Practitioners need skills and resources to appraise, synthesize, and diffuse the best evidence into practice. Patient outcomes must reflect discipline-specific and interdisciplinary accountabilities. Collaboration between researchers and practitioners within and among disciplines will enhance the diffusion of evidence-based practice innovations.
The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.
The purpose of this exploratory study was to gain a better understanding of the influences of Appalachian culture and rural living on illness experiences and health recovery behaviors. The study sample consisted of 257 randomly selected adult patients admitted to medical-surgical units in eight hospitals in West Virginia. Patients completed interviews in the hospital and by phone and in their homes 1 month after hospital discharge. In addition, 203 nurses and 79 physicians completed a values survey and decisional control questions. The triangulation of quantitative and qualitative data suggested that culture, age, gender, and rural residence affected responses to illness and recovery. Traditional values and roles persisted in this population and influenced health behaviors. The findings of this study support the need for culturally sensitive care and for innovative education programs to reduce health risks.
The advisory board's makeup tends to consist of professionals with domains of expertise relevant to the organization they serve. Organizations invite advisory board members to guide the organization's efforts over an extended period. Still, they do not have fiduciary, operational, or decision-making responsibilities for the organization in the way that a board of directors does. This article provides a framework for a behavior-analytic organization to (a) identify whether an advisory board would be feasible and beneficial, (b) establish an advisory board, and (c) engage and manage an advisory board to best leverage the unique skills and interests of the members. The article includes 2 examples of advisory boards to illustrate the suggested framework and recommendations.
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