Client Families Research Articles

AI-guided resource allocation and rescue decision system for medical applications

With the robust growth in the social environment, millions of families have vast medical plans nowadays. Each client requires a personalized medical rescue decision, making an intelligent recommendation system highly important. In practice, wealthy families tend to purchase tailored medical services, while others tend to seek medical services from local community hospitals. Noticeably, trillions-scale of medical service transactions occurs daily, making the development of a fully automatic intelligent recommendation system to match the suitable medical services to clients urgent. In this work, we propose a novel Internet-scale deep architecture that automatically recommends personalized and tailored medical rescue services based on the previously discovered clients with different financial tolerance. Specifically, given a massive number of client families, first, we create a set of features that represents the multiple medically related attributes of each family. These features capture the income, health status, type of diseases, occupation, and so on. The features are then combined into a descriptive feature by multi-view learning, which can dynamically assign the importance of each feature channels. Based on the combined feature, affinity graphs are created on a large scale to represent the relations between the client families. Also, an efficient dense subgraph mining is used to categorize the million-scale clients into 10 different medical groups. Finally, various customized medical services can be tailored for each client in a fully automatic and efficient manner. Comprehensive experiments on our collected data sets demonstrated the competitiveness of our proposed intelligent recommendation system. Moreover, the results of visualized dense subgraph mining showed that the client families with different wealth levels can be distinguished accurately.

Targeting of HER/ErbB family proteins using broad spectrum Sec61 inhibitors coibamide A and apratoxin A

Coibamide A is a potent cancer cell toxin and one of a select group of natural products that inhibit protein entry into the secretory pathway via a direct inhibition of the Sec61 protein translocon. Many Sec61 client proteins are clinically relevant drug targets once trafficked to their final destination in or outside the cell, however the use of Sec61 inhibitors to block early biosynthesis of specific proteins is at a pre-clinical stage. In the present study we evaluated the action of coibamide A against human epidermal growth factor receptor (HER, ErbB) proteins in representative breast and lung cancer cell types. HERs were selected for this study as they represent a family of Sec61 clients that is frequently dysregulated in human cancers, including coibamide-sensitive cell types. Although coibamide A inhibits biogenesis of a broad range of Sec61 substrate proteins in a presumed substrate-nonselective manner, endogenous HER3 (ErbB-3) and EGFR (ErbB-1) proteins were more sensitive to coibamide A, and the related Sec61 inhibitor apratoxin A, than HER2 (ErbB-2). Despite this rank order of sensitivity (HER3 > EGFR > HER2), Sec61-dependent inhibition by coibamide A was sufficient to decrease cell surface expression of HER2. We report that coibamide A- or apratoxin A-mediated block of HER3 entry into the secretory pathway is unlikely to be mediated by the HER3 signal peptide alone. HER3 (G11L/S15L), that is fully resistant to the highly substrate-selective cotransin analogue CT8, was more resistant than wild-type HER3 but only at low coibamide A (3 nM) concentrations; HER3 (G11L/S15L) expression was inhibited by higher concentrations of either natural product. Time- and concentration-dependent decreases in HER protein expression induced a commensurate reduction in AKT/MAPK signaling in breast and lung cancer cell types and loss in cell viability. Coibamide A potentiated the cytotoxic efficacy of small molecule kinase inhibitors lapatinib and erlotinib in breast and lung cancer cell types, respectively. These data indicate that natural product modulators of Sec61 function have value as chemical probes to interrogate HER/ErbB signaling in treatment-resistant human cancers.

Nursing Care in Schizophrenic Clients (Delusion) in Hospital Service Management: A Case Study

