Transition Home Research Articles

Impact of an Area Agency on Aging pharmacist-led Community Care Transition Initiative

BackgroundRural older adults are at risk of readmissions and medication-related problems after hospital discharge. ObjectivesThis study aimed to compare 30-day hospital readmissions between participants and nonparticipants and describe medication therapy problems (MTPs) and barriers to care, self-management, and social needs among participants. Practice descriptionThe Michigan Region VII Area Agency on Aging (AAA) Community Care Transition Initiative (CCTI) for rural older adults after hospitalization. Practice innovationEligible AAA CCTI participants were identified by an AAA community health worker (CHW) trained as a pharmacy technician. Eligibility criteria were Medicare insurance; diagnoses at risk of readmission; length of stay, acuity of admission, comorbidities, and emergency department visits score more than 4; and discharge to home from January 2018 to December 2019. The AAA CCTI included a CHW home visit, telehealth pharmacist comprehensive medication review (CMR), and follow-up for up to 1 year. Evaluation methodsA retrospective cohort study examined the primary outcomes of 30-day hospital readmissions and MTPs, categorized by the Pharmacy Quality Alliance MTP Framework. Primary care provider (PCP) visit completion, barriers to self-management, health, and social needs were collected. Descriptive statistics, Mann-Whitney U, and chi-square analyses were used. ResultsOf 825 eligible discharges, 477 (57.8%) enrolled in the AAA CCTI; differences in 30-day readmissions between participants and nonparticipants were not statistically significant (11.5% vs. 16.1%, P = 0.07). More than one-third of participants (34.6%) completed their PCP visit within 7 days. MTPs were identified in 76.1% of the pharmacist visits (mean MTP 2.1 [SD 1.4]). Adherence (38.2%) and safety-related (32.0%) MTPs were common. Physical health and financial issues were barriers to self-management. ConclusionAAA CCTI participants did not have lower hospital readmission rates. The AAA CCTI identified and addressed barriers to self-management and MTPs in participants after the care transition home. Community-based, patient-centered strategies to improve medication use and meet rural adults’ health and social needs after care transitions are warranted.

The Effectiveness of Parental Education Programs within Neonatal Intensive Care Units: A Systematic Review

Introduction: Parenthood brings stress and anxiety to new parents due to the dramatic role transition. Parents who have a newborn in the neonatal intensive care unit (NICU) experience an increased level of stress. Increasing parental competencies in complex infant care compounds stress; therefore, finding the most effective method of parental education may improve parental health, well-being, and quality of life. Enhanced knowledge prepares parents to transition home. The objective of this systematic review is to evaluate the effectiveness of parental education interventions conducted within the NICU. Methods: CINHAL, Medline, PsychInfo, Web of Science, PubMed, and OT Search databases were searched to locate studies focusing on parental education, provided via healthcare workers, as a main intervention for parents with infants in the NICU. Articles were independently reviewed and selected based on defined inclusion criteria. Results: 20 articles were included and synthesized according to the method of education, parental outcomes, and the provider of education. Conclusions: Parental education is an effective way to facilitate positive parental outcomes. Utilizing combined methods to deliver education with repeated, consistent exposure, and checking for parent understanding is the best approach to minimize negative parental outcomes and improve preparedness for discharge.

My Home is My Castle/My Home is My Prison

Abstract This article focuses on the co-constitution of the home and age(ing) in the retirement transition, that is, how the experiences of home change in the transition from work to retirement, and how the experiences of retiring change with transformations of the home. The article first outlines current literature on transitions in later life and the home. Subsequently, it presents data from the project ‘Doing Retiring’ along three lines of inquiry: meanings, practices and negotiations of and within the home, and how they change across the retirement transition. Finally, it discusses implications of understanding the transition from work to retirement and the home as not merely related, but co-constitutive. It concludes by suggesting a ‘doing’ approach to life course transitions which focuses on socio-material practices and thus offers a prominent place in transition research to spatiality, materiality and processuality.

A qualitative evidence synthesis exploring people after stroke, family members, carers and healthcare professionals' experiences of early supported discharge (ESD) after stroke.

