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Sama SR, Quinn MM, Gore RJ, Galligan CJ, Kriebel D, Markkanen PK, Lindberg JE, Fallon PJ. The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation. J Appl Gerontol 2024:7334648241246472. [PMID: 38652665 DOI: 10.1177/07334648241246472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.
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Affiliation(s)
- Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Rebecca J Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - David Kriebel
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pamela J Fallon
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
- Employee Health and Wellness, Southern New Hampshire Health, Nashua, NH, USA
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Huang N, Che Y, Hu X, Liu J, He C. Current Status and Factors Influencing Emergency Response Capability of Shared Nurses in the Internet + Nursing Service Model: A Descriptive Cross-Sectional Study. Risk Manag Healthc Policy 2024; 17:803-814. [PMID: 38606346 PMCID: PMC11006594 DOI: 10.2147/rmhp.s452053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
Aim To evaluate the existing level of emergency capabilities among shared nurses and analyze the factors influencing these capabilities. Methods An descriptive cross-sectional survey was conducted from September to October 2023, a purposive sampling method was employed to select 340 shared nurses as the subjects for investigation in Nanchang and Ganzhou cities of Jiangxi Province, as well as Wenzhou city in Zhejiang Province. A self - designed questionnaire on the emergency capabilities of shared nurses was utilized for data collection. Results This investigation encompassed the collection of 340 valid questionnaires, assessing the overall emergency response proficiency of shared nurses. The cumulative score amounted to (170.81±24.62), averaging (4.27±0.62). It is noteworthy that the dimension scoring the highest was preparedness (4.33±0.68), whereas the recovery capability dimension received the lowest score (4.17±0.75). Through multiple linear regression analysis, it was determined that marital status, participation in emergency capability training, and experience in home nursing services significantly influenced the emergency capabilities of shared nurses (P<0.05). Conclusion Shared nurses in China demonstrate a moderately high level of emergency response capability. The marital status, participation in emergency capacity training, and on-site nursing service experience are pivotal factors influencing the emergency capabilities of shared nurses. Nursing administrators should prioritize the development of emergency capacity training and team building for shared nurses, establishing a scientifically standardized mechanism for training, assessment, and management. The implementation of performance evaluation mechanisms for shared nurses is crucial to enhance professional awareness within the workforce.
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Affiliation(s)
- Nanxing Huang
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China
| | - Yunqiu Che
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China
| | - Xiaju Hu
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China
| | - Jiajia Liu
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China
| | - Chaozhu He
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, People’s Republic of China
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Markkanen PK, Gore RJ, Sama SR, Lindberg JE, Galligan CJ, Quinn MM. Coaching Home Care Clients to Prepare Their Homes for Safe Care Visits: A Mixed-Methods Study to Evaluate a Nurse-Led Educational Intervention Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:360. [PMID: 38541359 PMCID: PMC10970455 DOI: 10.3390/ijerph21030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/10/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024]
Abstract
Assuring home care (HC) workers' safety is challenging because the work environment is a private home. This paper presents the process evaluation for a proof-of-concept safety intervention study to assess whether nurse-led safety coaching, using motivational interviewing and a safety handbook, could enable HC clients to improve safety in their homes. The process evaluation objectives were to (i) document the intervention's implementation progress and (ii) assess the intervention's dose delivery, dose reception, and fidelity. Five agencies employing liaisons (n = 5) and nurse managers (NMs, n = 8) implemented this study's intervention and control arms. NMs assigned to the intervention arm (n = 6) coached 34 clients. Process evaluation metrics were assessed with mixed-methods data from (i) surveys completed by NMs during the intervention, (ii) postintervention audio-recorded and transcribed interviews (n = 6) with NMs and liaisons, and (iii) study progress tracking tools. The delivered dose efficiency was 85%, measured by the distribution of safety handbook copies to clients. About 94% of clients (n = 32) were considered "engaged" or "maybe engaged" during the safety coaching. Most coached clients (n = 30) were reachable for follow-up by NMs to assess intervention progress. Despite challenges, the intervention was implemented with good fidelity. Safety coaching can be applied in many HC contexts in larger populations.
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Affiliation(s)
- Pia K. Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Rebecca J. Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
- Department of Biomedical Engineering, Francis College of Engineering, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA
| | - Susan R. Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - John E. Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Catherine J. Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
| | - Margaret M. Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell (UMASS Lowell), Lowell, MA 01854, USA; (R.J.G.); (S.R.S.); (J.E.L.); (C.J.G.); (M.M.Q.)
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Dewan N, Ziebart C, Dabbagh A, MacDermid JC. GoPro video-based therapist-rating of comprehensive-home-fall-hazard checklist shows excellent inter-rater reliability for postmenopausal women with distal radius fracture: A technical report. J Hand Ther 2023; 36:1028-1030. [PMID: 37586991 DOI: 10.1016/j.jht.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/01/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Neha Dewan
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.
| | - Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Armaghan Dabbagh
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, Ontario, Canada
| | - Joy C MacDermid
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
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Yin G, Lin S, Chen L. Risk factors associated with home care safety for older people with dementia: family caregivers' perspectives. BMC Geriatr 2023; 23:224. [PMID: 37029350 PMCID: PMC10082513 DOI: 10.1186/s12877-023-03893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/15/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Many older people with dementia currently prefer home care; however, homes are neither professionally designed nor regulated like health care facilities, and home care is more prone to safety incidents. Many studies have examined home care safety for older people with dementia. However, factors contributing to safety incidents in home care have not been adequately considered. This study explored the risk factors for home care safety for older people with dementia based on the perspective of family caregivers. METHODS This study used a qualitative research approach; a total of 24 family caregivers were interviewed face-to-face and semi-structured from February 2022 to May 2022, and the Colaizzi seven-step phenomenological research method was used to analyze the data and refine the themes. RESULTS Safety risks in home care for older people with dementia stem from five areas: poor health of older people with dementia, dementia symptoms, unsafe home environment, the insufficient caring ability of family caregivers, and lack of safety awareness of family caregivers. CONCLUSION The risk factors for home care safety for older people with dementia are complex. And as the primary caregivers of older people with dementia, the caregiving ability and safety awareness of family caregivers primarily determine the safety of home care for older people with dementia. Therefore, when addressing home care safety for older people with dementia, the focus should be on providing targeted education programs and support services for family caregivers of older people with dementia.
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Affiliation(s)
- Guo Yin
- School of Nursing, Sanquan College of Xinxiang Medical University, Xinxiang City, Henan Province, China
| | - Siting Lin
- School of Nursing and Health, Nanfang College, Guangzhou, Guangzhou City, Guangdong, China
| | - Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
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Keyvanloo Shahrestanaki S, Rafii F, Najafi Ghezeljeh* T, Ashghali Farahani M, Amrollah Majdabadi Kohne Z. Concept analysis of patient safety in home care: a hybrid model. BMJ Open Qual 2022; 11:bmjoq-2022-002077. [PMID: 36521926 PMCID: PMC9756164 DOI: 10.1136/bmjoq-2022-002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept. OBJECTIVE The objective of the present study was to analyse patient safety in home care in Iran. METHODS The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008-2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented. FINDINGS Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses). CONCLUSION Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.
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Affiliation(s)
| | - Forough Rafii
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh*
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Ziebart C, Dewan N, MacDermid J. Content validity of the comprehensive home fall hazard checklist, an observational study. Medicine (Baltimore) 2022; 101:e31781. [PMID: 36451495 PMCID: PMC9704902 DOI: 10.1097/md.0000000000031781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
One strategy to reduce the number of falls in older adults is through home hazards assessment checklists. The comprehensive home fall hazard checklist (CHFHC) was designed to guide individuals through their home, assessing fall hazards. The checklist systematically prompts the individuals to check 10 general locations in the house The purpose of this study was to assess the content validity of the comprehensive home fall hazard checklist. A 4-point ordinal Likert rating scale was used to evaluate the content validity of each of the 74 items on the checklist. The relevance and clarity of each item was assessed. Nine experts rated the content validity of each test in relation to the 5 tasks in the rating protocol. The item content validity index, and the scale content validity index were determined, and a kappa rating was calculated. Three of the 74 items on the CHFHC were determined to be not relevant receiving a content validity index of 0.78 or less. All of the items were ranked as being quite clear or highly clear, with all items receiving at least 0.78 on the content validity index. The Kappa score indicates expert agreement. The content validity index was determined to be excellent, with high ratings for both relevance and clarity for 71 of 74 items on the CHFHC.
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Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- * Correspondence: Christina Ziebart, Faculty of Health Science, Western University, London, ON N6G 1H1, Canada (e-mail: )
| | - Neha Dewan
- Department of Health Sciences, Lakehead University, Thunder Bay ON, Canada
| | - Joy MacDermid
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
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Munjal KG, Yeturu SK, Chapin HH, Tan N, Gregoriou D, Garcia D, Grudzen C, Hwang U, Morano B, Neher H, Gorbenko K, Youngblood G, Misra A, Dietrich S, Gonzalez C, Appel G, Jacobs E, Siu A, Richardson LD. Feasibility of the Transport PLUS intervention to improve the transitions of care for patients transported home by ambulance: a non-randomized pilot study. Pilot Feasibility Stud 2022; 8:169. [PMID: 35932067 PMCID: PMC9354351 DOI: 10.1186/s40814-022-01138-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency medical technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. Methods Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the fall safety assessment (FSA) and the discharge comprehension assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, the presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. Results One-hundred three EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%) and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported. Conclusions The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study.
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Affiliation(s)
- Kevin G Munjal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Sai Kaushik Yeturu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.
| | - Hugh H Chapin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Nadir Tan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Diana Gregoriou
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Daniela Garcia
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Corita Grudzen
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Barbara Morano
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Hayley Neher
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Ksenia Gorbenko
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.,Institute for Health Equity Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Glen Youngblood
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Anjali Misra
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Staley Dietrich
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Cyndi Gonzalez
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Giselle Appel
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Erica Jacobs
- George Washington University School of Medicine, Washington D.C., USA
| | - Albert Siu
- Department of Geriatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.,Institute for Health Equity Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Quinn MM, Markkanen PK, Galligan CJ, Sama SR, Lindberg JE, Edwards MF. Healthy Aging Requires a Healthy Home Care Workforce: the Occupational Safety and Health of Home Care Aides. Curr Environ Health Rep 2021; 8:235-244. [PMID: 33982149 PMCID: PMC8114970 DOI: 10.1007/s40572-021-00315-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW To identify important home care (HC) aide occupational safety and health (OSH) hazards and examine how addressing these can improve aide health and the delivery of HC services overall. Specifically, this review seeks to answer: Why is HC aide OSH important? What are the most significant OSH challenges? How can improving HC aide OSH also improve the safety and health of their clients? What implications do the findings have for future research? RECENT FINDINGS HC is one of the fastest growing US industries. Aides comprise its largest workforce and are increasingly needed to care for the rapidly aging population. There is an aide shortage due in part to instabilities in HC work organization and to serious job-specific hazards, resulting in aides losing work time. Recent social, economic, and technological factors are rapidly changing the nature of HC work, creating OSH hazards similar to those found in nursing homes. At the same time, aides are experiencing social and economic inequities that increase their vulnerability to OSH hazards. These hazards are also a burden on employers who are challenged to recruit, retain, and train aides. OSH injuries and illness interrupt the continuity of care delivery to clients. Many OSH hazards also put HC clients and families at risk. A new framework and methodologies are needed to assess aide and client safety together in order to guide future HC research, policies, and practices. Government, industry, and labor commitment is needed to fund and coordinate a comprehensive, multidisciplinary research program.
