The article highlights some drawbacks of not managing knowledge in academia and suggests knowledge-sharing strategies that can be used to leverage knowledge on research procedures. The study investigated the research procedures used by Master of Information Studies students at the University of Natal in South Africa between 1982 and 2002. The results indicated that there was no uniformity in the research procedures used in the theses. For instance, issues relating to sampling, validating survey protocols and summarising research findings were not always handled according to established methodological standards. The variability in research processes that were employed partly implied that the levels of knowledge of research supervisors differed. It is evident from the research outputs that knowledge that is scattered among research supervisors is not easily accessible. In that regard, this article provides a model for academic institutions interested in bridging existing knowledge gaps and enhancing performance of research supervisors. [ABSTRACT FROM AUTHOR]
Copyright of Mousaion is the property of University of South Africa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Study finds homecare falls short. (2006). Aging Today, 27(4), 2-2.
Hybrid filing schemes: the use of metadata signposts in functional file plans. (2007). [Article]. Records Management Journal, 17(1), 17-31.
Purpose - The purpose of this paper is to highlight the problems of using metadata to file electronic documents as well as the problems of using a purely functional filing scheme. It aims to explore how a functional file plan can be created from a business classification scheme by inserting "metadata signpost folders" at strategic points in the filing hierarchy to create a "hybrid functional file plan". Design/methodology/approach - The paper draws on experience and published literature to discuss methods for creating a hybrid functional file plan. Findings - The paper concludes that functional filing is the only method of filing e-documents that can effectively support good information management practice, enabling all e-documents to be managed in line with corporate information management policies, and that it may also be the only viable method of providing true "shared" filing in support of knowledge management and business efficiency. Originality/value - The article shows that a functional filing scheme, retrieving, cross-referencing and grouping documents by subject (or other metadata attributes) requires special measures and suggests that current IT, EDRM and related technologies may not fully meet the requirements by searching/sorting on metadata terms. It may be necessary to compromise a purely functional file plan by the inclusion of metadata "signpost" folders into the functional folder structure in order to create a hybrid functional file plan. [ABSTRACT FROM AUTHOR]
Copyright of Records Management Journal is the property of Emerald and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Abelson, J., Gold, S. T., Woodward, C., O'Connor, D., & Hutchison, B. (2004). Managing under managed community care: the experiences of clients, providers and managers in Ontario's competitive home care sector. Health Policy, 68(3), 359-372.
In 1996, a newly elected government in the Province of Ontario, Canada, introduced a managed competition environment into the home care sector through the establishment of a competitive contracting process for home care services. Through 65 in-depth, semi-structured interviews conducted between November 1999 and January 2001, we trace the implementation of this competitive contracting policy within Ontario's newly established managed community care environment and assess the effects of competitive contracting against two sets of goals: (1). quality of care goals that consider continuity of care of paramount importance in the provision of home care; and (2). the managed competition goal of increased efficiency. In assessing the implementation of this policy against these goals, we highlight the conflicts that can arise in pursuing different policy goals in response to different formulations of the policy problem that underpin them. We map stakeholder experiences with the competitive contracting policy onto relevant contracting and managed competition literatures. When measured against the goals of quality of care and efficiency, the findings presented here offer a mixed review of the experiences to date with the competitive contracting process introduced in Ontario's home care sector and suggest improvements for managing future competitive contracting processes.
Ahlner-Elmqvist, M., Jordhoy, M. S., Bjordal, K., Jannert, M., & Kaasa, S. (2008). Characteristics and quality of life of patients who choose home care at the end of life. Journal of Pain and Symptom Management, 36(3), 217-227.
Cancer patients with advanced disease and short-survival expectancy were given hospital-based advanced home care (AHC) or conventional care (CC), according to their preference. The two groups were compared at baseline to investigate whether there were differences between the AHC and the CC patients that may help explain their choice of care. The patients were consecutively recruited over 21/2 years. Sociodemographic and medical data, and the health-related quality of life (HRQL) of the two groups were compared. HRQL was assessed using a self-reporting questionnaire, including the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQC30), the Impact of Event Scale (IES), five questions about social support, and two items concerning general well-being. The AHC group showed significantly poorer functioning on all the EORTC QLQ-C30 scales and an overall higher symptom burden than the CC patients. Fewer of the AHC patients were receiving cancer treatment. The AHC patients had lived longer with their cancer diagnosis, had a significantly shorter survival after study enrollment, and a significantly poorer performance status. The major differences between the two groups seemed to be related to being at different stages in their disease. The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden. These findings should be taken into consideration in planning palliative care services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Ahlner-Elmqvist, M., Jordhoy, M. S., Jannert, M., Fayers, P., & Kaasa, S. (2004). Place of death: Hospital-based advanced home care versus conventional care: A prospective study in palliative cancer care. Palliative Medicine, 18(7), 585-593.
The purpose of this prospective nonrandomized study was to evaluate time spent at home, place of death and differences in sociodemographic and medical characteristics of patients, with cancer in palliative stage, receiving either hospital-based advanced home care (AHC), including 24-hour service by a multidisciplinary palliative care team or conventional hospital care (CC). Recruitment to the AHC group and to the study was a two-step procedure. The patients were assigned to either hospital-based AHC or CC according to their preferences. Following this, the patients were asked to participate in the study. Patients were eligible for the study if they had malignant disease, were older than 18 years and had a survival expectancy of 2-12 months. A total of 297 patients entered the study and 280 died during the study period of two and a half years, 117 in the AHC group and 163 in the CC group. Significantly more patients died at home in the AHC group (45%) compared with the CC group (10%). Preference for and referral to hospital-based AHC were not related to sociodemographic or medical characteristics. However, death at home was associated with living together with someone. Advanced hospital-based home care targeting seriously ill cancer patients with a wish to remain at home enable a substantial number of patients to die in the place they desire. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Aimonino Ricauda, N., Tibaldi, V., Leff, B., Scarafiotti, C., Marinello, R., Zanocchi, M., et al. (2008). Substitutive "hospital at home" versus inpatient care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. Journal of the American Geriatrics Society, 56(3), 493-500.
OBJECTIVES: To evaluate hospital readmission rates and mortality at 6-month follow-up in selected elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). DESIGN: Prospective randomized, controlled, single-blind trial with 6-month follow-up. SETTING: San Giovanni Battista Hospital of Torino. PARTICIPANTS: One hundred four elderly patients admitted to the hospital for acute exacerbation of COPD were randomly assigned to a general medical ward (GMW, n=52) or to a geriatric home hospitalization service (GHHS, n=52). MEASUREMENTS: Measurements of baseline sociodemographic information; clinical data; functional, cognitive, and nutritional status; depression; and quality of life were obtained. RESULTS: There was a lower incidence of hospital readmissions for GHHS patients than for GMW patients at 6-month follow-up (42% vs 87%, P<.001). Cumulative mortality at 6 months was 20.2% in the total sample, without significant differences between the two study groups. Patients managed in the GHHS had a longer mean length of stay than those cared for in the GMW (15.5+/-9.5 vs 11.0+/-7.9 days, P=.010). Only GHHS patients experienced improvements in depression and quality-of-life scores. On a cost per patient per day basis, GHHS costs were lower than costs in GMW ($101.4+/-61.3 vs $151.7+/-96.4, P=.002). CONCLUSION: Physician-led substitutive hospital-at-home care as an alternative to inpatient care for elderly patients with acute exacerbations of COPD is associated with a substantial reduction in the risk of hospital readmission at 6 months, lower healthcare costs, and better quality of life.
Aitken, P., & Wiltshire, M. (2005). Parental satisfaction with a nurse-led emergency assessment unit. Paediatric Nursing, 17(9), 31-35.
Parents of children discharged from the paediatric emergency assessment unit of a large regional children's unit were surveyed to discover their perceptions of the care experience and post discharge support. Data from 40 parents revealed that the family journey through the unit was generally positive, although not without problems. The majority of children were referred from their general practitioner, and most were seen by a paediatrician within an hour of arrival. Morning-after phone calls and 24-hour access after discharge increased family satisfaction. However, nearly a third of families reported they were not shown the facilities of the unit and just under half mentioned lack of privacy as a concern. An action plan to address these issues has been subsequently implemented and will be evaluated periodically.
Al-Hawamdeh, S. (2005). Introduction to the special topic section: Knowledge management in Asia. [Article]. Journal of the American Society for Information Science & Technology, 56(11), 1154-1155.
The article focuses on knowledge management in Asia. While most Asian countries share the common goal of moving toward the knowledge economy, the infrastructure development and technology vary from one country to another. Countries like Singapore, Malaysia, Taiwan, Hong Kong, and Korea have invested heavily in information infrastructure, while others like Indonesia, the Philippines, and Thailand are still catching up, and many are behind when it comes to the use of the Internet and information technology. In Singapore, for example, the government launched IT2000 initiatives, which laid the groundwork for the first international and nationwide commercial broadband infrastructure. An empirical study that involved 32 final-year business students reading an elective module entitled Knowledge Management Systems in one of the higher education institutes in Singapore was carried out. The results of the study showed that the simulation game is an effective instructional tool for imparting knowledge to the participants.
Alkema, G. E., Wilber, K. H., Shannon, G. R., & Allen, D. (2007). Reduced mortality: The unexpected impact of a telephone-based care management intervention for older adults in managed care. Health Services Research, 42(4), 1632-1650.
Objective: This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program(CA Program) designed to link those with high health care utilization to home- and community-based services. Data Source: Secondary data from the CA Program, part of the California Health-Care Foundation's Elders in Managed Care Initiative. Study Design: Randomized-control trial in which participants (N = 781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. Population Studied: Older adults (65+) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. Principal Findings: ITT group had a significantly lower odds of mortality throughout the study (OR = 0.55; p = .005) and during the care management intervention (OR = 0.45; p = .006), whereas differential risk in the post-intervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. Conclusions: Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Alwyn, T., John, B., Hodgson, R., & Phillips, C. (2004). The addition of a psychological intervention to a home detoxification programme. Alcohol and Alcoholism, 39(6), 536-541.
Aims: Home detoxification is a recognized method of treating problem drinkers within their own home environment. The aim of this research is to determine whether a relatively brief psychological intervention adds to its effectiveness. Methods: A pragmatic trial with 91 participants randomly assigned to either the psychological intervention or treatment as usual. Community Psychiatric Nurses were trained to administer the brief psychological intervention involving motivational interviewing, coping skills training and social support. A manual was developed in order to standardize the training and implementation. Results: At the 3 month and 12 month follow-up the psychological intervention resulted in significant positive changes in alcohol consumption, abstinent days, social satisfaction, self-esteem and alcohol-related problems. Further, a cost analysis confirmed that the psychological intervention was a ninth of the cost of inpatient treatment. Conclusions: Adding a psychological intervention to a home detoxification programme was successful and cost-effective. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Annas, G. D. (2007). Home care on the geriatrics service: a medical student's perspective. Annals of Long Term Care, 15(9), 17-19.
A physician recounts the invaluable experience he gained as a medical student "meeting people where they are," in their home environments surrounded by many factors that can affect a patient's health--a grab bar in a shower, a phone with Braille for a vision-impaired patient, the sanitary condition of a house--things that are hidden when patients are seen in a clinical setting.
Appelin, G., & Berterö, C. (2004). Patients' experiences of palliative care in the home: a phenomenological study of a Swedish sample. Cancer Nursing, 27(1), 65-70.
In recent times the rapid expansion of interest in palliative care has become a significant feature of health care development. Caring in the palliative way means simultaneous attention to the medical, nursing, spiritual, emotional, and social needs of the patient. The main purpose of the present study has been to obtain an understanding of patients' experiences of palliative care at home with service from district nurses. The research design is influenced by Giorgi's phenomenology. Six patients diagnosed with cancer and receiving palliative care at home were interviewed and the transcribed interviews were analyzed. Interviews were conducted in the patients' homes. The findings show that the essential meaning of the patients' experiences of palliative home care can be described as uncertain safety. This meaning of essence is explicated by 4 themes, which are labeled Safe but unsafe at home, A sense of powerlessness, Change of everyday life, and Hope and belief in the future. The findings of the study point out the importance of well functioning teamwork and resources to facilitate patient's experiences of safety in their own homes. It should be noted that the patient and their next of kin are members of the team.
Appelin, G., Brobäck, G., & Berterö, C. (2005). A comprehensive picture of palliative care at home from the people involved. European Journal of Oncology Nursing, 9(4), 315-324.
The purpose of this study was to identify the comprehensive picture of palliative care in the home, as experienced by the people involved. The study is a secondary analysis of three phenomenological studies including six cancer patients, six next of kin and six district nurses. Data were collected in qualitative interviews using an interview guide. The interviews were tape-recorded and transcribed verbatim. In this secondary analysis, data were analysed by hermeneutic analysis guided by Gadamer. The guiding questions during the reading were: Is there an advantage receiving palliative care at home? Is there a disadvantage receiving palliative care at home?
The findings indicate that the advantages of palliative care at home is; striving for normal life, including the care in the home composed of physical care and emotional/mental care. Striving for normal life also includes emotional feelings, safety and resources and policies which regulates this activity. Disadvantages of palliative care at home are commitment, composed of adaptation and extra work, and demands, composed of frustration and uncertainty. If the people involved are to be able to manage the situation and optimize living while dying, there must be support and resources facilitating the situation.
Aronow, H. U., & Hahn, J. E. (2005). Stay Well and Healthy! Pilot Study Findings from an Inhome Preventive Healthcare Programme for Persons Ageing with Intellectual and/or Developmental Disabilities. Journal of Applied Research in Intellectual Disabilities, 18(2), 163-173.
Background: While disparities in the health status for persons ageing with intellectual and developmental disabilities have been well documented, interventions that address individual risks in physical, emotional, social and environmental health among this population are lacking. This pilot study evaluated the feasibility of two inhome interventions designed to reduce health risks and improve health outcomes among persons ageing with intellectual and developmental disabilities. Method: Interventions and assessment tools were developed. Adults with intellectual and developmental disabilities, aged 32 and over (n = 201) living in non-institutional settings were recruited and assigned to either an advance practice nurse (APN) intervention of inhome multidimensional assessment, targeted recommendations and follow-up visits (n = 101) or an inhome health risk appraisal (HRA) with printed feedback only (n = 100). Results: The development and pilot testing of the interventions, assessment tools and methods demonstrated feasibility in the population from mild to moderate intellectual and developmental disabilities. In addition, high levels of health risks were identified (mean = 5.0; range 0-16) in the sample suggesting the need for effective interventions. Both pilot groups showed significant reduction in health risks between baseline and followup. Further rigorous randomized field trials are required to test the effectiveness of each intervention. Conclusions: Community-based preventive interventions are feasible for randomized trials in this population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Ayalon, L. (2009). Fears come true: The experiences of older care recipients and their family members of live-in foreign home care workers. International Psychogeriatrics, 21(4), 779-786.
Background: Foreign home care services provided to frail older adults by individuals from the developing world are a global phenomenon. This study evaluated the challenges associated with live-in foreign home care from the perspective of older care recipients and their family members. Methods: Qualitative interviews were conducted with 23 family members and seven older care recipients. Interviews were analyzed thematically. Results: Three main themes were identified: (i) the intense fears associated with witnessing the decline of the older care recipient and the subsequent employment of a foreign home care worker; (ii) actual negative experiences within this caregiving setting; and (iii) the ways in which family members and older care recipients coped with these challenging experiences. Conclusions: The key to this caregiving arrangement is the establishment of trust. Yet, many care recipients experienced violations of trust that resulted in abuse and neglect, which served to further intensify fears and concerns about this caregiving arrangement. The same coping methods used to maintain this arrangement, despite fears and concerns, are the ones responsible for maintaining the older care recipient in an abusive situation. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Barnes, S. (2006). Space, Choice and Control, and Quality of Life in Care Settings for Older People. Environment and Behavior, 38(5), 589-604.
This cross-sectional study aims to establish whether gradation of space and daytime location are associated with quality of life in care home residents, irrespective of dependency. Thirty-eight homes and 452 residents are recruited. Quality of life measures used are as follows: observation of the time residents spent in active behavior and observation of well-being, both derived from Dementia Care Mapping, and a measure of environmental control. Residents in homes providing more gradation of space have higher observed well-being and environmental control, and those spending the day located in their own rooms have higher observed active behavior and environmental control. Higher dependency residents are more likely to be located in lounges. Gradation of space is associated with resident quality of life, highlighting the necessity for design guidance to emphasize a variety of spaces. However, well-designed buildings with a variety of spaces can offer little choice to residents if access to different daytime locations is restricted. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Barnett, T. E., Chumbler, N. R., Vogel, W., Beyth, R. J., Ryan, P., & Figueroa, S. (2007). The cost-utility of a care coordination/home telehealth programme for veterans with diabetes. Journal of Telemedicine and Telecare, 13(6), 318-321.
We examined the cost-effectiveness of a care coordination/home telehealth (CCHT) programme for veterans with diabetes. We conducted a retrospective, pre-post study which compared data for a cohort of veterans (n = 370) before and after the introduction of the CCHT programme for two periods of 12 months. To assess the cost-effectiveness, we converted the patients' health-related quality of life data into Quality Adjusted Life Year (QALY) utility scores and used costs to construct incremental cost-effectiveness ratios (ICERs). The overall mean ICER for the programme at one-year was $60,941, a value within the commonly-cited range of cost-effectiveness of $50,000-100,000. The programme was cost-effective for one-third of the participants. Characteristics that contributed to cost-effectiveness were marital status, location and clinically relevant co-morbidities. By targeting the intervention differently in future work, it may become cost-effective for a greater proportion of patients. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bee, P. E., Barnes, P., & Luker, K. A. (2009). A systematic review of informal caregivers' needs in providing home-based end-of-life care to people with cancer. Journal of Clinical Nursing, 18(10), 1379-1393.
