Home Care Clinicians Research Articles

Effectiveness of the Teach-Back Method for Improving Caregivers' Confidence in Caring for Hospice Patients and Decreasing Hospitalizations.

Health care professionals use teach-back to foster adherence to treatment recommendations and to improve safety and quality of care. This improvement project, conducted in one division of a home care agency, used a pretest-posttest design with an interprofessional group of hospice home care clinicians to incorporate teach-back into home visits to evaluate if the use of teach-back enhanced caregiver and patient-provider communication, improved caregivers' confidence in caring for hospice home care patients, and decreased hospitalizations. After the intervention, the teach-back group had zero hospitalizations compared with 2 for the non-teach-back group (0% and 1.97%, respectively), and patient-caregiver "confidence" increased from 58% to 81%, pre to post intervention. In conclusion, teach-back is a cost-effective teaching methodology that can be implemented by any discipline to improve patient-provider communication and patient outcomes.

Promoting Skin Care for Older Adults

Chronic conditions and age-related changes place older adults at increased risk for skin breakdown and damage to skin integrity, leading to poor outcomes that may impact quality of life. Although we cannot stop skin from aging, home care clinicians are in the best position to mitigate further skin problems and influence healthier outcomes for patients with skin issues. Home healthcare clinicians can improve skin health and well-being for older adults by incorporating simple but thorough systematic skin assessments at every visit. This includes identifying the patient's personal skin care practices and preferences. Home healthcare clinicians can intervene and address excessive moisture or extreme dryness of skin, use available resources for best practices in wound care, and educate about sun protection.

Period from Loss of the Ability to Access Toilets Independently to Death in End-Stage Cancer Patients.

Background: Toileting independence is considered to be important factors for achieving a “good death” for terminally ill patients.Aim: To clarify the period from loss of the ability to access toilets independently to death in end-stage cancer patients.Design: Observational study.Setting/Participants: The medical records of all end-stage cancer patients who had died while using home care services provided by Medical Corporation Kagayaki General Home Care Clinic between September 2011 and August 2017, were retrospectively reviewed.Results: A total of 220 patients were included. The median time from total dependence in toileting to death was 6.0 (95% confidence interval: 5.0–7.0) days. When the duration was 7 days or shorter and 21 days or shorter, the cumulative death rate was 55.9% and 86.4% respectively.Conclusion: A large percentage of terminally ill cancer patients maintained the ability to access toilets independently until very close to the end of their lives, so the duration of total assistance needed was shorter. These findings may be useful to make a care plan to support achieving “good death” for patients.

Evaluation of Home Care Service Program in Batua Public Health Center of Majority in Working Area of Makassar City

Home Care program started in the Stone Clinic from may 2014 by the Government of the city of Makassar. He had to do in a program evaluation is a process whereby an orderly and systematic there is scope in the evaluation i.e. the input, process, and output. This research aims to know the evaluations program Home Care in clinics Stone Makassar City Year 2018. This research is a descriptive analysis with qualitative research to explore the phenomenon concerning the evaluation of the implementation of the Home Care program in health centers by using a method of Makassar Stone in-depth interviews (in-depth interviews) and observation. The results showed that the evaluation of the input stage, covering the 5. In terms of the Man in the Stone Clinic is the need to add a number of implementing power, especially for the Home Care program. In terms of the Machine, equipment used in the Home Care Service is complete. in terms of the Method were in accordance with the existing and standard operational procedure prevailing, in terms of Money the Ministry Home Care comes from a GRANT and that has been determined and was sent from the City Health Office of Makassar. For Materials (documentation/report) using a mobile phone camera and posted using WA to WA Group Ministry Home Care Clinics Stone, then the evaluation at this stage of the process needs to be proper coordination is not constrained in the implementation, and evaluation on the output stage, namely the lack of the skill of nurses to influence the independence of the patient

Factors That Affect People's Interest In The Utilization Of Home Care In Clinics Kites

