Challenges Faced by Patients with Low Socioeconomic Status Essay

Challenges Faced by Patients with Low Socioeconomic Status Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Challenges Faced by Patients with Low Socioeconomic Status Essay literature review please provide 2 literature review at least 150 words each Challenges Faced by Patients with Low Socioeconomic Status Essay please see attached dyrstad_et_al_2015_journal_of_clinical_nursing.pdf s11606_013_2571_5.pdf ORIGINAL ARTICLE A observational study of older patients’ participation in hospital admission and discharge – exploring patient and next of kin perspectives Dagrunn N Dyrstad, Kristin A Laugaland and Marianne Storm Aims and objectives. To explore older patients’ participation during hospital admission and discharge. Background. Patient participation is suggested as a means to improve the quality of transitional healthcare. Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer from primary to hospital healthcare and vice versa. Design. This study adopts a participant observational research design. Methods. Participant observations of 41 older patients (over 75 years of age) during hospital admission and discharge were conducted in two hospitals in Norway (in 2012). The observations included short conversations with the patient and their next of kin to capture their participation experiences. Systematic text condensation was used to analyse the data material from the field notes. Results. Varying degrees of information exchange between healthcare professionals and patients, and a lack of involvement of the patient in decision-making (in admission and discharge) were observed and experienced by patients and their next of kin. The next of kin appeared to be important advocates for the patients in admission and provided practical support both during admission and discharge. Data suggest that patient participation in admission and discharge is influenced by time constraints and the heavy workloads of healthcare professionals. Patients’ health conditions and preferences also influence participation. Conclusions. Several issues influence the participation of the older patients during hospital admission and discharge. Participation of the older patients needs continuous support from healthcare professionals that acknowledges both the individual patient’s preferences and their capacity to participate. Relevance to clinical practice. Study findings report discrepancies in the involvement of older people and their next of kin. There is a need to increase and support older patients’ participation in hospital admission and discharge. What does this paper contribute to the wider global clinical community? Older patients’ preferences and their capacity for participation in hospital admission and discharge varied considerably. Challenges Faced by Patients with Low Socioeconomic Status Essay This information must be taken into consideration to assist in informing healthcare workers about the appropriate level of patient participation. Heavy work load, crowded hospital wards, time pressure on healthcare professionals, ward routines constrain the participation of older patients during hospital admission and discharge. Increased awareness and competencies for healthcare professionals can be useful to improve patient participation during hospital admission and discharge. Key words: experiences, observational study, older patients, patient participation, patient perspective, transitional care Accepted for publication: 3 December 2014 Authors: Dagrunn N Dyrstad, MNSc, RN, ICCN, PhD Candidate, Department of Health Studies, Faculty of social Sciences, University of Stavanger and Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger; Kristin A Laugaland, MNSc, RN, PhD Candidate, Health Trust Førde, Førde; Marianne Storm, MNSc, RN, PhD Associate Professor, Faculty of social Sciences, Department of Health Studies, University of Stavanger, Stavanger, Norway Correspondence: Dagrunn N Dyrstad, PhD Candidate, University of Stavanger, 4036 Stavanger, Norway. Telephone: 0047 93676824. E-mail: [email protected] This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2015 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. Journal of Clinical Nursing, 24, 1693–1706, doi: 10.1111/jocn.12773 1693 DN Dyrstad et al. Introduction Older people with chronic diseases, physical disabilities and cognitive impairments often need to transfer between primary and hospital healthcare services (Coleman & Boult 2003). Transitional care is defined as a set of actions ensuring the coordination and continuity of healthcare, as patients transfer between levels of care, between locations or within the same location (i.e. admission to and discharge from hospital healthcare to community care) (Coleman & Boult 2003). Policy documents emphasise the need for patient participation to improve the quality of transitional care (WHO 2011, Norwegian Ministry of Health & Care Services 2008–2009). Under Norwegian law (Ministry of Health & Care Services 