Home Health Care Management & Practice recent issues

I Was Thinking

Gingerich, B. S. — 2008-09-05

A Cross-Sectional Investigation of Status Post-Lower Extremity Joint Replacement Patients

Maloney, S., Ng, D., Schneider, D. — 2008-09-05

The objective of this cross-sectional investigation is to describe a cohort of 275 status post joint replacement patients who received home health services from an orthopedic home health agency in St. Louis, Missouri. This study also aims to determine if these patients achieved statistically significant improvements in their functional mobility skills, pain, and emotional status. Demographic data were collected together with functional mobility elements from the Outcome and Assessment Information Set pertinent to the rehabilitation of status post joint replacement patients on admission and discharge from home care. Because of the limited nature of participant selection and convenience sampling, no correlations or trends were established among the data collected. However, this cross-sectional analysis validated the incidence of a patient subpopulation that is admitted directly to home care after undergoing joint replacement surgery and demonstrated that these patients achieved significant positive outcomes in functional measures.

Cultural Competence of North Carolina Nurses: A Journey From Novice to Expert

Lampley, T. M., Little, K. E., Beck-Little, R., Xu, Y. — 2008-09-05

This study reports the survey findings of self-reported cultural competence of a convenience sample of 66 registered nurses of varying ages, gender, ethnicity, educational backgrounds, and experience in North Carolina. Campinha-Bacote's model of cultural competence and Benner's model of clinical skills acquisition serve as the conceptual frameworks. The process of cultural competence among health care professionals, developed by Campinha-Bacote, is used to measure cultural competence in participants. In addition to descriptive statistics, bivariate analysis of variance was conducted to compare means of cultural competence scores of different groups. Findings indicate that level of education, nursing experience, and continuing education are factors that promote cultural competence, whereas gender and race/ethnicity have no bearing. In addition, qualitative data generated four themes: language or verbal communication barrier, religious beliefs, different health beliefs and behaviors, and culturally inappropriate nonverbal communication. Implications of these findings for nursing education, practice, and future research are elaborated.

Understanding Oropharyngeal Dysphagia: From Hospital to Home

Riquelme, L. F., Soyfer, A., Engelman, J., Palma, G. L., Stein, L., Chao, J. L. — 2008-09-05

Providing services in the home to a patient with oropharyngeal dysphagia remains a clinical challenge. All health care providers involved in the care of patients with dysphagia need to understand the complexities of swallow physiology, its impact on the patient's overall well-being, and the experience the patient has recently undergone. Namely, it is important to know if the patient is returning home after an acute care stay, if the patient is returning home after a stay at a rehabilitation center, or if simply the patient has become increasingly decompensated while at home. This will allow the clinician working in the home to understand the work-up and possible treatments the patient has thus far undergone, and possibly better understand the overall etiology. Furthermore, it is important to understand that while returning home may be one of the most exciting moments for the patient and his/her family, it may also be the most stressful, as the patient is probably returning home with a different set of needs. This article provides an in-depth approach and discussion of the subject of swallow physiology, diagnosis, and treatment, and provides a resource for all members of the patient care team. It concentrates on the experience of older adults diagnosed with oropharyngeal dysphagia who are returning home.

Actualizing "Professional Altruism": A Comparison of Home Health Care and Hospice Social Workers

Cabin, W. D. — 2008-09-05

The Medicare home health benefit and the Medicare Hospice Benefit (HMB) differ significantly in social work coverage, with social work being only 1%-2% of national Medicare home health visits compared to about 10% of national HMB visits. There has been some research on the frustrations of home care and hospice social workers. However, there is no research that compares home care and hospice social workers. The article presents results of convenience sample interviews of 34 home care social workers and 42 hospice social workers in New York City from August 2006 to October 2007. The analysis finds that, in contrast to home health social workers, hospice social workers feel more able to actualize their altruism professionally; their professional training is more relevant to actual practice; their patients and caregivers have fewer unmet psychosocial needs; and their care is less constrained, and actually enhanced to a great extent, by payer requirements.

