Prevention of Catheter Associated Urinary Tract Infections

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Abstract

CAUTIs is the second most common hospital-acquired infection (HAI). Identifying barriers to implementation of CAUTI prevention programs and evaluating the effectiveness will help decrease CAUTI rates. The purpose of this review is to appraise two studies, one qualitative and one quantitative regard to Catheter-Associated Urinary Tract Infections (CAUTIs). The qualitative study was found on the Journal Medical Association (JAMA) search engine. The quantitative study was found on the EBSCO host engine under Rutgers University libraries. Both studies were peer-reviewed and current within five years of 2018, in English, full text, creditable publishers. The quality of evidence met the criteria of the level of evidence pyramid. Minimal studies existed in the literature for CAUTI, which can cause studies to produce insignificant results. However, identifying key barriers to adherence of programs designed to help decrease the occurrence of CAUTI initiated possible solutions to the barriers determined from the qualitative study. Establishing standard CAUTI programs and assigning a leader to monitor is crucial in order to reduce the rate of CAUTIs. Health-care providers (HCPs) following guidelines, documentation, efficient communication with physicians, and educating nursing staff on updated evidenced-based practices will reduce the occurrence of such infections.


Keywords:

CAUTI, CCU patients, reduction, prevention, prevention bundles


Introduction

Urinary Tract Infections (UTIs) are common and potentially lethal infections that are responsible for millions of healthcare visits each year. UTIs account for approximately 40 percent of all hospital-acquired infections annually, with fully 80 percent of these hospital-acquired urinary tract infections attributable to indwelling urethral catheters, CAUTIs (Institute for Healthcare Improvement, 2018). CAUTIs are costly, adding $500-$1000 to the direct care cost of acute-care hospitalization and dangerous causing high institutionalized death rates (Safe Campaign, 2018). In 2008, there were major changes in Medicare policies for CAUTIs to not be reimbursed, forcing healthcare professionals (HCPs) to adhere to a strict protocol for catheter indication. With CAUTI being the second most common nosocomial infection, it is important to identify barriers when implementing CAUTI prevention programs and to evaluate effective current CAUTI prevention programs.


Background

Evidenced-based research has shown that patients with indwelling catheters have a higher risk of developing CAUTI per day of indwelling time. Therefore, catheter indication should only be used when patients are unable to drain their bladders. Queens University School of Medicine, (n.d.). states indications for short-term and long-term indwelling catheterization. For short-term indwelling catheterization:

  • Post-surgery and in critically ill patients to monitor urinary output.
  • Prevention of urethral obstruction from blood clots with continuous or intermittent bladder irrigations.
  • Instillation of medication into the bladder.
  • Surgical procedures involving pelvic or abdominal surgery repair of bladder, urethra, and surrounding areas.
  • Urinary obstruction (e.g. enlarged prostate), acute urinary retention.

For long-term indwelling catheterization:

  • Refractory bladder outlet obstruction and neurogenic bladder with urinary retention.
  • Prolonged and chronic urinary retention.
  • To promote healing of perineal ulcers where urine may cause further skin breakdown.

For the issue of CAUTI, there are gaps that exist such as a lack of research on standard CAUTI protocol, limited CAUTI prevention programs, limited data to measure necessary/unnecessary catheter use, and HCPs different perspective about the level of importance on CAUTI.


Methods

The article, “Barriers to Reducing Catheter Use” was found on the Journal of the American Medical Association (JAMA) search engine. JAMA is a peer-reviewed medical journal. The article, “A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections” was found on the EBSCO host search engine under Rutgers University libraries. Both article’s search criteria were within five years of 2018, must be in English, full text, credible publishers, reduction, nursing intervention, nursing strategies, etc. For the article, “Barriers to Reducing Catheter Use” the inclusion criteria were hospitals that did and did not use various practices to prevent CAUTI, hospital size, medical school affiliation, collection data to measure necessary/unnecessary catheter use, and type of unit that implemented Bladder Bundle (intensive care units, medical/surgical floors, or entire hospitals) (Forman, Harrod, Kowalski, Krien & Saint, 2013). For the article, “A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections” the inclusion criteria were patients from critical care unit (CCU), patients were over 18 years old, those who had indwelling catheters, those who had been admitted without an UTI but developed an UTI after two calendar days, and patient without suprapubic catheters or intermittent catheterizations (Blanck, Brentlinger, Donahue, Stinger & Polito, 2014).


Analysis

The article “Barriers to Reducing Catheter Use” purpose is to use qualitative assessment to examine the key challenges to implementing the Bladder Bundle program from the perspective of participating hospitals (Forman et al., 2013, p. 882). Qualitative research concepts include the ideas, experiences, situations or events (Burns, Gray & Grove, 2015, p.156). For this qualitative study, the concept was to understand the experience of hospitals implementing the Bladder Bundle program (Forman et al., 2013, p. 885). This study would be considered as a Phenomenological design. The researchers wanted to gain a more holistic understanding of implementation at each site and to test or further explore issues identified by the telephone interviews (Forman et al., 2013, p. 882). There were 18 semi-structured telephone interviews and 24 onsite interviews. The information was digitally recorded and lasted 30-60 minutes. Both telephone and onsite interviews were transcribed and analyzed into extensive summaries for each of the research team members to recognize and determine preliminary themes.

The methods that were used to recruit participants were surveys sent to infection preventionists. At the time of the study survey, 54 of the 103 responding hospitals in the state of Michigan were implementing the Bladder Bundle and served as the sampling frame for the qualitative phases of the study (Forman et al., 2013, p. 882). Forman et al. (2013) presented their Sample in Table 2 (Selected Characteristics of Bladder Bundle Implementation) and discussed it throughout the narrative of the article. The Sample “Primary champion” and “Team Participants” had the same characteristics (Infection control, Nurse or preventionist, Nurse manager, Quality manager, Hospital epidemiologist, Infectious diseases physicians, and None). The “Implementation” (On the floor only, in an intensive care unit, or hospital-wide) referred to where the Bladder Bundle program was put into effect.

The outcomes of the study were sufficient. Researchers were able to identify key barriers with the Bladder Bundle implementation (1) difficulty with nurse and physician engagement, (2) patient and family request for indwelling catheters, and (3) the role of the emergency department (ED) in catheter insertion (Forman et al., 2013, p. 883). Along with key barriers identified from interviews, participants in the study suggested potential solutions to help decrease CAUTI. Some of the findings were unexpected such as patient or family requests with catheter use and indication in the ED. Forman et al. (2013) suggest patient/family education is needed to understand the risks and complications. From their analysis, Forman et al. (2013) stated that hospitals identified the need for strategies in targeting catheter insertion in the ED.

