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The explosive outbreak of COVID-19 led to a shortage of medical resources, including isolation rooms in hospitals, healthcare workers (HCWs) and personal protective equipment. Here, we constructed a new model, non-contact community treatment centres to monitor and quarantine asymptomatic and mildly symptomatic COVID-19 patients who recorded their own vital signs using a smartphone application. This new model in Korea is useful to overcome shortages of medical resources and to minimise the risk of infection transmission to HCWs.

Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work toward establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: "minimal care," "intermediate care," and "comprehensive (guidelines-based) care." Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra-clinic mean HbA1c levels range from 12.0% to 14.0% (108-130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64-80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52-69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

Asthma inflicts a significant health and economic burden in the United States. Self-management approaches to monitoring and treatment can be burdensome for patients.To assess the effect of a digital health management program on asthma outcomes.Residents of Louisville, Kentucky, with asthma were enrolled in a single-arm pilot study. Participants received electronic inhaler sensors that tracked the time, frequency, and location of short-acting β-agonist (SABA) use. After a 30-day baseline period during which reference medication use was recorded by the sensors, participants received access to a digital health intervention designed to enhance self-management. Changes in outcomes, including mean daily SABA use, symptom-free days, and asthma control status, were compared among the initial 30-day baseline period and all subsequent months of the intervention using mixed-model logistic regressions and χThe mean number of SABA events per participant per day was 0.44 during the control period and 0.27 after the first month of the intervention, a 39% reduction. The percentage of symptom-free days was 77% during the baseline period and 86% after the first month, a 12% improvement. Improvement was observed throughout the study; each intervention month demonstrated significantly lower SABA use and higher symptom-free days than the baseline month (P.001). Sixty-nine percent had well-controlled asthma during the baseline period, 67% during the first month of the intervention. Each intervention month demonstrated significantly higher percentages than the baseline month (P.001), except for month 1 (P = .80).A digital health asthma management intervention demonstrated significant reductions in SABA use, increased number of symptom-free days, and improvements in asthma control.ClinicalTrials.gov Identifier: NCT02162576.

BACKGROUND: The medium care unit (MCU) or "stepdown" unit is an increasingly important, but understudied care environment. With an aging population and more patients with complex multiple diseases, many patients often require a higher level of inpatient care even when full intensive care is not indicated. However, the nurse-to-patient ratio required on a MCU is neither well defined nor clear whether this ratio should be adjusted per shift. The Nursing Activities Score (NAS) is an effective instrument for measuring nursing workload in the intensive care unit (ICU) but has not been used in an MCU. The aim of this study was to measure the nursing workload per 8-hour shift on an MCU using the NAS and compare it with the NAS from an ICU in the same hospital. We also compared the NAS between groups of patients with different admission sources. METHODS: The NAS was prospectively measured per patient per shift for 2 months in a 9-bed tertiary referral university hospital MCU and during a similar period in an ICU in the same hospital. RESULTS: The mean NAS per patient did not differ between day (7:30 am to 4:00 pm) and evening (3:00 pm to 11:30 pm) shifts, but the NAS was significantly lower during the night shift (11:00 pm to 8:00 am) than during the day (P < 0.0001) and evening (P < 0.0001) shifts. The mean NASs in the ICU for day and night shifts were significantly lower than the scores in the MCU (P = 0.0056 and P < 0.0001, respectively), but NAS during the evening shift did not differ between the ICU and the MCU. The mean NAS for patients admitted to the MCU from the accident and emergency department was significantly higher than for those admitted from the ICU (P = 0.002), recovery (P = 0.002), and general ward (P < 0.0001). Patients on the MCU had a NAS comparable with that of ICU patients. CONCLUSIONS: In our university hospital, NAS was higher during the day and evening hours and lower at night. We also found that patients from accident and emergency had a higher NAS than those admitted to the MCU from other locations. NAS in the MCU was not lower than the NAS in the ICU. Because of its ability to discriminate between day and evening workloads and between patients from different sources, the NAS may assist MCU managers in assessing staffing needs. (Anesth Analg 2015;121:1274-80)

