Making Home Visits Research Articles

A Cost Analysis of Kidney Replacement Therapy Options in Palestine

This study provides a cost analysis of kidney replacement therapy options in Palestine. It informs evidence-based resource allocation decisions for government-funded kidney disease services where transplant donors are limited, and some of the common modalities, i.e., peritoneal dialysis (PD) and home hemodialysis (HD), are not widely available due to shortages of qualified staff, specialists, and centers to follow the patient cases, provide training, make home visits, or provide educational programs for patients. The average cost of kidney transplant was US$16 277 for the first year; the estimated cost of HD per patient averaged US$16 085 per year—nearly as much as a transplant. Consistent with prior literature and experience, while live, related kidney donors are scarce, we found that kidney transplant was more adequate and less expensive than HD. These results have direct resource allocation implications for government-funded kidney disease services under Palestinian Ministry of Health. Our findings strongly suggest that investing in sufficient qualified staff, equipment, and clinical infrastructure to replace HD services with transplantation whenever medically indicated and suitable kidney donors are available, as well as deploying PD programs and Home HD programs, will result in major overall cost savings. Our results provide a better understanding of the costs of kidney disease and will help to inform Ministry of Health and related policy makers as they develop short- and long-term strategies for the population, in terms of both cost savings and enhanced quality of life.

The Influence of Various Intervention Types on Treatment Success Rates among Category II Tuberculosis Patients

Background: Category II tuberculosis (TB) patients (i.e. re-treatment TB patients) are at an increased risk for defaulting on treatment compared to Category I TB patients. Therefore, extra steps need to be taken to help Category II TB patients follow through with their treatment. The goal of this study was to examine the effectiveness of three different types of interventions to help improve treatment success rates among Category II patients. Materials and Methods: Three different interventions that were implemented among Category II TB patients in the Bardhaman, Hugli, Malda and Murshidabad districts in West Bengal, India, were: 1) setting up group patient provider meetings (PPMs), 2) making home visits and reinforcing the message of full course of treatment, and 3) linking poor TB patients to social welfare schemes (SWSs) to incentivize them to complete treatment. Results: PPMs and SWSs improved treatment success rates among Category II patients. The treatment success rates for patients who received PPMs and patients who received SWSs were 94.2% and 90.7%, respectively, compared to the 74.5% treatment success rate of patients who received no intervention. The effectiveness of home visits, however, depended on the number of home visits the patient received. Conclusion: PPMs and SWSs improve treatment success among Category II TB patients and may easily be incorporated in Directly Observed Treatment, Short-Course programming as feasible ways. A conclusion regarding home visits, however, could not be drawn from this study.

Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial.

BackgroundIn Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation.MethodsAll 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices.ResultsFour of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby’s first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities.ConclusionsA home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival.Trial registrationTrial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009)

Carol Bradley, MSN, RN, CENP

Carol Bradley, MSN, RN, CENP, is the Senior Vice President and Chief Nursing Officer, Legacy Health System in Portland, Oregon. Legacy Health, based in Portland, Oregon includes 6 hospitals and a regional network of primary care clinics. The system employs 3,500 nurses and approximately 200 advanced practice nurses. This is Carol's third experience as a health system nurse executive, and she considers this to be her "destination job." Legacy Health is on the cutting edge of what is happening in healthcare. Oregon is a very progressive state in promoting healthcare access and is actively involved in care transformation. Within Legacy, all of the primary care clinics have adopted the health home model, and the organization has a strong orientation toward performance excellence and patient engagement. Among Carol's many professional contributions is her service as American Organization of Nurse Executives (AONE) president in 1999.

Research-Based Recommendations for Implementing International Service-Learning

An increasing number of schools of nursing are incorporating international service-learning and/or immersion experiences into their curriculum to promote cultural competence. The purpose of this paper is to identify research-based recommendations for implementing an international service-learning program. A review of literature was conducted in the Cumulative Index of Nursing and Allied Health Literature database using the keywords international, immersion, cultural competence, nursing, and international service-learning. Additional references were located from the reference lists of related articles. Planning of international or immersion experiences requires consideration of the type of country, the length of time, and design of the program; the use of a service-learning framework; opportunities that require the student to live and work in the community, provide hands-on care, participate in unstructured activities, and make home visits; and a method of reflection. Increasing cultural competence does not require foreign travel, but it does necessitate that students are challenged to move outside their comfort zone and work directly with diverse populations. These research-based recommendations may be used either internationally or locally to promote the most effective service-learning opportunities for nursing students.