The article, “A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections” purpose was to test the use of a bundled approach of catheter care practices for a 3-month period to reduce the occurrence of CAUTIs in adult critical care patients who had indwelling urinary catheters (Blanck et al., 2014, p. 101). The key concepts were clearly defined. The main design for this study was to reduce the incidence of CAUTI in CCU patients within a three-month period. The methods of data collection, sampling, and calculations were identified clearly throughout the article. The study was a Quasi-Experimental study design in a quantitative research approach.

The Quasi-experimental design was to identify a cause-effect relationship between two or more variables where the researcher didn’t assign groups or manipulated the independent variable, and the control groups were identified and exposed to the variable (Quantitative Approaches, 2012). The results were then compared. This study had two groups: pre-intervention group and intervention group. There were 317 participants in the pre-intervention group, and 310 in the intervention group. The Sample size was based on the number of catheter days for all the patients combined and the correspond CAUTI incidence rate (Blanck et al., 2014, p. 105). The outcome was not statistically significant, with p = .285, but it was clinically significant (Blanck et al., 2014, p. 106). There was a 50 % reduction rate as it was shown in Table 2 (CAUTI incidence rates during pre and post-intervention).

Both studies have similarities with the samples of the ICU patients. Forman et al. and Blanck et al. also mentioned bundle programs were used to conduct their studies. In addition to bundle programs, both groups of researchers mentioned the need for a leadership position. The role of a leader is important because he/she will be the driving force behind implementing CAUTI prevention programs.

Forman et al. and Blanck et al. both had strengths in their studies. Forman et al. strength was using Bladder Bundle, a successful program that resulted in a reduction of 30% in urinary catheter use and is currently serving as a model nationwide (Forman et al., 2013, p. 882). Forman et al. also addressed the issue of perceptions/misperceptions of safety measures. For example, some HCPs viewed urinary catheters to prevent falls, others saw catheters as a potential fall hazard (Forman et al., 2013, p. 885). Forman et.al included HCPs as participants who had experience with CAUTI. Forman et al. findings were also linked to quotes and addressed differences in findings by sample characteristics. In Blanck et al. article, there was only one study. However, one of the strong points in this study was the process of their data collection method. It was closely monitored. For example, to ensure that catheter care was provided, there would be designated person to make sure that the disposable wipes were placed in the same spot each room and can be easily seen. The researchers also used many reliable tools in their study. For example, the Wilcoxon signed rank test was used to compare CAUTI rates and used of NHSN formula to calculate the incidence rate for CAUTIs (Blanck et al., 2014, p. 105). NHSN formula is the number of new CAUTIs divided by the total number of catheter days multiplied by 1000 (Blanck et al., 2014).

Both groups of research presented strong points, but there were also a few weaknesses in their studies. In Forman et al. (2013) study, the researchers mentioned limitations in their study. Researchers mentioned their findings addressed barriers within local settings and can only be applied outside the study sample if the reader recognizes the phenomenon described (Forman et al., 2013, p. 886). Potential bias with HCPs perspective about Bladder Bundle initiative was also mentioned as a limitation (Forman et al., 2013, p. 886). In Blanck et al. (2014) study, there was one weakness that all patients were in CCU, so the population was limited. Also, patient’ condition was not clearly specified, such as their cognitive status, ethnicity, literature level. One inconsistent factor in this study was the chlorhexidine wipes. It was mentioned in the article that chlorhexidine wipes were only used in the late stage of the study, so it may or may not have an impact on reducing the infection rate.


Results

Based on our analysis, Forman et al. qualitative study presented with strong and convincing evidence. The Bladder Bundle program serves as a model for reducing CAUTI and is considered by Forman et al as the foundation for quality improvement. Forman et al. (2014) stated their qualitative findings especially the solutions identified to overcome key barriers-can be used to enhance CAUTI prevention-related activities worldwide (Forman et al., 2013, p. 886). The article by Blanck et al. did not have strong and convincing evidence regarding our topic. Due to previously mentioned limiting factors such as patient population and use of chlorhexidine wipes, the study would not be reliable. In addition, it was mentioned in the article that for ethical reasons, standard catheter care could not be withheld from CCU patients, thus eliminating the possibility of a true control group for this study (Blanck et al., 2014, p. 106). The study was too inconsistent to be applied to all of the patient population.


Discussion

There are not many studies exist in the literature that supports specific nursing care to prevent the occurrence of CAUTIs for patients with an indwelling catheter (Blanck et al., 2014, p. 107). Even though the research by Blanck et al. was only limited to CCU setting, it was evidenced that reducing the rate of CAUTI is achievable through the effort of health care providers. The CAUTI prevention that was mentioned in Blanck et al. research provided standardize care for patients with an indwelling urinary catheter. The initiative to have every healthcare team member and a primary champion on all units are needed for CAUTI prevention. The issue of CAUTI needs to be treated with a high level of importance from all HCPs. The next step for nursing regarding the prevention of CAUTI should not only include the adherence to current guidelines, but to meticulously document data pertaining to catheters, reminding physicians of the catheter and discussing potential removal, and to actively seek new and updated evidence-based practices regarding the care of catheters and prevention of CAUTI.


References

Are hospice and home-health nursing a part of population-centered nursing?

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Are hospice and home-health nursing a part of population-centered nursing?

Many nurses believe that hospice and home-health nursing are focused on the individual and it therefore should not be considered a part of population-centered nursing. Other nurses argue that hospice and home-health nursing both focus on the family, take place in the community, and should be considered a part of population-centered nursing. Are hospice and home-health nursing focused on the individual, family, or community or on all three? Are hospice and home-health nursing a part of population-centered nursing? Why or why not? Explain how these nurses provide leadership in care coordination in the community.
Topic 2: Advanced Practice Nurses
Referring to the text and the ANA’s Advanced Practice Nurses page (https://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses.aspx), describe the educational requirements for population-focused advanced practice nurses, and identify five stressors that may affect nurses in expanded roles.
topic 2. The chapter reference is
Stanhope, M., & Lancaster, J. (2012). Public health nursing: Population-centered health care in the community (8th ed.). Maryland Heights, MO: Elsevier
• American Nurses Association. (2012). Advanced practice nurses. Retrieved from https://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses.aspx
• Home Healthcare Nurses Association. (n.d.). Retrieved from https://www.hhna.org/
• Hospice Foundation of America. (2012). Retrieved from https://www.hospicefoundation.org/

PICOT Statement Paper Discussion

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PICOT Statement Paper Discussion

PICOT Statement Paper Discussion

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the time frame needed to implement the change process.

Formulate a PICOT statement.  (CHILDWOOD OBESITY). The PICOT statement will provide a framework for your capstone project.

In a paper of 750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

Evidence-Based Solution

Nursing Intervention

Patient Care

Health Care Agency

Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the time frame needed to implement the change process.

