By Melinda Young
EXECUTIVE SUMMARY
Brain injury patients and their caregivers face difficult care transitions after leaving an inpatient setting. But care teams with case management can help caregivers by assessing their readiness and engaging with them in interprofessional meetings early.
- Readiness assessment can be performed through the Preparedness for Caregiving Scale.
- The goal is to improve communication and ensure patients understand each step of the transition process.
- Each patient is treated with an individual plan as the care team assesses their challenges, needs, and strengths.
Brain injuries affect several million people each year in the United States. One of the biggest care transition challenges is ensuring caregivers can handle the patients when they return home.1
When case management or care teams meet with patients with brain injuries, caregivers should be involved. Much of the patient’s care transition success will rely on caregiver support. But this does not always happen as early in the process as is needed.
“The standard practice was an interprofessional team meeting, but not always including the caregiver. They would include the caregiver if [he or she] were there,” says Barbara Buchko, DNP, RN, director of evidence-based practice and nursing research at WellSpan Health in York, PA.
A better tactic is to include caregivers in early interprofessional meetings, which can help the care team better understand caregivers’ needs as they prepare to help the brain injury patient at home, according to recent research co-authored by Buchko.1
Buchko and colleagues evaluated the effect of a standardized interprofessional team meeting with caregivers, within three or four days of admission. The team assessed the caregivers’ readiness through the Preparedness for Caregiving Scale (PCS).
“We believe meeting earlier in the hospital admission — with that focus of getting to know the caregiver and their needs — could help us establish an open rapport and communication in preparing them for discharge,” Buchko explains.
The brain injury unit at WellSpan implemented the new process of meeting with caregivers early, says Andrea Lutz, MSN, RN, CBIS, CRRN, lead study author and a clinical nurse educator at WellSpan Surgery and Rehabilitation Hospital.
The brain injury team — consisting of a physician, nursing, case management, therapists, and a psychologist — held the same meetings with patients as before, but they made sure caregivers were present.
“The focus for the meeting was to really get to know the patient and the caregiver, and to get to know their concerns and perspective,” Lutz explains. “This was a new process implemented for our brain injury unit. During the study, all patients got this intervention.”
The most striking result of the change was how it improved the relationships, rapport, and trust between staff and caregivers. “This helped increase discharge preparedness, and we were able to meet everyone’s goals,” Lutz notes.
These meetings shed more light on patients’ lives before their brain injury. These clues can aid in treatment. “We asked if they had any trauma in the past, and the same for the caregiver, too,” Lutz explains. “Sometimes, there was some kind of trauma that was significant to the care.”
At first, adjustment to this new process was difficult for staff. But they eventually enjoyed it because they learned information that allowed them to tailor treatment to each patient and caregiver. “There were no missed communication and interpretation, and the caregiver could hear everyone’s input,” Lutz says.
Before the change, it might have been a week before caregivers would hear from the team. That was a long time to make assumptions before issues are clarified, Lutz says.
“What was happening when we weren’t meeting early with the caregiver is the caregiver would not necessarily support the plan and would be upset, and then you’d have a reactionary meeting,” Buchko says.
The PCS consists of eight questions. It is used for palliative care, Parkinson’s disease, hospice, and other situations. Brain injury staff administer the preparedness scale at the beginning of the admission. If the caregiver scores low on a component, the team makes sure it is addressed. The scale is used again within three days of discharge to see if the score has improved. Nursing assistants, case managers, therapy techs, and others could administer the scale.
“Case managers are already addressing a lot of these areas of questions, so it would make sense for case managers to do it,” Lutz says.
The PCS questions include:
- “How well prepared do you think you are to take care of your family member’s physical needs?”
- “How well prepared do you think you are to respond to and handle emergencies that involve him or her?”
- “How well prepared do you think you are to find out about and set up services for him or her?”
“The big area in our meetings was to address the question of how well prepared you are to take care of his or her emotional needs,” Lutz says.
Lutz, Buchko, and colleagues were worried about safety, such as the question about the caregiver’s ability to handle emergencies. “We reviewed what they would do if they encountered an emergency, and it was very patient-specific,” Lutz reports. “Say they were concerned about the patient getting out of the house. We’d talk about safe house set-ups and putting locks on the doors.”
With technology, caregivers can use alarms, trackers, and apps to assist them in helping patients take their medication and perform other tasks. “Technology has come a long way for the brain injury population,” Lutz notes.
The main idea is to find out what motivates caregivers and patients, and what they are concerned about. “Is there anything in their past that we need to know about? It’s the focus of getting to know them so the plan would be focused on their needs,” Buchko says. “This is something our health system has embraced, and we took it a step further. Getting to know patients as a person makes it personalized. Patients are not coming off an assembly line — they all have unique needs.”
REFERENCE
- Lutz AM, Warehime KM, Woods AB, et al. Implementation of interprofessional meetings preparing caregivers of patients with brain injury for discharge: A pilot study. Prof Case Manag 2022;27:239-245.
Brain injury patients and their caregivers face difficult care transitions after leaving an inpatient setting. But care teams with case management can help caregivers by assessing their readiness and engaging with them in interprofessional meetings early.
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