Care Transitions to the Community from Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection.
Care Transitions to the Community from Veterans Affairs Nursing Homes: Experiences of Social Connection and Disconnection.
复制标题
从退伍军人事务疗养院到社区的护理过渡：社会联系和脱节的经历。
DOI：
10.1016/j.jamda.2020.07.029
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发表时间：
2021
影响因子：
7.6
通讯作者：
Mills,WhitneyL
中科院分区：
文献类型：
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作者：
Simons,KelseyV;Bower,EmilyS;Gillespie,SuzanneM;Mills,WhitneyL
这项研究旨在进一步了解老年退伍军人从退伍军人事务部养老院过渡到社区的经历（社区生活中心或CLC），重点是社会功能。设计除了标准化的抑郁和精神状态筛查外，还使用了定性研究设计。设置和监护人退伍军人（n = 18）和照顾者（n = 14）有目的地抽样，并从2个农村CLC招募纽约. MethodsSemi-structured访谈退伍军人在CLC前出院（探索CLC住院期间的经历以及对出院和回家的期望）和出院后2-4周在家中的经历（探索日常生活和整体健康，心理健康和社会功能的看法）。护理人员参加了1次访谈，出院后完成。9项患者健康问卷和简短的精神状态访谈管理postdischarge.ResultsThematic分析逐字记录显示3个相互关联的主题：（1）退伍军人可能会遇到改善的社会联系，在CLC的性质独特的护理环境（主要是男性，有共同的军事经验）;（2）退伍后社会参与和联系的经历各不相同，可能与退伍军人在退伍前对康复的期望不一致;（3）退伍军人在出院后，当身体被隔离时，可能会也可能不会形容自己是“孤独的”。退伍军人缺乏中度至重度认知障碍（精神状态的简短访谈：范围= 14-15）;然而，他们报告了出院后抑郁症状严重程度的广泛范围，（9项患者健康问卷：平均值= 4.9，SD = 6.1，中位数/众数= 3，范围= 0-23）。结论和含义本研究确定了潜在的增加社会孤立和脱离退伍军人事务部疗养院出院后。护理之家应整合其居民的社会功能评估，同时扩展护理规划和过渡护理，以解决以病人为中心的社会功能目标。
ObjectiveThis study aimed to further knowledge of older Veterans’ experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning.DesignA qualitative study design was used in addition to administration of standardized depression and mental status screens.Setting and ParticipantsVeterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York.MethodsSemistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2–4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge.ResultsThematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans’ expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as “lonely” after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14–15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0–23).Conclusions and ImplicationsThis study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.