Home Healthcare Nurses Research Articles

The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson’s Disease and Related Disorders: pilot study of I SEE PD Home

BackgroundIndividuals with advanced Parkinson’s Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals.MethodsHome health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0–10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen’s d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants’ intentions to change their practice.ResultsParticipants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension.ConclusionsA virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.

Modeling the Effectiveness of Healthcare Personnel Reactive Testing and Screening for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Omicron Variant Within Nursing Homes.

The SARS-CoV-2 Omicron variant has been hypothesized to exhibit faster clearance (time from peak viral concentration to clearance of acute infection), decreased sensitivity of antigen tests, and increased immune escape (the ability of the variant to evade immunity conferred by past infection or vaccination) compared to prior variants. These factors necessitate re-evaluation of prevention and control strategies—particularly in high-risk, congregate settings like nursing homes that have been heavily impacted by other COVID-19 variants. We used a simple model representing individual-level viral shedding dynamics to estimate the optimal strategy for testing nursing home healthcare personnel and quantify potential reduction in transmission of COVID-19. This provides a framework for prospectively evaluating testing strategies in emerging variant scenarios when data are limited. We find that case-initiated testing prevents 38% of transmission within a facility if implemented within a day of an index case testing positive, and screening testing strategies could prevent 30-78% of transmission within a facility if implemented daily, depending on test sensitivity.

Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia

BackgroundAdequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse’s encounters with resistance to care from home-dwelling persons with dementia.Research aimTo get insight into how nurses experience resistance to care from home-dwelling persons with dementia.MethodsA qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021.Ethical considerationsApproved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality.ResultsTwo main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices.ConclusionOur findings indicate that nurses’ responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care.A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake.

Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study.

BackgroundPatients’ spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients’ spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting.ObjectiveThis study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows.MethodsThis study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices—Saramonic Blink500, Sony ICD-TX6, and Black Vox 365—were further evaluated in a clinical setting (patients’ homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews.ResultsSaramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65% and 26%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management.ConclusionsThis study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation.

Patient Satisfaction with the Nursing Care Quality in a Home Health Care Center in Madinah Region, Saudi Arabia: A Cross-Sectional Article

Home health care services are provided to more than 2,900 patients in the Madinah region in Saudi Arabia, and vary according to the patient’s needs and level of care required. The home health care center in Medina alone provides services to more than 700 patients. Nursing care is considered one of the main pillars of home health care, and all home health care centers depend on nurses to provide service. This makes the quality of nursing services in home health care one of the most important means of identifying the level of service quality in general in-home health care. In this article, the researcher aimed to determine the quality of nursing services based on patient and family caregiver satisfaction with the services provided; identify the most important factors that affect patients’ and family caregivers’ level of satisfaction; and determine whether there is a relationship between service quality, patient satisfaction, and improvement of the patient’s health in general. A cross-sectional method was used in this article; the Home Nursing Quality Scale (HNQS) questionnaire was translated into Arabic and distributed to participants via Google Forms. There were 267 participants in this article; the majority were female (54.7%), whereas only 45.3% were male. The patients’ and family caregivers’ level of education was one of the strongest factors affecting the extent of patient satisfaction, where satisfaction decreased with an increase in education level, i.e., patients and family caregivers with postgraduate degrees had mean scores of 3.83 (standard deviation [SD] = 1.17) and patients and family caregivers with primary degree had mean scores of 4.68 (SD = 0.76). Likewise, the age factor also affected the level of satisfaction: older patients and family caregivers were more satisfied, where patients and family caregivers aged &gt;65 years had mean scores of 4.84 (SD = 0.37). There was a strong and positive relationship between nursing care quality and level of satisfaction among patients and family caregivers with home health care, which reflected the health status of the patients. Moreover, nursing managers and home health care managers must implement interventions to empower patients and caregivers to be more aware and capable of understanding the level of quality in the care provided by home health care nurses. Keywords: Patient Satisfaction, Nursing Care, Quality DOI: 10.7176/JHMN/100-08 Publication date: May 31 st 2022

Burnout Experience of Home Healthcare Nurses

Purpose: This study aimed to clarify the related phenomenon structure and meaning by an in-depth exploration of theexhaustion experience of home healthcare nurses. Methods: Six nurses belonging to a general hospital or a higher gen eral hospital with home healthcare nursing experience were interviewed in-depth, and data were collected. Colaizzi sphenomenological research method was used to analyze the results. Results: It was integrated into 13 topics, 6 topiccollections, and 3 categories ( be weary of home care, the responsibility and burden as a professional, and the drivingforce of overcoming exhaustion. ) Conclusion: This study presented the difficulties and demands faced by nurses whoparticipated in home healthcare nursing along with the adaptation process. Therefore, legal and institutional support isneeded to improve the working environment in the home healthcare nursing process.

