Home Care Setting Research Articles

Preliminary Usability Evaluation of Personal Medical Devices towards Better Home Healthcare

Portable medical devices have been playing an important role in improving health outcomes across the socio-economic spectrum. In the recent decades, substantial population have started using such devices to monitor important vital signs. Significant proportion of these users are older patients with chronic diseases, declined physical and/or cognitive capabilities. Furthermore, these portable devices are often used in unguided environments, that can present unpredictable use contexts. In this preliminary study, we conducted usability inspection on five portable medical devices. Cognitive walkthrough followed by Nielson’s ten Usability Heuristic evaluation method were utilized for the purpose of usability inspection. Sixteen usability concerns were uncovered in such evaluation study. We also recorded the elapsed time of measuring vital signs with all five devices on a daily basis in a month. The average total completion time after familiarization (after the first week) was 5.17 minutes. Results suggest that ‘non-expert’, independent users may face challenges when using portable medical devices in home care settings. Further, the study results also indicate that unsatisfactory usability of portable medical devices could pose hinderances in technology adoption among low eHealth literate users.

Bladder Scanners in Personal Care Homes


 For older adults with incontinence in a personal care home setting, using a bladder scanner to assist traditional urinary incontinence care may reduce the amount of daytime urine loss and use of incontinence pads without increasing caregivers’ care burden.
 Adding a bladder scanner to urinary incontinence care may not impact patient quality of life, mental state, depression, physical function, and level of motivation.
 These findings were based on 2 studies, 1 of which lacked a control group and did not directly measure the effect of adding a bladder scanner to urinary incontinence care on patients’ urine loss. This may limit our confidence in the findings.
 We did not find any studies that reported on the effect of using bladder scanners in the personal care setting on rates of catheterization, emergency department visits, urinary tract infections, or other harms. We also did not identify any cost-effectiveness studies or evidence-based guidelines that met inclusion criteria for this report.

A typology of integrated care policies in the care home sector: A policy document analysis.

Health and social care systems in many countries have begun to trial and adopt "integrated" approaches. Yet, the significant role care homes play within the health and social care system is often understated. A key first step to identifying the care home integration interventions that are most (cost-)effective is the ability to precisely identify and record what has been implemented, where, and when-a "policy map." To address gaps relating to the identification and recording of (cost-)effective integrated care home interventions, we developed a new typology tool. We conducted a policy mapping exercise in a devolved region of England-Greater Manchester (GM). Specifically, we carried out systematic policy documentary searches and extracted a range of qualitative data relating to integrated health and social care initiatives in the GM region for care homes. The data were then classified according to existing national ambitions for England as well as a generic health systems framework to illustrate gaps in existing recording tools and to iteratively develop a novel approach. A combined total of 124 policy documents were identified and screened, in which 131 specific care home integration initiatives were identified. Current initiatives emphasized monitoring quality in care homes, workforce training, and service delivery changes (such as multi-disciplinary teams). There was comparatively little emphasis on financing or other incentive changes to stimulate provider behavior for the care home setting. We present a novel typology for capturing and comparing care home integration policy initiatives, largely conceptualizing which part of the system or specific transition point the care home integration is targeting, or whether there is a broader cross-cutting system intervention being enacted, such as digital or financial interventions. Our typology builds on the gaps in current frameworks, including previous lack of specificity to care homes and lack of adaptability to new and evolving initiatives internationally. It could provide a useful tool for policymakers to identify gaps in the implementation of initiatives within their own areas, while also allowing researchers to evaluate what works most effectively and efficiently in future research based on a comprehensive policy map.

Nurse delivered medication safety screening program for home care visits.

