Client Situations Research Articles

Home Care Services and Early Detection & (Risk)Signaling: An Indispensable Link in Integrated Primary Care

Summary: Funded by the city of Antwerp, this project wants to optimize the preventive role and position of Home Care Services (HCS) in primary care by (1) improving the early detection en (risk)signaling of the home care professionals, (2) and elaborating the bridging function between HCS and the different primary care disciplines and sectors through shared vision and goals, suitable tools, communication systems and clear procedures in information sharing.
 Short description: HCS provide essential (non-medical) support that a person or a family in need of care requires in order to continue to live independently at home. Typical for Home Care Services is that employees spend many hours in close contact to the person or family in need of care. As a confidant to the client they quickly pick up on behavior changes, evolution in illness or condition. They are often the “eyes and ears” to a multidisciplinary team of care providers surrounding a client or patient. Or at least: they could be. All too often this indispensable role of HCS is insufficiently recognized by welfare organizations and medical care providers.
 The confidant position and early detection role of HCS professionals can bridge gaps between other professional care givers and a (psychologically or mentally vulnerable) client/patient, via signalization and referral to best placed (mental) health care or welfare actors.
 Several conditions need to be fulfilled for HCS to being able to effectively play this part in an integrated care system, like shared vision and goals, suitable tools, clear procedures in information sharing, recognition of HCS professionals as equal partners in primary care. All these conditions are being addressed in this project.
 Target group: All independent living persons in need of care and their care givers. In the first phase the project focusses on people with a psychological or mental vulnerability. 
 Project design
 * Involved actors:
 All HCS active in the City of Antwerp, in intense collaboration with a network of mental health care organizations, the social health services of the City of Antwerp. A sounding board is established to ensure the involvement of all relevant parties (project intervision, monitoring, adjustment).
 
 * Co –design approach: the target groups are therefore being involved via focus groups and quality surveys, throughout the project.
 * Possible restrictions:
 
 Legal restrictions on information sharing (e.g. GDPR, professional secrecy)
 Diversity in ways of financing of organizations.
 A broad and diverse set of (online) communication tools and ways of information sharing between health care sectors
 
 Next steps:
 
 Roll out of training programs to add to the competences of HCS professionals.
 Adjustment of internal and external communication protocols.
 Development and testing of uniform and shared (digital) communication tools.
 Application of uniformized methods concerning early detection, signalization and guidance in all vulnerable client situations.
 
 Learning for the international audience:
 
 Insights regarding the project's approach
 Importance of the role and contribution of a home care service (with lower-skilled staff) compared to the (highly-skilled) GP or home care nurse.
 
 
 

IMPLEMENTING AN AREA AGENCY ON AGING COMMUNITY CARE TRANSITION INITIATIVE: FACILITATORS AND BARRIERS

Abstract The Michigan Region VII Area Agency on Aging (AAA) implemented a Community Care Transition Initiative (CCTI) for rural hospitalized older adults at high risk for readmission. After discharge home, AAA CCTI participants received a home visit by an AAA-trained pharmacy technician community health worker (CHW), a telehealth AAA pharmacist medication review, assessments by the CHW and pharmacist, education, primary care follow-up coaching, and referrals. As part of a program evaluation, we conducted six interviews with AAA key informants (e.g., pharmacist, director, CHWs). A semi-structured interview guide was piloted and revised to assess implementation, processes, impact, and future directions. Interviews were conducted via Zoom, recorded, transcribed, and checked for accuracy. Thematic analysis was used to identify implementation facilitators, barriers, and areas for program refinement. Three researchers coded the transcripts, developed a codebook, and resolved discrepancies by consensus. NVivo 14® was used for data management and analysis. Barriers to AAA CCTI implementation included unknowns at project start and need for procedures, anxiety about entering a client’s house, client’s lack of familiarity with technology, lack of perceived pharmacist benefit, limited personnel, and billing or financial reimbursement. Facilitators identified were the AAA’s reputation and backing, relationships built between healthcare providers, referral processes (e.g., community mental health), and pharmacist telehealth visit efficiency. Program refinements included shortened follow-up time and tailored visits to different client situations and needs. The results provide insights into the design of implementation strategies to disseminate the AAA CCTI to meet rural older adults’ health and social needs after hospitalization.