Aims: This paper presents the results of a systematic review examining the practical information needs of informal caregivers providing home-based palliative and end-of-life care to people with advanced cancer. Background: Modern hospice care has led to increases in home-based palliative care services, with informal caregivers assuming responsibility for the majority of care. In response, health policy emphasizes the provision of palliative care services in which both the patient and carer receive adequate support throughout illness and death. While the emotional needs of carers have been extensively researched, their practical needs with respect to the provision of physical care are yet to receive systematic attention. Design: Systematic review. Methods: Eligible articles were identified via electronic searches of research and evidence-based databases, hand-searching of academic journals and searches of non-academic grey literature websites. Quality of research was assessed via accepted guidelines for reviewing non-randomized, observational and qualitative literature. Data were synthesized by comparing and contrasting the findings to identify prominent themes. Results: Research consistently highlights this lack of practical support, often related to inadequate information exchange. These deficits typically manifest in relatives adopting a 'trial and error' approach to palliative care. Informal carers request a greater quantity of practically-focused information, improvements in quality and increased methods of dissemination. Conclusion: Synthesis of the literature suggests that home-based palliative care services have been insufficiently focused on assisting informal caregivers acquire practical nursing skills. Relevance to clinical practice: Enhanced access to professional advice represents a potentially effective method of increasing carers' confidence in their ability to undertake practical aspects of home-based care. Evidence suggests that nurses and other health providers may better assist home-based carers by providing the information and skills-training necessary to facilitate this. This may necessitate the involvement of carers in the design and testing of new educational interventions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Beeber, L. S., Cooper, C., Van Noy, B. E., Schwartz, T. A., Blanchard, H. C., Canuso, R., et al. (2007). Flying under the radar: Engagement and retention of depressed low-income mothers in a mental health intervention. Advances in Nursing Science, 30(3), 221-234.
A randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers used innovative design features to reduce stigma and enhance acceptability. Despite these features, advanced practice psychiatric mental health nurses used specialized, relationship-based strategies to engage and retain these high-risk mothers in the intervention. Data revealed that the nurses needed to diligently maintain contact, provide encouragement, use empathy for rapid assessment and response, and control the intensity of the relationship-based contacts in order to retain mothers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bendiane, M. K., Galinier, A., Favre, R., Ribiere, C., Lapiana, J. M., Obadia, Y., et al. (2007). French district nurses' opinions towards euthanasia, involvement in end-of-life care and nurse-patient relationship: a national phone survey. Journal of Medical Ethics, 33(12), 708-711.
OBJECTIVES: To assess French district nurses' opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients. DESIGN AND SETTING: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses. PARTICIPANTS: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate (response rate 75%). MAIN OUTCOME MEASURES: Opinion towards the legalisation of euthanasia (on a five-point Likert scale from "strongly agree" to "strongly disagree"), attitudes towards terminal patients (discussing end-of-life issues with them, considering they should be told their prognosis, valuing the role of advance directives and surrogates). RESULTS: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients (70%), who consider competent patients should always be told their prognosis (81%) and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients (68% and 77% respectively). Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny. CONCLUSIONS: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care.
Bensink, M., Hailey, D., & Wootton, R. (2006). A systematic review of successes and failures in home telehealth: Preliminary results. Journal of Telemedicine and Telecare, 12(Suppl 3), 8-16.
We conducted a systematic review of the literature to identify studies in home telehealth that compared a home telehealth intervention with a non-telehealth standard/usual care alternative in terms of administrative changes, patient management decisions, patient outcomes, caregiver outcomes, economic impact or social impact on patients. A search of various databases produced 6643 references. Of these 769 papers were selected for more detailed investigation. These papers, combined with hand searching of relevant telehealth journals and cross-referencing of citations in identified publications, resulted in 138 papers referring to 130 projects for review. In this preliminary analysis we used a quality appraisal approach that took into account the study design. An additional analysis of patient numbers was then used to calculate a net evidence score. A large proportion of studies (80%) were randomised controlled trials. Only 22 projects (17%) reported economic data deemed to be sufficient for appraisal. Evidence exists for the clinical effectiveness of home telehealth in diabetes, the general area of mental health, high risk pregnancy monitoring, heart failure and cardiac disease. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bethune-Davies, P., McWilliam, C. L., & Berman, H. (2006). Living With the Health and Social Inequities of a Disability: A Critical Feminist Study. Health Care for Women International, 27(3), 204-222.
Clients living at home with chronic disabling conditions together with their caregivers, service providers, and policymakers face major challenges in optimizing health care. In this critical feminist interpretive study we examined the experiences of women receiving home care for chronic disabling conditions. Five themes emerged: struggling with the embodied limitations of disabling chronic conditions; actively seeking health; struggling with service limitations; seeking ways to manage; and living with isolation and marginalization. Having done this study, we learned that home care services do not always contribute sufficiently to the overall health and well-being of women living with chronic disabling conditions and, in fact, may negatively impact upon their health. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Biehal, N. (2005). Working with adolescents at risk of out of home care: The effectiveness of specialist teams. Children and Youth Services Review, 27(9), 1045-1059.
This paper reports findings from a quasi-experimental study of services for young people who appeared to be at risk of placement. It compares outcomes for young people in England referred to specialist support teams, which offered an intensive service with those for a group referred to the mainstream 'service as usual' delivered by local area social work teams. The services offered by the specialist teams bear some similarities to intensive family preservation services (IFPS) in the USA, insofar as they offer an intensive, short-term preventive service whose principal aim is the prevention of placement. Many of the young people had serious emotional and behavioural difficulties, and many had lengthy histories of abuse, neglect, or past placement. At follow-up, many young people and families receiving both types of service showed considerable improvement on a variety of measures of child and family functioning, but results were not significantly better for the group served by the intensive service. However, the intensive services group were found to be significantly less likely to enter placement. The paper discusses the merits of considering both individual and service outcomes, and considers the impact of a variety of child and service system factors. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bierlein, C., Hadjistavropoulos, H., Bourgault-Fagnou, M., & Sagan, M. (2006). A Six-Month Profile of Community Case Coordinated Older Adults. CJNR: Canadian Journal of Nursing Research, 38(3), 32-50.
The purpose of this study was to assess the needs of older case coordinated clients receiving community health services, by examining changes in cognitive status, physical and mental health status, social support, risk for institutionalization, and service use over a 6-month period from initial intake into home care. Significant predictors of professional and supportive home care, as well as emergency room use and hospital days, were also examined. Standardized interviews were conducted with 234 clients at the time of referral; follow-up interviews were conducted with 179 of these clients after 6 months of case coordination. Results reveal that physical and mental health improved, while cognitive status remained stable. Although social interaction and instrumental support decreased, subjective support remained stable. Risk of institutionalization decreased. Occupational therapy, nursing, and homemaking were the most frequently used services. The best predictor of professional and supportive home care was a risk of institutionalization score. The needs of this older adult population changed even within the relatively short span of 6 months. Frequent review of needs in some form may. be warranted in order to maintain effective service plans. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bilotta, C., & Vergani, C. (2008). Quality of private personal care for elderly people with a disability living at home: Correlates and potential outcomes. Health & Social Care in the Community, 16(4), 354-362.
To investigate correlates of the quality of private personal care for community-dwelling elderly people, this cross-sectional study enrolled 100 elderly outpatients living at home, along with their private aides and 88 informal caregivers, from May 2005 to January 2007. Cases were stratified according to the quality of private care as was described by both elderly participants and informal caregivers. In cases where the elderly person was suffering from overt cognitive impairment, only the opinions of the informal caregivers were taken into account. A comparison was made between the 'poor or fair care' group (n = 16), the 'intermediate care' group (n = 39) and the 'optimal care' group (n = 45). Considering the characteristics of private aides, there was a significant trend across the three groups in terms of language skills (P = 0.002) and level of distress with life conditions (P = 0.020). A statistical analysis performed on elderly participants without an overt cognitive impairment (n = 59) and informal caregivers showed an increase in the European Quality of Life Visual Analogue Scale score in the elderly group [mean + standard deviation (SD) were, respectively, 45 +or- 23.2, 63.7 +or- 19.7 and 68.8 +or- 21.6; P = 0.007], and a decrease in the Caregiver Burden Inventory score (mean +or- SD were, respectively, 34.9 +or- 25.3,26 +or- 17.7 and 17.6 +or- 14.6; P = 0.020) across the three groups. We found no significant difference between elderly people in the three groups in terms of social variables, functional and cognitive status, prevalence of depressive disorders and morbidity. Therefore, good language skills and non-distressing life conditions of private aides appeared to be correlates of an optimal quality of care for community-dwelling elderly people with a disability, and also a better quality of life for them and less distress for their informal caregivers appeared to be potential outcomes of the quality of personal care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Birdsong, S., & Parish, S. L. (2008). The Healthy Families Act: Vital support for families of people with developmental disabilities. Intellectual and Developmental Disabilities, 46(4), 319-321.
The proposed Healthy Families Act (2007) would extend leave to workers who need to care for family members as well as themselves. Most U.S. workers who receive paid sick time cannot use it other than for their own illnesses, including 94 million working parents who are not allowed to use their sick leave to care for a sick child. Only 11% of low-income families are afforded paid sick leave that allows for care of sick family members, which adversely affects people with developmental disabilities and their families, who are over-represented in poverty. Families of individuals with developmental disabilities experience higher rates of poverty. In essence, families of children with disabilities forego earning income to care for their children through adolescence and into the child's adulthood, and families bear elevated costs of caregiving over time, which contribute to diminished financial well being. The Healthy Families Act is vital legislation for all of America's working families. However, it is most critical for families of people with developmental disabilities, who experience greater living costs and elevated, enduring caregiving responsibilities. Policymakers should directly address the needs of families caring for people with developmental disabilities by passing the Healthy Families Act and legislating critical support of vulnerable families who balance caregiving and employment. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Bjornsdottir, K. (2009). The ethics and politics of home care. International Journal of Nursing Studies, 46(5), 732-739.
BACKGROUND: In the dominant health-care policy, commonly referred to as New Public Management, primary emphasis is placed on the reduction of costs in health care. This development threatens to increase inequality in society based on levels of health or impairment and on gender. AIM: The aim of this paper is therefore to raise awareness among nurses about the impact of New Public Management and explore how they might develop services that meet the diverse needs and wishes of those being served. THEORETICAL APPROACH AND METHOD: Although this policy has been criticised by nurses, it has also been observed that they are key players in its realisation. This discussion paper explores the impact of different discourses upon the practice of home-nursing care. It was developed within the post-structural tradition, where discourses are considered of key importance in shaping practice. Discourses represent different viewpoints and interests, and determine what can be considered meaningful and possible. The empirical studies which form the base for many of the main arguments presented were identified through an extensive review of published ethnographic research of home care in the years 2000-2008. RESULTS: A review of studies conducted in a number of countries both in North America and Europe showed that home-care services have in many ways been diminished. Clients and their caregivers experience insecurity and wish for more assistance. With New Public Management the focus has shifted from an ethical discourse to an economic one, although this shift has not been clearly articulated and critiqued. By understanding the impact of New Public Management, nurses can better focus their practice to meet the diverse needs of patients and their caregivers. CONCLUSION: In order to be able to respond to retrenchment in health services, nurses need to understand the complex ethical and political issues of New Public Management. A number of practices can be developed for working with patients and their families in such a way that their needs and wishes are respected.
Bocchi, S. C. M., & Angelo, M. (2008). Between freedom and reclusion: Social support as a quality-of-life component in the family caregiver-dependent person binomial. Revista Latino Americana de Enfermagem, 16(1), 15-23.
This is a qualitative study which uses Grounded Theory as its methodological framework and Symbolic Interactionism as a theoretical base to understand the experience of family caregivers for Cerebrovascular Accident (CVA) patients with regard to social support during their rehabilitation process at home. The components (themes and categories) of the phenomenon assuming home care and specifically the themes assuming care with support and assuming care without support were inter-related for the purpose of comparison and analysis, in order to apprehend how the interaction between them occurred. It was observed that, in addition to the recovery of the patient's autonomy, social support is one of the intervening variables in quality of life for the family caregiver-disabled person binomial, particularly with respect to the caregiver's freedom to resume his/her life plan. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Boeve, B. F. (2008). Update on the diagnosis and management of sleep disturbances in dementia. Sleep Medicine Clinics, 3(3), 347-360.
Sleep disturbances in patients who have dementia are common and are a major cause of reduced patient, and particularly caregiver, quality of life, often leading to patient institutionalization. The literature has several excellent reviews on sleep disturbances in dementia. The principal goals of this article are to (1) review the most common and pertinent sleep disturbances in the home/ambulatory setting, (2) provide a simple diagnostic scheme for clinicians (and caregivers) to determine the likely cause or causes of the sleep disturbances, and (3) provide a summary of non pharmacologic and pharmacologic strategies for managing the disturbances. The ultimate purpose is to maximize quality of life for patients and their bed partners, and to enable patients who have challenging sleep disturbances to remain in the home environment as long as possible. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bono, K. E., Dinehart, L. H., Claussen, A. H., Scott, K. G., Mundy, P. C., & Katz, L. F. (2005). Early Intervention with Children Prenatally Exposed to Cocaine: Expansion with Multiple Cohorts. Journal of Early Intervention, 27(4), 268-284.
Prenatal cocaine exposure is an indicator for adverse developmental outcomes. To prevent developmental disabilities, an early intervention program for children birth to 3 years was developed that included three groups: center-based, home-based, and primary care comparison. The intervention was implemented across 10 years and data were collected on 342 children and families who were primarily urban, poor, and members of traditionally underrepresented groups. At 36 months of age, center and home-based intervention participants had more advanced cognitive and language abilities and fewer behavior problems than the primary care group participants. In addition, center-based participants had more advanced language abilities than home-based participants. The findings indicate that the early intervention impact is sustainable over time and has a positive effect on children at risk due to prenatal cocaine exposure. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Bost, N. S. (2008). An investigation of the prospective criminogenic effect of out-of-home care placement among aging out youth: The role of mediating mechanisms. Dissertation Abstracts International Section A: Humanities and Social Sciences, 69(2-A), 751.
Violent delinquency represents a small, albeit, burgeoning area of research interest in the field of child welfare. Investigators have recently turned their attention to the impact of child welfare services on delinquent offending. Particularly relevant to this line of inquiry are investigations of the impact of placement experiences, involving youth who have been removed from their homes and placed into substitute care settings, on later offending patterns. Initial reports suggest that experiences such as number of placements, type of placement, and re-entry affect later offending. Using survey data from the Midwest Study of the Adult Functioning of Former Foster Youth (The Midwest Study), this study uses structural equation modeling to examine two models which hypothesize that adverse care experience is associated with violent delinquency directly and indirectly through poor social bonds encompassing parent/caregiver attachments, school commitment, and involvement in prosocial activities. In the first model, parent/caregiver attachments are characterized by closeness to birth parents and grandparents. In the second model, parent/caregiver attachments are characterized by closeness to foster parents. Overall, analysis of the structural models revealed that a direct association between poor out-of-home care experience and violent delinquency is maintained when controlling for abuse, mental health diagnosis, and parent/caregiver problems. Moreover, social bonds composed primarily of school commitment, but also attachment to foster parents, and involvement in prosocial activities have a full mediating effect on the relationship between poor care experience and violent delinquency. Attachment defined by closeness to foster parents failed to yield any positive associations in the hypothesized model. Finally, each model functions differently across race and gender subgroups. Study findings support the need for further research to test a causal model along with other factors of importance to the care experience/violent delinquency relationship. Findings also have implications for researchers', policy makers', and practitioners' understanding of the impact of child welfare services intervention and achieving successful outcomes among youth in out-of-home care. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Boucharlat, M., Montani, C., Myslinski, M., & Franco, A. (2006). How can psychological help be provided for the patient/caregiver tandem home? L'Encephale: Revue de psychiatrie clinique biologique et therapeutique, 32(1), 92-96.
The literature shows us that psychological assistance is more common at distance from home, in hospitals, in special institutions or specific organizations. However, there is a clear need of help at home. We propose to develop psychological assistance at home for the patient/helper tandem in cases of dementia. This prospective study reports three different cases. Patients were diagnosed with severe dementia, assistance showed deep fatigue of the helper, both members of the tandem lived at home, age above 69 years, the eed for nursing care at home. Our methodology included two assessments: the first, assessing the task of the helper before the evaluation and the second taking into account a new measurement of the task and the opinions of the participants following a semi-directed interview. Clinical observation of the therapeutic assistance appears to show that psychological help at home could lead to the improved psychological function of the helper. This was emphasized when we established the limits of the caregiver/patient relationship. This prospective study leads us to the conclusion that the superposition of the frame of life and of the therapeutic frame represents a limit to psychotherapy but is not exclusive of psychological support at home. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Bowden, G., & Bliss, J. (2008). Does using a hospital bed have an impact on the meaning of home? British Journal of Community Nursing, 13(12), 556.
During the end of life care of patients with cancer, hospital beds are often introduced into the home setting. The impact of this intervention is not known. Clinical experience of the phenomena indicates that two components may be relevant in this scenario -- the preference for home care and the meaning of home. A review of related literature revealed that there is a high preference for being at home at the end of life and that 'home' has multiple meanings for people such as familiarity, control and biography. The meaning of home has implications for community nursing practice.
Bowey, L., & McGlaughlin, A. (2005). Adults with a learning disability living with elderly carers talk about planning for the future: Aspirations and concerns. British Journal of Social Work, 35(8), 1377-1392.
The majority of adults with a learning disability live with family carers, many of whom are ageing and have support needs of their own. Planning for the future thus becomes the key to preventing a crisis situation when family care is no longer viable because of death or ill health. Existing knowledge and practice are largely based upon the perspective of professionals and carers. This study explores the views, aspirations and concerns of adults with a learning disability, about living at home and planning for the future. Findings show that participants were very aware of the need for alternative housing or support in the future and had clear preferences about their future options. However, they also showed extensive concern for their family carers and this often impacted on their willingness to plan for the future or to move to alternative housing. Their demonstrable awareness of the inevitable death or ill health of family carers, and willingness to engage with the implications, emphasize the importance of involving adults with a learning disability in planning for their future, as well as providing them with bereavement support. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Boyce, P. S., & Feldman, P. H. (2007). ReACH National Demonstration Collaborative: early results of implementation. Home Health Care Services Quarterly, 26(4), 105-120.
