Unanticipated Care Research Articles

Family Caregivers' Psychosocial Well-being in the Context of the Great Recession.

The economic instability of the Great Recession contributed to a rise in multigenerational households as more individuals took on unanticipated care responsibilities for older family members while navigating financial uncertainties. Guided by the life course perspective, this study compared the psychological and social well-being of family caregivers and examined the moderating influences of financial challenges experienced during the Great Recession. Filial and sandwiched caregivers (N = 138; Mage = 52.80; SDage = 11.25) from the Refresher Cohort of the Midlife in the United States (MIDUS) survey provided information on demographics, caregiving, financial challenges, and well-being. Findings from regression analyses showed that sandwiched caregivers exhibited lower environmental mastery and positive relations with others than filial caregivers (p = .07). Moderation analyses showed that sandwiched caregivers with fewer than average financial challenges exhibited lower social actualization than the other family caregivers (p = .01). Study findings underscore the need to support family caregivers' psychosocial well-being as they navigate caregiving responsibilities and financial disruptions.

One of My Best Friends is 93

When I started my career as an intensive care unit nurse, I thought I had a pretty good idea of what it takes to be a nurse practitioner (NP). But my experience in post-acute and long-term care over the past five years has certainly changed that. It has been a privilege to be a part of older adults’ care teams. The relationships I have developed over the last five years as an adult geriatric NP have afforded me a lifetime of smiles, tears, laughter, and personal growth in addition to my professional experience, and this is just the beginning of my journey in PALTC. I moved to Texas from Minnesota five years ago to begin my career as an NP, not knowing what to expect but anticipating an amazing journey nonetheless. Unbeknownst to me, I would learn more than I ever expected from the older adults I care for. For instance, a 113-year-old taught me about what matters: never leave your room without lipstick and colorful scarf so you will always look presentable. These older adults also have given me unanticipated care in return: the handwritten thank-you cards, the candid conversations of first loves, the shared stories of the last six democratic conventions from a couple who attended them together, and even a romantic crush on another resident that someone felt comfortable sharing with me, an NP from “way up north.” A 93-year-old has called me on my personal cell phone just to check and make sure I’m OK during the COVID-19 pandemic. Older adults have taught me to be comfortable in my NP role and remain true to my authentic self. Whether I’m talking about the latest haircut, wigs, or lip color with my “girlie girl” residents or listening to Hank Williams’ “Hey, Good Lookin’” while sifting through pictures of tractors from the 1950s with retired farmers living in nursing homes, I have learned to find great joy in these shared moments. I have to remind myself when rounding in a building or making home visits to make sure I actually address the medical concerns because it is easy to get lost in conversation with my newfound extended family. As a 2016 Futures scholarship recipient, I have learned so much since beginning the program and joining the family of AMDA – The Society for Post-Acute and Long-Term Care. The Society has furthered my love for establishing relationships with residents in my long-term care, assisted living, and clinic settings. I find myself checking in on residents “just because,” and I have felt comfortable crying, laughing, praying, or just sitting in a few moments of silence together. It’s the shared experiences that make this work special for me. The Society has strengthened my knowledge base within the management of acute and chronic illness and encouraged my advocacy on behalf of this population. I had the privilege to attend a policy conference hosted by the American Association of Nurse Practitioners in 2020 right before the pandemic and was amazed at the impact I can have as an NP advocating for change. The Society has helped strengthen this voice. In addition, I have been invited to join in subcommittees within the Society to include clinical issues, where I led the creation of the Society’s white paper on the use of marijuana in long-term care and helped update the white paper on staffing issues in long-term care. In addition, I participate in the Nurse Practitioner/Physician Assistant Practice Group and participated on a panel in 2020 regarding our role as NPs in practice. The 2021 Annual Conference will be my third year speaking on a panel, and I am honored to continue to represent my fellow NPs/PAs in long-term care. I thought I had the “patience of Job” before becoming an NP as I had spent many nights with complicated patients in the intensive care unit during my bedside nursing days. Now I accept there is an entirely new level of patience I have to learn as a PALTC practitioner, as I walk families through transitions of care, end of life, and new diagnoses. Learning how to discuss changes/recommendations with patients and families, using the terminology and culturally/spiritually inclusive language and practices, has helped strengthen my ability to truly help older adults age better. What a privilege and honor to be a part of my patients’ health journey as they age. To my special “golden girls,” see you at the next virtual tea party! Ms. Walker is an adult-geriatric nurse practitioner at Baylor Scott and White Health in Texas. She is also currently a doctoral student at the University of Texas, focusing on transitions of care among older adults.

Health resource utilization of labor induction versus expectant management

Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization. The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum. This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum. Of 6096 women with data available, those in the induction of labor group (n= 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P= .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all). Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

854 Post-Endoscopy Fever in Children: Impact of a Management Protocol on Unanticipated Care

Fever following pediatric endoscopic procedures is one of the most common adverse events encountered, causing concern for perforation and/or significant infection as a complication of endoscopy. As a result, patients are often referred to the emergency department or receive other unanticipated evaluation for further assessment. Results of these evaluations are almost uniformly normal yet lead to additional costs and interventions.