Introduction: care for mental patients needs to be continuous and collaboration between health workers and the client's family is needed. This collaboration can be done by carrying out one of the complementary training activities to extend the recurrence time and prepare the client to return to the community. Objective: to find out schizophrenia nursing care in a hospital. Method: The process of writing this scientific article uses a case study approach with a descriptive method drawn from the life and personal experience of the author. To collect data in the form of articles, the author uses several databases, namely Science Direct and Google Search. The author also uses several search keywords such as "Psychiatric Disorder", "Perception Disorder", "Delusion", "Therapy Complementer", using the boolean "AND". In addition to using keywords, the author also uses inclusion and exclusion criteria starting from articles published 2010-2020, using Indonesian and English as well as fulltext articles with reliable sources. From the search above, thousands of articles were obtained and the authors analyzed and raised the title "Nursing Care for Schizophrenic Clients (Delusions) in Hospital Service Management: Case Studies". Results and Discussion: Clients in cases showing chronic schizophrenia with prominent symptoms are delusions. Clients with delusions can be done training or complementary therapy for the process of preparation for returning home and returning to the community. Conclusions and Recommendations: The nursing process in psychiatric patients especially chronic schizophrenia must be continuous and continuous. This severe mental disorder is chronic and there will be a recurrence so there is a need for cooperation between the nurse and the client's family for the implementation of therapy. Therapies such as music therapy, aromatherapy, massage, reflexology, animal therapy, cinema therapy, yoga and social skill training. Further research is needed related to the effects of complementary therapy associated with schizophrenia. Keywords: Nursing Care, Schizophrenia, service management, delusions

Understanding differences in family engagement and provider outreach in New Journeys: A coordinated specialty care program for first episode psychosis

The present study examined clinician outreach efforts to families and family engagement; and predictors of engagement in a coordinated specialty care (CSC) for first episode psychosis. From 2015 to 2019, 211 clients experiencing their first episode of psychosis and their family members received services from New Journeys, a network of CSC programs in the United States. Analyses examined the association between race/ethnicity, insurance type, referral source, housing stability, and outreach efforts and family attendance. Overall, 70% of client family members attended at least one psychoeducation appointment and in the first month of treatment 40% of family members attended family psychoeducation. Outreach efforts including phone attempts (β=1.09; p = 0.02) and phone contact (β=1.10; p = 0.02) were significantly higher for Black families relative to White families; whereas Black families were scheduled less often for a family psychoeducation (β=-0.28; p = 0.02) compared to Whites families. Significant differences in family attendance based on insurance type were also found (p<0.01). Referral source and housing stability were not significant predictors of outreach or attendance. These findings suggest that alternative engagement efforts that extend beyond in-person contact may be needed to continuously engage families, specifically Black families and those with public and no insurance.

Qualitative accounts of PrEP discontinuation from the general population in Eswatini

People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These ‘discontinuation’ clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini. Reasons for discontinuation included changes to self-perceived HIV risk such as the end of pregnancy and absent partners. Others described PrEP as inaccessible when working away from home and many described difficulties relating to a daily pill regimen and managing side effects. Female clients described being prohibited from using PrEP by their partners and co-wives. From these results, we recommend that client-centred counselling stresses the prevention-effective adherence paradigm, which promotes PrEP use in risk periods that are identifiable and PrEP discontinuation when the risk period has finished. A national scale up of PrEP may mitigate problems accessing PrEP. Extended counselling and support could assist with adherence and the management of side effects. Education and support for partners and families of PrEP clients may also contribute to better PrEP continuation.

Perceptions and experiences of live-in carers: why acknowledging versus neglecting personal identity matters for job satisfaction and wellbeing

AbstractFor some older people and their families, live-in care offers a way of continuing to live independently at home in their local community. While research in the care industry has consistently highlighted the effects of caring on workers, little research has specifically explored the experiences of live-in carers. The current study examines the ways in which live-in carers construct their role, the different challenges they face and the strategies they use to mitigate them. Semi-structured interviews were carried out with 21 live-in carers in the United Kingdom and the data were analysed using thematic analysis. The findings suggest that carers perceive their role as complex and characterised by a heavy workload and tiredness. Participants emphasised the variability which was introduced to the role as a function of the quality of agency support, the character and condition of the client, and the carer's relationships with the client's family. Participants’ accounts reflected an acknowledgement of the need to orient and respond constantly to the needs and routine of the client. While this orientation was recognised as necessary for effectively fulfilling the demands of the role, it was also linked to feelings of dislocation and loss of identity. Drawing on understandings of personal and social identity, the implications of these findings for the psychological wellbeing of live-in carers and organisational support are discussed.

Improving outcomes for marginalised rural families through a care navigator program.

