Implementation Of Care Plans Research Articles

Barriers to and facilitators of advance care planning implementation for medical staff after the COVID-19 pandemic: an overview of reviews

ObjectiveThe COVID-19 pandemic has impacted the capacity for advance care planning (ACP) among patients, families and healthcare teams. We sought to identify and review the barriers to and facilitators of...

The Implementation and Evaluation of Pharmaceutical Care Plan in Stroke Patients at Tertiary Care Hospital

Objective: To assess the pattern and prevalence of adverse drug reactions (ADRs) reported by the neurology department and review the benefits of the pharmaceutical care plan. Materials and Methods: A total of 148 stroke cases with previous medication history correlated with current complaints leading to hospitalization were included in the prospective study for one year in the neurology department. Results: This study identified non-adherence (50%) and ADRs (38%). Ignorance of the disease, its complications, and the possible adverse effects of self-medication have been identified as risk factors. The medication-related problems were mainly observed with antimicrobials, central nervous system (CNS), central venous system (CVS), and inflammatory and immune modulators. Conclusion: The risk factors involved are illiteracy regarding prescribed therapy benefits. In the patient’s medication therapy, warfarin has more adverse events, and an observation of the patient’s plasma concentration levels increased.

Nursing Intervention for the Timing of Catheterization in a Patient with Frequent Abnormal Autonomic Reflexes from Cervical Medullary Injury: A Case Report

Introduction: Cervical medullary injury is a severe type of spinal cord injury that can lead to neurogenic bladder and neurogenic rectum, which increases the risk of autonomic dysreflexia (AD) in patients. Autonomic dysreflexia is a common group of clinical syndromes characterized by autonomic dysfunction after spinal cord injury in the T6 or higher level. If left untreated, AD can lead to severe complications such as hypertensive crisis, paroxysms, intracranial hemorrhage, and even death. Nursing interventions are crucial in selecting the timing of catheterization for a patient with frequent AD during intermittent catheterization for cervical medullary injury, enhancing the overall quality of care for patients with cervical medullary injury. Case Presentation: This study focused on a tetraplegic patient with a cervical medullary injury who developed AD during intermittent catheterization. The factors influencing AD during intermittent catheterization were explored through a literature review, urodynamics, and a bladder scanner. The nursing interventions implemented included active control of AD, personalized assessment of the risk of abnormal autonomic dysreflexia, prevention, early identification, acute episode management, precise bladder management, and implementation of a personalized care plan. After 31 days of treatment, the number of AD episodes was significantly reduced, leakage was decreased, and urine volume was controlled in the normal range with good results. The key points of care included timely control of urine output, selection of the best catheterization timing, and other health education methods. The nursing interventions played an active and effective role in maintaining normal bladder function, and the patient resumed regular intermittent catheterization. Conclusions: Nursing interventions are vital in managing patients with cervical medullary injuries who require intermittent catheterization. A comprehensive nursing care plan that includes personalized assessment and management of AD can significantly improve outcomes for these patients and prevent the occurrence of AD, ultimately leading to a better quality of life.

How Nurses Develop Standardized Care Plans Under a Clinical Decision Support System: A Mixed-Methods Study.

Standardized care plans are being increasingly introduced to health facilities; however, their level of adoption remains unsatisfactory. Little is known about nurses' use of standardized care plans in China. This study aims to investigate acute care nurses' practices and experiences of care planning within a clinical decision support system embedded with standardized nursing languages. We explored the importance and performance of nursing interventions by retrospective analysis of 400 standardized care plans (performance) and a survey among nurses (importance). Semistructured interviews were conducted to supplement quantitative findings and delve deeper into nurses' experience with standardized care plans. A total of six core nursing diagnoses were determined, each corresponding to seven to 15 nursing interventions. The correlations between nurses' perceived importance and actual performance of nursing interventions in the care plan were weak. Qualitative interviews identified three themes: negative attitudes toward the care plan, uncertainty regarding care planning, and new routines with the care plan. Our findings indicate that nurses' care planning may not reflect their professional judgments. Effective leadership from nurse administrators is warranted to engage nurses with standardized care plan implementation. The content of the standardized nursing language embedded-knowledge base should be continuously adapted to clinical needs to facilitate nurses' care planning practices.