Early supported discharge (ESD) after stroke has been shown to generate significant cost savings and reduce both hospital length of stay, and long-term dependency. This study aimed to systematically review and synthesise qualitative studies of the experiences and views of ESD from the perspective of people after stroke, their family members, carers and healthcare professionals. A systematic search of eleven databases; CINAHL, PubMed Central, Embase, MEDLINE, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journal, The Cochrane Library, PsycARTICLES and SCOPUS, was conducted from 1995 to January 2022. Qualitative or mixed methods studies that included qualitative findings on the perspectives or experiences of people after stroke, family members, carers and healthcare professionals of an ESD service were included. The protocol was registered with the Prospero database (Registration: CRD42020135197). The methodological quality of studies was assessed using the 10-item CASP checklist for qualitative studies. Results were synthesised using Thomas and Harden's three step approach for thematic synthesis. Fourteen studies were included and five key themes were identified (1) ESD eases the transition home, but not to community services, (2) the home environment enhances rehabilitation, (3) organisational, and interprofessional factors are critical to the success of ESD, (4) ESD is experienced as a goal-focused and collaborative process, and (5) unmet needs persisted despite ESD. The findings of this qualitative evidence synthesis highlight that experiences of ESD were largely very positive. The transition from ESD to community services was deemed to be problematic and other unmet needs such as information needs, and carer support require further investigation.

Exploring the lived experiences of mothers of extremely preterm infants in the UK

The adverse impact of preterm birth on maternal mental health is well documented, yet there is limited available research regarding the subjective experiences of mothers of extremely preterm infants as a distinct cohort. The aim of this study was to explore the lived experiences of mothers of extremely preterm infants, born alive at less than 28 weeks gestation, in the UK. Three mothers of extremely preterm infants participated in a semi-structured interview conducted online, which invited them to share their experiences of pregnancy, their time in neonatal intensive care unit, the transition home and their present-day experiences. An interpretative phenomenological analysis explored a delayed transition to mothering and experiences relating to initial disconnection, missed moments and establishing a maternal connection. Owing to the traumatic experiences associated with an extremely preterm birth, it is concluded that mothers would benefit from health visitor support relating to attachment, mental health and connecting to parenting communities.

“I Had Bills to Pay”: a Mixed-Methods Study on the Role of Income on Care Transitions in a Public-Payer Healthcare System

BackgroundIncome disparities may affect patients’ care transition home. Evidence among patients who have access to publicly funded healthcare coverage remains limited.ObjectiveTo evaluate the association between low income and post-discharge health outcomes and explore patient and caregiver perspectives on the role of income disparities.DesignMixed-methods secondary analysis conducted among participants in a double-blind randomized controlled trial.ParticipantsParticipants from a multicenter study in Ontario, Canada, were classified as low income if annual self-reported salary was below $29,000 CAD, or between $30,000 and $50,000 CAD and supported ≥ 3 individuals.Main MeasuresThe associations between low income and the following self-reported outcomes were evaluated using multivariable logistic regression: patient experience, adherence to medications, diet, activity and follow-up, and the aggregate of emergency department (ED) visits, readmission, or death up to 3 months post-discharge. A deductive direct content analysis of patient and caregivers on the role of income-related disparities during care transitions was conducted.Key ResultsIndividuals had similar odds of reporting high patient experience and adherence to instructions regardless of reported income. Compared to higher income individuals, low-income individuals also had similar odds of ED visits, readmissions, and death within 3 months post-discharge. Low-income individuals were more likely than high-income individuals to report understanding their medications completely (OR 1.9, 95% CI: 1.0–3.4) in fully adjusted regression models. Two themes emerged from 25 interviews which (1) highlight constraints of publicly funded services and costs incurred to patients or their caregivers along with (2) the various ways patients adapt through caregiver support, private services, or prioritizing finances over health.ConclusionsThere were few quantitative differences in patient experience, adherence, ED visits, readmissions, and death post-discharge between individuals reporting low versus higher income. Several hidden costs for transportation, medications, and home care were reported however and warrant further research.

True "outpatient discharge" following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most.

