Transitions From Hospitals to Skilled Nursing Facilities for Persons With Dementia: A Challenging Convergence of Patient and System-Level Needs
Transitions From Hospitals to Skilled Nursing Facilities for Persons With Dementia: A Challenging Convergence of Patient and System-Level Needs
复制标题
DOI：
10.1093/geront/gnw085
复制
发表时间：
2017-10-01
期刊：
影响因子：
5.7
通讯作者：
Kind, Amy J. H.
中科院分区：
文献类型：
--
作者：
Gilmore-Bykovskyi, Andrea L.;Roberts, Tonya J.;Kind, Amy J. H.
描述专业护理机构（SNF）护士对痴呆患者（PwD）在医院到SNF过渡期间的经验和需求的看法，并确定与这些过渡质量相关的因素。SNF转换在很大程度上被描述为PwD及其护理人员的痛苦，并由痴呆相关的行为症状占主导地位，这些症状被认为是医院人员在出院沟通中故意沟通不足的。SNF护士将PwD描述为具有独特的过渡性护理需求，主要涉及需要额外的出院预先计划，以便在转移之前准备量身定制的行为/社会护理计划和物理环境。SNF护士确定不准确/有限的出院沟通行为症状，短的出院时间框架，有限的护理控制SNF入院决策的因素，导致质量较差的过渡居民伤害，再住院，和负面的居民/护理人员的经验增加的风险。在整个过渡和高质量的放电通信的存在下，被确定为提高PwD的过渡质量的因素，从这项研究的结果提供了重要的洞察因素，可能会影响过渡护理质量在这个高度脆弱的过渡。需要进一步的研究来探讨这些因素与过渡性护理结果之间的关联，如再住院和护理人员压力。未来的工作还应探索策略，以改善PwD表现出具有挑战性的行为症状的设置间的沟通和护理协调。
To describe skilled nursing facility (SNF) nurses' perspectives on the experiences and needs of persons with dementia (PwD) during hospital-to-SNF transitions and to identify factors related to the quality of these transitions.Grounded dimensional analysis study using individual and focus group interviews with nurses (N = 40) from 11 SNFs.Hospital-to-SNF transitions were largely described as distressing for PwD and their caregivers and dominated by dementia-related behavioral symptoms that were perceived as being purposely under-communicated by hospital personnel in discharge communications. SNF nurses described PwD as having unique transitional care needs, which primarily involved needing additional discharge preplanning to enable preparation of a tailored behavioral/social care plan and physical environment prior to transfer. SNF nurses identified inaccurate/limited hospital discharge communication regarding behavioral symptoms, short discharge timeframes, and limited nursing control over SNF admission decisions as factors that contributed to poorer-quality transitions producing increased risk for resident harm, rehospitalization, and negative resident/caregiver experiences. Engaged caregivers throughout the transition and the presence of high-quality discharge communication were identified as factors that improved the quality of transitions for PwD.Findings from this study provide important insight into factors that may influence transitional care quality during this highly vulnerable transition. Additional research is needed to explore the association between these factors and transitional care outcomes such as rehospitalization and caregiver stress. Future work should also explore strategies to improve inter-setting communication and care coordination for PwD exhibiting challenging behavioral symptoms.