Health promotion programs are based on the premise that health and well-being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services. This family program in a small rural town in Western New South Wales targeted marginalised families with children under five years of age with a chronic health issue. The navigator developed a cross-sectoral care plan to provide services to address family issues. The study aimed to identify navigator factors supporting improved family outcomes. Participants included parent/clients (n=4) and the cross-sectoral professional team (n=9) involved in the program. During the interview, participants were asked about their perspective of the program. Interview transcripts were thematically analysed informed by the Chronic Care Model underpinned by Health Promotion Theory. The program improved client family's lives in relation to children's health and other family health and social issues. Trust in the care navigator was the most important factor for parents to join and engage with the program. The care navigator role was essential to maintaining client engagement and supporting cooperation between services to support families. Essential care navigator skills were commitment, ability to persuade and empower parents and other professionals. SO WHAT?: This descriptive study demonstrated the positive influence of the care navigator and the program on high risk families in a small isolated community. It can be adopted by other communities to improve life for families at risk.

COVID-19 - An avoidable epidemic: A family medicine practitioner's perspective.

Sir, The COVID-19 has been declared as a Global Health emergency by the WHO Emergency Committee. This declaration was based on an increased number of cases being notified from Wuhan, the capital city of Central China's Hubei province. India has also been a victim of this disease now and as per ICMR COVID-19 update[1] till 10th April 2020, a total of 1,61,330 samples from 1,47,034 individuals were tested. A total of 6782 tests have been confirmed positive among suspected cases or contacts of confirmed cases. Coronavirus has been known to exist in mammals and avian hosts. Coronavirus belongs to family coronaviridae which are single-stranded RNA viruses with a genome size of 26 to 32 kb in size.[2] The recent study based on next-generation sequencing suggests that the COVID-19 virus is 88% identical to already known bat-associated SARS viruses collected in 2018 in Zhoushan, another province of China in 2018.[3] This major route for its spread of infection is from viral droplets and it is propagating throughout the world by international travelers. At this point, I would bring in your kind attention to my serious observation of a lack of knowledge among travelers. The responsibility has to be owned by the fraternity of family medicine practitioners. Our health system has been made to evolve in such a way that we always tend to overload common man with scientific and nonscientific information, once calamity has already happened. I strongly feel that the role of family medicine practitioners has been always undermined. The bond which has been shared between family physicians and the client family could have played a very pivotal role in preventing such kind infectious pandemics. The contagious nature of the disease, its symptoms, and precautions could have been known to very few initial contacts and positive cases. This exponential rise in several cases could have been prevented. For a country like India, wherein an already overburdened health system is undergoing a radical transfiguration of controlling body i.e. from Medical Council of India to National Medical Commission (NMC). As highlighted in the editorial of a previous issue of this esteemed journal,[4] NMC needs to understand the importance of family medicine and probably a time-bound need for representation of family medicine practitioners for requisite rectifications to include subject as an integral part of undergraduate/postgraduate medical curriculum.[4] The prevailing circumstances of infectious based pandemics and the overflow of factual and fake information specially related to medical conditions, that too during ongoing global emergency needs to be checked and validated. This validation of the continuous flow of information can only be done with the support of family medicine practitioners. The inclusion of family medicine in the curriculum of medical graduate and postgraduate courses will facilitate exposure of students towards this medical field which has been not implemented in India. It must be emphasized now that many global phenomena of this kind of chaotic and manmade crisis can be prevented by strengthening the holistic practice of family medicine. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

TERAPI PENYEMBUHAN AUTIS MELALUI PENDEKATAN KONVENSIONAL DAN ZIKIR DI PEKANBARU DAN YOGYAKARTA

On account of the development of science, there are recently many alternative treatments to cure autism through various kinds of therapies such as used by the Permata Hati Pekanbaru School and the Islamic Boarding School of Taruna Al-Quran in Yogyakarta. The purpose of the current paper was to determine healing therapy on autism through conventional and Dhikr approaches. Conducted through qualitative approach, the chosen subjects consisted of clients, therapists and client families. The results of this study showed that therapy through conventional approaches at the Permata Hati Pekanbaru School used 5 treatments; 1. Speech therapy, 2. occupational therapy, 3. social interaction therapy, 4. sensory interaction therapy, and 5. eating therapy. Otherwise, the Dhikr therapy in the Islamic Boarding School of Taruna Al-Quran in Yogyakarta noticed the results of the morning evening Dhikr through several stages; 1. assessment, 2. determining goals, 3. patterns of habitualizing behavior, 4. and changes in behavior. The project showed that the Permata Hati Pekanbaru therapy focused on physical health, while the Dhikr therapy focused on spiritual factors.

