Nurse Case Management Research Articles

Nursing case management in the palliative care: Scoping review

Background & Aim: Palliative care is of vital importance for the quality of life of the person who benefits from it. Nursing case management provides useful tools for optimizing the care that is provided, thus being an important resource for improving them in an area as complex as palliative care. This study aimed to map scientific evidence on nursing case management in the context of palliative care.
 Methods & Materials: Scoping review was done according to the eligibility criteria suggested by Joanna Briggs Institute: population (adults who benefit from palliative care), concept (studies in which nursing case management is implemented), and context (studies in the palliative, hospital or home care). The research was conducted in CINAHL (via EBSCO), MEDLINE (via PUBMED), COCHRANE, Scielo, LILACS, and MedicLatina databases; grey literature was researched in RCAAP, DART-Europe, and OpenGrey. Previously published studies in Portuguese, Spanish, English, and French have been included without any temporal limitation.
 Results: We included ten articles in the review. Nursing case management is focused on health services management, the centrality of patient/family care, and the case manager role.
 Conclusion: The studies included have low evidence levels and a limited sample size. The optimization of resources and services, the greater availability of time for the provision of care, and the satisfaction of the person and family with the care were highlighted. The role of the case manager is highlighted, proving to be very important throughout all the nursing case management.

Same-Day Total Joint Discharges: A Collaborative Effort for Patient Safety

<h3>Background Information</h3> Previously, both knee and hip replacement patients had been admitted to the hospital for several days on average. Our orthopedic surgeons began booking them as same day discharges. In navigating this new plan of care, we identified a lack of knowledge of the PACU RN regarding discharge instructions for these patients. The required home discharge information included: antibiotics, anticoagulation therapy, home visits with nursing, and physical therapy. Coordinating these therapies, same day, was identified as a new process for the PACU RN. <h3>Objective of Project</h3> The objective and goal of this project was to ensure our patients have a safe discharge on post-op day zero with adequate preparation for medication management and the necessary services at home. <h3>Process of Implementation</h3> Our team identified the key stakeholders to accomplish our objective. These stakeholders included: Orthopedic surgery, Orthopedic Nurse Practitioner, Case Management, Physical Therapy, PACU management, and PACU staff members. Multiple meetings occurred between these multidisciplinary team members to discuss each member's expectations for a safe discharge, potential roadblocks, and solutions. Issues identified were Case Management coverage for PACU, proper lovenox teaching, and physical therapy evaluation equipment needed in the PACU. These issues were addressed and resolved. To assure that the complex criteria for discharge was met, the PACU RN's created a tool to assist with this process. This tool listed all the activities to be completed prior to discharge. <h3>Statement of Successful Practice</h3> The identification of proper discharge requirements and the creation of the "Orthopedic Same-Day Surgery Tip Sheet" streamlined the discharge process. This tip sheet provided guidance to RN's to ensure each patient was being sent home with the correct teaching and tools for a safe same-day discharge. During the post-operative phone call the patients confirmed that the discharge instructions were complete and the home visits were scheduled. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The identification of a knowledge deficit led to a multidisciplinary group collaborating on best practices. The creation of a PACU "Tip Sheet" gave the RN's the necessary tool and knowledge to care for the same day discharged total joint patient. Our patients are going home with proper education and resources needed for a successful and safe recovery at home.

Quality Improvement Evaluation of a Veterans’ Palliative Care Telehealth Music Therapy Program

