Home Health Care Management and Practice最新文献

{"title":"Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study","authors":"M. Narayan, R. Mallinson","doi":"10.1177/10848223211027860","DOIUrl":"https://doi.org/10.1177/10848223211027860","url":null,"abstract":"Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"234 3-4","pages":"24 - 34"},"PeriodicalIF":1.1,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211027860","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41309325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Experience of Caregiving for an Adult Sibling with Down Syndrome","authors":"Patricia Sciscione","doi":"10.1177/10848223211027861","DOIUrl":"https://doi.org/10.1177/10848223211027861","url":null,"abstract":"Adults with Down syndrome are living longer than ever before and are likely to outlive their parents. Adult siblings have been identified as future caregivers, yet little is known about this experience. The prominent caregiving literature focuses on the anticipation of caregiving rather than on the experience of being a caregiver. The aim of this study was to explore the lived experience of being a caregiver to an adult sibling with Down syndrome. A descriptive phenomenological approach was used to interview seven siblings who were partial and full caregivers for an adult sibling with Down syndrome. The participants fulfilled multiple roles in the lives of their siblings throughout their adult lives, but felt unprepared to fulfill the duties of being full-time caregivers upon the death of their parents. Navigation of the social service system was complex and frustrating with no support or guidance. Everyday tasks of caregiving were time consuming and managing the medical and social service needs of their siblings was viewed as a huge responsibility. Participants felt the responsibilities of caregiving put limitations on their personal lives. Despite the challenges, participants felt caregiving had benefits also. The transition to being caregivers was difficult because of the lack of planning by their parents, yet participants have not made plans for the future succession of caregiving. Implications are identified for healthcare and social service professionals to aid families in the care of adults with Down syndrome and in planning for the future transition of caregiving in families.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"34 1","pages":"3 - 8"},"PeriodicalIF":1.1,"publicationDate":"2021-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211027861","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42693172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-existing Inequality II: Social Workers Assess Impact of COVID-19 on Medicare Home Health Beneficiaries","authors":"W. Cabin","doi":"10.1177/10848223211020433","DOIUrl":"https://doi.org/10.1177/10848223211020433","url":null,"abstract":"There is significant data on the adverse impact of COVID-19 on persons who were poor, minorities, had compromised physical or mental health, or other vulnerabilities prior to the COVID-19 pandemic. A significant portion of the Medicare population has such vulnerabilities. The Medicare home health beneficiary population is even more vulnerable based on gender, race, income level, living alone status, and number of chronic conditions. A literature review indicated there were no studies on the impact of COVID-19 on Medicare home health beneficiaries. In a previous issue of this journal, the author addressed the literature gap by presenting a study on home care nurses’ perceptions of the impact of COVID-19 on Medicare home health beneficiaries. The current study is a companion qualitative study to the nurses’ study. It is based on interviews of a convenience sample of 52 home care social workers from 11 different home health agencies in New York City between April 1 and September 30, 2020. Seven major themes emerged, 6 of which were identical to the themes identified by the nurses. The only new theme was limits on the ability to provide psychosocial interventions had more severe consequences. The 7 themes were: need for social service supports increased; loneliness and depression increased among patients; physical and mental health conditions became exacerbated; substance use and abuse increased; evidence of domestic violence against patients increased; there was limited staff and equipment to care for patients; and limits on the ability to provide psychosocial interventions had more severe consequences.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"305 - 313"},"PeriodicalIF":1.1,"publicationDate":"2021-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211020433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46287637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Transition Care Interventions from Hospital to Home on Rehospitalization in Older Patients with Heart Failure: An Integrative Review","authors":"Wanich Suksatan, T. Tankumpuan","doi":"10.1177/10848223211023887","DOIUrl":"https://doi.org/10.1177/10848223211023887","url":null,"abstract":"Heart failure (HF) is one of the common causes of rehospitalization in older people leading to an increase in the number of mortalities, disabilities, and readmission rates. However, there has been a lack of literature reviews on current evidence regarding the effects of transition care interventions (TCI) on rehospitalization before discharge from hospital to home. The current review aims to examine the effectiveness of transition care interventions on rehospitalization within 30-days for older patients with HF. The current review of international knowledge employs the PRISMA guidelines and includes primary studies published between 2011 and 2021 taken from PubMed, CINAHL, PsycINFO, Cochrane, and Scopus. Our review identified 15 relevant studies that together examined 10,701 patients with HF. We found that the effectiveness of TCIs could reduce rehospitalization rates and costs of care. The findings asserted that nurses, pharmacists, and multidisciplinary teams were predominantly provided transition care interventions. In principle, transition care intervention could inform policymakers to develop the current discharge planning practices in older HF patients. Therefore, interdisciplinary healthcare teams and caregivers should develop the transition care interventions with long-term periods before discharge from hospital to their home, particularly for older patients with HF in order to improve their capacity for self-care, quality of care, and promote continuing care.