Home care clients have safety barriers related to medication storage, disposal, and safe use of opioids. Limited research is available regarding medication safety initiatives in the home care setting. This study evaluates a medication safety initiative, linked with opioid misuse and overdose prevention screening, for home care clients with different levels of service. Training and screening tools designed for community pharmacies by the Opioid & Naloxone Education (ONE) Program were modified for use by home health nurses. All new admits to the home health services were screened for medication storage, medication disposal, and use of pain medications. Patients taking opioids were screened for opioid-specific risks. Interventions based on screening results included education, provision of medication lock boxes, drug disposal packets, and/or naloxone. Most home care clients (85%) are properly storing their medication and 38% were not properly disposing unused medications. Higher levels of care had greater pain medication needs, including the provision of naloxone. This study demonstrates the opportunity to incorporate medication safety screening into nursing home health visits.

Understanding of home care and interest level of nursing students working as home care nurses

Introduction: Comprehension materials in the learning curriculum allow students to think critically about nursing care while practicing in-home care. It also can foster an interest in working as a home care nurse but not all nurses students want to be home care nurses as hope. The purpose of this study is to analyze the relationship of understanding about home care with the interest level of nursing students to be home care nurses. Methods: This study is a quantitative correlational method with a cross-sectional approach. Data were examined in the univariate and bivariate analysis with Pearson correlation. Sixty participants were recruited by using a stratified random sampling technique. Results: This study showed that respondents have a good understanding of home care, as many as 51 respondents (85%). Also, most of the respondents are interested in working as a home care nurse, as many as 25 respondents (41.7%). The results obtained a p-value 0.000 (p<0.05) (r=0.633). This study showed that the level of understanding of nursing students is good, and the interest in working students as home care nurses is high. It can be concluded that the understanding of home care influences the work interests of nursing students to work as home care nurses. Conclusion: The theory and concept of home care as one of the working areas of nurses should be delivered to nursing students since they are in the academic stage, and clinical exposure to home care during the nurse profession will enhance them to involve more caring people in the home care setting.

Clinical Features of Hypoxemia Due to Infection Under Home-Based Medication During the COVID-19 Pandemic Period.

Despite the growing demand for home-based medication during the COVID-19 pandemic period, there remains scarce evidence of hypoxemic infection in home-care settings. In this study, we investigated the clinical features of hypoxemic respiratory failure due to infection during the period under home-based medication (defined as 'home-care-acquired infection'). This retrospective observational study enrolled patients with home-care-acquired infection, other than COVID-19, in two home-care clinics in Sapporo, Japan, between April 2020 and May 2021 (the early phase of the COVID-19 pandemic). The participants were divided into two groups according to whether they required additional home oxygen therapy, and were compared to assess the predictors of hypoxemic respiratory failure. Furthermore, the clinical features were compared with those in patients aged >60 years with COVID-19 who were admitted to Toyama University Hospital during the same period. A total of 107 patients with home-care-acquired infections were included in the study (median age, 82 years). Twenty-two patients required home oxygen therapy, and 85 did not. Thirty-day mortality rates were 32% and 8%. Among the patients in the hypoxemia group, none had desired a care-setting transition, following the advanced care planning. Multivariable logistic regression analysis showed that initial antibiotic treatment failure and malignant disease were independently associated with hypoxemic respiratory failure (odds ratio, 7.28 and 7.10; p=0.023 and p<0.005, respectively). In comparison with hypoxemia in the COVID-19 cohort, the lower incidence of febrile co-habitants and earlier onset of hypoxemia were significant in those due to home-care-acquired infection. This study demonstrated that hypoxemia due to home-care-acquired infection was characterized by distinct features, possibly differentfrom those due to COVID-19 in the early pandemic period.