Unavoidable Stressful Client Situations: Sources of Social Support on Clinical Psychologists’ and Counsellors’ Psychological Well-Being

Unavoidable Stressful Client Situations: Sources of Social Support on Clinical Psychologists’ and Counsellors’ Psychological Well-Being

File of Uncertainties: Exploring student experience of applying decolonizing knowledge in practice

It is critical that nursing education programs in Canada respond to the Truth and Reconciliation Commission’s call to develop a course about the documented impacts of Indigenous-specific racism on the health outcomes of Indigenous people. Initiatives such as San’yas Anti-racism Indigenous Cultural Safety Education, courses on trauma-informed care, and required Indigenous health and history classes in nursing programs are providing a solid beginning. However, the effectiveness of this education requires interrogation. This mixed methods study aimed to identify barriers and supports to incorporating decolonizing and antiracist knowledge into nursing practice with Indigenous patients/clients. Fourth-year nursing students at a Canadian university who had completed a core course on the impacts of colonization and Indigenous-specific racism on Indigenous health and wellness in Canada were surveyed to explore their experience of applying this knowledge during their clinical rotations. Sixteen participants responded to an anonymous online survey consisting of three short-answer open-ended questions and six Likert-style questions about their experiences. The emergent narrative themes and Likert-scale data indicate that although the students valued the information provided in the class, they continued to feel cultural tension and uncertainty when caring for Indigenous clients. Prominent areas of uncertainty included applying knowledge to practice, student confidence in disrupting racist treatment of Indigenous patients by their healthcare colleagues and knowing how to approach sensitive client situations to avoid re-traumatization. This article discusses the study’s implications and identifies areas for future research.

Vocal indicators of facilitative interpersonal skills

AbstractThe facilitative interpersonal skills (FIS) method uses simulations of difficult client moments as a test of helpers' ability to remain therapeutic in therapeutically stressful situations. A total of 135 participants completed the FIS task as part of a training in helping skills and provided verbal responses that were assessed by trained raters for interpersonal skills. Audio recordings of these verbal responses were then analysed acoustically for fundamental frequency (F0), spectral slope and F0 range. Mean F0 and F0 range were more highly associated with trained raters' ratings of FIS for female participants than for male participants, although F0 range was associated with FIS of both males and females. The results suggest that F0 is associated with FIS for females, especially the FIS items that are indicative of emotional expression and verbal fluency. Findings are discussed as possibly indicating that some expression of higher F0 in response to distressed client situations may be part of interpersonal skills, such that more skilled therapists respond to stressful client situations with a higher F0.

How Cognitive Behavioural Therapy Helps on Addictive Behaviour?

One of the well-known theories applied in the group counselling session is Cognitive Behavioural Therapy (CBT). This article explores the systematic literature reviews on the benefit of using CBT in group counselling among clients who were having issues with drugs. This systematic literature review is managed through the following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. The Emerald, ProQuest Electronic and Cambridge University Press are used. This research utilized the Google Scholar website too. The term “drug”, “abuse”, “effect”, “group counselling” and other relevant derivations used in web searching. Only 10 most relevant journal articles were extracted and reviewed. Findings showed that there were positive effects of CBT in group counselling on drug abused group members. The findings suggested that Cognitive Behavioural Therapy is effective in changing the perceptions and behaviours of drug addicts, controlling anger and increasing self-esteem. CBT may raise the sense of self-awareness as well as increased confidence not to relapse after they have been released from the rehab centre. Application of CBT in group counselling helped counsellor to propose the action plan properly, which involves several steps such as identifying the level of client motivation, risky situations, client relapse processes, client situations in making irrelevant decisions, cognitive factors related to relapse, and lifestyle changes. In conclusion, it is proved that group counselling benefits in accordance with CBT application during the session to help clients have a better view of life after they recover from drug addiction.

Moral distress in public health practice: Case studies from nursing education.

