Nurse Home Visits Research Articles

Longitudinal Prevalence and Correlates of Elder Mistreatment Among Older Adults Receiving Home Visiting Nursing

The objectives of this study were to identify elder mistreatment (EM) prevalence among a cohort of older adults receiving visiting nurse care in their homes, determine EM subtypes, and identify factors associated with EM. EM data were collected by nurses during monthly home visits for up to 24 months. It took the nurses a mean of 10.5 visits to discern EM. Fifty-four (7.4%) of 724 patients were identified as mistreated, of which 33 had enough information to subtype the EM. Of these 33, 27 were victims of neglect, 16 of psychological abuse, and 10 of financial exploitation, and 17 suffered more than one type. Among the entire sample, 11 variables were positively correlated with EM presence. Nurses visiting older adults in their homes should be aware that their patients are, as a group, vulnerable to EM, and that the factors identified here may be specific markers of greater risk.

Organization, teamwork, and advocacy: Important skills needed by hospice family caregivers who manage medications.

121 Background: In the home hospice setting, family caregivers (CGs) often assume medication administration responsibilities traditionally performed by licensed nurses. Little is known about how to assess and support CG medication management skills. As part of an ongoing study of nurse-caregiver interactions in home hospice, we gathered data on CG medication management needs. Methods: A longitudinal, multicenter study of home hospice nurse visits captured audiorecorded communication between nurses and CGs. Participants included patients with cancer and their self-identified CGs who were recruited upon home hospice enrollment. The current sub-study included participants aged ≥65 and their family CGs from 7 hospice agencies. Two investigators independently coded transcriptions of the first audio recorded nurse home visit using a directive content analytic approach to map conversations to a previously published, interview-derived, framework for hospice medication management by CGs. Results: A total of 18 patients (mean age 76.5 [SD 10.7], 56% female) and their CGs (mean age 59.6 [SD13.4], 78% female) were included. Content analysis revealed that CG skills needed for medication management are not limited to drug knowledge. Complicated organizational skills are needed to track medication acquisition and dosing, record the use of short- and long-acting drugs with similar modes of action, and coordinate medication administration by multiple CGs. Teamwork skills are needed to help coordinate medication prescribing between specialist, primary, and hospice physicians. CGs also need symptom management skills regarding the proper selection of medications, as well as skills to manage side effects, inadvertent errors, and possible medication related-emergencies. CGs play a vital role in patient advocacy, alerting providers to the burden and quality of life issues related to medication use, including whether medications have intended or unintended effects, or are potentially unnecessary or causing harm. Conclusions: CGs must have multiple skills to effectively manage medications in home hospice. A systematic approach and intervention is needed to support CGs’ medication management skills.

Effects of radium-223 dichloride (Ra-223) on risk for hospitalization and health care resource use in the phase 3 ALSYMPCA trial.

21 Background: Ra-223 is a first-in-class alpha-emitter approved for treatment (tx) of patients (pts) with castration-resistant prostate cancer and symptomatic bone metastases. In ALSYMPCA, Ra-223 significantly improved overall survival by 3.6 months vs placebo (pbo) (HR = 0.70; 95% CI, 0.58-0.83; P < 0.001) and was well tolerated. To understand whether the tx benefit corresponds to differences in utilization, hospitalization and other types of health care resource use were evaluated. Methods: Data on hospitalization, nursing home visits, home health care and adult day care services use, and physician visits were captured for each pt. Tx groups were compared, based on percentage needing each type of health care resource, using Fisher’s exact test. To account for differences in each pt resource use in ALSYMPCA, the number of encounters (eg, office visits) and duration of encounters (eg, days hospitalized) were divided by observation time. The mean number and duration of encounters were compared using analysis of variance. To compare tx groups based on the rate of use per year, incidence rates and ratios were calculated using a generalized estimating equation (GEE) regression model. Results: The mean follow-up time in months for Ra-223 vs pbo was 10.0 vs 8.6. The incidence rate for Ra-223 vs pbo was 1.1 vs 1.4 (incidence rate ratio = 0.77; 95% CI, 0.62-0.95; P = 0.013). The mean number of hospitalizations and hospitalization days per year for Ra-223 vs pbo were 1.3 vs 1.7 (P = 0.020) and 8.1 vs 14.6 (P < 0.001), respectively. The percentage of pts that required hospitalization was nominally lower for Ra-223 vs pbo (42.3% vs 49.0%, P = 0.062). Among pts who experienced at least one hospitalization, the mean number of hospitalization days per year for Ra-223 vs pbo pts was 19.4 vs 30.4 (P < 0.001). No significant differences were found between tx groups in terms of visits or durations of time in nursing homes per year, amount of adult day care and home health care services utilized per year, and number of physician visits per year. Conclusions: Compared with pbo, Ra-223 tx resulted in a 23% reduction in incidence of hospitalizations per year and about 6.5 fewer hospitalization days per pt per year. Clinical trial information: NCT00699751.