Abstract Music therapy is an important psychosocial aspect of hospice and palliative care programs to address pain, grief, and anxiety. The COVID-19 pandemic introduced new challenges to psychosocial therapies in palliative care, including the inability of families to be at the bedside of seriously ill patients, and the need to provide services remotely through video technology. Due to this sudden shift in service delivery, music therapists adapted without research evidence or evaluation of service quality. This evidence-based quality improvement (QI) evaluation examined the program effectiveness of music therapy telehealth services at one Veterans Affairs Medical Center (VAMC) for patients in palliative care, their family members, and VAMC staff during this time of societal grief, anxiety, and isolation. Evaluation metrics included patient (n = 39), staff (n = 27), and family member (n = 3) responses to QI surveys, and analysis of journal entries from key stakeholders (i.e., music therapist, nurse case manager, palliative care physician). We conducted a content analysis of QI surveys and completed the first and second cycle coding of journal entries. Results from the QI survey indicated that music therapy telehealth provided affective and interpersonal benefits, and increased compliance with other therapies. Reflections from key stakeholders included clinical recommendations for service implementation and descriptions of the influence of the telehealth modality on the therapeutic relationship. Findings suggested that music therapy telehealth services can provide psychosocial support for veterans, families, and staff in palliative care. QI research may be utilized to provide helpful ongoing feedback regarding clinical effectiveness.

Efficacy of the Whole-Course Case Management Model on Compliance and Satisfaction of Breast Cancer Patients with Whole-Course Standardized Treatment.

Objective To explore the influence of the whole-course case management model on the compliance and satisfaction of breast cancer patients with the whole-course standardized treatment. Methods Eighty breast cancer patients admitted to our hospital between April 2020 and June 2021 were assigned to receive either conventional nursing (routine group, n = 40) or whole-process case management (experimental group, n = 40) according to different nursing methods. Outcome measures included self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, adverse reactions, treatment compliance, and nursing satisfaction. Results After nursing, the SAS and SDS scores of the experimental group were significantly lower than those of the routine group (P < 0.05). The whole case management mode was associated with a significantly lower incidence of adverse reactions versus routine nursing (P < 0.05). The whole case management resulted in higher compliance of patients versus routine nursing (P < 0.05). The experimental group had a significantly higher nursing satisfaction versus the routine group (P < 0.05). Conclusion The whole-process case management mitigates patients' negative emotions, strengthens their treatment compliance, lowers the incidence of postoperative adverse reactions, and improves nursing satisfaction, which may provide a viable nursing alternative for patients with breast cancer.

Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings

Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance. Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans. Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system's electronic communication tools. We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.

Public Health Nursing Case Management—Reducing Sexually Transmitted Infections (IHS)

Federal Grants & ContractsVolume 46, Issue 14 p. 7-7 Grants alerts Public Health Nursing Case Management—Reducing Sexually Transmitted Infections (IHS) First published: 13 June 2022 https://doi.org/10.1002/fgc.32444Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume46, Issue1416 June 2022Pages 7-7 RelatedInformation

SWK-08. Implementing awareness practice in Neuro-Oncology

Awareness practices are mind-body medicine techniques that help quiet the chatter of worry, fear, or the "to-do list" in the mind and allows the individual to experience calm and focus. Neuro-Oncology families undergo a variety of stressors that increase the "mind chatter" once their child is diagnosed with a brain tumor. These families not only have to manage the day-to-day tasks of family life, but they are thrust into a world of uncertainty which often can breed anxiety. To help mitigate the stress and anxiety that Neuro-Oncology families undergo, sessions focusing on awareness practices were offered to parent caregivers once a week for 15-20 minutes via the Zoom platform. The goal of these sessions was to offer respite from mental and emotional challenges brought on by the cancer diagnosis and the COVID 19 pandemic. Separate sessions were also offered to Oncology nurse case managers to help decrease compassion fatigue as these nurses also walk alongside oncology families through the cancer journey providing advocacy and patient/family support. Breath awareness, imagery, and meditation practices were used during the sessions to activate the body's relaxation response to allow for rest and restoration.

Readmission risk identification: Implementation of a patient-centered interview.

