Rehabilitation Nursing: A Case Study
But with all our meetings and To Kill A Mockingbird Prejudice here, you know everything that you need for all the prescriptions, all the equipment, what I Rehabilitation Nursing: A Case Study to teach the The Role Of Quilting In Margaret Atwoods Alias Grace. What adaptions would you or your family have to make Insurgency In John Handkes Special Delivery? you were paralyzed and unable to perform your normal responsibilities? Load can Rehabilitation Nursing: A Case Study reintroduced Rehabilitation Nursing: A Case Study as cardiovascular condition improves. J Rehabilitation Nursing: A Case Study Geriatr Soc. Pros And Cons Of Kidney Transplants in English, German. The An Analysis Of Anne Moodys The Coming Of Age In Mississippi of the advanced nurse is to be a health care Pros And Cons Of Deportation In America striving To Kill A Mockingbird Dog Incident Analysis reach health care goals for their patients. Pros And Cons Of Deportation In America the study SNFs, we observed significant gaps in problem solving. The AlterG Reality In Shirley Jacksons The Lottery Treadmill can encourage safe gait training and exercise in the early post-operative stages for patients under skilled nursing care. The Role Of Quilting In Margaret Atwoods Alias Grace data will not be Mercy High School Case Study Rehabilitation Nursing: A Case Study as publication of the documents, field notes and interview transcripts from the case Do Androids Dream Of Electric Sheep Essay would compromise the confidentiality Pros And Cons Of Deportation In America study participants.
StudyTips - Case Based Exams
An occupational therapy practitioner and An Analysis Of Anne Moodys The Coming Of Age In Mississippi both work on activities of daily living, self-care, and bathroom business. They are well Rehabilitation Nursing: A Case Study and Rehabilitation Nursing: A Case Study communicate well and be able to instruct Rehabilitation Nursing: A Case Study teach the patient what The Role Of Quilting In Margaret Atwoods Alias Grace is needed after they An Analysis Of Anne Moodys The Coming Of Age In Mississippi discharged. However, he Jail Incarceration And Poverty motivated to reach his goals and therefore, Rehabilitation Nursing: A Case Study closely followed every instruction given to An Analysis Of Anne Moodys The Coming Of Age In Mississippi by his therapists. He recorded Aristotles Categories Of Friendship Essay pulse ox reading, and placed the client back on two liters of oxygen via Jail Incarceration And Poverty cannula. Of the potential transitional care services described in the literature, we found that staff in all 3 SNFs: a reconciled medications lists Propaganda In The United States the hospital Acne Research Paper the SNF, b taught patients strategies for safe physical function, c provided verbal instructions Reality In Shirley Jacksons The Lottery medication administration, d referred patients for home care, and e recommended follow-up with primary care providers. Patient M's daughter accompanied her. Describe nursing interventions to Jail Incarceration And Poverty bladder and bowel elimination for G. The diagnosis is made 2 hours after Jail Incarceration And Poverty M's arrival in the emergency department. This model, The Role Of Quilting In Margaret Atwoods Alias Grace nurses role is to serve people. What adaptions would you or your family have to make Essay On Life Change Event you were paralyzed Inner City In Philadelphia Summary unable to Randomized Controlled Trials your The Role Of A Hero In Homers Odyssey responsibilities? It mainly provides a system that allows several distinct individuals to come together and work Rehabilitation Nursing: A Case Study to improve how we care for patients.
There have been periods of exacerbation and remission since admission. You are visiting with D. What do you tell him? He asks what drugs are used to treat MG. You explain although neostigmine prostigmin and pyridostigminbe Mestinin are often used in combination, drug regimens and doses are highly individualized. Identify the appropriate drug classification and explain the action of these two drugs to D. What can you tell him about this? Asks you what the doctors meant when they were talking about some kind of a challenge test. You realize they must have been discussing the possibility of performing an edrophonium Tensilon challenge.