A Key to Success in Home Health Care!

McIntyre, E. — 2008-09-05

This article presents five specific components of the certified nursing assistant's (CNA's) role in the clinical setting that are essential to patient care quality. These are hands-on skill level, communication, reliability and integrity, documentation and technology, and clinical knowledge base. The importance of education and communication by the caregiver staff for patients within long-term- and home-care settings is discussed relative to how these elements affect care and service delivery. Central to this ongoing observation and reporting is the role of the CNA within the long-term-care setting or the home health aide within the home care setting. By taking preventive actions and working as a team in the provision of patient care to individuals at risk for dehydration and renal failure, improved patient outcomes can be achieved. An education tool is also provided as a resource to direct caregivers in long-term- and home-care settings.

Back to the Future for Home Care: Roots of Social Work and Nursing in America

Byrd, M. D. — 2008-09-05

This article presents a historical look at early home care and social work in Charles Town, South Carolina. The article references specific statements and recollections of home care and social work through out the 1700s and 1800s. This history was similar to the national impetus for home care and social work through out the British Colonies during the early 1700s and the United States after the Revolutionary War. Even in the early beginnings, home care was perceived to be a less expensive care delivery option than the hospital setting and care quality within the home care setting reported to be of better quality than the hospital setting.

Another Year . . . Another Failed Outcome

Veronesi, J. F. — 2008-09-05

Wound Healing and Nutrition: An Evidence Update

DePalma, J. A. — 2008-09-05

Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Accreditation

Gingerich, B. S. — 2008-09-05

Centers for Disease Control and Prevention's (CDC) An Ounce of Prevention--Keeps the Germs Away Campaign: A Resource for Home Health Nurses to Help Prevent the Spread of Infectious Diseases

Thobaben, M. — 2008-09-05

Advantages of Online Education

Nelson, J. A. — 2008-09-05

Mentoring and Career Development of Minority Nurses and Faculty

Xu, Y. — 2008-09-05

Resource Review: Home Health Aide Guidelines for Care: A Handbook for Caregiving at Home

Gingerich, B. S. — 2008-09-05

I Was Thinking

Gingerich, B. S. — 2008-07-22

From the Issue Editor

Childress, S. — 2008-07-22

Integrative Health and the Management of Pain at the End of Life

Trevithick, S. G. — 2008-07-22

The blend of complementary alternative medicine (CAM) and traditional Western medicine is known as integrative medicine (IM). It is based on the mind, body, spirit, and community and supports the concept that healing is always possible, even when curing is not; IM is relationship-centered care requiring the active participation of the patient to become more self-aware, to think about their experiences of health and illness, to develop and maintain caring relationships, and to commit to effective communication with the healing team. An integrated treatment strategy to meet the integrative health care needs of the individual is then based on individual CAM therapies. The management of patients at the end of life is often managed through palliative care and acknowledges that dying is a normal part of life. Each healing journey of the mind, the body, and the spirit enriches the individual, the family, and the healing team.

Transitions of Care: Optimal Communication Between Hospital and Hospice

Supiano, K. P., Gregory, J. — 2008-07-22

In this article, the key elements of a successful transition of terminally ill patients from the inpatient hospital to home hospice care setting are described. This article describes the role and responsibilities inpatient palliative care teams and receiving hospice agencies have for communicating with patients and families and preparing them for hospice care. This article explains one approach to educating the varied members of the health care team and describes how to collaborate on care plans to facilitate an effective and satisfying transfer of care.

Bereavement Care in Home Care and Hospice

Ashton, J. M. — 2008-07-22

The diagnosis of a chronic or terminal illness causes a variety of emotions for the patient and the care giver. Often bereavement and grief are not addressed by health care professionals. This article seeks to assist the health care provider in understanding the grief process and in offering interventions to aid the ill and dying.

