Community Home Health Research Articles

Incorporating Diversity, Equity, and Inclusion Within Community Health Nursing Simulation.

Undergraduate nursing institutions face difficulties providing learners with community and public health nursing clinical opportunities. An opportunity existed to improve a senior-level undergraduate community and public health nursing course by developing alternative clinical teaching-learning experiences that promote diversity, equity, and inclusion. Utilizing theory and evidence-based practice, a simulation emulating a community home health visitation allowed learners to function as members of a health care team who provide care for a family in their home setting. The results indicate that all learners met project objectives, and 88% of learners reported increased self-efficacy related to the project's topics after implementation. Learner reflections offered their perception of the experience. A community and public health nursing teaching-learning project provided learners with clinical hours by completing a simulation learning experience incorporating diversity, equity, and inclusion through exposure to patient inequities within the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Improving Care Coordination Between Veterans Health Administration Primary Care Teams and Community Home Health Aide Providers: A Qualitative Study.

Effective coordination between medical and long-term services is essential to high-quality primary care for older adults, but can be challenging. Our study assessed coordination and communication through semi-structured interviews with Veterans Health Administration (VHA) primary care clinicians (n = 9); VHA-contracted home health agencies (n = 6); and home health aides (n = 8) caring for veterans at an urban VHA medical center. Participants reported (1) establishing home health services is complex, requiring collaboration between many individuals and systems; (2) communication between medical teams and agencies is often reactive; (3) formal communication channels between medical teams and agencies are lacking; (4) aides are an important source of patient information; and (5) aides report important information, but rarely receive it. Removing structural communication barriers; incentivizing reporting channels and information sharing between aides, agencies, and primary care teams; and integrating aides into interdisciplinary teams may improve coordination of medical and long-term care.

Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach

BackgroundThe general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services.MethodThis study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis.ResultsThe inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues.ConclusionsThis study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

New kid on the block? Community nurses' experiences of caring for sick children at home.

To investigate the experiences of Swedish community nurses in caring for sick children at home, as this is a growing population of patients in community care. There is international consensus that sick children should receive care in their homes as far as possible. Home health care allows the family to stay together while the child is undergoing treatment and thus reduces strain on the family. However, it can also be demanding for parents to take on increased responsibilities for their sick child. Children as a patient group is a relatively new phenomenon in community home health care in Sweden and represents a small part of the community nurse responsibilities, making it difficult to accumulate experience. A qualitative descriptive design. In-depth interviews with twelve nurses in community health care. Qualitative content analysis was used. 'Feeling confident in order to instil confidence' was key in nurses' experiences. Two main themes emerged: 'Building a trusting relationship with the family' and 'Feeling confident in the role as caregiver'. Nurses aimed at creating a trusting nursing relationship and working closely with parents. The nurses' feeling of confidence in their role as caregivers depended on the support they received and the knowledge they had. Many community nurses felt unconfident about caring for children at home but experienced it as manageable when peer support and a distinct collaboration with the paediatric clinic/hospital were present. The ongoing shift from hospital to home care urges paediatric clinics/hospitals and community health care to develop formal policies of transmural collaboration to train and support home nurses to deliver adequate care to sick children and their families at home and safeguard good outcomes. The implication of the study may contribute to efforts being made to extend and improve cooperation between paediatric clinics/hospitals and community health care.

Moving to a Culture of Safety in Community Home Health Care

Community home health care workers and their clients are faced with a mixture of occupational health and safety challenges that are not typically experienced by health care providers or patients in the acute care sector. The aim of this project was to explore the concept of safety in community home health in one health care authority in British Columbia. A participatory action research approach was employed to explore staff and client safety risks in this environment. In the first phase, three focus groups were held with staff (n = 39) and the data analysed to identify themes. These were validated by additional focus groups. In the second phase, interviews were held with staff followed by chart reviews. Finally, in phase three, an interdisciplinary working group developed a risk identification tool for staff which was subsequently piloted. The exploration focused on answering the following questions: What constitutes safety in community home health care? What are the priority areas for action in relation to safety? What type of risk identification would be most helpful to community health workers to prepare them adequately to meet their clients' and their own safety needs? Risk themes identified included: poor communication, acute care staff not understanding the needs of community staff, working alone, mobility, medication concerns, lack of pre-screening of clients' homes, and community health workers accepting a high degree of risk. Findings suggest that typical notions of safety and risk in acute care are not easily translated into the community sector, that staff and clients' safety concerns are intertwined, and staff require better and more timely information from acute care staff when patients are discharged home.

