Home Health Care Staff Research Articles

Home care nurses' descriptions of important agency attributes.

To identify attributes of home care agencies described by nurses as important to their professional practice and job satisfaction. Seven focus groups with home health care staff nurses were conducted at 6 home care agencies located in three states in the Mid-Atlantic region of the United States. A total of 58 home care nurses participated in the study. Transcriptions of tape-recorded focus groups were subjected to open and axial coding techniques. Six major categories and eight subcategories of organizational attributes described by home care nurses as important to the support of their practice and job satisfaction were identified. Attributes described by home health nurses were not only similar to those described by hospital-based nurses as reported in the "magnet hospital" literature, but they also were consistent with key concepts described in theories of professional workforce organization. Findings provide insight into developing workplace environments to support home care nurses.

The Hospice Decision: Psychosocial Facilitators and Barriers

This study examined the social and contextual process of discussion and decision making around the use of the hospice in order to clarify the facilitative and obstructive aspects to hospice patient entry. Four participants groups of physicians, hospice and home health care patient family survivors, and hospice and home health care staff, completed four complementary mail surveys of their discussions and decision process for hospice care. Non-parametric analysis of the data reaffirmed the central and key role of the physician as the expected initiator and gatekeeper of the hospice discussion and decision-making process. Physicians were found generally aware of hospice and to have discussed hospice with their patients, though that awareness and the frequency of hospice patient discussions varied by the type of medical practice. Patient family survivors were unaware of hospice prior to the terminal illness, with a majority of hospice patient family survivors receiving their initial hospice information from relatives. Implications of these results and issues for future research are identified.

Integration of Dietitian Services in a Hospital-Based Pediatric Home Health Care Department

LEARNING OUTCOME: To describe how limited dietitian hours can be used to provide nutrition services for the hospital's Home Health Care patientsSince July 1994 a dietitian liaison from the hospital's Nutrition Department has been a member of the Home Health Care (HHC) team. This dietitian acts as a resource to HHC staff and organizes weekly patient case conferences for enteral and total parenteral nutrition (TPN) patients. The dietitian liaison also assisted HHC in the development of a nutrition screening assessment used prior to hospital discharge. Weekly case conferences include the dietitian liaison, a HHC nursing supervisor or metabolic nurse, and a HHC pharmacist. Each person gathers information from appropriate primary care providers and the family, before a round table style discussion and documentation process. Patients are systematically reviewed so that all enteral feeding patients are discussed at least every 6 months and all TPN patients at least every month.Because of the dietitian's involvement, the HHC Department has been able to meet and exceed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Prior to this program, only about 75% (57/73) of the HHC patients receiving enteral feedings and/or TPN had any involvement with a dietitian, even on an inconsistent basis. As a result of the case conferences, patients have been identified who appear to be using less product than prescribed, HHC services have been terminated or nursing visits restarted in a more timely manner, and complete nutrition reassessments have been initiated to ensure that the patient continues to receive the desired intake. When HHC field nurses were surveyed in March 1996, all nurses responding indicated they had consulted with a hospital dietitian in the past 6 months. These nurses also indicated an interest in written guidelines or periodic inservices on nutrition related topics. A repeat survey of the nurses a year later and documentation of patients identified for further nutrition consultation are tools for evaluating how well the dietitian is used as a resource within the HHC Department.

Risk management in home health care

Home health care staff members often feel that they are literally drowning in paper. There is also increasing concern among agencies about cost-effectiveness in view of recent cuts in Medicare reimbursement, increasing enrollments in managed care plans, and the possibility of health care reform. Some are exploring the possibilities of electronic record keeping in attempts to address these issues. Key words: risk management, home health care

Chemically dependent home health care nurses are too impaired to practice

Home health care staff members are not immune from the increasing problem of drug addiction. This article suggests guidelines that an agency can use in developing a pro gram that helps an addicted staff member seek treatment. The article includes informa tion on symptoms, a discussion of job performance problems, and considerations for early intervention.

The role of prevention in home healthcare nursing practice.

Prevention is part of nursing practice, including home healthcare. Two National Health Objectives are highlighted: prevention of breast and cervical cancer. Skilled management, under Medicare, may be one way for home healthcare staff to focus on prevention and health promotion.

Surveillance of infection in home care.

Home care accreditation standards from the Joint Commission on the Accreditation of Healthcare Organizations require a system for recording, reporting, and evaluating infections related to the services provided. We developed a surveillance system for home care related infections to meet these requirements. Our goal was to reduce the risk of infection and improve the quality of care. Definitions for home care-related infections were adapted from the Centers for Disease Control's 1988 definitions for nosocomial infections. The home health care staff assisted by reporting clients with possible infections. Surveillance was completed by the infection control coordinator. On the basis of our findings in the population, we concentrated our efforts on reducing the risk of catheter-related genitourinary infection in our home care patients.

Diabetes mellitus in home health care as it relates to the diabetic foot

This article focuses on the causative physiology of foot problems in the diabetic and discusses preventative measures. In addition to teaching foot care to prevent problems, the home health care staff is often the first to recognize the symptoms of complications. This article provides information to assist the caregiver to do both.

QA in home care: the staff nurse's challenge.

The home healthcare staff nurse faces formidable challenges that can be met only by an extraordinary commitment to quality care. Functioning autonomously much of the time, the home healthcare nurse must act as the client's case manager. Coordination of multiple services and extensive client education are vital to positive outcomes, and intervention decisions must be based on a holistic view of the client's needs and environment. Reimbursement issues under Medicare often conflict with the delivery of high-quality care. To achieve the goals of the home healthcare agency and perform optimally, the home healthcare nurse needs a supportive QA program and frequent peer review procedures.