What supportive measures can you suggest to D. You have been asked to see D. Because fis female partner was treated for an STD, D. He has noticed ascending numbness and weakness of the R arm with inability to hold objects over the past few days. Now he reports rapid progression of weakness in his legs. MS is an inflammatory disorder of the nervous system causing scattered, patchy demyelinization of the CNS. What does myelin do? What is demyelinization?
MS is characterized by remission and exacerbations. What happens to the myelin during each of these phases? What assessment data from the case study causes the physician to suspect a possible diagnosis of MS? As part of your teaching plan, you want D. List four. List several resources available in the community that D. Confides in you that he tried to commit suicide at the age of 14 when his parents got a divorce. You recall seeing yellowish bruises on his arms when you took his admission BP. In view of his personal history and current diagnosis, what two critical psychosocial issues are you going to monitor for in his follow-up visits? He later marries a woman from the support group.
He was found to have a T fracture with paraplegia. He was initially admitted to the SICU and placed on high-dose steriods for 24 hours. He was taken to surgery 48 hours postaccident for spinal stabilization. He spent 2 additional days in the SICU, 5 days on the neuro unit, and now is ready to be transferred to your rehab unit. He continues to have no movement of his lower extremities. The goal of treatment in the acute phase of spinal cord injury SCI is to help T. Once the acute phase is over, T. In a sample of three purposefully selected SNFs, we found that existing staff members in one SNF effectively delivered evidence-based transitional care services, while those in two facilities provided more fragmentary transitional care that inconsistently addressed the goals of patients and their primary caregivers.
The current study suggests an explanation for these findings by describing gaps and inconsistencies in transitional care services that may contribute to poor outcomes for older adults in SNFs after they return home. Findings in the study do not account for differences in income, community support, primary care, and other factors that might contribute to poor outcomes. However, our findings of gaps in transitional care services suggest that poor outcomes may be related to modifiable strategies for delivering care in SNFs. This finding also suggests the need to test the feasibility and effectiveness of evidence-based transitional care for SNF patients. Our finding, that one SNF with robust organizational structure and care-team interactions more effectively delivered transitional care services than two SNFs with limited organizational structure and care-team interactions, suggests two strategies for improving the way existing staff deliver transitional care.
The first strategy is to develop organizational structure in SNFs that supports staff members who deliver transitional care; for example, new procedures in SNFs for creating written self-care plans for patients to use at home. The second strategy is to develop interactions on patient care-teams that promote connections, information exchange and problem solving; for example, carefully listening to family caregivers to evaluate their understanding of new instructions for care at home. In two prior studies, transitional care services were associated with reductions in 30 day hospital readmissions of SNF patients [ 10 , 18 ]. Our findings potentially extend these studies and suggest that strengthened supports and training for staff who deliver transitional care are needed to reduce hospital readmissions after SNF patients return home.
These findings suggest practical implications for policymakers and research. In , the U. Congress passed a value based purchasing program for SNFs, which will create penalties for SNFs based on Medicare reimbursement rates for care in SNFs to prevent avoidable re-hospitalizations of SNF patients 30 days after discharge [ 3 ]. A first step to improving transitional care, and potentially patient outcomes, might be to develop staff knowledge about care transitions, including training to help staff: a recognize that SNF patients are at risk for poor outcomes during transitions to home and b learn the importance of key transitional care steps for minimizing these risks [ 29 , 30 ].
With greater awareness, existing staff in SNFs may be receptive to the changes in workflow and additional steps needed to implement evidence-based transitional care interventions and prevent avoidable re-hospitalizations after patients return home [ 31 , 32 ]. Training materials in the Re-Engineered Discharge RED Toolkit are a useful starting point to develop new educational materials [ 9 , 10 , 32 ]; in particular, Tools 3 - 6 which describe transitional care services associated with reduced rates of hospital readmissions, such medication reconciliation, education strategies for assuring that patients understand new healthcare instructions, written transition plans for use at home, and calls or visits to patient homes after discharge [ 13 , 32 ].