Efectividad de la atención domiciliar de enfermería en el mejoramiento del autocuidado de personas adultas mayores

Antecedentes: El objetivo de este artículo es presentar la mejor evidencia disponible en relación con el desarrollo de las visitas domiciliares de enfermería, brindadas a personas adultas mayores, con un enfoque de promoción de la salud y prevención de las enfermedades para el mejoramiento en su autocuidado. El proceso de envejecimiento poblacional en Costa Rica y a nivel mundial, como producto de los avances en condiciones socioeconómicas y sanitarias, ha generado necesidades para la atención de personas adultas mayores que permiten un mantenimiento o mejoramiento de la calidad de vida.Método: como método se utilizó la investigación basada en la evidencia, la cual parte de una pregunta clínica; en cuanto a los datos, se realizó una búsqueda bibliográfica en las bases de datos EBSCO, PubMed y ProQuest, para luego ejecutar una lectura crítica con el programa FLC 2.0. Resultados: Se obtuvo un total de 58 artículos, de cuya lectura crítica se seleccionó seis que presentaron la mejor evidencia.Conclusión: Se concluye que las personas adultas mayores que reciben atención domiciliaria del profesional de enfermería desde un enfoque de la promoción de la salud y prevención de la enfermedad mejoran su autocuidado.

Teaching nursing consultation and home visit - experience report enseñando CONSULTA

ABSTRACT Objective: to report the experience of professors and students of the Nursing Graduation course of the University of Santa Catarina in the process of learning nursing consultation and home visit. Method : experience report . An active methodology was used, with undergraduate students of the discipline Human Living Process I , in the years 2010 and 2011. Professors had previously reflected on ways of enabling collective discussions and action strategies for effective student participation . The topics: nursing consultation, home visit and humanization were organized in such a manner as to be taught simultaneously, in order to promote critical reflexive thinking and the immersion of participants in the topic approached. Results : students used tools such as planning, organization and comprehension of the use of nursing consultation and home visit. Conclusion : students were encouraged to think critically and to reflect about aspects of home visit and nursing consultation. Descriptors: Education; Nursing; Human Resources in Health . RESUMO Objetivo: descrever a experiencia de docentes e discentes do Curso de Graduacao em Enfermagem da Universidade Federal de Santa Catarina no aprendizado da consulta de enfermagem e visita domiciliar. Metodo : relato de experiencia, aplicando uma metodologia ativa, com academicos da disciplina de Processo de Viver Humano I, nos anos de 2010 e 2011. Docentes refletiram previamente sobre como possibilitar a discussao coletiva e elaboracao de estrategias de acao para a efetiva participacao dos alunos. Os assuntos: consulta de enfermagem, visita domiciliaria e humanizacao foram organizados de modo a ser ministrados no mesmo momento, para promover a imersao dos participantes na tematica abordada e o pensamento critico-reflexivo . Resultados : os academicos utilizaram ferramentas como o planejamento, organizacao e compreensao da utilizacao da consulta de enfermagem e da visita domiciliar. Conclusao : os academicos foram motivado a exercitar a critica e a reflexao sobre aspectos da visita domiciliar e da consulta de enfermagem. Descritores: Educacao; Enfermagem; Recursos Humanos em Saude. RESUMEN Objetivo: reportar la experiencia de profesores y estudiantes del Curso de Graduacion en Enfermeria de la Universidad Federal de Santa Catarina en el aprendizaje de la consulta de enfermeria y visita domiciliaria. Metodo : reporte de experiencia. Se aplico una metodologia activa, con estudiantes de la asignatura de Proceso del Vivir Humano I, en los anos de 2010 y 2011. Los profesores reflexionaron previamente sobre como posibilitar la discusion colectiva y la elaboracion de estrategias de accion para la efectiva participacion de los alumnos. Los temas: consulta de enfermeria, visita domiciliaria y humanizacion fueron organizados de tal manera que permitiera abordarlos simultaneamente, para promover el pensamiento critico y reflexivo, y la inmersion de los participantes en la tematica abordada . Resultados : los estudiantes utilizaron herramientas como planificacion, organizacion y comprension de la utilizacion de la consulta de enfermeria y de la visita domiciliaria. Conclusion : los estudiantes fueron motivados a ejercitar la critica y la reflexion sobre aspectos de la visita domiciliaria y de la consulta de enfermeria. Descriptores: Educacion; Enfermeria; Recursos Humanos en Salud. Normal 0 21 false false false PT-BR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Tabela normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:Times New Roman; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