Pediatric Advance Care Planning: A Scoping Review.

To assess current practice and provide a basis for a provincial template, clinicians at a Canadian pediatric hospice reviewed the literature surrounding pediatric advance care planning (pACP) documentation, process, and implementation for children/youth. The scoping review protocol was developed in accordance with the Joanna Briggs Institute methodology for scoping reviews, and was prospectively registered on the Open Science Framework. MEDLINE, Embase, CINAHL, the Web of Science Core Collection, and Google Scholar, as well as sources of unpublished studies and grey literature, were reviewed. Sixty-four articles met the criteria. Fifteen pACP documentation forms/tools were also identified. Overall, the included articles highlighted that pACP should be a structured, collaborative and iterative process between the family and a trusted or relevant healthcare provider, encompassing medical and non-medical issues. Few articles provided insights into specific elements recommended for advance directive forms. Identified strategies for implementation included a structured, step-by-step pACP interventional tool along with ongoing training, mentorship, and defined organizational structures for the clinician. No single specific ACP tool was acknowledged as the gold standard. Use of a pACP tool, along with ongoing provider education and communication skill development, standardized/accessible documentation, and system-wide quality improvement support, were noted as integral components of pACP.

Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections.

The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.

Advance Care Planning in Malaysia

BackgroundIn Malaysia, advance care planning is still in its infancy. There is no national implementation of Advance Care Planning. AimsTo describe the national state of advance care planning development in Malaysia MethodsReview of relevant advance care planning literature locally and internationally was undertaken. ResultsPositive development in Malaysia includes implementation of advance care planning at institutional level, initiatives to develop educational programmes as well as research activities to understand the attitude and perception of patients on advance care planning. However, there remain challenges, including lack of knowledge and awareness, lack of legislative framework to guide advance care planning implementation and lack of strong initiatives at a national level. ConclusionsIt is evident that there is much to learn nationally and internationally about ACP before any decision on implementation of ACP is made in Malaysia. ACP is a public health issue and requires concerted effort of all stakeholders, including Government agencies, academic institutions, and non-government organizations to raise public awareness. More research is needed to shape the future direction of ACP development in Malaysia.

Pediatric Medical Traumatic Stress and Trauma-Informed Care in Pediatric Chronic Illness: A Healthcare Provider Survey

To inform approaches to pediatric medical traumatic stress (PMTS) by exploring providers' (1) perception of the impact of PMTS on the medical care of patients with pediatric-onset chronic illnesses, (2) self-reported competencies and practices of PMTS prevention, treatment, and counseling, and (3) perception of the barriers influencing the adoption of these practices. A convenience sample of multidisciplinary healthcare providers was recruited through a multimodal recruitment strategy to participate in an electronic survey adapted from the Trauma-Informed Care Provider Survey. Among participants (n=304), 99% agreed that PMTS impacts patient health. Participants report altering medical care plans due to PMTS, including deferring or stopping treatments (n=98 [32%]) and changing medication regimens (n=88 [29%]). Sixty-eight percent (n=208) report negative impact of PMTS on patient implementation of medical care plans, including medication nonadherence (n=153 [50%]) and missed appointments (n=119 [39%]). Although participants agreed it is their job to decrease patient stress (n=292 [96%]) and perform PMTS assessments (n=268 [88%]), few practiced PMTS-focused trauma informed care. Systems-level barriers to practice included insufficient training, absent clinical workflows, and lack of access to mental health experts. Our findings have helped inform a conceptual framework for understanding the relationship between PMTS and health outcomes. Systems-level opportunities to optimize PMTS-focused trauma-informed care include (1) dissemination of provider training, (2) integrated workflows for PMTS mitigation, and (3) enhanced accessibility to mental health providers. Further work is required to determine if these interventions can improve health outcomes in patients with pediatric-onset chronic illnesses.