Improving Confidence in Dementia Care by Helping Care Staff Articulate Skills They Already Possess: The Value of the Communication and Interaction Training (CAIT) Programme

This article discusses the findings from a training programme called ‘Communication and Interaction Training’ (CAIT). CAIT was designed to improve the confidence of carers in their use of communication skills with people living with dementia, particularly when managing behavioural agitation. This pre/post assessment study employed a mixed design, and showed positive effects in terms of quantitative and qualitative features. The participants were mainly from a specialist team who were experienced in managing episodes of agitation in care home settings. Twenty-three staff were assessed on the Confidence in Dementia Scale (CODE), which is a measure for assessing carers’ confidence in communicating with people living with dementia. The findings showed increased levels of confidence in communicating and interacting with people with dementia following the training. The qualitative findings showed improvements in participants’ abilities to articulate their communication strategies (i.e. higher degrees of specificity in their communication skills), indicative of improved dementia ‘literacy’ regarding their interventions. As a consequence of such improvements, it is suggested that greater confidence and literacy would lead to the delivery of better care due to enhanced self-awareness of good practices, and enhanced communication skills both within the staff group and between staff and residents.

Provision of eye care services and interventions in care homes: a narrative synthesis review.

The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population. This paper reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions are: (1) What is the existing evidence for eye care interventions or services (including service configuration) for care home residents? (2) Does the provision of these interventions or services improve outcomes? Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data were extracted and evaluated using narrative synthesis. 13 original papers met the inclusion criteria. Domiciliary optometrist services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions, such as cataract surgery, refractive error correction and low-vision rehabilitation, improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes such as falls. Care home-based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.

1270 DEVELOPMENT OF A COMPETENCY FRAMEWORK FOR EARLY CAREER NURSES UNDERTAKING POST-REGISTRATION EDUCATION IN CARE FOR OLDER PEOPLE

Abstract Introduction Despite recognition of the status of gerontological nursing as a speciality, there is no specific UK competency framework for early career nurses working with older people. As part of a feasibility intervention to improve recruitment and retention of nurses within the speciality (ECHO Early Careers in Healthcare of Older People and PEACH Programme for early careers for care home nurses), we developed a bespoke competency framework appropriate for nurse working within all sectors. Method The national and international literature on published competency frameworks was reviewed to identify core domains of knowledge and skill. We integrated these within a CGA model to develop a draft competency framework which we then tested for face and content validity. It was reviewed by expert practitioners and managers from NHS and care home providers, and a national reference group (British Geriatrics Society Nurse Special interest group). It was then implemented by students under taking the ECHO and PEACH programmes. A mixed-methods approach was used involving online surveys, one-to-one interviews and focus group interviews with students, mentors, ward managers and care home managers. Ethical approval was obtained from the university ethics committee. Results From an initial draft of 80 competency statements 69 were adopted across 10 domains. Thirty students across the ECHO and PEACH programmes used the framework and participated in evaluation. Our analysis found that students benefited from recognising unique gerontological knowledge, expanded insights into practice and affirmation through mentor feedback. Some students faced logistical challenges including access to mentors. The framework was found to be appropriate and acceptable across both hospital, community and care home settings. Conclusion/s The competency framework was valid in clinical gerontological settings across hospital, community and care homes, and supported knowledge and skills development and evidencing for early career nurses.

1343 ADVANCE CARE PLANS (ACP) IN SECONDARY CARE: WHAT ARE THE PATIENT OUTCOMES FOLLOWING DISCHARGE FROM HOSPITAL WITH AN ACP?

Abstract Introduction Treatment escalation plans are discussed in hospital but not always communicated to community care on discharge, leading to avoidable admissions to hospital and hospital deaths which may be not what the patient wants. The project aimed to review what happened to patients discharged from hospital with an ACP over a 12-month period. Method Older person service (OPS) inpatients were identified for ACP discussions, using Clinical frailty score, presence of life limiting conditions, co-morbidities, significant decline. Over a 12-month period 155 ACP's were completed using the ACP document on the Trust electronic record (EPR), including the level of appropriate care and preference for location of on-going care. On discharge copies of the ACP were sent with the patient, to their GP and the ambulance service. EPR was used to review patients up to 12 months post discharge. Results Of patients with an ACP; the wish of all patients was to remain out of hospital and be cared for in the community; 63% were discharged to care home setting; 19% were readmitted as inpatients (43.7% Trust OPS/no ACP readmissions); 8% of patients died before discharge; 92% of patients who died after discharged, died out of hospital (47.5% Trust OPS/no ACP deaths); 25% were still alive at 12 months. The process of completing the ACP and communicating the ACP was found to be long and not user friendly with multiple steps and needed refining. Conclusion ACP's offer support to facilitate patient's wishes. The use of ACP's in secondary care benefits patients on discharge, it reduces readmissions and in-hospital deaths. The current ACP document is lengthy and requires simplifying. This has led to a work group to redevelop the ACP into a more user friendly/shareable document, which will encourage on-going use of ACP's and can be adopted throughout the Trust.