Background: In the Netherlands diabetes specialist nurses play an important role in specialized, long-term care for the chronically ill. One of the goals of nurse-led, shared care is to encourage chronically ill people to participate actively in selecting the organisation and interventions of care. This paper reports the findings of a study to determine which concepts of autonomy people with type 2 diabetes use in a nurse-led, shared-care setting. Objectives: The aim of this article was to portray how people with type 2 diabetes mellitus who are being cared for by diabetes specialist nurses in a shared-care unit view autonomy. Design and setting: This qualitative study used in-depth interviews and was carried out in a nurse-led, shared-care unit in the Netherlands. Participants: The study population consisted of 15 people who were enrolled for at least 1 year at the nurse-led, shared-care unit and who lived independently at home. Method: Data were analysed with a grounded-theory-like method. Result: The core category, 'competency in shaping one's life', described how people with diabetes exercise their autonomy. Seven categories that emerged were considered dimensions of autonomy. The dimensions were: identification, self-management, welcomed paternalism, self-determination, shared decision-making, planned surveillance, and responsive relationship. Conclusion: Autonomy is a multi-dimensional, dynamic and complex construct. Further research is needed to investigate which decision-making processes patients with type 2 diabetes use in a nurse-led, shared-care setting.

Relatively recent changes in health care have seen shorter hospital stays and a considerable increase in day-only admissions, anticipated to involve 60% of all patients admitted for surgery and/or investigations within the next couple of years. Surprisingly little is known about the experiences of the approximately 40% of patients who will begin to convalesce in hospital following illness, trauma or surgery. Findings from a qualitative study, briefly reported here, identified a sense of vulnerability in transition as a significant discomfort. By examining assumptions underlying the care of patients recovering in hospital, the nexus between system-determined care trajectories transition, and patient vulnerability can be identified and problems suitably addressed. (author abstract)

• Change in nursing practice has been dogged by factors which have been perceived to be outside the autonomy of nurses. Consequently, projects have been initiated which have then faltered or even ceased altogether. • This paper reports on an action research study that was carried out in Newcastle from 1997 to 1999 and used the process within a focus group setting to rekindle and sustain an innovative change. • The aim of the study was to look at staff perceptions surrounding development of the practice of self-administration of medication for patients. • The findings support the view that all disciplines need to be involved in health service change. • Health service employees should have a knowledge of the theory associated with the change process and be open about their views of proposed alterations in practice. • They also need to have a sense of dissatisfaction with the present, a clear outline of what the problem is and the direction which they intend to take. • Change involves many complex issues. It should be worked through from a bottom-up approach and consist of repeated evaluation exercises which are akin to a cyclical strategy and include a reflective process.

The postpartum hospital stay has been decreasing in the United States in recent decades. Early discharge to achieve cost savings has been criticized by many inside and outside the health care community as sometimes being detrimental to the mother and infant. This article describes the efforts of the administration, nursing staff, and medical staff of a large public urban hospital to develop an alternative to the forced early discharge of mothers and infants.

Patient-centered hospital units have grown out of the national trend to greater consumerism, but few of these units have been evaluated rigorously. We used a randomized controlled trial to compare patient outcomes on the Planetree Model Hospital Unit with other medical-surgical units in the hospital. Planetree patients were significantly more satisfied than controls with their hospital stay, the unit's environment and nursing care, but did not differ in ratings of physician care. Planetree patients reported more involvement in their care while hospitalized and higher satisfaction with the education they received. There were few differences between Planetree and controls in health behaviors. While Planetree patients reported better mental health status and role functioning after discharge, their health status was similar to controls after 3 to 6 months. There were no differences in length of stay and charges for the index hospitalization, readmissions or outpatient care during the following year.

