Home Care Practice Research Articles

Promotion of Healthy Eating and Regular Physical Activity in Children Attending Family Child Care Homes

Determine the effects of the Journey to a Healthy Child Care Home (JHCCH) intervention on family child care home (FCCH) policies and practices related to healthy eating and physical activity.

CORRELATION OF ORAL HEALTH HOME-CARE PRACTICES, SNACKING HABITS AND DENTAL CARIES EXPERIENCE AMONG HIV-POSITIVE CHILDREN IN NAIROBI, KENYA.

To determine the correlation of oral health home-care practices, snacking habits and dental caries experience among 3-15 year-old-HIV-positive children attending out-patient clinic at the Kenyatta National Hospital, Kenya. Cross-sectional descriptive study. Kenyatta National Hospital comprehensive care centre out-patient clinic. Two hundred and twenty participants were selected by consecutive sampling. The children's socio-demographic characteristics and oral health home-care practices were obtained from parent or guardian interviews. Oral examination of the children was carried out to determine the presence of dental caries. Of the 220 children in the study, 126 (57.3%) brushed their teeth at least once a day. Forty one (18.6%) children regularly consumed sweetened snacks daily. Almost all children (75.5%) were taking medication in the form of tablets and capsules. One hundred and seventy nine (81.4%) children had never had a dental visit. The prevalence of dental caries was 65% while the mean dmft and DMFT scores were 1.75 and 1.08 respectively. Caries experience was significantly higher for those children who frequently consumed sweetened snacks and those who took their medication in the form of sweetened syrups while it was lowest in those who brushed their teeth at least twice a day. Dental caries experience was significantly higher among HIV-infected children who had increased frequency of consumption of sweetened snacks and those who used syrupy medication. There was poor attendance for dental treatment among the children.

Rhetoric and reality of daily life in English care homes: the role of organised activities

In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the ’’activities of daily living’’ support procedures restricts residents’ involvement in the organised social activities.Within the general provision of services, the organised ’’social activities’’ offered failed to meet the interest, cognitive and physical abilities of residents. The reality of ’’choice’’ is therefore questionable. Policy needs to support a transformation in the delivery of care to ensure it addresses the actual needs and expectations of older people experiencing care home life.

The Effect of Nurse Practitioner Practice in Home Care on Emergency Department Visits for Homebound Older Adult Patients

The impact of nurse practitioners (NPs) in home care on emergency department (ED) usage in Canada has not been documented in the literature. This article discusses the potential impact of care provided by NPs on ED use for home care patients in Canada. The authors used a 2-group prospective design for this pilot study to compare the number of ED visits in home care patients followed by NPs (intervention group, n = 30) with those receiving usual care and not followed by NPs (control group, n = 9). Data were collected by accessing provincial electronic medical records at the time of recruitment and at 3 additional time points: 2 weeks, 4 weeks, and 8 weeks. Descriptive statistics and the z-test of 2 proportions were used to compare the 2 groups. The authors found more ED visits were documented in the control group than in the intervention group at 2 and 4 weeks, but not at 8 weeks. Six subjects dropped out in the intervention group and 1 in the control group during the study due to death. The number of ED visits was reduced at 2 and 4 weeks in the intervention group, but there was no significant difference in the death rates between the 2 groups. This study serves as a springboard for future studies of NPs in home care in Canada.

Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015

AimThis paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4.MethodsWe applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007–2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method.ResultsThe top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24–48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of new simple and effective interventions for providing thermal care to LBW infants, if KMC is not acceptable to the mother.ConclusionThe context for this exercise was set within the MDG4, requiring an urgent and rapid progress in mortality reduction from low birth weight, rather than identifying long-term strategic solutions of the greatest potential. In a short-term context, the health policy and systems research to improve access and coverage by the existing interventions, coupled with further research to improve effectiveness, deliverability and acceptance of existing interventions, and epidemiological research to address the key gaps in knowledge, were all highlighted as research priorities.

Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.

This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4.We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method.The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of new simple and effective interventions for providing thermal care to LBW infants, if KMC is not acceptable to the mother.The context for this exercise was set within the MDG4, requiring an urgent and rapid progress in mortality reduction from low birth weight, rather than identifying long-term strategic solutions of the greatest potential. In a short-term context, the health policy and systems research to improve access and coverage by the existing interventions, coupled with further research to improve effectiveness, deliverability and acceptance of existing interventions, and epidemiological research to address the key gaps in knowledge, were all highlighted as research priorities.

