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Revista Brasileira de Enfermagem 2017analyze scientific production on nursing practice in home care. (Review)
Review
OBJECTIVE:
analyze scientific production on nursing practice in home care.
METHOD:
integrative review employing databases LILACS, BDENF, IBECS, and MEDLINE. Studies in Spanish, English, and Portuguese were included, regardless of publishing date.
RESULTS:
after analyzing 48 articles, it was found that nursing practice in home care is complex, employing a multitude of actions by using three technologies: soft; soft-hard especially; and hard. Challenges related to the home-care training process are reported in the literature. Nurses use knowledge from their experience and scientific recommendations in conjunction with their reflections on the practice.
CONCLUSION:
home nursing practice is fundamental and widespread. Relational and educational actions stand out as necessary even in technical care, with a predominant need for home-care training.
Topics: Home Care Services; Home Health Nursing; Humans; Nurses, Community Health; Nursing Care
PubMed: 28226061
DOI: 10.1590/0034-7167-2016-0214 -
Atencion Primaria Nov 2019
Topics: Day Care, Medical; Health Transition; Home Care Services; Humans; Practice Guidelines as Topic; Primary Health Care
PubMed: 31594675
DOI: 10.1016/j.aprim.2019.07.005 -
Primary Health Care Research &... Oct 2019
Topics: Home Care Services; Humans; Nursing Care; Practice Patterns, Nurses'
PubMed: 31571554
DOI: 10.1017/S1463423619000707 -
International Wound Journal Jun 2008
Topics: Cost-Benefit Analysis; Evidence-Based Medicine; Home Care Services; Humans; Negative-Pressure Wound Therapy; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 18577131
DOI: 10.1111/j.1742-481X.2008.00473.x -
Soins; La Revue de Reference Infirmiere 2016
Topics: Aged; Chronic Disease; Forecasting; France; Home Care Services; Humans; Intersectoral Collaboration; Length of Stay; Neoplasms; Patient Care Team; Population Dynamics
PubMed: 27393977
DOI: 10.1016/j.soin.2016.05.001 -
BMC Palliative Care Jan 2016Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness.
METHODS
A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95% confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria.
RESULTS
Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver's coping skills.
CONCLUSIONS
Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care team were identified, which may be amenable to interventions that improve the likelihood of a patient dying in the preferred location. Place of death may not be a very good indicator of the quality of end-of-life/palliative care since it is determined by multiple factors and is therefore dependent on individual circumstances.
Topics: Attitude to Death; Canada; Death; Health Planning; Home Care Services; Humans; Nursing Homes; Outcome Assessment, Health Care; Retrospective Studies; Terminal Care
PubMed: 26791258
DOI: 10.1186/s12904-016-0077-8 -
JAMA Network Open Jun 2021New Centers for Medicare & Medicaid Services waivers created a payment mechanism for hospital at home services. Although it is well established that direct admission to...
IMPORTANCE
New Centers for Medicare & Medicaid Services waivers created a payment mechanism for hospital at home services. Although it is well established that direct admission to hospital at home from the community as a substitute for hospital care provides superior outcomes and lower cost, the effectiveness of transfer hospital at home-that is, completing hospitalization at home-is unclear.
OBJECTIVE
To evaluate the outcomes of the transfer component of a Veterans Affairs (VA) Hospital in Home program (T-HIH), taking advantage of natural geographical limitations in a program's service area.
DESIGN, SETTING, AND PARTICIPANTS
In this quality improvement study, T-HIH was offered to veterans residing in Philadelphia, Pennsylvania, and their outcomes were compared with those of propensity-matched veterans residing in adjacent Camden, New Jersey, who were admitted to the VA hospital from 2012 to 2018. Data analysis was performed from October 2019 to May 2020.
INTERVENTION
Enrollment in the T-HIH program.
MAIN OUTCOMES AND MEASURES
The main outcomes were hospital length of stay, 30-day and 90-day readmissions, VA direct costs, combined VA and Medicare costs, mortality, 90-day nursing home use, and days at home after hospital discharge. An intent-to-treat analysis of cost and utilization was performed.