Moral distress in critical care nursing has been well studied; however, there is a gap in the literature related to moral distress among nurses and nursing students practicing in the community. This paper describes moral distress experienced during participation in the Interprofessional Care Access Network, a community-based nurse-led education and practice program providing longitudinal care coordination for underserved individuals and families in rural communities and urban neighborhoods. Two case studies represent client situations resulting in moral distress for nursing faculty and students. Contributing factors include unaddressed social determinants creating barriers to health and health care; inexperience and discomfort with people living in extreme poverty; lack of access to critical services for the most vulnerable; and powerlessness to influence discriminatory systems. Strategies are described to reduce moral distress and build moral resilience among students and faculty practicing in the community. Research is needed to expand understanding of causes, interventions, and consequences of moral distress in public health nursing.

Social workers’ use of critical reflection

Summary This article explores critical reflection as practiced by social workers in the context of their personal and professional privilege. It was found that social workers in direct practice were not invested in critical reflection about oppressive discourses in their consciousness when interacting with clients. Rather, critical reflection often happened in times of crises or when social workers encountered difficult client situations. Using the phenomenological methodology of Van Manen and the social constructionist perspective, I present and discuss the findings of a qualitative study of semi-structured interviews with 20 social workers in direct practice. Findings Data analysis indicated that critical reflection is not a priority for direct practice social workers in the context of privilege. Three themes are identified: (1) No time for reflection, (2) Fear of reflection, and (3) Too much reflection. Nevertheless, social workers were still able to reflect alone, with colleagues and with supervisors, and they outlined the benefits of reflection. Applications Social work agencies should provide infrastructure for reflection, create an atmosphere for workers to freely discuss challenges and difficulties, and reduce their fear of reprisals from management. This article broadens the idea of phenomenological reflection by Van Manen.

Zwischen Anspruch und Wirklichkeit - Perspektive von fallverantwortlichen Pflegefachpersonen zur Rationierung in der spitalexternen Pflege.

Between demand and reality - Perspectives of case-leading nurses on rationing in home care Abstract. Background: The demand for home care services in Switzerland (Spitex) is growing at an annual rate of 8 %. With increasingly complex client situations, lack of time and professional resources, the risk of rationing care is rising. Objective: This study explores how case-leading nurses (CLNs) experience rationing of care and how they deal with this in their daily practice. Methods: We chose a qualitative approach with an interpretative description. Between September and December 2018, we conducted semi-structured interviews with 12 CLNs from seven Spitex organisations in the German-speaking part of Switzerland. The data were analysed according to the thematic analysis of Brown and Clarke. Results: CLNs often experience not having enough time to fully oversee a client's care plan from the assessment to the evaluation of care needed. They show a high level of commitment to providing good quality of care, but have to walk a tightrope between demand and reality. Additionally, they are under pressure to defend the financing of needed services from health insurance companies. Conclusions: Rationing is an everyday experience of CLNs' practice and they invest a lot of effort in reducing its effects for their clients. CLNs work under pressure, thus targeted measures are necessary both at the political and Spitex organizational level, to reduce rationing of care.

A Qualitative Study of Nursing Students' Experiences in Fall Prevention for Older Home Care Clients.

The aim of this study was to describe the experiences of nursing students in fall prevention during clinical practice in the context of older home care clients. This was a qualitative focus group study of nursing students (n = 9) who had completed clinical practice in older clients' home care. The data were analysed using inductive content analysis. The nursing students described their experiences regarding falls and fall prevention in older clients' home care from two perspectives: evaluation of falls at older people's homes and fall prevention during home visits. Systematic evaluation of falls was based on physical examination and is the basis of fall prevention. However, evaluation of nutrition and adverse drug effects seemed to be ignored. In addition, fall prevention during home visits included concrete fall prevention in authentic client situations, confidential relationships with older clients, and evidence-based knowledge. From the perspective of fall prevention, there was a lack of comprehensive evaluation and understanding of the meaning of psychological factors, such as fear of falling. In order to be able to prevent falls in the older client population, students need more guidance regarding a comprehensive approach based on evaluation of falls. In addition, there is a need for continuous collaboration between education and home care services to develop educational approaches that interlink knowledge and skills in fall prevention.