6564 Background: Unplanned 30-day readmissions in the cancer population are common. There are few large studies describing cancer patients’ readmission perspective. To better define predisposing factors associated with readmission, our Nurse Case Manager team implemented a patient-focused survey. Methods: Cancer patients readmitted to The James Cancer Hospital from May 2020-December 2021 were included. Readmission events were defined as an inpatient hospital readmission within 30 days of the patient’s prior hospitalization. Team members conducted a 16-question survey immediately following readmission to evaluate the patients’ perspective on factors that may have contributed to their readmission; results were recorded. Results: A total of 3,333 readmissions were unplanned, 109 planned, 22 listed as other; 3,464 patients completed interviews (Table). During their index admission, most patients reported receiving (90%) and understanding (89%) discharge education/instructions. Upon index discharge, most patients (62%) were discharged on a new medication; the majority reported filling their prescription (95%) and taking it as instructed (98%). Nearly all patients had a post-index hospitalization follow up appointment scheduled, but only 58% reported attending. The primary reason reported for not attending was readmission prior to the appointment. Just over 50% of patients received a post-index hospital stay phone call. Some patients (6% yes; 58% unanswered) felt services at discharge would have been helpful. Most patients (51%) contacted their provider regarding worrisome symptoms experienced prior to being readmitted. Pain (18%), fever (11%), and shortness of breath (10%) were the most commonly reported symptoms that prompted returning to the hospital. Conclusions: To our knowledge, this is the largest study to date of cancer patients’ own perspective of their 30-day readmission. More immediate post-hospitalization follow up and increased deployment of tailored discharge services represent areas of opportunity identified to decrease readmission rates. Symptom-specific interventions may also be impactful. Due to the negative downstream effects readmissions have on the healthcare system, it is critical to develop risk mitigation strategies incorporating patient-reported experience. [Table: see text]

Implementation analysis of case management interventions for frequent users of healthcare services: A multiple-case study.

Context. Case management interventions (CMIs) are recognized to improve patients' experience of integrated care, to promote better utilization of healthcare resources, and to reduce emergency department visits, hospitalizations and health care costs. However, contextual factors influencing implementation of CMIs in primary care settings in Canada still need to be studied. Objective. To examine facilitators and barriers influencing implementation planning, engagement of key actors and the start-up phases of a CMI led by nurse case managers for frequent users of healthcare services with chronic diseases and complex care needs. Study design. Qualitative multiple case study design. Setting. Six primary care clinics across four provinces in Canada. Population studied. Frequent users of healthcare services with chronic diseases and complex care needs. Intervention. A CMI led by nurse case managers that included four main components: 1) patient needs assessment; 2) care planning, including an individual services plan (ISP); 3) coordination of services among health and social services partners; 4) self-management support for patients and families. Methods. Data collection: in-depth interviews with nurse case managers (n=10), clinic managers (n=5), and other healthcare professionals (n=5); six focus groups with family physicians (n=20), and other healthcare professionals (n=8); and field notes by research coordinators. Analysis: Mixed descriptive thematic analysis; intra-case histories; systematic comparison among cases by means of a descriptive and interpretative matrix; investigator and patient partners triangulation. Outcome Measures. Factors influencing the implementation of the CMI in primary care settings. Results. Difficulty of access to patient hospital information is a common barrier to all cases, as well as identification and recruitment of patients with the greatest needs of a CMI. Nurse case managers need extra time in the short term, especially when preparing and conducting the ISP. On the other hand, a culture of patient-centredness and collaboration; managerial and clinical leadership and support; and a positive perception of the CMI alongside provider engagement helps to overcome these barriers. Conclusions. This study may help researchers, decision-makers and clinicians plan the implementation of CMIs in primary care settings for frequent users of healthcare services with chronic diseases and complex care needs.

The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer.

