Home Healthc Nurse
· 2014 Jan · PMID 24326477
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Motivational interviewing (MI) as a strategy to promote behavior change has its roots in the addiction field. In recent years there is growing use of MI as an intervention to help patients with diet, physical activity, a...Motivational interviewing (MI) as a strategy to promote behavior change has its roots in the addiction field. In recent years there is growing use of MI as an intervention to help patients with diet, physical activity, and other lifestyle changes. This counseling approach initially developed by clinical psychologists is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (). MI is appealing because it is seen as a practical front-line intervention that is concordant with patient-centered care that is being called for in the health service environment.This column profiles four published research/synthesis articles describing experiences by different groups in implementing MI strategies. As you will read, results from trials evaluating MI on patient outcomes are mixed and there continues to be gaps in the evidence on how to best implement MI and on which patients will most likely benefit. Even with outstanding questions, MI shows promise in the very challenging area of promoting behavior change and warrants continued investigation. Interested readers are encouraged to read the original articles for more details.
Home Healthc Nurse
· 2014 Jan · PMID 24326475
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Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among thes...Home care nursing occurs in a complex care environment. Nurses working in this setting care for a wide array of individuals who often are sicker and more complex than ever before. The high prevalence of wounds among these individuals requires that home care nurses have a certain level of knowledge to provide excellent care. Many times, individuals with wounds do not have the capacity to heal or are burdened with numerous symptoms affecting quality of life. In these cases, the home care nurse must understand concepts of palliative wound care to alleviate symptoms with the goal of improving quality of life.
Home Healthc Nurse
· 2014 Jan · PMID 24326473
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The nursing bag has been used by home care visiting staff for decades to carry needed equipment and supplies to provide patient care in the home. The nursing bag is transported from patient home to home and may serve as...The nursing bag has been used by home care visiting staff for decades to carry needed equipment and supplies to provide patient care in the home. The nursing bag is transported from patient home to home and may serve as a vehicle for transmitting microorganisms by virtue of the bag's contact with the staff's hands and contact with the patient's environment. This article establishes guidelines for the management of the nursing bag used by home care and hospice staff and offers strategies to prevent and control the transfer of microorganisms through its use.
Home Healthc Nurse
· 2014 Jan · PMID 24326472
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PURPOSE: To assess whether there was a significant improvement and stabilization (not worse at discharge) in pressure ulcers, lower extremity venous ulcers, surgical wounds, urinary incontinence, bowel incontinence, and...PURPOSE: To assess whether there was a significant improvement and stabilization (not worse at discharge) in pressure ulcers, lower extremity venous ulcers, surgical wounds, urinary incontinence, bowel incontinence, and urinary tract infections in home health care (HHC) patients cared for by a certified WOC nurse. SUBJECTS AND SETTING: There were 449,170 episodes of care from a national convenience sample of 785 HHC agencies with 447,309 nonmaternity, adult patients between October 1, 2008, and December 31, 2009. DESIGN: Descriptive and comparative. INSTRUMENTS AND METHODS: Data from the Outcome and Assessment Information Set documented by HHC clinicians were analyzed using mixed-effects logistic regression, propensity score analysis, and appropriate parametric and nonparametric tests. An Internet survey identified whether WOC nurses provided care to patients in an HHC agency. Home health care agencies identified records of patients receiving WOC nurse visits/consults. RESULTS: An HHC patient assigned to a WOC nurse had surgical wounds, pressure ulcers, and incontinence problems that were significantly worse than HHC patients not assigned to a WOC nurse. Patients cared for by a WOC nurse showed significant improvement and stabilization of the number of pressure ulcers and surgical wounds and the frequency of urinary and bowel incontinence, despite having problems that were more severe than other patients. Home health care patients not cared for by WOC nurses, with less-severe wound and incontinence problems, also got better. CONCLUSIONS: WOC nurses are effective in achieving positive health outcomes for pressure ulcers, surgical wounds, and incontinence in HHC patients with severe health problems.
Home Healthc Nurse
· 2014 Jan · PMID 24326471
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The Latino population is the fastest growing ethnically diverse group in the United States, but U.S. healthcare studies report poorer health status in this population than in non-Latinos. Using Campinha-Bacote's Inventor...The Latino population is the fastest growing ethnically diverse group in the United States, but U.S. healthcare studies report poorer health status in this population than in non-Latinos. Using Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R, 2003), a single-session pilot educational program to enhance culturally responsive home care nursing to Latinos resulted in a 27% increase in the nurse participant cultural competency levels.