Interventions to increase influenza vaccination rates of those 60 years and older in the community.

The effectiveness of interventions to increase the uptake of influenza vaccination in people aged 60 and older is uncertain. To assess access, provider, system and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. We searched CENTRAL (2014, Issue 5), MEDLINE (January 1950 to May week 3 2014), EMBASE (1980 to June 2014), AgeLine (1978 to 4 June 2014), ERIC (1965 to June 2014) and CINAHL (1982 to June 2014). Randomised controlled trials (RCTs) of interventions to increase influenza vaccination uptake in people aged 60 and older. Two review authors independently assessed study quality and extracted influenza vaccine uptake data. This update identified 13 new RCTs; the review now includes a total of 57 RCTs with 896,531 participants. The trials included community-dwelling seniors in high-income countries. Heterogeneity limited meta-analysis. The percentage of trials with low risk of bias for each domain was as follows: randomisation (33%); allocation concealment (11%); blinding (44%); missing data (49%) and selective reporting (100%). Increasing community demand (32 trials, 10 strategies)The interventions with a statistically significant result were: three trials (n = 64,200) of letter plus leaflet/postcard compared to letter (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15); two trials (n = 614) of nurses/pharmacists educating plus vaccinating patients (OR 3.29, 95% CI 1.91 to 5.66); single trials of a phone call from a senior (n = 193) (OR 3.33, 95% CI 1.79 to 6.22), a telephone invitation versus clinic drop-in (n = 243) (OR 2.72, 95% CI 1.55 to 4.76), a free groceries lottery (n = 291) (OR 1.04, 95% CI 0.62 to 1.76) and nurses educating and vaccinating patients (n = 485) (OR 152.95, 95% CI 9.39 to 2490.67).We did not pool the following trials due to considerable heterogeneity: postcard/letter/pamphlets (16 trials, n = 592,165); tailored communications (16 trials, n = 388,164); customised letter/phone-call (four trials, n = 82,465) and client-based appraisals (three trials, n = 4016), although several trials showed the interventions were effective. Enhancing vaccination access (10 trials, six strategies)The interventions with a statistically significant result were: two trials (n = 2112) of home visits compared to clinic invitation (OR 1.30, 95% CI 1.05 to 1.61); two trials (n = 2251) of free vaccine (OR 2.36, 95% CI 1.98 to 2.82) and one trial (n = 321) of patient group visits (OR 24.85, 95% CI 1.45 to 425.32). One trial (n = 350) of a home visit plus vaccine encouragement compared to a home visit plus safety advice was non-significant.We did not pool the following trials due to considerable heterogeneity: nurse home visits (two trials, n = 2069) and free vaccine compared to no intervention (two trials, n = 2250). Provider- or system-based interventions (17 trials, 11 strategies)The interventions with a statistically significant result were: two trials (n = 2815) of paying physicians (OR 2.22, 95% CI 1.77 to 2.77); one trial (n = 316) of reminding physicians about all their patients (OR 2.47, 95% CI 1.53 to 3.99); one trial (n = 8376) of posters plus postcards (OR 2.03, 95% CI 1.86 to 2.22); one trial (n = 1360) of chart review/feedback (OR 3.43, 95% CI 2.37 to 4.97) and one trial (n = 27,580) of educational outreach/feedback (OR 0.77, 95% CI 0.72 to 0.81).Trials of posters plus postcards versus posters (n = 5753), academic detailing (n = 1400) and increasing staff vaccination rates (n = 26,432) were non-significant.We did not pool the following trials due to considerable heterogeneity: reminding physicians (four trials, n = 202,264) and practice facilitators (three trials, n = 2183), although several trials showed the interventions were effective. Interventions at the societal level We identified no RCTs of interventions at the societal level. There are interventions that are effective for increasing community demand for vaccination, enhancing access and improving provider/system response. Heterogeneity limited pooling of trials.