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Affiliation(s)
- M. M. Quinn
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - P. K. Markkanen
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - C. J. Galligan
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - S. R. Sama
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - J. E. Lindberg
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
| | - M. F. Edwards
- Safe Home Care Project, Lowell Center for Sustainable Production and Department of Public Health, University of Massachusetts Lowell, 600 Suffolk Street, Suite 520, Lowell, MA 01854 USA
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Development of the Home Fall Hazard Checklist. Rehabil Res Pract 2021; 2021:5362197. [PMID: 34158978 PMCID: PMC8187056 DOI: 10.1155/2021/5362197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Home hazard assessment is particularly important following a fracture as a means of preventing subsequent fractures. The purpose of this study was to evaluate current checklists and evidence on home hazard to develop a usable self-administered checklist that could be used by adults to assess home hazards. Design Review and observational, prospective study. Setting. Community dwelling. Participants. Nine adults (4 men, 5 women) were asked to review the checklist and provide feedback on whether items were relevant, comprehensive, and easy to understand. Intervention. A search for literature examining the causes of falls that focused on home hazards or behaviours was conducted, and causes were extracted. Using the combined list of home hazards, a draft checklist was created. The participants were asked to pilot the checklist through their home. Primary and Secondary Outcome. An initial iteration of the checklist was modified to reduce redundancy (by grouping certain items together), improve usability (by adding a “not applicable category”), and improve readability (by removing double-barrelled questions or rewriting certain items). Results This process resulted in 74 items in 10 areas. On average, it took 10 minutes for the participants to complete the home walk-through while filling out the checklist. Conclusion The fall hazard-home checklist is a new checklist designed to identify home fall hazards with the intended use of being either administered by self-report through memory or supported by a walk-about, and that could potentially be completed by a patient who has incurred a fall, fracture, a family member, or caregiver. Given the expense of home hazard assessments that involve a home visit, the validity of this method of detection warrants further investigation.
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Grønoset Grasmo S, Frostad Liaset I, Redzovic SE. Home health aides' experiences of their occupational health: a qualitative meta-synthesis. Home Health Care Serv Q 2021; 40:148-176. [PMID: 33949920 DOI: 10.1080/01621424.2021.1921650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions.A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO.HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported.More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home.
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Affiliation(s)
- Sunniva Grønoset Grasmo
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ingeborg Frostad Liaset
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Skender Elez Redzovic
- Faculty of Medicine and Health Sciences, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Russell D, Dowding D, Trifilio M, McDonald MV, Song J, Adams V, Ojo MI, Perry EK, Shang J. Individual, social, and environmental factors for infection risk among home healthcare patients: A multi-method study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:780-788. [PMID: 33606903 PMCID: PMC8084932 DOI: 10.1111/hsc.13321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 and included qualitative interviews with HHC nurses (n = 50) and structured observations of nurse visits to patients' homes (n = 400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter-relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Marygrace Trifilio
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | | | - Marietta I. Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Eun K. Perry
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Jingjing Shang
- Columbia University School of Nursing, New York, NY, USA
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Zhang ZR, Wu Y, Wang FY, Wang WJ. Traumatic spinal cord injury caused by low falls and high falls: a comparative study. J Orthop Surg Res 2021; 16:222. [PMID: 33771177 PMCID: PMC8004393 DOI: 10.1186/s13018-021-02379-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quite a few traumatic spinal cord injuries (TSCI) were caused by falls. However, the comparison of different causes of TSCI or the epidemiological characteristics of TSCI caused by falls of different heights are rare. This study investigated the epidemiological characteristics of TSCI caused by falls and conducted a comparison between low falls and high falls. METHOD Data from cases with TSCI admitted to China Rehabilitation Research Center from 2010 to 2019 were collected, including age, gender, occupation, cause, neurological level, and severity of the injury in admission, combined injuries, complications, and rehabilitation length of stay. Mann-Whitney U and chi-square (χ2) tests were used to assess the differences between two groups at a statistical significance level of 0.05. RESULT A total of 1858 TSCI cases were included and 41.7% were caused by falls, 11.4% by low falls and 30.3% by high falls, respectively. Patients with fall-induced TSCI were older and had a shorter rehabilitation length of stay than those with non-fall-induced TSCI. Patients with high fall-induced TSCI were younger and more likely to suffer from paraplegia, severer injuries, and combined injuries, and had longer time from injury to rehabilitation and rehabilitation length of stay, compared with patients with low fall-induced TSCI. CONCLUSION Falls is the leading causes of TSCI and high fall is becoming more common. Attention not only should be paid to high falls for the severe injury and longer hospitalization, but also low falls due to the higher neurological level of the injury and the aging of population in China.
