Search PubMed⌕ Search

Biomedical subjects

M D Naylor

Publications and source records attributed to M D Naylor.

At least 19 recordsLinked to original sources
PubMed2000

A decade of transitional care research with vulnerable elders.

This article describes the contributions to knowledge development and clinical practice during the past decade resulting from testing and refining a transitional care model with hospitalized elders by a multidisciplinary research team. A major goal of this research program has been to improve the postdischarge outcomes of older adults admitted to hospitals for an acute exacerbation of a chronic cardiovascular illness. In addition to demonstrating positive outcomes for elders while reducing costs, findings from the testing of the transitional care model have advanced knowledge of important patient and caregiver issues including the effects of the model of elders with medical versus surgical conditions, the profile of elders at risk for poor outcomes, predictors of caregiver burden, the unique needs of elders and the contributions of advanced practice nurses in meeting these needs, and decision making regarding home care referrals.

Aged↗
PubMed2000

Factors associated with referral of elderly individuals with cardiac and pulmonary disorders for home care services following hospital discharge.

Referrals for home care services initiated prior to hospital discharge may prevent or delay readmission or nursing home placement, especially for elderly individuals with multiple, chronic health problems. While multiple factors could justify the need for home follow-up after hospital discharge, little is known about those patient factors associated with clinicians' decisions to refer older adults with cardiac or pulmonary disorders. Increased understanding of factors that contribute to initiating a home care referral could enhance clinicians' decision-making and thus improve post-discharge outcomes for these patient groups. This study examined patient factors associated with and predictive of the decision to refer for home follow-up, using a sample of older adults hospitalized with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Study findings suggest a model that includes patients diagnosed with both COPD and CHF, who are not married, need home health aides, and have a longer than average length of hospital stay may be helpful in predicting the need for home care referrals.

Aftercare↗
PubMed1999

Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.

CONTEXT: Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients, but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied. OBJECTIVE: To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions. DESIGN: Randomized clinical trial with follow-up at 2, 6, 12, and 24 weeks after index hospital discharge. SETTING: Two urban, academically affiliated hospitals in Philadelphia, Pa. PARTICIPANTS: Eligible patients were 65 years or older, hospitalized between August 1992 and March 1996, and had 1 of several medical and surgical reasons for admission. INTERVENTION: Intervention group patients received a comprehensive discharge planning and home follow-up protocol designed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses. MAIN OUTCOME MEASURES: Readmissions, time to first readmission, acute care visits after discharge, costs, functional status, depression, and patient satisfaction. RESULTS: A total of 363 patients (186 in the control group and 177 in the intervention group) were enrolled in the study; 70% of intervention and 74% of control subjects completed the trial. Mean age of sample was 75 years; 50% were men and 45% were black. By week 24 after the index hospital discharge, control group patients were more likely than intervention group patients to be readmitted at least once (37.1 % vs 20.3 %; P<.001). Fewer intervention group patients had multiple readmissions (6.2% vs 14.5%; P = .01) and the intervention group had fewer hospital days per patient (1.53 vs 4.09 days; P<.001). Time to first readmission was increased in the intervention group (P<.001). At 24 weeks after discharge, total Medicare reimbursements for health services were about $1.2 million in the control group vs about $0.6 million in the intervention group (P<.001). There were no significant group differences in post-discharge acute care visits, functional status, depression, or patient satisfaction. CONCLUSIONS: An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions, lengthened the time between discharge and readmission, and decreased the costs of providing health care. Thus, the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs.

Aged↗
PubMed1999

The effects of a discharge planning and home follow-up intervention on elders hospitalized with common medical and surgical cardiac conditions.