Exploring the completeness of comprehensive geriatric assessment in relation to care outcomes in hospitalized older patients

Exploring the completeness of comprehensive geriatric assessment in relation to care outcomes in hospitalized older patients

Early experiences of telehealth monitoring for patients with COPD and implementation of person-centred care plans

Aims: The authors share their early experiences of developing and implementing a telehealth service for patients with chronic obstructive pulmonary disease (COPD), through a collaborative approach. The article will explore the process of implementing telehealth service in a local care community team, identifying opportunities for improving care delivery and person-centred care. Discussion: The initial feedback and thoughts of both patients and healthcare professionals were obtained. Such feedback included patient's health insights, which helped improve risk assessment and personalised parameter settings. Conclusions: To-date, there has been a lack of robust evidence for the clinical benefits of telehealth. However, the feedback from staff and patients using telehealth was positive in several areas. Person-centred care plans also helped provide greater insight into patient's health goals, thereby streamlining care.

Acute Kidney Injury Survivor Care Following Hospital Discharge: A Mixed-Methods Study of Nephrologists and Primary Care Providers.

Widespread delivery of high-quality care for acute kidney injury (AKI) survivors after hospital discharge requires a multidisciplinary team. We aimed to compare management approaches between nephrologists and primary care providers (PCPs) and explored strategies to optimize collaboration. Explanatory sequential mixed-methods study using a case-based survey followed by semi-structured interviews. Nephrologists and PCPs providing AKI survivor care at 3 Mayo Clinic sites and the Mayo Clinic Health System were included. Survey questions and interviews elucidated participants' recommendations for post-AKI care. Descriptive statistics were used to summarize survey responses. Qualitative data analysis used deductive and inductive strategies. A connecting and merging approach was used for mixed-methods data integration. 148 of 774 (19%) providers submitted survey responses (24/72 nephrologists and 105/705 PCPs). Nephrologists and PCPs recommended laboratory monitoring and follow-up with a PCP shortly after hospital discharge. Both indicated that the need for nephrology referral, and its timing should be dictated by clinical and non-clinical patient-specific factors. There were opportunities for improvement in medication and comorbid condition management in both groups. Incorporation of multidisciplinary specialists (eg, pharmacists) was recommended to expand knowledge, optimize patient-centered care, and alleviate provider workload. Survey findings may have been affected by non-response bias and the unique challenges facing clinicians and health systems during the COVID-19 pandemic. Participants were from a single health system, and their views or experiences may differ from those in other health systems or serving different populations. A multidisciplinary team-based model of post-AKI care may facilitate implementation of a patient-centered care plan, improve adherence to best practices, and reduce clinician and patient burden. Individualizing care for AKI survivors based on clinical and non-clinical patient-specific factors is needed to optimize outcomes for patients and health systems.

Analysis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus.

To estimate the prevalence of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus through the diagnostic accuracy of the defining characteristics. A diagnostic accuracy study on the diagnosis of Readiness for enhanced health literacy in patients with type 2 diabetes mellitus was conducted using the latent class analysis model. The sample comprised 180 individuals attending a referral outpatient clinic in Maranhão, Brazil. The data analysis was conducted in the R Core Team software. The prevalence of the nursing diagnosis was 55.23%. The main defining characteristics were expresses desire to enhance health communication with healthcare providers and expresses desire to enhance the understanding of health information to make healthcare choices. All defining characteristics showed significant specificity values. Accurate diagnoses contribute to individualized care plans for patients. The diagnosis Readiness for enhanced health literacy should be considered in implementing care plans, including interventions to reduce complications in the health status of patients with type 2 diabetes mellitus.

Role of the MS nurse specialist in the patient's care pathway

The specialized nurse in MS is a new profession practiced in MS clinics and outpatients specialized coordination structures. Sheis part of a specialized multi-professional team. The nurse must master a broad knowledge of the disease and the treatments. Have skills in therapeutic education, communication and coordination. She has a detailed knowledge of the resources of the care offer. The MS nurse thus participates in the assessment of the patient's needs for the implementation of a personalized care plan combining response to medical, paramedical, psychological and social needs.