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Affiliation(s)
- Zhen-Rong Zhang
- School of Rehabilitation, Capital Medical University, No. 10, Jiaomen North Road, Fengtai District, Beijing, 100068, People's Republic of China
| | - Yao Wu
- School of Rehabilitation, Capital Medical University, No. 10, Jiaomen North Road, Fengtai District, Beijing, 100068, People's Republic of China
| | - Fang-Yong Wang
- School of Rehabilitation, Capital Medical University, No. 10, Jiaomen North Road, Fengtai District, Beijing, 100068, People's Republic of China.
- Department of Spine Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, People's Republic of China.
| | - Wen-Jing Wang
- School of Rehabilitation, Capital Medical University, No. 10, Jiaomen North Road, Fengtai District, Beijing, 100068, People's Republic of China
- Department of Occupational Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, People's Republic of China
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14
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Ziebart C, Bobos P, Furtado R, MacDermid JC, Bryant D, Szekeres M, Suh N. The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Arch Rehabil Res Clin Transl 2021; 2:100065. [PMID: 33543091 PMCID: PMC7853376 DOI: 10.1016/j.arrct.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults. Data Sources CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles. Study Selection Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome. Data Extraction Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome. Data Synthesis A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10). Conclusions The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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Affiliation(s)
- Christina Ziebart
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Rochelle Furtado
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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15
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Ziebart C, MacDermid J, Bobos P, Furtado R, MacDermid-Watts S, Bryant D, Szekeres M, Suh N. Fall Hazard Identification: A Scoping Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2020.1806424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy MacDermid
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Rochelle Furtado
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Sara MacDermid-Watts
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
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Turkelson C, Keiser M, Sculli G, Capoccia D. Checklist design and implementation: critical considerations to improve patient safety for low-frequency, high-risk patient events. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 6:148-157. [DOI: 10.1136/bmjstel-2018-000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/03/2022]
Abstract
Purpose: This pilot project describes the development and implementation of two specialised aviation-style checklist designs for a low-frequency high-risk patient population in a cardiac intensive care unit. The effect of the checklist design as well as the implementation strategies on patient outcomes and adherence to best practice guidelines were also explored. The long-term objective was to improve adherence to accepted processes of care by establishing the checklists as standard practice thereby improving patient safety and outcomes.Methods: During this project, 10specialised crisis checklists using two specific aviation-style designs were developed. A quasiexperimental prospective pre-post repeated measure design including surveys along with repetitive simulations were used to evaluate self-confidence and self-efficacy over time as well as the perceived utility, ease of use, fit into workflow and benefits of the checklists use to patients. Performance, patient outcomes and manikin outcomes were also used to evaluate the effectiveness of the crisis checklists on provider behaviours and patient outcomes.Results: Overall self-confidence and self-confidence related to skills and knowledge while not significant demonstrated clinically relevant improvements that were sustained over time. Perceptions of the checklists were positive with consistent utilisation sustained over time. More importantly, use of the checklists demonstrated a reduction in errors both in the simulated and clinical setting.Conclusion: Recommendations from this study consist of key considerations for development and implementation of checklists including: utilisation of stakeholders in the development phase; implementation in real and simulated environments; and ongoing reinforcement and training to sustain use.
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Sligo J, Roberts V, Gauld R, Villa L, Thirlwall S. A checklist for healthcare organisations undergoing transformational change associated with large-scale health information systems implementation. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Money AG, Atwal A, Boyce E, Gaber S, Windeatt S, Alexandrou K. Falls Sensei: a serious 3D exploration game to enable the detection of extrinsic home fall hazards for older adults. BMC Med Inform Decis Mak 2019; 19:85. [PMID: 30992072 PMCID: PMC6469143 DOI: 10.1186/s12911-019-0808-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background Falls are the main cause of death and injury for older adults in the UK. Many of these falls occur within the home as a result of extrinsic falls risk factors such as poor lighting, loose/uneven flooring, and clutter. Falls education plays an important role in self-management education about extrinsic hazards and is typically delivered via information leaflets, falls apps, and educational booklets. Serious games have the potential of delivering an engaging and informative alternative to traditional methods but almost exclusively, these are currently delivered as exergaming applications that focus solely on intrinsic falls risk factors. This study presents ‘Falls Sensei’ a first-person 3D exploration game that aims to educate older adults about extrinsic falls risk factors within the home environment. After presenting Falls Sensei, game usability and older adults’ perceptions and attitudes towards using the game in practice are explored. Methods This study involved 15 community dwelling older adults. After playing the Falls Sensei game, participants completed a Systems Usability Scale (SUS) questionnaire and post task interview, and follow-up interviews three weeks later. Inductive and deductive thematic template analysis, informed by the Unified Theory of Acceptance and Use of Technology model, was used to analyse the think-aloud, post-task and follow-up interview transcripts. Descriptive statistical analysis and one-sampled t-tests were used to analyse log-file data and SUS responses. Results Three high-level themes emerged from the analysis of transcriptions: Performance Expectancy; Effort Expectancy; Social Influence. The SUS score was 77.5/100 which indicates ‘Good’ levels of usability. Interestingly, reported usability of the game increased with participant age. Participants were positive about the usability of the game (p < = 0.05 for 9/10 items). The most memorable fall hazards were those most commonly encountered in the game or those most challenging to participants. Conclusions The results support the use of serious games as an engaging tool for educating older adults about extrinsic falls risk factors. Awareness of home hazard detection was raised by the game, and some older adults became more aware for the need to adapt their own homes after gameplay. Further research would be needed to draw comparisons with established interventions.