Delineation of Risk Through the Exploration of a Culture of Safety in Community Home Health

In one large Canadian healthcare region, there was no consistent way of identifying factors impacting safety and risk in community home healthcare. A participatory action research approach was employed to explore client safety risks in this environment. Staff identified a lack of adequate information as their primary safety concern. A novel chart review tool was developed to capture baseline information regarding client risks, including frequency, context and severity. Very little documentation regarding safety was identified in the reviewed charts. The most frequent risks identified were mobility, falls prevention and medication concerns, which is consistent with the literature.

Sleep-wake rhythm and physical fitness in relation to activities of daily living in stroke survivors residing at home

To clarify the relationship between sleep-wake rhythm, physical fitness, and competence level of elderly stroke survivors living at home, thirty-seven stroke survivors living at home (65.4 ± 7.3 years) voluntarily participated in a cross-sectional study with an interview survey and measurement of physical fitness. All subjects lived in a community and received community home health care services. Sleep-wake rhythm and competence were evaluated by the questionnaire method. Physical fitness in relation to daily living activities was measured by both die time needed to walk 10 meters and that needed to stand up from bed rest position. There was a significant positive correlation between rising time and the 10 meter walking time. Regarding rising time and the competence score, there was a significant negative correlation. Stroke survivors who actively participated in community activities arose earlier than those who had a negative attitude toward participation in community activities. The sleep-wake rhydim, especially rising time, and the participation in community activities were related to the high competence level of stroke survivors living at home. Strengthening the synchronization of the sleep-wake rhythm and increasing the social network may serve as useful procedures to improve the competence of stroke survivors living at home.

Marketing Your Skills Outside the Hospital Walls

As patient care shifts from acute care to outpatient and community home health care, nurses need to repackage their skills. A personal skill assessment on an ongoing basis helps nurses plan for the future.

Home health care: pediatric education in the community.

The purpose of this paper is to describe a curricular innovation involving a community home health care (HHC) experience for third-year medical students as an integral part of a pediatric clerkship. Students at George Washington University are required to participate in an afternoon of HHC visits, one of which requires their reviewing a patient's record before the visit. They then do a pertinent history and a focused physical examination, followed by an assessment and plan, and provide integrated care with the home health care professional. They record this information on a consultation form that is reviewed and evaluated by the clerkship director. Most students have rated this experience positively. A questionnaire before and after the HHC experience and a wrap-up session at the conclusion of the rotation revealed that students are becoming more informed about aspects of home health care and have more positive attitudes about their identified role as future physicians in this important area.

Families U.S.A. (United for Senior Action) Foundation.

Families U.S.A. (United for Senior Action) Foundation.

DRG ripple effects on community health nursing.

AbstractProspective payment by diagnosis‐related groups (DRGs) has influenced hospital care in at least two ways: patients are experiencing shorter hospital stay and they are being discharged in a less healthy state than in the past. As a result, home health agencies are reporting an increase in the number of patients needing services, with the majority of these patients being sicker, older, and requiring more complex care. As hospital‐based care shifts to community care, the impact on community home health agencies continues to increase. To date, little has been written about role changes for community health nurses, especially home health nurses, as a result of the ripple effect of DRGs. The authors suggest likely changes in the caring, counseling, and coordination aspects of the nurse's role. The community health nurse's role is evolving into one that requires expertise in advanced technologies, more sophisticated assessment and counseling skills, and a more comprehensive case management component. Concomitant alterations must be made in resource requirements and distribution. Such changes provide opportunities for innovative and creative nursing strategies.