Challenges of Noncancer Patients Transitioning to Hospice

Brunker, C. P. — 2008-07-22

The traditional model of hospice care based on the course of incurable cancer with rapid decline and death does not apply to chronic diseases. Cancer also may take a chronic course and no longer accounts for the majority of admissions to hospice. Hospice admissions now include a majority of noncancer diagnoses. The second challenge is the wide disparity between chronic disease courses. Case examples of people with different diagnoses demonstrate a variety of contrasting trajectories of illness. With ever-increasing advances in medical care, the indications for intensive treatments have never overlapped so much with the indications for hospice referral. This represents the third challenge. In addition, some treatments and medications that improve symptoms and quality of life may significantly prolong life, thus contradicting the traditional expectation of "foregoing life-sustaining treatment" in favor of enrolling in hospice. Finally, a description of various assessment tools helps in identifying the indications for hospice.

End of Life Intensive Care: Pain and Symptom Management at Home

Jennings, P. — 2008-07-22

Symptom management at the end of life can be a challenge for any provider. With careful assessment and tenacity, providers need to determine the cause of any discomfort and determine the best possible treatment. Sometimes the best intervention is presence. Sitting with the patient and family, listening, answering questions, and providing reassurance should not be discounted.

Caring for the Patient and the Family in the Last Hours of Life

Kehl, K. A. — 2008-07-22

Recognition of the signs and symptoms that are common in the final hours of life and a basic understanding of how to manage these signs and symptoms are important to helping the patient and family experience a good death in the home setting. The most common signs and symptoms, including pain, dyspnea, and terminal restlessness or delirium, and their management are discussed. Also addressed are other signs and symptoms, such as cardiovascular signs and symptoms including cold extremities, mottling, and changes in vital signs; respiratory signs and symptoms such as changes in breathing pattern, noisy breathing, and mandibular breathing; and neurological signs and symptoms such as disorientation, sensory changes, and semicomatose state. Changes in metabolism such as fatigue, surge of energy, and increased temperature are presented, along with decreased intake, excretion, and communication changes.

Ethics at the End of Life

Childress, S. — 2008-07-22

Patients, families, and health care providers all face ethical issues at the end of life. Related to increased technology, decreased resources, and immense cultural diversity, these controversies are a common concern to providers in home care. Increased knowledge and skills related to ethical discussions are crucial tools for providers in home care. Providers'abilities to facilitate these discussions with families and patients at the end of life can ease the transition from aggressive care to hospice care. This article describes basic principles of an ethical discussion and discusses the common ethical dilemmas faced at the end of life.

Time Isn't On My Side!

Veronesi, J. F. — 2008-07-22

What to Notify Your Carrier of, Which to Notify, When, and Why

Newfield, J. S. — 2008-07-22

Internet Web Sites Specifically Designed to Provide Support for Informal Caregivers

Thobaben, M. — 2008-07-22

Technology and Training: Simulated Patient Care

Nelson, J. A. — 2008-07-22

ACHC's Quest for Accreditation Leadership

Cesar, T. — 2008-07-22

Communicative Competence of International Nurses and Patient Safety and Quality of Care

Xu, Y. — 2008-07-22

Introducing Sue Childress, RN, MN, OCN

Gingerich, B. S. — 2008-07-22

Resource Review: Smart Technology for Aging, Disability, and Independence

Gingerich, B. S. — 2008-07-22

I Was Thinking

Gingerich, B. S. — 2008-05-13

The Black Sheep of Clinical Ethics: Home Health Ethics Services

Fry-Revere, S. — 2008-05-13

The way health care services are delivered today is dramatically different from how they were delivered just a few decades ago, yet we have done little to rethink how ethics services should accommodate those changes. As hospital systems are growing bigger through mergers and joint ventures, they are absorbing home health agencies in their efforts to provide a wider range of services. The vital function of peer support that home health ethics committees provide will be lost if they are also absorbed by institutional committees. If at all possible, home health agencies should maintain their own ethics committees or at least their own ethics teams.