Reflexive Photography

This qualitative descriptive study used reflexive photography to evaluate the learning process of cultural competence during an international service-learning project in Guatemala. Reflexive photography is an innovative qualitative research technique that examines participants' interactions with their environment through their personal reflections on images that they captured during their experience. A purposive sample of 10 baccalaureate nursing students traveled to Guatemala, where they conducted family and community assessments, engaged in home visits, and provided health education. Data collection involved over 100 photographs and a personal interview with each student. The themes developed from the photographs and interviews provided insight into the activities of an international experience that influence the cognitive, practical, and affective learning of cultural competence. Making home visits and teaching others from a different culture increased students' transcultural self-efficacy. Reflexive photography is a more robust method of self-reflection, especially for visual learners.

Authentic clinical experiences and depth in systems: toward a 21st century curriculum

In 1952, a midwestern US medical school launched a revolution in medical education, introducing increased learner responsibility, an organ systems-based curriculum, and early student engagement in patient care through a ‘Family Clinic’ programme. This programme, which linked medical students with pregnant women, created a meaningful mini-immersion for these pre-clerkship students as they followed women through pregnancy, delivery and postnatal care, and infants into early childhood. Students attended all appointments, made home visits, and often developed important longitudinal relationships with mother, child and family, actively contributing to these patients’ health care.

‘Midwives are the backbone of our health system’: Lessons from Afghanistan to guide expansion of midwifery in challenging settings

Backgroundover the last decade Afghanistan has made large investments in scaling up the number of midwives to address access to skilled care and the high burden of maternal and newborn mortality. Objectiveat the request of the Ministry of Public Health (MOPH) an evaluation was undertaken to improve the pre-service midwifery education programme through identification of its strengths and weaknesses. The qualitative component of the evaluation specifically examined: (1) programme strengths; (2) programme weaknesses; (3) perceptions of the programme's community impact; (4) barriers to provision of care and challenges to impact; (5) perceptions of the recently graduated midwife's field experience, and (6) recommendations for programme improvement. Designthe evaluation used a mixed methods approach that included qualitative and quantitative components. This paper focuses on the qualitative components which included in-depth interviews with 138 graduated midwives and 20 key informants as well as 24 focus group discussions with women. Settingeight provinces in Afghanistan with functioning and accredited midwifery schools between June 2008 and November 2010. Participantsmidwives graduated from one of the two national midwifery programmes: Institute of Health Sciences and Community Midwifery Education. Key informants comprised of stakeholders and female residents of the midwives catchment areas. Findingsmidwives described overall satisfaction with the quality of their education. Midwives and stakeholders perceived that women were more likely to use maternal and child health services in communities where midwives had been deployed. Strengths included evidence-based content, standardised materials, clinical training, and supportive learning environment. Self-reported aspects of the quality education in respect to midwives empowerment included feeling competent and confident as demonstrated by respect shown by co-workers. Weaknesses of the programme included perceived low educational requirement to enter the programme and readiness of programmes to commence education. Insecurity and geographical remoteness are perceived as challenges with clients' access to care and the ability of midwives to make home visits. Key conclusionsthe depth of midwives' contribution in Afghanistan – from increased maternal health care service utilisation to changing community's perceptions of women's education and professional independence – is overwhelmingly positive. Lessons learned can serve as a model to other low resource, post-conflict settings that are striving to increase the workforce of skilled providers.

Atribuições dos Técnicos em Saúde Bucal na Estratégia Saúde da Família em Minas Gerais, Brasil

The scope of this article is to analyze the self-reporting of duties performed by the Oral Health Technicians in the State of Minas Gerais. A cross-sectional descriptive study was conducted through telephone interviews, with a representative sample of 231 workers. The descriptive analysis involved the calculation of proportions. It was found that 71.6% (95% CI, 64.4 to 77.5) performed coronal polishing, 63.2% (95% CI, 56.1 to 69.7) carried out scaling of dental calculus and 14.7% (95% CI, 10.3 to 15.4) inserted restorative materials. Regarding preventive/collective actions, 100% (95% CI, 97.6 to 100.0) participated in educational activities, 99% (95% CI, 96.1 to 99.8) demonstrated oral hygiene techniques, 96.6% (95% CI, 92.7 to 98.4) administrated topical fluoride, 77.9% (95% CI, 71.5 to 83.3) made home visits, and 96.6 % (95% CI, 92.7 to 98.4) performed collective actions, especially in schools. Oral Health Technicians have spent their more time on preventive/collective activities than on individual clinical care.