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"34 1","pages":"63 - 71"},"PeriodicalIF":1.1,"publicationDate":"2021-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211023887","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49272694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demonstration of an Analytic Process using Home Health Care Electronic Health Records: A Case Example Exploring the Prevalence of Patients with a Substance Use History and a Venous Access Device","authors":"H. Byon, Soojung Ahn, Virginia T. LeBaron, G. Yan, Ronald M. Grider, M. Crandall","doi":"10.1177/10848223211021840","DOIUrl":"https://doi.org/10.1177/10848223211021840","url":null,"abstract":"Electronic health records (EHR) are an important, but underutilized source for home health care research and practice improvement. Although the use of EHR is more efficient than prospective data collection, an analysis of EHR data can be complex and time-consuming. To demonstrate the overall process, we describe a secondary analysis of EHR data that explored the prevalence of home health care patients with a substance use history (SUH) and a venous access device (VAD). We detail our process of EHR data extraction, management, and analysis to assist researchers and clinicians interested in similar work. The example analysis showed that that 10.6% of adult home health care patients had a SUH, 8.8% had a long-term VAD, and 1.3% had both. EHRs can be a valuable data source for home health care research and quality improvement projects, but a systematic and thoughtful strategy is needed to fully leverage their potential.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"34 1","pages":"35 - 41"},"PeriodicalIF":1.1,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211021840","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41525081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing","authors":"S. Bigger, L. Haddad, Sangeeta C. Ahluwalia, L. Glenn","doi":"10.1177/10848223211021393","DOIUrl":"https://doi.org/10.1177/10848223211021393","url":null,"abstract":"Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"288 - 295"},"PeriodicalIF":1.1,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211021393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49001224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Home-Based Self-Care Education on Blood Pressure and Self-Care Behaviors among Middle-Aged Patients with Primary Hypertension in Iran: A Randomized Clinical Controlled Trial","authors":"Sara Hazrati Gonbad, M. Zakerimoghadam, Shahzad Pashaeypoor, S. Haghani","doi":"10.1177/10848223211012727","DOIUrl":"https://doi.org/10.1177/10848223211012727","url":null,"abstract":"Self-care education (SCE) through home visit is one of the methods with potential effects on self-care. This study aimed to evaluate the effects of home-based SCE on blood pressure and self-care behaviors among middle-aged patients with primary hypertension in Iran. This randomized controlled trial was conducted on 110 middle-aged patients with hypertension recruited from public healthcare centers in the south of Tehran, Iran in September 2019. After convenience sampling, Participants were simple randomly allocated to control and intervention groups. Intervention group received a 2-month home-based SCE while control group received routine care services. Before and 2 months after the intervention, self-care behaviors were assessed using the Hypertension Self-Care Activity Level Effects (H-SCALE). Data were analyzed using the SPSS software (v. 16.0) at a significance level of less than .05. After 2 months, the posttest mean scores of self-care behaviors in medication adherence (17.42 ± 1.03 vs 14.49 ± 1.01, p = .04), physical activity (8.16 ± 0.39 vs 6.47 ± 0.52, p = .01), low-salt diet (52.51 ± 3.8 vs 35.36 ± 3.47, p = .001), and blood pressure control (3.47 ± 0.22 vs 2.42 ± 1.89, p = .001), in the intervention group were significantly greater than the control group. However, there were no significant between-group differences respecting the posttest mean scores of the weight management (p = .06) and smoking cessation (p = .2). Also, the mean blood pressure between the 2 groups changed after the intervention, but this difference was not statistically significant. This study suggests the effectiveness of home-based SCE in significantly improving self-care behaviors among patients with hypertension. But more studies are needed to measure the effectiveness of intervention on blood pressure. IRCT code: IRCT20190623043985N1. Registered 06/30/2019, https://fa.irct.ir/trial/40351.