Clustering Research in Fifth Generation Mobile Communication Networks

Clustering procedures are utilized to broaden the life of systems and increment vitality proficiency. In this study, some clustering algorithms and traffic expectations consider in 5G communication systems are inspected. There is a need to explain how to improve the nature of client experience through clustering. Understanding the requirements of clients is basic to give the capacity to help various situations in smart frameworks. Client mindfulness or client situated plan is a challenge in clustering. Inquires about have demonstrated that the usage of clustering plans in 5G systems presents difficulties and that clustering procedures created with insightful system determination arrangements can be of extraordinary advantage. The present investigations are not perfect in unique frameworks with a wide assortment of client situations since they are performed in both homogeneous and low-level heterogeneous systems and can't work. Also, when the 5G happens, the issue will turn out to be more mind-boggling than customarily rearranged. Different challenges identified with the execution of clustering methods in 5G networks are introduced and examined.

EXPERIENTIAL METHODS FOR IDENTIFYING AND REDUCING POINT OF SALE RETAIL FRAUD

This paper is aimed at management, accountants, auditors and loss prevention officers responsible for assuring the existence and effectiveness of internal controls to minimise fraud in retail business environments. Retail is defined to include the wide array of retailers serving consumers across shopping malls and on the high street as well as organisations that have retail operations supporting their main non-retail business activities, such as book stores in universities and souvenir shops in museums. Whether cash or cashless, retail point-of-sale (POS) transactions present multiple fraud opportunities despite the existence of internal controls. Based on experiential observations at clients in the UK, US and Australia, approximately 3% of staff entrusted to process customer payments at the POS create inventive ways to steal cash, credit card data and stock during routine POS till operation. Anonymised fraud schemes from real client situations are provided in this short paper. To help combat these kinds of fraud, POS systems have inbuilt transaction summaries and audit trails useful to management, loss prevention officers and auditors. But these inbuilt system controls are insufficient on their own and therefore must be augmented by human behavioural controls such as policies, management procedures and CCTV. This paper summarises how an array of controls can work together to reduce, if not entirely eliminate, potential fraud scenarios by POS operators.

Nursing Experience Using Watson's Caring Theory to Mitigate Suicidal Behaviors in a Homosexual Male

This report describes our experience providing nursing care between 7th October and 7th November 2016 to a homosexual male who repeatedly engaged in stress-related suicide attempts and self-harm. Information was collected using comprehensive nursing assessment, observation, and interviews and the health problems of ineffective coping and disabled family coping were identified. Because of affection-related distress and the lack of recognition of his gender orientation by his family, the client engaged repeatedly in self-harm and attempted suicide on several occasions in order to cope with the self-perceived unbearable stress and stressful situations. The authors provided nursing care based on Watson's theory of human caring. We fulfilled the nature of caring, prompted respect and acceptance, and established a therapeutic, interpersonal relationship. We also adopted the concept of suicide intervention, and used the protective factors as the main coping strategies. These approaches allowed the client to acknowledge the events and reactions that may trigger his suicidal ideas, to develop better self-reflection and impulse control, and to mitigate the ideas and behaviors related to suicide and self-harm. Because constant conflicts between the client and his parents hampered a harmonious family relationship, we adopted family-centered care in order to enhance family resilience, which created room for mutual learning and development and reconstructed a healthy family relationship. Our successful results with this case encouraged our writing this paper in order to share this nursing experience with caregivers facing similar client situations and needs.

MANAGEMENT OF OPERATIONAL RISK COSTS: DEALING WITH CONFLICTS OF INTERESTS AND SENSITIVE CLIENT SITUATIONS IN AUDIT FIRMS

The purpose of this paper is to look into the challenges of management of potential operational risk costs by dealing with conflicts of interests and sensitive client situations in audit firms. Furthermore, the author’s goal is to propose a framework addressing those risks proactively and thus minimizing the potential costs that might arise from such situations. The paper starts with an introduction to the importance of understanding the concepts of conflict of interest situations and sensitive client situations, and why it is often crucial for the leadership and professionals working for audit firms to address the risks arising from them. The author presents a framework, containing policies and procedures for operational risk management with respect to conflicts of interest and sensitive client situations. The proposed framework is tested via a comprehensive survey among a number of audit firms. The results of the survey show that all of the surveyed companies have implemented at least some of the proposed policies and procedures. The results also show that there is a general agreement among the leadership teams of the audit firms that adopting a comprehensive operational risk management framework would benefit the audit firms in the long term minimizing its costs.

