Enabling and constraining successful reablement: Individual and neighbourhood factors

Using multilevel logistic regression to analyse management data of reablement episodes collected by Essex County Council, a UK local authority, this article identifies constraining and enabling factors for successful reablement. Overall, 59.5% of reablement clients were classed as able to care for themselves when assessed after 13 weeks following the reablement intervention (N = 8,118). Several age-related, disability, referral, and social factors were found to constrain reablement, but some of the largest constraining effects were neighbourhood deprivation as measured through the Index of Multiple Deprivation and, particularly, unfavourable geodemographic profiles as measured through Experian Mosaic consumer classifications. The results suggest that in order to optimise reablement, programmes should consider broader social and environmental influences on reablement rather than only individual and organisational aspects. Reablement might also be better tailored and intensified for client groups with particular underlying disabilities and for those displaying specific geodemographic characteristics.

Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint

Digital health tools and technologies are transforming health care and making significant impacts on how health and care information are collected, used, and shared to achieve best outcomes. As most of the efforts are still focused on clinical settings, the wealth of health information generated outside of clinical settings is not being fully tapped. This is especially true for children with medical complexity (CMC) and their families, as they frequently spend significant hours providing hands-on medical care within the home setting and coordinating activities among multiple providers and other caregivers. In this paper, a multidisciplinary team of stakeholders discusses the value of health information generated at home, how technology can enhance care coordination, and challenges of technology adoption from a patient-centered perspective. Voice interactive technology has been identified to have the potential to transform care coordination for CMC. This paper shares opinions on the promises, limitations, recommended approaches, and challenges of adopting voice technology in health care, especially for the targeted patient population of CMC.

Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?

BACKGROUND

There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission.

OBJECTIVE

We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors.

DESIGN

A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis.

SUBJECTS

Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care.

MEASURES

The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission.

RESULTS

Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12).

CONCLUSIONS

Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.

'The Elephant on the Table': Religious and Ethnic Diversity in Home Health Services

Healthcare services are increasingly being provided in the home. At the same time, these home contexts are changing as global migration has brought unprecedented diversity both in the recipients of care, and home health workers. In this paper, we present findings of a Canadian study that examined the negotiation of religious and ethnic plurality in home health. Qualitative analysis of the data from interviews and observations with 46 participants-clients, administrators, home healthcare workers-revealed how religion is expressed and 'managed' in home health services.

Ensuring Safety When Pets Are in the Home

This article discusses safety issues involved when home healthcare clinicians visit the homes of patients with pets, particularly cats and dogs. Threats to the safety of home care clinicians are explored and concerns such as animal bites, animal scratches, and infection control are detailed in this article. Although it is acknowledged that pets can provide positive health benefits to owners, the focus is on the responsibility of the pet owners to secure pets when clinicians visit in order to keep the clinician and patient safe during the home visit. A proposed Pet Policy Agreement is presented whereby the pet owner as patient bears some responsibility for ensuring the safety of home healthcare clinicians.

A Study to Assess Home Health Nurses from a Carative Perspective

The aging population is steadily rising, resulting in an increased need for in-home healthcare. This study examined the impact of several carative factors demonstrated by home health nurses. Multiple regression was used to examine the impact of the carative factors, measured by the Caring Nurse Patient Interaction Scale (CNPI-70). A total of 77 home health nurses from five home health agencies in Northeastern Pennsylvania participated in the study. The findings indicate that the principles of care theory are widely applied in home health settings. The author recommends that care theory be a focus of educational health programs and future research.

Civilian Nurses' Knowledge, Confidence, and Comfort Caring for Military Veterans: Survey Results of a Mixed-Methods Study

More than 20 million Veterans currently live in the United States, representing World War II, Korea, Vietnam, Iraq, and Afghanistan war eras, as well as many who served during peacetime. Little is known regarding what home care nurses know about the unique healthcare needs of this population. Using Purnell's Model for Cultural Competence, a mixed-methods study was designed to examine home care nurse's knowledge, comfort, and confidence in caring for active military, Veterans and their families. This article provides the data from a national survey of 102 home care nurses. Findings suggest that civilian home care nurses have limited experience working with active military but work with Veterans at least monthly, if not weekly. Nurses were most confident in managing pain and least confident in managing issues related to military sexual trauma. Knowledge of resources available to Veterans, war-specific exposures, and Veteran-specific health issues were the top areas nurses felt less confident in. Continued efforts need to be put in place so that 100% of all patients seeking healthcare are screened for military/Veteran status. In addition, continuing education for nurses needs to include Veteran-specific topics so evidence-based, culturally sensitive care can be provided.

Isolating the Effects of a Mobile Phone on the Usability and Safety of eHealth Software Applications

Mobile phones are used in conjunction with mobile eHealth software applications. These mobile software applications can be used to access, review and document clinical information. The objective of this research was to explore the relationship between mobile phones, usability and safety. Clinical simulations and semi-structured interviews were used to investigate this relationship. The findings revealed that mobile phones may lead to specific types of usability issues that may introduce some types of errors.

Charcot Neuroarthropathy of the Foot and Ankle

Charcot neuropathy is a painless, progressive, degeneration most notably of the ankle or midfoot joints, seen in patients with diabetes and neuropathy. This article will describe the etiology, diagnosis, and treatment of this potentially debilitating joint disease and provide implications for home care clinicians.

