Date of Award


Document Type

Doctor of Nursing Practice (DNP)

Degree Name

Doctor of Nursing Practice (DNP)



Committee Chair

Karen Frith

Committee Member

Susan Alexander

Committee Member

Zaheer Khan


Older people--Medical care, Critical path analysis, Long-term care of the sick, Geriatric nursing, Nursing care plans


The period of care transition for the older adult is one of greatest risk often leading to negative consequences and avoidable hospital readmissions. The transition from hospital to home was explored in older adults aged 65 years and older being discharged from an unit specializing in elder care known as an Acute Care for the Elderly or ACE unit (n= 12) or a non-ACE unit (n=85). Prior to discharge a Mini Mental State Examination (MMSE) was performed and a follow up telephone survey was conducted using the Care Transition Measure-15 (CTM-15) which reflects the overall quality of the care transition. Although this exploration did not find significant main effect for age groups on CTM-15 or MMSE scores, ACE units did show lower MMSE scores than the non-ACE units as well as longer length of hospital stays. Findings suggest that future studies include comparisons with similar sample sizes between ACE and non-ACE units as well as more consistently aligned patient types with surgical versus medical diagnosis. Implications of understanding the patient experience of the care transition can lead to quality improvement in the transitional process, possibly avoiding many of the negative consequences.



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