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Affiliation(s)
- Arthur G Money
- Department of Computer Science, Brunel University London, Uxbridge, UB8 3PH, UK.
| | - Anita Atwal
- Faculty of Health and Social Care, London South Bank University, London, SE1 0AA, UK
| | - Emily Boyce
- North London Forensic Service, Barnet, Enfield and Haringey Mental Health NHS Trust, Enfield, EN2 8JL, UK
| | - Sophie Gaber
- Department of Neurobiology, Care Sciences & Society, Division of Occupational Therapy, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Susan Windeatt
- CIS Westminster Rehabilitation Service, Gordon Hospital London, CNWL NHS Foundation Trust, SW1V 2RH, London, UK
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Squires A, Ridge L, Miner S, McDonald MV, Greenberg SA, Cortes T. Provider Perspectives of Medication Complexity in Home Health Care: A Qualitative Secondary Data Analysis. Med Care Res Rev 2019; 77:609-619. [DOI: 10.1177/1077558719828942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A primary service provided by home care is medication management. Issues with medication management at home place older adults at high risk for hospital admission, readmission, and adverse events. This study sought to understand medication management challenges from the home care provider perspective. A qualitative secondary data analysis approach was used to analyze program evaluation interview data from an interprofessional educational intervention study designed to decrease medication complexity in older urban adults receiving home care. Directed and summative content analysis approaches were used to analyze data from 90 clinician and student participants. Medication safety issues along with provider–provider communication problems were central themes with medication complexity. Fragmented care coordination contributed to medication management complexity. Patient-, provider-, and system-level factors influencing medication complexity and management were identified as contributing to both communication and coordination challenges.
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20
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Lavender SA, Polivka BJ, Darragh AR, Sommerich CM, Stredney DL, Wills CE. Evaluating Home Healthcare Workers' Safety Hazard Detection Ability Using Virtual Simulation. Home Healthc Now 2019; 37:265-272. [PMID: 31483358 DOI: 10.1097/nhh.0000000000000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Home healthcare workers (HHWs) are routinely exposed to occupational safety hazards when servicing patients in their homes that put them at risk for injury. These hazards can be broadly classified as "electric, fire and burn," "environmental," or "slip, trip, and lift" hazards. To better train HHWs regarding their potential exposure to these hazards, a home healthcare virtual simulation training system (HH-VSTS) was developed. The HH-VSTS contains three training modules, corresponding to the aforementioned hazard categories, and an assessment module. In each training module, the trainee must navigate the virtual space, via a mouse click, and identify items or conditions that represent hazards. Once an item has been clicked on, the HH-VSTS asks the user if the item or condition is a hazard. For items or conditions that are hazards, additional text boxes present material to the user as to why the item constitutes a hazard and potential remediation approaches. Thus, it is important that hazards be identified and clicked on for the trainee to receive the educational component of the training system. This article evaluated the ability of 49 HHWs to find hazards in each of the three categories. In all modules, participants found the most salient hazards (e.g., clutter on stairs, unattended candles, biohazard stains) but struggled to find some of the less salient hazards. Several less salient hazards included the pet food bowls in the path of travel, the frayed electrical cord, oxygen tube leaking into a mattress, hot water that was too hot, and elevated room temperatures. Overall, this analysis found that most of the hazards within the training modules could be found by naïve HH-VSTS users. These data suggest the need for including hints that guide users toward hazards with which they are less familiar.
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Affiliation(s)
- Steven A Lavender
- Steven A. Lavender, PhD, CPE, is an Associate Professor, Departments of Integrated Systems Engineering & Orthopaedics, The Ohio State University, Columbus, Ohio. Barbara J. Polivka, PhD, RN, FAAN, is an Associate Dean of Research & Professor, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas. Amy R. Darragh, PhD, OTR/L, is an Associate Professor, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio. Carolyn M. Sommerich, PhD, CPE, is an Associate Professor, Departments of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio. Donald L. Stredney, MA, is Director, Interface Lab, The Ohio State University, Columbus, Ohio. Celia E. Wills, PhD, RN, is an Associate Professor, College of Nursing, The Ohio State University, Columbus, Ohio
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Blanchet R, Edwards N. A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review. BMC Geriatr 2018; 18:272. [PMID: 30413144 PMCID: PMC6234792 DOI: 10.1186/s12877-018-0958-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/19/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Falls occurring on stairs or in bathrooms are associated with a high risk of injuries among older adults. Home environmental assessments are frequently used to guide fall-prevention interventions. The aims of this review were to describe how, where, by whom, and for whom environmental hazard checklists are used, and to examine the characteristics of environmental hazard assessment checklists with specific attention to features of bathrooms and stairs/steps assessed in them. METHODS Studies published before January 5, 2018, were identified using several databases. Publications reporting the use and/or evaluation of environmental hazard checklists were eligible if they assessed bathrooms or stairs/steps in homes of older adults (≥65 years). Content analysis was conducted on publications that provided a complete list of specific environmental hazards assessed. Checklist items related to bathrooms and stairs/steps were extracted and categorized as structural or non-structural and as objective or subjective. RESULTS 1119 studies were appraised. A pool of 136 published articles and 4 checklists from the grey literature were included in this scoping review. Content analysis was conducted on 42 unique checklists. There was no widely used checklist and no obvious consensus definition of either environmental hazards overall or of single hazards listed in checklists. Checklists varied greatly with respect to what rooms were assessed, whether or not outdoor stair/steps hazards were assessed, and how responses were coded. Few checklists examined person-environment fit. The majority of checklists were not oriented towards structural hazards in bathrooms. Although the majority of checklists assessing stair/steps hazards evaluated structural hazards, most features assessed were not related to the construction geometry of stairs/steps. Objective features of bathrooms and stairs/steps that would deem them safe were rarely specified. Rather, adequacy of their characteristics was mostly subjectively determined by the evaluator with little or no guidance or training. CONCLUSION The lack of standard definitions and objective criteria for assessing environmental hazards for falls is limiting meaningful cross-study comparisons and slowing advances in this field. To inform population health interventions aimed at preventing falls, such as building code regulations or municipal housing by-laws, it is essential to include objectively-assessed structural hazards in environmental checklists.