Work engagement and attitudes toward caring for dying patients and families among home-visiting nurses in Japan.

Nurses with higher levels of work engagement tend to be highly efficient in their work and more willing to keep working and to provide patient-centred care. However, whether more engaged nurses provide end-of-life care more proactively has not been examined in the home-care setting. This study aimed to examine work engagement among home-visiting nurses in Japan and its relationship with their attitudes toward caring for dying patients and their families. A total of 343 nurses working in 62 agencies across Chiba prefecture, eastern Japan, received an anonymous self-administered questionnaire from July to August 2012. The authors performed multiple regression analysis to explore the relationships between home-visiting nurses' work engagement and attitudes. Data from 184 nurses (53.6%) was analysed. Work engagement was significantly positively related to the nurses' attitudes toward caring for dying patients and their families. As more engaged nurses tend to have more positive attitudes toward caring for dying patients and their families, further research is needed to identify the factors that might help nursing managers to enhance their staff's engagement and perhaps thereby improve their attitudes, with the ultimate aim of achieving better outcomes for patients and families.

Academic-Practice Partnership in Public Health Nursing: Working with Families in a Village-Based Collaboration.

The purpose of this program development and evaluation project was to promote healthy families and communities by creating academic-practice partnerships, educating BSN students and building family-nursing student partnerships that were supported by a "village" of interconnected resources. A mixed-methods design was used for the project. Data were collected from a convenience sample of vulnerable families, BSN students engaged in PHN practica, and partner members. Nine tools were developed to capture data over two semesters including a GIS mapping strategy. One hundred and seventy-five home visits were completed with 20 families, 14 of whom needed interpreter assistance. Families reported satisfaction with the quality of home visits, education, and assistance toward health goals. Fifty-three students provided 202 educational interventions, 39 community resource connections, and 46 care transitions. Students reported linking theory with practice and valued the PHN practicum experience. Academic-practice partners identified opportunities for program development and sustainability. GIS mapping illustrated complex family linkages to community resources. Results suggest that young, vulnerable families benefit from public health nursing (PHN) home visits, but sustaining home visit programs is challenging. Academic-practice partnerships can guide students and families partnered in a reciprocal relationship with "village" resources.

Characteristics of Clients Using Home Visiting Nursing Services at Nighttime and Early Morning in Japan

Our objectives were to classify the characteristics of clients such as their diseases and the period of services provided to clients who are using home visiting nurse agency (HVNA) services at nighttime. The nighttime HVNA services provided to 31 clients were analyzed. Two major reasons for cancellation of nighttime and early morning HVNA service were identified: (1) cancellation due to death, and (2) cancellation as a result of achieving goals for receiving the service. As to the former reason, those who died of terminal cancer used the service for approximately 2 months, whereas those who died of other causes used the service for approximately 11 months. The establishment of such a service system requires the development of a method to achieve stable management of an HVNA.

Evidence-based Intervention with Women Pregnant after Perinatal Loss

To test the feasibility and acceptability of a caring-based nurse home visit intervention for women pregnant after perinatal loss (PAL), the goal of which was to provide a safe, supportive environment, normalize the pregnancy after loss, reduce anxiety and depression through stress reduction skills, and facilitate prenatal attachment. This mixed methods study was conducted in two phases: Phase I, to determine the components of the intervention, and Phase II, a randomized trial that used the revised intervention components. Pregnant women with a history of at least one perinatal loss (9 in Phase I and 24 in Phase II) were recruited from obstetrical practices. Phase II sample size was adequate to detect group differences. Background measures of demographics, obstetrical history, and meaning of past losses were collected at baseline. Measured at three points across pregnancy were threat appraisal of pregnancy; and emotional states: anxiety (pregnancy, state, trait), depression, self mastery, prenatal attachment, and satisfaction with social support. The caring-based nurse home visit intervention included activities aimed to reduce anxiety and promote prenatal attachment. The control group were sent pregnancy information booklets that coincided with their gestational age. Qualitative and quantitative evaluations were obtained. In Phase I, 8 women received the intervention; in Phase II, 13 received the intervention and 11 were in the control group. No baseline between-group differences were found. The intervention group had significantly higher satisfaction with social support over time. Women's evaluations were very positive; home visits were rated most liked and helpful. They appreciated a knowledgeable nurse who knew their story, listened, normalized the PAL experience, and was there with nonjudgmental support. The intervention is both feasible and acceptable. Most women felt that they could reduce their own anxiety using the tools and skills they were provided. Healthcare providers should consider past history's impact on current pregnancy experiences and incorporate process and content of the intervention into their practice.

