Often developed for acute care and less frequently for primary care, care bundles are clusters of evidence-based practices for improving care delivery and patient outcomes. Care bundles usually arise ...when ineffective or costly outcomes are identified, are meant to make care more reliable, and require superb teamwork and communication.
Patients using the highest proportion of health care services are those living with complex health conditions and challenging sociocultural lives, statistics corroborated within our primary care clinic. In our nurse practitioner (NP)-led, interprofessional, team-based primary care program serving mainly low-income patients, we noted that many patients with multiple chronic conditions had an excess of clinic encounters, emergency department visits, and hospitalizations.
To improve health status for these patients and reduce costly care inefficiencies, we developed a unique bundle of care practices for embedding within our NP-led complex care program. Our goals were to improve patient efficacy for self-management of chronic conditions and promote appropriate use of health care resources and services.
Using AEIØOU as a mnemonic, the derived care bundle better focused our team efforts and provided us with a planning, communication, and documentation schema for quality improvement. It was particularly useful for team-based care because tasks could be documented or communicated by letter or number and easily reviewed by team members or others involved in patients' care.
Use of the AEIØOU bundle within our program resulted in better coordination of team-based comprehensive care for our high-needs patients, seen anecdotally in fewer unnecessary contacts and missed appointments and in patient appreciation comments. Emergency department visits and hospitalization data for the six months before compared with 6 months after enrollment in the program showed significant reductions.
To improve the primary care of complex patient populations, we recommend further use and testing of the AEIØOU bundle within other care models.
In this Practice Inquiry, Mexican American parents’ perceptions of cultural influences on grieving the death of their child were described. Findings were used to inform a continuing education module ...for nurses involved in the care of Mexican American parents who have experienced the death of their child. This line of inquiry is important as the needs of grieving Mexican American parents are not always recognized by those providing care. Ethnographic methodology was used to explore the narratives of three Mexican American fathers and three Mexican American mothers who had experienced the death of their child. A purposive sample was recruited from a faith based community health center in Tucson, AZ. In depth interviews were conducted primarily in the participants’ homes by the researcher. All interviews were conducted in Spanish language. Data sources included participant interviews, participant observation, field notes and measures for demographic data and acculturation (ARSMA-II). The overarching cultural theme that represents the participants’ perspectives is El Dolor de los Padres: Pain in the Parent. The three major themes that support the overarching cultural theme include: (a) Enduring Great Pain, (b) Voices of Mexican American Parents, and (c) Cultural Death Traditions. The fourth major theme, Going Forward: For the Provider specifically addresses data gathered to educate nurses for supporting Mexican American parents grieving the death of a child. The findings of the study are interpreted within the context of the Mexican cultural concepts of familismo, machismo, marianismo, fatalismo, spiritualidad, respeto, confianza and personalismo and the concept of vulnerability. The study’s significance for the practice of nursing is upheld in the findings that are specific to understanding and preventing disparities in the care of Mexican American parents who have experienced the death of a child. Increasing nursing knowledge of the cultural context of grieving, especially spiritualidad and continuing memories, offering culturally competent nursing interventions at this time of deep emotional pain are elucidated in this Practice Inquiry.
In this Practice Inquiry, Mexican American parents' perceptions of cultural influences on grieving the death of their child were described. Findings were used to inform a continuing education module ...for nurses involved in the care of Mexican American parents who have experienced the death of their child. This line of inquiry is important as the needs of grieving Mexican American parents are not always recognized by those providing care. Ethnographic methodology was used to explore the narratives of three Mexican American fathers and three Mexican American mothers who had experienced the death of their child. A purposive sample was recruited from a faith based community health center in Tucson, AZ. In depth interviews were conducted primarily in the participants' homes by the researcher. All interviews were conducted in Spanish language. Data sources included participant interviews, participant observation, field notes and measures for demographic data and acculturation (ARSMA-II).The overarching cultural theme that represents the participants' perspectives is El Dolor de los Padres: Pain in the Parent. The three major themes that support the overarching cultural theme include: (a) Enduring Great Pain, (b) Voices of Mexican American Parents, and (c) Cultural Death Traditions. The fourth major theme, Going Forward: For the Provider specifically addresses data gathered to educate nurses for supporting Mexican American parents grieving the death of a child. The findings of the study are interpreted within the context of the Mexican cultural concepts of familismo, machismo, marianismo, fatalismo, spiritualidad, respeto, confianza and personalismo and the concept of vulnerability.The study's significance for the practice of nursing is upheld in the findings that are specific to understanding and preventing disparities in the care of Mexican American parents who have experienced the death of a child. Increasing nursing knowledge of the cultural context of grieving, especially spiritualidad and continuing memories, offering culturally competent nursing interventions at this time of deep emotional pain are elucidated in this Practice Inquiry.