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Affiliation(s)
- Rosanne Blanchet
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 212, Ottawa, ON K1H 8M5 Canada
| | - Nancy Edwards
- School of Nursing, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON K1H 8M5 Canada
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Larsson A, Westerberg M, Karlqvist L, Gard G. Teamwork and Safety Climate in Homecare: A Mixed Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112495. [PMID: 30413052 PMCID: PMC6266672 DOI: 10.3390/ijerph15112495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/11/2018] [Accepted: 11/01/2018] [Indexed: 11/16/2022]
Abstract
A rapidly changing homecare service sector implies difficulties to control safety and health risks for staff and to guarantee standardised deliveries of services to recipients. This study aimed to describe staff perceptions of safety climate and practices in homecare service teams, and suggestions for improvements. A second aim was to identify if and how the appraisals of safety climate were related to individual perceptions of safety, mental strain and adverse events/injury. A convergent parallel mixed methods design was used. Nursing assistants and care aides (133 in total, representing 11 work teams) in the north of Sweden replied to a survey and participated in focus group interviews. Results were analysed with ANOVA (inter-team differences) and by qualitative content analysis. Significant diversity was identified between the teams in five of seven dimensions of safety climate. Important areas for improvement were: a need to define and agree on criteria for a safe working environment; leadership prioritising safety at work; and management able to provide trust, support and time. A prerequisite for these agreements was improved authority and communication between all parties involved. The safety climate dimensions were related to personal perceptions of safety and mental strain and, partly, to adverse events/injuries.
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Affiliation(s)
- Agneta Larsson
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, 97187 Luleå, Sweden.
| | - Mats Westerberg
- Division of Innovation and Design, Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, 97187 Luleå, Sweden.
| | - Lena Karlqvist
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, 97187 Luleå, Sweden.
| | - Gunvor Gard
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, 97187 Luleå, Sweden.
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Czakert J, Lehmann Y, Ewers M. [Patient safety in home care : A review of international recommendations]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2018; 135-136:18-26. [PMID: 29891231 DOI: 10.1016/j.zefq.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/04/2018] [Accepted: 05/09/2018] [Indexed: 05/26/2023]
Abstract
BACKGROUND In recent years there has been a growing trend towards nursing care at home in general as well as towards intensive home care being provided by specialized home care services in Germany. However, resulting challenges for patient safety have rarely been considered. Against this background we aimed to explore whether international recommendations for patient safety in home care in general and in intensive home care in particular already exist and how they can stimulate further practice development in Germany. METHODS A review of online English documents containing recommendations for patient safety in intensive home care was conducted. Available documents were analyzed and compared in terms of their form and content. RESULTS Overall, a small number of relevant documents could be identified. None of these documents exclusively refer to the intensive home care sector. Despite their differences, however, the analysis of four selected documents showed similarities, e. g., regarding specific topics of patient safety (communication, involvement of patients and their relatives, risk assessment, medication management, qualification). Furthermore, strengths and weaknesses of the documents became apparent: e. g., an explicit understanding of patient safety, a literature-based introduction to safety topics or an adaptation of the recommendations to the specific features of home care were occasionally lacking. CONCLUSIONS This document analysis provides interesting input to the formal and content-related development of specific recommendations and to practice development in Germany to improve patient safety in home care.
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Affiliation(s)
- Judith Czakert
- Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Germany.
| | - Yvonne Lehmann
- Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Germany
| | - Michael Ewers
- Charité - Universitätsmedizin Berlin, Institut für Gesundheits- und Pflegewissenschaft, Berlin, Germany
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Abstract
In the United States, home health care (HHC) is a rapidly growing industry and home infusion therapy is a rapidly growing market. HHC can present substantial occupational safety and health (OSH) risks. This article summarizes major OSH risks relevant to home infusion therapy by illustrating them through real-life scenarios collected systematically using qualitative research methods by the National Institute for Occupational Safety and Health-funded research projects at the University of Massachusetts Lowell. The need for home infusion therapy will continue to grow in the future, and safety interventions to prevent or minimize OSH risks are essential.