Current Occupational Therapy Publications in Home Health: A Scoping Review

Recently, home health services have been a topic of increasing interest. Occupational therapy practice and utilization patterns in home care have not been the subject of recent research. I examined 65 publications addressing current occupational therapy practice in U.S. home health. Articles were analyzed to uncover factors influencing occupational therapy utilization and practice. Results indicate that research has looked at a variety of typologies and efficacy measures for occupational therapy in home care. However, occupational therapy utilization and practice patterns in home health do not appear to be entirely consistent with research. I identify factors explaining this inconsistency and make research and practice recommendations. Results suggest that system challenges limit the utilization and practice of occupational therapy to deliver expected outcomes in home health practice.

Caring for Children with Medical Complexity: Definitions, Challenges and Solutions

Increasing prevalence of children with complex and chronic diseases has occurred in the last half century and will likely continue to occur. These children, their parental caregivers, their families and the health care system are challenged in providing seamless coordinated care that optimizes outcomes in an effective and efficient manner. This paper outlines some potential solutions including clarifying definitions of the population and evaluations of existing and evolving models of care such as the chronic care model, the primary care medical home and non-primary care practice based models, such as comprehensive clinics focused on a specific disease or population, comprehensive clinics focused on a non-categorical population (not focused on a single/limited set of disease(s)), interventions focused on home care; and, other models focusing on more limited types of interventions or policy change. Ongoing growth in impact of complex chronic disease of childhood demands increased attention across sectors of care as an immediate area of focus for child health policy. Keywords: complex care, children with medical complexity, children with special health care needs, chronic care models, Medical Home

Newborn Care Practices by the Mother / Care Givers’ and Their Knowledge about Signs of Sickness of Neonates

Background: Despite proven cost effective intervention, there has been little change in neonatal mortality. In Bangladesh neonatal mortality accounts for two third of infants death. About 90% deliveries take place in home and majority of neonatal death are taking place within 7 days of birth. Information about reasons for delivering at home and newborn care practices will be useful to undertake simple intervention measures by policy makers.Aims and objective: To see the knowledge, perception and behaviour of mothers towards their normal and sick newborn.Methods: A cross sectional study was carried out in Dhaka Shishu Hospital from June to November, 2007. A semistructured, pretested questionnaire was used to interview mothers attending inpatient (IPD) and outpatient department (OPD) of hospital.Results: A total 198 mothers were interviewed. Home deliveries were 35.5% and Institutional were 64.5%. Among the Institutional deliveries 35% (44 out of 127) were planned and tried first at home, but when failed mothers were taken to hospital. Majority (86%) of home deliveries were conducted by Dai/relatives. Umbilical cord was cut with new/boiled blade in 85% of home deliveries and household knife was used in 4% cases. Birth place were not at all heated in all home deliveries. In 32 % of home deliveries babies were given bath within 1 hour of birth and it was 15% in case of hospital deliveries. Forty-eight percent babies of home deliveries were wrapped within 10 minutes. Prelacteal feed was given in 51% of home deliveries in comparison to 23% of institutional deliveries. The rate of initiation of breast feeding within one hour of birth was 52% in home and 35% in institutional deliveries. In all cases breast milk was given within 48 hours. Main reasons cited for delivering at home were preference (43%) and fear about hospital (39%). In case of educated (graduate) mothers 72% deliveries took place at hospital. Less feeding (56%), vomiting (42%), less movement (32%), fever (29%) and cough (27%) could be recognized by mothers as signs of sickness.Conclusion: Home deliveries and poor newborn care practices are commonly found in this study. Traditional birth attendants should be adequately trained as they are conducting majority of home deliveries. Female education is very important to reduce home delivery as it is seen that deliveries of educated mothers are taking place in hospital. High risk traditional newborn care practices like delayed wrapping, early bathing, use of oil in umbilical stump and prelacteal feeding need to be addressed. This study also found that knowledge to identify sickness in newborn is still poor.DOI: http://dx.doi.org/10.3329/bjch.v35i3.10497 Bangladesh J Child Health 2011; Vol 35 (3): 90-96

Supportive Care to Family Caregivers is Not Supportive Enough: Moving Towards an Equitable Approach to Dementia Home Care