Single-stage bilateral unicompartmental knee arthroplasty (BUKA) has shown post-operative function and cost benefits over staged bilateral procedures, without increased complications. A rapid discharge protocol at the current study site has reported outpatient discharge for the unilateral procedure exceeding 97%. However, the feasibility of outpatient discharge following BUKA remains unclear. Therefore, the purpose of this study was to determine the success of achieving outpatient (< 24h) discharge following BUKA, and identify patient variables associated with failure. A retrospective chart review was completed for 104 BUKA patients. All patients with bilateral, symptomatic unicompartmental knee arthritis were offered the single-stage procedure. Data collection included patient demographics, discharge status, and disposition location. Independent t tests (continuous) and Chi-squared tests (categorical) determined differences between discharge (outpatient/inpatient) and disposition (home/other) groups. Variables associated with discharge status and location were assessed with multivariable regression. While 96 (92.3%) patients discharged within 24h, only 63.5% were able to discharge directly home. Patients requiring a longer hospital stay (> 24h) were more likely to require a pre-operative assistive device (62.5% and 25.0%, p = 0.037) and live alone (37.5 vs 8.3%, p = 0.033). For those discharged within 24h, living alone significantly increased the risk (odds ratio: 5.800, p = 0.038) of requiring an acute inpatient facility prior to transition home. Achieving "true" outpatient discharge is only modestly successful for most BUKA patients, as many required an acute inpatient or short-term rehabilitation facility prior to returning home. BUKA should be differentiated from the unilateral procedure regarding outpatient discharge expectations. III, Case-control study; Retrospective comparative study.

Feasibility of Problem-Solving Training During Inpatient Rehabilitation in Patients With Stroke.

Stroke survivors report feeling unprepared to manage challenges that arise during the transition from hospital to home. Cultivating problem-solving skills before discharge may better prepare patients for the transition home. To determine the feasibility of a protocol to deliver Problem-Solving Training (PST) to stroke survivors during inpatient rehabilitation to increase goal achievement. Single-group feasibility study. Academic and county hospital inpatient rehabilitation units. Adult patients with stroke and planned discharge home. Up to six PST sessions over 2 to 3 wk followed by 3 mo of mobile health boosters. Of 17 eligible participants, 15 consented and 11 completed three or more PST sessions. Six participants used electronic boosters, achieving at least one goal postdischarge. Participants reported high satisfaction with PST (Client Satisfaction Questionnaire-8 M score = 29.3, SD = 4.4; range = 8-32), moderate depression at baseline (eight-item Patient Health Questionnaire [PHQ-8] score, M = 11.0, SD = 6.1; range = 0-27), mild depression at 3 mo postdischarge (PHQ-8 score, M = 8.3, SD = 5.5), moderately high self-efficacy at baseline (General Self-Efficacy Scale [GSE] score, M = 31.1, SD = 7.3; range = 10-40), and a self-efficacy increase at 3 mo postdischarge (GSE score, M = 34.1, SD = 4.2). PST among patients with stroke during inpatient rehabilitation was feasible, and participants demonstrated improvements in clinical outcomes and goal attainment. Barriers to participation and adherence should be addressed in future studies. What This Article Adds: Teaching patients problem-solving skills early after a stroke using a metacognitive strategy is feasible and may decrease depression and increase self-efficacy while fostering independent goal setting and problem solving.

Experiences of people with non-traumatic spinal cord injuries returning home after inpatient rehabilitation

Purpose The aim of this study was to explore the experience of people with non-traumatic spinal cord injuries who have recently returned home from inpatient rehabilitation. Methods Semi-structured interviews were conducted with seven adults with non-traumatic spinal cord injuries who had been discharged from inpatient rehabilitation from an Australian rehabilitation hospital, within the last two years. Results Three themes were identified: the practicalities of coming home; adjusting to "my altered home life"; pursuing recovery. When people felt prepared by their rehabilitation service, and had appropriate support from others, they had a more positive adjustment experience, although not one without challenges. Due to less independence and inability to participate in meaningful life roles, participants experienced a sense of lost or changed identity. Maintaining hope for physical recovery was very important and motivated participants to actively engage in rehabilitation efforts. Conclusions This study adds to the knowledge regarding the lived experience of people with non-traumatic spinal cord injury transitioning from rehabilitation to home. Facilitators for successful rehabilitation discharge included ensuring community services contacted patients immediately after they left hospital, and providing support for carers. Health care workers can positively influence the adjustment process of people with NTSCI by facilitating re-engagement in meaningful roles. IMPLICATIONS FOR REHABILITATION The transition home from inpatient rehabilitation after non-traumatic spinal cord injury (NTSCI) is facilitated by early discharge planning and follow-up from services after discharge. Establishing routines helped participants adjust to their new circumstances. The emotional and practical support of carers is vital for successful adjustment to living in the community with an NTSCI. Health care workers can positively influence the adjustment process of people with NTSCI by facilitating their re-engagement in meaningful roles.