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Macdonald M, Moody E, MacLean H. Organizational Considerations for Supporting the Safety of Home Support Workers: Results From a Scoping Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317720185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the population ages, and more people are living at home with chronic conditions, there is an increasing need for home support workers (HSWs). Safety is a central concern for HSWs, and contributes to the recruitment and retention of HSWs and ultimately to a sustainable home care sector. This article reports on a scoping review that was conducted to assess the state of the literature related to the safety of HSWs. Studies were selected that address the central phenomenon and that were conducted from 2000 to 2015. One hundred twenty-six studies were included in the synthesis of findings. This article outlines two of the four major findings, those related to safety factors associated with home care organizations: (1) injury prevention initiatives and (2) human resource planning. The findings have important implications for developing strategies to address safety concerns for HSWs.
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Affiliation(s)
| | - Elaine Moody
- Dalhousie University, Halifax, Nova Scotia, Canada
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Love M, Tendick-Matesanz F, Thomason J, Carter D, Glassman M, Zanoni J. "Then They Trust You …": Managing Ergonomics in Home Care. New Solut 2017; 27:225-245. [PMID: 28554305 DOI: 10.1177/1048291117712544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The home care workforce, already at 2.7 million caregivers, will become the nation's fastest growing occupation by 2024 as the senior boom generation accelerates the demand for in home services to meet its long-term care needs. The physically challenging work of assisting clients with intimate, essential acts of daily living places home care workers (HCWs) at risk for musculoskeletal disorders (MSDs); yet, HCWs typically receive little formal job training and may lack appropriate assistive devices. In this qualitative pilot study, HCW focus groups described workplace MSD risk factors and identified problem-solving strategies to improve ergonomic conditions. The results revealed that HCWs rely on their behavioral insights, self-styled communications skills and caring demeanor to navigate MSD risks to themselves and increase clients' physical independence of movement. We suggest changes in employer and government policies to acknowledge HCWs as valued team members in long-term care and to enhance their effectiveness as caregivers.
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Affiliation(s)
- Marsha Love
- 1 Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
| | | | | | | | - Myra Glassman
- 5 SEIU Healthcare, Illinois/Indiana/Missouri/Kansas, Chicago, USA
| | - Joseph Zanoni
- 1 Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, USA
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Brouillette NM, Quinn MM, Kriebel D, Markkanen PK, Galligan CJ, Sama SR, Gore RJ, Laramie AK, Davis L. Risk of sharps injuries among home care aides: Results of the Safe Home Care survey. Am J Infect Control 2017; 45:377-383. [PMID: 28063731 DOI: 10.1016/j.ajic.2016.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Home care (HC) aides constitute an essential, rapidly growing workforce. Technology advances are enabling complex medical care at home, including procedures requiring the percutaneous use of sharp medical devices, also known as sharps. Objectives were to quantify risks of sharps injuries (SI) in a large HC aide population, compare risks between major occupational groups, and evaluate SI risk factors. METHODS A questionnaire survey was administered to aides hired by HC agencies and directly by clients. One thousand one hundred seventy-eight aides completed questions about SI and potential risk factors occurring in the 12 months before the survey. SI rates were calculated and Poisson regression models identified risk factors. RESULTS Aides had a 2% annual risk of experiencing at least 1 SI (95% confidence interval [CI], 1.1-2.6). Client-hired aides, men, and immigrants had a higher risk than their counterparts. Risk factors among all HC aides included helping a client use a sharp device (rate ratio [RR], 5.62; 95% CI, 2.75-11.50), observing used sharps lying around the home (RR, 2.68; 95% CI, 1.27-5.67), and caring for physically aggressive clients (RR, 2.82; 95% CI, 1.36-5.85). CONCLUSIONS HC aides experience serious risks of SI. Preventive interventions are needed, including safety training for clients and their families, as well as aides.
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Affiliation(s)
| | - Margaret M Quinn
- College of Health Sciences, University of Massachusetts Lowell, Lowell, MA.
| | - David Kriebel
- College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Pia K Markkanen
- College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | | | - Susan R Sama
- College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Rebecca J Gore
- College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Angela K Laramie
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA
| | - Letitia Davis
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA
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Darragh AR, Lavender S, Polivka B, Sommerich CM, Wills CE, Hittle BA, Chen R, Stredney DL. Gaming Simulation as Health and Safety Training for Home Healthcare Workers. Clin Simul Nurs 2016; 12:328-335. [PMID: 27239244 DOI: 10.1016/j.ecns.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Amy R Darragh
- 406 Atwell Hall, 453 W 10 Ave, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210
| | - Steve Lavender
- Departments of Integrated Systems Engineering & Orthopedics, The Ohio State University, Columbus, OH, 43210
| | - Barbara Polivka
- University of Louisville School of Nursing, Louisville, KY, 40292
| | - Carolyn M Sommerich
- Departments of Integrated Systems Engineering, The Ohio State University, Columbus, OH, 43210
| | - Celia E Wills
- 1585 Neil Avenue Columbus, College of Nursing, The Ohio State University, Columbus, OH 43210
| | - Bradley A Hittle
- Ohio Supercomputer Center, 1224 Kinnear Road, Columbus, OH 43212
| | - Renee Chen
- Ohio Supercomputer Center, 1224 Kinnear Road, Columbus, OH 43212
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Abstract
Avoidable patient harm is a major public health concern, and may already have surpassed heart disease as the leading cause of death in the United States. While the public health community has contributed much to one aspect of patient harm prevention, infection control, the tools and techniques of public health have far more to offer to the emerging field of patient safety science. Patient safety practice has become increasingly professionalized in recent years, but specialist degree programs in the field remain scarce. Healthcare organizations should consider graduate training in public health as an avenue for investing in the professional development of patient safety practitioners, and schools and programs of public health should support further research and teaching to support patient safety improvement.