Assessment of Stress Reactions and Identification of Family Experiences in Primary Care Post Restrain Schizophrenia in East Java Indonesia. Mix Method: Sequential Explanatory

After the life of the schizophrenia, post-Restrain is a person who has been free from restraining, but stress reaction on the client family schizophrenia post-Restrain has not been said to end the role in family factors . The aim of the study was to investigated stress reaction and family experiences in primary care post restrain schizophrenia and to explain the stress reaction and experience of families who have people with schizophrenia post-restrain. Material and Method: A total of 135 families who have people with schizophrenia post-restrain October to December 2018. This research Mix Method: Sequential Explanatory design, the research instrument used was The Kempe Family Stress Inventory with The sensitivity of the KFSI was calculated at 80%. The specificity was 89.4%. the positive predictive value was 52.5%. Negative predictive value was 96.8%. The results of the study illustrated that the total mean score of a stress reaction in families normal was 43.48 [S.D=5.6], Mild was 34.33 [S.D=4.7], Severe was 56.45 [S.D=4.45]. The psychological burden was expressed by families in the form of fear and worry, the results showed a reaction to high stress and family experience lacking in primary care of people with post-restrain mental disorders. Conclusions: Most of the stress on families who have schizophrenia post-restrain in East Java is still showed revealed that the overall family stress reaction parent beaten of deprived schizophrenia and A majority parent has substance abuse history and Multiple stress.

Genetic Risk Assessment in Psychiatry.

Most psychiatric disorders of pediatric and adult onset are caused by a complex interplay of genetic and environmental risk factors. Risk assessment in genetic counseling is correspondingly complicated. Outside of neurodevelopmental conditions, genetic and genomic testing has not achieved clinical utility. Genetic counselors most often base risk assessment on the client's medical and family history and empiric recurrence risk data. In rare cases significant familial risk may arise from variants of large effect. New approaches such as polygenic risk scores have the potential to inform diagnosis and management of affected individuals and risk status for at-risk individuals. Research on the genetic and environmental factors that increase risk for schizophrenia and etiologically related disorders are reviewed, guidance in determining and communicating risks to families is delivered, and new opportunities and challenges that will come with translating new research findings to psychiatric risk assessment and genetic counseling are anticipated.

Reducing Barriers to Postabortion Contraception: The Role of Expanding Coverage of Postabortion Care in Dar es Salaam, Tanzania.

In Tanzania, limited access to postabortion care (PAC) contributes to high rates of maternal mortality. To address the issue, Pathfinder International and the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) introduced and expanded coverage of PAC in 64 public health facilities in Dar es Salaam, Tanzania. During a 30-month period, we implemented a multifaceted approach to introduce and expand PAC, including clinical training and mentorship for health care providers; service reorganization, equipment provision, and an expanded method mix offering; standardization of PAC reporting tools; and community engagement and referral. We assessed outcomes using PAC service statistics from 64 public health facilities in 4 districts of Dar es Salaam and health care provider mentorship data from 385 observed PAC visits. From January 2016 to June 2018, voluntary postabortion contraceptive uptake increased steadily. A total of 6,636 PAC clients, including 2,731 young people (ages 10-24), adopted a method post-procedure. Average semesterly client volume per facility increased from 27 to 52.4 manual vacuum aspiration clients and 17.6 to 43.9 postabortion contraceptors between the first and last periods. Overall postabortion contraceptive uptake was 80.6% (6,636/8,230), with a method mix of 58.3% implant, 18.9% intrauterine device, 13.7% pills, 8.6% injectables, and 0.5% permanent methods. Adults and young people had comparable method mix. Mentored providers showed improvements in service quality indicators. During the last period, 92% counseled the client on contraception, 93% considered the client's sexual and reproductive health intentions, 94% provided correct method information and supply, and 96% documented services on the client's family planning card. Different provider types (mid- and senior-level) performed comparably. Expanding PAC coverage to primary- and secondary-level facilities led to high uptake of voluntary contraception among postabortion clients. Key interventions included PAC clinical training and mentorship; service reorganization, equipment provision, and an expanded method mix offering; use of standardized PAC registers; and community engagement for awareness building and linkage to PAC.