Time to FOCUS - 'Palliative Medicine Point-of-Care Ultrasound'.

Point-of-care diagnosis has become the need of the hour and along with its guided interventions, ultrasound could be utilised bedside in a palliative care patient. Point-of-care ultrasound (POCUS) in palliative care medicine is fast emerging and has varied applications ranging from performing bedside diagnostic evaluation to the performance of interventional paracentesis, thoracocentesis and chronic pain interventions. Handheld ultrasound devices have transformed the application of POCUS and should revolutionise the future of home-based palliative care. Palliative care physicians should be enabled to carry out bedside ultrasounds at home care and hospice setting for achieving rapid symptom relief. The aim of POCUS in palliative care medicine should be adequate training of palliative care physicians, transforming the applicability of this technology to OPD as well as community driven to achieve home outreach. The goal is towards empowering technology by reaching out to the community rather than the terminally ill patient transported for the hospital admission. Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency and early triaging. The inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis. Limiting POCUS application to certain selected sub-specialities such as emergency medicine, internal medicine and critical care medicine should be overcome. This would need acquiring higher training as well as improvised skill sets to perform bedside interventions. Ultrasonography competency among palliative care providers proposed as palliative medicine point-of-care ultrasound (PM-POCUS) could be achieved by imparting dedicated POCUS training within the core curriculum.

Primary care provider confidence in addressing opioid use disorder: A concept analysis.

Primary care providers (PCPs) are well-positioned to provide care for opioid use disorder (OUD), yet very few address OUD regularly. One contributing factor may be PCPs' lack of confidence in their ability to effectively treat OUD. Evidence demonstrates that clinician confidence in home care and hospital settings is associated with improved care delivery and patient outcomes. However, a conceptual definition of PCP confidence in addressing OUD has yet to be established. The aim of this concept analysis is to enhance conceptual understanding of PCP confidence in addressing OUD and inform future measurement strategies. Following Walker and Avant's method of concept analysis, PubMed, PsycINFO, and Google Scholar were searched in October 2021. Manuscripts were included if they referenced confidence in relation to PCPs who provide care to adult patients with OUD. Studies conducted outside the US and not published in English were excluded. The search resulted in 18 studies which were synthesized to conceptualize PCP confidence in addressing OUD. Defining attributes include self-efficacy, experience, and readiness to address OUD. These attributes may be influenced by organizational culture, training, support, and resources. Consequences of PCP confidence addressing OUD may include improved patient outcomes, improved delivery of and access to OUD care, and PCP attitude changes. This concept analysis-which grounds the concept of PCP confidence in addressing OUD in the theoretical and empirical literature-lays the framework for future measurement of the concept. This represents a critical first step towards developing strategies to enhance PCP confidence in addressing OUD.

Role of Enteral Feeding Pumps in Precision Enteral Nutrition

: Initiating early nutritional feeding in hospitalized patients will decline patients’ complications, shorten hospital length of stay and costs, and improve health outcomes. Over the years, with the emergence of the enteral feeding pumps, the process of enteral feeding has become easier with higher accuracy and safety. Enteral feeding pumps provide the ability to combine methods like continuous feeding during the overnight and bolus feeding during the day to make the feeding process more adaptable to patients’ status. Nowadays, prescriber’s knowledge regarding individualized nutrition for each patient according to their specific needs has been increased, and enteral feeding had shifted to home care settings. The need for precision enteral nutrition programs according to differences in human phenotype, genotype, food preferences, and health status becomes more apparent. Personalized nutrition programs can reduce the prevalence and risk of disease-related malnutrition and improve patients’ quality of life in home care settings. In this way, feeding pumps facilitate the personalized feeding process by making it unique and improved.

