation modeling (SEM) was employed to analyze whether latent constructs within the minority stress framework mediated the relationship between sexual identity and cannabis use longitudinally. Results A preliminary logistic regression confirmed that 2SAPBQ + individuals were more likely to consume cannabis than LG individuals. The results suggest that the minority stress constructs accounted for a significant portion of the variance within the relationship between sexual orientation and cannabis use. Conclusion The pathway between sexual orientation and routine cannabis use was complex. Findings signal that not all sexual minority individuals should be grouped into one category and call for attention to careful measurement practices.

Sharing health care wishes among older adults with cognitive impairment in primary care: Results from a randomized controlled trial.

Best practices for conducting advance care planning (ACP) among persons with cognitive impairment exist, but evidence-based models are lacking for the primary care setting. We tested a remote multicomponent ACP model (SHARE) versus minimally enhanced usual care in 273 person-family dyads from eight primary care practices. Mean patient age was 88.0years, 85 (31.1%) were Black/Latino; 189 (69.2%) had moderate-to-severe cognitive impairment. Most (101/145; 69.6%) intervention dyads engaged in ACP. At follow-up, no treatment effect was observed for care partner-reported quality of communication about end-of-life care at 6 or 12 months, but intervention patients reported better quality of communication about end-of-life care at 12 months. Intervention care partners and patients reported greater readiness to engage in ACP at 6 and 12 months, respectively, and increased completion of key aspects of ACP. SHARE supported key aspects of ACP processes and communication about end-of-life care. Primary care-based models of ACP for persons with dementia are lacking. Involving persons with cognitive impairment in remote ACP is feasible with care partner involvement. Results indicate benefit for aspects of ACP processes and communication about end-of-life care.

Transforming harmful representations, investigating violence and empowering care practises in masculinities.

Stemming from a critical perspective of feminist studies on masculinities, this article proposes to explore how dominant and hegemonic masculinities are being reimagined, renegotiated and reconstructed, by understanding new patterns of violence amongst boys, on the one hand; and how care, as the opposite of violence, and a concept in construction from a feminist perspective, can be adopted, put in practise and understood. From a feminist standpoint masculinities studies need to go through a renewed problematisation of the social constructions of masculinities in a space-time context that intersects the economic crisis, health crisis and, on the other hand, implementation of legislation and initiatives for gender equality and citizenship, and is marked by social challenges that are related to the increase of gender inequality, violence indicators and extremism but also the emergence of caring masculinities that need closer attention. This feminist approach to masculinities allows us to critically challenge hegemonic models of boyhood/manhood, specifically by developing a FEMINIST THEORY OF CARING MASCULINITIES. Through a critical understanding of the new patterns and ways in which patriarchal masculinities are perpetuated in society, and placing CARE as the centrepiece and pro-active practise that opposes violence sustained models of masculinities, feminist masculinities studies can challenge dominant forms of masculinity by taking action in diverse social contexts and emphasising empathy, emotional expression, and cooperative relationships.

The Emergence of Anthroposophical Curative Education in Israel

Abstract This paper tracks anthroposophical social initiatives in Israel in the mid-20th century. It follows the migration of people involved in the anthroposophical movement, the transfer of anthroposophical ideas and the transnational translation of social work knowledge and practice from Europe to Mandatory Palestine and Israel. Archival material was collected from official, institutional, and private archives in Israel, Switzerland, Britain, and Germany and some data was obtained through oral history interviews. Transnational correspondence between anthroposophists in Palestine, later Israel, and those in Europe and Britain up to the late 1960s reveals efforts to tackle the newly founded state’s most burning struggles to adjust, realize, and embed an anthroposophical care practice. The paper suggests that the transnational translation of anthroposophical curative education played a significant role in the reception of anthroposophy in Israel through a process in which European cultural aspects of anthroposophy were adjusted, and its universal human aspects were prioritized.

Evaluation of Cost-Effectiveness of a Virtual Multidisciplinary Stroke Care Clinic for Community-Dwelling Survivors of Stroke.