SUMMARY The current relationship between family caregivers and home care providers needs to be reconceptualized from one that is nonsupportive and potentially exploitive, to one that fosters a collaborative, empowering relationship. I present my argument in three parts. First, I focus on the problem of the current complementary model of care, one in which home care workers supplement and compensate for the care provided by family caregivers. In effect, I outline how this model of dementia home care in Canada perpetuates an inequitable distribution of care between formal and familial caregivers. Here, I underscore the negative consequences of this complementary approach on the caregiver–provider relationship. In the second part, I call for a reappraisal of ‘supportive relationships’ between home support workers and caregivers, identifying underlying values and principles (e.g., quity) that I believe should inform home care practices and policies in the future. Finally, I propose some possible strategies that may ultimately support both family caregivers and providers in promoting optimal dementia home care.

Development of a Carer Support Needs Assessment Tool (CSNAT) for end-of-life care practice at home: A qualitative study

Background: Current end-of-life care policy and guidance recognises the important contribution of family carers, recommending that their needs should be assessed to support them in their caring role. How regular carer assessment is to be achieved is unclear, particularly because there is no evidence-based tool for directly assessing carers’ support needs that is suitable for use in end-of-life home care practice. Aims: To obtain carers’ perspectives of key aspects of support needed during provision of end-of-life care at home and to develop a carer support needs assessment tool suitable for use in everyday practice. Design: Qualitative using focus groups and telephone interviews. Thematic analysis uses a framework approach. Setting/participants: 75 adult bereaved carers who were family members/friends of patients referred to five Hospice at Home services in the UK. Results: Carers’ needs fell into two distinct groupings of key support areas or ‘domains’: support to enable them to provide care for their relative and more direct personal support for themselves. Many aspects of supportive input were common across domains, for example, anticipatory information, explanations or being included in the care process. Therefore, the tool was designed as a screening measure, to identify support needs requiring further detailed assessment. Conclusions: The Carer Support Needs Assessment Tool (CSNAT) is an evidence-based direct measure of carers’ support needs in 14 domains. It is short but comprehensive in approach and thus suitable for both end-of-life care research and practice. Further work has been undertaken to test its psychometric properties.

The impact of state regulations on nursing home care practices

This article assesses the effect of the minimum quality standards of deficiencies and nurse staffing requirements on the nursing home care practices of physical restraint, indwelling urinary catheter, and feeding tube use. National longitudinal data on nursing homes reveal that the effect of specific deficiency citations on care practice use depends on the clinical complementarity or substitutability of the deficiency and the specific care practice, while a high number of deficiencies can lead to a greater use of each care practice. Higher direct care staffing requirements increased the use of physical restraints and decreased the use of feeding tubes. Increases in licensed nursing staff requirements had no effect on the care practices studied. Regulators should be aware that using minimum quality standards when quality is multidimensional creates incentives for offsetting quality improvement practices.

What do medical students learn from home care practice?

What do medical students learn from home care practice?

Acute Respiratory Illness and Health-Seeking Behavior in Egyptian Villages: Enhancing Pandemic Preparedness by Understanding Local Realities

The emergence of influenza viruses has raised awareness worldwide about influenza pandemic risks. Pandemic preparedness emphasizes development of risk communication and surveillance systems. The objective was to explore community classification of Acute Respiratory Illness (ARI) and health-seeking behaviors. Twenty in-depth interviews and 18 focus group discussions were conducted with caretakers in Egypt. The interviews were recorded, transcribed, and analyzed using the thematic analysis. ARI terminology contained few terms, usage of them was complex, and microorganism not part of illness explanation. Severe ARI was associated with social stigma. Homecare included extensive use of medications. In mild and severe ARI, health-seeking determinants varied. Classification of ARI parallels World Health Organization case definitions for ARI, facilitating risk communication. Homecare practices are social norms that can be expanded to include messages on ARI. Risk communication strategies and surveillance systems need to consider socio-cultural understanding of ARI.

Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

Evidence-based Standardized Care Plans for Use Internationally to Improve Home Care Practice and Population Health

Factors associated with physical activity in children attending family child care homes

ObjectiveTo determine the relationship between family child care home (FCCH) practices and characteristics, and objectively measured physical activity (PA) among children attending FCCHs. MethodsFCCH practices and characteristics were assessed in 45 FCCHs in Oregon (USA) in 2010–2011 using the Nutrition and Physical Activity Self-Assessment for Child Care Instrument. Within the 45 FCCHs, 136 children between ages 2 and 5years wore an accelerometer during child care attendance over a one-week period. Time spent in light, moderate, and vigorous PA per hour was calculated using intensity-related cut-points (Pate et al., 2006). ResultsFCCH characteristics and practices associated with higher levels of PA (min/h; p<0.05) included provision of sufficient outdoor active play [32.2 (1.0) vs. 28.6 (1.3)], active play using portable play equipment [31.7 (1.0) vs. 29.3 (1.4)], the presence of a variety of fixed play equipment [32.2 (1.0) vs. 28.9 (1.3)], and suitable indoor play space [32.2 (1.0) vs. 28.6 (1.3)], engaging in active play with children [32.1 (1.1) vs. 29.6 (1.2)], and receiving activity-related training [33.1 (1.2) vs. 30.3 (1.1)]. ConclusionsThis is the first study to identify practices and characteristics of FCCHs that influence children's PA. These data should be considered when developing programs and policies to promote PA in FCCHs.

We should highlight examples of good practice in care homes

Jackie Morris, dignity champion of the British Geriatrics Society, identifies a lack of systematic approaches to the management of common health problems in care homes (reflections September 7).

We should highlight examples of good practice in care homes

We should highlight examples of good practice in care homes

The effect of participatory women's groups on birth outcomes in Bangladesh: does coverage matter? Study protocol for a randomized controlled trial

BackgroundProgress on neonatal survival has been slow in most countries. While there is evidence on what works to reduce newborn mortality, there is limited knowledge on how to deliver interventions effectively when health systems are weak. Cluster randomized trials have shown strong reductions in neonatal mortality using community mobilisation with women's groups in rural Nepal and India. A similar trial in Bangladesh showed no impact. A main hypothesis is that this negative finding is due to the much lower coverage of women's groups in the intervention population in Bangladesh compared to India and Nepal. For evidence-based policy making it is important to examine if women's group coverage is a main determinant of their impact. The study aims to test the effect on newborn and maternal health outcomes of a participatory women's group intervention with a high population coverage of women's groups.MethodsA cluster randomised trial of a participatory women's group intervention will be conducted in 3 districts of rural Bangladesh. As we aim to study a women's group intervention with high population coverage, the same 9 intervention and 9 control unions will be used as in the 2005-2007 trial. These had been randomly allocated using the districts as strata. To increase coverage, 648 new groups were formed in addition to the 162 existing groups that were part of the previous trial. An open cohort of women who are permanent residents in the union in which their delivery or death was identified, is enrolled. Women and their newborns are included after birth, or, if a woman dies during pregnancy, after her death. Excluded are women who are temporary residents in the union in which their birth or death was identified. The primary outcome is neonatal mortality in the last 24 months of the study. A low cost surveillance system will be used to record all birth outcomes and deaths to women of reproductive age in the study population. Data on home care practices and health care use are collected through interviews.Trial registrationISRCTN: ISRCTN01805825

Case report: Unusual dental morphology in a child with ankyioblepharon-ectodermal defects-cleft lip/palate (AEC) syndrome

Anomalies of dental anatomy are common in the ectodermal dysplasia syndromes. These anomalies, when found in combination with dental caries, can pose a restorative challenge for the paediatric dentist. Modification of traditional techniques and approaches may help the practitioner provide a successful treatment outcome. A 3 years and 11 months old girl with a diagnosis of ankyloblepharon-ectodermal dysplasiacleft lip/palate (AEC) syndrome was referred for treatment to a specialist paediatric dental service. Her abnormal dental anatomy, hypodontia and dental caries formed a triad of challenges for the team. Under general anaesthesia, her dentition was restored using a combination of restorative approaches and techniques, including the placement of both composite resin and preformed metal crown restorations. At 18-month followup, the family had successfully implemented good home care and dietary practices, and the local dental service had instituted a preventive programme consisting of regular examination, advice and fluoride varnish placement. The restorations remained intact and no further caries was detected. At 24-month follow-up, the first permanent molars were partially erupted, and displayed unusually deep fissures. There was also a degree of ectopic eruption of the first permanent molars, and possibly of one of the maxillary permanent incisors. Dental care for children with AEC syndrome is optimised by early intervention, good home care and regular professional review. Dental care providers should be aware of the possibility of complex dental anatomy, and bear this in mind should it become necessary to formulate a restorative treatment plan.