Home Care Training Research Articles

The home care teaching and learning process in undergraduate health care degree courses.

Home care, one of the services provided by the health system, requires health practitioners who are capable of understanding its specificities. This study aimed to build a substantive theory that describes experiences of home care teaching and learning during undergraduate degree courses in nursing, pharmacy, medicine, nutrition, dentistry and occupational therapy. A qualitative analysis was performed using the grounded theory approach based on the results of 63 semistructured interviews conducted with final year students, professors who taught subjects related to home care, and recent graduates working with home care, all participants in the above courses. The data was analyzed in three stages - open coding, axial coding and selective coding - resulting in the phenomenon Experiences of home care teaching and learning during the undergraduate health care degree courses. Its causes were described in the category Articulating knowledge of home care, strategies in the category Experiencing the unique nature of home care, intervening conditions in the category Understanding the multidimensional characteristics of home care, consequences in the category Changing thinking about home care training, and context in the category Understanding home care in the health system. Home care contributes towards the decentralization of hospital care.

CAREGIVER SUPPORT AFTER HOSPITAL DISCHARGE: THE DUKE ELDER FAMILY CAREGIVER TRAINING (DEFT) PROGRAM

The decline in functional reserves and comorbidities complicate the recovery of older adults following a hospital discharge. Consequently, the assistance of family and friends (caregivers) while convalescing at home is particularly needed. The Duke Elder Family Caregiver Training (DEFT) Center offers a model for an academic-medical-community partnership for integrated caregiver support after hospital discharge. Under the leadership of the Duke School of Nursing, caregivers referred by Duke Hospital providers receive education and training in home care from Duke learners in Nursing, Medicine, Physical Therapy programs. Video technology is used for real-time observation of skills and communication at home. The DEFT collaborates with community-based agencies for resources and activation of lay volunteers for instrumental support. The DEFT aims to increase caregiver preparation for home care reduce preventable health care utilization among patients, and increase competence among learners in interprofessional care and care transitions. Preliminary data will be discussed in the presentation.

Effects of Home-Care Training on the Self-Efficacy of Patients with Beta Thalassemia Major

Background:The self-efficacy of thalassemia patients is an important factor in creating behavioral changes in such patients. Home-care training reduces hospitalization duration as well as relevant costs and improves disease outcomes. This study was designed to assess the effect of home-care training on the self-efficacy of patients with beta thalassemia major.Methodology:This was a quasi-experimental, case-control, before and after intervention study conducted on 136 thalassemia cases from January 2014 to October 2015. Data was collected through Shere general self-efficacy questionnaire (SGSES). Home-care trainings were provided in the form of training courses with respect to the training needs of thalassemia major cases. Two (2) months after the end of training courses, SGSES questionnaire was filled again and the obtained data was analyzed by SPSS 21 as well as descriptive-inferential statistics (significance level=P≤0.05).Results:The results of this study revealed that the mean self-efficacy score of control group was 48.69±6.82 before intervention which increased to 46.69±6.81 after intervention. The mean self-efficacy score of case group was 44.58±5.23 before intervention which increased to 49.5±6.66 after intervention. The rise of self-efficacy score, after intervention, was significantly higher in the case group compared with the control group (P≤.001).Conclusion:According to results, home-care training can develop self-efficacy in thalassemia patients. In home-care training procedure patients play an active role. By providing home-care trainings, therefore, an effective step should be taken to promote the self-efficacy of the patients and to decrease associated problems.