A technologically integrated, multidisciplinary approach to stroke rehabilitation service was delivered and embedded into conventional health care practice. This article reports an evaluation of cost-effectiveness analysis of a new Virtual Multidisciplinary Stroke Care Clinic (VMSCC) service for community-dwelling survivors of stroke. A randomized controlled trial was conducted. Adults with a first/recurrent ischemic/hemorrhagic stroke were recruited from 10 hospitals. Eligible participants were randomly assigned to receive the VMSCC service (individual virtual consultations with a registered nurse, home blood pressure telemonitoring, and unlimited access to an online resource platform) plus usual care or usual care alone. Cost-effectiveness analyses were performed based on incremental cost-effectiveness ratios expressed as incremental cost per emergency admission reduced, and day of hospitalization reduced over the study period. A total of 256 participants (intervention group n=141 versus control group n=115) with complete cost and health care use data were included in the cost-effectiveness analyses. The VMSCC service, on average, resulted in a greater reduction in the number of emergency admission (-0.06 [95% bootstrapped CI, -0.14 to 0.01]) and fewer days of hospitalization (-0.08, [95% bootstrapped CI -0.40 to 0.24]) but incurred a higher total cost of HK$375 (95% bootstrapped CI, -2103 to 2743) compared with the usual care. The incremental cost-effectiveness ratios of the VMSCC service compared with the usual care were HK$6070 and HK$4826 per an emergency admission and a day of hospital stay reduced respectively. The study provides preliminary but not confirmative evidence that the VMSCC service could be more effective but more costly than usual care in reducing health service use. URL: https://www.chictr.org.cn. Unique identifier: ChiCTR1800016101.

Assessing the implementation of healthy eating and physical activity policies and practices in Early Childhood Education and Care in New South Wales, Australia: A cross-sectional study.

Australian children are not meeting the recommended physical activity (PA) and healthy eating (HE) guidelines. Health behaviour practices implemented in community settings such as early education services can improve child's health outcomes and are therefore key to help meet guidelines. This study aimed to measure the implementation of HE and PA policies and practices in Early Childhood Education and Care (ECEC) services in New South Wales (NSW), Australia, and to examine their association with service characteristics. A random sample of 1122 centre-based ECEC services were invited to a cross-sectional survey measuring HE and PA policy and practice implementation. Regression analyses were conducted to assess the relationship between the service characteristics and implementation of policies/practices. In total, 565 ECEC services completed the survey. Results show that while some practices are implemented, the implementation of practices promoting HE and PA education is low. Practices related to educator training for HE (18%) and PA (13%) were poorly implemented. The implementation of practices such as 'providing educator training around child PA', 'engaging families in activities to increase child PA' and 'encouraging supportive feeding practices' were significantly higher in services located in major cities than regional/remote services. 'Having a PA policy' and the practice of 'limiting the use of screen time' was significantly higher in long day care services than in preschools. The implementation of 'providing educator-led PA', 'providing free play opportunities' and 'having a PA policy' was significantly lower in private not-for-profit community managed services than in private for-profit services. Implementation of various HE and PA policies and practices in regional/remote services, private not-for-profit services and preschools across NSW could be improved. SO WHAT?: Future research should be prioritised towards identifying factors influencing the implementation of these policies and practices to best tailor implementation support efforts for those who need it the most.

Expert assessment of the state and problems of implementation of health technology assessment in Ukraine

Health Technology Assessment (HTA) is widely used worldwide as a transparent tool for determining the value of both new and existing medical technologies (MTs), including drugs, medical devices, vaccines, and other interventions. The use of the independent expertise results allows to make reasonable decisions on the feasibility of using the medicinal products (market authorization, inclusion in protocols and relevant regulatory lists), as well as pricing, reimbursement and procurement. HTA affects the access and affordability of MTs, thereby contributing to the efficiency of medical care and the rational use of resources. In our opinion, the limited use of НТА in Ukraine is primarily due to the low level of awareness of the professional community about НТА and its role in providing decision support at various levels of government. An expert survey was conducted to study the current state, problems, and prospects for the development of НТА in Ukraine. There were 77 respondents who were divided into three groups (developers, users, and informed persons) according to the level of involvement in the НТА sphere. According to the survey results, more than half of the respondents consider OMT as a professional expert activity related to the preparation of high-level evidence. The rest of the respondents classify HTA as a field of scientific research that is currently not sufficiently integrated into practical health care and decision-making. The majority of respondents see the main purpose of the HTA as identifying the safest medical technologies with proven efficacy and economic feasibility for inclusion in standards and regulatory lists. Among the main problems of HTA development at the current stage, experts identify the following: lack of a formed professional environment, insufficient awareness of potential stakeholders, unresolved issue of using HTA results, especially at the level of healthcare facilities. At the same time, a comparison of the survey results with the data of previous studies shows an increase in awareness and understanding of the importance of implementing HTA in medical and pharmaceutical practice at different levels of government. To improve the implementation of HTA in the national practice of health care, it is proposed to strengthen the educational and informational component and ensure the publicity of the processes and use of HTA results in decision-making at the state, regional and local levels.