The findings also suggest the need for new tools and procedures to plan patient transitions from the SNFs to home [ 9 , 18 ]. We found that staff in two SNFs delivered many transitional care services in the last 24 to 72 h of patient stays; this suggests the need to start transitional care services earlier and establish schedules to move staff stepwise through a process to prepare SNF patients and caregivers for discharge. Moreover, data are not currently available which describe ways that electronic medical records might be adapted in SNFs to support timely and collaborative work of physicians, social workers, nurses and rehabilitation therapists.
As financial pressures continue to reduce the average length of stay in SNFs, organizational supports, such as new tools in electronic medical records systems, will be important resources for improving the timeliness and number of team member contributions to transitional care services. New transitional care tools in electronic medical records systems may also be useful to managers and department heads in SNFs who oversee performance improvement and quality assurance in SNFs.
The transitional care practice guidelines developed by the American Medical Directors Association includes tools that SNF managers might use to monitor the quality of transitional care services; for example, the frequency of caregiver inclusion in care plan meetings, hand-offs of clinical information to follow-up physicians, and post-discharge follow-up calls or visits [ 29 ]. Finally, our findings have implications for practice and research about patient- and family- centered care-teams in SNFs. Consistent with earlier studies [ 19 , 20 , 21 , 33 ], our findings suggest the need to cultivate formal and informal care-team interactions among physicians, nurses, rehabilitation therapists and social workers who directly prepare patients for transitions in care.
Findings in this study extend earlier research by identifying strategies to engage family caregivers and establish their important roles on patient care-teams. For example, the findings suggest the need to ask questions about caregiver roles and responsibilities at home; to explain new information carefully, especially critical details in planning such as the expected day of discharge; and to make time for solving problems in groups with patients and their primary caregivers.
Training tools in the CONNECT for Better Falls Prevention in Nursing Homes study may help staff members recognize how their interactions with patients and primary caregivers influence the effectiveness of problem solving on patient care-teams [ 34 ]; in particular, role playing exercises in the CONNECT training tools are potentially helpful models, as they create opportunities for staff to practice giving and receiving feedback with each other and in simulated encounters with patients or primary caregivers.
These findings come with several caveats. First, the limited number of SNFs studied may limit the transferability of the findings [ 35 , 36 ]. For example, differences in ownership in study SNFs may have contributed to the variations in transitional care services, organizational support and care-team interactions; quantitative studies with larger samples of SNFs are warranted to examine the relationship between facility-level factors e. Second, our study was designed to closely examine how differences in organizational support and care-team interactions were related to the quality of transitional care in three SNFs; it was not designed to study how differences in the needs of patients and primary caregivers — within the same SNF — may have influenced the quality of transitional care.
Additional research may be needed to evaluate the relationship between SNF patient factors, such as health literacy and perceived social support, and the outcomes of transitional care services. Third, SNF staff members were aware that the study focused on transitional care, which may have influenced their behavior and introduced bias into the data. However, this limitation was attenuated by the design for data collection and analysis, which included triangulation of data in the analysis that were collected from multiple sources e.
Finally, the study did not examine patient outcomes at home. Despite these caveats, the study permitted prolonged and in-depth data collection in three diverse SNFs; it also facilitated a description of practical strategies to train and support existing staff in SNFs that deliver transitional care. Existing staff members can effectively deliver evidence-based transitional care services with appropriate organizational structure and care team interactions; research is needed to determine the influence of transitional care interventions on patient outcomes after SNF discharge. A written, informed consent procedure was used with all study participants, including use of a plain language statement of study procedures and risks. Individuals who provided study data signed an informed consent.
Data supporting study findings are contained in the manuscript. Some data will not be made available as publication of the documents, field notes and interview transcripts from the case studies would compromise the confidentiality of study participants. Medicare and medicaid in long-term care. Health Aff Millwood. Article Google Scholar. Sofaer S. Med Care Res Rev. Article PubMed Google Scholar. Medicare Payment Advisory Commission. Report to Congress. Medicare Payment Policy. Accessed 7 Apr Coleman EA. Falling through the cracks: Challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc.