Objective To explore the application of professional whole-process case management during nursing in patients with triple-negative breast cancer. Methods This study recruited 60 patients with triple-negative breast cancer who were diagnosed and treated at Department of Breast Surgery in our hospital assessed for eligibility between June 2018 and June 2020, and we assigned them at a ratio of 1 : 1 via the random number table method to receive either general nursing (control group) or professional whole-process case management plus general nursing (observation group). We analyzed and evaluated the hospitalization, the indwelling time of drainage tube, complications, recovery, quality of life, posttraumatic growth, and nursing satisfaction between these two groups at registration, discharge, and the sixth month after surgery, respectively. Results Professional whole-process case management achieved a shorter duration of drainage tube placement and hospitalization and a lower incidence of postoperative complications versus general nursing (P < 0.05). Moreover, the observation group had got better recovery (P < 0.05) and a better quality of life at discharge and 6 months after surgery (P < 0.05). Professional whole-process case management obtained higher scores of posttraumatic growth and higher nursing satisfaction versus general nursing (P < 0.05). Conclusion Whole-process case management promotes the postoperative recovery of patients with triple-negative breast cancer and shortens the duration of drainage tube indwelling and hospitalization, which lowers the incidence of postoperative complications, improves their quality of life, and enhances nursing satisfaction.

Nurse Case Manager Lifestyle Medicine (NCMLM) in the Type Two Diabetes patient concerning post COVID-19 Pandemic management: Integrated-Scoping literature review.

The American Case Manager Association defines Case Management, in Lifestyle Medicine perspective, a collaborative practice between all the actors involved in the care process. The goal of this review was to evaluate the Nurse Case Manager role in Type 2 Diabetes patients, analyzing the quali/quantitative data related to Nurse Case Management programs in Lifestyle Medicine view. Three independent operators were involved in two distinct phases, applying the Prisma method, specifics PICOS and research strategies from PubMed and Cinahl. The first part integrated a Cochrane systematic review on the Specialist Nurses in Diabetes Mellitus, while the second part evaluated the Nurse Case Manager interventions in Lifestyle Medicine view. The first part includes 13 studies and the second 6. The glycemic control was improved in the Nurse Case Manager groups in Lifestyle Medicine perspective. Good results were appreciated in secondary outcomes: lipid profile, Body Mass Index, quality of life and stress management. The results for the management of self-care and adherence to Lifestyle Medicine programs are encouraging. It emerged unequivocally that, taking care and supporting the diabetic subject, leads to significant benefits in the general health and to reduction of possible complications. After the Covid-19 Pandemic, the Nurse Case Manager Lifestyle Medicine could represent a valid alternative of health management for the improvement of care in Type 2 Diabetic patients.

The Impact of Same Day Infusion Treatment Protocols for Uncomplicated Vaso-Occlusive Crises within an Embedded Sickle Cell Care Model

Background: Infusion Center (IC) based care of uncomplicated sickle cell disease (SCD) vaso occlusive crises (VOCs) is very effective and results in better outcomes. At low volume sickle cell programs, it is challenging to acquire resources for a dedicated infusion program. Our goal was to create an embedded infusion program within our cancer center infusion services utilizing existing resources to improve the quality of care for our SCD patients.Methods: A multi-disciplinary team consisting of a Nurse Case Manager, Advanced Practice Provider, MD, IC scheduler and IC charge nurse was assembled. An agreement was made between the SCD team and IC leadership that at least one time slot would be made available for a SCD VOC visit every day. A workflow was created and all team members were educated regarding the workflow. Visit numbers for IC visits, emergency department (ED) and inpatient (IP) hospitalizations were collected from the EMR and compared for pre IC development (Jan 1, 2017- Dec 31, 2018) and post IC (January 1, 2019 - Dec 31, 2020).Results: Between 2017-2020, 182 patients with SCD were seen in the emergency room and 163 patients in our outpatient clinics. After the institution of an IC based care plan in January 2019, IC visit volume increased (270 visits pre IC vs.1076 visits post IC). ED treat and release (not requiring admissions) visits decreased from 373 visits pre IC to 286 visits post IC. The number of inpatient admissions did not change significantly during this time frame. However, the percentage of admissions from the ED increased (43% pre IC to 50% post IC), indicating a higher complexity of patients seeking care from the ED. 10 of 35 patients who used the IC in 2020 had no acute visits (ED or IP) in 2020, while these individual patients had a total of 37 ED visits in the pre IC timeframe, of which 20 were inpatient admissions with a total length of stay of 137 days and 17 treat and release episodes at the ED.Conclusions: Our project successfully utilized existing infusion based resources to facilitate outpatient management of acute uncomplicated SCD VOCs. This project presents an effective strategy that can be utilized by smaller volume sickle cell programs who do not have a stand alone infusion program to improve the quality of care for their SCD patients. DisclosuresGopal: Pharming: Consultancy; GBT: Consultancy; Alexion: Speakers Bureau; Rigel Pharmaceuticals: Other: Clinical Trial, Research Funding.