Water in the Park by Emily Jenkins, and: Boris Gets a Lizard by Andrew Joyner, and: Boris on the Move by Andrew Joyner (review)

Reviewed by: Water in the Park by Emily Jenkins, and: Boris Gets a Lizard by Andrew Joyner, and: Boris on the Move by Andrew Joyner Jeannette Hulick Joyner, Andrew . Boris Gets a Lizard; written and illus. by Andrew Joyner. Branches/Scholastic, 2013. [80p]. Trade ed. ISBN 978-0-545-48446-6 $15.99 Paper ed. ISBN 978-0-545-48447-3 $4.99 E-book ed. ISBN 978-0-545-48783-2 $4.99 Reviewed from galleys R Gr. 1-2. Boris on the Move; written and illus. by Andrew Joyner. Branches/Scholastic, 2013. [80p]. Trade ed. ISBN 978-0-545-48442-8 $15.99 Paper ed. ISBN 978-0-545-48443-5 $4.99 E-book ed. ISBN 978-0-545-48782-5 $4.99 Reviewed from galleys Ad Gr. 1-2. In Boris on the Move, young warthog Boris dreams of adventure, and thus is thrilled when his family uproots their previously stationary RV-like bus from boring Hogg Bay and head to parts unknown. He's sadly disappointed, however, when the bus only goes as far as Greater Hogg Bay Conservation Park and a grumpy Boris has to partake in a family hike. While he doesn't encounter the lion he'd feared, he does meet a nice stray cat, who is quickly adopted and dubbed "Lion." In Boris Gets a Lizard, Boris invites the local zoo to send their Komodo dragon on vacation to Boris' home and excitedly tells all his friends about his impending visitor. When it turns out the Komodo dragon doesn't make home visits, he quickly substitutes a skink for his classmates' viewing, claiming it's a baby Komodo dragon, but it escapes, sending everyone into a panic. The plot in on the Move is lackluster and rambling, but Boris is a likable guy, and the development of Gets a Lizard is much stronger and more satisfying. While the page count is longer than that of many easy readers, the numerous full-color illustrations fill much of that space; the brief text will be decodable to many primary-graders despite some challenging vocabulary. Joyner's illustrations are crisply and tidily composed, and the gray shaggy-haired but anthropomorphized warthogs have a springy energy. Boris' desires for adventure and for exotic pets will resonate with most kids; readers who want a "thicker" book but who aren't yet quite up to the challenge of a lengthier chapter book will find these Australian imports fill the bill nicely. [End Page 514] Copyright © 2013 The Board of Trustees of the University of Illinois

Occupational Therapy Interventions to Improve Leisure and Social Participation for Older Adults With Low Vision: A Systematic Review

This systematic review examined evidence regarding the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in leisure and social participation for older adults with low vision. We identified and reviewed 13 articles that met the inclusion criteria. Four themes related to interventions to improve leisure and social participation emerged from the literature review: using a problem-solving approach, delivering a combination of services, providing skills training, and making home visits and environmental adaptations. The strongest evidence supports using a problem-solving approach to improve leisure and social participation for older adults with low vision. Evidence was moderate supporting the delivery of a combination of services, either by one professional or through an interdisciplinary approach. Results for the effectiveness of skills training and home visits and home adaptations were mixed. Implications for practice, education, and research are discussed.

Feasibility of a Caregiver-Assisted Exercise Program for Preterm Infants

Mounting evidence shows that low-birth-weight and prematurity are related to serious health problems in adulthood, including increased body fat, decreased fitness, poor bone mineralization, pulmonary problems, and cardiovascular disease. There are data to suggest that increasing physical activity in preterm infants will have effects on short-term muscle mass and fat mass, but we also hypothesized that increasing physical activity early in life can lead to improved health outcomes in adulthood. Because few studies have addressed the augmentation of physical activity in premature babies, the objective of this study was to evaluate the feasibility of whether caregivers (mostly mothers) can learn from nurses and other healthcare providers to implement a program of assisted infant exercise following discharge. Ten caregivers of preterm infants were taught by nurses, along with occupational therapists and other healthcare providers, to perform assisted infant exercise and instructed to conduct the exercises daily for approximately 3 weeks. The researchers made home visits and conducted qualitative interviews to understand the caregivers' experiences with this exercise protocol. Quantitative data included a caregiver's daily log of the exercises completed to measure adherence as well as videotaped caregiver sessions, which were used to record errors as a measure of proficiency in the exercise technique. On average, the caregivers completed a daily log on 92% of the days enrolled in the study and reported performing the exercises on 93% of the days recorded. Caregivers made an average of 1.8 errors on 2 tests (with a maximum of 23 or 35 items on each, respectively) when demonstrating proficiency in the exercise techniques. All caregivers described the exercises as beneficial for their infants, and many reported that these interventions fostered increased bonding with their babies. Nearly all reported feeling "scared" of hurting their babies during the first few days of home exercise but stated that fears were alleviated by practice in the home and further teaching and learning. Caregivers were willing and able to do the exercises correctly, and they expressed a belief that the intervention had positive effects on their babies and on caregiver-infant interactions. These findings have important implications for nursing practice because nurses are in key positions to teach and encourage caregivers to practice these exercises with their newborn babies.