Formulate a PICOT statement.  (CHILDWOOD OBESITY). The PICOT statement will provide a framework for your capstone project.

In a paper of 750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

Evidence-Based Solution

Nursing Intervention

Patient Care

Health Care Agency

Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style.

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Describe the importance of knowing the specific laws in your state pertaining to Nurse Practitioners prescribing medications

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Describe the importance of knowing the specific laws in your state pertaining to Nurse Practitioners prescribing medications

Tell the class what your state laws are related to nurse practitioner prescribing.
Include how many continuing education hours are required for your state.
Describe the importance of knowing the specific laws in your state pertaining to Nurse Practitioners prescribing medications.

Leadership. In Nursing Discussion Minimum 250 And.3 References For Part 1- Minimum 150 Words And 2 References For Part 2 And Part 3

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Part 1: 

Confronting Sexual Harassment

You are a new female employee at Valley Medical Center’s intensive care unit and love your job. Although only 25 years old, you have been a nurse for 4 years, and the last 2 years were spent in a small critical care unit in a rural hospital. You work the 3:00 PM to 11:00 PM shift. Ever since you came to work there, one of the male physicians, Dr. Long, has been especially attentive to you. At first, you were flattered, but more recently, you have become uncomfortable around him. He sometimes touches you and seems to be flirting with you. You have no romantic interest in him and know that he is married. Last night, he asked you to meet him for an after-work drink and you refused. He is a very powerful man in the unit, and you do not want to alienate him, but you are becoming increasingly troubled by his behavior.

Today, you went to your shift charge nurse and explained how you felt. In response, the nurse said, “Oh, he likes to flirt with all the new staff, but he’s perfectly harmless.” These comments did not make you feel better. At approximately 7:00 PM, Dr. Long came to the unit and cornered you again in a comatose patient’s room and asked you out. You said no again, and you are feeling more anxious because of his behavior.

ASSIGNMENT:

Outline an appropriate course of action. What options can you identify? What is your responsibility? What are the driving and restraining forces for action? What support systems for action can you identify? What responsibility does the organization have? Be creative and think beyond the obvious. Be able to support your decisions.

Part 2:

LEARNING EXERCISE  18.7

A Chief Nursing Officer’s Dilemma

You are the chief nursing officer of County Hospital. Dr. Martin Jones, a cardiologist, has approached you about having an intensive care unit/critical care unit (ICU/CCU) nurse make rounds with him each morning on all of the patients in the hospital with a cardiac-related diagnosis. He believes that this will probably represent a 90-minute commitment of nursing time daily. He is vague about the nurse’s exact role or purpose, but you believe that there is great potential for better and more consistent patient education and care planning.

Audrey, one of your finest ICU/CCU nurses, agrees to assist Dr. Jones. She has always wanted to have an expanded teaching role. However, for various reasons, she has been unable to relocate to a larger city where there are more opportunities for teaching. You warn Audrey that it might be some time before this role develops into an autonomous position, but she is eager to assist Dr. Jones. The other ICU/CCU staff agree to cover Audrey’s patients while she is gone, although it is obviously an extension of an already full patient load.

After 3 weeks of making rounds with Dr. Jones, Audrey comes to your office. She tearfully reports that rounds frequently take 2 to 3 hours and that making rounds with Dr. Jones amounts to little more than “picking up his pages and being a personal handmaiden.” She has assertively stated her feelings to him and has attempted to demonstrate to Dr. Jones how their allegiance could result in improved patient care. She states that she has not been allowed any input into patient decisions and is frequently reminded of “her position” and his ability to have her removed from her job if she does not like being told what to do. She is demoralized and demotivated. In addition, she believes that her peers resent having to cover her workload because it is obvious that her role is superficial at best.

You ask Audrey if she wants you to assign another nurse to work with Dr. Jones, and she says that she would really like to make it work but does not know what action to take that would improve the situation.

You call Dr. Jones, and he agrees to meet with you at your office when he completes rounds the following morning. At this visit, Dr. Jones confirms Audrey’s description of her role but justifies his desire for the role to continue by saying, “I bring $10 million of business to this hospital every year in cardiology procedures. The least you can do is provide the nursing assistance I am asking for. If you are unable to meet this small request, I will be forced to consider taking my practice to a competitive hospital.” However, after further discussion, he does agree that eventually he would consider a slightly more expanded role for the nurse after he learns to trust her.

ASSIGNMENT:

Do you meet Dr. Jones’s request? Does it make any difference whether Audrey is the nurse, or can it be someone else? Is the amount of revenue that Dr. Jones generates relevant in your decision making? Should you try to talk Audrey into continuing the position for a while longer? While trying to reach a goal, people must sometimes endure a difficult path, but at what point does the means not justify the end? Be realistic about what you would do in this situation. What do you perceive to be the greatest obstacles in implementing your decision?

Part 3:

LEARNING EXERCISE  19.12

Memo to Chief Executive Officer Leads to Miscommunication

Carol White, the coordinator for the multidisciplinary mental health outpatient services of a 150-bed psychiatric hospital, feels frustrated because the hospital is very centralized. She believes that this keeps the hospital’s therapists and nurse-managers from being as effective as they could if they had more authority. Therefore, she has worked out a plan to decentralize her department, giving the therapists and nurse-managers more control and new titles. She sent her new plan to Chief Executive Officer Joe Short and has just received this memo in return.

Dear Ms. White:

The Board of Directors and I met to review your plan and think it is a good one. In fact, we have been thinking along the same lines for quite some time now. I’m sure you must have heard of our plans. Because we recently contracted with a physician’s group to cover our crisis center, we believe this would be a good time to decentralize in other ways. We suggest that your new substance abuse coordinator report directly to the new Chief of Mental Health. In addition, we believe your new director of the suicide prevention center should report directly to the Chief of Mental Health. He then will report to me.

I am pleased that we are both moving in the same direction and have the same goals. We will be setting up meetings in the future to iron out the small details.

Sincerely,

Joe Short, CEO

ASSIGNMENT:

How and why did Carol’s plan go astray? How did her mode of communication affect the outcome? Could the outcome have been prevented? What communication mode would have been most appropriate for Carol to use in sharing her plan with Joe? What should be her plan now? Explain your rationale.

Communication In Chronic Obstructive Pulmonary Disease Palliative Care Nursing Essay

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The following is an evaluation of enhanced communication techniques in palliative care for patients with chronic obstructive pulmonary disease (COPD) with reference to a case study.

COPD is a debilitating terminal condition that is distinguished by a progressive airflow obstruction, primarily caused by smoking. It is usually not fully irreversible (NICE, 2010).