Discussing End-of-Life Issues in Mexico With Older People and Family Caregivers

Older persons often lack the assurance that their needs, wishes, and preferences will be respected. This is the first project in Mexico to involve older adults and family caregivers in end-of-life care discussions. The aim is to better understand concerns around end-of-life issues. This qualitative, phenomenological study used listening events held in 6 culturally, socially, and geographically diverse areas to discuss end-of-life issues with older adults and family caregivers. Framework analysis was used to classify and organize data according to key themes, concepts, and emergent categories. Data were reviewed and discussed until consensus was reached. A total of 121 persons participated. Six major themes were expressed: (1) lack of knowledge of advance directives, (2) little concern regarding pain management and do-not-resuscitate orders and opposition to euthanasia, (3) need for home care training, (4) male caregivers, (5) importance of religious faith, and (6) preferences of dying. Important information was obtained about preferences and concerns of older adults and their caregivers, and a discussion forum was provided. Participants wanted respect from the health care team, to be accompanied by family and religious leaders, and to have a pleasant environment in their final days. Caregivers coped using reciprocity, a work-oriented attitude, pride in caregiving, and faith.

Effect of Educational Program on the “Quality of Life” of Family Caregivers of Patients Undergoing Hemodialysis

Background: The family caregivers of patients undergoing hemodialysis have a major role in the care of patients at home. The study results indicate that these caregivers face with multiple problems regarding responsibilities and issues arising from the care and treatment of the patients. These issues decrease their quality of lives. However, these caregivers are mostly neglected and no studies are available on the effectiveness of educational program on their quality of lives. Therefore, this study aimed to examine the effects of educational program on the quality of life of family caregivers of patients undergoing hemodialysis. Methods: This research was a randomized controlled clinical trial, conducted on 76 family caregivers of patients undergoing hemodialysis referred to Shahid Hasheminejad, a medical and educational center in Tehran, Iran. The subjects were equally allocated into 2 groups of 38 patients. The caregivers of the patients who referred in even or odd days of the week were randomly assigned into the intervention and control groups, respectively. The intervention group received 4 training sessions on home care training program during 2 weeks, but the control group just received the routine training at the center. Both groups answered demographic information and “quality of life” (SF-36) questionnaires before and 6 weeks after the intervention. Then, the obtained data were analyzed in SPSS, 21. Descriptive statistics, the Chi-square and Fisher exact tests, as well as independent samples t-test, t-couple, and Mann-Whitney U test were used to analyze the data. Results: The majority of caregivers (54%) were in the age range of 35-55 years. About 68.4% were female and 70% were married. No significant difference was found between the baseline mean scores of “quality of life” of the intervention and the control groups (45.95±14.94 vs. 45.08±11.02, P=0.775). However, the mean scores of quality of life of the intervention group increased at the end of the study and the 2 groups were significantly different in this regard (63.51±11.55 vs. 41.74±10.51, P<0.001). Conclusion: The current study showed that home care training program can be effective in improving the quality of life and compatibility with the responsibilities of caregivers and change their lifestyle. Therefore, we suggest that managers of educational and medical center encourage their staffs to use such programs for improving the caregivers’ health. A B S T R A C T

Compassion Fatigue in Adult Daughter Caregivers of a Parent with Dementia

Adult daughters face distinct challenges caring for parents with dementia and may experience compassion fatigue: the combination of helplessness, hopelessness, an inability to be empathic, and a sense of isolation resulting from prolonged exposure to perceived suffering. Prior research on compassion fatigue has focused on professional healthcare providers and has overlooked filial caregivers. This study attempts to identify and explore risk factors for compassion fatigue in adult daughter caregivers and to substantiate further study of compassion fatigue in family caregivers. We used content analysis of baseline interviews with 12 adult daughter caregivers of a parent with dementia who participated in a randomized trial of homecare training. Four themes were identified in adult daughter caregiver interviews: (a) uncertainty; (b) doubt; (c) attachment; and (d) strain. Findings indicated adult daughter caregivers are at risk for compassion fatigue, supporting the need for a larger study exploring compassion fatigue in this population.