1999), patients are entitled to receive relevant healthcare information and participate in decisions about their treatment and care. Healthcare quality is characterised by patients and their next of kin as individualised and patientfocused, with healthcare personnel attending to the needs and concerns of patients and their next of kin (IOM 2001, Wiig et al. 2013). Patient participation in transitional care might entail the receipt of sufficient information about their illness, course of illness, care rehabilitation, participation in discussions about medical treatment, goals and needs for care, services and the rehabilitation process (Almborg et al. 2008). Current research indicates that older patients’ participation in transitional care is not well developed (Foss & Hofoss 2011, Flink et al. 2012). Challenges Faced by Patients with Low Socioeconomic Status Essay Variability in how participation is managed and experienced by older patients and their caregivers is reported (Roberts 2002, Almborg et al. 2008; Foss & Hofoss 2011). Studies of transitional care across levels of care have primarily been concerned with hospital discharge, as compared to hospital admission (Richardson et al. 2007). It has been asserted that it is necessary to better understand the experiences of patients during the hospital admission and discharge process to develop patient-centred care (Richardson et al. 2007). This article focuses on older patients’ participation in hospital admission and discharge. Background Coulter (1999, p. 719) defined paternalism in healthcare services as ‘doctor (or nurse) knows best, making decisions on behalf of patients without actual involving them’. In contrast to paternalism, patient-centred care, patient participation and shared decision-making incorporate the 1694 patients’ experiences with care (Berwick 2009, Storm & Edwards 2013). Comprehensive information and the involvement of the patient and their family members/caregivers in the decision-making process about their treatment and care is emphasised (Coulter 2005, Berwick 2009, Foss & Hofoss 2011). Thompson (2007) suggests five levels of patient participation: (0) non-involvement, where the patients are passive recipients of care and treatment; (1) information-seeking, where patients are receptive of information which is a prerequisite to take part in decisions; (2) information-giving, where professionals and patients both provide the other with information; (3) shared decision-making, a cooperation between the professionals and the patients to determine the best solution and; (4) decision-making, where the patient makes decisions independently, without consulting professionals. Aim The aim of this study is to explore older patients’ participation during admissions to, and discharges from, a hospital. Two research questions are addressed: 1 How is patient participation attended to by healthcare professionals during hospital admission and discharge? 2 What are the experiences of older patients and their next of kin with patient participation in hospital admission and discharge? Methods Design and study setting This study uses an observational research design that consists of participant observations (Polit & Beck 2008). Participant observation means that the observer takes part in the studied field with the research participants (Polit & Beck 2008, Arman et al. 2010). Observations took place in two hospitals in one Regional Health Authority during 2012 in Norway. Observations were conducted in two emergency departments and seven hospital wards: three medical wards, one geriatric ward, and three orthopaedic wards. The observations covered the acute hospital admissions of older patients from home-based care services or nursing homes, as well as hospital discharges to follow-up care in nursing homes or home-based care services. The observations included short conversations with the patient and/or their next of kin to capture their experiences with participation in admission and discharge (Aase et al. 2013). © 2015 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. Challenges Faced by Patients with Low Socioeconomic Status Essay Journal of Clinical Nursing, 24, 1693–1706 Original article The participant observations included frail older patients (over age 75) with an orthopaedic diagnosis (e.g. hip fracture) or a medical condition [e.g. pneumonia, chest pain, syncope, stroke, chronic obstructive pulmonary disease (COPD), reduced general health condition] and poly-pharmacy (>5 medications daily). Patients with cognitive impairments meeting the above inclusion criteria were included in the study (Aase et al. 2013). The observations during admission started when the patient transferred from the ambulance personnel to the emergency department nurse. Observations continued until the patient was transferred to the hospital ward. Focus was placed on the interaction, coordination and dialogue among ambulance personnel, doctors, nurses and patients. Conversations were conducted with the patients at the hospital ward one