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"34 1","pages":"9 - 16"},"PeriodicalIF":1.1,"publicationDate":"2021-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211012727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41710852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Pharmacists in Home Health Care: A Study Set in a Regional Hospital in Taipei City","authors":"Mei-Ju Chen, Feng-Hsia Kao","doi":"10.1177/10848223211016416","DOIUrl":"https://doi.org/10.1177/10848223211016416","url":null,"abstract":"In response to population aging, there is an increase in demand for the coverage of and the necessary services provided by home health care and home care for socially vulnerable groups. This study explored whether the instructions and recommendations offered by pharmacists during their home visits play a key role in the factors that influence a patient’s prognosis. A home health care database was analyzed in this study. The subjects received home visits from pharmacists. There were 262 subjects following the exclusion of closed cases that were not due to improved outcomes or death. To validate the research framework, multiple regression analysis was employed for model validation. The level of consciousness and Barthel Index score mediated the effects of multimorbidities, and these mediating effects significantly affected patient outcomes (improvement or death). The medication-related knowledge and instructions for correct medication use provided by pharmacists did not exhibit significant moderating effects on the influence of a patient’s level of consciousness and Barthel Index score on their improved outcomes. However, the pharmacists’ provision of instructions and recommendations for patient self-care had significant moderating effects on the path by which patients with multimorbidities experienced improved outcomes through higher total Barthel Index scores. In comparison with physician home visits, which merely cover the treatments for diseases, pharmacists also play a vital role in home health care. Pharmacists provide patients with medication-related knowledge and instructions for correct medication use. This study addressed aspects that have not been considered in previous studies.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"272 - 279"},"PeriodicalIF":1.1,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211016416","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42324084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms Experienced by Women at Home and Self-Care Agency after Breast-Conserving Surgery","authors":"G. Cankaya, Rabia Sağlam","doi":"10.1177/10848223211011710","DOIUrl":"https://doi.org/10.1177/10848223211011710","url":null,"abstract":"This study was conducted to determine the symptoms experienced by women at home and self-care agency after breast-conserving surgery. The study was carried out in a public hospital in Istanbul between January and June 2018. The sample of the study consisted of 65 women. The data were collected through face-to-face interviews using Patient Description Form, Symptom Check List and Self-Care Agency Scale during outpatient check-ups in the first and third weeks following discharge. The mean age of the women was 52.68 ± 13.24. Fatigue, weakness, pain and insomnia were mostly experienced symptoms in the first and third weeks after discharge while fever, discharge from the wound area and nausea-vomiting symptoms were the least experienced symptoms in these weeks. It was determined that women had moderate self-care agency in the first and third weeks of discharge. Women who were married and whose income was equal to their expenses had higher self-care agency, and those living alone had lower self-care agency than those living with their spouses and children (p < 0.05). The self-care agency scores of those who did not have a chronic disease were higher than those with chronic diseases (p < 0.05). It is found that women with breast-conserving surgery experience symptoms related to the operation in the first and third weeks of discharge. Women’s self care agency was moderate during the follow up period, meaning that these patients should be supported by nurses with regard to self care agency and symptoms experienced at home.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"264 - 271"},"PeriodicalIF":1.1,"publicationDate":"2021-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211011710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46542154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Oral Health Literacy, Behaviors, and Oral Health Care among Caregivers to the Homebound Population","authors":"Agata Wilk, Lisa LaSpina, L. Boyd, Jared Vineyard","doi":"10.1177/10848223211008435","DOIUrl":"https://doi.org/10.1177/10848223211008435","url":null,"abstract":"This study aimed to explore the level of perceived oral health literacy (OHL) among caregivers of the homebound population in the Chicago metropolitan area and how caregivers’ OHL impacts their oral care to the homebound population. The relationships between demographic characteristics, perceived OHL levels, personal oral health behaviors, and oral health care to clients were also assessed. This cross-sectional survey research examined 69 caregivers of the homebound population employed by home health agencies. The OHL was determined by the validated Health Literacy in Dentistry Scale (HeLD-14). Independent t-tests, chi-square tests set at p < .05 significance level, and logistic regressions were used for analysis. The mean age of participants was 43. The HeLD-14 scores indicated a high perceived OHL among this group. Caregivers came from diverse groups, and the majority spoke a second language at home. About 93% performed oral self-care the recommended amount of time or more, while only 57% did it for their clients. Those who cleaned clients’ mouth twice a day had a higher OHL score (M = 23 compared to M = 19). About 43% did not check for sores in the client’s mouth, and those who checked had a higher OHL score (M = 25 compared to M = 19). Controlling for OHL, age was a good predictor of oral care frequency to clients. These findings provide current evidence and add to the body of knowledge on OHL among homebound individuals. The results provide insights for designing a preventive approach in oral health care to the homebound population.","PeriodicalId":45762,"journal":{"name":"Home Health Care Management and Practice","volume":"33 1","pages":"280 - 287"},"PeriodicalIF":1.1,"publicationDate":"2021-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/10848223211008435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49076438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}