The purpose of this review was to critically examine the literature published in the English language (1983-1995) related to the use of self-medication programmes by hospital patients and to determine whether such a scheme could be implemented and evaluated within the acute medical setting. Searches revealed a wealth of information relating to self-medication and it was evident that such schemes have been welcomed with enthusiasm by clinical nurses. However, only 12 empirical studies evaluating the advantages and disadvantages of self-medication programmes could be located. The remainder were all anecdotal or described the process of implementation in such broad terms that they could not be considered to fulfil the rigorous requirements demanded of research studies. Even the 12 empirical studies contained serious methodological flaws. Thus authors' claims that self-medication increased compliance with the drug regime could not be accepted with confidence. Nevertheless, the authors made a number of sensible recommendations which logically would be expected to increase compliance. These included simplification of the drug regime and careful patient assessment with the programme tailored to meet individual need. It was also possible to highlight areas where future research could be conducted (e.g. more detailed examination of the importance nurse-patient interaction to the success of self-medication, longer-term evaluation) and to identify means of improving research designs so that this important field of patient care may in future be examined with greater rigour.

Summary • The purposes of this study were twofold. The first was to determine the rationale behind the adoption of a self-care approach to nursing. The second, to determine how a self-care philosophy is applied in practice. • The study was carried out from a phenomenological perspective, as it facilitated an understanding of nursing practice from the practitioners' perspective. • The adoption of a self-care philosophy and approach to caring, appears to have evolved through patients need. This finding has implications for all practitioners.

The availability and an assessment of the nutritionally-relevant information from 100 medical records of ambulatory residents in ten special care units (SCU) for Alzheimer's patients was determined. Eight facilities had estimated calorie and fluid needs and four estimated protein needs of residents. Over 40% of the residents were underweight and significant weight loss was reported for 20%. Values for hemoglobin, hematocrit, albumin and cholesterol were available on 61, 60, 36, and 25% of the patients, respectively. Hemoglobin, hematocrit and albumin were 8% lower and cholesterol was 24% higher than the levels associated with high death rates among institutionalized elderly. Many factors existed placing patients at high risk for malnutrition. Staff at all the facilities monitor the nutritional status of Alzheimer's patients to a variable extent.

The nature, advantages and disadvantages, and cost of a hospital-based self-care unit as part of a rehabilitation service are described. The unit's operational policy is critically examined after analysing the records of 40 patients admitted consecutively over a 2-year period and conducting interviews with 27 patients between 4 and 48 weeks after discharge. It is concluded that, compared with a hospital ward, a self-care unit is inexpensive to run and helps to prevent patients from giving up their homes and being admitted to residential homes prematurely. In addition to an assessment and confidence-building role, the unit provides a more appropriate and acceptable environment for patients waiting housing alteration or rehousing than a hospital ward.

The New York University Medical Center Cooperative Care (CC) program is a model of a delivery system of acute inpatient hospital care characterized by a live-in family member or friend acting as a "care partner". It has an emphasis on education in order to encourage full patient and family involvement in care during the acute hospitalization, thereby preparing both parties for management at home after discharge. The education-intensive experience of CC provides an alternative to traditional inpatient hospital care with the expected outcome of CC being to increase patient and family knowledge and satisfaction, adherence to the medical regimen, and appropriate self-management. The functioning ability of the patient-care partner team should be improved on discharge, which may result in decreased subsequent utilization of high cost healthcare resources such as rehospitalization. This paper describes the structure of the CC form of inpatient care, the types of patients appropriate for such care, and the experience of its first ten years of operation, with its implications as a replicable model for other institutions.

