Context Of Home Care Research Articles

Advance care planning in care homes for older people: an English perspective

Advance care planning (ACP) as a process of discussing and recording wishes for future care and treatment is increasingly being promoted and discussed in the UK, reflecting recent changes in legislation. This study describes current ACP practice in care homes for older people drawing on data from a questionnaire survey (n = 213) of, and interviews (n = 15) with, care home managers. Whilst consultation about general care is taking place in the majority of homes surveyed using both formal and informal processes, the number of residents that have completed any ACP processes varies. Managers face intrinsic and extrinsic challenges related to the ascertaining of, and the implementing of wishes as they address ACP in the care home context. Until these wider contextual factors are addressed it will be difficult for staff in care homes to effectively undertake and implement ACP in care homes.

Exploring new operational research opportunities within the Home Care context: the chemotherapy at home

Home Care (HC) services provide complex and coordinated medical and paramedical care to patients at their homes. As health care services move into the home setting, the need for developing innovative approaches that improve the efficiency of home care organizations increases. We first conduct a literature review of investigations dealing with operation planning within the area of home care management. We then address a particular issue dealing with the planning of operations related to chemotherapy at home as it is an emergent problem in the French context. Our interest is focused on issues specific to the anti-cancer drug supply chain. We identify various models that can be developed and analyze one of them.

Living While Dying/Dying While Living

v Palliative care involves dynamic relationships among clients, their families, and professionals, all with unique perceptions and approaches to the sociocultural construction of end-of-life care. In the home care context, this subculture may be particularly complex, because clients relate more readily as people than as patients, and professionals are not always prepared for this reality. This article presents ethnographic investigation of the culture of home-based palliative care as experienced by people older than 65 years who are dying of cancer. Through field visits to four client participants over 6 to 10months, researchers conducted 16 interviews 1 to 2 hours long and participatory observation. Findings portray seniors’ dynamic, constantly changing journey of ‘‘living while dying/dying while living.’’ At one and the same time, seniors seized the opportunities and interpersonal relationships of ‘‘living while dying’’ and confronted the challenge of ‘‘dying while living’’ through the following: ‘‘celebrating life/grieving losses,’’ ‘‘connecting with/detaching from others,’’ ‘‘resigning to/accepting life circumstances,’’ and ‘‘holding on to/moving beyond life in the present moment.’’ The insights gained may inform nurses’ provision of psychosocial end-of-life care but suggest that more education, time, and informed collegial and employer support would help to optimize their potential for this challenging role.

The meaning of consolation as experienced by nurses in a home‐care setting

The aim of this study was to illuminate nurses' experiences of consolation and how these experiences relate to suffering and care. Consolation is commonly associated with the relief of suffering. The question of consolation in terms of its definition and relevance for care has, however, been a matter of discussion among nurse researchers. The question raised concerns about the nature of consolation, its place and its role in relation to care and the caring sciences. An explorative qualitative interview study with 12 participants, six registered and six enrolled nurses, was carried out in a home-care context. A phenomenological-hermeneutic method inspired by the French philosopher Paul Ricoeur was used for the text analysis. Results. Two main aspects of consolation appeared: 'the present consolation', which is flexible, sustaining and opening and 'the absent consolation', which conceals the suffering and is incapable of consoling. The result was interpreted from a philosophical-ethical perspective, based on the works of Levinas and Lögstrup. Consolation appears as a complex phenomenon, both in terms of its existence and its absence consolation, constituting a caring and non-caring consolation. A caring consolation entails meeting the other as different and being present in a way that gives the other space to be the one he or she really is. It requires acceptance, accepting the sufferer and his/her way of suffering as unique. Relevance to clinical practice. The clinical nurse is involved in complex care situations, which entails both reflecting upon and using intuition when consoling. A caring consolation is a contradictory phenomenon that requires a nurse to be capable of both reflecting upon and acting intuitively on the unique suffering of the other.

Can We Afford Consumers Choice in Home Care?

As demands for home care escalate in a system concerned with cost containments, initiatives promoting client involvement in the management oftheir chronic illnesses and attendant services have attracted increasing attention. For longer term in-home care, varied approaches to case management reflect these trends. This article reports a study exploring the cost consequences of clients' choice of three approaches to case management within a single home care context. The first involved leaving the control of services and care to the system's case manager. The second option was to share this control in partnership with their in-home service providers. The third approach featured clients directing their own case management Overall the average costs per month of services for clients in the three groups did not differ significantly over 6 or more months. However, clients who chose direct involvement in their case management actually had significantly lower cost increases than clients with little control over their case management. While further investigation is needed, offering clients choice of involvement in their in-home case management may both lower costs and optimize clients' potential for involvement in their care.