James MB, Kimmons NJ, Schasberger B
… +1 more, Lefkowitz A
Home Healthc Nurse
· 2014 Jan · PMID 24326470
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Reducing risk of falls has been identified as a national safety goal by The Joint Commission (TJC). The purpose was to determine if the total score on the multifactorial Falls Risk Assessment accurately identifies the ri...Reducing risk of falls has been identified as a national safety goal by The Joint Commission (TJC). The purpose was to determine if the total score on the multifactorial Falls Risk Assessment accurately identifies the risk of falls in a homebound client. In addition, the study examined if any individual item had a higher predictive power with the incidence of falls. One hundred clients (> 65 years old) who sustained an avoidable fall during a home care episode of care, plus 25 home care clients in the same age range and time period, who did not fall. A retrospective chart review, including Falls Risk Assessment (FRA) performed at start of care, demographic information, specific physical therapy (PT) evaluation, and visit notes if necessary to determine if the fall met the inclusion criteria. Scores for each individual area of the assessment were collected for statistical analysis. Data were analyzed by a biostatistician using simple linear regression, t-tests, and regression of variable combinations. The total score on the multifactorial risk assessment tool was shown to have a strong relationship with incidence of falls. The average scores of individuals who fell after assessment were significantly higher than those of individuals who did not fall. No single factors were found to be highly predictive. A single approach to decreasing falls is likely to be less effective than a multipronged approach. Caregivers and providers are advised to consider the entirety of the falls risk and direct comprehensive interventions to address the multiple factors that lead to falls.
It is important for nursing programs to use culturally focused activities to increase student preparation in caring for diverse older adults in their homes. The purpose of this study was to examine strategies that promot...It is important for nursing programs to use culturally focused activities to increase student preparation in caring for diverse older adults in their homes. The purpose of this study was to examine strategies that promote students' reflection on cultural awareness using home care-focused case studies, simulations, and self-reflective writing activities. Cases and simulations were designed to depict diverse patients living at home with a variety of demographic characteristics, such as health history, age, culture, religion, dietary preferences, marital status, family involvement, and socioeconomic status. Qualitative data regarding student perceptions of cultural awareness was gathered via written surveys, and findings suggest that junior- and senior-year nursing students enhanced the depth and breadth of how they defined "cultural competence" after participating in culturally focused classroom and clinical laboratory activities. Levels of reflective writing using framework also improved by the semester's end for both groups of students.
Respectful communication with people who have disabilities is essential to providing superior care. Knowing exactly how to do this, however, can be confusing for some healthcare providers. The purpose of this article is...Respectful communication with people who have disabilities is essential to providing superior care. Knowing exactly how to do this, however, can be confusing for some healthcare providers. The purpose of this article is to provide the clinician with resources using a case scenario.
Burn injury to individuals older than 60 years occurs with a frequency that is disproportionate to that of all other victims except the very young. Burns continue to remain a major healthcare problem in the United States...Burn injury to individuals older than 60 years occurs with a frequency that is disproportionate to that of all other victims except the very young. Burns continue to remain a major healthcare problem in the United States and globally. Seniors 65 years and older make up 13.7% of the total population of the United States, and these numbers are expected to increase during the next 30 years (). Further, older adults who live alone are 30% more likely to suffer an unintentional injury than the rest of the population. As seniors age, their potential for suffering a fire or burn-related injury increases because of the aging process, comorbidities, and limited financial means. These factors describe a vulnerable population in need of protection and safety. This article assists the home healthcare provider to recognize the characteristics and vulnerability of the older adult as related to a burn injury. Guidelines that will assist the home healthcare provider in promoting a safe and comfortable environment are discussed.
This longitudinal, prospective pilot study (N = 23) explored patterns of functional recovery using the functional independence measure (FIM) at 2 weeks, 1 month, and 3 months poststroke. Results showed that the subcatego...This longitudinal, prospective pilot study (N = 23) explored patterns of functional recovery using the functional independence measure (FIM) at 2 weeks, 1 month, and 3 months poststroke. Results showed that the subcategory of self-care had the most observable improvement, whereas communication had the least improvement. Study results have implications for clinicians, as they are instrumental in assessment, and in determination of treatments and level of care required to promote optimal rehabilitation and recovery of function across all dimensions.
The demand for personal care workers in home-based care is expected to double with the aging of the baby boomer population at the same time that home care agencies struggle with high rates of turnover. This article exami...The demand for personal care workers in home-based care is expected to double with the aging of the baby boomer population at the same time that home care agencies struggle with high rates of turnover. This article examines the job experience of 171 home care aides who remained on the job over 18 months of data collection in the longitudinal home care worker retention study. The three groups of themes that emerged from the analysis of telephone interviews with study participants-challenges of the job, compensating strategies, and potential employer interventions-provide insight on how to offer support to these valuable workers.