The primary objective of this study was to test the hypothesis that inpatient care which emphasized structured, patient education, self-care and social support from a care partner (the Cooperative Care Program) is a cost-effective alternative to the more expensive staff-intensive, traditional hospital care; and that such care can be substituted without resulting in poorer outcomes with regard to subsequent health status or use of services. The effects of this program on patient and physician acceptance, patient knowledge and treatment and health status, were evaluated by means of an experimental design with comparable groups of patients assigned to experimental (cooperative care) or control (usual hospitalization) group status. Follow-up analyses of both groups of patients for a 12-month time period concluded that there were comparable and equally positive post-hospitalization experiences, with greater than 90% of both groups of patients functioning well with respect to a series of measures of functional status. There was no evidence that Cooperative Care patients were re-hospitalized more often or needed more emergency, home care or other types of services. There was, on the other hand, evidence of the positive effect on patient understanding, adherence to treatment, satisfaction, and self-management.

Creating an environment in which patient's responsibility for self is fostered and nurses can practice professional and autonomous nursing practice is a challenge in today's hospitals. Innovative systems and structures need to be developed to assure quality of patient care and a high quality work environment. Newark Beth Israel Medical Center responded to the many demands of the mid1980s, including increasing acuity of patients hospitalized, personnel shortages in nursing, physical therapy and other disciplines, and diminishing dollars available to the health care institution, through the creation of Self-Care Units. This article reviews how they came about, the way in which Self-Care Units function within the acute care setting and the management philosophy and structure which make them work. The experience at Newark Beth Israel Medical Center demonstrates that the potential exists to put control back at the bedside with the patient and the health care team working with the patient to achieve mutual goals. The focus of care has shifted from a “doing for” to a “working with” patients to identify interventions which promote active participation in hospitalization and a sense of self responsibility.

Competition among healthcare institutions, the need to improve outcomes, and the desire to decrease costs have motivated blood and marrow stem cell transplant centers to develop innovative care models. In an effort to meet these challenges, a major midwestern medical center adapted the transplant process to the outpatient setting. This transition created greater educational and care demands for patients and families. To address these demands and provide improved accommodations and amenities for patients and families, the center adopted an innovative model of care, Cooperative Care, for transplant recipients. Cooperative Care embraces patients and families as key members of the healthcare team. A family member serves as a primary caregiver for the patient during the acute inpatient phase of the transplant. Care becomes more personal and individualized, cost is reduced, the rate of rehospitalization potentially is decreased, and patients ultimately become more confident and competent in caring for themselves. The healthcare team shifted its care philosophy to incorporate a care partner, increase patient control and independence, and create greater emphasis on education. Outcomes, including patient satisfaction, have demonstrated success and motivated expansion of this model to other patient populations.

The DoH (1999) describes how it 'needs leaders who are motivated, self aware, socially skilled and able to work together with others across professional and organisational boundaries'. Self-medication incorporates all professional groups and divisions within Calderdale and Huddersfield NHS Trust; we work in partnership with the pharmacy departments. The main purpose of any organisation in the health and social sector is to ensure that a high quality service is delivered to service users (Martin 2001), so self-medication is now being given the attention it deserves. Assessment will be integral to every service user's stay and will continue throughout their stay, including transfer from secondary to primary care. It is expected that following its introduction, quality will improve; patients will receive their medication on time and it is anticipated that discharge delays will reduce. We acknowledge however that this will be difficult to demonstrate, as often medical conditions are cited as reasons for admission, not non-compliance with medication regimes. We see ourselves as being competent in the roles of change agents and our styles have changed throughout the process. We have worked together as equals and focused on one outcome. It will call on all our professional and educational skills to mould staff so that they are ready to embrace the change. Perhaps the lesson that has been learned so far is that, despite meticulous planning, the actions of others for whom we are not responsible can seriously disrupt the plan. The opportunity to manage change through experiential learning, reflection and the transfer of knowledge has been challenging while enhancing our personal growth and self-awareness. The project has been extended until March 2004 because of the merger and the associated increased workload. Becoming a project manager, leader and change agent has proved to be an exciting, interesting and challenging experience, although at times we felt isolated. The project has now entered a phase that involves intense staff training and phase one of introduction.