Home Care Nurses' Experiences of the Use and Introduction of the Subacute Functional Decline in the Elderly Instrument.

Registered nurses are crucial in home care nursing for elderly patients, as detecting geriatric conditions can be difficult due to age-related changes or communication barriers. Disability is often overlooked in elderly care, requiring different assessment tools to determine patient status and necessary nursing interventions. During the COVID-19 pandemic, the subacute functional decline in the elderly (SAFE) instrument was implemented in some Oslo districts to detect early signs of sub acute functional decline in hospital and home care settings. However, the nurses' perception of this new assessment tool and its effectiveness has not been evaluated. This study aims to explore home care nurses' experiences and perceptions regarding the introduction and use of the new assessment tool, SAFE. Objectives were to conduct focus group interviews and perform qualitative analysis. The study followed Consolidated Criteria for Reporting Qualitative Research guidelines, had a qualitative design, and included 15 out of 60 permanently employed RNs at Oslo municipality's home care service in Frogner district. Data was collected via three focus group interviews and analyzed thematically. The study identified three themes: (1) Nurses learned to use SAFE through direct experience due to a lack of standard introduction or training. (2) SAFE supported patient-centred care by enabling communication, preventive work, and identifying patients' needs. (3) Integrating SAFE into electronic databases and daily clinical work could improve nursing efficiency. Overall, using SAFE can improve patient outcomes and care quality in home care, but clear guidelines, ongoing support, and standardized procedures are crucial for its effectiveness. Regular updates and complete management support are also necessary. The study's findings align with previous research and can guide the development and implementation of tools in home care to enhance patient outcomes and the quality of care delivered.

Nutritional management using ultrasonography of the temporal muscle for patients with pressure injuries in a home care setting: a case report

Nutritional management using ultrasonography of the temporal muscle for patients with pressure injuries in a home care setting: a case report

Quem são os fonoaudiólogos que trabalham com afasia progressiva primária no Brasil? Um estudo de inquérito transversal exploratório

ABSTRACT Primary Progressive Aphasia (PPA) is a progressive language disorder associated with frontotemporal impairment and mainly affects the left hemisphere of the brain. In general, this condition compromises abilities related to comprehension and expression of language. The diagnosis of PPA depends on in-depth knowledge regarding functions of language, neurology, and neuropsychology. Speech and language therapists (SLTs) have a pivotal role in the diagnosis and rehabilitation of PPA. The absence of these professionals involved in the diagnosis and rehabilitation may reflect on the quality of care of people with PPA. Objective: To identify the sociodemographic, educational, and professional practice characteristics of SLTs who work with people with PPA in Brazil. Methods: An online questionnaire was disseminated to reach SLTs across Brazil. The questionnaire collected information regarding sociodemographics, training and education, practice (time, setting, service provision), and sources of referral. Results: The study included 71 participants (95.8% women). Specialization was the most frequent educational level followed by master’s degree, and participants where mainly from the Southeast and South regions of Brazil. Neurologists were the professionals who most referred patients with PPA to SLTs. Finally, SLTs worked primarily in homecare settings and provided mainly individual therapy services. Conclusion: SLTs who work with PPA in Brazil can be characterized mainly as professionals with postgraduate degrees, relatively young, and from the South and Southeast regions of Brazil.