For an airflow obstruction to qualify, post bronchiodilation FEV1/FVC is less than 0.7 ( FEV: forced expiratory volume in one second, FVC: forced vital capacity). The course of COPD is highlighted as being an illness characterised by a long inexplorable disease, punctuated with protracted periods of disabling breathlessness, reducing exercise tolerance, causing recurrent hospital admissions and premature death (Buckley, 2008). Diagnosis of COPD is not entirely dependent on severity of breathlessness but also history, physical examination and also spirometry confirmation of airway obstruction (Buckley, 2008; NICE, 2010). Because of the difficulty with the prognosis of COPD, it presents a challenge for physicians and healthcare practitioners to provide adequate care to patients (Curtis, 2006; NICE, 2010).

Due to the nature of symptoms associated COPD (such as dyspnoea), patients more often die with COPD or related than from it (NICE, 2010) with mortality rate for men steadily reduced from 1970 while women’s has seen a small but steady rise, although COPD mortality is on the general rise. Buckley (2008) reported that there was a relatively higher proportion, (72%) of COPD who die in hospital care, compared with 12% at home and none in hospices.

Palliative Care

Palliative care has several definitions but has similar concepts according to Campbell (2009). NICE (2010) guidelines define palliative care as active holistic care of patients with advanced progressive illness. Curtis (2006) defines palliative care as the goal being to prevent and relieve suffering and support the best possible loyalty of life for patients and their families and their families, regardless of the state of disease or the need for other therapies.

The general aim of palliative care is to improve the quality of care through alleviation of symptoms and promoting comfort over treatment as some treatment involve mechanical aids which patients might find taxing (Curtis, 2006). This has brought about the suggestion for the need of specialised centres (Curtis, 2006) considering how little attention palliative care quality has received. Curtis (2006) then went on to report that there was a very low number of patients who talked about end of life care with their physicians, which can be made even more difficult with loss of emotional control or fear of having little training (Wittenberg-Lyles et al., 2008). There is also a need for patients to show more confidence in their carers (Curtis, 2006).

The Gold Standards Framework GSF (2006) Prognostic Indicator Guidance (PIG) lists the criteria that would assist in making a prognosis for requirement of palliative care as:

Severity of disease, such as FEV1 being less than 30% predicted

Recurrent hospital admissions

Long term oxygen therapy

Shortness of breath with 4/5 grade on the Medical Research Council (MRC) Dyspnoea scale

Signs and symptoms of right heart failure

Other factor such as non invasive ventilation (NIV)

The GSF (2006) PIG summarises which three steps are key to determine which patient needs palliative care. They are

Identifying patient based on criteria

Assessing needs

Planning administration

The above steps are dependent on patients satisfying chronic condition criteria listed earlier.

Communication

Communication is the process of enhancing thoughts or information between individuals through different media: spoken or written and through body language gestures (Payne et al., 2004).

Buckley (2008) states that good communication is the key to the delivery of effective supportive palliative care services as it has an interpersonal perspective that is about health professionals and patients engaging emotionally (Wittenberg-Lyles et al., 2008).

Delivering bad news is not an easy or comfortable feat. The United States EPEC (Education for Physicians on End of life) is a training program based on SPIKES model (Setting, Perception, Invitation, Knowledge, Empathy, and Strategy/Summary), that has listed steps to follow that in the delivery of bad news, summarised below:

Preparing to meet i.e. location setting

Assess what patient knows about condition

Determine amount of information to give patient

Delivery of news

Respond to any questions from patient and/ or family

Make follow up plan

Case Study: Patient profile

The subject used in the case study was an eighty year old man in a nursing home who presented as generally quiet, with long standing chronic obstructive pulmonary disease (COPD). Consent was obtained from him to participate in the study with the potential benefits explained to him. The subject had history of chain smoking and was diagnosed with heart murmurs in 1986. Long term smoking causes the damage to the lung tissues and repeated chest infections (NICE, 2010) and is a major contributor to COPD. The subject was prescribed bronchodilator salbutamol 2.5mg/2.5ml nebuliser liquid unit dose vial, administered by mask one or two ampoules four times a day. It was used as and when it was required although he did not usually exceed three doses daily.

The subject had shortness of breath with basic living tasks and dependent on staff. The subject had several GP visits for COPD associated chest infections in the last twelve months and had to be supported by pillows in an almost upright position to sleep to reduce the discomfort caused by the dyspnoea. The subject was chosen as he satisfied most of the criteria from the GSF (2006) in terms of shortness of breath, reliance on the bronchiodilator, several GP visits for chest infections and long history of smoking. The do not resuscitate (DNR) forms were filled in passed on to the multidisciplinary team that include the Ambulance service with the family aware.

Communication in Palliative care with COPD

Different communication techniques were employed when it came to dealing with the subject to reassure him and the family skills i.e. maintaining appropriate eye contact, low tone of voice is the key to the delivery of effective supportive palliative care service (Buckley, 2008). A SPIKES model approach was employed with the current case study.

Discussion

It is essential for nurses to establish a therapeutic relationship with patients as they interact more with the patient, employing strategies such as empathy, spending more time listening and being more initiative (Edwards, et al 2006). Communication sometimes can also been limited by workplace policies or insufficient training (Edwards, et al 2006), which raises the need for proper training to better these relationships (Davidson et al., 2002). The current case study was able to overcome the difficulties of communicating with the patient and family as they had been there already offering support, and hence during the meeting to discuss the end of life they stated that they were satisfied with the progress as part of the continued care.

The subject did not seem to be happy with the nebulisation therapy at first and he expressed fear and anxieties because it was a new therapy, which was not unusual (Stevens et al., 2009). Curtis (2006) study argues that health care for patients with COPD was often initiated proactively based on a previously developed plan for managing their disease. The subject was given a choice if he wanted a member of his family to be present and if the time was appropriate to which he had no objection, being emotionally functional and able to make his decisions (Lemmens et al. 2008). It was also noted that the subject became more relaxed when the nebulisation therapy was explained to him that it would reduce the dyspnoea, rattly chest, symptoms that he acknowledged made his breathing difficult and other symptoms such as wheezing and sleep disturbance.

It is important to have a suitable location where there would be few disturbances when breaking bad news (Stevens et al, 2009; Wittenberg- Lyle, 2006). In the case study, the subject’s family was contacted in order to arrange a meeting to discuss his diagnosis, the way forward regarding his treatment and control of his symptoms and also make them aware of any changes that would need to be made in terms of his care. This afforded the subject and family to be to be reassured that the patient would be made as comfortable as possible to alleviate the symptoms of his condition through to end of life and bereavement.