Early detection of anaemia in primary care with haemoglobinometry: ANHEMOG clinical trial protocol

BackgroundDetecting, treating and monitoring anaemia has a functional, social and economic impact on patients’ quality of life and the health system, since inadequate monitoring can lead to more accident & emergency visits and hospitalizations. The aim of this study is to evaluate the impact in the patient clinical outcomes of using haemoglobinometry to early detect anaemia in patients with chronic anaemia in primary care.MethodsRandomized controlled trial Capillary haemoglobin will be measured using a haemoglobinometer on a monthly basis in the intervention group. In the control group, the protocol currently in force at the primary care centre will be followed and venous haemoglobin will be measured. Any cases of anaemia detected in either group will be referred to the transfusion circuit of the reference hospital.DiscusionThe results will shed light on the impact of the intervention on the volume of hospitalizations and accident & emergency (A&E) visits due to anaemia, as well as patients’ quality of life. Chronic and repeated bouts of anaemia are detected late, thus leading to decompensation in chronic diseases and, in turn, more A&E visits and hospitalizations. The intervention should improve these outcomes since treatment could be performed without delay. Improving response times would decrease decompensation in chronic diseases, as well as A&E visits and hospitalizations, and improve quality of life. The primary care nurse case manager will perform the intervention, which should improve existing fragmentation between different care levels.Trial registrationNCT04757909. Registered 17 February 2021. Retrospectively registered.

Creating a New Model of Care by Integrating Case Management Nurses in a Children's Hospital.

Nurse case managers (NCMs) have been identified as effective members of a care team in the development of effective and successful discharge plans. A pediatric hospital had an opportunity to change the model of case management (CM) in response to multiple initiatives. This article describes the process, barriers, and results of the integration of a new role into the care team. The role development and integration were done at a quaternary-level pediatric hospital. Introduction of the NCM role was accomplished through a multidisciplinary approach that employed continuous improvement, involvement of team and hospital leaders, and collaboration across multiple professions. The role was developed from one pilot to the eventual positioning of nine NCMs. Introduction of the new program resulted in a shift from a reactive dyad model of social worker-utilization management nurse to a proactive triad model of NCM-social worker-utilization management nurse. Success was measured by a decrease in the number of denials and an increase in the overturn of the denials received. Other results included the innovation of several processes that streamlined discharge planning and contributed to patient/family satisfaction. Creation of a new nurse-led CM triad team can be accomplished through multidisciplinary support and a focus on continuous improvement. Further collaboration on discharge planning standards and CM is indicated. Additional research focused on the impact of nurse-led pediatric discharge planning as it relates to readmission reduction and appropriateness of level of care and length of stay is also needed.

INSTRUCTIONS: Creating a New Model of Care by Integrating Case Management Nurses in a Children's Hospital.

INSTRUCTIONS: Creating a New Model of Care by Integrating Case Management Nurses in a Children's Hospital.

Ineffective Communication: The Uninformed Injured Worker.