Supplemental Material for Predicting Adolescent and Young Adult Outcomes From Emotional Support and Cognitive Stimulation Offered by Preschool-Age Home and Early Care and Education Settings

Supplemental Material for Predicting Adolescent and Young Adult Outcomes From Emotional Support and Cognitive Stimulation Offered by Preschool-Age Home and Early Care and Education Settings

Timely Identification of Patients With Cancer and Family Caregivers in Need of End-of-Life Discussions by Home-Visit Nurses in Japan: A Qualitative Descriptive Study

End-of-life (EOL) discussions for patients with cancer are a key factor of successful EOL care; however, identifying the optimal timing for these discussions in Japanese home-care settings is difficult. To identify the time at which patients with cancer and their caregivers need EOL discussions, we explored when home-visit nurses start EOL discussions. We interviewed 23 home-visit nurses and analyzed the data using qualitative content analysis. Three themes were derived from the analysis. Participants identified the timing of EOL discussions as being sensitive to patients’ changing health and care needs (increases in patient’s total pain), changes in the family caregiver’s physical or mental condition through daily care (increases in family caregiver distress), and the EOL process that patients follow (trajectory of disease). Developing a tool or in-service educational program that will enable inexperienced or new graduate home-visit nurses to implement EOL discussions at appropriate times is necessary.

Assessment of the Burden of Care and Burnout Level in Caregivers of Dementia Patients in a Home Care Setting

Aim: This study aims to evaluate the factors affecting the care burden and burnout levels of caregivers with dementia patients receiving home care services. Methods: This descriptive study was conducted in Samsun Training and Research Hospital Home Care Services which paid a visit at home between March 20 and June 20, 2021. The caregivers of the patients who were followed up by the diagnosis of dementia were included in the study after having agreed to participate in the study with their written informed consents. The 'Socio-demographic Data Form', 'Zarit Burden Interview' and 'Maslach Burnout Inventory’ were administered to caregivers during face-to-face interviews. Results: A total of 157 caregivers were included in our study, of which 70.1% (n=110) were women. 68.2% (n=107) were in the 40-64 years age group. The mean Zarit Burden Interview score was calculated as 47.10±16.14 (min=21, max=85). 76.4% of caregivers had moderate to severe escalated care burden. Once the impact of the increase in caregiver burden score on Maslach Burnout Inventory subgroups was examined, the relationship was found to be positively significant with emotional exhaustion and depersonalization, and negatively significant with personal achievement. Conclusion: As the burden of care increases, the level of burnout of individuals increases. Female gender, illiteracy, lack of income, duration of care given which is prolonged for more than one year, and daily care duration exceeding 12 hours were determined as outstanding factors that increase the care burden and level of burnout. Keywords: home care services, caregivers, dementia, caregiver burnout

Hydration Practices in Maltese Residential Care Homes for Older Adults

Despite consensus about the preventable nature of dehydration, it remains particularly prevalent among older adults residing in residential care home settings. The aim of this study is to explore current hydration practices in residential care homes in Malta. An exploratory qualitative approach was adopted to provide an in-depth understanding of staffs practices for supporting residents hydration in care homes for older adults. Following a feasibility study to increase the overall methodological rigour, thirty-one staff participants across six residential care homes, covering all the six regions of Malta, participated in either face-to-face or online semi-structured interviews. Data was analysed through open coding, followed by axial coding. Peer debriefing amongst the research team was carried out until agreement was reached about the final themes. Three main themes emerged from the data: culture of promoting fluid intake; challenges in supporting older adults to achieve optimum hydration; and hydration practices and approaches. A hydration-promotion culture was evident across all care homes. However, there was a lack of consistency in monitoring hydration and daily fluid targets which emphasises the need for staff training and implementation of clear and accessible guidelines, policies and/or procedures in relation to hydration care within residential settings for older adults. Future research attention should focus on establishing an evidence-based approach to monitoring hydration status and identifying residents at risk of dehydration. Difficulty in monitoring the fluid intake of independent residents was highlighted and we contend that this group of residents should not be overlooked in view of the risk of dehydration. Employing robust and rigorous methods to establish the effectiveness and implementation of innovative approaches would help in making valid contributions to the local evidence base on hydration care in residential care settings.