Conclusion

Palliative care for COPD has not received much attention until recently. Communication is a very important aspect for high standards of care particularly in end of life care. Nurse to patient relationships are even more important as they play a major role; liaising with the family and multidisciplinary team to make the end of life as comfortable as possible. There is still much to be done in terms of communication training for nurses and also getting more physicians involved. The role of a multidisciplinary team is highly valued as it helps streamline the planning and administration of palliative care. The current case study found that the patient was happy with the way that the way that his care was planned.

What factors have led to care being offered outside of the hospital setting?

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What factors have led to care being offered outside of the hospital setting?

What factors have led to care being offered outside of the hospital setting?

Girard, K. (2013). Health care delivery systems and occupations. Retrieved from https://www.youtube.com/watch?v=T1WpakHcjRs

Having completed the required readings and viewed the video, you should now have a basic understanding of the characteristics and components of the United States health care delivery system. Health care delivery is no longer confined to the hospital setting. Over the past few years we have witnessed the emergence of outpatient surgery centers, home health, hospice, etc.

For this assignment, conduct additional research as needed to address the following questions in complete 2-3 pages paper :

What factors have led to care being offered outside of the hospital setting?
What are the advantages and disadvantages of these settings? Who benefits the most: consumers or organizations?
How will the Affordable Care Act (ACA) impact this new trend? Will it encourage more alternative settings or put care back into the hospital setting? Explain.
In your paper must include

· Complete 2-3 pages length
· Proper introduction and conclusion.
· 3-5 references from provided readings and cited all in APA.

Required Readings

· Asaria, M., Ali, S., Doran, T., Ferguson, B., Fleetcroft, R., Goddard, M., & Cookson, R. (2016). How a universal health system reduces inequalities: lessons from England. Journal of Epidemiology and Community Health, 70(7), 637-643.
· Beitsch, R. (2015). Hospitals oppose site-neutral outpatient pay proposal in Obama’s budget. Inside Washington Publishers’ Inside CMS, 18(5).
· Beland, D., Rocco, P., &Waddan, A. (2016). Obamacare wars: Federalism, state politics, and the Affordable Care Act. Lawrence: University Press of Kansas. Retrieved from https://muse.jhu.edu/book/43112
· Galarraga, J. E., & Pines, J. M. (2016). Costs of ED episodes of care in the United States. The American Journal of Emergency Medicine, 34(3), 357-365.
· Harrison, S. (2015). Health care reform may drive higher comp costs. Business Insurance, 49(6), 4-4,22.

The nursing conceptual model

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The nursing conceptual model

Posted on 15th September 2015 by Mike G in Fast Dissertations Writing Service, Fast College Dissertations, College Term Papers, College Research Papers, Dissertations

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Medical Malpractice in India and in General

/in /by



Master of Health Management

LWN164 Health Care Law and Ethics


Assessment Item No. 3



Abstract



:

The interrelationship between medical ethics and the law are perhaps nowhere as starkly obvious as in the domain of medical malpractice. Ethical and legal conduct and practices regularly operate harmoniously however in cases of medical malpractice ethical standards and issues encompassing therapeutic risk can clash. Some examples include disclosure of mistakes; quality change practices; non-adherence to professional standards; managing patients who act against therapeutic guidance; and the different assurances of Good Samaritan laws. Malpractice cases may be further complicated when doctors oversee the investigation process. For these reasons, research into medical malpractice in India is timely to understand the causes, prevalence, current processes and may provide solutions for improved practice. The literature review will specifically consider the Legal and Ethical side of Medical malpractice in India and in general, with a critical evaluation of the legal system, approach to ethics, the implications of the failure of the medical malpractice system for the health system and case reviews from an Indian perspective.




Causes of Malpractice in India




Main points will include:

  • Private Hospitals, often with profit as their primary aim, utilize a system of incentives and disincentives to push specialists to over-bill, sometimes unethically.
  • With places in the financed government medical schools limited, aspiring medical students often choose private Medical universities that charge high fees. This tempts doctors to work in private hospitals to recover their costly investment in therapeutic training.
  • Overcharging has further implications for health insurance. Unethical practices are a distress to individual patients and organizations, on account of salaried employees who get health coverage benefits from their managers. Insurance premiums are arranged intermittently and the rates are chosen on the basis of earlier years’ claims. The more expensive the claims one year, the higher the premium will be the next year.
  • In this way, patients or their employers (if insurance is part of a salary package) need to an indirect way bear the rising cost health insurance premiums. The insurance agencies rarely question claims unless their net installment commitments surpass the net premiums. Insurance providers have devised approaches to confine their general liabilities, for example, capping installments for the treatment of particular sicknesses. If everything fails, Health Insurance Company raises the premium for family cover to compensate for a low return in corporate health coverage.
  • Thus, medical specialists, private hospitals, pharmaceutical, and insurance agencies are profiting at the cost of individual patients and enterprises who give the insurance advantages to their employees in a largely unregulated healthcare market.



The Way Forward

The Medical Council of India is inefficient in checking malpractice and corruption in the medical field and may be disbanded soon. An arrangement of standardized treatment protocol may help control malpractice, however that may likewise constrain specialists. Plus, standardized treatment protocol may raise the cost of treatment. The preferred hospital network system has improved convenience; however it is insufficient to control corrupt specialists and clinics. Tweaking the system of incentives and disincentives, enhanced access to data and, thus, a more straightforward healthcare services market can end unethical therapeutic practices.



Main points will include



:


  • Incentives

    : Increasing the supply of seats in government medical universities and capping fees will decrease investment costs for medical students and thus lessen the incentives to work in private hospitals, which are frequently run not by doctors but rather by MBAs. Lowered debt will lessen the motivating factors for doctors to cheat and overbill.

  • Access to data and transparency

    : Mandatory video recordings, in addition to archiving and sharing the recording to patients or their representatives, will make specialists responsible. At present, private health facilities should distribute the qualifications and experience of top specialists. That practice should be extended to incorporate each specialist’s record in treating patients. For example, a gynecologist’s profile must show the number and type of deliveries supervised. Such data will help patients make informed choices about which specialist to go to for treatment.

The accessible, online rating and positioning of doctors in fraud-prone specialties, for example, kidney transplants, gynecology, and cardiology, by third party independent agencies can be useful. Similarly, rating hospitals in light of their basic infrastructure, charges, and a few markers of ethical business practices, such as the number of medical malpractice suits filed can guarantee improved conduct. The capping of fees will prevent well-regarded health care providers from overcharging.


  • Disincentives

    : Aggrieved patients ought to be encouraged to take their grievances to consumer courts, which are less expensive, speedier, and don’t require legal counselors. Corporations, particularly the larger ones with greater insurance premium bills, are encouraged to hire in-house specialists and medical lawyers to explore whether they are profiting by unethical specialists, clinics, or insurance agencies, and take suitable remedial actions.

