Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best practice research information from scholarly nursing journals and official nursing websites. Analytical strategies included a review of the literature to examine data from nursing journals, websites, and other publication sources in addition to the use of a synthesis matrix that classified different ideas rated by the Cochrane Consumer Network. The findings of this project might contribute to positive social change by fostering improved patient assessments, enhanced communication with PCPs, early intervention, and decreased LTC-to-hospital admission rates through the improvement of nursing practice policy.

With the increasing incidence and prevalence of heart failure in the United States, the burden imposed on both the patients and healthcare system is becoming increasingly difficult to manage. In 2009, the American Heart Association estimated that there were 15 million office visits and 6.5 million days spent in the hospital due to heart failure. Complex regimens requiring lifestyle alterations make it difficult for patients to adhere to provider recommendations. In an attempt to decrease this burden, the effects of home telemonitoring have been under investigation. An integrated review of the literature was conducted to summarize findings from studies investigating whether home telemonitoring increases patient adherence to prescribed therapy while reducing hospital admissions and readmissions. The search included relevant studies from 2005 to 201 0. A total of eleven studies were reviewed in this thesis. Statistically significant improvements were found in four of the five articles regarding patient adherence. Two of the articles reporting on hospital admissions indicated statistically significant reductions. while the others showed a trend towards a reduction in hospitalizations. Statistically significant decreases were found in hospital readmissions in three of five studies. While the evidence was not strong enough to support broad-scale implementation, telemonitoring can be recommended as a viable adjunct to usual care for some patients. Nurses should be at the forefront for providing patient education and assessing data provided by telemonitoring equipment. Large-scale. replicable studies are recommended to further determine the effectiveness of telemonitoring related to outcomes of heart failure patients.

Mental health services in Australia (and in most western countries) have undergone considerable changes in the past 20 years. These changes have included the closing or downsizing of the old tertiary institutions and a move towards community treatment of people with a mental illness (consumers). Consumers no longer live in hospitals; as a consequence housing has become an important aspect of their lives. Research has demonstrated that when consumers live in good quality housing of their own choosing they report improved quality of life, more satisfying supportive social relationships, and have fewer admissions. People with schizophrenia are the largest psychiatric diagnostic group treated by the public health system in Australia. As a result of their illness people with schizophrenia often have difficulty in maintaining reasonable quality accommodation and supportive social relationships. A review of the available literature on housing options indicates that, for people with a mental illness, boarding houses are the least desirable type of community housing and that living in their own home is the most desirable. These were the two types of housing chosen for the study. Aims of the study This study aimed to explore the impact of housing on the mental health of people with schizophrenia. Study Design Stage 1 For the initial stage of the project archival data was used to investigate the relationship between types of accommodation and illness patterns of people with schizophrenia. The hypotheses for stage 1 of the project were: 1. Admission rates will be significantly different for people with schizophrenia who are discharged to a private home when compared to those discharged to a boarding house. 2. Length of stay in hospital will not be significantly different for people with schizophrenia discharged to a private home when compared to those discharged to a boarding house. 3. Symptoms, as measured by scores on HoNOS scale, will be significantly different for people with schizophrenia living in a private home when compared to those living in a boarding house. 4. The level of functioning, measured using an LSP 16, will be significantly different for people with schizophrenia living in a private home when compared to those living in a boarding house. Inclusion Criteria The subjects included were between 18 and 65 years of age and had a principal diagnosis of schizophrenia. Findings Findings indicate that people with schizophrenia are more likely to be admitted to hospital if discharged to a boarding house. Surprisingly, results also indicated that while there were no differences in the level of psychiatric symptoms experienced, people with schizophrenia living in boarding houses had less access to social support, meaningful activities and work and had lower levels of global functioning. These findings contradict the conventional wisdom that people with schizophrenia resort to living in boarding houses because of their level of disability. Stage 2 Stage 2 of the study further explored the impact of housing type on the mental health of people with schizophrenia by examining the experience of thirteen people living independently in private homes or in a boarding house. The study aimed to use the experiences of the participants to develop a grounded theory explanation of the impact of housing on people with schizophrenia. Findings from Stage 2 indicated a strong desire amongst all participants to live in their own home. Participants living in their own home had access to more opportunities and resources for staying well than participants living in boarding houses. Those participants who lived in their own home felt they belonged, they felt safe and most importantly they had greater opportunities to make and maintain supportive social relationships with friends and family. Participants reported that stable housing and supportive relationships helped them to stay well.