This study was a secondary analysis of data collected on 202 patients hospitalized with common medical or surgical cardiac conditions who completed a 24-week postdischarge follow-up program as part of a large-scale randomized clinical trial. Subjects were age 65 years or older, admitted from their homes with one of the following diagnosis-related groups: heart failure, angina, myocardial infarction, coronary artery bypass graft surgery, or cardiac valve replacement. The intervention consisted of comprehensive discharge planning and home follow-up by an advanced practice nurse (APN) for 4 weeks after discharge. Control subjects received usual care. Findings indicated that medical patients in the intervention group had fewer multiple readmissions during the 24 weeks of follow-up and a reduced total number of days of rehospitalization. There were fewer hospital readmissions in the surgical group when measured from discharge to 6 weeks. There were no differences in functional status between intervention and control groups for either population. The findings of this study suggest that high-risk elders with significant cardiac problems may benefit from a care program that emphasizes collaborative, coordinated discharge planning and home follow-up that includes telephone and home visits by APNs.

Aged↗
PubMed1999

Breaking through the hegemony of homogeneity: revitalizing curriculum and students.

Undergraduate programs provide fertile ground from which future practitioners, researchers, and teachers of psychiatric mental health nursing will emerge. Health care has changed dramatically, offering opportunities for new and innovative roles and prompting faculty to develop novel ways of thinking about the future role of psychiatric nurses. Nursing faculty are challenged to devise new and creative approaches to teaching psychiatric nursing at the undergraduate level in ways that will instill enthusiasm for the field. In this article, the efforts of the University of Pennsylvania to approach psychiatric mental health courses in new ways will be described. These innovations are designed to stimulate passion for what the authors see as a complex and exciting field that requires revitalization.

Career Choice↗
PubMed1998

Discharge planning and home follow-up of the elderly patient with heart failure.

Older adults with heart failure have extensive and complex care needs. This article presents a framework for assessment and intervention with this fragile patient group. Comprehensive assessment of elders with heart failure includes gathering information about care, advocacy, and knowledge needs. Nursing interventions are focused on providing direct care, counseling, teaching, and advocacy. The unique role of the advanced practice nurse in discharge planning and home follow-up of elders with heart failure is emphasized.

Aged↗
PubMed1997

Factors contributing to rehospitalization of elderly patients with heart failure.

This article describes factors contributing to rehospitalizations of elderly patients with heart failure. Advanced practice nurses' logs, study questionnaires, and medical record summaries from a recent clinical trial provided rich, descriptive information about a variety of social and behavioral factors surrounding rehospitalization in these medically fragile older people. Medication and dietary nonadherence were factors affecting symptom appearance and rehospitalization. Social and behavioral factors, such as the absence of strong social support or motivation, contributed to nonadherence. These results suggest that social and behavioral factors must be identified and addressed in an individualized manner to prevent recurrent hospitalizations for elderly patients with heart failure.

Aged↗
PubMed1996

Nursing intervention classification systems.

PURPOSE: To analyze the features, development, and research of the Omaha System, the Iowa Nursing Intervention Classification, and the Home Health Care Classification and provide a critical review of the unique components of each. ORGANIZING FRAMEWORK: Five elements: achievement of original purpose, language used, ease of computerizing format, clinical utility, and linkage of the Nursing Minimum Data set (NMDS) nursing care elements. CONCLUSIONS: Further testing and development of nursing classification systems should be done to determine the general value of nursing classification, the extent to which the original goals and purposes of classification are met, and to identify the unique features and contributions of each system. Further testing is important to determine the strengths, weaknesses, and applicability of the various systems for capturing the elements of the NMDS for different care settings, care givers, and patient populations. IMPLICATIONS: Nursing classification may eventually lead to naming and describing the work of nurses. Research findings will continue to provide information leading to a unified nursing language system that describes the practice of nursing in local, regional, national, and international health-care data sets used for research, clinical, education, policy, and administrative purposes.

Community Health Nursing↗
PubMed1995

Nurses' effect on changing patient outcomes.

Emphasis on examining provider effects and resulting patient outcomes has grown considerably in the past several decades. This paper highlights the effect of nurses on changing patient outcomes. The most important issues raised include the types of patient outcomes that should be measured; the amount and type of nursing (or "nurse dose") needed to effect patient outcomes; the nurse dose needed in a given health care environment to demonstrate an effect; and the nurse dose needed for effects with differing patient groups.