ABSTRACT 182

Background and aims: The Ear, Nose, Thorat (ENT) Department of United Christian Hospital is one of the 2 paediatric ENT centres in Hong Kong and is a collaborative training and research center affiliated with the Chinese University of Hong Kong. Patients with various reasons for tracheostomy are referred to our hospitals and they are managed in PICU pre-operation, post-operation as well as education for home care. The education program includes tracheostomy management, tube changing, appropriate suctioning, management of potential emergencies and cardio-pulmonary resuscitation as well as management of the tracheostomized children at school. The PICU nurses play different roles in the education process, including as a multi-disciplinary coordinator, health care planner, counselor, educator and assessor. Aims: The purpose of our study is to review the quality, safety and effectiveness of the education program. Methods: A retrospective review of the discharge records by CDARS from year 2002–2013, aged 0–18, with the procedure code of tracheostomy. Results: There were a total of 28 children with tracheostomy done during the study period, in which 57% of the children are referred from other hospitals. Twenty-six percents of the children with tracheostomy could be successfully decanulated. Forty-seven percents of the children with tracheotomy were eligible to home. There was no readmission for emergency situation like accidental dislodgment or tube blockage. Conclusions: A nurse-led tracheostomy home care training program ensures the discharge and the safety of tracheostomized children at home.

Home care learning model for medical students in chile: a mixed methods study.

Introduction. The relevance of home care training is not questioned. However, there are no reported learning models to teach in this setting. Aims. To develop and evaluate a learning model to teach home care to medical students. Methods. Stage 1: Learning Model Design. Tutors teaching home care and a sample of medical students were invited to focus groups analyzed according to the grounded theory. Later, the researchers designed the learning model, which was approved by all participants. Stage 2: Learning Assessment. All students in their family medicine internship at Pontificia Universidad Catolica de Chile were invited to participate in a nonrandomized before-and-after pilot trial, assessing changes in their perception towards home care and satisfaction with the learning model. Results. Stage 1: Six tutors and eight students participated in the focus groups. The learning model includes activities before, during, and after the visits. Stage 2: 105 students (88.2%) participated. We observed improvement in all home care training domains (P ≤ 0.001) and a high satisfaction with the model. Students with previous home visit experiences and who participated with nurses and social workers reported more learning. Conclusions. We report an effective learning model to train medical students in home care. Limitations and recommendations for future studies are discussed.

Effects of a dysphagia home care training program for local residents and home care staff in Kawasaki City&apos;s northern areas

Effects of a dysphagia home care training program for local residents and home care staff in Kawasaki City&apos;s northern areas

Qualitative analysis of the subjective evaluation of home-care training by resident trainees

Qualitative analysis of the subjective evaluation of home-care training by resident trainees

A Prospective Controlled Trial of the Influence of a Geriatrics Home Visit Program on Medical Student Knowledge, Skills, and Attitudes Towards Care of the Elderly

To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge. Using a mixed methods, prospective, controlled trial, volunteer control group students (n = 17) at two sites and intervention group students (n = 16) at two different sites within the same internal medicine clerkship were given Internet and CDROM-based geriatric self-study materials. Intervention group students identified a geriatrics patient from their clinical experience, performed one "home" visit (home, nursing home, or rehabilitation facility) to practice geriatric assessment skills, wrote a structured, reflective paper, and presented their findings in small-group teaching settings. Papers were qualitatively analyzed using the constant comparative method for themes. All students took a pre-test and post-test to measure changes in geriatrics knowledge and attitudes. General attitudes towards caring for the elderly improved more in the intervention group than in the control group (9.8 vs 0.5%; p = 0.04, effect size 0.78). Medical student attitudes towards their home care training in medical school (21.7 vs 3.2%; p = 0.02, effect size 0.94) improved, as did attitudes towards time and reimbursement issues surrounding home visits (10.1 vs -0.2%; p = 0.02, effect size 0.89). Knowledge of geriatrics improved in both groups (13.4 vs 15.2% improvement; p = 0.73). Students described performing a mean of seven separate geriatric assessments (range 4-13) during the home visit. Themes that emerged from the qualitative analysis of the reflective papers added depth and understanding to the quantitative data and supported results concerning attitudinal change. While all participants gained geriatrics knowledge during their internal medicine clerkship, students who performed a home visit had improved attitudes towards the elderly and described performing geriatric assessment skills. Requiring little faculty time, a geriatrics home visit program like this one may be a useful clerkship addition to foster medical students' professional growth.