The Reducing Acute Care Hospitalization (ReACH) National Demonstration Collaborative is a two-year multi-wave initiative using a "virtual" Collaborative Learning Model to reduce acute care hospitalization rates among home care patients. ReACH aims to reduce hospitalization to 23%, as recommended by the Centers for Medicare and Medicaid Services in its 8th Scope of Work for Quality Improvement Organizations. This article reports on the early implementation experience of a sample of 17 of 65 home health agencies participating in Wave I of ReACH. It examines agency challenges in implementing a structured practice improvement initiative, improving hospital to home transitions and focusing appropriate resources on high risk patients. Lessons learned will inform future home health care quality improvement initiatives.
Brega, A. G., Goodrich, G. K., Powell, M. C., & Grigsby, J. (2005). Racial and ethnic disparities in the outcomes of elderly home care recipients. Home Health Care Services Quarterly, 24(3), 1-21.
The purpose of this study was to examine racial/ethnic disparities in functional outcomes of elderly home health care recipients. Analyses were conducted using Outcome and Assessment Information Set (OASIS) data for a nationally representative sample of home health care episodes for patients aged 65 and older. Risk-adjusted regression analyses examined the association between race/ethnicity and functional outcomes. Fourteen outcome measures reflected improvement in specific functional areas (e.g., ambulation) and two reflected overall functional change. Non-Hispanic Whites ("Whites") experienced substantially better functional outcomes than did home health care recipients of other racial/ethnic backgrounds. The disparity in outcomes was most pronounced between Whites and African Americans.
Brennan, E. M., Bradley, J. R., & Lieberman, L. A. (2008). Child care: An essential support for working families. Rosenzweig, Julie M, 175-200.
(create) This chapter looks at the challenges of finding and maintaining child care. This includes choice and availability of child care, and the lack of access to quality care. Although parents of children with typical development may have to look hard for quality child care arrangements, for many families with children who have emotional or behavioral challenges, finding and maintaining adequate child care can be a nearly impossible quest. As research and other sources of evidence uncover the additional challenges experienced by families caring for children with mental health disabilities, the urgent need for comprehensive systems and services that address the needs of parents who are employed or wish to be employed is increasingly apparent. The chapter also looks at mental health consultation in child care settings, and in-home child care arrangements. Finally, the chapter details the benefits of appropriate child care, as well as applications and implications for policy, practice, and families. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Bridge, G. (2004). Disabled Children and Their Families in Ukraine: Health and Mental Health Issues for Families Caring for Their Disabled Child at Home. Social Work in Health Care, 39(1-2), 89-105.
In the Eastern European countries included in the communist system of the USSR, parents of disabled children were encouraged to commit their disabled child to institutional care. There were strict legal regulations excluding them from schools. Medical assessments were used for care decisions. Nevertheless many parents decided to care for their disabled child at home within the family. Ukraine became an independent country in 1991, when communism was replaced by liberal democracy within a free market system. Western solutions have been sought for many social problems existing, but 'hidden,' under the old regime. For more of the parents of disabled children, this has meant embracing ideas of caring for their disabled children in the community, and providing for their social, educational, and medical needs, which have previously been denied. The issue of disability is a serious one for Ukraine where the nuclear disaster at Chernobyl in 1986 caused extensive radiation poisoning. This almost certainly led to an increase in the number of disabled children being born and an increase in the incidence of various forms of cancer. This paper is based on a series of observation visits to some of the many self-help groups established by parents, usually mothers, for their disabled children. It draws attention to the emotional stress experienced both by parents and their disabled children in the process of attempting to come to terms with the disabling conditions, and the denial of the normal rights of childhood resulting from prejudice, poor resources, ignorance, and restrictive legislation. Attempts have been made to identify the possible role and tasks of professional social workers within this context. International comparisons show that many parents and their children do not benefit from the medical model of disability, and that serious consequences include the development of depressive illness among those who find that little help is available from public services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Brink, P., Smith, T. F., & Linkewich, B. (2006). Factors associated with pressure ulcers in palliative home care. Journal of Palliative Medicine, 9(6), 1369-1375.
Background: Studies have identified factors associated with pressure ulcers in many health care settings including acute care, complex continuing care, long-term care, and home care. Objective: The purpose of this study was to identify factors associated with pressure ulcers among palliative home care clients. Identifying associations specific to each setting is important for ulcer prevention and has implications for clients overall well-being and quality of life. Methods: The study included all palliative home care clients diagnosed with terminal cancer from one palliative home care agency in Ontario. Information on health was gathered using the interRAI instrument for palliative care. Results: The study found male gender, the inability to lie flat because of shortness of breath, catheter, or ostomy care, and a reduced ability to perform activities of daily living to be associated with pressure ulcers. Significance of results: In some instances, treatment and prevention of pressure ulcers is the primary goal of care. However, pressure ulcers are also suggestive of deterioration and considered as a part of the disease trajectory. Sometimes the primary goal of care of treatment and prevention is displaced by a greater need for comfort. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Broadhurst, K., & Pendleton, T. (2007). Revisiting children 'home on trial' in the context of current concerns about the costs and effectiveness of the looked-after children system: findings from an exploratory study. Child & Family Social Work, 12(4), 380-389.
Statute and practice relating to s.31 part IV of The Children Act 1989 allow children subject to care orders to be placed at home with their parent(s). It is not uncommon for the courts to accept a plan for children to return home at the final hearing of care proceedings at which full care orders are granted. In such instances, children retain looked-after status but, in terms of their day-to-day care, are looked after by parent(s). Whilst there are a small number of studies conducted in the 1990s relating to children 'home on trial', there is a much more limited recent literature. It is important to revisit this population of children, given current concerns about the burgeoning costs of child care proceedings and the looked-after children system (LAC). This paper reports on a small-scale exploratory study in one north-west local authority area. Consisting of a file study and interviews with parents and professionals, the study examines the factors that contributed to initial removal of children to public care, the impact of the LAC system for children 'home on trial', stability of placements at home, as well as issues to do with the discharge of care orders. Particular attention is drawn to lone father headed households, a social group over-represented in our sample. The study aims to inform further multi-location studies.
Broekhuis, M., de Blok, C., & Meijboom, B. (2009). Improving client-centred care and services: the role of front/back-office configurations. Journal of Advanced Nursing, 65(5), 971-980.
Aim. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Background. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Method. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). Findings. The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. Conclusions. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.
Brown, E. L. (2006). The role of individual and community characteristics in child welfare placement decisions. Dissertation Abstracts International Section A: Humanities and Social Sciences, 67(1-A), 335.
This research examines both individual and community characteristics that may influence decisions of a local child welfare agency, following a substantiated report of maltreatment, to place children in out-of-home care or leave them in their own home. There is little research to date that integrates characteristics of the child and mother, with characteristics of the local agency and surrounding county, and methodological concerns have precluded analysis of possible cross-level interactions. The study presented here makes use of recent advances in event history analysis, and uses data routinely collected such as vital statistics, child welfare administrative records, and US Census Bureau reports. Support for this research was provided by the CAPTA fellowship grant (2003-2005) from the Children's Bureau, US DHSS, Administration for Children and Families. Findings suggest three areas where individual and community characteristics seem to play a role in decisions to place a child. First, it would appear that placement decisions are associated with characteristics that describe very vulnerable children---low birth weight, newborn abnormalities, multiple reports of maltreatment, victim of abuse rather than neglect, or age 0-30 days at substantiation. Second, results suggest that for many children without these vulnerabilities, placement decisions are based on maternal characteristics evaluated differently from one agency to another. The education levels of agency staff, participation in reform, and use of foster home initial placements, seem to moderate the influence of maternal characteristics such as prenatal care, marital status, and prior births. Finally, levels of staff turnover, use of foster care versus in-home services, and social services reform appear to influence placement decisions for African-American children differently than for other children. However, results address associations not causality, and are exploratory not conclusive. As child welfare research has only begun to include multi-level analyses, and few studies address any of the community contextual variables included here, further research would help determine whether results can be confirmed in other settings. More information about agency and maternal characteristics, and a more focused analysis of race and ethnicity, would also be helpful in exploring the issues illuminated by this analysis. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Bryant-Stephens, T., & Li, Y. (2008). Outcomes of a home-based environmental remediation for urban children with asthma. Journal of the National Medical Association, 100(3), 306-316.
CONTEXT: Increasing urban asthma prevalence and severity is found among minority, underserved populations. Improving asthma self-management includes home management of complex medical protocols as well as environmental trigger removal. OBJECTIVE: To study the effectiveness of a low-cost approach to improve control of asthma symptoms in an urban population through lay educators who promote a generalized approach to asthma trigger avoidance in the bedrooms of children with asthma. DESIGN AND PATIENTS: Prospective, randomized controlled trial with two arms: historical controls and matched controls for each subject. SUBJECTS: Two-hundred-eighty-one patients living in an urban environment, randomized to receive home visits only (n = 128) or home visits with environmental remediation (n = 153). One-hundred-fifteen controls matched according to age, gender and ethnicity did not receive any intervention. INTERVENTIONS: In-home education visits covered asthma physiology, asthma trigger avoidance and asthma management. Environmental remediation was conducted together with the caregiver. OUTCOMES: Primary outcomes include length of hospital stay, number of emergency visits and number of sick visits. Secondary outcomes are symptom frequency, medication management and trigger reduction. RESULTS: Both intervention groups experienced reduction of hospitalizations, emergency room visits, sick visits and asthma symptoms. Both groups showed outcomes significantly superior to the matched control group. Intervention effectively reduced the presence of rodents and carpet in home and increased the use of mattress and pillow covers. CONCLUSIONS: This study shows that low-cost in-home education and environmental remediation improve outcomes for children with asthma. Lay educators can deliver effective asthma-specific education that results in improved asthma control.
Cabin, W. D. (2008). Moving toward Medicare home health coverage for persons with Alzheimer's disease. Journal of Gerontological Social Work, 51(1-2), 77-86.
Medicare home health care policy does not incorporate research evidence of effective palliative home care interventions for Alzheimer's disease and dementia patients and caregivers. This article examines the dissonance between the needs and burdens of Alzheimer's disease patients and caregivers, research results on medical and palliative care interventions, and medicalized public policy in the Medicare home health benefit. The article asserts existing research establishes a prima facie case exists for the federal government to fund a Medicare Palliative Home Care for Alzheimer's disease demonstration project. The article cites the success of the Medicare Hospice Demonstration project and Hospice Medicare Benefit in reducing costs and improving client quality of life as precedent and a model for Alzheimer's disease. Other research implications are identified. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Cabin, W. D. (2009). Evidence-based research challenges home care PPS patient benefits, costs, and payment structure. Home Health Care Management & Practice, 21(4), 240-245.
A neglected area of discussion in home care is the relationship and dissonance between evidence-based research on effective home and community-based interventions, Medicare home health practice, and the Medicare Home Health Prospective Payment System (PPS). PPS is critical because the literature increasingly indicates that the PPS reimbursement framework drives home health agency and practitioner resource allocation and practice decisions. However, the PPS system does not have an evidence-based evaluation process to evaluate the effectiveness and cost-effectiveness of new, or existing, intervention. The article reviews existing evidence-based research on the effectiveness of home-based environmental skills building, counseling, and support group interventions, which benefit patients, caregivers, home health agencies, and Medicare. The article indicates these interventions have never been evaluated, nor are they covered by Medicare. The article asserts the need for such an evaluation process to evaluate intervention cost-effectiveness and related changes in Medicare coverage, eligibility, reimbursement, and outcomes measurement criteria necessary for their adoption.
Cai, P., Hebert, M., Cowie, R., & Meadows, L. (2006). Experience with home telehealth to support disease management in teenagers with asthma... 6th International Conference on Successes and Failures in Telehealth, SFT-6, Brisbane, Queensland, Australia, 24-24 August, 2006. Journal of Telemedicine & Telecare, 12, S3:23-25.
We explored the role of home telehealth in teenagers' asthma management. Six female teenagers were identified at the asthma clinic of the Alberta Children's Hospital. Qualitative interviews were conducted with the teenagers, their parents and their health care providers before and after they used a home unit to report peak flow and adherence to asthma self-management plans. The equipment was used for three months. Using social cognitive theory allowed five themes to be identified: usability of technology, using technology, technology and personal factors, technology and environmental factors, and technology and behavioural factors. The unsuccessful experience with peak flow data transmission suggested that testing the usability of an approved technology with a particular group of patients is important. Disease status, self-efficacy and asthma management behaviour prior to using the technology, as well as access to healthcare facilities, all seem likely to influence the role of technology in disease management.
Cameron, J. I., Shin, J. L., Williams, D., & Stewart, D. E. (2004). A brief problem-solving intervention for family caregivers to individuals with advanced cancer. Journal of Psychosomatic Research, 57(2), 137-143.
Objective: To evaluate a brief problem-solving intervention for family caregivers to individuals with advanced cancer. Method: Family caregivers were recruited through oncology clinics of a large tertiary care hospital in Canada. Those providing informed consent completed a baseline survey, received a brief problem-solving intervention, received a detailed home care guide, and completed a follow-up survey over the telephone 4 weeks after receiving the intervention. Results: Thirty-four family caregivers completed all aspects of the study. Sixty-eight percent of caregivers were women, 73.5% were married to the care recipient, and their average age was 53.6 years. This brief intervention resulted in improvements in emotional tension (P<.03), caregiving confidence (P<.06), and positive problem-solving orientation (P<.06). Conclusion: These findings suggest that even a brief problem-solving intervention may be beneficial for family caregivers to individuals with advanced cancer. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Campbell, M. (2008). (Dis)continuity of care: Explicating the ruling relations of home support. DeVault, Marjorie L, 266-288.
(from the chapter) This chapter is based on Marie Campbell's participatory research on home care for people with disabilities and its transformation as new managerial strategies are introduced into the Canadian health system. Her analysis here focuses on continuity of care, an explicit goal in service delivery. The puzzle she explores is how the new contracting and accounting arrangements displace continuity in favor of budgetary considerations, despite stated goals and good intentions. Campbell finds answers in a mode of supervision introduced to monitor the work of nonprofessional health aides and in a contracting system that shifts responsibility for continuity from the provincial funding entity to the agencies that hire and schedule workers. New public management theorists suggest that decoupling funding and service delivery will allow the state to benefit from market efficiencies. But Campbell asks us to consider several different ways of knowing (and not knowing) built into these relations, suggesting that those with mandated responsibility for programs know financial impacts better than what happens in the service encounter. She also suggests that these accounting practices contribute to making health-support work one of the so-called bad jobs of the New Economy; it is not only low-paid work but increasingly work that does not provide the satisfaction of personal relationships with clients. Her analysis suggests that such jobs are not simply or inevitably "bad" ones; the work could be organized differently. Like Daniels study of her own work environment, Campbell's study illustrates how professionals and other front-line workers might join with clients to explore and map the social processes that govern their interactions. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Canady, L. M. (2008). One organization's experience. Implementing a home telemonitoring program. Home Healthcare Nurse, 26(4), 231-236.
In the current healthcare arena, it is imperative that home healthcare agencies seek to re- duce costs and produce positive outcomes from the care they give. Telemonitoring offers the ability to monitor closely the daily status of the patients that home healthcare agencies serve, to provide best practice care, and to produce positive outcomes from that care. This article presents the experience of how 1 hospital-based agency implemented a home telemonitoring pro-gram and describes the lessons learned throughout the process. The current healthcare arena demands cost reduction and improved patient care outcomes from home healthcare agencies (HHAs). The direction that each HHA chooses to take to answer these demands will set the stage for their future. This article describes the steps needed to implement a telemonitoring program. The description is based on how 1 HHA chose its course of action and set it in motion and shows what was learned throughout the process.
Carey, I. M., De Wilde, S., Harris, T., Victor, C., Richards, N., Hilton, S. R., et al. (2008). What Factors Predict Potentially Inappropriate Primary Care Prescribing in Older People?: Analysis of UK Primary Care Patient Record Database. Drugs & Aging, 25(8), 693-706.
BACKGROUND: Potentially inappropriate prescribing (PIP) in older people has been identified as a substantial problem, but few large population-based studies have investigated the underlying factors that predict it. OBJECTIVE: To: (i) examine trends in PIP in UK older primary care patients; and (ii) assess factors associated with PIP. METHODS: An analysis of routine, anonymized, computerized patient records of 201 UK general practices providing data to the DIN-LINK database between 1996 and 2005, which included approximately 230 000 registered patients per year aged >/=65 years. The main outcome measures were the number of different drugs prescribed per patient annually and the percentage of patients prescribed a PIP drug (modified 2003 Beers criteria). These were assessed for all drugs, and then for selected sub-classes (analgesics, antidepressants and sedatives/anxiolytics). RESULTS: Whilst the number of drugs prescribed per patient increased, the percentage of subjects receiving a PIP drug declined from 32.2% in 1996 to 28.3% in 2005, largely due to a fall in co-proxamol (dextropropoxyphene/paracetamol [acetaminophen]) prescribing. In 2005, female gender, being older, more socio-economically deprived or in a care home were strongly associated with PIP. However, the number of drugs prescribed was strongly associated with these variables and the strongest predictor of PIP; adjusting for number of drugs dramatically reduced the strength of all other associations except female gender with PIP. Factors predicting PIP in drug sub-groups were similarly reduced when adjusted for polypharmacy. However, some age trends remained: in the oldest group (aged >/=85 years), PIP of analgesics was less likely (odds ratio [OR] = 0.70, 95% CI 0.66, 0.75) while PIP of antidepressants was more likely (OR = 1.39, 95% CI 1.28, 1.51). CONCLUSION: PIP amongst older people in the UK, although declining, remains at a high level. The association of PIP with age, deprivation and care homes is largely explained by the higher overall prescribing rates in these groups. The overall rise in prescribing emphasizes that polypharmacy does not necessarily increase PIP and attempts to reduce PIP by focusing on polypharmacy have not been successful. Reductions in PIP have previously been achieved by introducing national guidelines (e.g. co-proxamol), but might also be achieved by alerting practitioners at the point of prescribing.
