RELATED TO CHANGES ASSOCIATED WITH HEALTH CARE FACILITY TRANSFERS OR ADMISSION TO LONG-TERM CARE FACILITY
Prevention is Key. Strategize How Best to Prevent Stress for Each Person Before Relocation
All staff members must be aware of and alert to the complex process of relocation for both the person and family before proactively decreasing stress factors (Maun, 1996; Morgan, 1996).
Reduce or Eliminate Causative and Contributing Factors
Environmental Differences Between Old and New Settings/Minimal Continuity of Care in New Environment
Design a program to prepare relocated residents and staff for the move, orienting them to the physical layout many times until they feel familiar with the new environment.
Provide visual presentations (through bulletin boards, posters, letters, and so forth) and first-hand accounts of new environment for those who cannot view the area before relocation.
Seek input from former staff regarding client and plan of care.
Initially maintain client on same activity level and diet through pretransfer and post-transfer units.
Transfer person to similar, proximal area when possible.
Wean any monitoring equipment gradually before transfer.
Transfer all personal items with the person, such as mobility aids, eyeglasses, hearing aids, dentures, prostheses, and belongings.
Transfer person during daytime hours.
Maintain similar heights of furnishings/beds.
Clearly mark steps and other potential environmental hazards.
Maintain people in familiar groups at mealtimes and in living arrangements.
Promote a welcoming, warm, and clean receiving environment.
Allow time for discussions regarding living spaces in old and new environments.
Gradually decrease nursing attention before ICU transfer, when possible.
Involuntary Relocation/Lack of Control in Decision Making
Offer decision-making opportunities throughout relocation experience.
Promote person’s input regarding new environment when possible, such as use of decorations and arrangement of furniture.
Present transfer from a critical care unit as an indicator of improvement.
Inform hospitalized person of signs of daily progress.
Transfer client in an unhurried manner.
Establish mutual goals before relocation to nursing home.
Provide opportunities for questions/answers with relocation preparation.
Hold regular staff/resident meetings after relocation, encouraging new members to be involved with the facility’s rules and regulations (Wilson, 1997).
Include parents in the care of their hospitalized premature infant as much as possible.
Promote use of support systems both inside and outside the hospital for parents of hospitalized infants.
Recent or Concurrent Interpersonal Loss
Discuss adaptation to the relocation with family members.
Assess responses of all family members to the relocation.
Identify family members who may need additional help with adjustment.
Encourage family members to share their perceptions of relocation with one another.
Offer the person help in maintaining contact with significant others by telephone calls, letters, and visits with previous roommates when applicable.
Introduce person to nurse from post-transfer unit before transfer.
Accompany client to post-transfer unit.
Provide follow-up visit of nurse from pretransfer unit to person on post-transfer unit.
Encourage family members to visit person during and after relocation.
Minimize number of transfers in the health care facility.
Visit resident daily.
Promote formation of friendships in new environment.
Encourage family involvement in resident’s care.
Visit person in own home before nursing home placement.
Support the client’s efforts to adjust to the new environment.
Assist client to remember past relocations that were positive (Johnson & Hlava, 1994).
Provide gatherings for clients and staff experiencing closure of their facility (Craig, 1997).
Decreased Physical and/or Psychosocial State
Promote discussion of feelings regarding relocation.
Encourage use of problem-solving skills.
Offer potential solutions to problems when person cannot do so.
Promote sleep with use of previous bedtime routines, back rubs, white noise, music, warm milk, and minimization of noise in surrounding areas.
Encourage positive eating habits with use of favorite foods, a pleasant eating environment, and any appropriate supplements.
Orient the client fully to the new environment.
When possible, retain highly anxious person in pretransfer unit until anxiety decreases.
Provide for spiritual needs (eg, visit from clergy, hanging religious symbols in new location, transporting client to a religious ceremony).
Use cues such as signs and arrows for the relocated.
Assist person in learning to view the relocation more positively.
Teach/mobilize coping strategies.
Reassess relocation perceptions periodically.
Residents diagnosed with pneumonia have more effective outcomes when treated at the nursing home compared with those who were hospitalized (Fried et al., 1997).
Reduce the Physiologic Effects of Relocation (Refer to Key Concepts)
Assess Before Relocation
Identify Person at High Risk for Selected Physiologic Responses
Changes in orientation
Cardiovascular complications (eg, ischemia, dysrhythmias)
Prevent or Reduce Confusion and Activity Intolerance
Promote Integration After Transfer into a Long-Term Care Nursing Facility
Allow as many choices as possible regarding physical surroundings and daily routines.
Encourage person or family to bring familiar objects from person’s home.
Orient to physical layout of environment.
Introduce relocated individuals to new staff and fellow residents.
Encourage interaction with other people in new facility.
Assist client to maintain previous interpersonal relationships.
Clearly state smoking rules and orient client to areas where smoking is permitted.
Promote the development or maintenance of a relationship with a confidante.
Reestablish normal routines, while initially increasing staffing and lighting, when a large number of long-term care residents are involved in a secondary relocation.
Assist nursing home residents to meet people from their previous geographic area.
Arrange frequent contacts by a volunteer or staff member with each newly admitted resident. Also, match a successfully relocated resident with the new resident to begin the networking process.
Initiate Health Teaching and Referrals, as Indicated
Prepare person for relocation.
Include family in teaching.
Offer information about positive health habits and resources during illness.
Make appropriate professional referrals as needed, as well as suggesting a phone monitoring system such as “Lifeline.”
Refer relocated families to community agencies related to newcomers and to mental health agencies when at risk for relocation stress syndrome.
Assess the perceptions of parents of hospitalized infants regarding an upcoming transfer and their interest in related information.
Maintain at least daily communication with parents about their hospitalized infant (eg, condition, timing of transfer, mechanisms for continuity of care between the pre- and post-transfer nurseries) and their concerns.
Suggest that parents of hospitalized infants visit the nursery where their child will be transferred before the event.
Develop and use a mechanism for a thorough exchange of information between pre- and post-transfer nurseries.