Use of a structured transition process with joint appointments and transition coordinator improves adherence to follow-up and reduces diabetes-related distress.
Heart failure (HF), predominant in adults older than 65, is a chronic and progressive syndrome frequently associated with the burden of distressing symptoms. HF symptom management is directed at treating the underlying causes of acute decompensation, which commonly relate to lack of medication adherence or dietary restriction. Therefore, for older adults capable of managing their health care needs, promotion of self-care is essential for symptom management. Using the Model of Heart Failure Self-Care as a guide, the purpose of this article is to discuss the relationship between self-care and HF symptom management and to provide nursing strategies for assessment and promotion of self-care in older adults with HF.
Background. This study reviewed all patients managed by the Gynecologic Oncology service of a tertiary care facility (n = 468) whose deaths occurred between 1980 and 1990 to ascertain the site of death and potential factors affecting whether patients died at home or in a hospital.
Methods. Gynecologic Oncology Tumor Registry data were analyzed for patient diagnosis, age at diagnosis, age at death, marital status, insurance coverage, and year of death in relation to location of death.
Results. This study found that 78% of patients died in the hospital, and 22% died at home. The mean terminal hospital stay was 15 days. The variables examined in this study could only accurately predict location of death in 59% of the cases. Examination of the variable year of death, however, demonstrated that the likelihood of death in the hospital generally increased from 1980 to 1990, despite introduction of diagnosis related groups and aggressive efforts by caregivers to facilitate and encourage death at home.
Conclusions. Philosophical and economic considerations to the contrary, a significant majority of terminal patients with gynecologic cancers will die in a hospital, thus extensively utilizing our limited health resources.
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