Patient problems and advanced practice nurse interventions during transitional care

This study is a secondary analysis of patient records written by advanced p ractice nurses (APNs) as they provided discharge planning and 4 weeks of ho me follow-up to elderly patients hospitalized with common medical and surgi cal conditions. The purposes of this study were to examine the problems exp erienced by elders who were hospitalized and discharged to home, the interv entions used by APNs as they cared for these patients, and the linkages bet ween patient problems and APN interventions. Care logs written by the APNs to document the patient problems and nursing interventions were content ana lyzed and coded using the Problem Classification Scheme and Intervention Sc heme of the Omaha System. The results provided a description of the 10 most frequent problems experienced by the patients linked with the APN's interv entions. The study provides a description of the nature and complexity of p atient problems as they transition from hospital to home and increases our understanding of the contribution of APNs to the care of elders.