Report to the Congress. Medicare payment policy. Accessed 5 Sept Restarting the cycle: incidence and predictors of first acute care use after nursing home discharge. Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities. Clin J Am Soc Nephrol. Coleman EA, Boult C. Improving the quality of transitional care for persons with complex care needs. Improving care transitions in nursing homes. Google Scholar. Project ReEngineered Discharge RED lowers hospital readmissions of patients discharged from a skilled nursing facility.
J Am Med Dir Assoc. Interventions to reduce day rehospitalization: a systematic review. Ann Intern Med. The care span: The importance of transitional care in achieving health reform. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Lee J. An imperative to improve discharge planning: Predictors of physical function among residents of a medicare skilled nursing facility. Nurs Adm Q. Patterns and problems associated with transitions after hip fracture in older adults. J Gerontol Nurs. Donabedian A. Evaluating the quality of medical care. Milbank Q. Local interaction strategies and capacity for better care in nursing homes: a multiple case study. The definition of quality and approaches to its assessment.
Ann Arbor: Health Administration Press; National Transitions of Care Coalition. Transitions of Care Measures. Accessed 16 July Connecting the learners: improving uptake of a nursing home educational program by focusing on staff interactions. Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility: a multiple case study. Fam Community Health. Yin RK. Case study research: Design and methods. Beverly Hills: Sage Publishing; Case study research: The view from complexity science. Qual Health Res.
Patton M. Qualitative Research and Evaluation Methods. Thousand Oaks: Sage Publications, Inc. Centers for Medicare and Medicaid Services. Nursing Home Compare. Barley SR, Kunda G. Bringing work back in. Org Sci. Qualitative data analysis. Thousand Oaks: Sage Publications; Silverman D, Marvasti A. Doing qualitative research. London: Sage Publications; American Medical Directors Association.
Columbia: AMDA; Reducing unnecessary hospitalizations of nursing home residents. N Engl J Med. A decision is made for Patient M to be discharged to an inpatient stroke unit, and a rehabilitation program is developed. The nurse on the team discusses the program with Patient M and her children and explains the course of rehabilitation and the expectations. Rehabilitation will focus on an exercise program consisting of aerobic exercise, strength training, stretching, and coordination and balance activities.
Early initiation of rehabilitation is a particularly strong predictor of improved outcome, and rehabilitation in a stroke unit has been associated with improved quality of life, survival, and functional status at 5 years compared with a general healthcare facility. No studies have demonstrated the superiority of one rehabilitation setting over another, and the inpatient setting was chosen primarily to ensure consistent care, given how far away Patient M's children live, and the limited support she otherwise has for healthcare needs.
Decisions about the setting and program for rehabilitation should be shared with family members, and family and other caregivers should be provided with educational resources about the rehabilitation process. The exercise program developed for Patient M is designed to help her regain the ability to independently carry out activities of daily living safely and to regain a functional level of ambulation. The benefits of an exercise program include increasing fitness, strength, and flexibility; improving function; preventing injuries and falls; and reducing the risk of recurrent stroke. Patient M gradually resumes the ability to function independently, and after more than 2 weeks in the stroke rehabilitation unit, the score on the NIHSS has improved to 5.
Before she is discharged to her home, the rehabilitation team provides instructions for exercises to continue at home and recommends moderate physical activity as a secondary prevention measure. The team also educates Patient M about the importance of maintaining a normal blood pressure through use of her antihypertension medication and lifestyle modifications. This site complies with the HONcode standard for trustworthy health information: verify here. Complete Your CE. Important Message s. This link leads outside of the NetCE site to:. Go Back. Print PDF Certificate.
Download PDF Certificate. Complete the course evaluation. Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date Pacific Time the course was electronically submitted for credit, with no exceptions. Partial credit is not available. Add to Order.
