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We evaluated the Iowa Return to Community, a service demonstration designed to coordinate care and reduce preventable healthcare utilization among at-risk older persons living at home in rural communities. During 2021, 262 older persons elected to participate in the IRTC program. Individuals who participated were more likely to live in micropolitan areas (OR = 2.30, 95% CI 1.34–3.95) relative to metropolitan locations. Individuals who used recommended services were more likely to be men (OR 3.65, 95% CI 1.16–11.51) and more likely to live in rural (OR 17.48, 95% CI 1.37–223.68) and micropolitan areas (OR 3.17, 95% CI 1.00–10.05). However, prevention of health care use corresponded more with consistent and prolonged IRTC program engagement rather than volume of service use. The IRTC constitutes a population aging and rural health strategy to reduce unnecessary health care use while supporting individual preferences to remain at home. [ABSTRACT FROM AUTHOR]

Introduction: An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden. Methods: A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends. Results: Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care. Conclusion: The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health. [ABSTRACT FROM AUTHOR]

All aspects of nursing practice are regulated by politics and affected by changes in public policy. For that reason, nurses need to be active in the political process through which they may influence public policies on health. However, nurses' participation in political activities in many countries is either low or moderate at best. Studies that explore political participation among nurses are rare in Africa. We conducted this study to identify factors that may enhance or hinder nurses' political participation. Through a cross-sectional survey, we collected data from 225 registered nurses sampled from three hospitals and two nursing training schools in Tamale, Ghana, using a structured questionnaire. We analyzed the data using descriptive statistics and correlations. The most frequently reported barriers to political participation were having little free time, lack of trust in politicians, fear of conflict/confrontation, lack of educational preparation, and lack of access to the right connections. The major facilitators of political participation were identified as availability of free time and money, civic skills, personal interest in politics, self-belief and confidence, and a strong party affiliation. These findings call for integration of political content into the nursing education curriculum and for professional nursing organizations to create opportunities for their members to learn about the political process. [ABSTRACT FROM AUTHOR]

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients' self-care performance, nurses need an integrated approach that considers a patient's age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness. [ABSTRACT FROM AUTHOR]

Introduction: Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses’ input to understand challenges faced during home care, to derive a framework to address the challenges. Methods: Semistructured interviews were conducted to saturation with 16 community nurses in Singapore. Interviews were transcribed verbatim and transcripts independently coded for emergent themes. Themes were interpreted using grounded theory. Results: Seven major themes emerged from 16 interviews: Strained social relationships, complex care decision-making processes within families, communication barriers, patient’s or caregiver neglect of health issues, building and maintaining trust, trial-and-error nature of work, and dealing with uncertainty. Discussion: Community nurses identified uncertainty arising from complexities in social-relational, personal, and organizational factors as a central challenge. Nursing education should focus on navigating and managing uncertainty at the personal, patient, and family levels. [ABSTRACT FROM AUTHOR]

The purpose of this pilot study was to assess the cost-effectiveness of four different doses (based on patients’ level of cognition and activation) of a home-based care transitions intervention compared with usual care at 2 and 6 months after hospital discharge to home for 126 adult patients with three or more chronic diseases. Health care utilization was measured, and a cost-effectiveness analysis was used to estimate incremental costs and quality-adjusted life-years associated with each intervention arm. At 6 months, results from this pilot study are very promising and support cost-effectiveness for Group 2-low cognition/high activation, Group 3-normal cognition/low activation, and Group 4-normal cognition/high activation patients. However, Group 1-low cognition/low activation needs a more intensive treatment than what was provided in the intervention, because of their low cognition and activation levels. Our intervention strategies provided to the groups would be scalable to a larger patient population and across different facilities. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the benefit of a Saturday rehabilitation service in improving employees' return to work outcomes at 12 months. The study involved a randomized controlled trial in a general inpatient rehabilitation service. Results show that the service has demonstrated no improvement in work outcomes.

Environment has long been a primary concern in nursing, beginning with Nightingale's attention to the power of the environment to heal. Policy is a dimension of the practice environment with great potential to influence patients' health. In this column, a practice vignette illustrates some of the barriers to nurses' awareness of policy-as-environment. Characteristics of conceptualizations of environment, arising from nursing science, that have potential to surmount barriers and increase awareness are identified. Creative attention to conceptualizing policy-as-environment is urged as a way to encourage nurses to consider policy activity as a satisfying aspect of practice. [ABSTRACT FROM AUTHOR]