Using the Donabedian framework to examine transitional care for cardiac patients and family caregivers

Abstract

Purpose This study aims to examine how health-care managers in acute care and post-acute care facilities support and plan to improve transitional care for cardiac patients and their family caregivers, to better manage care in the home. Design/methodology/approach A qualitative descriptive approach, guided by appreciative inquiry was used in this study. A purposive sample of 16 participants were engaged in the study. Participants completed a demographic questionnaire, the caregiver policy lens questionnaire and participated in one of four focus group interviews. The semi-structured focus group interviews were audio-recorded and analyzed using thematic analysis. Findings Using Donabedian’s framework, six major themes contributed to how health-care managers can improve transitional care: structure included supporting personnel and continuing education; process included enacting approaches of care, coordinating care among the health-care team and calling to work upstream; and outcomes included needing to clarify expectations of home care services and witnessing the impact of the caregiver role. Originality/value These findings demonstrate the importance of Donabedian’s core dimensions of structure and processes in influencing caregiver outcomes. These results emphasize the central role of the manager in influencing system change to improve transitional care.

The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review

“…All of the 5 studies were published between 2015 and 2022. The studies were conducted in different countries including Norwegian (Glette et al, 2018), Dublin (Coyne et al, 2016), Canada (Okoniewska et al, 2015; Udod et al, 2022), and Australia (Feo et al, 2022). The total sample in the included studies was 221 participants including nurse leaders, staff nurses, midwives, physicians, and allied health providers.…”

“…The total sample in the included studies was 221 participants including nurse leaders, staff nurses, midwives, physicians, and allied health providers. Two studies used a focus group interview (Glette et al, 2018; Udod et al, 2022), two used a one-to-one semi-structured interview (Coyne et al 2016; Feo et al, 2022), and a paper-based survey asking participants to respond to one used an open-ended question (Okoniewska et al, 2015). All of the studies utilized a thematic analysis, except one (Glette et al, 2018) used a content analysis approach.…”

“…Of these studies, detailed assessments resulted in the review of 15 studies meeting all inclusion criteria. Out of the 15 studies, 10 studies utilized quantitative design (Carthon et al, 2015;Gilbert et al, 2021;Hoyer et al, 2018;Kara et al, 2015a;Lasater & Mchugh, 2016;Ma et al, 2015;Mathews et al, 2014;McHugh & Ma, 2013;Oliver et al, 2022;Shirey et al, 2019), and five utilized a qualitative approach (Coyne et al, 2016;Feo et al, 2022;Glette et al, 2018;Okoniewska et al, 2015;Udod et al, 2022). For search strategy, see Figure 1.…”

“…The most common weakness was the lack of using a theoretical framework in majority of the studies (3 out of 5). One study utilized Donabedian's framework to highlight the role of nursing leadership in transition of care to reduce readmission rate (Udod et al, 2022) and the other study utilized the Critical Realist framework (Feo et al, 2022).…”

“…In addition, researchers (Feo et al, 2022;Hoyer et al, 2018;Gilbert et al, 2021) found that nursing leadership can reduce the patient readmission rate by designing a transition programs to ensure appropriate follow up after discharge. Udod et al (2022) conducted focus group interviews with 16 nurse leaders in acute and post-acute care facilities in order to identify the role nursing leadership plays in transitional care for cardiac patients. Nurse leaders improved the transition of care according to Donabadian's framework through three phases, including structure, process, and outcome.…”