Nurses' wound care competency in a sample of hospitals in Northern Vietnam

This study aimed to investigate the current situation regarding wound care by nurses in eight hospitals in the north of Vietnam, in order to plan the training for nurses to enable them to achieve the National Basic Competency Standards for Nurses. A cross-sectional descriptive prospective study was conducted from June 2020 to October 2020, with nurses in eight hospitals in four provinces of Northern Vietnam - Hanoi, Quang Ninh, Thai Nguyen and Bac Ninh. Data were collected based on a checklist of direct observation of nurses who provide wound care. The two main indicators were the knowledge score and the practical capacity/competence of the nurses in wound care. A total of 518 nurses participated in the study, the mean age was 32.25±7.31; with 438 (84.6%) being female. Clinical experience of less than 10 years was reported by 63.6%; college education level (diploma) was reported by 58.1%, university level by 28.2%; and post-university level by 4%. The highest mean scores for knowledge were found in the categories of health education for patients, followed by care of clean wounds, communication skills and team work, management and professional development and pressure ulcer wound care. Under the practice domain the highest mean scores were ability to plan wound care, followed by self-evaluation, identification of wound types and implementation of wound care plans. The results showed that when judged against the competency standards, nurses' level of wound care competency needs to be improved. Also that there is a distinct theory-practice gap, which must be addressed. It is recommended that hospitals should conduct training for all nurses using the basic competency standards for Vietnamese nurses to improve the quality of care.

Care Processes and Quality-of-Life Outcomes Affecting the Gynecologic Cancer Survivorship Experience.

To describe and assess physical and psychosocial concerns and care processes related to cancer and treatment in gynecologic cancer survivors. 44 survivors of gynecologic cancer at City of Hope National Medical Center in southern California were enrolled. A descriptive mixed-methods approach was used. Data were collected on survivorship care plan implementation, supportive care referrals, and barriers to receiving care. Participants completed questionnaires assessing quality of life, unmet needs, and other outcomes at three, six, and nine months after enrollment. Changes over time were analyzed, and quantitative and qualitative results were compared. The most common unmet needs were stress reduction, side effect management, fear of cancer recurrence (FCR), and perception of adequate communication among the care team. Qualitative themes centered around communication, care coordination, FCR, financial distress, and need for information about peer support and healthy lifestyles. Nurses play a key role in coordinating care, assessing symptoms, and addressing psychosocial concerns. Providing education and coaching can reduce stress and facilitate survivors' self-management and self-efficacy.

Improvement and implementation of a national individual care plan in paediatric palliative care: a study protocol

IntroductionPaediatric palliative care (PPC) is care for children with life-threatening or life-limiting conditions, and can involve complex high-tech care, which can last for months or years. In 2015, the National...

Impact of Enriched Dementia Care Planning on Individualized Care Approaches and Psychological Well-Being of Residents

Introduction: The enriched dementia care-planning program seeks to enhance the quality of life for individuals with dementia by addressing their physical, emotional, social, and spiritual needs. This study aims to assess the impact of enriched dementia care planning on caregivers’ individualized care approaches and the psychological well-being of residents. Materials and method: A pretest and posttest cross-sectional one-group study including caregivers and persons with dementia. Formal caregivers (n=32) and individuals with dementia (n=17) were recruited from two nursing homes. Pretest and posttest measurements were conducted using distinct data collection tools for both caregivers and individuals with dementia. The caregivers were exposed to life story booklets, training modules, “about me” profiles, and individualized care tips and reminders over an eight-week period. Results: Pre-test and post-test analysis indicated that staff perceptions of persons with dementia were more positive and communication between staff and residents improved at post-test (8.52±2.04) compared with the pre-test (7.10±1.71) (p<0.05). However, there was no significant change in residents’ psychological well-being at the post-test (p>0.05). Conclusion: The implementation of enriched care planning has the potential to empower caregivers to engage with residents and deliver individualized care with a more positive attitude. Enhancing communication between staff and residents is recognized as a pivotal factor with substantial potential for advancing individualized care initiatives in nursing homes. Keywords: Dementia; Nursing Homes; Person-Centered Care; Psychological Well-Being

A Retrospective Cohort Study Evaluating the Association Between Implementation of a Digital Care Plan and Hospitalization Rates for Home Care Residents in the United Kingdom