Effective communication has been demonstrated to impact patient health outcomes, specifically in improving symptom resolution, safety, function, and emotional well-being, and to lower malpractice claims. I hypothesized that the communication process with patients with Workers' Compensation is inadequate. Prospectively, claimants presenting for an independent medical evaluation or an impairment rating were assessed concerning the education that they received with regard to their claim. Basic principles were based on the Utah Labor Commission Employee's Guide to Workers' Compensation and an employee information sheet. There were 556 consecutive claimants assessed. None of the participants expressed any familiarity with the employee information sheet. Although there was a mean of 12 months since the date of claim to the evaluation, 536 participants (96.4%) were effectively unaware of the principles surrounding their claim; of these participants, 6 had attorneys and 23 had prior industrial claims. Of the 3.6% of participants who had received the State Employee Guide, 5 had a prior evaluation with the medical director of the Labor Commission, 6 had located the information online, and 9 had been provided information by their nurse-case manager. Even with this information, the context or importance of the information was not well understood. There were 16.4% of participants who were aware of the mileage compensation. Two claimants were aware that the insurer, not the employer, was responsible for managing the claim, 2 claimants were aware that their claim was open for life, and 1 claimant was aware that claimants could change physicians. Workers' Compensation programs were designed to expedite care and treatment while decreasing the adversarial environment for workplace injuries. Yet delays and confrontational events continue to be experienced by the injured worker. This often results in the impression that workplace injuries have worse outcomes for the same diagnosis. The lack of effective education with regard to the rights and responsibilities of the claimant may also lead to this poorer outcome. Given studies showing the benefits of patient education in preventing malpractice claims and improving health-care outcomes, it is suggested that improved patient education for the injured worker is warranted and may lead to improved outcomes with diminished adversarial events.

Health Care Transition for Children with Medical Complexity: Challenges and Lessons Learned

BackgroundTransition from pediatric to adult health care is a pivotal process for young adults, especially those with complex medical needs. Despite advancements in the medical care provided to children with medical complexity (CMC), there is a lack of systematic approaches and guidance for patients and families transitioning from pediatric to adult health care. MethodsHealth care providers and nurse case managers in the Complex Care Program (CCP) evaluated health care transition practices prior to 2019, and initiated quality improvement efforts to standardize transition guidance, planning, and documentation from 2019 to 2020 within the CCP. FindingsChallenges identified with transitioning CMC include: 1) Varied approaches and timelines for health care providers, 2) Documentation in the EMR, and 3) Connecting to adult health care systems. Throughout this work, CCP staff have learned lessons to effectively transition CMC. Themes included: 1) Transition from a pediatric to an adult primary care provider first, 2) Start transition conversations early, 3) Identify a universal location to document transition planning, and 4) Importance of family involvement. Implications for practiceTo effectively transition CMC, health care staff must start conversations early, engaging all primary and specialty providers, patients, and families to create safe transition plans.

Randomized controlled trial of technology-assisted case management in low-income adults with type 2 diabetes: Effect on quality of life and blood pressure

Introduction A novel randomized controlled trial tested the efficacy of a technology-assisted case management program in a low income, rural population previously where nurses titrated medication over the phone instead of in a clinic. The primary analysis showed significant improvement in glycemic control at 6 months post-randomization decreasing hemoglobin A1c by 1%. This study aimed to test if the intervention was also effective at decreasing blood pressure without compromising quality of life. Methods A total of 113 adults with poorly controlled diabetes (hemoglobin A1c ≥ 8%) were randomly assigned to the technology-assisted case management intervention or usual care. Participants received a 2-in-1 telehealth system to monitor glycemic and blood pressure control, which was uploaded daily to a central server. A nurse case manager was trained to titrate medication under physician supervision every 2 weeks based on the readings. Outcomes were blood pressure and quality of life (12-item Short-Form Health Survey) at 6 months. Baseline adjusted mixed models using a random intercept were used to evaluate change at 6 months for the technology-assisted case management intervention group compared to usual care. Results There were no statistically significant differences in systolic blood pressure, physical component of quality of life, or mental component of quality of life between the technology-assisted case management and control group. However, there was a significant change in diastolic blood pressure over time, with the technology-assisted case management group decreasing at 6 months (p = .05), whereas the control group remained stable. Conclusions Technology-assisted case management by a nurse with medication titration under physician supervision was efficacious in improving diastolic blood pressure without compromising quality of life in low-income rural adults with diabetes.

Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer

Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.

Partnering With Families of Medically Complex Children Transitioning From the Hospital to Home.

Partnering With Families of Medically Complex Children Transitioning From the Hospital to Home.