Carmel, S., Morse, C. A., & Torres-Gil, F. M. (2007). Lessons on aging from three nations, Volume II: The art of caring for older adults. 230.
(from the publicity materials) The global phenomenon of the aging of societies during a period of outstanding scientific, economic, and technological advancements is a blessing for humanity. These fundamental changes, however, create new needs and problems in all areas of life, often difficult to address. In some countries, the trend is toward compression of the period of age-related morbidity--fewer years of living with disabilities--but the absolute numbers of elderly people living with disabilities are increasing worldwide. This book highlights a series of global threats, problems, and challenges in the areas of care and caregiving, through the prism of three multicultural nations: the United States, Israel, and Australia. The contributors to this book, experts in their fields, focus on the art of caregiving at the national level, including the interface between family and state responsibilities, policies and practices in the provision of services, and the demands for education and training, as well as the problems and difficulties faced by family caregivers. One section is devoted to the art of letting go and the agonizing conditions that can be related to end-of-life care, often faced by elderly patients, families, and their professional caregivers. By examining some of the most pressing challenges confronting all aging societies and drawing from the experiences of their own, diverse societies, the authors provide directions, suggestions, and promises for solutions for policymakers, advocacy groups, and the private sector--ways of improving the quality of care for recipients and easing the burden of caregivers. This is the second of two edited volumes on aging and caregiving. The first, Lessons from Three Nations--Volume I: The Art of Aging Well, examines positive aspects of and successful adaptations to aging. This second volume focuses on challenges and concerns for families, policy makers, and governments in caregiving and end-of-life issues. In this way, we hope to provide clues and suggestions for future research, policies, and practices in the comparative study of global aging. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Carnevale, F. A., Alexander, E., Davis, M., Rennick, J., & Troini, R. (2006). Daily living with distress and enrichment: the moral experience of families with ventilator-assisted children at home. Pediatrics, 117(1), e48-60.
OBJECTIVE: The growing shift toward home care services assumes that "being home is good" and that this is the most desirable option. Although ethical issues in medical decision-making have been examined in numerous contexts, home care decisions for technology-dependent children and the moral dilemmas that this population confronts remain virtually unknown. This study explored the moral dimension of family experience through detailed accounts of life with a child who requires assisted ventilation at home. This study involved an examination of moral phenomena inherent in (1) the individual experiences of the ventilator-assisted child, siblings, and parents and (2) everyday family life as a whole. METHODS: A qualitative method based on Richard Zaner's interpretive framework was selected for this study. The population of interest for this study was the families of children who are supported by a ventilator or a positive-pressure device at home. Twelve families (38 family members) were recruited through the Quebec Program for Home Ventilatory Assistance. Children in the study population fell into 4 diagnostic groups: (1) abnormal ventilatory control (eg, central hypoventilation syndrome), (2) neuromuscular disorders, (3) spina bifida, and (4) craniofacial or airway abnormalities resulting in upper airway obstruction. All 4 of these diagnostic groups were included in this study. Among the 12 children recruited, 4 received ventilation via tracheostomies, and 8 received ventilation with face masks. All of the latter received ventilation only at night, except for 1 child, who received ventilation 24 hours a day. Family moral experiences were investigated using semistructured interviews and fieldwork observations conducted in the families' homes. RESULTS: Data analysis identified 6 principal themes. The themes raised by families whose children received ventilation invasively via a tracheostomy were not systematically different or more distressed than were families of children with face masks. The principal themes were (1) confronting parental responsibility: parental responsibility was described as stressful and sometimes overwhelming. Parents needed to devote extraordinary care and attention to their children's needs. They struggled with the significant emotional strain, physical and psychological dependence of the child, impact on family relationships, living with the daily threat of death, and feeling that there was "no free choice" in the matter: they could not have chosen to let their child die. (2) Seeking normality: all of the families devoted significant efforts toward normalizing their experiences. They created common routines so that their lives could resemble those of "normal" families. These efforts seemed motivated by a fundamental striving for a stable family and home life. This "striving for stability" was sometimes undermined by limitations in family finances, family cohesion, and unpredictability of the child's condition. (3) Conflicting social values: families were offended by the reactions that they faced in their everyday community. They believe that the child's life is devalued, frequently referred to as a life not worth maintaining. They felt like strangers in their own communities, sometimes needing to seclude themselves within their homes. (4) Living in isolation: families reported a deep sense of isolation. In light of the complex medical needs of these children, neither the extended families nor the medical system could support the families' respite needs. (5) What about the voice of the child? The children in this study (patients and siblings) were generally silent when asked to talk about their experience. Some children described their ventilators as good things. They helped them breathe and feel better. Some siblings expressed resentment toward the increased attention that their ventilated sibling was receiving. (6) Questioning the moral order: most families questioned the "moral order" of their lives. They contemplated how "good things" and "bad things" are determined in their world. Parents des ribed their life as a very unfair situation, yet there was nothing that they could do about it. Finally, an overarching phenomenon that best characterizes these families' experiences was identified: daily living with distress and enrichment. Virtually every aspect of the lives of these families was highly complicated and frequently overwhelming. An immediate interpretation of these findings is that families should be fully informed of the demands and hardships that would await them, encouraging parents perhaps to decide otherwise. This would be but a partial reading of the findings, because despite the enormous difficulties described by these families, they also reported deep enrichments and rewarding experiences that they could not imagine living without. Life with a child who requires assisted ventilation at home involves living every day with a complex tension between the distresses and enrichments that arise out of this experience. The conundrum inherent in this situation is that there are no simple means for reconciling this tension. This irreconcilability is particularly stressful for these families. Having their child permanently institutionalized or "disconnected" from ventilation (and life) would eliminate both the distresses and the enrichments. These options are outside the realm of what these families could live with, aside from the 1 family whose child is now permanently hospitalized, at a tremendous cost of guilt to the family. CONCLUSIONS: These findings make important contributions by (1) advancing our understanding of the moral experiences of this group of families; (2) speaking to the larger context of other technology-dependent children who require home care; (3) relating home care experiences to neonatal, critical care, and other hospital services, suggesting that these settings examine their approaches to this population that may impose preventable burdens on the lives of these children and their families; and (4) examining a moral problem with an empirical method. Such problems are typically investigated through conceptual analyses, without directly examining lived experience. These findings advance our thinking about how we ought to care for these children, through a better understanding of what it is like to care for them and the corresponding major distresses and rewarding enrichments. These findings call for an increased sensitization to the needs of this population among staff in critical care, acute, and community settings. Integrated community support services are required to help counter the significant distress endured by these families. Additional research is required to examine the experience of other families who have decided either not to bring home their child who requires ventilation or withdraw ventilation and let the child die.
Caron, C. D., Ducharme, F., & Griffith, J. (2006). Deciding on Institutionalization for a Relative with Dementia: The Most Difficult Decision for Caregivers. Canadian Journal on Aging, 25(2), 193-205.
The decision to move a family member with dementia to a nursing home is a difficult experience for caregivers. Complex psychosocial factors are involved and knowledge of predictive factors alone is insufficient. Using grounded theory, this study explores the decision-making process with regards to institutionalization, from the perspective of family caregivers. Fourteen people who moved a relative to long-term care in the preceding 6 months were interviewed. Data analysis using comparative analysis and line-by-line dimensional analysis was used to develop a theoretical model of the decision-making process. Three factors within the model were central to the process: (a) caregivers' perceptions of their ability to provide care, (b) caregivers' evaluations of their relatives' ability to make care decisions, and (c) the evolving influence of contextual factors and interactions with healthcare professionals. The contribution of these findings to new conceptualizations of institutionalization is discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Carretero, S., Garcés, J., & Ródenas, F. (2007). Evaluation of the home help service and its impact on the informal caregiver's burden of dependent elders. International Journal of Geriatric Psychiatry, 22(8), 738-749.
AIM: This study looks at the objective and subjective characteristics of home respite service provision and its impact on the informal care burden of dependent elders. METHOD: A sample of 296 dependent people and their informal caregivers was randomly selected among users and non-users of the Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). An experimental design was used and a field study was carrying out that collected information on sociodemographic variables of the dependent person and his/her caregiver, HHS characteristics and the assessment of the services delivered by this resource as well as the informal caregivers'burden. RESULTS: The results show that the services of this resource are very limited, with low cover and frequency, and they do not address the real dependency needs in specific activities of daily living. However, users and caregivers are satisfied with this care and experience a higher quality of life since it was implemented, although the HHS does not alleviate informal caregivers' stress. CONCLUSION: These data show the need to extend the services delivered by the HHS and the duration of care, address the caregiver's need for psychological care, and look at potentially modifiable variables in the care context when designing prevention and psychosocial intervention programmes to lessen the informal caregiver's burden. Copyright (c) 2006 John Wiley & Sons, Ltd.
Ceci, C. (2008). Increasingly distant from life: problem setting in the organization of home care. Nursing Philosophy, 9(1), 19-31.
The analysis undertaken in this paper explores the significance of a central finding from a recent field study of home care case management practice: a notable feature of case management work is the preparation of an orderly, ordered space where care may be offered. However, out of their encounters with an almost endless variety of situations, out of people's diverse narratives of need, case managers seem able to pick out only limited range of recognized needs to which to respond and demonstrate a series of responses themselves equally limited. Though this observation suggests a kind of efficiency that is currently highly valued within healthcare systems, it also underlines the system's inability to engage difference and variability in a meaningful way. This inability or limitation in effectively engaging difference is conceptualized here as, in some sense, a problem, and the nature of this problem is explored through the rhetorical process of problem setting. The central question becomes how might we develop and deploy an orderly and coherent system of care without essentializing people's experiences, without treating these experiences reductively, without, in a Foucaultian frame of reference, allowing what can be understood as similarity or resemblance among clients and situations to be folded back into sameness? As we encounter complexity, variability and difference in practice, how should we treat it?
Childress, S. B., & Christensen, A. R. (2007). Improving symptom management at the end of life in the home care environment. Home Health Care Management & Practice, 19(5), 360-363.
Symptom management for terminal or end-of-life patients in the home environment is an important quality-of-life issue. Providers in home care have a responsibility to evaluate the quality of their symptom management and make changes as necessary to meet patient needs and national guidelines. This article explores some of the specific challenges seen in the home care environment and makes suggestions for addressing these challenges. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Chvetzoff, G., Garnier, M., Perol, D., Devaux, Y., Lancry, L., Chvetzoff, R., et al. (2005). Factors Predicting Home Death for Terminally Ill Cancer Patients Receiving Hospital-Based Home Care: The Lyon Comprehensive Cancer Center Experience. Journal of Pain and Symptom Management, 30(6), 528-535.
This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Chvetzoff, G., Garnier, M., Pérol, D., Devaux, Y., Lancry, L., Chvetzoff, R., et al. (2005). Factors predicting home death for terminally ill cancer patients receiving hospital-based home care: the Lyon Comprehensive Cancer Center experience. Journal of Pain & Symptom Management, 30(6), 528-535.
This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives. © 2005 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Ciechanowski, P., Wagner, E., Schmaling, K., Schwartz, S., Williams, B., Diehr, P., et al. (2004). Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 291(13), 1569-1577.
Examined community-integrated home-based depression treatment in 138 older adults (mean age 73 yrs), in a randomized controlled trial using the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS). Ss were adults aged 60+ yrs or older who were receiving services from senior service agencies or living in public housing with DSM-IV minor depression or dysthymia diagnostic criteria. The Primary Care Evaluation of Mental Disorders screening tool was completed. Ss were interviewed by trainer researcher using the Structured Clinical Interview for DSM-IV. Health-related quality of life, physical, social, and emotional functioning were assessed at baseline and 12 months. Health-care utilization was assessed in three 6 month periods from 6 mo before to 12 mo after baseline. Results revealed that the PEARLS intervention resulted in significantly lower severity and greater remission of depression compared with usual care at 6 and 12 months. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Clark, P. G. (2007). Understanding aging and disability perspectives on home care: Uncovering facts and values in public-policy narratives and discourse. Canadian Journal on Aging, 26(Suppl1), 47-62.
Every public-policy problem can be defined in terms of its empirical ("facts") and normative ("values") dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of "narrative frame" analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure--including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Clarke, J. N. (2005). Fathers' Home Health Care Work When a Child Has Cancer: I'm Her Dad; I Have to Do It. Men and Masculinities, 7(4), 385-404.
This report is based on qualitative interviews studying the health care work described by sixteen fathers whose children had been diagnosed with cancer. Childhood cancers are important diseases that are growing in incidence. Greater life expectancy is associated with intense treatment protocols, which often include chemotherapy, radiation, surgery, and sometimes bone marrow transplants. Parents or parental figures play a significant role in the treatment in the home, in the outpatient clinic, and in the hospital. But very little is known about the health care work done by fathers or mothers when their children have cancer. This article examines fathers' home health care work, including specific health care, medical advocacy, administration/financial management, and emotion work. It points to the value and the necessity of further systematic investigation of the often invisible health care work that fathers may do when their children are ill. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Clarke, J. N. (2006). Mother's Home Healthcare: Emotion Work When a Child has Cancer. Cancer Nursing, 29(1), 58-65.
Home healthcare work, involving physical labor, nursing care, medical monitoring, administrative, planning and accounting, advocacy and emotion work, is unpaid and largely invisible. This article, based on focus group interviews with mothers whose children have had cancer, describes one part of their home healthcare labor, their emotion work. Specifically, it examines how mothers: manage the moral imperatives of mothering; think about and try to manage the strong feelings, particularly of fear and uncertainty that they often have when their children are ill with cancer; work to understand and maintain their marital relationships; the strategies that seemed to help; and finally, the self-transformation that many mothers experience. The article concludes with a discussion of the substantive, theoretical, research, and policy implications of emotion work in the provision of home healthcare work. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Clegg, K. A. (2006). Review of Home treatment for acute mental disorders: An alternative to hospitalization. Psychiatric Services, 57(11), 1665.
Reviews the book, Home Treatment for Acute Mental Disorders: An Alternative to Hospitalization by David S. Heath (see record 2005-06148-000). This text will appeal to readers from a variety of disciplines in mental health care, as well as to clients and their family members interested in increasing their fund of knowledge about available treatment options. In a particularly useful review, the author discusses the use of mobile crisis home treatment for several common psychiatric diagnoses--including depression, schizophrenia, borderline personality disorder, mania, first-episode psychosis, and severe postpartum depression--and illuminates this discussion with numerous detailed case examples. The author utilizes sidebars to discuss areas of related interest, thereby highlighting these areas for interested readers as well as for those who do not wish for a diversion from the content at hand. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Coleman, E. A., Smith, J. D., Frank, J. C., Min, S., Parry, C., & Kramer, A. M. (2004). Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. Journal of the American Geriatrics Society, 52(11), 1817-1825.
OBJECTIVES: To test whether an intervention designed to encourage older patients and their caregivers to assert a more active role during care transitions can reduce rehospitalization rates. DESIGN: Quasi-experimental design whereby subjects receiving the intervention (n=158) were compared with control subjects derived from administrative data (n=1,235). SETTING: A large integrated delivery system in Colorado. PARTICIPANTS: Community-dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions. INTERVENTION: Intervention subjects received tools to promote cross-site communication, encouragement to take a more active role in their care and assert their preferences, and continuity across settings and guidance from a transition coach. MEASUREMENTS: Rates of postdischarge hospital use at 30, 60, and 90 days. Intervention subjects' care experience was assessed using the care transitions measure. RESULTS: The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 (95% confidence interval (CI)=0.28-0.96) at 30 days, 0.43 (95% CI=0.25-0.72) at 90 days, and 0.57 (95% CI=0.36-0.92) at 180 days. Intervention patients reported high levels of confidence in obtaining essential information for managing their condition, communicating with members of the healthcare team, and understanding their medication regimen. CONCLUSION: Supporting patients and caregivers to take a more active role during care transitions appears promising for reducing rates of subsequent hospitalization. Further testing may include more diverse populations and patients at risk for transitions who are not acutely ill.
Cormican, K., & Dooley, L. (2007). Knowledge Sharing in a Collaborative Networked Environment. [Article]. Journal of Information & Knowledge Management, 6(2), 105-114.
Knowledge is a key resource that must be managed within organisations and across collaborative enterprise networks. In particular, the two major challenges that such organisations face are ensuring that they have the appropriate knowledge to support their operations and ensuring that they optimise these knowledge resources available to them. In recent years, researchers, consultants and industrialists have developed approaches in an attempt to address these requirements. Most of these approaches have been technology oriented. In other words, the implementation of information technology systems is seen as the solution to enterprise knowledge management problems. However, research indicates that organisations are still failing to convert individual skills and competencies into tangible products and services. Knowledge management is an emerging discipline and it is still not very well understood or managed in industry. Consequently, new knowledge initiatives are not exploited to their full potential. In other words, companies are not reaping the full benefits of knowledge management projects. This paper explores the key constituents to managing knowledge and examines the main problems with sharing knowledge across teams and organisational boundaries. Findings from a qualitative study suggest that the key problems to managing knowledge across a collaborative network are person centric and consequently managers should focus their efforts on improving critical areas such as motivation and trust as well as people oriented methods and tools. [ABSTRACT FROM AUTHOR]
Copyright of Journal of Information & Knowledge Management is the property of World Scientific Publishing Company and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Coultas, D., Frederick, J., Barnett, B., Singh, G., & Wludyka, P. (2005). A randomized trial of two types of nurse-assisted home care for patients with COPD. CHEST, 128(4), 2017-2024.