RESULTS
A total of 405 veterans (mean [SD] age, 66.7 [0.83] years; 399 men [98.5%]) with medically complex conditions, primarily congestive heart failure and chronic obstructive pulmonary disease exacerbations (mean [SD] hierarchical condition categories score, 3.54 [0.16]), were enrolled. Ten participants could not be matched, so analyses were performed for 395 veterans (all of whom were men), 98 in the T-HIH group and 297 in the control group. For patients in the T-HIH group compared with the control group, length of stay was 20% lower (6.1 vs 7.7 days; difference, 1.6 days; 95% CI, -3.77 to 0.61 days), VA costs were 20% lower (-$5910; 95% CI, -$13 049 to $1229), combined VA and Medicare costs were 22% lower (-$7002; 95% CI, -$14 314 to $309), readmission rates were similar (23.7% vs 23.0%), the numbers of nursing home days were significantly fewer (0.92 vs 7.45 days; difference, -6.5 days; 95% CI, -12.1 to -0.96 days; P = .02), and the number of days at home was 18% higher (81.4 vs 68.8 days; difference, 12.6 days; 95% CI, 3.12 to 22.08 days; P = .01).
CONCLUSIONS AND RELEVANCE
In this study, T-HIH was significantly associated with increased days at home and less nursing home use but was not associated with increased health care system costs.
Topics: Aged; Female; Health Care Costs; Home Care Services; Hospitalization; Humans; Male; Middle Aged; Patient Transfer; Philadelphia; Quality Improvement; Time Factors; Veterans
PubMed: 34185069
DOI: 10.1001/jamanetworkopen.2021.14920 -
Journal of Gerontological Nursing Jan 2018Future nursing education is challenged to develop innovative and effective programs that align with current changes in health care and to educate nurses with a high... (Review)
Review
Future nursing education is challenged to develop innovative and effective programs that align with current changes in health care and to educate nurses with a high level of clinical reasoning skills, evidence-based knowledge, and professional autonomy. Serious games (SGs) are computer-based simulations that combine knowledge and skills development with video game-playing aspects to enable active, experiential, situated, and problem-based learning. In a PhD project, a video-based SG was developed to teach nursing students nursing care for patients with chronic obstructive pulmonary disease in home health care and hospital settings. The current article summarizes the process of the SG development and evaluation. [Journal of Gerontological Nursing, 44(1), 15-19.].
Topics: Clinical Competence; Computer Simulation; Computer-Assisted Instruction; Education, Nursing; Home Care Services; Hospitalization; Humans; Problem-Based Learning; Professional Autonomy; Program Development; Pulmonary Disease, Chronic Obstructive; Video Games
PubMed: 29355884
DOI: 10.3928/00989134-20171213-05 -
Health & Social Care in the Community Sep 2019Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps... (Review)
Review
Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra-professional and Inter-professional and Inter-sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter-related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra- and inter-professional and inter-organisational contexts.
Topics: Canada; Clinical Competence; Community Health Nursing; Community Health Services; Decision Support Systems, Clinical; Home Care Services; Humans; Leadership; Public Health Nursing
PubMed: 31231890
DOI: 10.1111/hsc.12797 -
Pediatric Allergy, Immunology, and... Jun 2022Children with respiratory technologies, particularly those with mechanical ventilation, represent a growing population that require complex home nursing, medical...
Children with respiratory technologies, particularly those with mechanical ventilation, represent a growing population that require complex home nursing, medical equipment, outpatient medical and habilitative supports to live and thrive in their community. Care coordination is essential to support these children and their families to navigate and integrate key community-based health and educational services, however, care is often fragmented and care coordination needs unmet. Therefore, to fully support children with respiratory technologies, it is critical to understand the role of care coordinators (CCs) and how to sustain this workforce. The aim of this article is to describe CCs' perspective on (1) their role in supporting families in a home care program for children with respiratory technologies and home nursing, and (2) the core components of recruiting into and sustaining the CC workforce. Semistructured interviews were conducted with 15 CC from the Division of Specialized Care for Children (DSCC) Home Care program for children with technology dependence and home nursing in Illinois. Two independent coders utilized a modified template approach and discussed to agreement to analyze transcripts. CC averaged 6.6 years of CC experience; the majority had social work or nursing backgrounds. CCs' job satisfaction was derived from their role supporting hospital discharge, seeing children improve over time, and navigating challenges with families. CCs enjoyed working in a collaborative environment where they could draw from their colleagues' experience to solve problems. Job dissatisfaction and job turnover stemmed from difficult family interactions, high caseloads, and redundant and time-intensive administrative tasks, which interfered with family engagement. CCs for children with respiratory technologies require diverse skills, but interdisciplinary teams enable collaborative support of families. Seeing children thrive can sustain the workforce, however, CCs report challenges due to high caseloads and administrative tasks, which impede direct family involvement.
Topics: Child; Home Care Services; Home Nursing; Humans; Social Work; Technology; Workforce
PubMed: 35723661
DOI: 10.1089/ped.2021.0236