Vacuum‐assisted closure home care training: a process to link education to improved patient outcomes

Negative pressure wound therapy (NPWT) applies subatmospheric pressure across the wound bed inducing cellular and molecular changes that are beneficial to wound healing. This healing modality may facilitate tissue debridement, infection/inflammation control, and moisture balance; the key components of the wound bed preparation paradigm. To ensure that scientific evidence is diffused into daily clinical practice, we are proposing a knowledge transfer model that articulates an educational plan for the various levels of professional development. The discussion highlights the challenges and potential solutions to integrate NPWT into a seamless continuum of care including a community-based patient care model.

Evaluation of interprofessional training in home care

The increasing number of patients in home care and the importance of teamwork make it important to provide successful ways of interprofessional learning for students. The aim of this study was to evaluate a group of undergraduate students' experiences of a one-day interprofessional home care training in a realistic setting. A study group comprised of 88 students and a control group with 182 students answered the questionnaire. In the study group the students practised interprofessional learning for a fictitious case in a real flat. The clinical education was performed in five steps. A group of local instructors supported the students during the day. The result showed that compared to the students in the control group the students in the study group had received a higher level of understanding or satisfaction in all comparable questions. The training day seemed to be especially important for the physiotherapy students. The students also gave feedback which can be used for future improvements. The arranged one-day home care training seemed to be a successful platform for interprofessional learning in primary health care. Nonetheless, certain logistics problems and the participation of medical students are two areas where improvement is necessary.

The determinants of attitudinal change among medical students participating in home care training: a multi-center study.

To report attitudinal changes of medical students from five medical schools rotating through a home care program, and to determine which of the program characteristics influenced attitudes the most. A survey instrument covering four home care domains (general attitudes, home-based therapies, home care training, and time and reimbursement) was designed and validated by the five schools involved. Using pre- and post-rotation scores, analyses were done to evaluate for attitudinal changes within and among schools. The programs had similar basic characteristics (home visits, attending physicians' involvement, didactics), but had differing degrees of these components. Significant improvements in attitude scores were found in three domains: general attitudes, homebased therapies, and home care training. For time and reimbursement, only three schools improved significantly between pre- and post-rotation scores. Among the five schools, there were significant differences in the homebased therapies and home care training domains (p <.05), and in the time and reimbursement domain the difference approached significance (p =.06). None of the students' characteristics but all of the programs' characteristics significantly correlated with changes in total scores. In the first multiple regression model, educational level (third year instead of fourth) was the only independent predictor of change in score, (adjusted r(2) =.14). In Model 2, the strongest predictor was "contact with physician-program director," followed by "number of visits" and "physician-precepted visits" (r(2) =.23). Educational home care programs of varying intensities can positively affect medical students' attitudes towards home care. At least three program characteristics, (the physician-program director, number of visits, and physician-precepted home visits), are important parts of a successful program.

There's No Place Like Home: Evaluating Family Medicine Residents' Training in Home Care

ABSTRACT This study examined residents' experiences in a physician home visit program and their attitudes toward working with older patients in a home setting. In-depth personal interviews were conducted with all second and third year residents in a family medicine residency program (n = 17). Most residents expressed positive attitudes about caring for patients in their homes. Residents said home visits allowed them to provide better care, and enhanced their assessment skills and understanding of community services. We identified a lack of coordination and consistency in several areas, including home visit assessments and the role of physician preceptors. The need for formal training to identify and treat elder abuse was also identified. Participation in a home visit program appears to be an effective learning experience for residents, and helps residents to understand the needs of older people living in the community.