Pragmatic Trial of Palliative Care Support Using Extension for Community Healthcare Outcomes Mentoring.

Increasing rates of chronic diseases and an aging population have placed palliative care at the forefront of public health efforts. The major goal of palliative care is to achieve the best possible quality of life for patients and their families or caregivers. To reduce barriers and improve palliative care, the From Advance Care Planning Toward Palliative Care coalition was first formed in South Dakota in 2017. It comprises an interprofessional, multi-institutional group of health care professionals who aim to promote palliative care through education, research, and advocacy. The project's purpose was to increase awareness and knowledge of best palliative care practices and to improve access to resources and networking among stakeholders. In 2021 and 2022, the coalition implemented the Extension for Community Healthcare Outcomes model. The objective was to provide a centralized structure for distant providers to obtain mentoring in palliative care through case-based learning according to a standardized communication and mentoring strategy, thereby increasing access to palliative care networking opportunities in rural and underserved regions.

O PAPEL DA ENFERMAGEM NA PREVENÇÃO, EDUCAÇÃO, ASSISTÊNCIA E COMO LIDAR COM A DEPRESSÃO PÓS-PARTO

Postpartum depression (PPD) is a mental health condition that affects many women after the birth of their children, with significant consequences for the mother’s health and the baby’s development. This article addresses the fundamental role of nurses in the prevention and treatment of PPD within primary health care. It is widely recognized that nurses are in a strategic position to identify risk factors associated with PPD early, such as a history of depression, high levels of stress, and lack of adequate social support. In addition to early identification, nurses are essential in screening, monitoring and intervening with women who are at risk or already have symptoms of PPD. The assistance offered by nurses includes emotional support and education about PPD, helping to reduce the stigma surrounding the condition and promoting the mental well-being of mothers. Collaboration between nurses and other healthcare professionals is crucial to ensure comprehensive, patient-centered care, from the prenatal to postpartum period. Strengthening these practices in primary care is vital to improving maternal and child health outcomes, ensuring that women receive the support they need to cope with and overcome PPD.

Relationship among death conferences, willingness and confidence in end-of-life care, and practice of grief care in Japanese home-visit nursing stations

Relationship among death conferences, willingness and confidence in end-of-life care, and practice of grief care in Japanese home-visit nursing stations

Comparative Analysis on Safe Traditional Practices by Iraqi and Philippine Mothers in the Treatment of Newborn Health Problems: A Narrative Review

Background: Traditional practices are usually derived from the relationships with the environment and human attitude towards nature. Various societies, especially in developing nations, have unsafe traditional practices for newborns, traditionally associated with poverty, low educational levels, religiosity, culture, and by word of mouth intergenerationally handed over advice by elders in the families. Objectives: This narrative review points out the prevalence, cultural significance, and health implications of unsafe traditional newborn care practices in Iraq and the Philippines. Methods: Literature was searched in PubMed, Scopus, Web of Science, CINAHL, and Google. All iterations searched literature among mothers whose neonates were at issues, favoring traditional techniques rather than modern medicine—a total of 51 articles to be reviewed from articles published from 2019 to June 2024. Results: The following ten critical themes of unsafe practices were identified: care of the umbilical cord, feeding, traditional healing, bathing rituals, circumcision, swaddling, and treatments for gastrointestinal, respiratory, and eye problems, besides newborn isolation and practices of exposure. All these practices are comparatively prevalent in the rural setup and are ingrained in the fabric of cultural beliefs and traditions. These could include exposure to infection, complications, developmental delays, and neonatal mortality. The practices have also been associated with the perpetuation of poverty, low literacy levels, and cultural backgrounds. Conclusion: This review indicates that interventions towards these problems have to be multi-faceted. Multiple dimensions can be integrated into evidence-based interventions to improve education and economic opportunities, engagement with religious and cultural leaders, health system strengthening, fomenting research, and community engagement to develop culturally relevant solutions linking tradition and evidence-based care to improve newborn health outcomes.

Development and internal validation of a multivariable prognostic model to predict chronic pain after a new episode of non-specific idiopathic, non-traumatic neck pain in physiotherapy primary care practice

ObjectiveTo develop and internally validate a prognostic model to predict chronic pain after a new episode of acute or subacute non-specific idiopathic, non-traumatic neck pain in patients presenting to physiotherapy...