STUDY OBJECTIVES: Whereas pulmonary rehabilitation reduces symptoms and improves the quality of life of patients with COPD and is recommended in management guidelines, few patients have access to rehabilitation services. The purpose of this study was to investigate the effectiveness of increasing access to selected components of pulmonary rehabilitation by providing nurse-assisted home care that was composed of patient education, efforts to improve patient self-management skills, and enhanced follow-up. DESIGN: We conducted a 6-month, randomized, controlled trial. SETTING: Primary care clinics associated with an urban academic health system. PATIENTS: Patients were > or = 45 years of age with a physician diagnosis of COPD, and had a > or = 20-pack-year smoking history, had experienced at least one respiratory symptom during the past 12 months, and had airflow obstruction (ie, FEV1/FVC ratio, < 70%; FEV1, < 80%). INTERVENTIONS: Four nurses were trained in the use of the Global Initiative for Chronic Obstructive Lung Disease guidelines, and two of the four nurses received additional training in collaborative management. Patients were randomly assigned to usual care (UC), nurse-assisted medical management (MM), or nurse-assisted collaborative management (CM). MEASUREMENTS: The main outcome measures were of generic (Medical Outcome Study 36-item short form [SF-36], illness intrusiveness) and disease-specific (St. George's respiratory questionnaire [SGRQ]) quality of life and self-reported health-care utilization. RESULTS: Overall, 151 patients (UC group, 51 patients; MM group, 49 patients; and CM group, 51 patients) completed the study, their average age was 69 years, and 56.9% were women. The average change in the SF-36 general health domain for the MM group vs the UC group was 1.1 (95% confidence interval [CI], -7.9 to 11.2), and for the CM group vs the UC group the average change was 2.5 (95% CI, -7.0 to 12.3). The corresponding changes in SGRQ total domain were -2.9 (95% CI, -9.8 to 4.1) and -2.6 (95% CI, -9.5 to 4.3). There was no change in the number of self-reported emergency department visits or hospitalizations, but the utilization of these services was infrequent. CONCLUSION: The findings of our investigation and those from the published literature suggest that interventions to enhance patient education, self-management skills, and follow-up among patients with COPD do not result in clinically meaningful improvements in health status or self-reported health-care utilization. Moreover, future studies of disease management programs for patients with COPD need to evaluate interventions that address associated comorbidities, exercise, and social support.
Crist, J. D., McEwen, M. M., Herrera, A. P., Kim, S., Pasvogel, A., & Hepworth, J. T. (2009). Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services. Research & Theory for Nursing Practice, 23(3), 165-180.
Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.
Crist, J. D., Velazquez, H., Durnan, I., & Figueroa, D. R. (2006). Instrument development of the Confidence in Home Care Services Questionnaire for use with elders and caregivers of Mexican descent. Public Health Nursing, 23(3), 284-291.
Mexican American elders use home care services less than non-Hispanic white elders, and a larger study is testing whether lack of confidence in home care services, measured by the Community Service Attitude Inventory, is a factor. In order to further develop the questionnaire for use with Mexican American elders and caregivers, qualitative interviews were conducted with Mexican American elders (n = 5), Mexican American caregivers (n = 5), and home care providers (n = 5). Content analysis of interviews supported 2 dimensions: confidence and fear/worry. The research team developed 29 items from the dimensions. Testing of the items (n = 15) suggested content validity and two additional items. The revised questionnaire was translated and tested for language equivalence in Spanish and English, assisted by a local community advisory council (n = 9). Through collaboration, bicultural/bilingual teams and community partners refined 1 instrument that can be used to measure one of many barriers to equity in health care services with vulnerable populations. Thematic findings may be incorporated into nurses' interventions as they offer home care services to families.
Currow, D. C., Christou, T., Smith, J., Carmody, S., Lewin, G., Aoun, S., et al. (2008). "Do terminally ill people who live alone miss out on home oxygen treatment: An hypothesis generating study": Correction. Journal of Palliative Medicine, 11(9), 1285.
Reports an error in "Do terminally ill people who live alone miss out on home oxygen treatment? An hypothesis generating study" by David C. Currow, Toula Christou, Joanna Smith, Steve Carmody, Gill Lewin, Samar Aoun and Amy P. Abernethy (Journal of Palliative Medicine, 2008[Sep], Vol 11, 1015-1022). On page 1015 of the original article, the correct affiliation for Samar Aoun, M.P.H., Ph.D. is WA Centre for Cancer and Palliative Care, Curtin University of Technology, Western Australia. (The following abstract of the original article appeared in record 2008-13717-016). Introduction: Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria for long-term home oxygen therapy are not met. Is palliative oxygen less likely to be prescribed when a person lives alone at the end of life? Methods: Three years of consecutively collected clinical data from a regional community palliative care program in Western Australia were used in univariate analyses utilizing chi superscript 2 and analysis of variance, as appropriate. Multivariable logistic regression was used to identify characteristics of people for who oxygen has been prescribed. Results: Of the study population (n = 5203), 9.8% (n = 507) did not have a caregiver. Oxygen was less likely to be prescribed for patients living alone (11.8% versus caregiver 20.6%; p < 0.001), those with cancer (18.8% versus non cancer 26.5%; p < 0.001), and older people (oxygen 68.1 years versus no oxygen 69.6 years; p = 0.005), and more likely to be prescribed for those with worse dyspnea (mean score 7/10, oxygen 7.6 versus no oxygen 4.2; p < 0.001). With severe dyspnea (= 7/10), people who lived alone had twice as many clinician visits before oxygen was prescribed (4.2 versus caregiver 1.7; p = 0.03). In multi factor analyses lung disease, dyspnea severity, and female gender predicted oxygen prescription, while not having a caregiver reduced the likelihood significantly (odds ration [OR] 0.51, 95% confidence interval [CI] 0.35-0.74; p < 0.001). Discussion: Presence of a caregiver in the home is associated with palliative oxygen prescription having controlled for time in hospital. This study raises questions about the reasons for oxygen prescription, and the role caregivers may play in initiating requests for therapy. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Davitt, J. K., & Marcus, S. C. (2008). The differential impact of Medicare home health care policy on impaired beneficiaries. Journal of Policy Practice, 7(1), 3-22.
The Balanced Budget Act of 1997 (BBA'97) dramatically decreased reimbursements in the Medicare home health program. The first phase of BBA'97, the Interim Payment System (IPS), slashed reimbursements to 1993 levels and established a new capitated reimbursement. To identify potential moderating influences of these changes on the relation-ship between patient impairment and home care use, we compared 1996 and 1998 Medicare Current Beneficiary Survey data. Using multivariate regressions controlling for health/functional, predisposing and enabling characteristics, we demonstrate dramatic decreases in home health use post IPS by persons with ADL, health, and memory impairments. The IPS encouraged agencies to cut services to more impaired patients who might exhaust the per-beneficiary cap. Similar policies may be adopted for other health systems. Thus, it is critical to understand the differential impact of sweeping changes on vulnerable populations.
de Azevedo, G. R., & de Gouveia Santos, V. L. C. (2006). (Handicapped) Caregiver: The social representations of family members about the caregiving process. Revista Latino Americana de Enfermagem, 14(5), 770-780.
This study aimed to analyze what looking after physically disabled persons with spinal cord injury by trauma means to their caregivers and family members. The analysis of the testimony of eight caregivers, obtained in open interviews, which was methodologically based on the Social Representations Theory (SR), pointed out two main routes: coping with the suffering process in care practice and the troubled waters that permeate this suffering process. These two routes, characterized as SR Central Core and Peripheral System, respectively, consisted of themes like the way of looking at impairment, affectivity, religiosity, social-economical changes and (lack of) technical and institutional support. The results show a handicapped caregiver dedicated to look after someone who is physically disabled, considered incapacitated, and who leads his or her chores with distress and privations, based on guilt and religiosity, supported by ambiguous affection and affected by deteriorating social-economical changes and (lack of) technical and institutional support to practice an activity that implies so many peculiarities. The transformation alternatives of these caregivers' daily life principally lead to a symbiosis of disability with the patient--to live for the physically disabled--or yet, for a few, a sketch to restart personal life projects--to live with the physically disabled. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Desai, N. R., Smith, K. L., & Boal, J. (2008). The positive financial contribution of home-based primary care programs: the case of the Mount Sinai Visiting Doctors. Journal of the American Geriatrics Society, 56(4), 744-749.
The coming decade will see a rise in the number of homebound seniors. These vulnerable patients have great difficulty accessing primary care. Home-based primary care (HBPC) can fill this healthcare need. Presently, such programs have been slow to develop, in part because of the perception that they are fiscal liabilities. Using the Mount Sinai Visiting Doctors (MSVD) program, the total financial effect of an HBPC program on an Academic Health Center (AHC) was assessed. A retrospective cohort analysis (n=692, 565 patient years) of Medicare-eligible individuals who were enrolled in the MSVD HBPC program was conducted. Revenues and associated costs for direct physician home care services, inpatient admissions, and outpatient clinic and emergency department visits for 1 calendar year were captured. Sensitivity analyses varying efficiency and cost variables were performed. Total direct cost for HBPC for the patient cohort was $976,350. Direct billing from home visits generated revenues that covered 24% of total direct care costs. Over a 12-month period, the cohort had 398 inpatient admissions and 1,100 non-HBPC outpatient visits, generating an overall contribution to margin of nearly $2.6 million. It is likely that this analysis underestimates the true contribution to margin, because it does not capture patient encounters at specialty clinics not in the Department of Medicine, unaffiliated medical centers, or private community-based practices. Although direct billing for HBPC programs does not generate enough revenue to meet operating costs, they can be significant revenue generators for the wider healthcare system and thus are fiscally worthy of subsidization.
Diamond, K. E., & Kontos, S. (2004). Families' resources and accommodations: Toddlers with Down syndrome, cerebral palsy, and developmental delay. Journal of Early Intervention, 26(4), 253-265.
Constructing and maintaining a supportable daily routine is an important task for families with young children, particularly when the child has a disability. In this study, we examined relationships between children's developmental needs, disability diagnosis, and families' resources and accommodations. Participants included families with infants or toddlers receiving early intervention services because of Down syndrome, cerebral palsy, or developmental delay. Results provide evidence that the numbers and types of families' accommodations reflect their child's developmental needs, the child's diagnosis, and family income. The usefulness of examining accommodations as one approach for understanding the ways in which families organize their lives when they have a child with a disability is discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Dick, K., & Frazier, S. C. (2006). An exploration of nurse practitioner care to homebound frail elders. Journal of the American Academy of Nurse Practitioners, 18(7), 325-334.
Purpose: To identify and classify care activities of nurse practitioners (NPs) providing primary care for frail homebound elders and to describe NPs' perceptions of the outcomes of their care activities. Data sources: Three focus groups were held with 24 NPs with at least 1-year experience in caring for frail homebound elders to elicit NPs' descriptions of their practice. In addition, individual interviews with 10 NPs and participant observation of 2 NPs visiting elders in their homes validated the data. The total sample size was 36 NPs. Field notes and audiotapes were transcribed for analysis and coded using Brykczynski's existing domains and competencies of NP practice. Conclusions: Most of the care activities of NPs providing primary care to frail elders in their home involve management of patient health and illness, case management, and the teaching-coaching function. The NP informants believe that they prevent medication errors, falls, emergency room visits, hospitalizations, and even death. They reported that they improve their patients' quality of life and help to provide a peaceful death when death is imminent. Implications for research: Further refinement of the proposed model is needed in order to examine the effectiveness of NP care on clinically relevant patient outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Diefenbach, G. J., Tolin, D. F., Gilliam, C. M., & Meunier, S. A. (2008). Extending cognitive-behavioral therapy for late-life anxiety to home care: Program development and case examples. Behavior Modification, 32(5), 595-610.
Data suggesting that cognitive-behavioral therapy (CBT) is efficacious for late-life anxiety are accumulating; however, effectiveness has not been well established. Incorporating CBT for anxiety into home care is needed to facilitate access to evidenced-based treatment for a growing population of community-dwelling, functionally impaired elderly people. In this article, the authors describe the development of a home-based CBT program for late-life anxiety, outlining their experience partnering with a community care management organization. They also describe the CBT protocol and present data form two participants who completed the treatment. The two case examples illustrate multiple barriers to achieving successful treatment outcomes with this population. Future research needs to determine the extent to which adaptations are necessary to optimize the success of CBT for anxiety in a home care setting. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Dinesen, B., Nøhr, C., Andersen, S. K., Sejersen, H., & Toft, E. (2008). Under surveillance, yet looked after: telehomecare as viewed by patients and their spouse/partners. European Journal of Cardiovascular Nursing, 7(3), 239-246.
INTRODUCTION: In this research project, a group of heart patients were transferred from traditional hospital settings to home hospitalisation across sectors. The project involved patients with heart failure and arrhythmia. AIM: The aim was to understand the experiences and attitudes of patients and their spouses/partners with regard to the application of telehomecare technology as an option within home hospitalisation. METHODS: A phenomenological hermeneutic approach was used to collect and interpret the findings and data. A triangulation of data collection techniques was applied using participation observation and qualitative interviews with patients and spouse/partner. Data were analysed from the perspective of the sociology of everyday life. FINDINGS: The impact of home hospitalisation on patients is described according to several themes: security, freedom, increased awareness of own symptoms, being 'looked after' but annoyed with their spouse/partner. The patients experience a seamless cross-sector patient care process. The impact on the spouse/partner includes elements of increased responsibility, nervous tension, and invasion of privacy. CONCLUSION: Patients believe that home hospitalisation speeds up the process of returning to everyday life, both physically and mentally. It is important to be aware of certain anxieties experienced by the patient's spouse/partner about home hospitalisation, and these anxieties may also affect the patient.
Doran, D. M., Hirdes, J., Blais, R., Ross Baker, G., Pickard, J., & Jantzi, M. (2009). The nature of safety problems among Canadian homecare clients: evidence from the RAI-HC© reporting system. Journal of Nursing Management, 17(2), 165-174.
Aim(s) The purpose of this study was to identify the nature of patient safety problems among Canadian homecare (HC) clients, using data collected through the RAI-HC<sup>©</sup> assessment instrument. Background Problems of patient safety have been well documented in hospitals. However, we have very limited data about patient safety problems among HC clients. Method(s) The study methodology involved a secondary analysis of data collected through the Canadian home care reporting system. The study sample consisted of all HC clients who qualified to receive a RAI-HC assessment from Ontario, Nova Scotia and Winnipeg Regional Health Authority for the 2003-2007 reporting period. There were a total of 238 958 cases available for analysis; 205 953 from Ontario, 26 751 from Nova Scotia and 6254 from Winnipeg Regional Health Authority. Results New fall (11%), unintended weight loss (9%), new emergency room (ER) visits (7%) and new hospital visits (8%) were the most prevalent potential adverse events identified in our study. A small proportion of the HC clients experienced a new urinary tract infection (2%). Conclusion(s) Understanding clients' risk profiles is foundational to effective patient care management. Implications for nursing management We need to begin to develop evidence about best practices for ameliorating safety risk.
Doty, P., Mahoney, K. J., & Simon-Rusinowitz, L. (2007). Designing the Cash and Counseling Demonstration and Evaluation. Health Services Research, 42(1,part2), 378-396.
Objective: The Cash and Counseling Demonstration and Evaluation (CCDE) was designed as an experiment in shifting the paradigm in home and community-based long-term care from a professional/bureaucratic model of service delivery to one emphasizing consumer choice and control. The experimental intervention was an individualized budget offered in lieu of traditional Medicaid-covered services, such as agency-delivered aide services or a plan of care developed and coordinated by a professional case-manager, which typically involves authorization for several different providers to deliver a range of services. Within the spending limits established by their budgets, program participants were largely free to choose the types and amounts of paid services and supports they judged best able to meet their disability-related personal assistance needs. Study Population: Medicaid beneficiaries in selected states who volunteered to participate. In all of the participating state Medicaid programs, beneficiaries eligible to participate included elders and younger adults with chronic disabilities and, in one state, adults and children with mental retardation/developmental disabilities could also participate. Minor children and adults with cognitive impairment could participate via representatives (family or friends who agreed to assist them in managing their services or to act as their surrogate decision-makers). Data Sources: Members of the CCDE management team describe the rationale for and implications of key design decisions. Study Design: Key design decisions included the choice of research methodology (random assignment of CCDE participants in each state to treatment and control groups), selection of the state sites (AR, FL, NJ, NY), and the need for the CCDE to comply with federal waiver requirements for Medicaid research and demonstration projects. Principle Findings: The CCDE design was successfully implemented in three of the four state Medicaid programs selected for participation. Conclusions: The successful implementation of the CCDE (results from the evaluation are reported elsewhere) led to replication efforts in other states. The CCDE also inspired changes in Medicaid law and policy, including the 2002 "Independence Plus" Initiative by the Centers for Medicare and Medicaid and sections of the Deficit Reduction Act of 2005 intended to promote consumer-direction in Medicaid. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Downing, D. A. (2008). Response to "Flying under the radar: Engagement and retention of depressed low-income mothers in a mental health intervention". Advances in Nursing Science, 31(1), 2-3.
Comment on an article by Beeber et al. (see record 2007-12951-003), who conducted a randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers and used innovative design features to reduce stigma and enhance acceptability. The current author, noting the ineffectiveness of the in-home intervention used by Beeber et al., recommends the success of the Program of Assertive Community Treatment (PACT), a service-delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illnesses. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Drieskens, K., Bilsen, J., van den Block, L., Deschepper, R., Bauwens, S., Distelmans, W., et al. (2008). Characteristics of referral to a multidisciplinary palliative home care team. Journal of Palliative Care, 24(3), 162-166.
