The purpose of this qualitative study was to explore spiritual care for dying nursing home residents from the perspectives of registered nurses, practical nurses, certified nursing assistants, advanced practice nurses, and physicians. Five major themes emerged: honoring the person's dignity, intimate knowing in the nursing home environment, wishing we could do more, personal knowing of self as caregiver, and struggling with end-of-life treatment decisions. Spiritual caring was described within the context of deep personal relationships, holistic care, and support for residents. Spiritual care responses and similarities and differences in the experiences of participants are presented. Education and research about how to assist residents and families as they struggle with difficult end-of-life decisions, adequate time and staff to provide the kind of care they "wished they could," and development of models that honor the close connection and attachment of staff to residents could enhance end-of-life care in this setting.
Background and Purpose: The chances of experiencing a second event are significantly increased in those with recent stroke or transient ischemic attack (TIA). Gaps in care due to the movement of patients between health settings and/or practitioners, also known as transitions of care (TOC), may contribute to secondary events. The impact of TOC on stroke/TIA outcomes has not been thoroughly examined. The Doctorate of Nursing Practice (DNP) is a relatively new role within the nursing profession that provides advanced practice nursing care, leadership and research expertise. As the first phase of a long term goal to evaluate a DNP-led TOC model specific to the stroke/TIA population in Southeastern Arizona, the purpose of this study was to identify the essential elements of a model specific for stroke/TIA using data from one urban primary stroke center. Methods: 1) Existing TOC models such as PRISMA, Hospital to Home, and STEPS were identified with applicability to the stroke/TIA patient. 2) Get With The Guidelines [GWTG®]-stroke database from a primary stroke center located in an urban setting in Southern Arizona was used to identify patient demographics and the essential elements that best reflect TOC. Results: We found 1) the Care Transitions Intervention model best suits a DNP-led TOC model for stroke-TIA. Key elements of this model include an interdisciplinary team approach utilizing case-management strategies, discharge planning, and patient self-management education. In addition, the advanced practice nurse has been found to be most successful in leading TOC models aimed at reducing readmissions. 2) Key outcome variables in a stroke specific TOC model include frequency of admission/readmission, patient demographics, prior hospitalizations, length of stay, discharge disposition, presence of stroke risk factors and urban vs. rural settings. 3) Post-discharge phone interviews may be needed to explore gaps in care not captured in GWTG. Conclusions: While TOC models have been described for other diagnoses, models for stroke/TIA are lacking. The use of the Care Transitions Intervention model for stroke/TIA could yield important reductions in the burden, morbidity, and mortality of stroke/TIA in Southeastern Arizona and thus, deserves further study.
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