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The effect of using high facilitation when implementing the Gold Standards Framework in Care Homes programme: A cluster randomised controlled trial
Background:
The provision of quality end-of-life care is increasingly on the national agenda in many countries. In the United Kingdom, the Gold Standards Framework for Care Homes programme has been promoted as a national framework for improving end-of-life care. While its implementation is recommended, there are no national guidelines for facilitators to follow to undertake this role.
Aim:
It was hypothesised that action learning alongside high facilitation when implementing the Gold Standards Framework for Care Homes programme will result in a reduced proportion of hospital deaths for residents and improvement in the care home staff ability to facilitate good end-of-life care.
Design:
A cluster randomised controlled trial where 24 nursing homes received high facilitation to enable them to implement the Gold Standards Framework for Care Homes programme. The managers of 12 nursing homes additionally took part in action learning sets. A third group (14 nursing homes) received the ‘standard’ Gold Standards Framework for Care Homes facilitation available in their locality.
Setting/participants:
In total, 38 nursing homes providing care for frail older people, their deceased residents and their nurse managers.
Results:
A greater proportion of residents died in those nursing homes receiving high facilitation and action learning but not significantly so. There was a significant association between the level of facilitation and nursing homes completing the Gold Standards Framework for Care Homes programme through to accreditation. Year-on-year change occurred across all outcome measures.
Conclusion:
There is a danger that without national guidelines, facilitation of the Gold Standards Framework for Care Homes programme will vary and consequently so will its implementation. The nurse manager of a care home must be actively engaged when implementing the Gold Standards Framework for Care Homes programme.
Journal Article
The ethics of educational healthcare placements in low and middle income countries : first do no harm?
This book is open access under a CC BY 4.0 license. This book examines the current state of elective placements of medical undergraduate students in developing countries and their impact on health care education at home. Drawing from a recent case study of volunteer deployment in Uganda, the authors provide an in-depth evaluation of the impacts on the students themselves and the learning outcomes associated with placements in low resource settings, as well as the impacts that these forms of student mobility have on the host settings. In addition to reviewing the existing literature on elective placements, the authors outline a potential model for the future development of ethical elective placements. As the book concurs with an increasing international demand for elective placements, it will be of immediate interest to universities, intermediary organizations, students as consumers, and hosting organisations in low-resource settings.
Book
Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes
Interprofessional teamwork and collaborative practice are emerging as key elements of efficient and productive work in promoting health and treating patients. The vision for these collaborations is one where different health and/or social professionals share a team identity and work closely together to solve problems and improve delivery of care. Although the value of interprofessional education (IPE) has been embraced around the world - particularly for its impact on learning - many in leadership positions have questioned how IPE affects patent, population, and health system outcomes. This question cannot be fully answered without well-designed studies, and these studies cannot be conducted without an understanding of the methods and measurements needed to conduct such an analysis.
This Institute of Medicine report examines ways to measure the impacts of IPE on collaborative practice and health and system outcomes. According to this report, it is possible to link the learning process with downstream person or population directed outcomes through thoughtful, well-designed studies of the association between IPE and collaborative behavior. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes describes the research needed to strengthen the evidence base for IPE outcomes. Additionally, this report presents a conceptual model for evaluating IPE that could be adapted to particular settings in which it is applied. Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes addresses the current lack of broadly applicable measures of collaborative behavior and makes recommendations for resource commitments from interprofessional stakeholders, funders, and policy makers to advance the study of IPE.
eBook
Emerging technologies in healthcare
This book provides detailed descriptions of the latest mobile health (mhealth) technologies. It outlines the role of mhealth for self-care and remote care and describes the differences among telemedicine, telehealth, and telecare. It justifies the use of mhealth technology for meeting regulatory standards of care and explains how analytics and social media are being used to improve the delivery of healthcare. It addresses healthcare reform and risk management in healthcare and concludes by discussing future directions for healthcare technologies.-- Source other than Library of Congress.
Book
Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care
Background
Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU?
Methods
This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process.
Results
We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge.
Conclusions
Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.
Journal Article
Unscheduled home consultations by registered nurses may reduce acute clinic visits
Background
To effectively utilize available healthcare resources, integrated care models are recommended. According to such model’s, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model.
Methods
A descriptive cross-sectional study was designed. Data from registered nurses (
n
= 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (
n
= 615) using a data collection tool from 2017 to 2018 were collected.
Results
Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone.
Conclusion
An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits.
Journal Article