Introduction: Until now, in Belgium at least, no scientific information has been available about which patients are referred to multidisciplinary palliative home care teams (MHCT) and by which caregivers, nor about timing of referral and factors associated with it. Methods: A prospective cohort study was carried out during a nine-month period in the oldest Flemish MHCT, and included all patients for whom a palliative care trajectory had been initiated. Results: In total, 325 patients (54% male, mean age 71 years, 83% cancer patients) were referred: 25% by their GP, 24% by hospital social workers, and 22% by the patient's family. Median timing of referral was 26 days (IQR 8-78) before death. Patients of 75 years or older were more likely to have been referred later by comparison with younger patients. Discussion: Timely referral to a MHCT seems to be difficult and not equal for all patients. Referral timing varies largely by age groups and diseases. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Dube, L., & Ocholla, D. N. (2005). Insight into the management and diffusion strategies of HIV/AIDS Information in institutions of Higher Education in South Africa. [Article]. South African Journal of Library & Information Science, 71(2), 187-200.
The study focuses on the management and diffusion of HIV/AIDS information in institutions of higher learning in South Africa. The HIV/AIDS Policy for Educators, Learners and Students provided a strong foundation on government involvement on HIV/AIDS management in Higher Education. Both Qualitative and quantitative research design and methodologies were employed largely through survey, observation and document analysis. The findings reveal that the response of the higher education sector to HIV/AIDS is not uniform, but there is a positive move towards strong management of HIV/AIDS and information diffusion. The study recommends further research on feasibility, applicability and effectiveness of the centralized coordination of the higher education HIV/AIDS response. Other hidden issues have been unearthed and a model for effective HIV/AIDS management and information diffusion in the sector suggested. [ABSTRACT FROM AUTHOR]
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Duggleby, W. D., Degner, L., Williams, A., Wright, K., Cooper, D., Popkin, D., et al. (2007). Living with Hope: Initial Evaluation of a Psychosocial Hope Intervention for Older Palliative Home Care Patients. Journal of Pain and Symptom Management, 33(3), 247-257.
The overall purpose of this study was to evaluate the effectiveness of a psychosocial supportive intervention called the "Living with Hope Program" (LWHP) in increasing hope and quality of life for older adult, community-living, terminally ill cancer patients. Using a mixed method concurrent nested experimental design, 60 terminally ill cancer patients over the age of 60 years were randomly assigned to a treatment group and a control group. Baseline hope (Herth Hope Index [HHI]) and quality-of-life scores (McGill Quality of Life Questionnaire [MQOL]) were collected at the first visit in the patients' homes by trained research assistants. Those in the treatment group received the LWHP, which consisted of viewing an international award-winning video on hope and a choice of one of three hope activities to work on over a one-week period. The control group received standard care. Hope and quality-of-life data were collected one week later from both groups. Qualitative data using open-ended hope questions were collected from the treatment group. Patients receiving the LWHP had statistically significant higher hope (U = 255, P = 0.005) and quality-of-life scores at Visit 2 (U = 294.5, P = 0.027) than those in the control group. Qualitative data confirmed this finding, with the majority (61.5%) of patients in the treatment group reporting the LWHP increased their hope. This preliminary evaluation of the effectiveness of the LWHP suggests that it may increase hope and quality of life for older terminally ill cancer patients at home. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Dussel, V., Kreicbergs, U., Hilden, J. M., Watterson, J., Moore, C., Turner, B. G., et al. (2009). Looking beyond where children die: Determinants and effects of planning a child's location of death. Journal of Pain and Symptom Management, 37(1), 33-43.
While dying at home may be the choice of many, where people die may be less important than argued. We examined factors associated with parental planning of a child's location of death (LOD) and its effects on patterns of care and parent's experience. In a cross-sectional study of 140 parents who lost a child to cancer at one of two tertiary-level U.S. pediatric hospitals, 88 (63%) planned the child's LOD and 97% accomplished their plan. After adjusting for disease and family characteristics, families whose primary oncologist clearly explained treatment options during the child's end of life and who had home care involved were more likely to plan LOD. Planning LOD was associated with more home deaths (72% vs. 8% among those who did not plan, P < 0.001) and fewer hospital admissions (54% vs. 98%, P < 0.001). Parents who planned were more likely to feel very prepared for the child's end of life (33% vs. 12%, P = 0.007) and very comfortable with LOD (84% vs. 40%, P < 0.001), and less likely to have preferred a different LOD (2% vs. 46%, P < 0.001). Among the 73 nonhome deaths, planning was associated with more deaths occurring in the ward than in the intensive care unit or other hospital (92% vs. 33%, P < 0.001), and fewer children being intubated (21% vs. 48%, P = 0.029). Comprehensive physician communication and home care involvement increase the likelihood of planning a child's LOD. Opportunity to plan LOD is associated with outcomes consistent with high-quality palliative care, even among nonhome deaths, and thus may represent a more relevant outcome than actual LOD. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Dyeson, T. B. (2004). Social work licensing and the evolving home care setting. Home Health Care Management & Practice, 16(2), 150-151.
The home health care industry has recently undergone dramatic changes in Medicare reimbursement and the delivery of patient care services to the chronically ill elderly. One of the primary differences in the funding structure is that medical social services are no longer directly billable within the Medicare home health system. Many authors support the contention that social work field-educational experiences in health care are crucial in order to have a more prepared work force. Unfortunately, field practicum opportunities for social work students have been rare in the home health care industry because of the converging problems of licensing regulations and Medicare reimbursement. Although students must be supervised and monitored by a licensed social worker, there are many functions that they can perform in the home health care setting.
Dyeson, T. B. (2005). Social work update. Home health and wound care: an interdisciplinary research opportunity. Home Health Care Management & Practice, 17(3), 222-224.
This article reviews the role of the social worker in home care, briefly describes the literature concerning the psychosocial impact on wound care patients, and suggests opportunities for expanding this area of inquiry. The literature suggests that patients who have leg, foot, or pressure ulcers experience quite a number of psychosocial problems related to the presence and treatment of the wounds. The author is of the opinion that wound care research should include more disciplines, specifically social workers.
Ehrlich, P. L. (2006). Caring for the Frail Elderly in the Home: A Multidisciplinary Approach. Home Health Care Management & Practice, 19(1), 38-44.
As people live longer, maintaining independence in the home will become a significant health care issue. This article explains how one home care agency developed a comprehensive multidisciplinary program to identify, screen, assess, and treat the four common geriatric syndromes that affect quality of life for older people and are often the cause for nursing home admissions. The four syndromes are falls risk, incontinence, dementia, and depression. By screening for these four syndromes clinicians can develop care plans that address the needs of the frail elderly. Through an interdisciplinary approach, the team can work together to keep patients safe and independent in their own homes, allowing them to stay in their own environment with assistance if needed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Ellenbecker, C. H., Frazier, S. C., & Verney, S. (2004). Nurses' observations and experiences of problems and adverse effects of medication management in home care. Geriatric Nursing, 25(3), 164-170.
The purpose of this nonexperimental, descriptive study was to explore and describe the current state of medication management for patients receiving services from certified home health care agencies (CHHAs). Data were collected by self-report from a convenience sample of 101 home health care nurses from 12 agencies in six states. Nurses reported on a total of 1467 patients. Results of this study support the findings from previous research on medication management of older people living in the community. The majority of older home care patients were taking more than five prescription drugs. Many patients were taking medications in ways that deviated from the prescribed medication regimen. The results also suggest that patients are experiencing many adverse effects from medication errors. The reasons for these errors were reported to be a result of individual patient characteristics and, most frequently, communication problems in the system. Results of this study support recommendations for technology application, regulatory and policy changes, further research, and nursing practice.
Eriksson, M., & Andershed, B. (2008). Care dependence: a struggle toward moments of respite. Clinical Nursing Research, 17(3), 220-236.
The purpose of this study was to describe people's experiences of being dependent on others for care in their final stage of life, as well as what they felt made their experience of being dependent easier or more difficult. The phenomenological-hermeneutical method was chosen, where data collection consisted of open-ended interviews with nine people undergoing palliative care at a hospice unit or at home. The meaning of being care dependent is described via the following themes: changed relationship with oneself and with others, striving to adapt oneself to the situation, obstacles, and opportunities along the way while dependent. The result is described as an effort, a journey from independence to moments where it was possible to rest and recuperate while struggling with care dependency. Nursing staff require knowledge and understanding of experiences with care dependency to make life easier for people during increasing dependency in the final stage of life.
Esmond, G., Butler, M., & McCormack, A. M. (2006). Comparison of hospital and home intravenous antibiotic therapy in adults with cystic fibrosis. Journal of Clinical Nursing, 15(1), 52-60.
Aim and objective: This study aimed to compare home and hospital treatment for clinical outcome and quality of life in adult cystic fibrosis patients receiving i.v. antibiotics for acute respiratory exacerbations. Background: Cystic fibrosis patients require intravenous (i.v.) antibiotic therapy to treat acute respiratory exacerbations. Traditionally, patients would be admitted to hospital to complete a 14-day course of i.v. antibiotics. The option of home i.v. antibiotic therapy for acute respiratory exacerbations has become an expectation of cystic fibrosis patients. Design and method: Comparison of hospital and home i.v. antibiotic therapy in adults with cystic fibrosis for clinical outcomes and quality of life was studied using a quasi-experimental design. A pre- and post-test was used to measure clinical outcomes of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), oxygen saturations (SaO2), body mass index (BMI) and quality of life using the Cystic Fibrosis Quality of Life (CFQoL) questionnaire. Results: Thirty adult cystic fibrosis patients (15 hospital and 15 home) were recruited to the study once they had chosen where they undertook their treatment. When the groups were compared for clinical outcomes, the hospital group showed greater improvement in FVC. There were no differences in quality of life when the hospital and home groups were compared, although changes achieved with treatment showed differences. In the home group, there were improvements in all nine quality of life domains, with statistically significant improvement in five domains, whereas in the hospital group there were improvements in eight out of nine quality of life domains, with only two showing statistically significant improvement. Relevance to clinical practice: Lung function improved more in the hospital group, suggesting that acute respiratory exacerbations were not as effectively treated at home, although there appeared to be greater quality of life when undertaking home treatment. The CFQoL questionnaire was able to detect transient changes in health status during the course of i.v. antibiotics. Conclusion: If the patient's right to choose where they receive treatment is to be supported, taking into account quality of life further research is required to determine the reasons for home care being less clinically effective in treating acute respiratory exacerbations in cystic fibrosis patients. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Essa, E. L., Bennett, P. R., Burnham, M. M., Martin, S. S., Bingham, A., & Allred, K. (2008). Do variables associated with quality child care programs predict the inclusion of children with disabilities? Topics in Early Childhood Special Education, 28(3), 171-180.
Little research has been carried out on the inclusion of children with special needs in child care. The purpose of this study was to determine what variables predict the inclusion of children with disabilities in centers and home care. Logistic regression was used to examine the association of several indicators of quality child care and inclusion. For directors, teachers, and home care providers, the strongest predictor was having taken a course on working with children with disabilities. Larger centers and groups were more likely to include children with special needs. The somewhat surprising results and implications are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Ettner, S. L., Conover, C. J., Proescholdbell, R. J., Weaver, M. R., Ang, A., & Arno, P. S. (2008). Triply-diagnosed patients in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study: patterns of home care use. AIDS Care, 20(10), 1177-1189.
Although AIDS is a chronic illness, little is known about the patterns and correlates of long-term care use among triply diagnosed HIV patients. We examined nursing and home care use among 1,045 participants in the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a multi-site study of HIV-positive patients with at least one mental health and one substance disorder. Patient interviews and medical record review data were used to examine the average monthly cost of nursing home, formal home and informal home care. Multinomial logit and two-part regression models were used to identify correlates of the use of formal and informal home care and the number of informal home care hours used. During the three months prior to baseline, 2, 7 and 23% of participants used nursing home, formal home and informal home care, respectively. Patients who were better-educated, had higher incomes, had Medicaid insurance (with or without Medicare coverage) and whose transmission mode was homosexual sex had higher regression-adjusted probabilities of receiving any formal home care; Latinos and physically healthier patients had lower probabilities. Women and patients who abused drugs or alcohol (but not both) were more likely to receive informal care only. Overall, patients who were female, better-educated, physically or mentally sicker or single-substance abusers were more likely to receive any home care (either formal or informal), while those contracting HIV through heterosexual sex were less likely. Women received 28 more monthly hours of informal care than men and married patients received 31 more hours than unmarried patients. We conclude that at least one mutable policy factor (Medicaid insurance) is strongly associated with formal home care use among triply diagnosed patients. Further research is needed to explore possible implications for access among this vulnerable subpopulation.
Evans, W. G., Cutson, T. M., Steinhauser, K. E., & Tulsky, J. A. (2006). Is there no place like home? Caregivers recall reasons for and experience upon transfer from home hospice to inpatient facilities. Journal of Palliative Medicine, 9(1), 100-110.
OBJECTIVE: To describe caregivers' reasons for transfer from home hospice to inpatient facilities, preferences for site of care and death, and their experiences during these transfers. DESIGN: Retrospective qualitative analysis of interviews with caregivers of deceased hospice patients who had undergone transfer. SETTING: A university-affiliated community hospice provider. SUBJECTS: Caregivers of deceased hospice patients who transferred to an acute care hospital, a freestanding inpatient hospice facility, or a nursing home while enrolled in hospice and died between January 2003 and February 2004. MEASUREMENTS: A semistructured interview protocol was developed and used for all interviews. Interviews were coded for reasons for transfer, preferences for site of care and death, and experience upon transfer using a grounded theory approach. RESULTS: Patients transferred because of an acute medical event, an uncontrolled symptom, imminent death, or inability to provide needed care safely at home. Although all caregivers expressed a strong preference for care at home, other concerns such as pain and symptom control, safety, and quality and quantity of life became more important with time. We found significant variation in specific preferences regarding care and site of death. Satisfaction with care at the transfer facilities was determined by clarifying goals of care, following treatment preferences, providing personalized care, and the patient's environment. CONCLUSIONS: Hospice patients usually transfer to facilities to accomplish goals consistent with good end-of-life care. We can improve their experience by treating patients and their caregivers as unique individuals, exploring and respecting treatment preferences, and creating a pleasant physical environment.
Faithfull, S., & Deery, P. (2004). Implementation of capecitabine (XELODA) into a cancer centre: UK experience. European Journal of Oncology Nursing, 8, S54-62.
Switching patients from intravenous 5-FU/LV to oral capecitabine (Xeloda) for the treatment of metastatic colorectal cancer is associated with a reduction in the need for hospitalisations to manage 5-FU-associated delivery and complications, with resulting healthcare savings. However, implementing oral therapy with capecitabine within a cancer centre in the UK has required a considerable change in attitude within healthcare services. The resulting need for patients to take an active role in their treatment, and the co-ordination and monitoring of such a service at home has raised issues for chemotherapy services. To enhance patient involvement and compliance with medication a patient guide was developed to educate, and support individuals and enable them to understand the rationale for treatment and when to seek help. In addition, patients are encouraged to monitor and record symptoms in a diary. This change in service focus has required an investment in time educating and informing patients, community health workers and hospital practitioners. This change has been co-ordinated through the chemotherapy outpatient clinic. Effective communication between hospital and home has been important in implementing oral chemotherapy. While the initial challenge of monitoring and educating patients receiving capecitabine has been met, the Primary Care team and cancer centre need to continue to assess side effects and patient compliance in order to improve knowledge of capecitabine among healthcare professionals and ensure safe practice.
Farmer, E., Lipscombe, J., & Moyers, S. (2005). Foster carer strain and its impact on parenting and placement outcomes for adolescents. British Journal of Social Work, 35(2), 237-253.
Feng, X. (2007). Upper-extremity performance assessment using an interactive, personalized computer-assisted neurorehabilitation motivating framework. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(5-B), 3195.
The disability and aging populations have been increasing during the last decade. In the United States, stroke affects about 5.6 million individuals today; the aging population has grown to about one in every eight Americans. Economic pressure has gradually shifted the burden of rehabilitation to outpatient and home healthcare with limited supervision, creating a need for alternative approaches to neurorehabilitation. These approaches should be cost-effective and accessible for the home environment, while also semi-autonomously providing timely assessment and a greater amount of therapy. In response to this challenge, a computer-assisted motivational neurorehabilitation framework, coined "UniTherapy", has been designed and implemented. It uniquely integrates three core technologies: (i) support for a suite of standard-compliant computer input devices, including force-reflecting joysticks and driving wheels as physical therapeutic interfaces, (ii) support for a suite of personalizable and remotely tunable goal-directed performance assessment and motivational interventional exercise protocols, including features like data archive, management, and analysis tools, and (iii) support for providing personalized user interfaces that are tuned to the abilities and preferences of the user while also supporting emerging user interface and remote access standards. The potential of the framework was evaluated via a suite of collaborative pilot studies. By using the selected goal-directed tasks and kinematic metrics, it was shown that the framework had the capability to differentiate between human subjects with various level of stroke-induced impairment and performance differences under different task settings (e.g. device type, force field settings). Usability data from study subjects, as well as from a focus group consisting of rehabilitation practitioners, suggested that the potential of the framework as a cost-effective, sensor-based assessment tool and a home-based motivational therapy platform. A second study evaluated the movement features of subjects with stroke-induced impairment in the trajectory tracking tasks under different force and tracking speed settings using the UniTherapy platform. Nonlinear effects for the selected kinematic measures confirm the necessity to customize the parameters of the training protocol for each individual client. The force from the conventional joystick is enough to influence the performance of accuracy and stability across subjects. The results also suggest that the selected kinematic metrics can be sensitive clinical measures, yet quick to administer in a simple setup. In summary, a computer-assisted motivational neurorehabilitation framework has been designed and implemented. The results of the evaluation studies had shown its potential as a sensitive upper-extremity assessment tool and a home-based motivating therapy platform. The results from the goal-directed task under various task settings, suggest the necessity to personalize the parameters of the training protocol for each client. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Fernando, A. D. (2008). Examples from the road: Mindlessness in-home. Journal of Infant, Child & Adolescent Psychotherapy, 7(2), 88-99.