Parents' Experience in an Italian NICU Implementing NIDCAP-Based Care: A Qualitative Study.

Background: The birth of a preterm infant and his/her immediate admittance to the Neonatal Intensive Care Unit (NICU) are sudden, unexpected, stressful and painful events for parents. In the last decade, in response to the increased awareness of the stressful experiences of parents, much attention has been paid to Family-Centered Care (FCC) and the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). According to the NIDCAP model, the infant-parents' dyad is the core of the care provided by the NICU professionals to reduce the stress experienced by parents. So far, the literature does not show a clear correlation between parental experiences and the NICU practices according NIDCAP principles. Aims: To explore how parents of preterm infants experienced the NIDCAP-based care from admission to discharge, in particular, their relationships with NICU professionals and with other parents, and the organization of the couple's daily activities during this process. Design: Qualitative exploratory study. Methods: Twelve parents of preterm infants born between January 2018 and December 2020 at the NICU of Modena, with a gestational age at birth of less than 30 weeks and/or a birth weight of less than 1250 g, were recruited. Three couples had twins, and the total number of infants was 15. All infants were followed for up to 24 months post-term age (PTA) for neurological outcomes. Each couple was given a semi-structured online interview about their experience during their infant's hospitalization in the NICU up to discharge. The interview was developed around three time points: birth, hospitalization and discharge. The data analysis was conducted according to the template analysis method. Results: The admission to the NICU was unexpected and extraordinary, and its impact was contained by the skilled staff who were capable of welcoming the parents and making them feel they were involved and active collaborators in the care of their infant. The emotional experience was compared to being in a blender; they were overwhelmed by changing emotions, ranging from terrible fear to extreme joy. The couple's activities of daily life were reorganized after the infant's birth and admission to the NICU. Fathers felt unbalanced and alone in taking care of their partners and their children. Conclusions: This is the first study in Italy to explore parental experience in an NICU implementing NIDCAP-based care. The NIDCAP approach in the NICU of Modena helps parents to be involved early, to develop parental skills, and to be prepared for the transition home; and it also facilitates and enhances the relationship between parents and NICU staff.

Enhancing the role of the social network in activity (re)engagement post-stroke: a focus group study with rehabilitation professionals

BackgroundPeople post-stroke are at risk of not being able to participate in valued activities. It is important that rehabilitation professionals prepare people post-stroke for the transition home and provide needed support when they live at home. Several authors have suggested that members of the broad social network should play an active role in rehabilitation. This includes informing them about the importance of activity (re)engagement post-stroke and learning strategies to provide support. It is not clear when and how the broad social network can best be equipped to provide adequate activity support. This study aimed to explore stroke professionals’ perspectives on strategies that establish a social network that supports activity (re)engagement of people post-stroke, when strategies are best implemented, and the factors that influence the implementation of these strategies.MethodsTwo focus groups were executed. Content analysis was used to analyze the transcripts of the recorded conversations.ResultsEighteen professionals with various professional backgrounds and roles in treating people post-stroke participated. Strategies to establish a supportive social network included identifying, expanding, informing, and actively engaging network members. Working with the network in the immediate post-stroke phase was regarded as important for improving long-term activity outcomes. Participants expressed that most strategies to equip the social network to support people post-stroke need to take place within community care. However, the participants experienced difficulties in implementing network strategies. Perceived barriers included interprofessional collaboration, professional knowledge, self-efficacy, and financial structures.ConclusionsStrategies to involve the social network of people post-stroke are not fully implemented. Although identifying members of a social network should begin during inpatient rehabilitation, the main part of actively engaging the network will have to take place when the people post-stroke return home. Implementing social network strategies requires a systematic process focusing on collaboration, knowledge, attitude, and skill development.

