Abstract
Background: With the aging population in Singapore, caregiving at home is no longer a straightforward task. Due to illnesses, patient deteriorate with functional impairment. Caregivers at home are challenged with care duties, especially if they do not have adequate time to learn how to care for the patient upon medical stability for discharge. Hospitals are facing the stress of bed occupancy and dilemma of keeping patients in wards while ensuring adequate caregiver training.
Carers are often overwhelmed by the complexities of providing care at home post discharge
Approach: Our team included patients’ carers as a member of the care team. They are provided with the necessary information, training, and support to fulfil their needs as carers at home. We also focused on building a collaborative relationship with carers, to better coordinate the care for the patient in the hospital.
The whole initiative started from the voices of our patients, noting their needs of carers to support them in the hospital or at home competently. To achieve this, we kickstarted the design processes with our Nurse Educators department and developed a carer onboard learning roadmap with “Three Wells” in mind: Move Well, Eat Well, Sleep Well. This becomes the principle to guide the carers on how to support the patients' activities during hospitalization.
Our team also collaborated cross-department with the corporate communication team, to formulate ways to give carers recognition of their roles and contribution, such as a badge signifying their presence as part of the care team. Our program empowers the carers by granting them access to specific facilities in the ward, extended visitation hours in the ward for more contact time with patient and clinical care team, Lastly, our team interacted with nurses from various departments during program roadshows, sharing with them the purpose of the program and their roles to support the onboarded carers.
Results: We recruited 204 carers within 4 months into the program. Qualitative survey indicated patients felt that communication between themselves and their carers improved and are more reassured their needs in hospitals are addressed promptly. Carers felt that the resources given were helpful and the extended time helped with their carer training. Nurses are more confident that carers are competent to take care of the patient post discharge. Patients were found to be more proactive in their care and recovery. Overall, analysis showed the carers stayed an average of 4hours per day during patient inpatient stay, which translated to 38 full-time equivalent (FTE) hours saved in a year for nursing workload.
Implication: This Carer-on-Board initiative showed the demand for carer to be more involved in inpatient care of patients and the great opportunity to foster strong collaborative relationship and improve communication between carers and healthcare providers.
We continue to expand the program to involve and benefit more inpatients. We continue the iterative process to gather feedback from patients and carers to ensure the interventions optimally address the family/carers on their needs, expectations, and concerns related to healthcare delivery.