Acceptability, feasibility and utility of a Mobile health family planning decision aid for postpartum women in Kenya

BackgroundUnmet need for contraception is high during the postpartum period, increasing the risk of unintended subsequent pregnancy. We developed a client facing mobile phone-based family planning (FP) decision aid and assessed acceptability, feasibility, and utility of the tool among health care providers and postpartum women.MethodsSemi-structured in-depth interviews (IDIs) were conducted among postpartum women (n = 25) and FP providers (n = 17) at 4 Kenyan maternal and child health clinics, 2 in the Nyanza region (Kisumu and Siaya Counties) and 2 in Nairobi. Stratified purposive sampling was used to enroll postpartum women and FP providers. Data were analyzed using an inductive content analysis approach by 3 independent coders, with consensual validation.ResultsFP providers stated that the Interactive Mobile Application for Contraceptive Choice (iMACC) tool contained the necessary information about contraceptive methods for postpartum women and believed that it would be a useful tool to help women make informed, voluntary decisions. Most women valued the decision aid content, and described it as being useful in helping to dispel myths and misconceptions, setting realistic expectations about potential side effects and maintaining confidentiality. Both women and providers expressed concerns about literacy and lack of familiarity with smart phones or tablets and suggested inclusion of interactive multimedia such as audio or videos to optimize the effectiveness of the tool.ConclusionsThe iMACC decision aid was perceived to be an acceptable tool to deliver client-centered FP counseling by both women and providers. Counseling tools that can support FP providers to help postpartum women make informed and individualized FP decisions in resource-limited settings may help improve FP counseling and contraceptive use in the postpartum period.

Family workers, stress, and the limits of self-care

High levels of work-related stress have been frequently documented among front-line family service providers including social workers, home visitors, and agency staff members. Left unaddressed, such stress contributes to burn-out and job turnover, with negative effects on client families as well as agencies and the workers themselves. In response to this problem, some child and family service organizations have encouraged the use of self-care practices to counteract the inherent stresses of these jobs. The present study reports on descriptions of stress and self-care contained in written portfolios of 99 family workers enrolled in a strength-based training program, the Family Development Credential®.As found in other research, virtually all study participants reported an over-arching sense of stress and anxiety, with specific issues of workload, client problems, and work/family imbalance most frequently mentioned. To deal with their stress, workers described a variety of self-care practices: most common were mindfulness, exercise, social connections, changing self-expectations, and time management. Results show a significant curvilinear relationship between the number of stresses and the number of self-care practices mentioned, such that workers discussing both the lowest and the highest number of stresses discussed fewer self-care practices than workers naming a moderate number of stresses. Although a similar relationship between the level of stress and individuals' ability to take advantage of available resources has been demonstrated for low-income families, to our knowledge the present study is the first empirical demonstration of this principle for people who serve such families. These findings illustrate the limits of individual self-care for dealing with high levels of stress, and suggest the importance of strengthening worker support at the agency level, as well as tailoring stress management programs to the needs of individual workers.

HUBUNGAN FAKTOR KELUARGA DENGAN KEKAMBUHAN PADA KLIEN SKIZOFRENIA DI POLIKLINIK RUMAH SAKIT JIWA PROF. DR. HB. SA’ANIN PADANG

The national prevalence of severe mental disorders in Indonesia is 1.7 per mile and 70% of them are schizophrenia. The inability to control symptoms can cause recurrence in schizophrenic clients. The purpose of this study was to determine the relationship of family factors with the relapse of schizophrenic clients at Prof. Dr. HB. Sa’anin Padang. This type of research was descriptive correlative with a cross sectional approach with the number of respondents 173 people schizophrenia clients and families at Prof. RS Polyclinic. HB. Sa’anin Padang. The sampling technique is convinience sampling. The study was conducted from April to June 2016. Data collection was carried out using a questionnaire. The results showed that there was a significant relationship between family support and caregiver burden with relapse of schizophrenic clients (p &lt;0,05). The results of this study are expected to be an input for nurses and related agencies to prevent the relapse of schizophrenia clients by providing an understanding of the importance of family support and forming a supportive group of schizophrenic client families.&#x0D; Keywords : Family, relapse, schizophrenia

가족희생양 세대전수 진행과정을 경험한 내담자 가족에 대한 단일사례 연구

가족희생양 세대전수 진행과정을 경험한 내담자 가족에 대한 단일사례 연구

Constituents of effective support for homecare workers providing care to people with dementia at end of life.