Skills-Enhancement Training Program for Home Care Providers: Implications for Redefining Quality Care

Coogle, C. L., Jablonski, R., Rachel, J. A., Parham, I. A. — 2008-05-13

This study reports on a skills-enhancement training series for direct care workers providing personal assistance under a waiver for Medicaid home care services. Designed to increase professionalism, the training was part of a federally funded state-level initiative to promote change in the community-based long-term-care system. A linear improvement in the ratings of training quality was documented, with the module on stress management rated most highly. The modules pertaining to issues of bereavement and stress management were judged to have more impact than those related to effective communication and dealing with the challenging needs of clients. In general, participants placed greater value on content that contributed to their personal and professional empowerment. Results are discussed as they relate to the social undervaluation of care work, and it is suggested that quality care can be elevated and redefined to reflect the moral bonds underlying professional relationships between caregivers and care recipients.

A Cultural Home Visit Training Experience in Medical School

Silk, H. J., Weber, C. M. — 2008-05-13

Home visits are an important aspect of the art and science of medicine. The home visit experience during the third year family medicine clerkship at the University of Connecticut School of Medicine is designed to help students gain a richer understanding of where patients "are calling from" to quote the American writer Raymond Carver. It challenges them to enhance their appreciation of the cultural diversity of patients and how a broadly defined culture affects their health. Students conduct a home visit, post reflections of the visit online for their colleagues and mentors to read, and participate in an end of rotation wrap-up discussion. The results show an improvement in student knowledge, confirmation that the experience is useful, and that students appreciate the provided resources. Furthermore, students discover that information gained in a home visit is vastly more relevant and succinct than that gained in an office setting.

Meeting Seniors' Information Needs: Using Computer Technology

Campbell, R. J. — 2008-05-13

This article discusses the design and development of a program to integrate computer technology into two Nurse Wellness Centers located in low-income minority high-rise facilities. The goal of the program is to teach residents how to use the computers and the Internet to locate health information and to take a more active role in their own health care. Previous research shows that low-income seniors have had limited access to a personal computer and the Internet, therefore creating a digital divide between those individuals having Internet access and those who do not. By teaching minority seniors how to locate Internet-based health information, it is hoped that they will seek more information regarding their health conditions, proposed treatments, and current medications. This article describes the training format, barriers to implementation, and initial qualitative findings.

Pandemic Economics: Financial Survival for Home Care Agencies in a Bird Flu Outbreak

Martin, S. D. — 2008-05-13

Flu pandemics have occurred regularly throughout recorded history. Preparation now will determine which home care agencies survive the next flu pandemic financially. This article discusses six cost areas that will affect the home care agency bottom line. These areas include supplies, staff shortages, reimbursement issues, vaccine and antiviral medication, unusual costs associated with a pandemic, and planning. Many suggestions for financial survival are offered. Major suggestions include financial planning in advance of a pandemic, stockpiling six essential supplies to last at least a 6- to 8-week period, and vigorous political action to pass a federal home care pandemic insurance plan and a federal home care paperwork modification plan to be implemented when the government declares a pandemic emergency regionally or nationally.

Ethics in Telehealth Nursing Practice

Rutenberg, C., Oberle, K. — 2008-05-13

Telehealth nurses frequently encounter ethical issues in practice. The ability to identify moral dimensions of practice concerns is an important first step in resolving such issues. In this article, some common ethical terms are explained, and typical ethical problems for Telehealth nurses described. A conceptual model applicable to Telehealth nursing is presented and discussed as a framework for ethical reflection. Characteristics of ethical Telehealth nurses are outlined, and the importance of values clarification in ethical practice emphasized.