or two days after their admission, when the patient’s health condition stabilized. Conversations were also conducted with the patient’s next of kin in the emergency department (ED) in hospital admission, either on the day of admission or the subsequent day at the hospital ward, if the patient consented. The observations during discharge started on the morning of the day of their expected discharge. Focus was placed on the interaction, coordination and dialogue among doctors, nurses and patients. Conversations with patients were conducted during the observations, while conversations with their next of kin were conducted via telephone (if consent from the patient existed). During the study, an observation guide was applied. The observation guide was developed based on: Laugaland et al. (2011), Laugaland et al. (2012), Storm et al. (2012) and Dyrstad et al. (2014). Observation guide themes included: (1) structures/plans, (2) coordination of care, (3) patient participation, (4) interdisciplinary collaboration, (5) documentation/information and (6) contextual factors. Patients and their next of kin were asked to describe their experiences with participation, information exchange, involvement in the decision-making process and their satisfaction with their care. Data collection Data were collected between March 2012–October 2012 and consisted of 72 hours (80 pages) of field notes of participant observations in hospital admission and 925 hours (153 pages) of field notes in hospital discharge. The researchers were present on the wards between 8:00 am–7:00 pm and identified the patients that were eligible for inclusion. Forty-one patient observations (21 observations in admission and 20 observations in discharge) were conducted by Older patients and hospital transitions two researchers (first and second authors) with a nursing background. In 27 of the total 41 patient observations, the patients participated in conversations with the researchers at the hospital wards. Challenges Faced by Patients with Low Socioeconomic Status Essay The researchers conducted 10 patient conversations in admission and 17 in discharge at the hospital. There were conducted 28 conversations with the next of kin, 13 of which were conducted by telephone as next of kin had not been present during admission or discharge. There were various reasons for patients not taking part in conversations with the researchers. Seven patient observations included patients that were cognitively impaired. Conversations were then conducted with their next of kin when this was possible. Patients were also occupied with tests and treatment when the researcher was at the hospital ward the first or second day after admission. Other reasons were early hospital discharge, patient transfer to the intensive care unit, and patients not feeling well and wanting to take part in a conversation. In admission, seven observations were of patients with orthopaedic diagnoses (e.g., hip fractures) and 14 observations were of patients with a medical diagnosis (e.g. pneumonia). In discharge, seven observations involved patients with an orthopaedic diagnosis, while 13 patients had a medical diagnosis. Details of the patient observations are presented in Table 1. Field notes were written by the two researchers during the observation process. A summary of each observation was written in electronic format immediately after each observation. Direct quotations from the patients and their next of kin were noted in some observations. Ethical considerations Approval for the study was obtained from the Western Norway Regional Ethics Committee for Medical Research (REC, no. 2011/1978). Patients were first approached by the nurse in charge of the ED (admission) and by the patients’ primary nurse across the medical- and orthopaedic wards (discharge). Patients were asked by the nurse if they wanted to be included in the study. The researchers did not contact the patients until they had provided their verbal consent to the nurse. Participation was based on informed, voluntary consent. If the patient suffered from cognitive impairment, family members were required to consent on behalf of the patient. Data analysis An in-depth analysis of the qualitative data material from the field notes, was conducted using Malterud’s (2012) © 2015 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. Journal of Clinical Nursing, 24, 1693–1706 1695 DN Dyrstad et al. Table 1 Patient observations: Hospital admissions (21) and hospital discharges (20) Patient conversations at the hospital ward Next of kin present during admission Conversations with next of kin Hours in the ED Primary care service ahead of admissions No No No No Daughter at ward No 15 3 Urinary infection, nauseous Cerebral insult Pneumonia No No No 2 No Yes No No No No 3 2 Male, age 86 Stroke, vomiting/diarrhoea No No 2 Male, age 84 Chest pain No (cognitively impaired) Yes Nursing home Living with brother, Home care nursing Living with brother, Home care nursing Nursing home Living alone, Home care nursing