Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self-management.

Effective use of exercise and activity modification to ameliorate cancer-related symptoms appears to require a linkage to a patient's usual and past activities, proactive negotiation of potential barriers, education regarding symptoms and exercise, and the positive support of their oncologist.

The nurse participants in this study viewed influenza vaccination as a personal health choice, not as an evidence-based nursing intervention. As a result, the decision to decline influenza vaccination was made in the context of personal health choice and/or risk of injury or illness to the nurse. Patient safety outcomes were not expressed as a factor in making the decision to decline influenza vaccination.

Objective To describe the proportion and characteristics of patients with late stage cancer that are and are not receptive to receiving rehabilitation services, as well as the rationale for their level of interest. Setting A comprehensive cancer center in a Northcentral US quaternary medical center Design A prospective mixed methods study Participants 311 adults with Stage IIIC or IV non-small cell or extensive stage small cell lung cancer. Interventions Not applicable Main Outcome Measures Telephone acquired responses to the administration of: 1) the Activity Measure for Post Acute Care Computer Adaptive Test (AM-PAC-CAT); 2) Numerical rating scales for pain, dyspnea, fatigue, general emotional distress, and distress associated with functional limitations; 3) a query regarding receptivity to receipt of rehabilitation services, and 4) a query about rationale for non-receptivity. Results Overall 99 (31.8%) of the study’s 311 participants expressed interest in receiving rehabilitation services; 38 at the time of enrollment and an additional 61 during at least one subsequent contact. Participants expressing interest were more likely to have a child as primary caregiver (18.18% vs. 9.91%, p = 0.04) and a musculoskeletal comorbidity (42.4% vs. 31.6%, p = 0.05). Function-related distress was highly associated with receptivity, as were lower AM-PAC-CAT scores. Reasons provided for lack of interest in receiving services included a perception of their limited benefit, being too busy, and prioritization below more pressing tasks/concerns. Conclusions One-third of patients with late stage lung cancer are likely to be interested in receiving rehabilitation services despite high levels of disability and related distress. These findings suggest that patient misperception of the role of rehabilitation services may be a barrier to improved function and quality of life. Efforts to educate patients on the benefits of rehabilitation and to more formally integrate rehabilitation as part of comprehensive care may curb these missed opportunities.

This qualitative study proposed to examine staff RN's decision making related to discharge planning and perceptions of their role. Themes resulting from interviews were following the script, and RN as coordinator. The decision to consult a Discharge Planner occurred when the patient's situation did not follow the RN's expectations. Discharge planning for non-routine situations was considered disruptive to the RN's workflow. The RN's role was limited to oversight when a Discharge Planner was involved. Understanding RNs' decision-making in this key process provides valuable insights into differentiating routine from non-routine patient situations and deploying appropriate resources in a timely fashion.Nurses' decision making in complex patient situations and the resulting influences on patient outcomes are important aspects of nurses' work. The recent Institute of Medicine report (Committee on the Work Environment for Nurses and Patient Safety Board on Health Care Services, 2004) describes this 'invisible work' of nursing as the cognitive work that incorporates knowledge gained through both formal education programs and experience. This cognitive work includes activities related to assessing a patient's health, monitoring for changes that require nursing intervention(s), interdisciplinary care planning, and provision of care.The responsibility for each patient's discharge planning involves a series of complex decision-making activities performed by Registered Nurses (RNs). The first and very important step in the discharge planning process is to screen the patient to determine the need to involve hospital discharge planning resources (e.g., Discharge Planner nurse [DPN] or social worker [SW]) for further assessment, design or implementation of the discharge Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. plan. When the need for further evaluation of the patient's discharge planning situation is not identified and acted on, the potential for the patient to experience adverse post-hospital outcomes increases (Code of Federal Regulations, 2004). Adverse outcomes associated with poor discharge planning include unaddressed continuing care needs, unexpected deterioration or medical complications, psychological distress, hospital readmissions, and death (Bowles, Foust, & Naylor, 2003; Coleman & Berenson, 2004;Mistiaen, 2007). Furthermore, eliminating just 5.2% of preventable Medicare rehospitalizations is estimated to save 5 billion annually (Lubell, 2007). NIH Public AccessEarly recognition of these types of patient DP situations is important in order to meet patient sa...

We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.

Our results demonstrate that periods of symptom exacerbation (i.e., flares) are commonly experienced by patients with fibromyalgia and symptoms of flares can be differentiated from every day or typical symptoms of fibromyalgia. Our study is the first of its kind to qualitatively explore characteristics, causes, and management strategies of fibromyalgia flares. Future studies are needed to quantitatively characterize fibromyalgia flares and evaluate mechanisms of flares.

Families do not interpret clinical cues leading up to death in the same way healthcare providers do; families need clear and direct explanations from providers. Clinicians should assess patient and family understandings of prognosis and communicate clearly and directly. Family members value being with their loved one at the time of death, and they value spending time with the body after death; this should be facilitated in clinical practice.