For patients to manage their medication regimens at home, adequate preparation is required prior to hospital discharge. Self-administered medication programs are a strategy for improving medication knowledge and regimen adherence. The purpose of this study was to evaluate the effectiveness of a self-administered cardiac medication program on patients knowledge of and adherence to their medication regimen. Patient and nurse satisfaction with the self-administered medication program were assessed. A comparison group, repeated measures design was used in which patients received nurse-administered medications (n = 172) or self-administered medications (n = 178). Data were collected at admission, discharge, and 2, 6, and 16 weeks post-discharge. Outcome variables were medication knowledge, medication adherence, and program satisfaction. Patients in the self-administered medication group had significantly higher medication knowledge scores over time compared to those in the nurse-administered medication group. There was no statistically significant difference between groups on medication adherence. The self-administered medication group reported significantly higher levels of satisfaction and had significantly fewer medication errors and medication-related problems compared to the nurse-administered medication group.

The purpose of this study was to determine the effect of a pediatric self-care book (SCB) with nurse telephone support on use of health services. The study was performed in a pediatric department of Kaiser Permanente in a suburb of Denver, Colorado. Well patients seen at age 2 weeks to 2.5 months (infant group) or 14 to 19 months (toddler group) were enrolled. Intervention families received a copy of the book, Your Child's Health and were oriented on its use. Rates of sick visits, advice nurse calls, pharmacy prescriptions, emergency department visits, and hospital admissions were assessed. Visit and call rates were calculated, and mean rates of the SCB group and the control group were then compared. Of 1,104 enrolles, 527 received the SCB; the other 577 served as controls. The SCB group had 14.0% fewer total visits (excluding well-baby visits) than controls did (p=0.018). For infants and toddlers who were not first-borns, the intervention was associated with a statistically significant decrease in sick visits (23%), advice nurse phone calls (24%), and pharmacy prescriptions (26%); no statistically significant differences in study outcomes were seen among firstborn study subjects. Promotion of self-care in a group model health maintenance organization can decrease use of services by families of young children.

On a recent trip to Hengelo, Holland, I discovered that nurses are functioning as hotel hostesses in a hospital experiment. With the decline in convalescence care, escalating inpatient hospital treatment and patient demands for a more flexible and dynamic healthcare service, this recent initiative in Holland could catch on in the UK.

This article describes how a nursing development unit (NDU), through the evolution of a self-care philosophy, responded to the changing needs and demands of patients. Patients in the NDU appeared to want to be more informed and involved in their health care. In addition, decreased length of stay as a result of increased sophistication of medical techniques and the need to have a faster throughput of patients has meant that a philosophy is required which is focused around empowering patients to take ownership for their own health care. The application of this philosophy is demonstrated through a case study which describes the experience of a gentleman who was cared for within the NDU.

1. Changing trends in health care reflect increasing involvement with clients and families in the development of treatment plans, such as self medication planning. 2. Acting as an advocate for the client, the nurse, in consultation with the client and the multidisciplinary team, developed a consumer-centered program, which allowed the client to master a complicated medication regime prior to discharge. 3. Discharge planning, follow-up, and evaluation of medication compliance, ensured continuity of care, successful outcomes, and reduced use of in-hospital health care dollars.

The expansion of a central renal unit's facilities by the establishment of a self-care satellite unit provided an opportunity for significant savings in travel time for patients. It was decided to offer self-care training to a number of older patients who might not otherwise have been considered for this modality. An effective training program was developed for these older patients, designed to meet their specific needs. They were able to learn at their own pace, thus reducing stress and the fear of failure.