Emergency Anesthesiology Encounters, Care Practices, and Outcomes for Patients with Firearm Injuries: A 9-Year Single-Center US Level 1 Trauma Experience.

Firearm injuries cause significant morbidity and mortality. Patients with firearm injuries require urgent/emergency operative procedures but the literature incompletely describes how anesthesia care and outcomes differ between high acuity trauma patients with and without firearm injuries. Our objective was to examine anesthesia care, resource utilization, and outcomes of patients with acute firearm injuries compared to nonfirearm injuries. We conducted a retrospective cross-sectional study of patients ≥18 years admitted to a regional Level 1 trauma center between 2014 and 2022 who required operative management within the first 2 hours of hospital arrival. We examined clinical characteristics, anesthesiology care practices, and intra- and postoperative outcomes of patients with firearm injuries compared to patients with nonfirearm injuries. Over the 9-year study period, firearm injuries accounted for the largest yearly average increase in trauma admissions (firearm 10.1%, blunt 3.2%, other 1.3%, motor-vehicle crash 0.9%). Emergency anesthesiology care within 2 hours of arrival was delivered to 4.7% of injured patients (2124; 541 firearm [25.4%] and 1583 [74.5%] nonfirearm). Patients with firearm injuries were younger (30 [23-40] years vs 41 [29-56] years; P < .0001), male (90% vs 75%; P < .0001), direct admissions from scene (78% vs 62%; P < .0001), had less polytrauma (10% vs 22%; P < .0001), arrived after hours (73% vs 63%; P < .0001), and received earlier anesthesiology care (0.4 [0.3-0.7] vs 0.9 [0.5-1.5] hours after arrival; P < .0001). Patients with firearm injuries more often received invasive arterial (83% vs 77%; P < .0001) and central venous (14% vs 10%; P = .02) cannulation, blood products (3 [0-11] vs 0 [0-7] units; P < .0001), tranexamic acid (30% vs 22%; P < .001), as well as had higher estimated blood loss (500 [200-1588] mL vs 300 [100-1000] mL; P < .0001), and were transferred to the intensive care unit (ICU) more frequently (83% vs 77%; P < .001) than patients with nonfirearm injuries. Intraoperative mortality was comparable (6% firearm vs 4% nonfirearm) but postoperative mortality was lower for patients with firearm injuries who survived the intraoperative course (6% vs 14%; P < .0001). Comparatively, more patients with firearm injuries were discharged to home, or to jail (P < .001). Over the study period, anesthesiologists increasingly cared for patients with firearm injuries, who often present outside of daytime hours and require urgent operative intervention. Operating room readiness and high-intensity resuscitation capacity, such as access to hemostatic control measures, are critical to achieving intraoperative survival and favorable postoperative outcomes, particularly for patients with firearm injuries.

Promoting sleep and rest in hospitalized children: a best practice implementation project.

The objective of this project was to implement scientific evidence to promote sleep and rest in pediatric patients during hospitalization. Hospitals are not conducive to quality sleep, as external factors such as light, noise, and interruptions from health care staff can disturb patients. Being hospitalized has a detrimental impact on children's sleep because it reduces how much sleep they get and the quality of that sleep. It has been reported that up to 20% to 30% of hospitalized children experience sleep problems. This project was conducted at the Marqués de Valdecilla University Hospital in Cantabria, northern Spain. The project used the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process, together with a structured approach to identifying and managing barriers to change. The study subjects were 100 children aged 2 to 16 years, who were admitted to the hospital's pediatric unit from November to December 2021, and 27 multi-disciplinary health care staff. Implementing the evidence-based strategies improved our care practices, with the follow-up audit results showing a marked improvement in compliance. Thus, training health care staff on pediatric sleep increased from 4% to 80%; using a multi-faceted approach to sleep promotion increased from 21% to 87%; and promoting relaxation techniques to promote sleep increased from 0% to 80%. The project met its objectives. Areas for improving children's sleep and rest during hospitalization were identified. To avoid resistance to change, it was necessary to involve the entire team and maintain training. We recommend follow-up audits once a year, to ensure the sustainability of the project. http://links.lww.com/IJEBH/A252.

Remember sustainability when identifying low-value clinical care practices in critical care.

Remember sustainability when identifying low-value clinical care practices in critical care.