We Care Enough to Hire Only the Very Best

Veronesi, J. F. — 2008-05-13

Office of Inspector General's 2008 Work Plan

Gingerich, B. S. — 2008-05-13

A Basic Understanding of Personality Disorders

Thobaben, M. — 2008-05-13

Let's Talk Tech: Technological Competency

Nelson, J. A. — 2008-05-13

Health Care Worker Certifications: Options and Benefits

Gingerich, B. S. — 2008-05-13

Introducing Editorial Board Members Julie A. Nelson, RN, BSN, MBA/HCM, and Rebecca B. Skrine, MS, CCC-SLP, CHCE, COS-C

Gingerich, B. S. — 2008-05-13

Nurses on the Move: Migration and the Global Health Care Economy

Zizzo, K., Xu, Y. — 2008-05-13

I Was Thinking

Gingerich, B. S. — 2008-03-13

The Preadmission Testing Unit: Patient's First Contact With the Health Care System

Morgan, M. J. — 2008-03-13

Shorter lengths of stay in the hospital decrease costs and the likelihood of hospital-acquired infections. Preadmission units replace the old practice of hospital admissions the day before surgery. This article describes how the preadmission unit at Maine Medical Center meets the need for getting patients thoroughly prepared for their surgical procedures in an outpatient setting.

On the Outside Looking In: A Nurse's Experience as a Volunteer EMT

Bennett, C. C. — 2008-03-13

The care delivered by emergency medical system (EMS) personnel makes intuitive sense in that it is similar to emergency department care—only sooner. The author of this article found that, in fact, quite of few differences exist in these systems of care! This article describes the experience of an ex-home care nurse who chose to use her skills as a volunteer with the community ambulance company. Differences in standards of practice and roles of the EMS versus a nurse are discussed, along with the process for resolving conflicting practice principles.

Parish Nursing: A Mission of the Heart and Soul

Koenig, L. — 2008-03-13

Parish nursing has been practiced for many years. It is the art of caring for the whole person: body, mind, and spirit. Parish nursing continues to grow as a vital component of community health. This article describes the role of the parish nurse and provides a case example of the impact the nurse can make in the parishioner's lives. The individual's practice, which is a ministry, is discussed within the scope of parish nursing.

The Rural Health Access Project: Using the Nursing Process to Staff a Primary Clinic

Brown, G. A. — 2008-03-13

Many communities have an underserved population. This article describes how one community and one nurse instituted a primary care service that meets the needs of a population that lacks access to quality health services. By applying the nursing process to staff scheduling within a rolling clinic setting, care and services were consistently available to the rural population.

The Roles and Responsibilities of a Foreign Service Health Practitioner: Serving in a Developing Country

Pieh, C. D. J. — 2008-03-13

Foreign service health practitioners (FSHPs) support the realization of the goals and objectives of U.S. embassies and ensure the health unit's operational capacity, from the treatment of minor emergencies to evacuating a patient for advanced emergency care. Effective planning for emergencies as a result of a terrorist attack, natural disaster, or highly communicable disease is contingent on the level of emergency preparedness. A FSHP is uniquely positioned to focus on critical issues involving the assessment of local health care resources and preparing for medical emergencies. This is especially true for assessing the availability and functionality of local medical resources in a developing country such as Sierra Leone, West Africa. The serious deficiencies in Sierra Leone's health system and its lack of ability to respond to medical emergencies demand the FSHP to integrate special knowledge, skills, and abilities that are essential for managing the overall health care services provided at the embassy's health unit.

Home Care Primary Nurse Case Management Model

Herleman, L. — 2008-03-13

A typical home care nurse is rarely taught a special structured method to do case management. During an orientation, nurses are told they are primary case managers and are oriented to all of the tasks for which they are responsible. However, there is no structured case management method taught. Nurses are typically told that they will develop their own style after observing others. This article describes an organized method of managing patients and their needs with three outcome objectives: to understand the importance of having a structured case management model, to be able to organize and manage all of the tasks for which a primary nurse case manager is responsible, and to increase efficiency with case management issues and decrease or eliminate additional time spent on case management outside of patient visits.