Objectives. Occupational therapy literature describes various independent living programs developed by occupational therapists and at times documents their effectiveness, yet none of the literature reviewed examined the involvement of occupational therapists in independent living programs. Method. Directors of independent living programs in the United States were surveyed to ascertain their use of occupational therapists, to discover which disciplines were providing traditional occupational therapy services (e.g., daily living skills, assistive device provision, etc.) in these programs, and to identify which types of independent living programs were more likely to use occupational therapy services. Results. Less than half of the 96 responding independent living programs (46%) reported using occupational therapy services, and those programs that did provide occupational therapy services did so at a minimal rate. The programs that employed occupational therapists offered traditional occupational therapy services more often than those with no occupational therapists, but frequently, occupational therapists were not the providers of these traditional occupational therapy services. Chi-square analyses indicated that an independent living program’s use of occupational therapy services was significantly affected by the type of facility (p = 0.05), the primary funding source (p = 0.04), and the program’s practices regarding the hiring of professionals without disabilities (p = 0.04). Conclusion. Possible reasons why occupational therapists are not employed more by independent living centers are discussed and recommendations for change are provided.

One hundred patients (aged 48 to 89) with chronic obstructive pulmonary disease were allocated to receive either "personalized hospital practice" (PHP), which includes training in aspects of their disease, or standard hospital practice. Changes in "consumption" of health services per patient from one year before until one year after the intervention admission were evaluated in 82 (PHP group 42, controls 40). The increase in consumption of health services after intervention was on average kr 15.298 per patient per year less in the PHP group than in the control group (p = 0.048). Consumption of general practitioner services was significantly increased in the control group compared with the PHP group (mean 95% confidence limits) kr 1346 (549-2143) versus -89 (-423-245) per patient per year, p = 0.001). PHP reduces the consumption of health services by patients with chronic obstructive pulmonary disease, probably by increasing patients knowledge of disease and their ability to manage themselves.

Parental involvement in their child's care in hospital has undergone great change over the last century. Studies have shown how ‘maternal deprivation’ and ‘separation anxiety’ expressed by children are detrimental to a child's recovery in hospital. Striving efforts have been made to develop family-centred care, promote normality of the family unit and continue with the normal routine of the child's life within the limitations of a hospital environment and the child's illness. Expectations of the parental role in hospital need to be identified and expressed from both the parents and staff to establish an understanding that will ultimately be best for the child. Many studies have highlighted benefits to both parent and child from parental participation in hospital. However, disadvantages have been identified from resident parents who feel captive to their new situation and role. Efforts for family-centred care are highly advocated now. Care-by-Parent units have been set up in some areas to promote this idea and, although many advantages have been identified, they are not without their problems. The success of parental involvement is dependent on both parents’ and staff's attitudes, enthusiasm and willingness to work together.

The CCM has been in development for more than 3 years and in operation for more than 2 years. According to Peters, "Developing a vision is a messy, artistic process. Living it convincingly is a passionate one beyond any doubt." This statement expresses our personal experience in development of the CCM in terms of time, effort, hurdles, growth, and satisfaction. An environment has been created that strengthens the nurse's role as clinical educator, advocate, and coordinator. Capable patients and families on pilot units express satisfaction because they have learned to participate actively in their care during hospitalization, to better understand their disease, and to better manage their care at home. The time saved for nurses allows them to be engaged in activities of health promotion and education, deliver selected aspects of care, and consult with other team members on issues of problematic patient management. In this environment, professional nursing practice has been enhanced and nurses are influencing positive patient outcomes. In addition, our nurse recruiter reports that it is easier to recruit nurses for CCM pilot units than for nonpilot units with similar patient populations. This project has tapped an often underused resource, the patient's self-care ability, and created an environment that benefits not only the care recipients but also the caregivers.

This paper describes the introduction of a self-medication programme for elderly in-patients using action research. The programme was initiated by a steering group which met regularly to implement and monitor self-medication. Ward staff were interviewed to assess their learning needs before the start, meetings were held as the project advanced, and a final staff evaluation questionnaire was administered. Patients' opinions were also monitored. Self-medication was successfully introduced and minor problems were rapidly solved by participating staff. Patients were highly satisfied with the new independence and self-esteem they had gained through taking their own medications. Nurses shared these feelings, but also felt that self-medication was more time consuming than previous drug rounds. Suggestions for further research and development are given.