Educational Interventions for Cervical Cancer Screening Behavior of Women: A Systematic Review

Background:Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women.Methods:In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed.Results:Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women.Conclusions:Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.

Lessons from Practice: Designing Tools to Facilitate Individualized Support for Quitting Smoking.

Many health care providers, with a variety of trainings, counsel clients on quitting smoking on a day-to-day basis. In their clinical practice, they draw from and adapt guidelines and research-based strategies to fit individual client situations and challenges. Designers of technologies to support quitting smoking can learn from these real world practices to create tools that better adapt to individual differences. We present findings from interviews with 28 providers with diverse experiences in smoking cessation counselling. Through analysis of their individualization strategies, challenges, and perceptions of technology, we find that providers: (1) individualize context appropriate coping strategies by involving clients in brainstorming, (2) emphasize the need to support nicotine withdrawal in clients, (3) mitigate social triggers and mediate social support for clients, and (4) need to navigate dependencies with other providers for managing medications and comorbid health conditions of clients. With this empirical understanding, we extend the discussion on the design of technology to support quitting smoking, highlight current barriers to individualization, and suggest future opportunities to address these barriers.

Social Work Education: A Vehicle for Innovative Practice

In light of continuous social change and the uniqueness of social problems faced by the clients of professional social workers, practice innovations are constantly needed to better address problems, strategies are needed to deal with emerging and challenging problems, and a commitment to innovate in the midst of ongoing treatment interventions due to changing client situations is necessary. Social work educators, in a unique position of preparing students for professional practice that focuses on knowledge, skills and values, can effectively teach innovation as a necessary facet of practice. Seeing innovation through its intellectual, affective, ethical, and societal and client drivers, social work educators can pose questions to students that can be creatively answered, at least in part, through both academic and field experiences.

Five-Way Experiential Learning Model for Social Work Education

Social workers exercise their practice skills by helping clients find strengths and solutions. In order to comprehensively practice skills for diverse client situations, it is crucial to practice and fine-tune the applications of various therapeutic approaches through clinical drills. This paper presents an experiential learning model, expanded from Kolb's Learning Cycle, which fits the dynamic pedagogical needs of the social work profession. It examines the implementation of the use of the ‘Five-Way Experiential Learning Model’ based on practice learning through personal reflections and professional evaluations. This practice learning study helped 79 MSW students define their ‘five-way learning’ and to analyze its impact on their acquisition of social work skills and clinical practice competencies. This process demonstrates the importance of the transtheoretical connection to achieve a better understanding of clients' situations through the process of change and peer input. Discussions will focus on the model elements, results on experiential learning, and ethical considerations.

Mindfully Increasing Quality of Life: A Promising Curriculum for MSW Students

MSW students may experience considerable stress during graduate school due to multiple life demands and the challenges of social work curricula, which often involves exposure to distressing client situations. Students' quality of life may be negatively impacted without sufficient tools to manage these stressful experiences. This paper presents evaluative findings of a course/module designed to enable MSW students in a university in the Southwestern United States to increase their quality of life and build stress coping abilities by incorporating mindfulness into their daily self care routines. Findings reveal that after completing the course/module, students reported increased quality of life even though perceived stress levels did not improve. Accordingly, mindfulness holds significant promise for bolstering students' ability to cope with the challenges of graduate school and preparing for professional practice.

Partnering for Mental Health Promotion: Implementing Evidence Based Mental Health Services Within a Maternal and Child Home Health Visiting Program

This article details the clinical foundations of a social work focused community-based participatory research project promoting women’s mental health during and around the time of pregnancy. Specifically, we discuss the theoretical, empirical and organizational implementation of an enhanced engagement model of mental health service delivery that integrates evidenced based practices into the structure and services of an existing non-profit maternal and child health home visiting agency. The model is grounded in literature addressing barriers to accessing mental health care among minority women living in low-income communities. We discuss informing the intervention through direct consumer involvement, as well the rationale supporting the inclusion of Interpersonal Psychotherapy and Cognitive Behavioral Therapy into the design and implementation of the model which emphasizes adequate training of staff with varying levels of mental health experience. Finally, we describe typical client situations and responses reflected by the Enhanced Engagement model and discuss future implications of this approach as a way to offer meaningful intervention to women and families who may not have access or eligibility to utilize specialty mental health services.