Living with wife, Home care nursing No No 3 Male, age 73 Male, age 87 Pneumonia TIA/concussion of the brain Reduced general health condition Dehydration Dehydration No Yes Yes No Wife in ED Daughter at ward 25 45 Yes Yes Daughter in ED 6 Yes Yes Yes Yes Daughter in ED Daughter in law in ED 2 75 Yes Yes Daughter in ED 5 Male, age 92 Delirium due to medications Fall No No No 45 Male, age 85 Fracture collum femoris Yes No No 2 Male, age 93 Fracture collum femoris Yes No 2 Female, age 92 Fracture collum femoris Yes 2 Nursing home Male, age 82 Fracture collum femoris Yes Daughter in ED 55 Nursing home Male, age 81 Fracture collum femoris No (cognitively impaired) No (cognitively impaired) No Daughter in law by telephone Daughter in ED Living with wife, Home care nursing Short stay nursing home Living with wife, Home care nursing Short-time stay nursing home, Home care nursing Home care nursing Short-time stay nursing home, Home care nursing Short-time stay nursing home, Home care nursing Living alone, Home care nursing Living alone, Home care nursing Nursing home No No 45 Yes Wife in ED 4 Fracture collum femoris No (cognitively impaired) Yes Living alone, Challenges Faced by Patients with Low Socioeconomic Status Essay Home care nursing Nursing home Yes Daughter in ED 5 Home care nursing Medical and orthopaedic diagnoses Patient conversations at the hospital ward Next of kin present during discharge Conversations with next of kin Yes No Wife by telephone 8 Short-time stay nursing home Yes No 6 Home with home care Yes Yes No No Daughter by telephone No No 9 7 Home with home care Home with home care Patient characteristics Medical and orthopaedic diagnoses* Hospital admissions Male, age 82 Chest pain Male, age 86 Syncope Male, age 85 Female, age 82 Female, age 81 Female, age 86 Female, age 91 Female, age 83 Female, age 90 Male, age 745 Female, age 83 Patient characteristics Fracture collum femoris Hospital discharge Male, age 90 Reduced general health condition Male, age 89 Pneumonia Female, age 92 Female, age 97 1696 Urinary sepsis Heart attack Days spent at the hospital Primary care service at discharge © 2015 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd. Journal of Clinical Nursing, 24, 1693–1706 Original article Older patients and hospital transitions Table 1 (continued) Patient characteristics Female, age 87 Female, age 87 Male, age 77 Medical and orthopaedic diagnoses Patient conversations at the hospital ward Next of kin present during discharge Yes Yes Yes Conversations with next of kin Days spent at the hospital Primary care service at discharge No No No Son by telephone Son by telephone Wife at ward 12 19 23 Short-time stay nursing home Short-time stay nursing home Nursing home No No Daughter by telephone Daughter by telephone 8 6 Short-time stay nursing home Short-time stay nursing home No No No No Son by telephone Daughter by telephone No Daughter at ward 18 20 7 9 15 Male, age 89 Female, age 89 Malnutrition COPD, malnutrition Reduced general health condition Arthritis Pneumonia Male, age 87 Male, age 80 Female, age 86 Female, age 96 Pleural drainage Pneumonia Pain in knee Urinary infection Yes No (cognitively impaired) Yes Yes Yes Yes Female, age 75 Fracture collum femoris Yes No Son at ward Male, age 85 Female, age 97 Male, age 84 Fracture collum femoris Fracture collum femoris Fracture collum femoris No No No Son by telephone Son at ward Wife by telephone 9 4 2 Female, age 89 Female, age 86 Fracture collum femoris Fracture collum femoris No No Son by telephone Sister by telephone 5 5 Short-time stay nursing home Short-time stay nursing home Male, age 84 Fracture collum femoris Yes Yes No (cognitively impaired) Yes No (cognitively impaired) Yes Short-time stay nursing home Short-time stay nursing home Intermediate care unit Retirement home for older people Nursing home, Rehabilitation unit Nursing home Intermediate care unit Nursing home No No 4 Short-time stay nursing home COPD, chronic obstructive pulmonary disease; ED, emergency department *Most of the older patients had additional diagnoses (e.g., heart disorder, kidney failure, Parkinson’s, diabetes, stroke, dementia, COPD and different types of cancer). systematic text condensation approach. The method is based on ‘a descriptive approach, presenting the experience of the participants as expressed by themselves, rather than exploring possible underlying meaning of what is said’ (Malterud 2011, p. 796). A four-step analysis of the researchers’ field notes was performed as follows: 1 The authors read through the text transcripts from the field notes several times to obtain a complete impression. Three preliminary themes emerged: the healthcare system, the older patient, and next of kin. 2 Meaning units [‘a text fragment containing some information about the research question’ (Malterud 2012, p. 797)] of participation in admission and discharge were identified from the field notes and div … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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