Client–nurse relationships in home‐based palliative care: a critical analysis of power relations

To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care. As in all social relations, power is present within client-nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client-nurse relationship in palliative care settings has not been extensively investigated. Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding. Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination. Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at various levels of the health care system. The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general.

Exploring comprehensibility and manageability in palliative home care: an interview study of dying cancer patients' informal carers.

The presence of an informal carer is often a prerequisite for successful palliative home care, and the staff's ability to support informal carers' coping in such situations is important. Recent research has revealed that it is possible to achieve positive psychological states in palliative care despite the burdening situation. As there is a lack of theory-based coping studies, the aim of this study was to describe, within the context of palliative home care, two concepts in Antonovsky's theory of Sense of Coherence: comprehensibility (a perception that the challenge is understood) and manageability (a perception that the resources to cope are available). Tape-recorded semi-structured interviews with 19 informal carers during ongoing palliative home care were transcribed and analysed with a qualitative hermeneutic approach. Elements that facilitated comprehensibility included open information, symbolic information, basic life assumptions and previous knowledge. These were important for creating a congruent inner reality (as opposed to chaos). Resources contributing to manageability dealt with power, support, competence and accessibility, which on a more abstract level resulted in a feeling of togetherness (as opposed to isolation). The findings are discussed in relation to the complexity of communication between staff and carers within palliative care.

Are Home Care Programs Cost-Effective? A Systematic Review of the Literature

The cost-effectiveness of home care programs and services is an important area of health care research given the recent growth and continuing trend in home health care, the current state of health care reform in Canada, and changing demographics in Canada. Home care programs often proceed with little evidence-based decision-making. Increased demandfor evidence-based decision-making is apparent in not only clinical settings, but also in policy environments thus creating a need for more research in this area. There are presently very few rigorous studies on the cost-effectiveness of home care programs. This systematic literature review addresses the research question, "What is the relationship between cost-consequence evidence and policy implications within the home care context?" The findings are not surprising. They include mixed results and indicate that cost-effectiveness of home care programs is an important area to study in spite of the many challenges. The challenges presented must be acknowledged and addressed in order to produce better research designs in future studies.

The children's sentinels: Mothers and their relationships with health professionals in the context of Japanese health care

The context of the Japanese health care setting shaped Japanese women's roles as the major and solo caretakers of their ill children, which caused them to be removed from the family unit during the children's illnesses. The mothers became sentinels and tried to protect their children from unnecessary physical and psychological distress and agony in the hospital context. Some of them comforted their children in the home-care context once their children reached the point where no other treatment could help. At the same time, they tried to establish effective relationships with health professionals, especially physicians. One third of the mothers gave the initiative to the physician, but almost half of the mothers shared the initiative to some degree with physicians on an equal or dominant-subordinate basis. Whether the mothers trusted the physicians did not relate to whether they shared the initiative or not, but was a primary factor in deciding whether to change hospitals. The mothers became monitors and advocates of their children during treatment, at first choosing to adapt to their subordinate position in the hospital, but becoming more assertive when they felt their children may be seriously harmed.

Ethical considerations in home care of the oncology patient

To examine the context of home care and the values of providers and patients that lead to potential ethical conflicts. To discuss a normative model of ethical decision making, and to suggest resources for resolving ethical issues. Published articles pertaining to ethical issues and home health care. Home care is a viable and beneficial alternative to hospital care for a variety of patients, yet home care can result in unique value conflicts between patients and their families, and patients and home care providers. Loss of privacy and determining who is in charge are several unique areas to home care that can lead to ethical problems. Policies, guidelines, value statements, and ethics committees are excellent resources to assist in ethical decision-making. A workable method or model to resolve ethical problems, and resources to assist in ethical decision-making can provide home care providers with guidelines to analyze an ethical problem and the support to choose and act on the best option.

Fathers and child care: an exploratory study of fathers with children in day care∗

The article represents an exploratory study focussing on fifteen fathers and their preschool children in home and day care contexts. A one hour structured interview with each father served as the principal source of data. The literature on father participation in family life and parental participation with caregivers is reviewed prior to a presentation and discussion of data from a day care research project based in Victoria, British Columbia, Canada. ∗ This project was undertaken with the funding assistance of the Social Sciences and Humanities Research Council of Canada