Visiting Nurse Association Research Articles

Efforts to reduce homemaker/home health aide turnover in a home care agency

The Visiting Nurse Association (VNA) of the Denver area conducted an action research project that identified and reduced high turnover rates of homemakers and home health aides. The research team worked to minimize attrition in the VNA's professional staff, which had annual turnover in excess of 95% and staffing losses as high as 60% from the first to the second day of employment. Through a collaborative effort within the organization, the team decreased turn over and reduced staffing losses to 25%, resulting in a first-year savings to the VNA of more than $5,900. Key words: reduction of home health aide turnover

Continence restoration in the homebound elderly: Interventions and outcomes

Urinary incontinence is a prevalent and costly problem among the homebound elderly. Home health care nurses are in an excellent position to implement interventions that will reduce inconti nence within this population. Following the clinical guidelines published by the Agency for Health Care Policy and Research, a Visiting Nurse Association in New Jersey offers continence restoration interventions to its clients. With the use of pelvic muscle exercises as the behavioral intervention of choice, stress and urge incontinence have been significantly reduced. Measured outcomes support both the clinical and cost effectiveness of these nursing interventions. Key words: urinary inconti nence, Agency for Health Care Policy and Research, pelvic muscle exercises, measured outcomes

Safety in the community: clinical guidelines.

Faculty at Barnes College of St. Louis, Missouri, and serves as a med-surgical CNS for the Family Services and Visiting Nurse Association of Alton, Illinois

Nursing diagnosis in home care: audit tool development.

Little research has been done to document the value of using nursing diagnosis in home care and the impact that increased acuity levels have had in diagnostic selection. Nursing diagnosis documentation in home care was examined to see whether it had a relation to select client and visit pattern variables. This retrospective chart audit, which piloted a newly developed instrument called the Home Care Audit Tool, utilized a sample of 199 closed records of a large midwestern Visiting Nurse Association. The mean age of the client population was 76 years, with 64% female. There were 269 initial nursing diagnoses cited in the sample records, averaging 1.75 diagnoses per case. The number of recorded visits increased when select nursing diagnoses were cited together in a single case.

MEDICARE AND THE NURSE

Marilyn D. Harris, RN, MSN, CNAA, FAAN, is the executive director of the Visiting Nurse Association of Eastern Montgomery County, a department of Abington Memorial Hospital, Abington, Pennsylvania.

A Bearable solution

Nurse-Educator/Patient Advocate Alzheimer's Program Visiting Nurse Association of Pioneer Valley, Inc. Springfield, Massachusetts

An effective approach to treating decubitus ulcers in home healthcare patients.

An innovative study conducted by the Visiting Nurse Association of Southern New Jersey resulted in a variety of benefits, including a more effective way for visiting nurses to help patients with pressure sores.

The impact of organizational and environmental factors on staffing in home health care.

Home health care agencies are experiencing changes in staffing demands. I evaluated the staffing patterns of such agencies and investigated the impact of organizational and environmental factors on staffing. Disproportionate stratified random sampling, based on type and region of agency, was used to select Visiting Nurse Associations and hospital-based agencies. Seventy-three percent responded to the mail survey, 120 and 156, respectively.) On average, the majority of staff nurses and supervisors in individual agencies had associate degrees or diplomas. Nursing experience and medical-surgical nursing experience were of greater importance than having a B.S.N. or home health care experience for potential nursing applicants. Type, size, and age of agency and types of services provided had relatively little impact on staffing patterns. However, the director's degree was associated with the percentage of staff nurses and supervisors by educational degree. Competition had little impact on staffing patterns, although the extent of rural service area and Medicare involvement were related to educational backgrounds of nurses and hiring preferences.

Clinical Documentation Guidelines

Faculty at Barnes College of St. Louis, Missouri, and serves as a med-surgical CNS for the Family Services and Visiting Nurse Association of Alton, Illinois

The Hospital???Visiting Nurse Association Partnership

The authors present a model for a joint continuous quality improvement program between a home health agency and a referring hospital. The program evaluates the patient's healthcare continuum and provides feedback to both organizations regarding the effectiveness of discharge planning, referral, and home care services. A program such as this, which fosters the sharing of information and collaboration on common goals, is essential to care coordination. Information criteria used to design the model, methodologies for implementing evaluation activities, and mutual benefits realized by the participating organizations are described.

