[Rehabilitation day-hospital of the heart failure unit: structure and functions].
Soccorso CapomollaOreste FeboAngelo CaporotondiGiampaolo GuazzottiFrancesca LentaMarina FerrariRoberto AquilaniGiuseppina MajaniStefano BoniSandro VerdirosiGian Domenico PinnaRoberto MaestriFranco Cobelli
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Chronic heart failure has emerged as an important public health problem. The consequent increase in the sanitary services has induced an increased consumption of financial resources and conditioned the need to investigate new sanitary models that guarantee, by integrating the inpatient and outpatient health care delivery, the continuity of health assistance. Cardiac rehabilitation in the context of a day-hospital Heart Failure Unit allows for the organization of a rehabilitation program including various health approaches aimed at guaranteeing a multidisciplinary program and the relief continuity. This article describes the experience developed in the Heart Failure Unit of Montescano.Cite
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Congestive heart failure is a major public health challenge and a leading cause of hospitalization in the United States. Despite major recent advances in the treatment of this condition, morbidity and mortality rates remain unacceptably high, and readmission rates can approach 50% at 6 months. Rehospitalization rates associated with this condition pose a significant economic burden on the health care budget. The main purpose of this article is to address how utilization of multidisciplinary heart failure units for the treatment of acute heart failure can lead to optimization of health care delivery for this condition, improved clinical outcomes, decreased rehospitalization rates, and reduced health care costs. We will explore the societal impact of heart failure and economic burden of this condition, with special focus on the impact of acutely hospitalized heart failure patients. Shortcomings and windfalls in the delivery of health care for this condition will be addressed. The multiple components of care essential to successful treatment of heart failure will be discussed. The article will then discuss how development of a formal multidisciplinary inpatient heart failure disease management program will consolidate and centralize all these various components and provide for optimal delivery of health care for this condition.
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Heart failure remains a major public health problem that is increasing in prevalence due to the aging of the population. Managing older hear failure patients can be particularly difficult due to the presence of multiple comorbid illnesses and psychosocial constraints. To address these issues, various strategies for multidisciplinary heart failure disease management have been developed. Benefits include reductions in hospital admissions improved quality of life, and decreased costs. Based on currently available evidence, multidisciplinary heart failure disease management programs should be considered for patients with heart failure at increased risk for poor outcomes, as indicated by the presence of multiple comorbid conditions, complex environmental issues, or an adverse psychosocial milieu.
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Despite the decreasing incidence of ischaemic heart disease and despite major medical advances in heart failure, the prevalence and mortality of chronic heart failure in the population is rising and the prognosis remains grim. Chronic heart failure is a complex disease, which is characterized by its progressive nature. In this paper, we approach the complexity of heart failure from four paradoxes: epidemiology, diagnosis, therapy and economical impact respectively. Taking these paradoxes into account, we formulate a number of essential components of alternative heart failure management programmes. Combating chronic heart failure requires the organization of centres for continuous care--as opposed to the traditional crisis intervention centres--preferably with a multidisciplinary structure to provide a "holistic approach" adapted to each patient's unique set of medical, psychosocial, physical and financial conditions. Patients taken care of in these novel multidisciplinary heart failure clinics have shown improved clinical status, decreased hospitalization rates, increased quality of life, longer life and lower costs.
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Clinical nursing unit is a new, innovative attempt to provide care for those who need high quality nursing temporarily as a means of achieving recovery. The unit is fundamentally different than a medical ward. The leader of the unit is a nurse and nursing is the main activity. The work is always multidisciplinary other healthcare professionals acting as consultants and working within the agreed philosophy. In this paper a short review of literature on the clinical nursing unit and its benefits are presented. Studies suggest that they are both feasible and beneficial alternatives to acute and community hospitals. Can such a unit become a part of reality in Finland is also discussed.
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In this paper, we describe a geriatric rehabilitation nursing model developed on the basis of the nursing and rehabilitation literature. That literature comprised some 120 articles addressing the rehabilitation of elderly patients and the work done by nurses in that process, various philosophical questions and the results of geriatric rehabilitation. One‐third of these articles has been evaluated on the strength of the articles’ evidence, and these are discussed in this paper. The findings show that the main factors in geriatric rehabilitation nursing are the patient with health or functional problems and the nurse with professional values, knowledge and skills. The patient is part of a family and the nurse works as part of a multidisciplinary team. In the geriatric rehabilitation process, the patient and the nurse work in close interaction. The aims of rehabilitation depend upon the patient's commitment to the objective and upon the nurse's commitment to help the patient achieve that objective. A health orientation, goal‐oriented work, nursing decision‐making and a rehabilitative approach to work are all central to this effort. Work is organized in multidisciplinary teams where nurses have equal responsibilities with other professional staff. Testing and development of the model is ongoing.
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Geriatric rehabilitation care (GRC) is short-term and multidisciplinary rehabilitation care for older vulnerable clients. Studies were conducted about its effects. However, elements that influence the quality of GRC have not been studied previously. In this study realist evaluation is used to find out which are the mechanisms and outcomes and which (groups of) persons are the context for GRC, according to GRC professionals. The mechanisms, outcomes and context of GRC were explored in three consecutive phases of qualitative data gathering, i.e. individual interviews, expert meeting, and focus groups. Eight mechanisms — client centeredness, client satisfaction during rehabilitation, therapeutic climate, information provision to client and informal care givers, consultation about the rehabilitation (process), cooperation within the MultiDisciplinary Team (MDT), professionalism of GRC professionals, and organizational aspects — were found. Four context groups—the client, his family and/or informal care giver(s), the individual GRC professional, and the MDT—were mentioned by the respondents. Last, two outcome factors were determined, i.e. client satisfaction at discharge and rehabilitation goals accomplished. In order to translate these insights into a practical tool that can be used by MDTs in the practice of GRC, identified mechanisms, contexts, and outcomes were visualized in a GRC evaluation tool. A graphic designer developed an interactive PDF which is the GRC evaluation tool. This tool may enable MDTs to discuss, prioritize, evaluate, and improve the quality of their GRC practice.
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