The above measures can check a large portion of, but not all, unethical practices. For genuine infractions, stringent punishments including fines, detainment and permanent disbarment, still might be required.



The Importance of Health Law


:

The Medical Council of India (Indian Medical Council Rules, 1957) has a redress system that can offer disciplinary action against misconducting specialists after appropriate investigative methods. The harassment of specialists who are falsely implicated in negligence has been curtailed by the Supreme Court, which has issued guidelines for the criminal charging of doctors (Rule 4 in Order XVIII of Consumer Protection Act

, 1986

). The medical profession that was once viewed as respectable is presently considered alongside other professions as liable for paying for damages. The patients who demanded refunds for alleged medical carelessness resorted to the civil courts. Public awareness of medical malpractice in India is developing. Hospital administrations are progressively confronting complaints in regards to the standards of professional competence, facilities, and the suitability of their therapeutic and diagnostic strategies. After the Consumer Protection Act (1986), has taken effect, a few patients have filed legal cases claiming the specialists were negligent in their treatment, and received compensation. Therefore, various legal decisions have been made on what constitutes negligence and what is required to prove it. The review will focus on why laws are failing in India, why the laws are not strict enough to put an end to malpractice and who is responsible, the health industry, management, the public, the government or the physicians themselves?



The legal issues will include


:

  • The fundamentals of medical malpractice and negligence, identifying malpractice and excluding cases with poor outcomes but no negligence.
  • Changing ideas of informed consent.
  • Practical issues of medical negligence with cases from the Indian Courts.
  • Investigating why individuals make medical negligence cases.
  • Approaches to manage medical accidents.
  • Causes of increase in medical carelessness.
  • Fundamentals of therapeutic liability in India



Medical Ethics



:

The medical profession in India is at intersection, confronting numerous ethical and legal difficulties. The fundamental values of medicine insist that the specialist’s commitment is to keep the patients interest above everything else. The vital issues of autonomy, justice, confidentiality, non-maleficence, and beneficence are key elements that ought to direct the day to day practice of the specialist. The ethical guidelines of medical practice given by The Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, (Code of Ethics Regulation, 2002) are aimed at strengthening the ethical measures among enlisted medical experts in India.



Points that will give basic insight into solutions to ethical issues in medical practice:

  • Improving relationship between patient and doctor.
  • Ethical training of postgraduates and undergraduates in their therapeutic training.
  • Challenges associated with modern medical practice.
  • Coverage of Doctors and Hospitals under Consumer Protection Act (Rule 4 in Order XVIII of Consumer Protection Act, 1986)



Research Methodology



:

Professional negligence by a health service provider has implication for both the legal and health profession. Avoidable medical injury increases the cost of treatment, while negligence claims have been blamed for further increase in cost of health care in India. This research is to analyze medical malpractice legislation and its consequences on stakeholders, for example, the health care consumer, the medical professionals, and the legal community. A thorough analysis of researches, articles and journals based on liability of hospitals in medical negligence, an analysis of medical negligence and law in India, Breach of patients trust in medical negligence, analysis and interpretation of medical negligence. The research will include arguments supporting the ethics and laws in medical malpractice as well as how laws are misused against the medical professionals by the patients for financial gain.

  • Causes of medical malpractice:

  1. Medical malpractice

    – (Sloan & Chepke, 2008 p. 302-303)
  2. Communication gaffes: a root cause of malpractice claims- (Hutington and Kuhn, 2003 p. 157-161)
  • Solutions to Medical Malpractice:

  1. Progress in Medicine: Compensation and medical negligence in India: Does the system need a quick fix or an overhaul?

    –

    Chandra

    and

    Math

    , (2016)

  2. Malpractice: Problems and Solutions- (

    Bernstein,

    2013 p.372-378)
  • Importance of health law and legal issues in medical malpractice:

  1. Journal of health and life sciences law- A Better Approach to Medical Malpractice Claims.

(Boothman, Blackwell, Campbell, Commiskey, and Anderson, 2009, p 125-159)


  1. Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense – A legal perspective. –

    Pandit & Pandit, (2009)
  • Ethics in medical malpractice:

  1. “Health Law and Medical Practice”

    – Chesnokova and Arina Evgenievna, (2016)

  2. “


    Ethics and Medical Malpractice


    “-

    Dougherty, (1990).
  • Case Reviews:

  1. “Important medical negligence cases in India”

    – Yadav, (2014)



References

Bernstein, J. (2013) Malpractice: Problem and Solutions

. Clinical Orthopedics and Related Research 471

(3). Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563820/

Boothman, R. C., Blackwell, A. C., Campbell Jr, D. A., Commiskey, E., & Anderson, S. (2009). A better approach to medical malpractice claims? The University of Michigan experience.

Chandra, M. S., & Math, S. B. (2016). Progress in Medicine: Compensation and medical negligence in India: Does the system need a quick fix or an overhaul?.

Annals of Indian Academy of Neurology

,

19

(Suppl 1), S21.

Chesnokova, Arina Evgenievna (2016). Health Law and Medical Practice.

AMA Journal of Ethics

,

18

(3),197.

Code of Ethics Regulation, (2002). Published in Part III, Section 4 of the Gazette of India, dated 6th April, 2002. Retrieved from

http://www.mciindia.org/RulesandRegulations/CodeofMedicalEthicsRegulations2002.aspx

Consumer Protection Act (Rule 4 in Order XVIII of Consumer Protection Act, 1986)

.


Bare acts

,

Code of Civil Procedure, 1908

,Order 18 Rule 4. Retrieved from

http://www.lawzonline.com/bareacts/civil-procedure-code/order18-rule4-code-of-civil-procedure.htm

Dougherty, C. J. (1990). Ethics and Medical Malpractice.

Creighton L. Rev.

,

24

, 1233.

Hutington B. and Kuhn N., (2003)

Communication gaffes: a root cause of malpractice claims


16(2): 157-161


.

Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201002/


J Health Life Sci Law

,

2

(2), 125-159.

Pandit, M.S. & Pandit, S., (2009).

Indian Journal of Urology


25(3): 372-378

.

Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense – A legal perspective.


https://dx.doi.org/10.4103%2F0970-1591

Sloan, F. A., & Chepke, L. M. (2008).

Medical malpractice

(pp. 302-03). Cambridge, MA: Mit Press.

Yadav S., (2014) “

Important medical negligence cases in India”.

