Massachusetts General Hospital

OverviewAwardee, Barbara Roberge, NP, Ph.D

The primary goal of The Nursing Ambulatory to Hospital Transitions Program (NAHT) is to determine whether communication of a preventive nursing care plan between ambulatory and hospital nurses will improve nursing care and reduce hospital complications. This study will identify those patients at risk of poor hospital outcomes, by tracking symptoms and complications throughout hospitalization and identifying how preventive nursing interventions improve care. Communication between ambulatory and hospital nurses during home-to-hospital transitions will focus on risk recognition and prevention of complications once hospitalized. This shared information, key to the care of patients, will occur within first 24 hours of hospitalization and thus, help the hospital nurse put into place a preventive care plan that will be tailored to the individual patient and focused on improving the patient’s hospital stay and avoiding injury.

The secondary objectives are two-fold. (1) To develop a pre-hospital patient risk index by identifying office based predictors of complications during hospitalization in vulnerable older adults. (2) To describe the hospital trajectory of patients within each risk index. Research on trajectories in the last year of life has demonstrated that frail elders have distinct declines in function that differ from those with organ failure, yet it is unknown if the nursing care of these groups differ. Specifically data will be collected about the nursing care requirements, the timing of and inter-relationship between symptoms and nurse interventions.

Symptom management is at the core of nursing yet we know little about the antecedents, interactions, and timing of symptoms and how nurses intervene to manage these complex phenomena over the course of a hospitalization. In summary the goal of this research study is to improve nursing communication in order to enhance the hospital experience for older adults.

Geriatric Medicine Unit

Phone: 617-726-4600
Fax: 617-228-6306

Public Transportation Access: yes
Disabled Access: yes

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