Analysis of rehabilitation of individuals after cholecystectomy in sanatorium-resort conditions as a prerequisite for the development of the concept of physical therapy

Laparoscopic cholecystectomy (LCС) is the most commonly performed surgical intervention. The presence of diseases of several body systems in individuals may indicate metabolic syndrome. The consequences of cholecystectomy are manifested by various symptoms and are generally called postcholecystectomy syndrome. The purpose of the article is to analyze the methods and means of rehabilitation of patients after LCC at the sanatorium stage on the example of the functioning of the Department "Lavanda Sanatorium" of CJSC "Ukrprofozdorovnytsia" of the sanatorium-resort complex "Morshynkurort". Research methods: analysis and synthesis of scientific and methodological literature, analysis of methods and means of rehabilitation of patients after LCC for one calendar year. A total of 1296 people diagnosed with gallbladder and biliary tract diseases received rehabilitation services, including those after LCC. Patients undergoing rehabilitation in the post-acute and long-term stages after surgical interventions are treated at the Lavanda Sanatorium department. The treatment period is from 18-24 days at the patient's request. The criteria for the quality of rehabilitation services were as follows: improvement of health, disappearance of pain, dyspeptic phenomena, increased appetite, normalization of bowel movements, normalization of instrumental and laboratory blood tests, etc. Patients after LCC have signs of metabolic and postcholecystectomy syndromes. In addition to the dysfunction of the gastrointestinal tract, there are also limitations of other various body systems, their functions, activities and participation. Therefore, it is necessary to use the international assessment tool "International Classification of Functioning and Participation" and, according to the established disorders, to set individual rehabilitation goals for patients. The use of mineral therapeutic water from well No. 3 in the village of Horishne, Stryi district, Lviv region, in a dilution of 3.0-3.4 g/dm3 on the functional state of the liver of patients after LCC in the conditions of the Morshynkurort sanatorium-resort complex leads to an improvement in liver function, which is confirmed by the results of biochemical studies of patients' blood. Conclusions. Preformed physical factors (physical procedures), heat therapy, various baths, mud therapy, reflexology, microclysters, exercise therapy and massage are traditionally the most popular in the prescription department. However, the use of such remedies, in addition to the use of mineral healing water, is a matter of great debate among the professional community and requires more detailed study in terms of evidence-based practice in health care.

Pioneering Patient-Centered Surgical Care and Anesthesia Practice: Hanaoka Seishū's Contribution to Surgery During Japan's Isolationist Era.

Pioneering Patient-Centered Surgical Care and Anesthesia Practice: Hanaoka Seishū's Contribution to Surgery During Japan's Isolationist Era.

Evaluating diabetic foot care knowledge and practices at education level.

Diabetic foot is one of the complications in type 2 diabetes mellitus. Adequate knowledge and practice are an important aspect to control further deteriorating conditions such as ulcers and amputations. Thus, the objective of this cross-sectional study was to investigate the impact of the education levels of diabetic patients on diabetic foot care knowledge and practice. This cross-sectional study with a convenient sampling technique was conducted on 534 patients with diabetes mellitus from public and private care hospitals. The data was collected using a validated, pretested and structured bilingual (Arabic, English) questionnaire. There were 534 patients interviewed, 39.1% of whom were males and 60.9% of whom were females and 61.4% of the patients had had T2DM for over 10 years. There was a significant difference in education levels between the male and female patients (53.8% and 46.2%, P = .001). Furthermore, 83.9% patients were married. The difference in education between the married and the single, divorced, and widowed patients was significant (P = .007). Patients with uncontrolled HbA1c were 2.43 times more likely to have hypertension (RR = 2.43, P = .03), while patients with highly uncontrolled diabetes had 3.1 times more chances of hypertension (RR = 3.1, P = .009). Heart disease prevalence was 3.27 times higher in diabetes patients with uncontrolled HbA1c and 3.37 times higher in patients with highly uncontrolled HbA1c. Patients with diabetes who have been diabetic for more than 10 years have a greater risk of heart disease (RR = 2.1; P = .03). Patients with lower education levels exhibited more diabetic complications compared to patients with higher education levels (P < .05). The present study highlights the importance of education and awareness campaigns targeting diabetic patients, especially those with lower education levels, to improve diabetes control and prevent, or manage, comorbidities. Healthcare providers should also prioritize patient education and medication adherence to improve diabetes management and reduce the risk of complications.