Retrieved from

Medical negligence in India

Comparison of Intervention Strategies for Youth Homelessness

/in /by


Introduction

Youth homelessness is becoming an increasingly important issue in Canada. In the 2014 article from Saddichha, S it reads, “Estimates of street/homeless youth in Canada ranged from 10,000-20,000 in 1993 (Brannigan & Caputo, 1993) and have increased to more than 65,000 in the latest count (Canadian Broadcasting Corporation, 2004). The problem is this issue will get worse if there are no interventions in place.  Childhood abuse, substance abuse, and mental health issues are common themes in the articles. Again, in the study from Saddichha, S 80% of homeless youth and adults suffered emotional abuse, 69% suffered physical abuse and 55% suffered from sexual abuse. Homeless youth and young adults make up 20% to 30% of the homeless population (Saddichha, 2014). Some studies were done in Ontario, Quebec, and British Columbia. This gives an overview of the provinces and the homelessness is relevant to healthcare because it affects peoples physical, emotional, and mental health. Homelessness can have serious impacts on the health of youth and young adults which includes suicidal thoughts, attempt, and completions (Sabbichha, 2018), (P) Are homeless youth and young adults impacted more by (I) counselling, family relations and social support (c) no treatment/ intervention (o) reduction in homelessness?

The database CINAHL was searched for articles on youth homelessness in Canada, substance abuse, mental health issues, and social determinants of health relating to homelessness. The years of publication ran from 2009 to 2019.  Some of the key search terms are substance abuse, homelessness, child abuse, youth and young adults, mental illness, social integration and social determinants of health. Using these terms made the most sense as a lot of homelessness is associated with mental health problem like schizophrenia, psychosis, post traumatic stress disorder and substance abuse

Literature review

All the studies were done in Canada with a focus on how homeless youth deal with being homeless. The main ideas circles around social integration and substance abuse. The average age in all four articles is 21-22 years of age. There were two studies that used the cross- sectional method. Two studies used the snow balling technique. Three of the four articles used over 180 participants in their studies while one study’s samples size was on 9 (n=9). All studies had wanted to have interventions so youth and young adults would not end up on the streets.

In the 2014 Saddichha article, adults and youth were compared. It was also the only one that did not stick to just one city; they sampled Vancouver, Prince George, and Victoria populations. There were 500 participants and 82 of them were homeless youth in this study. They tested for childhood trauma, addictions and socio- economic status. To collect data, they used the mini international neuropsychiatric interview, DSM 4, childhood addiction interview and the Mausley addiction profile.  They looked at childhood trauma more in depth than the other studies as they checked for physical, emotional and sexual assault, physical and emotional neglect. Childhood trauma was similar in both the adults and youth. Youth are more likely to have unsafe sex and drank alcohol then adults. Adults did more cocaine than the youth, but more youth used cannabis then adults. Adults are more likely to experience psychosis than youth perhaps because youth have not had developed enough to experience an episode of psychosis. Homeless youth are more likely to have depression and anxiety than their peers.

In the 2018 Thulian article, it was the only study that had qualitative data. In the study, they sampled youth that were formerly homeless while they learned to live independently.  Their framework was developed using the social determinates of health. It was the only study that focused more on the social determinants of health, done in Toronto, Ontario. Most youth were trying to escape from unstable home lives with poverty, neglect and abuse They meet 13 to 19 times between March 2015 and January 2016. They conducted the study based on a critical ethnographical methodology. For data collection, they used a baseline questionnaire, participant observation and informal interviews. Seven participants were on welfare; one was co parented and eight were raised by single mothers, where they had minimal contact with their fathers. Based on this study the youth had suffered from unaffordability housing, limited education, inadequate employment that were often dead-end jobs or low hours and psychosocial consequences. It was mentioned at the beginning of the study the youth had desires wanting to go to college and have a long-term plan. But they soon realized that they were worried about day to day living expenses and that the poverty began to set in the participant low self esteem, self-efficacy and sense of control.

In the 2018 Gasior article, they studied service provider network, social support, and family relations on the effects of perceptions of recovery. They recruited from drop in centre, shelters and service agencies. The study took place in London, Ontario. The first hypothesis of service provider network and perceptions of recovery was not supported. 73 participants had no service network providers and only 14 had seen one more than four times. The second and third hypothesis of integrated social support and family relations on the effect of perceptions of recovery were supported. Since majority of participants did not go to a service provider network they relied more on family and social support. The last hypothesis including all three and the perceptions of recovery were only partially supported. Youth had a desire to succeed and believed they have a purpose in life. They used a hierarchical multiple regression analysis. Youth were shown to have troubles asking for help or they might be embarrassed and not know where to start. The study showed that having stronger social and family support network could contribute to increased perceptions of recovery.

In the 2016 Roy article, it had the highest mean age of 22-year-old and 359 participants. This study was conducted in Montreal, Quebec.  They did the snowballing method as a quantitative approach. They conducted interviews and questionnaires and they did six follow ups interviews every three months. Having a high school education, formal activity and psychological help increase residential stability. Being a non formal education and activity decreased residential stability. Mortality rates are higher in the homeless youth than other young people. In the article it had states, “reported standardized mortality ratios show that mortality rates for homeless youth are 2.7 to 37.3 times higher than for other young people. (Roy, 2016 P.1)” In this study they used the Kaplan-Meier and Cox proportional-hazards regression analyses as a quasi-experimental study.

Some strengths of all the articles are they gave an overview of social integration, mental illness, substance abuse and childhood trauma. In one article they compared youth to adults, which could give an idea on what to improve in both groups. In one study where they only had nine participants, they were able to focus closely over a 10-month period. It also was able to illustrate the barriers like unaffordable housing and poverty level income that affect the youths’ self- esteem and self-efficacy. In three of the articles they had enough participant in order to accurately predict the outcomes. Another positive that came out of the 2016 Roy’s study, e is the outcomes adopted by the residential follow back calendar design which assessed the psychometric properties of the calendar with high- test retest.

Some limitations include the self reports that most studies gave out. This introduces both recall and social desirability biases into the studies. In the 2016 study of Roy, they focused on life conditions social and mental health factors might prevent childhood factors. In the Saddichha article, the snowball method which had difficulty performing a direct comparison between youth and adults, while the cross-sectional underestimated the rates of homelessness. In the 2014 Gasior article, it states of a limitation is, “The cross-sectional nature of the analysis limits the ability to support strong casual claim.(Gasior, 2018, pg 34)” three out of four studies were conducted in only one city which may not accurately predict youth in other areas of the province and country. With any study, there will always be limitations a researcher is faced with.


Discussion

From these articles, child abuse, mental health issues and inadequate social determinants of health, the main problems facing homeless youth. Only studying one city limits the ability to see and what other factor might contribute to youth homelessness across the country. Research should be combined so evidence from each province and/ or major city to have a clearer idea of the country. We also need to address local issues regarding youth and young adult homelessness. In the 2014 Saddichha study that included both youth and older adult it gave the idea that how we treat youth homelessness should be different than how we treat adults. The article mentions “interventions to prevent homelessness and support those who are homelessness are needed. Particularly age specific programs that address the high-risk behavior that youth are engaged in and increase their vulnerability to further victimization are the call of the hour. (Saddichha, 2014, pg. 205).” One thing that does need to be addressed in both age groups is childhood trauma. In the article from Thulian it said, “these young people are fleeing unstable and complicated home lives marked by abuse, poverty, and neglect (Thulian, 2018, pg.90).” Abuse can lead to post traumatic stress disorder, depression and anxiety (Thulian, 2018) and living on street could possible lead to more abuse.