MP5-19 SOCIO-DEMOGRAPHIC AND CLINICAL DIFFERENCES IN UNMET INFORMATIONAL AND SUPPORTIVE CARE NEEDS OF PATIENTS UNDERGOING CYSTECTOMY AND URINARY DIVERSION

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 2014MP5-19 SOCIO-DEMOGRAPHIC AND CLINICAL DIFFERENCES IN UNMET INFORMATIONAL AND SUPPORTIVE CARE NEEDS OF PATIENTS UNDERGOING CYSTECTOMY AND URINARY DIVERSION Nihal Mohamed, Heather H. Goltz, David M. Latini, Phapichaya Chaoprang Herrera, Cheryl T. Lee, and Simon Hall Nihal MohamedNihal Mohamed More articles by this author , Heather H. GoltzHeather H. Goltz More articles by this author , David M. LatiniDavid M. Latini More articles by this author , Phapichaya Chaoprang HerreraPhapichaya Chaoprang Herrera More articles by this author , Cheryl T. LeeCheryl T. Lee More articles by this author , and Simon HallSimon Hall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.402AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Assessing unmet needs of cancer patients can assist health care providers to tailor health care services to specific needs of patients and survivors. This study examined whether muscle invasive bladder cancer (MIBC) patients’ unmet informational and supportive care needs along the disease trajectory (at time of diagnosis, following surgery, and through extended survivorship) vary by the patients’ socio-demographic (age, gender) and clinical characteristics (time since diagnosis, comorbidity, and urinary diversion precodure). METHODS Participants (N = 30 survivors; 73.3% men;50% ileal condiut, 6.6% continent reservoir,43.33% orthotopic neobladder) were recruited from the Department of Urology and Oncological Science, at Mount Sinai and through advertisements on the Bladder Cancer Advocacy Network website between December, 2011 and September, 2012. Data was collected through individual interviews and electronic medical record review. Qualitative and quantitative analyses (Fisher’s Exact test) were employed to examine socio-demographic and clinical differences in reported unmet needs. RESULTS Qualitative and quantitative evaluation of patients’ interviews showed several areas of unmet informational and supportive needs that varied by the patient’s socio-demographics and clinical characteristics. Patients with neobladder were more likely to report difficulties with urinary incontinence, self-care, and sexual function compared to ileal conduit and continent reservoir patients (p < .05). Patients with ileal conduit had difficulties using stomal appliances and received assistance with self-care from home-visiting nurses whereas patients with a continent reservoir had difficulties using catheters. More women than men had difficulties with neobladder care and reported need of support with post-operative self-care (p < .05). Younger patients were more likely to report difficulties with post-operative self-care, worries about the future, and were also more likely to seek and receive professional support with sexual function than older patients (All ps < .05). CONCLUSIONS Unmet informational and supportive care needs of MIBC patients persist along the disease trajectory and vary by the patient’s age, gender, and urinary diversion. Educational and psychological interventions are needed to address patients’ unmet needs and should be specifically tailored to the type of unmet need and the patient’s demographic and clinical characteristics. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e89 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Nihal Mohamed More articles by this author Heather H. Goltz More articles by this author David M. Latini More articles by this author Phapichaya Chaoprang Herrera More articles by this author Cheryl T. Lee More articles by this author Simon Hall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Identification of the need for home visiting nurse: development of a new assessment tool

To develop a Home Visiting Nursing Service Need Assessment Form (HVNS-NAF) to standardize the decision about the need for home visiting nursing service. The sample consisted of older adults who had received coordinated services by care managers. We defined the need for home visiting nursing service by elderly individuals as the decision of the need by a care manager so that the elderly can continue to live independently. Explanatory variables included demographic factors, medical procedure, severity of illness, and caregiver variables. Multiple logistic regression was carried out after univariate analyses to decide the variables to include and the weight of each variable in the HVNS-NAF. We then calculated the sensitivity and specificity of each cutoff value, and defined the score with the highest sensitivity and specificity as the cutoff value. Nineteen items were included in the final HVNS-NAF. When the cutoff value was 2 points, the sensitivity was 77.0%, specificity 68.5%, and positive predictive value 56.8%. HVNS-NAF is the first validated standard based on characteristics of elderly clients who required home visiting nursing service. Using the HVNS-NAF may result in reducing the unmet need for home visiting nursing service and preventing hospitalization.