Envisioning a Thoughtful and Caring Child Welfare System

sidney goldberg studied at New York University and also with psychologist Albert Ellis, founder of Rational Emotive Behavior Therapy. He now works as a college counselor in New York City. The child welfare system in the United States is not living up to its name. Rather than nurturing the intellectual potential, capacity for joy, and emotional wellness of foster children, the system too often takes a narrow approach to maintaining only the children’s physical well-being. I speak from my experience as a caseworker, administrator, and creator of a unique program in child welfare. Twenty-five years of butting up against the constraints of this system have made clear to me that the problem is structural. The occasional caseworker who would seek to nurture a child’s potential interests or passions would usually be thwarted by the limited paradigm around which the system is constructed. Year after year, most caseworkers go through the motions, while heeding the entrenched and narrow mandates set forth by their agencies as the lives of children under their care stagnate. I believe another system is possible — one that starts from the foundational premise that all people are capable of building satisfying lives through the pursuit of their interests — and that is staffed by workers who treat children and their parents with deep care and respect. To create such a system, we will need to transform the entire structure and pedagogy of social work school, drawing on insights gained through a careful look at the problems with the current system.

The Black Bag

In the early- to mid-twentieth century, stories about nursing practice submitted by nurses frequently appeared in Public Health Nursing. The article reprinted here is an example of this genre of publications. Originally published in April 1936, this article tells the story of a day in the work of one public health nurse as she moves about the city making home visits. In this article, Snow (1936) used personification of the iconic black bag to tell her story. Using this technique she brings to life the nuances of her day, the personalities of her patients, and the importance of the black bag to the work of public health nurses. What did nurses learn from stories such as this one? Themes embedded in this story reflect the role of the Public Health Nurse (PHN), as well as the environment in which she worked. For instance, in this story we learn that not only was the PHN a welcomed visitor in the homes of families struggling with health problems, but that she brought order out of chaos, as illustrated in "The New Arrival". "The Black Bag" also highlights the humor nurses experienced in their encounters with families, as well as the pathos in other situations. Stories served as a vehicle for nurses to share and learn about both the common elements of their work, as well as the unique features related to location and environment, such as rural and urban locales.

Teaching family medicine: a longitudinal and modular competency-based approach

What problems were addressed? Our graduate medical school is located in Singapore. It runs a 4-year curriculum which closely follows the curriculum at Duke University (Durham, NC, USA). Basic sciences are taught during Year 1; clinical clerkships and electives are held in Years 2 and 4, and Year 3 is dedicated to research. The challenge was to design an innovative clerkship that complements the school’s unique curriculum. We abandoned the 4-week programme in Year 2 as taught at Duke University and adopted a modular competency-based approach. We created a year-long programme, allowing our students to experience care continuity and patient-centredness in the community. The first cohort of students completed the year-long clerkship in 2010 with encouraging results. What was tried? The family medicine clerkship is taught in three modules. The first is a knowledge foundation module, which is completed in the first 2 weeks of Year 3. Knowledge and skills learned during Year 2 clerkships are consolidated. Students learn to translate them to a family medicine setting, using team-based learning and clinical scenarios. These are supplemented with lectures and smallgroup discussions on conceptual topics in family medicine. Topics include family medicine principles, organisation of primary care, chronic disease management, preventative care and consultation skills. This is followed by two other modules, which are conducted in the community over the rest of the year. The continuity clinic module focuses on professionalism, patient care and system-based learning. Students are placed under the tutelage of two preceptors in community clinics. They complete a minimum of 20 clinic sessions distributed over a 1-year period. They are required to record their reflections after each session, using an electronic log book. In the patient-centred care module, students follow up two patients with chronic health issues, whom they encountered in their Year 2 clerkships. Students work in small groups of up to six and are supervised by a faculty member. Students make home visits and are encouraged to discover the perspectives of the patients and their caregivers as they cope with their illnesses. Students are encouraged to study system issues as they follow their patients’ journeys through the health care system. They are required to reflect on the impact of illness on the patients’ lives. Students ‘blog’ their reflections in their personalised web logs. We use a closed-access network which is shared only with team-mates and assigned faculty staff to maintain confidentiality. Students and teachers are encouraged to comment and interact with one another as they share experiences. What lessons were learned? An extended clerkship in which students are dispersed in the community is logistically challenging. Use of information technology, such as a web-based personal journal and electronic log books, is helpful. The programme was well accepted by faculty staff and students. On a scale of 0–5, the clerkship achieved a score of 4.21 in the students’ evaluation of the programme’s ability to achieve the goals and objectives of the rotation. Overall, 29.0% of students in the class gave the programme a score of 5 and 62.5% gave it a score of 4.