Home Health Nursing Care Time for Patients with Parkinson's Disease.

There is an urgent need to provide personalized care more efficiently to patients with Parkinson’s disease (PD) who live at home. To understand the impact of patient attributes and features on nursing care time, we assessed the amount of time required to perform home visits to patients with PD and identified patient characteristics related to differences in nursing care time. Twenty patient (median age 78.0 years) visits were video-recorded. Nursing care activities were categorized, while time spent on them was measured to identify differences in care time by patient. Correlations between patient characteristics and care times were calculated. The median time per visit was 49 min and 7 s. Time was mostly spent on daily living assistance (76.0%), followed by medical care assistance (10.0%) and record keeping and administration (14.0%). Results suggested that patient care was characterized by longer time spent on patient comfort, physical therapy, and patient consultation or education. In general, time per visit increased with patients’ age. The variation in care implementation time tended to be large in daily living assistance and small in medical care assistance. These data may be useful for providing and managing personalized care for patients. These data can also contribute to making nurse care more specialized.

Nurses’ Perspectives on an Electronic Medication Administration Record in Home Health Care: Qualitative Interview Study

BackgroundeHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals.ObjectiveThe objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality.MethodsThis qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz.ResultsOf the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses’ superior position. The experience of the eMAR was regarded as transitioning the nurses’ professional role—away from the point of care and toward more administration—and further strengthened the way of managing work through delegation to health care assistants.ConclusionsPrevious analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals’ work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels.

Interdisciplinary collaboration and computer-assisted home healthcare referral in the emergency department: a retrospective cohort study.

AimHome healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification.MethodsA computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts.ResultsThe model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant.ConclusionAn innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40520-022-02109-9.

Do nurses document all discussions of patient problems and nursing interventions in the electronic health record? A pilot study in home healthcare.

ObjectiveTo assess the overlap of information between electronic health record (EHR) and patient–nurse verbal communication in home healthcare (HHC).MethodsPatient–nurse verbal communications during home visits were recorded between February 16, 2021 and September 2, 2021 with patients being served in an organization located in the Northeast United States. Twenty-two audio recordings for 15 patients were transcribed. To compare overlap of information, manual annotations of problems and interventions were made on transcriptions as well as information from EHR including structured data and clinical notes corresponding to HHC visits.ResultsAbout 30% (1534/5118) of utterances (ie, spoken language preceding/following silence or a change of speaker) were identified as including problems or interventions. A total of 216 problems and 492 interventions were identified through verbal communication among all the patients in the study. Approximately 50.5% of the problems and 20.8% of the interventions discussed during the verbal communication were not documented in the EHR. Preliminary results showed that statistical differences between racial groups were observed in a comparison of problems and interventions.DiscussionThis study was the first to investigate the extent that problems and interventions were mentioned in patient–nurse verbal communication during HHC visits and whether this information was documented in EHR. Our analysis identified gaps in information overlap and possible racial disparities.ConclusionOur results highlight the value of analyzing communications between HHC patients and nurses. Future studies should explore ways to capture information in verbal communication using automated speech recognition.

Corona Virus Disease 2019 Pandemic Contributed to Pregnancy Devastating Outcomes in Low Income Countries

Corona Virus Disease 2019 (COVID-19) pandemic has been a public health threat of the 21st century. This pandemic has unexpectedly occurred, and countries have faced challenges to implement the preventive strategies against this unexpected killer. Pregnancy is a critical state among women, and special care should be provided to prevent pregnancy related complications as early as possible. COVID-19 pandemic has restricted services provided to pregnant women due to some prevention measures and treatment programs. Previous studies reported the high increase of obstetric complications among women infected or ever infected by COVID-19. Depression, suicidal intention, low quality of life during pregnancy, gestational hypertension and gestational diabetes mellitus, the premature rupture of membranes, miscarriage, preterm delivery, edema, maternal death, and hypoxia and other respiratory conditions were observed among women infected by COVID-19. Strategies for protecting pregnant women during pandemics should be enhanced to prevent pregnancy related complications and maternal death. There should be home health care nurses and midwives working with community health workers to assist pregnant women at home. Governments should develop policies and plans about maintaining maternal and child health during pandemics requiring travel ban and other prevention measures.