Do geriatric home visits enhance learning of post graduate trainees? –a qualitative study from Pakistan

Introduction : The Family Medicine Residency Program at the Aga Khan University, Karachi incorporated a didactic and clinical course on elderly care in 2009. To enhance experiential learning; a pilot home visit program was added for the final year residents. This was the first time that home visits were incorporated as part of post-graduate training in Pakistan. Home visits are unique as they allow physicians to assess and experience the health problems of the aged in their own environment. Objective : The objective of this study was to identify residents’ in-depth perspectives, positive and negative learning experiences of residents and to assess if nursing home visits were fulfilling the objectives of geriatric training. Method : Two batches of final year residents (n=9) consented to participate. Focused observations, focused group discussion (FGD) and phone interviews were conducted. A trained facilitator used broad questions made by the research team to explore participant perceptions. Responses were video- taped, transcribed and shared with participants for member checking. Phone interviews conducted were also recorded, transcribed and collated with data from FGD. Members of the research team then coded the data and generated themes independently which were then compared, merged and analyzed. Quotations by participants were documented. Result : The home visit experience was regarded as overwhelming positive and innovative. Uniqueness of nursing home visits in skill building was reported by most participants. Complexity of assessing and managing geriatric patients was acknowledged. Trainees expressed frustration with point of care testing and treatment adherence which hindered their learning in terms of patient outcomes. They also reported these visits as opportunities for self-reflection and introspection. One participant reported the possibility of choosing geriatrics as a career choice. Conclusion : The nursing home program strengthened geriatric knowledge and skills of trainees, fulfilling their learning objectives and provided a unique experiential opportunity to care for the elderly. Such programs may be replicated in regional universities to enhance geriatric skills in trainees.

A Review of the Present State and Future Policy Alternatives for Home Visit Nursing Services in Korea

The aim of this study was to describe the current state of home visit nursing services in the Korean context and to suggest future policy directions. First, the three home visit nursing services that have developed in Korea are compared using the analytic framework provided by Gilbert and Terrell in 2012. The framework is based on four dimensions of social welfare: users, services, source of funds, and service delivery process. Second, we perform a strength, weakness, opportunity, and threat analysis to suggest comprehensive and constructive home visit nursing service policies for the future. Specifically, we advocate the creation of an organization that steers the central government to operate an integrated management organization to distribute services and reduce redundancy for preventing the waste of both medical and state financial resources. This study also recommends the development of educational programs to improve the quality of services and service evaluation criteria for the objective assessment of those services. These policy guidelines may prove useful both for Korea and for other countries that intend to prepare or revise their home visit nursing service systems.

Home-visiting Nurse&apos;s Support for Children With Severe Motor and Intellectual Disabilities and Their Families : Literature Review

Home-visiting Nurse&apos;s Support for Children With Severe Motor and Intellectual Disabilities and Their Families : Literature Review

Women's Reasons for Attrition from a Nurse Home Visiting Program

To describe mothers' reasons for leaving a home visiting program early. Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site. A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children. Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors. Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis. The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention. NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development.

Nurse home visitors' perceived awareness of mandatory reporting requirements: pregnant women's and children's exposure to intimate partner violence

AbstractAimTo examine nurse home visitors' perceived awareness of reporting requirements for intimate partner violence during pregnancy and children's exposure to such violence.BackgroundMany home visitation programmes employ nurses to deliver prenatal and parenting education and services to pregnant women and mothers. Although home visitors are responsible for reporting child maltreatment, the extent to which mandated reporting laws apply to intimate partner violence perpetrated against pregnant women and children's exposure varies considerably between jurisdictions.DesignCross‐sectional descriptive survey design.MethodsA web‐based survey was sent to all home visitors in the Nurse‐Family Partnership programme in April/May 2010. The survey contained two vignettes describing client disclosure of intimate partner violence when: (1) the client is pregnant; and (2) the client's child is in her arms during the violent episode. Participants were asked about perceived reporting requirements and factors that guide reporting decisions.FindingsApproximately half of the target population returned completed surveys (n=532). Over a quarter of the sample believed that they were mandated to report abuse of a pregnant woman and two‐thirds indicated awareness of a mandate to report when the child was in the mother's arms during the violence. Most nurses indicated that reporting decisions should be based on state law.ConclusionNurse home visitors may believe that they are mandated to report children's exposure to intimate partner violence when the child is at risk of physical harm. Home visitation providers likely consider multiple factors when determining whether to report intimate partner violence and children's exposure to intimate partner violence.