Geriatric Care Management: A Special Kind of Private Practice

Goldberg, G. — 2008-03-13

This article provides an overview and exploration of the field of geriatric care management, a specialized, unique type of private practice. The author offers a firsthand look at what is involved in maintaining a private practice that is dedicated to helping elders and their families confront and resolve difficult and complex problems of everyday living. The author focuses on the emotional, financial, and family issues that arise in dealing with these situations and on providing the reader with an understanding of the business aspects of care provision. A case study that provides the steps of the care management assessment, care planning, and outcome development process is included.

Healing Through Loss: The Stepping Stones

Fitzgerald, L. — 2008-03-13

This article represents one approach to the bereavement process—a time-limited, grief-specific bereavement group. The highlights of this process include introduction to the individuals or families, the telephone contact, and individual and bereavement support group work. Bereavement group types are usually explored through a time sequence of an 8-week approach. Adult children, spouses, partners, and parents are included in these types of support groups. Although this article focuses on the time-limited, grief-specific bereavement group experience, quarterly reunions and reflection groups are additional opportunities for the bereaved to share their grief with others.

Developing a "Train the Trainer" Program to Identify Elder Abuse and Neglect: The Jewish Home Lifecare System Model

Radensky, L., Parikh, D. — 2008-03-13

Numerous elders are victims of abuse and neglect. Although in a better position than most health care staff to observe and report abuse and neglect in the home, many in the home health care services are not adequately equipped to identify the signs of abuse, much less know how to effectively navigate the vast web of available resources. Many staff are unclear regarding how to report and to whom, and often there is fear of the ramifications of reporting. In addition, in many instances the elder does not wish to seek interventions. The Jewish Home and Hospital Lifecare System's Elder Abuse "train the trainer" model focuses on providing in-service training for clinical and nonclinical members of the organization, with the hopes that personnel will improve their ability to take appropriate action when identifying elder abuse and neglect. In addition, the program prepares home care personnel to act as mentors to paraprofessional home health aides.

Social Work in Home Care and Adult Day Settings: A Comparative Study

Novick, J. G. — 2008-03-13

This article explores the job characteristics of social work practice in the home health care field versus the adult day care arena. In many ways, the two positions are very similar; the types of clients or patients serviced, the multidisciplinary nature of the work, and the issues faced when working with this population are examples of similarities. This comparison helps readers understand how the transition from fieldwork to the center setting can be achieved. This exploration represents the personal experiences of the author, who, after almost 25 years in the home health care field, now works in adult day care.

Revaluing Social Work in Home Care: Lessons From Innovators, Rebels, and Hospice

Cabin, W. D. — 2008-03-13

The Medicare and Medicaid home health benefits are extensive programs covering more than 4 million persons, costing $13 billion annually. However, these benefits have limited social work coverage, representing only 1% to 2% of all Medicare and Medicaid home health visits, and social work is not a required service under Medicaid. There has been limited research addressing home care social workers' frustrations with unmet patient needs but no research on coping strategies social workers use to deal with the devalued status of social work in home care. This article presents the results of an interview-based pilot study of the topic, using a convenience sample of 14 home care social workers in New York City interviewed in 2006. Policy makers and practitioners should take guidance from the innovator and rebel social work types and from the Hospice Medicare Benefit and create a more robust social work—based psychosocial care component in Medicare and Medicaid home health care.

Stamping Out the Madness That is Performance Evaluations

Veronesi, J. F. — 2008-03-13

Evidence to Support Social Work in Home Care for the Elderly

DePalma, J. A. — 2008-03-13

Corporate Integrity Agreements Update

Stover Gingerich, B. — 2008-03-13

Violence in the Workplace: Take Precautions

Thobaben, M. — 2008-03-13

Patient Safety Solutions

Stover Gingerich, B. — 2008-03-13

Racism and Discrimination in Nursing: Reflections on Multicultural Nursing Conference

Yu Xu, — 2008-03-13

Introducing Our Issue Editors and Editorial Board Members Susan Niewenhous and Judith Novick

Gingerich, B. S. — 2008-03-13

Resource Review: Notes

Stover Gingerich, B. — 2008-03-13