Humans↗
PubMed1993

The roles and functions of clinical nurse specialists.

This paper examines the research conducted on the role and function of Clinical Nurse Specialists (CNS). Four research themes have evolved over the past few decades: perceptions of the role; CNS' time allocation; effects of CNS on patient and family outcomes and cost of care; and, the actual functions of CNS. The authors identify areas for future research to demonstrate the differences that CNS make in health outcomes.

Attitude to Health↗
PubMed1991

Content analysis of pre- and post- discharge topics taught to hospitalized elderly by gerontological clinical nurse specialists.

THE PURPOSE OF this study was to analyze the content of topics taught to hospitalized elderly during hospitalization and after discharge by gerontological clinical nurse specialists (CNSs). Content analysis of the topics taught by two CNSs for 20 elderly subjects resulted in the identification of four major categories of patient information needs: management of the health problem that resulted in the current admission, need for and availability of post-discharge health and other support services, preparation for and care after diagnostic or surgical procedures, and health promotion and prevention of future health problems.

Aged↗
PubMed1991

Measuring the effectiveness of nursing practice.

This article examines the importance of outcomes as indicators of quality of care. The appropriateness of selected traditional and emerging outcomes in measuring the effectiveness of nursing interventions is addressed.

Activities of Daily Living↗
PubMed1990

Comprehensive discharge planning for the elderly.

Discharge planning for the elderly can potentially reduce patient length of hospital stay, prevent rehospitalization, enhance patient outcomes and lessen the burden of care on the families. While increased numbers of elderly are being discharged earlier, there are few data on the process and effects of discharge planning protocols developed specifically for this population. The proposed study will attempt to answer the following questions regarding hospitalized elderly with selected DRG classifications: Are there significant differences between elderly patients who receive the hospital's general discharge planning procedure used for all categories of patients and elderly who receive the hospital's general discharge planning procedure plus a comprehensive discharge planning protocol specific to the elderly and implemented by a gerontological nurse specialist in: (1) Patient Outcomes (length of initial hospitalization; post-discharge morbidity; post-discharge health services; functional status; mental status; satisfaction with care; self-esteem; patient's perception of health status; and stress level); (2) Family Related Outcomes (primary care giver's functional status; mental status; care giving demands; stress level and family functioning); (3) Cost of Care Outcomes (charges for initial hospitalization, rehospitalizations, post-discharge health services; family related costs; and gerontological nurse specialist costs). The study design is a randomized clinical trial with a total of 280 elderly (2 groups of 140). The control group will receive routine discharge planning; the treatment group will receive routine discharge planning plus an elder-specific comprehensive discharge planning protocol. Data analysis will include frequency distributions and summary statistics. For each of the research questions, multivariate analysis of variance or chi-square statistics will be used.

Aged↗
PubMedDate not supplied

Creating a curriculum for the 21st century.

The curriculum that was described in this article reflects our school's broad and bold definition of what constitutes knowledge in nursing. It also represents the faculty's dedication to a creative approach to education and practice, as well as a commitment to change in an age of change. It portrays a desire to design education that would develop the full range of human potential, the full potential of the university, and incorporate the full range of approaches to human problems. Our current changing practice environment underscores the challenges and complexities facing faculties and student nurses in pursuit of relevant and useful theoretic and clinical content. In addition, those of us who have practiced in the psychiatric field know that the care of clients with psychiatric problems requires heterogeneous approaches to treatment that vary with respect to type, frequency, severity, and chronicity of their conditions. We know that the impact of certain conditions is linked to age and developmental status, and we know that the effects of deviations from health are mediated by numerous features of ecology, including poverty, job and family instability, parental stress, social isolation, and community violence. As a result, nursing interventions and their outcomes no longer can be viewed in terms of simple cause and effect relationships; nor can they be thought of as occurring in the familiar settings of hospitals or institutions. For better or worse, those facilities have closed. This reality and the enormous complexities of human science speak to the multidimensional factors involved in the construction of new and different models of teaching and learning within a comprehensive conceptual framework to guide both learning and practice.

Curriculum↗