Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
University of Wisconsin-Madison School of Nursing.
Gerontologist. 2017 Oct 1;57(5):867-879. doi: 10.1093/geront/gnw085.
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.
描述熟练护理机构 (SNF) 护士对痴呆症患者 (PwD) 在医院到 SNF 过渡期间的体验和需求的看法，并确定与这些过渡质量相关的因素。
使用来自 11 家 SNF 的护士（N=40）的个人和焦点小组访谈进行扎根维度分析研究。
医院到 SNF 的过渡在很大程度上被描述为对 PwD 和他们的照顾者来说是痛苦的，主要由与痴呆症相关的行为症状主导，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 护士描述 PwD 有独特的过渡护理需求，主要涉及需要额外的出院前计划，以便在转移之前能够制定个性化的行为/社会护理计划和物理环境。SNF 护士确定了不准确/有限的关于行为症状的医院出院沟通、短的出院时间框架和对 SNF 入院决策的有限护理控制是导致过渡质量较差的因素，增加了居民伤害、再住院和负面居民/照顾者体验的风险。在整个过渡期间保持参与的照顾者和存在高质量的出院沟通被确定为改善 PwD 过渡质量的因素。
这项研究的结果提供了对可能影响这一高度脆弱过渡期间过渡性护理质量的因素的重要见解。需要进一步研究这些因素与再住院和照顾者压力等过渡性护理结果之间的关联。未来的工作还应探讨改善表现出挑战性行为症状的 PwD 的跨机构沟通和护理协调的策略。