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Quinn MM, Markkanen PK, Galligan CJ, Sama SR, Kriebel D, Gore RJ, Brouillette NM, Okyere D, Sun C, Punnett L, Laramie AK, Davis L. Occupational health of home care aides: results of the safe home care survey. Occup Environ Med 2015. [PMID: 26209318 PMCID: PMC4819650 DOI: 10.1136/oemed-2015-103031] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. METHODS HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides' OSH experiences. RESULTS The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. CONCLUSIONS The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.
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Affiliation(s)
- Margaret M Quinn
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Pia K Markkanen
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Catherine J Galligan
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Susan R Sama
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - David Kriebel
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Rebecca J Gore
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Natalie M Brouillette
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Daniel Okyere
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Chuan Sun
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Angela K Laramie
- Occupational Health Surveillance Programme, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Letitia Davis
- Occupational Health Surveillance Programme, Massachusetts Department of Public Health, Boston, Massachusetts, USA
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Amuwo S, Lipscomb J, McPhaul K, Sokas RK. Reducing occupational risk for blood and body fluid exposure among home care aides: an intervention effectiveness study. Home Health Care Serv Q 2015; 32:234-48. [PMID: 24372476 DOI: 10.1080/01621424.2013.851050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this quasi-experimental pretest/posttest research study was to examine the effectiveness of an intervention designed through a participatory process to reduce blood and body fluid exposure among home care aides. Employer A, the intervention site, was a large agency with approximately 1,200 unionized home care aides. Employer B, the comparison group, was a medium-sized agency with approximately 200 home care aides. The intervention was developed in partnership with labor and management and included a 1-day educational session utilizing peer educators and active learning methods to increase awareness about the risks for occupational exposure to blood and body fluids among home care aides and a follow-up session introducing materials to facilitate communication with clients about safe sharps disposal. Self-administered preintervention and postintervention questionnaires identifying knowledge about and self-reported practices to reduce bloodborne pathogen exposure were completed in person during mandatory training sessions 18 months apart. Home care aides in the intervention group for whom the preintervention and postintervention questionnaires could be directly matched reported an increase in their clients' use of proper sharps containers (31.9% pre to 52.2% post; p = .033). At follow-up, the intervention group as a whole also reported increased use of sharps containers among their clients when compared to controls (p = .041).
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Affiliation(s)
- Shakirudeen Amuwo
- a University of Illinois at Chicago School of Public Health , Chicago , Illinois , USA
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Markkanen P, Quinn M, Galligan C, Sama S, Brouillette N, Okyere D. Characterizing the nature of home care work and occupational hazards: a developmental intervention study. Am J Ind Med 2014; 57:445-57. [PMID: 24347541 DOI: 10.1002/ajim.22287] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Home care (HC) aide is the fastest growing occupation, yet job hazards are under-studied. This study documents the context of HC aide work, characterizes occupational safety and health (OSH) hazards, and identifies preventive interventions using qualitative methods. METHODS We conducted 12 focus groups among aides and 26 in-depth interviews comprising 15 HC agency, union, and insurance company representatives as well as 11 HC recipients in Massachusetts. All focus groups and interviews were audio-recorded, transcribed, and coded with NVIVO software. RESULTS Major OSH concerns were musculoskeletal disorders from client care tasks and verbal abuse. Performing tasks beyond specified job duties may be an OSH risk factor. HC aides' safety and clients' safety are closely linked. Client handling devices, client evaluation, care plan development, and training are key interventions for both aides' and clients' safety. CONCLUSIONS Promoting OSH in HC is essential for maintaining a viable workforce.
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Affiliation(s)
- Pia Markkanen
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts
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Abstract
ABSTRACT‘Ageing in place’ initiatives form an important part of broader ‘ageing well’ strategies that are being developed in response to demographic change. Increasingly, it is acknowledged that it is important to understand how individuals shape and modify the space within their own home and immediate environment to facilitate flexible solutions in the event of a loss of independence. The research presented here aims to understand how individuals construct the space both within their own home and their immediate surroundings and how this construction is linked to their own perception of ageing and growing old. A thematic analysis of 28 qualitative interviews resulted in two differentiated responses in relation to home adaptations: those respondents who had acted to modify their home and environment and those who instead sought to delay or ‘put off’ any modifications. The results demonstrate the multi-dimensional experience of ageing, the diversity of types of home environment, and the interplay between compensatory solutions and the social contexts within which they take place. The need for a more holistic approach that takes into account factors such as an individual's experience of ageing is suggested in order to understand the use of space in home environments and the adaptations that are made to them. Policy initiatives for ‘ageing in place’ can be reinforced by closer user involvement.
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Pittman P, Horton K, Terry M, Bass E. Residency Programs for Home Health and Hospice Nurses. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2014. [DOI: 10.1177/1084822313511457] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.
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Affiliation(s)
| | | | - Margaret Terry
- Visiting Nurse Associations of America, Washington, DC, USA
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