In part 1 of this 2-part series, we discussed principles of palliative care to help understand the goals of treatment in developing a plan of care. This article, Part 2, aims to provide knowledge of practical topical wou...In part 1 of this 2-part series, we discussed principles of palliative care to help understand the goals of treatment in developing a plan of care. This article, Part 2, aims to provide knowledge of practical topical wound management by common wound etiologies and symptoms among persons who would benefit from palliative wound care.
Home Healthc Nurse
· 2014 Mar · PMID 24584316
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Like the generation before them, an ever-increasing proportion of baby boomers in the United States have a chronic illness and often multiple chronic illnesses, using ever-increasing national healthcare resources. With t...Like the generation before them, an ever-increasing proportion of baby boomers in the United States have a chronic illness and often multiple chronic illnesses, using ever-increasing national healthcare resources. With the Triple Aim, Don Berwick's overarching goals to help guide positive transformation to the healthcare system, palliative care can be seen as a valuable ally in the growing arsenal of models of care aimed at addressing the nation's needs. The SPARK Program, the palliative care management program of a large home care agency in a metropolitan area, was created to address the needs of patients with chronic serious illness and palliative care needs.
Douglas B, Fitzpatrick D, Golub-Victor A
… +1 more, Lowe SM
Home Healthc Nurse
· 2014 Mar · PMID 24584314
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The use of algorithms for safe patient handling in the acute care setting has been established and integrated into the standards of practice. This is not the case in the home care setting where the patient and caregivers...The use of algorithms for safe patient handling in the acute care setting has been established and integrated into the standards of practice. This is not the case in the home care setting where the patient and caregivers are at risk for injury during patient transfers. Many factors need to be assessed before recommending a mechanical lift for home use. Some of the factors include the patient's weight-bearing status, cognitive level, and upper extremity strength, and the caregiver's ability to lift more than 35 pounds. All of these factors have been included in the clinical decision-making algorithm described in this article. Two case scenarios are presented to assist the reader with the analysis and application of the algorithm.
Home Healthc Nurse
· 2014 Mar · PMID 24584313
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Creating a meaningful infection control program in the home care setting proved to be challenging for agency leaders of one hospital-based home healthcare agency. Challenges arose when agency leaders provided infection c...Creating a meaningful infection control program in the home care setting proved to be challenging for agency leaders of one hospital-based home healthcare agency. Challenges arose when agency leaders provided infection control (IC) data to the hospital's IC Committee. The IC Section Chief asked for national benchmark comparisons to align home healthcare reporting to that of the hospital level. At that point, it was evident that the home healthcare IC program lacked definition and structure. The purpose of this article is to share how one agency built a meaningful IC program.
Hunt CW, Grant JS, Palmer JJ
… +1 more, Steadman L
Home Healthc Nurse
· 2014 Mar · PMID 24584312
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The prevalence of Type 2 diabetes mellitus has increased dramatically with a higher rate in rural populations. Diabetes self-management behaviors such as medication administration, blood glucose testing, and appropriate...The prevalence of Type 2 diabetes mellitus has increased dramatically with a higher rate in rural populations. Diabetes self-management behaviors such as medication administration, blood glucose testing, and appropriate diet and exercise regimens must be implemented daily to increase chances of achieving therapeutic patient outcomes. Home healthcare clinicians are pivotal in assisting these individuals to be more self-confident and independent in managing their diabetes, achieving therapeutic goals, and addressing diabetes-related complications. This article will discuss facilitators of diabetes self-management in rural populations and implications for home healthcare clinicians.
Reidt SL, Larson TA, Hadsall RS
… +3 more, Uden DL, Blade MA, Branstad R
Home Healthc Nurse
· 2014 Mar · PMID 24584311
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Medication regimens can be complicated during the transition from hospital to home for a variety of reasons. The primary purpose of this retrospective study was to measure the impact of integrating a pharmacist into a mo...Medication regimens can be complicated during the transition from hospital to home for a variety of reasons. The primary purpose of this retrospective study was to measure the impact of integrating a pharmacist into a model of care at a Medicare-certified home healthcare agency for clients recently discharged from the hospital. The secondary purpose was to describe the medication-related problems among clients receiving services from the model of care involving a pharmacist. Integrating a pharmacist within the model of care demonstrated a positive clinical impact on clients.