In defence of falling: the onomastics and ethics of “therapeutic” falls in rehabilitation

Aim: Despite efforts towards a more just culture, rehabilitation providers still experience shame and trauma when their patients fall. This paper proposes a shift in philosophy in how we classify, communicate and learn from falls, and joins the growing literature in which falls in rehab are not seen as something to be avoided at all costs, but rather as part of the recovery journey for some patients. Methods: Patients who understand and are willing to take on the risks of falling are more likely to collaborate with their care team to practice higher-risk activities, such as walking to the bathroom independently at night, as part of their recovery. If a fall takes place in this context, we argue that it should be considered a “therapeutic” fall. Results: This paper details some of the clinical and ethical approaches to supporting a care environment where values—and potential conflicts—about the benefits and challenges of risk-taking are recognized. An expanded concept of a therapeutic fall may help patients and providers take a more balanced and nuanced approach to promoting safety while maximising independence. Conclusion: The goal of this work is to offer rehabilitation patients greater opportunities to make autonomous decisions about their mobility, and lay the groundwork for a more successful transition home. IMPLICATIONS FOR REHABILITATION Despite best efforts, patients are often less active than they or their rehabilitation team might wish them to be. An expanded concept of a “therapeutic” fall may help patients and providers take a more balanced and nuanced approach to promoting safety while maximising independence. Rehabilitation is the right environment to support shared decision-making about risk that better prepares patients and families for the often challenging transition back to community living. This works represents a shift in philosophy in how we classify, communicate and learn from falls, and joins the growing literature in which falls are not something to be avoided at all costs, but can instead be part of the journey to recovery.

Fostering Hope: Comprehensive Accessible Mother-Infant Dyad Care for Neonatal Abstinence (CAIN).

Hospital and community healthcare providers have expressed concerns around the continuity and quality of care for infants with neonatal abstinence syndrome (NAS) during hospitalization and transition home. This qualitative study explored the experiences of hospital and community-based healthcare providers and identified themes related to the management of NAS for mothers and infants. Healthcare providers that cared for women with substance use disorders and/or cared for newborns with NAS in a large urban setting in Canada met inclusion criteria for this study and were interviewed in groups or as individuals. Interview transcripts were reviewed iteratively using inductive thematic analysis to identify an overarching theme linked with primary themes. In total, 45 healthcare providers were interviewed. Qualitative analysis of their experiences derived the overarching theme of hope with five primary themes being: mother/infant, mental health, system, judgement, and knowledge. The study identified gaps in NAS care including fear, stigma, and language. This research demonstrates that programs and interventions that work with mothers and newborns with NAS must foster hope in mothers, families, and in the extended care provider team and improve communication between hospital and community networks.

Effectiveness of interventions to support the transition home after acute stroke: a systematic review and meta-analysis

BackgroundEffective support interventions to manage the transition to home after stroke are still mostly unknown.AimThe purpose of this systematic review was to investigate the effectiveness of support interventions at transition from organised stroke services to independent living at home.MethodsThe Cochrane Central Register of Controlled Trials, six databases including MEDLINE and Embase, trial registries, grey literature, and Google Scholar were all searched, up to June 2021.We included randomised controlled trials enrolling people with stroke to receive either standard care or any type of support intervention from organised stroke services to home. The primary outcome was functional status.Two authors determined eligibility, extracted data, evaluated risk of bias (ROB2), and verified the evidence (GRADE). Where possible we performed meta-analyses using Risk Ratios (RR) or Mean Differences (MD).ResultsWe included 17 studies. Support interventions led to important improvements in functional status, as determined by the Barthel Index up, to 3-months (MD 7.87 points, 95%CI:6.84 to 19.16; 620 participants; five studies; I2 = 77%). Results showed modest but significant functional gains in the medium to long-term (6–12 month follow up, MD 2.91 points, 95%CI:0.03 to 5.81; 1207 participants; six studies; I2 = 84%). Certainty of evidence was low.Support interventions may enhance quality of life for up to 3-months (MD 1.3,95% CI:0.84 to 1.76), and reduce depression (SMD -0.1,95% CI:-0.29 to − 0.05) and anxiety (MD -1.18,95% CI:-1.84 to − 0.52) at 6–12 months. Effects on further secondary outcomes are still unclear.ConclusionsIncorporating support interventions as people who have experienced a stroke transition from hospital to home can improve functional status and other outcomes. Due to study heterogeneity, the essential components of effective transition of care interventions are still unknown. Adoption of core outcome sets in stroke research would allow for greater comparison across studies. Application of a development and evaluation framework engaging stakeholders would increase understanding of priorities for stroke survivors, and inform the key components of an intervention at transition from hospital-to-home.Trial registrationCRD42021237397 - https://www.crd.york.ac.uk/prospero