This research is based on because the utilization of home care in Clinics Layang unlike others clinic in Makassar city. Many factors being the cause of a lack of Community interest in the utilization of home care Clinics in the region Kites. So this research aims to identify the factors that influence people's interest in the utilization of home care in the clinic Layang, besides this research aims to analyze the influence of socialization, the environment, facilities services and image in the utilization of home care in Clinics of the overpass.
 This research using quantitative research approach to an analytic survey. Sample research as much as 92 people, namely people who are domiciled in the territory of the health workers and utilize Your facilities services home care at least 2 visits. Data collection techniques using questionnaires and observation.
 The results showed that the variables affecting people's interest in the socialization of the utilization of home care are not significant with the value of the sig = 0.097, residence environment variables affect people's interest in the utilization of home care are not significant with the value of the sig = 0.417, variable service facility affect people's interest in the utilization of home care are not significant with the value of the sig = 0.235, and image variables affect people's interest in the utilization of home care are not significant with the value of the sig = 0.133.
 In conclusion, the four variables examined, socialization variables, environment, facilities services and image have no significant influence on the people's interest in the utilization of home care.

Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study.

Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care. To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states. In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity. Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting. Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.

Online Resources to Support Clinical Practice.

Evidence-based practice requires access to practice guidelines, research articles, and other resources; however, home healthcare clinicians can face barriers when seeking health information. The purpose of this article is to provide home care clinicians with: a) free resources available on the internet, b) suggestions for searching and evaluating health information found on the internet, and c) opportunities for free continuing education for home healthcare clinicians.

Becoming a Home Care Clinician or Manager Information Needed for Success.

This chapter is an excerpt from Home Care Nursing: Surviving in an Ever-Changing Care published by Sigma Theta Tau International (Marrelli and Associates, Inc., 2017) and has been significantly condensed for purpose of publication in Home Healthcare Now. For more information about this book, Home Care Nursing: Surviving in an Ever-Changing Care Environment. Please visit Nursing Knowledge International at https://www.nursingknowledge.org/home-care-nursing-surviving-in-an-ever-changing-care-environment.html.

A Mixed Methods Evaluation of the Feasibility and Acceptability of an Adapted Cardiac Rehabilitation Program for Home Care Patients

Home care clinicians have an opportunity to improve care for post-hospitalization patients with cardiovascular disease. This mixed methods study examined the feasibility and acceptability of an adapted cardiac rehabilitation (CR) program for the home care setting. Surveys measuring patient self-care and knowledge were administered to patients (n = 46) at baseline and at 30-day follow-up. Semi-structured interviews were conducted with patients (n = 28) and home care clinicians (n = 11) at completion of the program. All survey indicators demonstrated a trend towards improvement, with a statistically significant increase in the self-care management subscale (p = 0.002). Qualitative analyses identified three patient themes (self-awareness, nutrition, motivation) and three clinician themes (systematic approach, motivation, patient selection process). Incorporating CR into the home care setting proved to be a feasible and acceptable approach to increasing access to CR services among elderly patients.

End-of-Life Care for WW II, Korea, and Vietnam-Era Veterans.

Military Veterans have made many sacrifices for our country and deserve high-quality care at end of life. The purpose of this article is to discuss the WW II, Korean and Vietnam Veteran population, and common concerns at the end of life. Areas of focus include spiritual and emotional needs, posttraumatic stress disorder, and pain management. Understanding of military/Veteran culture, the stoic mindset, and moral injury may provide foundational knowledge for nonmilitary home care and hospice clinicians to understand Veteran patients and their families. In addition, resources and other references are offered to enhance the knowledge of Veteran-related care.

Hypoglycemia in Diabetes Mellitus.

Hypoglycemia is a serious acute complication of diabetes treatment. Recognizing the risk factors and taking steps to prevent low blood glucose should be a part of self-management education for all people taking glucose-lowering medications. It is important for home care clinicians to evaluate their patient's understanding of hypoglycemia and the appropriate treatment options.

Artificial Nutrition and Hydration in People With Late-Stage Dementia.