In-home therapy, provided to both families and individuals, has been a staple among modes of intervention for many years, particularly for social workers. The literature notes the successful application of a variety of in-home therapies for children and adolescents, in working with substance-abusing and delinquent adolescents, adolescent mothers and in lessening the number of out-of-home placements of children. The demand for community-based, in-home psychotherapeutic services continues to grow to meet the needs of children and families who would otherwise not receive any mental health services. In the situation of the in-home therapist, there is an experience of being both victim and victimizer: a victim of the rejecting family who places unreasonable expectations and demands upon the therapist; a victim of the agency who forces the therapist to do the impossible work of in-home therapy with little support and little guidance; a victimizer of the child and the family by forcing oneself into a home when he or she is unwanted; a victimizer potentially enacting the racial discrimination easily found in our culture, our institutions, and in our field of psychology--a predominantly white, upper middle-class clinic forcing mental health diagnosis and help in the form of psychotherapy onto a mostly African American group of children who may not want to engage or have little choice. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Finne-Soveri, H., & Pitkala, K. (2007). Editorial: Is older age a blessing for persons with painful conditions? Pain, 129(1-2), 3-4.
Advancing age exposes individuals to chronic illnesses which have a well-known relationship with persistent pain. In this issue, a very large study performed in Canada among the older recipients of home-care services and residents in institutions suggests that aging predicts lower levels of pain. They show that expressions of pain consistently decrease in each 5-year age cohort compared with the younger age cohorts. Is higher age really a blessing for persons with painful conditions? The results of the study offer strong evidence of the fact that aging might offer a blessing for individuals with painful conditions. However, these results do not free us from paying attention to thorough assessment and treatment of pain in older persons and particularly among the oldest old. Pain is still common in this cohort, and it is undermanaged. In order to prevent undermanagement and negative consequences of pain, such as limiting activities, depression, and low quality of life, more attention should be paid to regular evaluations. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Fisker, T., & Strandmark, M. (2007). Experiences of surviving spouse of terminally ill spouse: a phenomenological study of an altruistic perspective. Scandinavian Journal of Caring Sciences, 21(2), 274-281.
The aim of the study was to illuminate the experiences of surviving relatives in connection with their care at home of terminally ill, dying spouses, followed by an outline of the need for palliative assistance by the district nurse. Qualitative interviews with eight surviving relatives have been analysed on the basis of the phenomenological method. The essence of these phenomena was the loving promise to the terminally ill and dying spouse in which the shared grief, structural disintegration and powerlessness, lifelines and supporters and viable grief appeared. This promise consisted of that dying spouse will be able to stay at home during the illness and his or her desire to die at home. It was given during uncomfortable hospitalization and springing from the spouse's desire for autonomy and integrity at the end of his or her life. In keeping the promise, the surviving spouse became altruistic, neglecting his or her own primary needs in the unselfish fulfilment of the needs of the terminally ill spouse. The surviving spouse grieved in lonely isolation characterized by stress and an ethical dilemma in connection with breaching the promise. Light was shed on the professional palliative care with the surviving spouse's lacking verbalization of grief and powerlessness, regardless of whether expert professional palliation or insufficient professional palliation was provided. In that way the findings of the study showed the necessity for professional involvement in the decision concerning palliation at home, including identification of the resources of the primary caregiver.
FitzGerald, J. D., Mangione, C. M., Boscardin, J., Kominski, G., Hahn, B., & Ettner, S. L. (2006). Impact of changes in Medicare home health care reimbursement on month-to-month home health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures. Medical Care, 44(9), 870-878.
BACKGROUND: Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000. OBJECTIVE: The objective of this study was to examine the impact of reimbursement policy on HH care utilization. RESEARCH DESIGN: We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users. SUBJECTS: A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. RESULTS: Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals. CONCLUSIONS: Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.
Fletcher, K., & Mant, J. (2009). A before and after study of the impact of Specialist Workers for Older People. Journal of Evaluation in Clinical Practice, 15(2), 335-340.
Background Case management of vulnerable older people by Community Matrons has been introduced into the UK.Alocally designed case management approach, The Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here we report an evaluation of this service. Methods Before and after study of 418 people (207 before; 211 after) aged > or =75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, coordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload. Results There was a non-significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine GP surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001). Conclusions Case management might reduce hospital admissions and is potentially a cost-effective service. However, not all case management schemes are successful.With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.
Forde, H., Lane, H., McCloskey, D., McManus, V., & Tierney, E. (2004). Link Family Support--An evaluation of an in-home support service. Journal of Psychiatric and Mental Health Nursing, 11(6), 698-704.
A significant body of research has shown that parents who have a child or a dependent adult with a disability experience significant and persistent levels of stress. One of the recognized strategies for coping includes the provision of in-home practical support. Enable Ireland provides a range of services for children and adults with a physical disability. The present study explored home support services with a sample of 16 families of service users of Enable Ireland Cork. Practical support was deemed to be whatever support or intervention requested by the parent of the child/dependant adult which afforded the service user the opportunity to engage in social/recreational opportunities and that gave the parent free time. Sixteen members of the chosen families were interviewed (15 mothers and one father) using a semi-structured interview schedule and a standardized stress measure before and after the introduction of Link Family Support (LFS). LFS was put in place for a period of 12 months, tailored to the families and service users' individual needs. Although levels of stress continued to be high and scores on the Parenting Stress Index (PSI) did not show a statistically significant reduction after the programme, reported stress levels had improved. Parents reported LFS to be very helpful in reducing perceived stress and improving family's quality of life through providing free time and access to leisure and recreation facilities. This study provided limited but clear evidence of the need for regular, flexible, in-home support for families with children and dependent adults with a disability. LFS provided a personal, regular and effective means of meeting this need as the findings of this study demonstrated. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Fortune, J. R., Smith, G. A., Campbell, E. M., Clabby, R. T., II, Heinlein, K. B., Lynch, R. M., et al. (2005). Individual Budgets According to Individual Needs: The Wyoming DOORS System. Stancliffe, Roger J, 241-262.
(from the chapter) Wyoming has pioneered an individual budget model for people with intellectual disabilities who receive services and supports through the state's Medicaid Home and Community-Based Services (HCBS) Waiver programs for adults and children. The DOORS individual budget model allocates dollars to each individual by objectively taking into account each person's support needs. More broadly, this model is the cornerstone of Wyoming's "person-centered system architecture" that positions each individual and his or her team to decide what services will best meet the person's needs and to freely select service providers. This chapter describes the origins, development, implementation, and refinement of the DOORS budget allocation model. The model's outcomes and its implications for people supported in Wyoming and their families, service providers, and the state's developmental disabilities service system are also discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Francis, S. L., Taylor, M. L., & Strickland, A. W. (2004). Needs and preference assessment for an in-home nutrition education program using social marketing theory. Journal of Nutrition for the Elderly, 24(2), 73-92.
Nutrition education programs for elder caregivers (CG) and their elder care recipients (CR) are important in preventing malnutrition. Using Social Marketing Theory, this study assessed the needs and preferences for nutrition education in elder CGs and their CRs in Guilford County, NC. Thirty-two pairs of community-residing elder CGs/CRs and three focus groups (FGs) participated. Health and diet questionnaires were administered to all CGs/CRs during in-home interviews. CGs/CRs and FGs evaluated nutrition education materials. Questionnaires were analyzed using SPSS v9. Ethnograph v5.0 was used to code the interviews regarding the education materials. The CGs were iddle age (58.9 years), overweight (BMI = 28.8) Caucasian women. The CRs were old (79.4 years), overweight (BMI = 26.0) Caucasian women. Identified malnutrition risk factors of CGs and CRs included inadequate fluid and dietary intake, polypharmacy, and chronic disease. Identified nutrition needs and education preferences of CGs/CRs were similar. Perceived nutrition education preferences of the FGs did not reflect the interests of the CGs/CRs. This information is being used to revise the education materials and develop an in-home nutrition education program for CGs and CRs in Guilford County, NC.
Fyffe, D. C., Sirey, J. A., Heo, M., & Bruce, M. L. (2004). Late-life depression among Black and White elderly homecare patients. The American Journal of Geriatric Psychiatry, 12(5), 531-535.
Objective: The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. Methods: A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. Results: The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Conclusions: Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gallagher, S., Phillips, A. C., Drayson, M. T., & Carroll, D. (2009). Caregiving for children with developmental disabilities is associated with a poor antibody response to influenza vaccination. Psychosomatic Medicine, 71(3), 341-344.
Objective: Older spousal caregivers of dementia patients have been found to show a relatively poor antibody response to medical vaccination. In the present case control study in a different caregiving environment, we sought to compare antibody responses to vaccination in parents of children with disabilities and parents of typically developing children. Methods: At baseline assessment, 32 parents of children with developmental disabilities and 29 parents of typically developing children completed standard measures of perceived stress and child problem behaviors. They also provided a blood sample and were then vaccinated with the thymus-dependent trivalent influenza vaccine. Further blood samples were taken at 1- and 6-month follow-ups. Results: Relative to parents of typically developing children (mean titer = 458, standard deviation (SD) = 155.7 at 1 month follow-up and mean titer = 265, SD = 483.0 at 6-month follow-up), caregivers (mean titer = 219, SD = 528.4 at 1-month follow-up and 86, SD = 55.0 at 6-month follow-up) mounted a poorer antibody response than controls to the B/Malaysia strain of the vaccine. Conclusion: The negative impact of caregiving on antibody response to vaccination would not seem to be restricted to older spousal caregivers, but is also evident in younger parents caring for children with developmental disabilities. The behavioral characteristics of the care recipients may be a determinant of whether or not antibody response to vaccination is compromised. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gantert, T. W., McWilliam, C. L., Ward-Griffin, C., & Allen, N. J. (2008). The key to me: seniors' perceptions of relationship-building with in-home service providers. Canadian Journal on Aging, 27(1), 23-34.
Changing demographics and hospital downsizing have placed increasing demands on the home care sector. Many of those receiving in-home care are seniors whose chronic conditions require a collaborative approach. Both providers' paternalistic orientations toward senior clients and seniors' passivity within provider-client interactions have the potential to undermine relationship building. While the former has been documented, how seniors perceive relationship building within the home has received little attention. The purpose of this study was to explore seniors' perspectives on relationship building with in-home providers, focusing particularly on the facilitators of and barriers to this experience. Applying interpretive phenomenology, in-depth interviews were conducted with a purposeful sample of senior clients and an immersion/crystallization analysis strategy was used to elicit the findings. Findings revealed that seniors perceived relationship building as a dynamic process that encompassed facilitators and barriers at both individual and contextual levels. The interpretive findings afford several insights into building provider-client relationships within the in-home context.
Geiger-Brown, J., Muntaner, C., McPhaul, K., Lipscomb, J., & Trinkoff, A. (2007). Abuse and violence during home care work as predictor of worker depression. Home Health Care Services Quarterly: The Journal of Community Care, 26(1), 59-77.
Objectives: Home care workers provide care without the normal protections afforded in the hospital. This study describes the prevalence of abuse and violence experienced by home care workers and its relationship to workers' depression. Methods: A two-wave telephone survey (N = 1,643) was conducted to assess the prevalence of abuse and prevalence/incidence of workers' depression. Results: Abuse was significant for elevated odds for depression, with a dose effect. Violence was highly associated with depression. Conclusions: Preventive and early intervention measures should be taken to reduce mental health consequences of abuse and violence among home care workers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gershon, R. R. M., Qureshi, K. A., Stone, P. W., Pogorzelska, M., Silver, A., Damsky, M. R., et al. (2007). Home health care challenges and avian influenza. Home Health Care Management & Practice, 20(1), 58-69.
Recent public health disasters, both nationally and internationally, have underscored the importance of preparedness in effectively responding to these events. Within the home health care sector, preparedness is especially critical, as home care patients may be at increased risk of disaster-related morbidity and mortality because of their age, disability, or other vulnerability. Importantly, the home health care population is growing, with an estimated 7 million patients currently receiving home health care services. Yet the degree of preparedness at all levels of the home care sector (agency, health care worker, and patient and/or family) is largely unknown. Without this knowledge, important first steps toward development and implementation designed to address barriers to preparedness cannot be taken. To help address some of these knowledge gaps, one aspect of preparedness, namely the willingness of home health care workers to respond during an avian influenza outbreak, was recently examined. Findings revealed very low levels of willingness. Preliminary recommendations designed to address this issue are presented following a general discussion of the issue.
Ghiotti, C. (2009). The Dementia End of Life Care Project (DeLCaP): Supporting families caring for people with late stage dementia at home. Dementia: The International Journal of Social Research and Practice, 8(3), 349-361.
This article describes the development of a locally based project funded by the BigLottery for 5 years from May 2008 to support five families at any one time caring for a relative with late stage dementia at home. The outcomes centre on improving the well-being of both the person with dementia and their caregivers. The assumption is that the principles of palliative care that have so sensitized the end of life care for people with cancer can be applied to improve the lot of people with dementia and their caregivers. Development of the project therefore entailed bringing together staff across dementia care, palliative care practitioners and crucial generalist community staff, such as GP's and District Nurses. A team with representation from these various professionals and care staff is now up and running to pilot a cross cutting service to meet the particular needs of people with late stage dementia and their families. The funding from the lottery includes additional respite care, training and consultancy. The project is small enough to enable experimentation and the design of a pathway to effectively utilize the knowledge and skills of the different practitioners involved. The scale of the project makes it possible to show how we can transcend the current underdevelopment and fragmentation of community services and help families who wish to do so, to care for their relatives at home. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gladman, J. R., Jones, R. G., Radford, K., Walker, E., & Rothera, I. (2007). Person-centred dementia services are feasible, but can they be sustained? Age & Ageing, 36(2), 171-176.
BACKGROUND: we evaluated a specialist community-based dementia service to establish whether high quality care was being delivered and the conditions for doing so. The service was in an urban part of Rushcliffe Primary Care Trust, Nottinghamshire, United Kingdom. The service comprised an assessment team of an occupational therapist, a community psychiatric nurse and a community care officer, supported by 235 h per week of care delivered by a team of specially trained community care workers. METHODS: a qualitative study was performed using non-participant observation, semi-structured interviews and focus groups, and analysed using a thematic framework approach. There were 2 focus groups involving staff, 11 interviews of staff and stakeholders, and interviews of 15 carers of people with dementia. RESULTS: the care provided was appreciated by carers, and the service was approved by staff and stakeholders. Care was delivered using a rehabilitative style that aimed to maintain personhood, rather than to promote independence. Clients were usually referred with the object of preventing unwanted admission to institutional care but, over time, moving into an institution ceased to be a uniformly undesirable outcome. The service's resources were reduced during the evaluation period, in part to meet mental health needs in intermediate care services. CONCLUSIONS: an appropriately resourced and constructed specialist service using an adaptive rehabilitation approach aimed at maintaining personhood can deliver good individualised care to people with dementia, but specific and appropriate commissioning for these services is needed to nurture them.
Godley, M. D., Godley, S. H., Dennis, M. L., Funk, R. R., & Passetti, L. L. (2007). The effect of assertive continuing care on continuing care linkage, adherence and abstinence following residential treatment for adolescents with substance use disorders. Addiction, 102(1), 81-93.
Aims: This study compared assertive continuing care (ACC) to usual continuing care (UCC) on linkage, retention and a measure of continuing care adherence. Outcome analyses tested the direct and indirect effects of both conditions and level of adherence on early (months 1-3) and longer-term (months 4-9) abstinence. Design: Two-group randomized design. Setting: Eleven counties surrounding a community-based residential treatment program in the Midwestern section of the United States. Participants: A total of 183 adolescents, ages 12-17 years, with one or more Diagnostic and Statistical Manual version IV (DSM-IV) substance use dependence disorder and met American Society for Addiction Medicine (ASAM) placement criteria for non-medical residential treatment. Intervention: Prior to discharge from residential treatment, participants were assigned randomly to receive either UCC, available at outpatient clinics in the 11-county study area, or ACC via home visits. Measurements: Self-reported interview data were collected at intake, 3, 6 and 9 months post-residential discharge. Urine test data and interviews with a caregiver were conducted at baseline and 3 months. Findings: ACC led to significantly greater continuing care linkage and retention and longer-term abstinence from marijuana. ACC resulted in significantly better adherence to continuing care criteria which, in turn, predicted superior early abstinence. Superior early abstinence outcomes for both conditions predicted longer-term abstinence. Conclusions: ACC appears to be an effective alternative to UCC for linking, retaining and increasing adherence to continuing care. Replication with larger samples is needed to investigate further the direct and indirect effects of ACC found in this study. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Golberstein, E., Grabowski, D. C., Langa, K. M., & Chernew, M. E. (2009). Effect of Medicare home health care payment on informal care. Inquiry (00469580), 46(1), 58-71.
This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden on some low-income families, but that many higher-income families were able to either forgo the care or finance it privately. Home care payment policies should recognize these effects, balancing costs of the program with the desire to protect families from the burdens associated with providing informal home care.
Goldschmidt, D., Groenvold, M., Johnsen, A. T., Strömgren, A. S., Krasnik, A., & Schmidt, L. (2005). Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses. Palliative Medicine, 19(3), 241-250.
BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced by 91%, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory. Dissatisfaction was caused mainly by lack of information from the home-care team to primary-care professionals. CONCLUSION: GPs and district nurses welcomed the palliative home-care team and most experienced benefits to patients. Strengthened communication, initiated by the home-care team would enhance cooperation.
Gomes, B., & Higginson, I. J. (2006). Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ: British Medical Journal, 332(7540), 515-521.