Cera, a homecare provider, uses digital care plans (DCP), to streamline the provision of home care. DCP rollout is part of a larger digitization initiative, including carer visit reports collected through a mobile app and branch actions recorded in a web application supported by a secure central database. This retrospective cohort study aimed to assess the association of a DCP rollout with service user hospitalization rates. his study utilized retrospective data from 2 groups of service users, those for whom their first 30 days of Cera membership occurred prior to DCP rollout (pre-DCP group) versus those whose first 30 days of Cera membership occurred after DCP rollout (post-DCP group). The 30-day hospitalization rate was the primary outcome measure and was determined through a combination of carer reports, reporting from service users or their families, and branch staff follow-up. There were 55 hospitalizations among 392 users in the pre-DCP group in the 30 days after joining Cera (14.0% hospitalization rate), compared to 23 hospitalizations among 297 users in the post-DCP group (7.7% hospitalization rate). This represented a significant reduction in hospitalizations in the post-DCP group (6.3% absolute difference in hospitalization rate; 45% relative reduction; P < .001). This result was robust to multiple sensitivity analyses. The implementation of a DCP was associated with a 45% relative reduction in the 30-day hospitalization rate for new service users when compared to pre-DCP enrollment. These benefits could be further amplified by combining the DCP with additional initiatives aimed at the prediction and prevention of avoidable hospitalizations.

Needs Assessment Study in a Dementia Colombian Population

AbstractBackgroundDementia is a public health problem. In Colombia, there is no policy for dementia patients or their caregivers. Patients with dementia have unidentified needs and this lack of knowledge has contributed that a formal policy has not been raised. The recognition and identification of the needs facilitate the planning, provision, and evaluation of health services, and constitutes the first stage for the implementation of services or care plans. If the Colombian State wants to formulate policies that protect the population with dementia it should conduct studies that contemplate all dimensions and guarantee the social inclusion and equity of the affected population. A needs assessment study is required that includes the identification and analysis of physical, social, patrimonial, legal, access and psychological needs of patients with early stages of dementia and their caregivers.ObjectiveTo identify and analyze the needs of Colombian patients with mild dementia and their relatives with the purpose of contributing to the design of the health policy strategy for dementia, from a perspective of social justice and equity.MethodExploratory sequential mixed methods design. We will include Colombian adults with a mild dementia diagnosis, their caregivers and health professionals. We will employ a structured interview, an assessment of quality of life, psychiatric and medical comorbidities and we will employ case studies and focus groups to identify categories and interactions of the study problem. In the second stage, we propose to employ a needs assessment methodology and a mixed method using triangulation to evaluate the burden of known and unknown needs. Then, a theoretical analysis of inequities will be carried out stratifying by the insurance regime and city.ResultThe results will be analyzed in light of the theory of recognition as social justice.ConclusionWe will recommend a proposal for the design of the strategy in health for this population.

Engagement of older adults in STRIDE's multifactorial fall injury prevention intervention.

Evidence-based multifactorial fall prevention interventions in clinical practice have been less effective than expected. One plausible reason is that older adults' engagement in fall prevention care is suboptimal. This was a post-hoc analysis of 2403 older adults' engagement in a multifactorial fall prevention intervention in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) pragmatic trial. Based on the direct clinical care level of the Patient and Family Continuum of Engagement (CE) framework, three indicators of progressively interactive engagement were assessed: (1) Consultation (receiving information), (2) Involvement (prioritizing risks), and (3) Partnership (identifying prevention actions). Drop off at each step was determined as well as predictors of engagement. The participants' engagement waned with increasingly interactive CE domains. Although all participants received information about their positive fall risk factors (consultation) and most (51%-96%) prioritized them (involvement), fewer participants (33%-55%) identified fall prevention actions (partnership) for most of their risk factors, except for strength gait or balance problems (95%). More participants (70%) identified home exercises than other actions. Finally, fall prevention actions were identified more commonly among participants who received two visits compared to one (OR=2.33 [95% CI, 2.06-2.64]), were ≥80 years old (OR=1.83 [95% CI, 1.51-2.23]), and had fewer fall risk factors (OR=0.90 [95% CI, 0.83-0.99]). The drop-off in participants' engagement based on the level of their interaction with clinicians suggests that future multifactorial fall prevention interventions need to be more focused on interactive patient-clinician partnerships that help older adults increase and maintain fall prevention actions. Our analyses suggest that more frequent contact with clinicians and more monitoring of the implementation and outcomes of Fall Prevention Care Plans could potentially improve engagement and help older adults maintain fall prevention actions.