The progressive nature of dementia marks this disease as a terminal illness in the advanced stage, and palliative care rather than curative treatment is indicated. The use of feeding tubes to deliver artificial nutrition and hydration at end of life is often part of the plan of care for people with dementia. Current evidence, however, suggests that tube feeding in advanced dementia is not beneficial and the burdens of the procedure and the feedings themselves outweigh any benefits. Evidence also reveals that healthcare providers may lack evidence-based knowledge about artificial nutrition and hydration to adequately inform families and surrogate decision makers. This article examines the evidence regarding use of artificial nutrition and hydration for patients with end-stage dementia and offers implications for home care clinicians.

Healthcare Benefits for Veterans: What Home Care Clinicians Need to Know.

Healthcare Benefits for Veterans: What Home Care Clinicians Need to Know.

Development of a Tool to Identify Problems Related to Medication Adherence in Home Healthcare Patients.

In the home healthcare setting, clinicians are required to evaluate patient's medication therapy, including adherence. To facilitate this conversation, a pilot question list to help uncover potential medication nonadherence was created after completing a review of the literature and ascertaining the common themes as to why patients were nonadherent to their medication therapies. Pharmacy personnel who provide onsite consultations in a home healthcare setting used the question list to identify medication-related problems that could contribute to nonadherence and to document potential solutions. Through pharmacist-patient interactions, which occurred after admission to the home healthcare agency, pharmacy personnel found on average 2.3 issues per patient, which could affect medication adherence. Side effects were the most common problem identified. After this tool was tested with 65 patient interviews, the questions were analyzed and condensed into a shorter list more specific to the identification of medication-related problems for use by home care clinicians.

Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW.

There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test. Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists. Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.

Supporting the information domains of fall-risk management in home care via health information technology

ABSTRACTIn the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians’ fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

Leveraging Health Information Technology for Fall-Risk Management in Home Care

Falls have a detrimental impact on home care outcomes. This study investigated home care clinicians’ perspectives on (1) how the currently adopted health information technology (IT) solutions supported fall-risk management activities, (2) various shortcomings of these solutions, and (3) ways to improve upon them. Within a case study design, qualitative data were collected through interviews and focus groups at one suburban home health agency in the United States. The clinicians mainly used the electronic health record but experienced substantial difficulties with documenting and accessing fall-related information. Improvement opportunities include providing better workflow support and usability, implementing medication alerts, facilitating fall-related information exchange, and leveraging the IT capabilities at patients’ homes. Additional IT solutions can improve the awareness, assessment, and intervention dimensions of fall-risk management.

Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians.

The purpose of this article is to describe an innovative method to help home care clinicians better communicate with older adults experiencing normal physiologic changes that impact their ability to communicate effectively. Developmental changes such as hearing, speech, vision, and cognition profoundly impede an older adult's ability to communicate with others, potentially undermining the quality of care delivered. The use of trigger films as an educational intervention can assist home care clinicians to improve communication with their patients. Trigger films are 2- to 4-minute video clips that end abruptly, encouraging learners to analyze clinical situations in a safe environment, such as a staff conference room. Trigger films are easy to make with the use of a smart phone and two staff members portraying the role of home care clinician and patient. Allowing discussion after viewing the trigger film places clinicians in an active learning role, thus fostering the sharing of ideas and best practice. Addressing age-related barriers to communication with this modality serves to improve patient interaction and healthcare outcomes. The use of trigger films is another tool that empowers the clinician to provide improved care for patients with communication deficits.

Parkinson Disease.

Parkinson disease (PD) is a progressive neurodegenerative disease that affects one million people in the United States. This article reviews the etiology and pathophysiology of PD, risk factors, clinical manifestations, diagnostic criteria, and treatment of this common disease. Implications for home care clinicians are included.

"Top Ten" List: A Brief Report of Adult Poisoning and Prevention Tips.

This article reviews the 10 major categories of poisoning exposures, as reported to the American Association of Poison Control Centers through the national surveillance system, provides an overview of adult poisonings, and offers tips for home care clinicians to educate themselves and patients on poison exposure, prevention, and response. Home healthcare clinicians provide a critical link in the chain of home safety throughout the care continuum. The phone number for the local poison control center should be readily available in patients' homes and known to all home healthcare staff members. The top 10 categories should be reviewed during orientation of new home care staff members and at staff meetings.