Planning and program development for psychiatric home care.

The psychiatric home care program of the Visiting Nurse Association and Hospice of Northern California (VNAHNC) was developed in March of 1984. The largest such program in the Bay area, the program generated a revenue of more than $1 million, made 9,756 visits, and served more than 500 patients in 1992. When discussing the program at two national conferences, members of the home care community asked many questions about the feasibility of starting up their own psychiatric home care programs. This article addresses the most frequently asked questions.

Managing uncompensated home care.

The purpose of this study was to determine the strategies used by managers of public health nursing and visiting nurse associations to cope with increased demand for uncompensated home care. A questionnaire was mailed to all public health nursing and visiting nurse associations in the upper midwest. Of the 161 agencies reporting their experience with uncompensated care demand, 129 experienced an increased demand for uncompensated care. Public health nursing and small agencies were more likely to experience increased demand for uncompensated care. Use of cost reduction, revenue enhancement, and quality assurance strategies varied by demand for uncompensated care status as well as by agency size and type. Managers of large and medium agencies and visiting nurses associations were more likely to use the identified strategies. Six strategies were used by more than 50% of the responding agencies.

Principles of universal precautions/body substance isolation.

Faculty at Barnes College of St. Louis, Missouri, and serves as a med-surgical CNS for the Family Services and Visiting Nurse Association of Alton, Illinois

The chief nurse officer as a board member: representation and compensation.

1A healthcare consultant in organizational restructuring, shared governance, patient care delivery systems, operations improvement, quality management, and professional staff salary compensation, has been Vice President and Director of Nursing at both community and tertiary care hospitals, and is Clinical Associate Professor of Nursing at St. Xavier University, Chicago. She is also a doctoral and MBA candidate at the University of Illinois at Chicago 2concentrates her solo law practice in representation, education, and consultation for healthcare providers, healthcare delivery systems, and nurse faculty. She has practiced and taught psychiatric nursing in a variety of settings and nursing education programs, including the Visiting Nurse Association of Cleveland and the University of Illinois at Chicago. She conducts seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice

Supervision of home care aides.

The supervision of home care aides is of the utmost importance, since these aides provide needed services in the less controlled and out-of-sight private homes of patients. The role of the supervisor is demanding to assure compliance with accreditation, certification, and agency standards. Supervision of the paraprofessional staff also provides the opportunity to provide positive feedback as well as constructive criticism to assure that high-quality in-home services are provided to home-bound patients. Supervision also provides the opportunity to interact with the aides, show respect for them as individuals, and convey to them that they are an important member of the home healthcare team.

Psychiatric evaluation and therapy.

Marilyn D. Harris, RN, MSN, CNAA, FAAN, is the Executive Director of the Visiting Nurse Association of Eastern Montgomery County, a department of Abington Memorial Hospital, Abington, Pennsylvania

Outcomes of care from patients' perspectives.

Marilyn Harris, RN, MSN, FAAN, is executive director of the Visiting Nurse Association of Eastern Montgomery County, a department of Abington Memorial Hospital, Abington, Pennsylvania

Extending community health nursing services. The Student Learning Center.

Faced with scarce resources, the Visiting Nurse Association of Omaha (VNA), Bishop Clarkson College, Creighton University, and University of Nebraska Medical Center collaborated to maintain services. Baccalaureate students learned to deliver community health nursing while serving a population in need of these services, but not coverable by funding sources. The Student Learning Center established by the VNA enabled 254 students to provide 5,035 home visits to families without funding sources.

Clinical Research in Home Care

Home care providers rarely initiate research because of limited resources and the perception that research belongs to academic institutions. A survey of the affiliates of the Visiting Nurse Associations of America identified the types of research activities performed and the interest level of nurses in participating in research activities.

Strategies for Increasing Referrals for Occupational Therapy in Home Health Care

The paucity of home health care referrals for occupational therapy led us to develop an educational approach to increase both the referral sources and the number of referrals to occupational therapy. With a consistent effort to exercise clearly identified strategies, the occupational therapy referrals at the Visiting Nurse Association of Porter County, Indiana, increased threefold from the number of referrals at the same time last year. The greater staff awareness of the need for occupational therapy in home health care requires occupational therapists to continually prevent old nonreferring habits from reemerging and to orient and educate new staff members as they enter the home health care field.