Westra BL, Bliss DZ, Savik K
… +2 more, Hou Y, Borchert A
Home Healthc Nurse
· 2014 Feb · PMID 24492272
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PURPOSE: The purpose of this study was to describe the prevalence, incidence, and effectiveness of home health care (HHC) agencies' services with and without a WOC nurse related to wounds, incontinence, and urinary tract...PURPOSE: The purpose of this study was to describe the prevalence, incidence, and effectiveness of home health care (HHC) agencies' services with and without a WOC nurse related to wounds, incontinence, and urinary tract infection (UTI) patient outcomes. SUBJECTS AND SETTING: There were 449,243 episodes of care from a national convenience sample of 785 HHC agencies representing nonmaternity patients who were aged 18 years or older and receiving skilled home health services between October 1, 2008, and December 31, 2009. DESIGN: This study employed descriptive and comparative designs for data collection and analysis. We analyzed data from HHC agencies' electronic health records and conducted an Internet-based survey of HHC agencies. INSTRUMENTS: Data for this study were documented by HHC clinicians using the Outcome and Assessment Information Set. An Internet survey identified if a WOC nurse provided care or consultations within an HHC agency. RESULTS: The majority of HHC agencies (88.5%) had some influence of a WOC nurse. The incidence of wounds, incontinence, and UTIs was higher for agencies with no WOC nurse. Home health care agencies with WOC nurses had significantly better improvement outcomes for pressure ulcers, lower extremity ulcers, surgical wounds, urinary incontinence, bowel incontinence, and UTIs as well as significantly better stabilization outcomes for these outcomes except lower extremity ulcers. Virtually all patients in HHC agencies with and without a WOC nurse had stabilization of their lower extremity ulcers. CONCLUSIONS: Findings of this study suggest that influence of a WOC nurse is effective in achieving several important positive outcomes of HHC agencies' services for wounds, incontinence, and UTIs.
Rosa MA, Lapides S, Hayden C
… +1 more, Santangelo R
Home Healthc Nurse
· 2014 Feb · PMID 24492270
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Diabetes is a national epidemic and a leading cause of hospitalizations in the United States. Home care agencies need to be able to provide effective Diabetes Disease Management to help prevent avoidable hospitalizations...Diabetes is a national epidemic and a leading cause of hospitalizations in the United States. Home care agencies need to be able to provide effective Diabetes Disease Management to help prevent avoidable hospitalizations and assist patients to live a good quality of life. This article describes one organization's journey toward providing patients with better diabetes care resulting in an improved quality of life.
Home Healthc Nurse
· 2014 Feb · PMID 24492268
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Falls and the fear of falling are major health concerns among older adults. The purpose of this study was to assess the effects of an evidence-based fall prevention program on the fear of falling and health-related quali...Falls and the fear of falling are major health concerns among older adults. The purpose of this study was to assess the effects of an evidence-based fall prevention program on the fear of falling and health-related quality of life among community-dwelling elders. The program consisted of 6 classes that covered topics such as risk factors for falls, balance exercises, medications, safe footwear, and home safety. Of those elders who were most fearful at baseline, the fall prevention program decreased their fear of falling and improved 1 dimension of their health-related quality of life.
Roberts D, McLeod B, Stajduhar KI
… +2 more, Webber T, Milne K
Home Healthc Nurse
· 2014 Feb · PMID 24492266
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Beyond their own family caregivers, home healthcare nurses play a pivotal role in caring for those dying at home. However, deciding the timing of the next visit for these patients and their families is not straightforwar...Beyond their own family caregivers, home healthcare nurses play a pivotal role in caring for those dying at home. However, deciding the timing of the next visit for these patients and their families is not straightforward. The Palliative Care: Determining Next Home Care Nurse Visit decision guide supports clinicians in their decision-making process of planning visits to most effectively meet the needs and goals of patients and families during the final months of life.
Meadows CA, Fraser J, Camus S
… +1 more, Henderson K
Home Healthc Nurse
· 2014 Feb · PMID 24492265
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This article describes how a provincial health authority in Canada improved patient care and staff satisfaction by transforming the role of home care (HC) liaison. The transformation focused on clearly defining the role,...This article describes how a provincial health authority in Canada improved patient care and staff satisfaction by transforming the role of home care (HC) liaison. The transformation focused on clearly defining the role, function and reporting structure, and identifying which healthcare providers could fill the liaison role. The transformation included adoption of transition best practices, leveraging an electronic referral system, creation of an interprofessional team, standardization of tools/orientation, and strong evaluation metrics, centralizing decision making, and developing a process for streaming referrals. The authors identify key success factors that made the transformation possible, as well as challenges and work that remains to sustain the change.