Young elephants in a large herd maintain high levels of elephant endotheliotropic herpesvirus-specific antibodies and do not succumb to fatal haemorrhagic disease.

Elephant endotheliotropic herpesviruses (EEHVs) have co-existed with elephants for millions of years, yet may cause fatal haemorrhagic disease (EEHV-HD), typically in elephants between 1 and 10 years of age. EEHV is omnipresent in (sub)adult elephants, and young elephants with low EEHV-specific antibody levels are at risk for EEHV-HD, suggesting that fatal disease may occur due to an insufficiently controlled primary infection. To further address this hypothesis, sera of three large elephant cohorts were subjected to a multiple EEHV species ELISA: (I) 96 Asian elephants between 0 and 57 years, including 13 EEHV-HD fatalities, from European zoo herds typically sized five to six elephants, (II) a herd of 64 orphaned elephants aged 0-15 years at the Elephant Transit Home in Sri Lanka and (III) 31 elephants aged 8-63 years, part of a large herd of 93 elephants at Pinnawala Elephant Orphanage, Sri Lanka. All Sri Lankan elephants showed high EEHV-specific antibody levels regardless of their age. While antibody levels of most European zoo elephants were comparable to those of Sri Lankan elephants, the average antibody level of the European juveniles (1-5 years of age) was significantly lower than those of age-matched Sri Lankan individuals. Moreover, the European juveniles showed a gradual decrease between 1 and 4 years of age, to be attributed to waning maternal antibodies. Maintenance of high levels of antibodies in spite of waning maternal antibodies in young Sri Lankan elephants is likely due to the larger herd size that increases the likelihood of contact with EEHV-shedding elephants. Together with the observation that low levels of EEHV-specific antibodies correlate with increased numbers of EEHV-HD fatalities, these results suggest that infection in presence of high maternal antibody levels may protect calves from developing EEHV-HD, while at the same time activating an immune response protective in future encounters with this virus.

Implementation of nurse-led early mobilisation after transcatheter aortic valve implantation: Identification of barriers to standardised practice

Abstract Funding Acknowledgements Type of funding sources: None. Background We examined the barriers of early nurse-led mobilisation after transcatheter aortic valve implantation (TAVI) to support safe next-day discharge home. Methods We conducted a prospective observational cohort study of patients treated in 2019-2021 using a standardised post-procedure nursing care standard to promote mobilisation in 4 to 6 hours after TAVI. Results are presented as mean (standard deviation) for continuous variables and as number (percentage) for categorical data; student t test was used to compare continuous variables and χ2 and Fisher exact tests were used to compare categorical variables. All analyses were performed in SAS version 9.4 (SAS Institute). Results The cohort included a convenience sample of 139 patients (64 women, 46%) mean age 82.5±6.7 years, NYHA III/IV 72 (51.8%), prior pacemaker 18 (13%), and prior SAVR 11 (7.9%). Patients were treated under local anaesthesia only (n=29, 20.9%) or conscious sedation (n=106, 76.3%) with a balloon expandable device (n=134, 96.4%) in a cardiac catheterisation laboratory (n=111, 79.9%) or hybrid operating room (n=28, 25.2%), and early recovery in cardiac telemetry (n=101, 72.7%) or critical care unit (n=38, 27.3%). Early mobilisation was achieved in 113 patients (81.3%: 4 hours: n=100, 71.9%, 4-6 hours: n=13, 9.4%); there were no significant (p≤0.05) differences in baseline characteristics between patients with early vs. late mobilisation; the primary reasons for delayed mobilisation included monitoring and/or managing cardiac conduction issues (n=6), vascular access hemostasis (n=6) and neurological status (n=4), patient preference or other self-reported issue (n=5) and nursing workload (n=5). In patients who achieved early mobilisation, 81.4% were discharge on post-operative day 1 and 86.3% by day 2, with 99.1% returning directly home. There was no significant difference in 30-day readmission between the two groups. Conclusions Early nurse-led protocol-driven mobilisation is safe and effective to facilitate rapid reconditioning and safe transition home after uncomplicated TAVI. Research is needed to better understand patient and systems-level enablers to improve standardisation of practice.