Implementation and Evaluation of a Home Healthcare Nursing Transition-to-Practice Pilot Program.

Rachild, Jill MSN, RN; Bowler, Lindsay MSN, RN-BC; Denno, Mary MSN, RN; Flynn, Danielle MSN, RN; Keim, Susan K. PhD, MS, MSN, RNEditor(s): Gallagher, Kelly A. MSN, RN, NPD-BC, NEA-BC Author Information

Is ANTT Achievable in the Home Healthcare Setting?

At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes "clean," "aseptic," or so-called "sterile" technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.

Stimuli changes and challenging behavior in nursing homes during the COVID-19 pandemic

BackgroundCOVID-19 restrictions in nursing homes resulted in a reduction in stimuli for residents. This study aimed to explore observed effects of changes in stimuli, both targeted (e.g., planned recreational activities) and untargeted (e.g., spontaneous noise), on challenging behavior in nursing home residents during COVID-19 anti-pandemic measures.MethodsIn an online survey, nursing home healthcare professionals in the Netherlands provided their perspectives on the effects of the reduction in untargeted stimuli on residents with mild, advanced, or no dementia, and on different types of challenging behavior (i.e., psychotic, depressed, anxious, agitated, or apathetic behavior). Additionally, we asked participants’ opinions about strategies for limiting untargeted stimuli and for adjusting targeted stimuli for optimal management of challenging behaviors.ResultsIn total, 199 professionals completed the survey. Residents with advanced dementia and those with psychotic and agitated behavior seemed to benefit from the reductions in stimuli not specifically targeted at the resident. In contrast, residents without dementia and those with depressive and apathetic behavior seemed to be negatively affected by reductions in untargeted stimuli. Participants would like to continue reducing untargeted stimuli in the future (e.g., limiting the use of corridors adjacent to residents' rooms) and to adapt existing or introduce new initiatives involving targeted stimuli (e.g., small-scale, individually tailored activities). Responses to open-ended questions revealed additional initiatives that could be useful in nursing home care.ConclusionsThis study provided lessons to learn from the COVID-19 measures in nursing homes. While many residents may have been negatively affected by the restrictions imposed during the pandemic, specific resident groups may have benefitted from the reduction in untargeted stimuli and from the adjustments made to daily activities. Various strategies and initiatives used in nursing homes during the pandemic seem promising for meeting individual needs in managing challenging behavior. These findings suggest that certain stimuli may affect specific resident groups differently. This underlines the importance of finding the right balance between stimuli and tranquility, tailored to the needs of individual residents. It is important to consider the stimuli present in nursing homes, whether targeted or untargeted, when analyzing and treating challenging behavior.

A novel approach to combat the spread of coronavirus and other respiratory infections with the aid of a smart sanitizing respirator

A novel approach to combat the spread of coronavirus and other respiratory infections with the aid of a smart sanitizing respirator

Controlling the Uncontrollable: Patient Safety and Medication Management From the Perspective of Registered Nurses in Municipal Home Health Care

Most adverse events in health care are related to medication management and they are almost always preventable. Increased knowledge of patient safety related to medication management in home health care is an urgent issue to provide safe care for all patients regardless of where the health care takes place. This study explored patient safety within medication management in municipal home health care. Vignettes were used as stimulus during qualitative interviews with registered nurses. Three main themes with related subthemes were identified as challenges to patient safety within medication management in home health care: (1) challenges to information transfer, (2) challenges related to delegation, and (3) challenges of advanced medical treatments in the home. The issue of transfer of information permeated our findings. Coordinating medications, delegating tasks, along with more advanced care require clear communication between care providers to be compatible with patient safety within medication management in home health care.

Oral health plays second fiddle in palliative care: an interview study with registered nurses in home healthcare