Home care training in internal medicine residencies: a national survey.

To determine the amount and type of training U.S. internal medicine residents receive in providing home care to patients. A four-item questionnaire was developed and sent to the program directors of all accredited internal medicine residencies in the United States (n = 397) to assess the amounts and types of training (didactic sessions or lectures, house calls, or both) internal medicine residents receive in providing home care. Demographic information about the residency programs was also collected and analyzed. A total of 312 (78.6%) of the program directors responded. Sixty-eight percent of their programs included instruction in home care consisting of house calls, lectures, or both. Fewer than half of the responding programs offered any lecture in home care in their curricula, and only 25% of them included a mandatory house-call experience for trainees. Residency programs that had primary care tracks were more likely than were other programs to include either of these experiences in their curricula. Most internal medicine residents receive limited training in home care. As a consequence, future internists may be inadequately prepared to meet the needs of their patients, particularly as the population ages.

Development of a pharmacy residency program in home care.

A residency training program developed by a college of pharmacy in conjunction with a home care company is described. The 12-month program is based on the ASHP Residency Learning System and the goal statements and educational objectives of ASHP's accreditation standard for pharmacy practice residency training with emphasis in home care. Establishing the program involved identifying goals, objectives, and learning experiences consistent with the expected outcomes. Specific objectives for meeting goals in four categories--practice foundation skills, direct patient care, drug information and drug policy development, and practice management--were linked to expected program outcomes. Learning experiences that would lead to achievement of the program objectives and outcomes were selected and organized into one- to eight-week rotations (e.g., in acute care, care of pediatric patients, pain management, nutrition, patient education and counseling, and administration and practice management). Throughout the program, residents gain experience in pharmaceutical services and research. Skills in care planning and monitoring are emphasized, as is practicing pharmaceutical care in an interdisciplinary environment. Residents who have completed the program have found employment immediately as pharmacy managers of home infusion centers. Pharmacy residency training in home care provides the experience needed to function as a competent clinician and manager who can identify and solve problems to improve patient care.

Curriculum recommendations for resident training in home care.

Journal of the American Geriatrics SocietyVolume 46, Issue 7 p. 910-912 Curriculum Recommendations for Resident Training in Home Care Gail M. Sullivan MD, MPH, Corresponding Author Gail M. Sullivan MD, MPH University of Connecticut, Farmington, Connecticut, and VA ConnecticutTravelers Center on Aging, MC5215, University of Connecticut Health Sciences Center, Farmington, CT 06030.Search for more papers by this authorPeter A. Boling MD, Peter A. Boling MD Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VirginiaSearch for more papers by this authorChristine Ritchie MD, MSPH, Christine Ritchie MD, MSPH University of Alabama at Birmingham, Birmingham, AlabamaSearch for more papers by this authorSharon Levine MD, Sharon Levine MD Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author Gail M. Sullivan MD, MPH, Corresponding Author Gail M. Sullivan MD, MPH University of Connecticut, Farmington, Connecticut, and VA ConnecticutTravelers Center on Aging, MC5215, University of Connecticut Health Sciences Center, Farmington, CT 06030.Search for more papers by this authorPeter A. Boling MD, Peter A. Boling MD Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VirginiaSearch for more papers by this authorChristine Ritchie MD, MSPH, Christine Ritchie MD, MSPH University of Alabama at Birmingham, Birmingham, AlabamaSearch for more papers by this authorSharon Levine MD, Sharon Levine MD Boston University School of Medicine, Boston, Massachusetts.Search for more papers by this author First published: 27 April 2015 https://doi.org/10.1111/j.1532-5415.1998.tb02728.xCitations: 15 Portions of the results were presented at the Annual Meeting of the American Geriatrics Society in May 1995. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume46, Issue7July 1998Pages 910-912 RelatedInformation

House Calls for the 21st Century

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The Effectiveness of a Home Care Training Program for Medical Students in Janan

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