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The Transitional Care Model provides the opportunity for nurses to ensure that patients, especially older adults, are communicated with and taken care of during the transition phase. However, the transition can have a different impact on patients. Laugaland, Aase, and Barach (2012) point out that while some of the reviews they examined are uncertain about the effectiveness of discharge arrangements in elderly patients, others stress that they were effective in patients with heart failure (namely, comprehensive discharge planning and other interventions). Moreover, if an advanced practice registered nurse was a manager of care or a discharge coordinator, communication between the patient and the caregiver also improved, along with their satisfaction (Laugaland et al., 2012). Rennke et al. (2013) argue that a pharmacist-led intervention can reduce the number of readmissions linked to problems with medication. If discharge medication counseling was provided, there was a reduction in adverse drug events as well (Rennke et al., 2013).
Nevertheless, Hesselink et al. (2012) point out that a single intervention was not proven to be effective. Watkins, Hall, and Kring (2012) discuss the difference of intervention programs and how different programs have different aims, depending on the patients diagnosis, the type of care they need, and the type of transition they experience. However, each of the programs showed a decrease in 30-day readmission rates (Watkins et al., 2012). The authors also point out that fragile elderly patients often need additional services that transition programs do not provide or do not focus on, such as light housekeeping and meal preparation (Watkins et al., 2012). Another study provides information about elderly patients who had an acute stroke or myocardial infarction; the authors point out that physician-led and nurse-led interventions had a positive impact on patients mental health and physical activity (Bettger et al., 2012). The authors of the study also stressed that hospital-initiated interventions can improve some outcomes (Bettger et al., 2012, p. 412).
Methodology and Design of the Study
The study design was a questionnaire provided to nurses who care for patients with cardiologic problems in several local hospitals and clinics.
The local hospitals were chosen randomly as this approach could provide some interesting insights into the strategies that hospitals and clinics implement in the transition of patients with heart-related conditions. The random choice was also preferred because a study conducted in one hospital could provide one-sided results.
At first, contact with the administration of the medical facility was made. After the author had received admission to conduct the study, nurses who fit the inclusion criteria (nurses who work with patients with heart-related conditions that had to experience transition recently) were contacted. Those nurses who agreed to take part in the study provided written consent. Non-responders were asked to explain their decision if possible: most of the non-responders claimed that the lack of time was the main reason why they were not able to take part in the research.
At first, a pilot questionnaire was used. The questionnaire-based on the studies, including those reviewed above, and provided questions about transition strategies that could positively or negatively influence elderly patients who had a heart-related condition. The participants were asked to complete the questionnaire; the questionnaire was anonymous and did not contain any data about the participant who completed it.
Only 86 out of 100 participants completed and returned the questionnaire; after the answers had been received, the main version of the questionnaire was developed. The main questionnaire included additional, more detailed questions and an improved version of possible answers (instead of simplified answers yes/no , the questionnaire allowed to grade an answer using numbers from one (no) to five (yes). Moreover, the questionnaire also included two open questions about transitional care strategies and their advantages and disadvantages. This time, 90 out of 100 participants completed and returned the questionnaire to the author.
It seems reasonable to stress that a qualitative study that relies on a questionnaire can be seen as biased. That is why Bettger et al. (2012) stress the importance of reviewers for any study; when reviewers are engaged to review the study, there is a chance that they will detect possible bias or mistakes that the author did not notice. What is more, reviewers enhance the credibility of the study and its results.
In this study, a reviewer from a hospital that did not take part in the study was invited to ensure that the amount of possible bias was reduced. The reviewer did not take part in the study, did not communicate with the participants, and had a long-term experience in conducting questionnaire surveys.
Sampling Methodology
The sampling methodology of participants was based on the random sampling of the medical facilities. After the random sampling, nurses that worked in the chosen medical facilities were sampled from the hospitals databases; only those nurses who worked with patients with heart-related conditions and who took part in transitional care were included in the sample of the study. Therefore, the sampling methodology was not randomized but rather stratified sampling that included several strata (nurses from different hospitals or clinics). The sample size consisted of 100 participants; the majority of the sample was female (72%), 22% of the participants worked less than one year in a medical facility, 38% of the participants were introduced to transitional care strategies two years ago or earlier.
Although the sample size was relatively small, it allowed the researcher to understand what strategies nurses found efficient and whatnot, and how transitional care influenced patients with heart-related conditions. However, the responses given by the participants cannot be seen as representative of the state of transitional care of patients with heart-related conditions in the USA because of possible bias. Moreover, the study was conducted in one city only; other cities or remote areas can provide different results.
Necessary Tools
In this study, a subpopulation questionnaire was used. The questionnaire was printed on paper and given to the respondents to complete. Usually, if questionnaires are used, they can be conducted in several forms: postal questionnaires that are sent to participants, phone questionnaires that include a Q&A session with participants, paper-and-pencil questionnaires (used in this study), and face-to-face questionnaires (the instructor asks the questions and completes the questionnaire).
The tools needed for this study were computer-printed questionnaires (2 copies for each of the participants) and a database with potential participants (employees at the hospitals and clinics selected for this study). It should be noted, however, that questionnaires developed for any study need to be easy to comprehend and need to avoid complex skip patterns (Johnson, 2014, p. 30). It is also advisable to provide a pilot questionnaire to the participants to understand what improvements can be made.
References
Bettger, J. P., Alexander, K. P., Dolor, R. J., Olson, D. M., Kendrick, A. S., Wing, L., & Duncan, P. W. (2012). Transitional care after hospitalization for acute stroke or myocardial infarction: A systematic review. Annals of Internal Medicine, 157(6), 407-416.
Hesselink, G., Schoonhoven, L., Barach, P., Spijker, A., Gademan, P., Kalkman, C., & Wollersheim, H. (2012). Improving patient handovers from hospital to primary care: A systematic review. Annals of Internal Medicine, 157(6), 417-428.
Johnson, T. P. (2014). Handbook of health survey methods. New York, NY: John Wiley & Sons.
Laugaland, K., Aase, K., & Barach, P. (2012). Interventions to improve patient safety in transitional carea review of the evidence. Work, 41(1), 2915-2924.
Rennke, S., Nguyen, O. K., Shoeb, M. H., Magan, Y., Wachter, R. M., & Ranji, S. R. (2013). Hospital-initiated transitional care interventions as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5), 433-440.
Watkins, L., Hall, C., & Kring, D. (2012). Hospital to home: A transition program for frail older adults. Professional Case Management, 17(3), 117-123.
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