Gender and social geography: Impact on Lady Health Workers Mobility in Pakistan

BackgroundIn Pakistan, where gendered norms restrict women's mobility, female community health workers (CHWs) provide doorstep primary health services to home-bound women. The program has not achieved optimal functioning. One reason, I argue, may be that the CHWs are unable to make home visits because they have to operate within the same gender system that necessitated their appointment in the first place. Ethnographic research shows that women’s mobility in Pakistan is determined not so much by physical geography as by social geography (the analysis of social phenomena in space). Irrespective of physical location, the presence of biradaria members (extended family) creates a socially acceptable ‘inside space’ to which women are limited. The presence of a non-biradari person, especially a man, transforms any space into an ‘outside space’, forbidden space. This study aims to understand how these cultural norms affect CHWs’ home-visit rates and the quality of services delivered.DesignData will be collected in district Attock, Punjab. Twenty randomly selected CHWs will first be interviewed to explore their experiences of delivering doorstep services in the context of gendered norms that promote women's seclusion. Each CHW will be requested to draw a map of her catchment area using social mapping techniques. These maps will be used to survey women of reproductive age to assess variations in the CHW's home visitation rates and quality of family planning services provided. A sample size of 760 households (38 per CHW) is estimated to have the power to detect, with 95% confidence, households the CHWs do not visit. To explore the role of the larger community in shaping the CHWs mobility experiences, 25 community members will be interviewed and five CHWs observed as they conduct their home visits. The survey data will be merged with the maps to demonstrate if any disjunctures exist between CHWs’ social geography and physical geography. Furthermore, the impacts these geographies have on home visitation rates and quality of services delivered will be explored.DiscussionThe study will provide generic and theoretical insights into how the CHW program policies and operations can improve working conditions to facilitate the work of female staff in order to ultimately provide high-quality services.

You've Got to Have the Right Stuff

You've Got to Have the Right Stuff

Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial

ObjectiveTo compare home-based cardiac rehabilitation (CR) with usual care (control group with no rehabilitation) in elderly patients who declined participation in centre-based CR.DesignRandomised clinical trial with 12 months follow-up and...

Value and Expectations of Supervised Agricultural Experiences as Expressed by Agriculture Instructors in Oklahoma Who were Alternatively Certified

The purpose of this qualitative descriptive study was to determine the value and expectations for student participation in supervised agricultural experience (SAE) programs, as expressed by first–year, agricultural education teachers in Oklahoma who were alternatively certified. This study revealed that teachers in this study value the fact that the SAE program: (a) prepares students for future, possible careers by developing their skills for college and life beyond high school; (b) allows students to build relationships and make connections with community industry representatives; and (c) enables teachers to build personal relationships with students by making home visits. Teachers in this study expect students to own and manage their own SAE program, keep accurate data (i.e., record books) of their SAE programs, and compete at a high level with their SAE. Additionally, these teachers expect the SAE program to teach students responsibility, accountability, and work ethic. Finally, these teachers believe that students should have a variety of SAE programs.

The Role of the Hospice Medical Director as Observed in Interdisciplinary Team Case Reviews

The purpose of this study was to observe the roles played by six hospice medical directors from two hospice programs during interdisciplinary team case reviews. The study analyzed videotapes of case reviews in two hospice agencies over a two year period. The results indicate that the roles and levels of participation vary. Medical Directors were observed reviewing and assisting with care plans, acting as a liaison with primary physicians, educating staff, consulting with attending physicians, participating in quality assurance activities, and dealing with budget issues. Medical Directors did not make home visits or assume the role of attending physician during the observation period. The study demonstrates variance in roles among medical directors and raises new questions for future research.