Physical Activity Outcomes of Nurse-Delivered Lifestyle Interventions

Promotion of physical activity has been a public health priority for decades. Over two million home healthcare nurses are at the front line to deliver effective health education and health promotion interventions in the United States. The purpose of this systematic review is to examine the effectiveness of nurse-delivered lifestyle physical interventions on physical activity outcomes conducted in home settings. Computerized database and ancestry search strategies located distinct intervention trials between 1990 and 2015. A total of eight quantitative studies were reviewed. Four of the eight studies were randomized control trials and four studies used an uncontrolled pretest-posttest design. The eight studies represented a total of 1,221 participants with mean ages from 43 to 81. Study sample sizes ranged from 16 to 504. Seven of the eight studies demonstrated modest effect of nurse-delivered home-based interventions on physical activity behaviors. Home-based physical activity promotion was most often incorporated into secondary prevention of postacute diseases, chronic disease management, or disease prevention/health promotion. Findings indicate that nurse-delivered home-based physical activity promotion show overall effectiveness in general adult populations. Possible effective intervention domains were also discussed in this review to guide future home-based health promotion. More large randomized controlled trials with longer study/follow-up periods and studies with cost-effectiveness data are warranted in future research.

Polymylagia rheumatica: common disease, elusive diagnosis

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease with little known about its etiology or incidence. Frequently found in older adult women, this disease can be debilitating, painful, and dangerous. Diagnosing PMR can be elusive due to lack of specific laboratory tests, and treatment with use of long-term glucocorticoids can be difficult due to side effects. The following article describes the pathophysiology, diagnosis, signs and symptoms, and treatment of PMR, as well as implications for home healthcare.

Effect of maternal-child home visitation on pregnancy spacing for first-time Latina mothers

OBJECTIVES

We examined the impact of a maternal-child home visitation program on birth spacing for first-time Latina mothers, focusing on adolescents and women who identified as Mexican or Puerto Rican.

METHODS

This was a retrospective cohort study. One thousand Latina women enrolled in the Pennsylvania Nurse-Family Partnership between January 1, 2003, and December 31, 2007, were matched to nonenrolled Latina women using propensity scores. The primary outcome was the time to second pregnancy that resulted in a live birth (interpregnancy interval). Proportional hazards models and bootstrap methods compared the time to event.

RESULTS

Home visitation was associated with a small decrease in the risk of a short interpregnancy interval (≤ 18 months) among Latina women (hazards ratio [HR] = 0.86; 95% confidence interval [CI] = 0.75, 0.99). This effect was driven by outcomes among younger adolescent women (HR = 0.80; 95% CI = 0.65, 0.96). There was also a trend toward significance for women of Mexican heritage (HR = 0.74; 95% CI = 0.49, 1.07), although this effect might be attributed to individual agency performance.

CONCLUSIONS

Home visitation using the Nurse-Family Partnership model had measurable effects on birth spacing in Latina women.

Frontloading and intensity of skilled home health visits: a state of the science

Frontloading of skilled nursing visits is one way home health providers have attempted to reduce hospital readmissions among skilled home health patients. Upon review of the frontloading evidence, visit intensity emerged as being closely related. This state of the science presents a critique and synthesis of the published empirical evidence related to frontloading and visit intensity. OVID/Medline, PubMed, and Scopus were searched. Seven studies were eligible for inclusion. Further research is required to define frontloading and visit intensity, identify patients most likely to benefit, and to provide a better understanding of how home health agencies can best implement these strategies.

Women's reasons for attrition from a nurse home visiting program

OBJECTIVE

To describe mothers' reasons for leaving a home visiting program early.

DESIGN

Qualitative descriptive study using semistructured interviews of mothers who dropped out of the Nurse-Family Partnership (NFP) and two focus groups with nurses and nurse supervisors at an NFP site.

SETTING

A New York State site of a NFP home visitation program for low-income new mothers designed to improve the physical and emotional care of children.

PARTICIPANTS

Participants included 21 mothers, 8 nurses, and 3 nurse-supervisors.

METHODS

Semistructured interviews and focus groups were used to collect data, which were analyzed using content analysis.

RESULTS

The program was not perceived to fit a mother's needs when she was overwhelmed with other responsibilities, the nurse did not meet her expectations, the content was not of interest, or the mother did not desire visits after the infant was born. Nurses and mothers described the need for mothers to have organizational and communication skills, such as keeping track of appointments, calling to reschedule, articulating needs, and asking for assistance. Disruptive external influences included nurse turnover and unstable living situations, including frequent moves and crowded housing. Each of these types of barriers had potential to interact with the others, creating complex combinations of challenges to retention.

CONCLUSION

NFP retention might be improved by reframing program relevance to individual mothers and increasing maternal organizational and communication skill development.

Identifying urinary incontinence in the home setting. Part 2: treatment and related care of incontinence

This is Part 2 of a 2-part series for treating urinary incontinence in the home care setting. Part 1 addresses the assessment, diagnosis, and strategies in the treatment of urinary incontinence; including a case study.

Evidence about the pharmacological management of constipation, part 2: implications for palliative care

Constipation remains a challenging problem for patients and caregivers in home healthcare. Part 1 of this two-part series discussed the scope, physiology, and evidence-based practice for nonpharmacological interventions for constipation. This second article will focus on evidence-based pharmacological prevention and management of constipation, medication cost, and implications for palliative care.