BackgroundOral health is crucial to the experience of well-being, and symptoms from the mouth are common at the end of life. Palliative care aims to identify and treat symptoms early to avoid unnecessary suffering and is thus an important part of nursing in home healthcare. The aim of this study was to illustrate the professional reflections of registered nurses about oral health amongst patients in palliative care, who are being cared for in a home healthcare setting.ResultsThe results showed oral health in end-of-life care, to be an area marked by responsibility and ethical considerations. This was seen in all four partly overlapping themes that emerged through the analysis: Oral health is easily overlooked in palliative care, Oral health is everybody’s but in reality nobody’s responsibility, Patient integrity can be an obstacle for oral health, and Focus on oral health is urgently needed. The mouth is often not included as part of the daily basic care routine, by the registered nurses and the home healthcare staff, until the patient is near end of life. Moreover, neither does the patient tell about symptoms from the mouth. The interpreted whole indicates that the registered nurses had a bad conscience about not doing what they are actually responsible for and ought to do.ConclusionThe oral health of patients at the end of life risks being forgotten or falling between the cracks, due to the nurses’ scattered tasks and unclear delimitations between their, and other professionals’ responsibilities. The responsibilities of registered nurses are also ethically demanding, since their intent to respect the patient’s integrity could mean that in some cases the patients does not allow them to help with oral health. To reduce the risk that oral health is overlooked, clearer demarcation and guidelines on the division of responsibilities are required. Routines that clearly implement early and recurring oral health assessments in home healthcare as well as continuing education updates on oral health and oral care are also needed.

An Outreach Phone Call Project: Using Home Health to Reach Isolated Community Dwelling Adults During the COVID 19 Lockdown.

Home health care (HHC) focuses on delivering skilled health care services to patients in their homes. Over 82% of HHC patients are 65 and older, and living with chronic health conditions. In an effort to respond to the risk the COVID-19 pandemic presented for patients, a HHC agency designed “The Outreach Phone Call Project”. This program was developed to provide telephone support to at-risk patients who had received HHC prior to the COVID-19 lockdown. In total, 16 Care Transition Managers participated in the project and over 4,000 patients received a call from the clinical team. Approximately 44% of the calls did not require any further follow up, 20% of the patients did not answer the call, and 3% of patients were referred back to HHC. Another 13% needed education and assistance with social issues. The calls provided a means of safe connection and support between providers and patients during the pandemic and facilitated access to health and social resources. However, the most beneficial aspect of the program was the opportunity for seasoned HHC nurses to identify clinical changes in the health of patients and to assist them in the triage process. Results of this study demonstrate that the implementation of a calling project during the pandemic shutdown provided invaluable connection and outreach to vulnerable populations. This simple change in practice enabled HHC professionals to reach patients who were isolated and in need of education and assistance. As a result of the implementation of an “Outreach Phone Call Project”, the HHC agency learned many lessons which may be helpful to others who would like to create a similar program in the future. It facilitated clinical assessment, education and intervention for isolated patients during the COVID 19 pandemic and implementation of similar practice should be considered in the post-pandemic world.

Design and Validation of the INCUE Questionnaire: Assessment of Primary Healthcare Nurses' Basic Training Needs in Palliative Care.

Many instruments have been created to measure knowledge and attitudes in palliative care. However, not only is it important to acquire knowledge, but also that this knowledge should reach patients and their relatives through application in clinical practice. This study aimed to develop and psychometrically test the INCUE questionnaire (Investigación Cuidados Enfermeros/Investigation into Nurses’ Care Understanding of End-of-Life) to assess the basic training needs of primary or home healthcare nurses in palliative care. A questionnaire was developed based on the classical theory of tests and factor analysis models. Initially, 18 experts developed 67 items in two blocks and determined content validity by two rounds of expert panels. Exploratory factor analysis and reliability testing were conducted with a non-probabilistic sample of 370 nurses. Some items were observed to have very low homogeneity indices or presented convergence problems and were eliminated. Questionnaire reliability was 0.700 in the theoretical block (KR20 Index) and 0.941 in the practical block (Cronbach’s alpha). The model converges and shows an adequate fit, specifically CFI = 0.977, TLI = 0.977 and RMSEA = 0.05. The correlation between the two factors in the model is ρ = 0.63. The questionnaire objectively evaluates primary or home healthcare nurses’ knowledge of palliative care and its practical application, thereby facilitating more efficient training plans.

Home Health Care Nursing Impacts on Emergency Department Utilization.

With health care costs continuing to rise, much attention has been focused on appropriate emergency department (ED) utilization, and nationwide interventions have been developed to support reduction in health care costs and ED use including primary care, community, and home health models. The following is a review of the current state of the evidence regarding patients receiving home health care nursing (HHN) services and impacts on ED utilization. There are significant gaps in the literature regarding the transition from home to ED in patients receiving HHN services; what tools are utilized by home health nurses for triage of patients at home in order to recommend transfer to the ED or other care sources; and what measures are in place for HHN patients regarding variables that are considered to have a higher impact on ED utilization. There is a substantial lack of evidence about whether the effects of HHN services have any relation to, in particular decreasing, ED utilization. There is increasing evidence of the impacts of nurse practitioner care within the community.