TY - JOUR
T1 - The course of readmission in frail older cardiac patients
AU - Rijpkema, Corinne J.
AU - Verweij, Lotte
AU - Jepma, Patricia
AU - Latour, Corine H. M.
AU - Peters, Ron J. G.
AU - Scholte op Reimer, Wilma J. M.
AU - Buurman, Bianca M.
N1 - Funding Information: This work was supported by the Netherlands Organization for Health Research and Development (ZonMw) as part of the ?From knowledge to Action II program? (grant number 520002002) and is partly financed by the Netherlands Organization for Scientific Research (NWO) grant number 023.008.024. Publisher Copyright: © 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Aim: The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
AB - Aim: The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
KW - cardiology
KW - caregivers
KW - frail elderly
KW - nurses community health
KW - nursing
KW - patient readmission
KW - physical therapists
KW - qualitative research
KW - transitional care
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85102777612&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33739473
UR - http://www.scopus.com/inward/record.url?scp=85102777612&partnerID=8YFLogxK
UR - https://pure.hva.nl/ws/files/18138799/Supplementary_material.docx
UR - https://pure.hva.nl/ws/files/18138801/FigS1.jpg
UR - https://pure.hva.nl/ws/files/18138803/FigS2.jpg
UR - https://pure.hva.nl/ws/files/18138805/FigS3.jpg
UR - https://pure.hva.nl/ws/files/18138807/FigS4.jpg
U2 - https://doi.org/10.1111/jan.14828
DO - https://doi.org/10.1111/jan.14828
M3 - Article
C2 - 33739473
SN - 0309-2402
VL - 77
SP - 2807
EP - 2818
JO - Journal of advanced nursing
JF - Journal of advanced nursing
IS - 6
ER -