Ethics

In all experimental studies involving human some form of approval is needed to make sure that methods used in studies do not cross any ethical boundaries. The ethical approval for the Thulian study was given by the University of Toronto Health Science Board and a review committee at the local shelter.  For the 2014 Saddicihha, study, “the Behavioral Research Ethics Board of the University of British Columbia and the Providence Health Care Research Institute provided ethics approval”.  The 2018 Gasior’s study had ethical approval was done by Western University’s ethics review board. In the 2016 Roy study “was conducted with the approval of the Comité d’éthique de la recherche en santé chez l’humain du Centre Hospitalier Universitaire de Sherbrooke et de l’Université de Sherbrooke and conformed to the principles embodied in the Declaration of Helsinki(Roy, 2016).

When dealing with people that are children and mentally ill, might misunderstand what is being asked of them. This could go against being ethical practice. Some people that have post-traumatic stress disorder and experience childhood abuse might not like talking about their experience or embarrassed. It is important for respect them and what the are comfortable talking about.

Conclusion

The PICO question was fit in the Thulian 2018 article.  The other three had touched on social integration but were more focused on the substance abuse, childhood abuse and mental illness. It put more pressure on the health care system has we must deal with the implications of homelessness. We need to keep the opportunity for youth to get an education and succeed in life. Also, we need programs where youth can go and talk with other people in the similar situations and to encourage going to counseling. If a youth wants to finish high school, they should have the opportunity while out worrying about day-to-day survival.


Summary Table
First Author

& Year

1 2 3 4 5 6 7 8 9 10
Sample:

Size

Country

Mean age

Diagnoses

Sampling Technique Research Question Approach (Qual/Quant) Research

Design

Data

Collection

& Analysis

Main Findings Strengths of

design & methods

Limitations of design & methods Level of Evidence
1 Gasior, s

&2018

187

Canada

20.9

Mental health and substance abuse

convenience sampling -larger network of service provider= higher levels of perceived recovery

-social support= higher levels of perceived recovery

-family relationships= higher levels of perceived recovery

-all three above= higher levels of perceived recovery

Quantitative Cross-sectional -Recovery assessment scale

– quality of life interview

– Service provider network was assessed using a derived variable from a measure from the primary study titled ‘‘Health, Social, Justice Service Use’’ examining the extent of access that the homeless participants had with service providers (Forchuk et al., 2013) (Gasior,s 2018).”

-Service provide network and perception of recovery hypothesis not supported

-social support and family relations do support the hypothesis of perceptions of recovery

-they had enough youth and young adults to try and get an accurate prediction of homelessness in youth and young adults. -self-report questionnaires could be bias.

-cross-sectional analysis limits strong cause and claim

-study only focused on one city and might not accurately predict youth in other areas of the country

–

9 Single correlational study
2 Thulien, N,S. 2018 9 participants

Mean age 21

Canada

Abusive homelives

Stratified sample How does social integration and social determinants of health affect youth homelessness? Qualitative ethnography -patient observation

-informal

Interviews

-questionnaires

Unaffordable housing

-limited education

-inadequate education

-poverty level income

-limited social capital

Made it difficult for youth and young adults to move on.

-was able to follow the 9 participants closely over a 10-month period.

Was able to see barriers to housing stability and self-esteem and self efficacy.

-focused on one city.

-only had 9 participant and whether it is enough to get an accurate view on youth homelessness.

10 Single qualitative or descriptive study
3 Roy, E 2016 359 participants

Mean age 22 years old

Canada

Mental health issues and homelessness

Snowball sampling Proximal predictors of residential stability in cohort of youth homelessness Quantitative Quasi experimental studies Interviews

Questionnaires

Six follow up interviews every 3 months

-high school degree

-formal sector activity -psychological help more likely to reach residential stability.

-Being a man,

-injecting substances,

-no informal sector activity

-decreased probability to reach residential stability

Stay outcomes adopted from residential follow back calendar design which assessed the psychometric properties of the calendar with a high-test retest Self report introduced both recall and social desirability biases

-focused on life conditions, social and mental health factors might prevent childhood factors

-may not generalize all street youth

5 Single quasi-experimental study
4 Saddichha,s & 2014 500

82 youth and young adults

21.5

Canada

Mental health issue, substance abuse, pass childhood abuse

Random sampling

and

snowball sampling

Homeless youth in terms of demographic and mental and physical health issues

Difference between youth and adult

Quantitative Cross sectional – Maudsley Addiction Profile (MAP),

-Childhood Trauma Questionnaire (CTQ)

-the Mini International Neuropsychiatric Interview (MINI) Plus

Homeless youth are more likely female

-aboriginal

More likely

Used people from 3 different cities. Snowball methods which had difficulty performing a direct comparison between youth and adults

-cross-sectional underestimate the rates of homelessness

9-Single correlational study

References

  • Gasior, S., Forchuk, C., & Regan, S. (2018). “Youth homelessness: The impact of supportive relationships on recovery.” (Canadian Journal of Nursing Research), 50(1), p.28-36. doi: 10.1177/0844562117747191
  • Roy, É., Robert, M., Fournier, L., Laverdière, É., Berbiche, D., & Boivin, J.-F. (2016). “Predictors of residential stability among homeless young adults: a cohort study.” (BMC Public Health), 16(1), p. 1–8. July 23, 2019 https://doi-org.libproxy. uregina.ca/10.1186/s 12889-016-2802-x
  • Saddichha, S., Linden, I., & Krausz, M. R. (2014). Physical and Mental Health Issues among Homeless Youth in British Columbia, Canada: Are they Different from Older Homeless Adults? Journal of the Canadian Academy of Child & Adolescent Psychiatry, 23(3), p.200–206. Retrieved July 22,2019 from

    http://search.ebscohost.com

    .libproxy.uregina.ca/ login. Aspx? direct =t rue&db=rzh&AN= 109681463&site=ehost-live
  • Thulien, N.S., Gastaldo, D., Hwang, S.W., & McCay, E. (2018). “

    The elusive goal of social integration: A critical examination of the socio-economic and psychosocial consequences experienced by homeless young people who obtain housing

    .” (Canadian Journal of Public Health), 109(1), p 89-98. doi: 10.17269/s41997-018-0029-6

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