Transitions of Care: Pulmonary Disease Part 2
Presented by Cathy Wollman
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This course will continue to highlight interventions to improve outcomes for skilled nursing facility (SNF) residents with chronic obstructive pulmonary disease (COPD) or pneumonia. The focus of Part 2 will be on self-care education, discharge planning, and quality transitions of care. Emphasis will be on educational interventions for the resident and caregiver to enhance their ability to manage self-care. The course’s overall goal is to prevent unnecessary hospitalization following discharge. The course will also focus on unique resident goals for COPD management, including preferences for palliative and end-of-life care. The course will conclude with a case study of a complex resident with pulmonary disease.
Meet your instructor
Cathy Wollman
Dr. Wollman has been an educator and clinician for more than 35 years. She has worked as a gerontologic nurse practitioner at multiple sites of care across the health care system. She also served as director of senior health for a large health system and the coordinator of the nurse practitioner program for more than ten…
Chapters & learning objectives
1. Education for Self-Care Management of Residents With COPD or Pneumonia
This chapter will focus on the role of the nursing staff and other members of the interdisciplinary team to enable residents and/or their caregivers to manage self-care when they return home. Education will include content related to diet, activity, medications, use of inhalers, and signs and symptoms that suggest worsening of the resident’s pulmonary disease.
2. Discharge Planning for Residents With COPD or Pneumonia
This chapter will focus on the essential clinical data to be shared with follow-up providers at the time of transition from the SNF. Appropriate referrals for residents with pulmonary disease will be discussed. This chapter will also focus on individual resident and caregiver goals based on prognosis and their potential for rehabilitation. The importance of advance care planning, hospice, and palliative care will be included.
3. Interactive Case Study
The case study will summarize and synthesize the learning related to the high-risk resident with COPD or pneumonia in the SNF. Interactive technology will allow the learner to use his/her knowledge and skills to provide quality care and achieve the desired outcomes for a complex resident with COPD or pneumonia.
