Work environment characteristics of high-quality home health agencies

How home health nurses plan their work schedules: A qualitative descriptive study

AIMS AND OBJECTIVES

To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process.

BACKGROUND

Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting.

DESIGN

Qualitative descriptive design.

METHODS

Semi-structured interviews were conducted with 20 registered nurses who had >2 years of experience in home health and were employed by one of the three participating home health agencies in the mid-Atlantic region of the United States. Data were analysed using conventional content analysis.

RESULTS

Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritise visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients.

CONCLUSION

Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments.

RELEVANCE TO CLINICAL PRACTICE

Home health nurses plan their work schedules to provide high quality care that is patient-centered and timely. The findings also highlight organisational priorities to facilitate continuity of care and support nurses while alleviating the burnout associated with high productivity requirements.

Home health nurse decision-making regarding visit intensity planning for newly admitted patients: a qualitative descriptive study

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency's protocols to develop the personalized visit plan. They revised the plan based on changes in the patient's clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients.

Pathway to better patient care and nurse workforce outcomes in home care

BACKGROUND

Unlike the Magnet Recognition Program, the newer Pathway to Excellence Program designed to improve work environments in a broader range of organizations has not yet been the focus of substantial research.

PURPOSE

The purpose of the study was to examine the association of Pathway to Excellence Program Standards with better patient care quality and workforce outcomes in home care.

METHOD

Cross-sectional survey of registered nurses yielded informants from 871 home care agencies in the United States. Variables representing each of the 12 Pathway Standards were entered into logistic regression models to determine associations with better patient care and nurse workforce outcomes.

DISCUSSION

All Pathway Standards are strongly and significantly associated with better patient care and better workforce outcomes. Home care agencies with better-rated professional work environments consistently had better patient care and nurse workforce outcomes.

CONCLUSIONS

This study validates the Pathway to Excellence Standards as important to patient care quality and nursing workforce outcomes in home care.

Relationship of embodied nursing knowledge and client outcomes in home health

Embodied nursing knowledge and its effects on patient outcomes are understudied in home health. The researchers performed a descriptive correlational study, in nine home health agencies in Ohio, to consider the effects of embodied nursing knowledge in expert practice in 107 registered nurses working in Medicare certified home health agencies. While statistical significance was not noted, findings of this study add to the understanding or research and the outcome improvement scores in home health. Findings also pose the question that the concepts used in acute care to improve mortality rates and patient outcome improvements may be different in home health.

Factors Affecting Job Satisfaction Among Agency-Employed Home Health Aides

To examine the predictors of job satisfaction by home health aides, we conducted structural equation modeling to identify how the predicting variables directly and indirectly influence job satisfaction by home health aides. A total of 3,274 female home health aides working in home health care industry were selected for this study from the nationally representative sample. Support from organizations and supervisors, and personal support have positive direct effects on the job satisfaction of home health aides. Organizational support and supervisor support have important roles in weakening the negative relationship between job-related stressors and job satisfaction. We conclude that support from organizations and supervisors might improve job satisfaction by home health aides through reducing stress.

Exploring Best Practices in Home Health Care

This article summarizes publicly available research related to outcomes and best practices in skilled home health and other kinds of home-based care. As the population ages and the home health care sector grows, the home health community must address current deficiencies in care and expand the use of evidence-based strategies to improve the quality and efficiency of care. Many promising innovations in service delivery currently exist, a wide variety of which have been tested and evaluated in postacute and long-term care settings. Our review found that home health agencies are well positioned to improve patient outcomes through a variety of approaches, including care coordination, telehealth, and data-driven quality of care monitoring. For the most part, evaluations of these interventions show that they can improve patient outcomes and/or cost-effectiveness.

Home care nurses' experience of job stress and considerations for the work environment

Home care nurses report increased stress in their jobs due to work environment characteristics that impact professional practice. Stressors and characteristics of the professional practice environment that moderate nurses' experience of job stress were examined in this embedded multiple case study. Real life experiences within a complex environment were drawn from interviews and observations with 29 participants across two home care agencies from one eastern U.S. state. Findings suggest that role overload, role conflict, and lack of control can be moderated in agencies where there are meaningful opportunities for shared decision making and the nurse-patient relationship is supported.