Postnatal Unit Care and Safe Transition Home.

The United States has the highest maternal mortality rate among developed nations with 60% of deaths occurring during the postpartum period. This chapter presents the case study of Maya Howard. Maya represents of composite of qualitative research studies that reveals missteps, gaps, and oversights of Black mothers and birthing people during birth and the postpartum period. Using a Black feminist framework, the chapter offers solutions to improve postnatal unit care and the transition home, a critical step in improving care and saving lives for all mothers and birthing people.

A mobile application-based home assessment tool for patients undergoing joint replacement surgery: A qualitative feasibility study

BackgroundMost adults prefer to age in place. However, the majority of homes are not designed to support resident needs, especially for adults undergoing joint replacement surgeries such as total knee arthroplasty (TKA) or total hip arthroplasty (THA). It is of paramount importance to proactively assess and modify the homes of adults undergoing TKA/THA such that they can safely transition home following surgery. Several tools utilize emerging technology like virtual reality, augmented reality, or teleconferencing to assess home environments. These are meant to be used by professionals like occupational therapists. However, the acceptance and uptake of simple technology like mobile applications for assessing homes proactively by residents has not been explored. ObjectiveA qualitative exploratory study was conducted to evaluate the feasibility and potential acceptance of a mobile application for resident-initiated home assessment. MethodsSemi-structured interviews were conducted with 22 patient-care partner dyads before and after THA/TKA to understand the perceived usefulness, likelihood of using a mobile application-based home assessment tool, and perceived barriers and facilitators of using the tool. ResultsAbout 68% of the patient-care partner dyads interviewed for this study perceived benefits of using a mobile application-based tool. All the participants who perceived the tool to be useful showed high likelihood of using it. A comparison of responses between pre-and post-surgery interviews revealed that around 50% of participants showed an increased intention of using an assessment tool after experiencing challenges in their homes post-surgery. Participants provided recommendations for key content, potential features to include in the assessment tool, and preferred formats (e.g., checklists, visuals, and videos). ConclusionsTo increase acceptance of a mobile application-based home assessment tool, it is crucial that residents are made aware of the home environment challenges and the importance of an assessment tool to improve their safety and independence. The content, features, formats, and usability suggestions from the participants in this study provide a framework for health mobile application and interface developers to design a home assessment tool.

The shortfalls of online learning catalyzed by COVID-19: Pre-health students’ perspective

Due to the COVID-19 pandemic, the pivot to distance learning left many higher education institutions scrambling to find the resources to shift materials online and instructors making significant modifications to their courses to adapt. This study is the critical initial step in explaining any relationships between the responsive move to remote learning and academic performance and stress, anxiety, and depression. An eight-month longitudinal cohort study design with an action research methodology was conducted over four waves from June 2020 to January 2021. Participants had the option to be involved with semi-structured, in-depth interviews via Zoom. The qualitative results from the in-depth themes include: health & wellness, relationships & connectedness, transition home, classroom changes, learning & participation, extra-curriculars, COVID-19, virtual challenges, academic performance, and self-regulation. Thus, through thoughtful and intentional accommodations, instructors and students may create a new digital space for learning to improve upon motivational barriers and retaining content.

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes.

The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. · Bridled NGT use after NICU is typically 1 month.. · Infants have low bridle NGT dislodgement.. · Most bridled NGT NICU grads attain full oral feeds..