The aim of this study was to enhance understanding about homecare workers providing care to people with dementia at end of life by exploring homecare workers' perceptions of challenges and the support they needed and sometimes received. Qualitative semi-structured interviews were conducted with 29 homecare workers and 13 homecare managers in England. Framework analysis was used to analyse the data. Four overarching challenges were identified: working with clients with dementia, including clients' sometimes unpredictable responses, communication difficulties, and mood changes; caring for the dying; conflict with family members; and working alone, which often left homecare workers at risk of exhaustion, fatigue, and a sense of isolation. When their work entailed high levels of emotion, such as a client's death or getting embroiled in a client's family conflict, they felt emotionally drained, under-prepared, and overwhelmed. Supportive elements include receiving encouragement and learning from experienced peers and their feelings being acknowledged by managers at their employing homecare agency. Some workers were offered time off or encouraged to attend the client's funeral as a means of supporting the process of bereavement. Peer and manager support are essential and effective in coping with work pressures. There is a need to develop models of effective support to alleviate staff's practical, emotional, and interpersonal pressures. However, due to the isolating nature of homecare work, managers may not recognise early signs of their staff finding stress unmanageable and miss the opportunity to mitigate these negative effects.

Clinician identified barriers to treatment for individuals in Appalachia with opioid use disorder following release from prison: a social ecological approach

BackgroundThe non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.MethodsA social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals with OUD in Appalachian Kentucky following release from prison. Semi-structured qualitative interviews with 15 social service clinicians (SSCs) employed by the Department of Corrections were conducted to identify barriers at the individual, interpersonal, organizational/institutional level, community, and systems levels. Two independent coders conducted line-by-line coding to identify key themes.ResultsTreatment barriers were identified across the social ecological spectrum. At the individual-level, SSCs highlighted high-risk drug use and a lack of motivation. At the interpersonal level, homogenous social networks (i.e., homophilious drug-using networks) and networks with limited treatment knowledge inhibited treatment. SSC’s high case load and probation/parole officer’s limited understanding of treatment were organizational/institutional barriers. Easy access to opioids, few treatment resources, and a lack of community support for treatment were barriers at the community level. SSC’s noted system-level barriers such as lack of transportation options, cost, and uncertainty about the implementation of the Affordable Care Act.ConclusionsMore rural infrastructure resources as well as additional education for family networks, corrections staff, and the community at large in Appalachia are needed to address barriers to OUD treatment. Future research should examine barriers from the perspective of other key stakeholders (e.g., clients, families of clients) and test interventions to increase access to OUD treatment.

Caregiver Preparedness Training Within Inpatient Brain Injury Rehabilitation: A Scoping Review

To examine caregiver training used within brain injury inpatient facilities, report descriptions of caregiver trainings and mastery outcomes, and report hospital-driven cost outcomes to determine hospital benefit. The review informs recent policy that advocates for providing inpatient caregiver training for families of clients with acquired brain injuries. Providing this evidence will also inform practice to ensure that caregiver needs are met, best practice is established, and hospital readmission costs are reduced.

"Who's Caring for Us?": Understanding and Addressing the Effects of Emotional Labor on Home Health Aides' Well-being.

Interventions to strengthen the home care workforce focus on workers' economic and physical well-being, without acknowledging the caring labor affecting emotional well-being. Our study examined workers' perceptions of the emotional effects of caring work, coping mechanisms, and desired support. We conducted 4 worker focus groups (n = 27). Moderators cross-checked codes and themes, and aides provided input through report-backs. Building close, trusting relationships with clients was central to aides' emotional well-being. Well-being was also influenced by relationships with client families and agency supervisors, work-life balance, and the level to which aides felt their work was valued. Aides were largely alone in managing job stressors and desired more communication, connection, and support from supervisors and peers. Recognizing and supporting the emotional demands of caring work is crucial to strengthening the workforce. Policy makers and agencies must realign reimbursement systems, job descriptions, and care plans to include measures of emotional labor, improve communication between workers and supervisors, and provide training, mental health benefits, and peer support.