Comparative Analysis of Medicare Spending for Medical Imaging: Sustained Dramatic Slowdown Compared With Other Services

The purpose of this study was to assess trends in Medicare spending growth for medical imaging relative to other services and the Deficit Reduction Act (DRA). We calculated per-beneficiary Part B Medicare medical imaging expenditures for three-digit Berenson-Eggers Type of Service (BETOS) categories using Physician Supplier Procedure Summary Master Files for 32 million beneficiaries from 2000 to 2011. We adjusted BETOS categories to address changes in coding and payment policy and excluded categories with 2011 aggregate spending less than $500 million. We computed and ranked compound annual growth rates over three periods: pre-DRA (2000-2005), DRA transition period (2005-2007), and post-DRA (2007-2011). Forty-four modified BETOS categories fulfilled the inclusion criteria. Between 2000 and 2006, Medicare outlays for nonimaging services grew by 6.8% versus 12.0% for imaging services. In the ensuing 5 years, annual growth in spending for nonimaging continued at 3.6% versus a decline of 3.5% for imaging. Spending growth for all services during the pre-DRA, DRA, and post-DRA periods were 7.8%, 3.8%, and 2.9 compared with 15.0%, -3.4%, and -2.2% for advanced imaging services. Advanced imaging was among the fastest growing categories of Medicare services in the early 2000s but was in the bottom 2% of spending categories in 2011. Between 2007 and 2011, the fastest growing service categories were evaluation and management services with other specialists (29.1%), nursing home visits (11.2%), anesthesia (9.1%), and other ambulatory procedures (9.0%). Slowing volume growth and massive Medicare payment cuts have left medical imaging near the bottom of all service categories contributing to growth in Medicare spending.

Moving Palliative Care From Research to Practice: Commentary on Uitdehaag et al.

Research that seeks to enhance the practice of palliative cancer care continues to face challenges. The work by Uitdehaag and colleagues is a valuable article in several regards. The authors describe in great detail the challenges they encountered in the design and testing of their nurse-led intervention for upper gastrointestinal cancers. I commend the authors for the careful detail they present surrounding the problems in implementing the intervention and the outcome measures. It is unfortunate that the authors did not present more information on the symptoms experienced by patients in each arm and if nurses were better able to manage symptoms at the end of life. Patients in the nursing arm were more costly, and patients in each arm experienced a roughly equal number of hospital readmissions and primary care contacts. Those in the nurse arm reported a nonsignificant reduction in depression, but this did not extend to their health-related quality of life. Perhaps, nurse home visits are important for support and relieving isolation, but given patients’ nearness to death, the dose of the intervention could

Randomized Controlled Trial of Universal Postnatal Nurse Home Visiting: Impact on Emergency Care

Although nurse home visiting has proven efficacious with small samples, scaling up to community populations with diverse families has not yet proven effective. The Durham Connects program was developed in collaboration with community leaders as a brief, universal, postnatal nurse home visiting intervention designed to screen for risk, provide brief intervention, and connect families with more intensive evidence-based services as needed. This study tested program effectiveness in reducing infant emergency medical care between birth and age 12 months. All 4777 resident births in Durham, North Carolina across 18 months were randomly assigned, with even birth date families to intervention and odd birth date families to control. Intervention families were offered 3 to 7 contacts between 3 and 12 weeks after birth to assess family needs and connect parents with community resources to improve infant health and well-being. Hospital records were analyzed by using an intent-to-treat design to evaluate impact among a representative subset of 549 families. After demographic factors (ie, birth risk, Medicaid status, ethnicity, and single parenthood) were covaried, relative to control families, families assigned to intervention had 50% less total emergency medical care use (mean [M] emergency department visits and hospital overnights) (M(intervention) = 0.78 and M(control) = 1.57; P < .001, effect size = 0.28) across the first 12 months of life. This brief, universal, postnatal nurse home visiting program improves population-level infant health care outcomes for the first 12 months of life. Nurse home visiting can be implemented universally at high fidelity with positive impacts on infant emergency health care that are similar to those of longer, more intensive home visiting programs. This approach offers a novel solution to the paradox of targeting by offering individually tailored intervention while achieving population-level impact.