Objectives: To determine the relative influence of different factors on place of death in patients with cancer. Data sources: Four electronic databases-Medline (1966-2004), PsycINFO (1972-2004), CINAHL (1982-2004), and ASSIA (1987-2004); previous contacts with key experts; hand search of six relevant journals. Review methods: We generated a conceptual model, against which studies were analysed. Included studies had original data on risk factors for place of death among patients, > 80% of whom had cancer. Strength of evidence was assigned according to the quantity and quality of studies and consistency of findings. Odds ratios for home death were plotted for factors with high strength evidence. Results: 58 studies were included, with over 1.5 million patients from 13 countries. There was high strength evidence for the effect of 17 factors on place of death, of which six were strongly associated with home death: patients' low functional status (odds ratios range 2.29-11.1), their preferences (2.19-8.38), home care (1.37-5.1) and its intensity (1.06-8.65), living with relatives (1.78-7.85), and extended family support (2.28-5.47). The risk factors covered all groups of the model: related to illness, the individual, and the environment (healthcare input and social support), the latter found to be the most important. Conclusions: The network of factors that influence where patients with cancer die is complicated. Future policies and clinical practice should focus on ways of empowering families and public education, as well as intensifying home care, risk assessment, and training practitioners in end of life care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gore, M., Brandenburg, N. A., Hoffman, D. L., Tai, K., & Stacey, B. (2006). Burden of illness in painful diabetic peripheral neuropathy: the patients' perspectives. Journal of Pain, 7(12), 892-900.
Our goal was to assess the patient-level burden among subjects with painful diabetic peripheral neuropathy (DPN). Community-based physicians recruited patients with painful DPN (N = 255) between April and October 2003. Patients completed a survey on pain experience (Brief Pain Inventory-DPN [BPI-DPN]), health status (EuroQoL [EQ-5D]), healthcare utilization (consults, prescription [Rx], and over-the-counter [OTC] medications), and work productivity/functioning. Patients were 61 +/- 12.8 years old and had diabetes for 12 +/- 10.3 years and painful DPN for 6.4 +/- 6.4 years; 25.5 and 62.7% had other neuropathic and musculoskeletal pain conditions. Average and worst pain scores (BPI-DPN, 0-10 scales) were 5.0 +/- 2.5 and 5.6 +/- 2.8. The mean EQ-5D utility was .5 +/- .3 (range = -.594-1). A majority (87.4%) took pain medications (Rx/OTC) in the preceding week: an average of 3.8 +/- 3.9 Rx and 2.1 +/- 1.3 OTC medications. Nearly half (46.7%) received NSAIDs. Other frequently reported medications were short/long-acting opioids (43.1%), anticonvulsants (27.1%), selective serotonin reuptake inhibitors/selective norepinephrine reuptake inhibitors (18%), and tricyclic antidepressants (11.4%). During the preceding 3 months, 59.6% had >/=2 health professional consults; 59% reported decreased home productivity; 85.5% reported activity limitations; and 64.4% of patients who worked (N = 73) reported missing work/decreased work productivity due to painful DPN. Our results underscore a substantial patient-level burden among subjects with painful DPN. PERSPECTIVE: Information on the patient-level burden among painful DPN sufferers in the U.S. was previously lacking. Our results suggest that this burden is significant, evidenced by moderate-to-high pain levels, polypharmacy, health resource use, and work/activity limitations. Results also suggest suboptimal pain management and low levels of satisfaction with treatments.
Grace, P. J., & Hardt, E. J. (2008). Ethical issues. When a patient refuses assistance. American Journal of Nursing, 108(8), 36-38.
The patient says, 'I don't trust hospitals and I don't want strangers in my home!'--how should clinicians respond?
Graneheim, U. H., & Jansson, L. (2006). The meaning of living with dementia and disturbing behaviour as narrated by three persons admitted to a residential home. Journal of Clinical Nursing, 15(11), 1397-1403.
Aim: The aim of our study was to illuminate the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home. Background: Living with dementia and so-called disturbing behaviour in an institution involves interaction with care providers and fellow residents and poses a challenge to all who are involved. Methods: We asked the head nurses at a residential home to select persons with dementia and disturbing behaviour who were willing to be interviewed and able to communicate verbally. We performed 10 informal conversational interviews with three persons. The interviews were transcribed into text and interpreted using a phenomenological hermeneutic method inspired by Ricoeur's philosophy. Results: The findings indicate that the meaning of living with dementia and disturbing behaviour, as narrated by three persons admitted to a residential home, is about being surrounded by disorder, being trapped by restriction and being set aside, as well as about being included. The findings are interpreted as a collapse of relations to self and others intertwined with occasional episodes of togetherness. This is reflected on in relation to the literature on homelessness and at-homeness and loss and maintenance of personal and social selves. Relevance to clinical practice: The view others have of the person with dementia and of disturbing behaviour determines the nursing care given. Taking the residents' personal history and actual context into account, disturbing behaviour may be seen as a way persons with dementia express their story and maintain their self. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Grayson, J. A. (2004). The maternal experience of caring for an adult with autism: An exploratory study. Dissertation Abstracts International: Section B: The Sciences and Engineering, 64(9-B), 4678.
The present study examined the experiences of mothers caring for an adult offspring with autism in their home with an emphasis on identifying parental needs so that they can be better addressed by professionals. A primary goal of the study was to gain a greater understanding of the challenges and stressors faced by families of adults with autism. Additional goals included providing parents of younger children with insight into the challenges they may face in the future and generating research questions for future research. Forty-three women recruited through various agencies serving adults with autism in the northeastern United States completed a 33-item questionnaire that was developed by the principal investigator and covered the following topics: pattern of care, employment, financial expenses, permanency planning, sexual behavior and stress and coping. Ten of the participants also took part in a semi-structured face-to-face interview containing open-ended questions that allowed for a greater depth of response. In addition to covering the above topic areas, the interviews also examined the gratifications of caring for their adult child, the lessons they have learned through their experiences, and the advice they have for parents of younger children and professionals working in the field. Several themes emerged from the data including that mothers of adults with autism are highly stressed and the burden of care overwhelmingly falls on their shoulders. For many families, an increasing cost of care over time significantly impacts their lifestyle and is a major source of stress. It was also found that there is a great shortage of both appropriate sex education programs for adults with autism and support groups for their parents. Preparing future residency plans for their children after they are no longer able to provide care and the fear of sexual abuse emerged as the greatest sources of stress for mothers. After recounting their hardships and challenges, however, the mothers had no difficulty describing their gratifications and the lessons they have learned along the way. The implications of these findings and recommendations for future research are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Gregory, T. R. (2007). Under-Served or Under-Surveyed: The Information Needs of Studio Art Faculty in the Southwestern United States. Art Documentation: Bulletin of the Art Libraries Society of North America, 26(2), 57-66.
The article discusses the information needs of studio art faculty in the southwestern U.S. According to it, libraries are being used by art faculty to find images for the purpose of teaching. Meanwhile, half of the respondents to the survey that was conducted said that they have computers in their classroom and studios that are connected to the Internet.
Gross, J. M. (2008). Review of 24/7. Journal of Mental Health Research in Intellectual Disabilities, 1(4), 260-261.
Reviews the video, 24/7 by M. A. C. Fallon and D. Priest (2005). Fallon and Priest have created a powerful documentary that takes a hard look at the realities of providing full-time care for someone with a significant developmental disability. In 24/7, caregivers talk about the emotional, physical, and financial demands associated with caregiving. This video also comments on the state of Medicaid supports and services for adults with developmental disabilities and their families. Specifically, it covers the home and community services waiver program and the extensive waiting list for waiver supports and services in Florida. This documentary offers video case studies of two families in Florida who provide full-time care for an adult child with a developmental disability. One family receives no governmental support for providing care and has been on a waiting list for services for over three years. This documentary could be a powerful tool for advocacy groups lobbying for improvements in funding for home and community based supports and services as it offers a window into the lives of those who depend on and need Medicaid services in order to continue to live in the community. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Grov, E. K., & Eklund, M. L. (2008). Reactions of primary caregivers of frail older people and people with cancer in the palliative phase living at home. Journal of Advanced Nursing, 63(6), 575-585.
Aim: This paper is a report of a study conducted to (1) compare means of the single items and the dimensions of the Caregiver Reaction Assessment among caregivers of frail older people and caregivers of cancer patients in the palliative phase; (2) examine gender differences for the scoring parameters in the Caregiver Reaction Assessment within each group and (3) examine the demographic variables' association with the caregiver groups' scores for the dimensions of the Caregiver Reaction Assessment. Background: Limited research has focused on the caregiver situation in the home-care setting among primary caregivers of frail older people, and caregivers of patients with cancer in the palliative phase. Methods. A convenience sample of 224 caregivers of frail older people, and 85 caregivers of patients with cancer in the palliative phase was recruited between 2002 and 2005. We used the Caregiver Reaction Assessment to collect the data. Results: The mean scores for the Caregiver Reaction Assessment dimensions showed statistically significant differences between the two groups of caregivers for the factors self-esteem, family support, finances and health. For caregivers of frail older people, we found statistically significant associations between several demographic variables and the Caregiver Reaction Assessment dimensions. For caregivers of patients with cancer in the palliative phase, age was the only demographic variable that was statistically significantly associated with the dimensions. Conclusion: Healthcare personnel should pay attention to how relatives experience their caregiver situation, and the Caregiver Reaction Assessment could be a valuable tool for gathering systematic data on this. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Gruneir, A., Mor, V., Weitzen, S., Truchil, R., Teno, J., & Roy, J. (2007). Where people die: a multilevel approach to understanding influences on site of death in America. Medical Care Research & Review, 64(4), 351-378.
Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home beds and state Medicaid payment rate, was associated with higher probability of nursing home death. These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience.
Gustafson, T., Franklin, K. A., Midgren, B., Pehrsson, K., Ranstam, J., & Ström, K. (2006). Survival of patients with kyphoscoliosis receiving mechanical ventilation or oxygen at home. CHEST, 130(6), 1828-1833.
BACKGROUND: Home mechanical ventilation (HMV) and long-term oxygen therapy (LTOT) are the two treatment alternatives when treating respiratory insufficiency in patients with kyphoscoliosis. We aimed to study the effect on survival with regard to HMV or LTOT alone in patients with respiratory insufficiency due to kyphoscoliosis. METHODS: Swedish patients with nonparalytic kyphoscoliosis (ie, scoliosis not related to neuromuscular disorders) who started LTOT or HMV between 1996 and 2004 were followed up prospectively until February 14, 2006, with death as the primary outcome. Treatment modality, arterial blood gas levels, the presence of concomitant respiratory diseases, and age were recorded at the onset of treatment. No patient was lost to follow-up. RESULTS: One hundred patients received HMV, and 144 patients received oxygen therapy alone. Patients treated with HMV experienced better survival, even when adjusting for age, gender, concomitant respiratory diseases, and blood gas levels, with a hazard ratio of 0.30 (95% confidence interval, 0.18 to 0.51). CONCLUSION: The survival of patients with kyphoscoliosis receiving HMV was better than that of patients treated with LTOT alone. We suggest HMV and not oxygen therapy alone as the primary therapy for patients with respiratory failure due to kyphoscoliosis, regardless of gender, age, and the occurrence of concomitant respiratory diseases.
Hage, J., Meeus, M. T. H., & MyiLibrary. (2006). Innovation, science, and institutional change. Oxford :: Oxford University Press.
Hahn, J. E., & Aronow, H. U. (2005). A Pilot of a Gerontological Advanced Practice Nurse Preventive Intervention. Journal of Applied Research in Intellectual Disabilities, 18(2), 131-142.
Background: Persons with an intellectual and developmental disability frequently face barriers in accessing preventive services in community-based health care systems. As they age into middle years, they are at increased risk for functional decline. This paper presents a description of an advanced practice nurse (APN) intervention used in a pilot study that explored the feasibility of using an in-home preventive model based on a comprehensive geriatric assessment with persons ageing with an intellectual and developmental disability. Method: The APN intervention was fully provided to a sub-sample (n = 70) of 201 participants with an intellectual and developmental disability enrolled in a programme called 'Stay Well and Healthy!' The APN intervention included an initial home visit for a comprehensive geriatric assessment with follow-up home visits to review health status and assess adherence with recommendations and provide education and support to promote health and prevent functional decline. Results: Advanced practice nurses identified a number of active health-related problems for persons ageing with an intellectual and developmental disability (mean 5.2; range 1-14) that had potential effects on function and survival. The majority of recommendations (mean 14.4; range 6-35) were for clinical preventive services (42.2%) and self-care for health-related issues (36.8%). Conclusions: This study showed that there were problems consistent with persons ageing with an intellectual and developmental disability and older adults without disability. The in-home preventive APN intervention to promote healthy ageing and reduce health disparities in this population is feasible, needed, and warrants further study. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hampton, D. M., Hollis, D. E., Lloyd, D. A., Taylor, J., & McMillan, S. C. (2007). Spiritual needs of persons with advanced cancer. American Journal of Hospice & Palliative Medicine, 24(1), 42-48.
Spiritual needs, spiritual distress, and spiritual well-being of patients with terminal illnesses can affect their quality of life. The spiritual needs of patients with advanced cancer have not been widely studied. This study assessed the spiritual needs of 90 patients with advanced cancer who were newly admitted to hospice home care. They completed a demographic data form and the Spiritual Needs Inventory shortly after hospice admission. Scores could range from a low of 17 to a high of 85; study scores were 23 to 83. Results showed great variability in spiritual needs. Being with family was the most frequently cited need (80%), and 50% cited prayer as frequently or always a need. The most frequently cited unmet need was attending religious services. Results suggest the importance of a focus on the spiritual more than the religious in providing care to patients at the end of life. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hebert, M. A., Brant, R., Hailey, D., & Van Der Pol, M. (2006). Potential and readiness for video-visits in rural palliative homecare: Results of a multi-method study in Canada. Journal of Telemedicine and Telecare, 12(Suppl 3), 43-45.
We compared conventional palliative homecare visits and a combination of conventional and home telehealth 'video-visits' with respect to symptom management and quality of life. Participants were recruited from 11 rural communities in Alberta and randomized to the treatment or control groups, remaining in the study for 8 weeks. Although we planned to recruit 200 clients over two years, only 44 clients participated. Factors contributing to low recruitment included the introduction of new service delivery models and changes in the home care environment. No significant differences were found between the groups in measures of symptom management and quality of life. Compared to the home care nurses, clients generally indicated a higher level of readiness to use the technology. The study suggested that videophone technology would probably not be adopted for palliative home care in the population that was studied although it might be considered for other applications in the management of chronic illnesses. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hebert, M. A., Paquin, M.-J., Whitten, L., & Cai, P. (2007). Analysis of the suitability of Video-visits' for palliative home care: Implications for practice. Journal of Telemedicine and Telecare, 13(2), 74-78.
We conducted a retrospective chart review to estimate the extent to which palliative home care visits could be carried out using videophones and to explore factors that might inform the eligibility criteria for video-visits. Four hundred palliative home care health records of deceased clients from 2002 were randomly selected from the Health Records Office in one Canadian health region. One visit was randomly selected from each of these health records. Three hundred and fifty-four visits were coded, and based on professional nursing judgment, the coder estimated whether video-visits could have been carried out. Approximately 43% of the visits were considered appropriate for video-visits. The results suggest that four factors may inform eligibility and decisions about a client's suitability for video-visits: diagnosis (cancer versus non-cancer), low Edmonton Symptom Assessment System (ESAS) score, no care-giver present, number and types of interventions required. Patients with a cancer diagnosis were more likely to be suitable for video-visits, which suggests that disease trajectory, rather than diagnosis of 'palliative', may be more influential in determining the care required and appropriateness of videophone use. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Henderson, V. (2004). Pressure area care in primary care: issues in equipment provision. British Journal of Community Nursing, 9(12), S29-30.
The pressure area care needs of primary care patients are becoming more complex due to changes in health care provision. Enabling patients to remain in their own home and allowing them some independence even though they are at high risk of developing pressure damage, relies on the nurse's knowledge of prevention strategies and equipment provision locally. This article discusses the key issues in relation to the provision of pressure relieving equipment in a rural care trust in England, and how the trust has overcome the problem of equipment failure, especially out of hours and weekends.
Hendricks-Ferguson, V. (2008). Physical symptoms of children receiving pediatric hospice care at home during the last week of life. Oncology Nursing Forum, 35(6), E108-115.
Purpose/Objectives: To identify symptoms of greatest parental concern on the last day and during the last week of their children's lives, the five most common symptoms of parental concern, and symptom-management strategies used during the last week of the children's lives.Research Approach: Descriptive, exploratory, and retrospective.Setting: A pediatric hospice program in St. Louis, MO.Participants: Convenience sampling of 28 bereaved parents.Methodologic Approach: The Krippendorff method for semantical content analysis of data collected from semistructured telephone interviews with parents.Main Research Variables: Parents' perceptions of their children's symptoms and symptom-management strategies.Findings: On the last day of life, change in the children's breathing was the most frequent symptom of concern. During the last week of life, loss of motor function was the most frequent symptom of concern. Physical comfort actions and use of pharmaceutical agents were the strategies perceived as most helpful in managing symptoms.Conclusions: The study is the first to document parents' perceptions of their children's symptoms and of symptom-management strategies during the last week of life while receiving care in the home from staff of the pediatric hospice program.Interpretation: Symptoms experienced by dying children during the last week of life and symptom-management strategies used by pediatric hospice programs to support dying children and their families have not been well described. Additional research is warranted to further identify pediatric symptoms at the end of life and effective symptom-management strategies. [Abstract for this article also available on page 893 of printed version. The full text of this article can be accessed at www.ons.org/publications/journals/ONF]
Hendrix, C. C., & Wojciechowski, C. W. (2005). Chronic care management for the elderly: an opportunity for gerontological nurse practitioners. Journal of the American Academy of Nurse Practitioners, 17(7), 263-267.
Purpose: To discuss the role that gerontological nurse practitioners (GNPs) may play in providing chronic care management for the elderly. Data Sources: Review of recent literature on chronic care management, personal experience of the authors in caring for older adults under the chronic care management model, and a case study. Conclusions: GNPs are the most appropriate practitioners to provide and coordinate chronic care management to the population that needs it most -- the elderly. Implications for Practice: Demographic shifts in the United States have increased the number of people with chronic illnesses; however, the nation's healthcare delivery system has not significantly evolved to meet the changing needs of its population. As a result, many people, especially older adults, suffer needlessly, and healthcare costs continue to rise. Chronic care management may alleviate older adults' chronic health problems, reduce expenditures for their health care, and promote their satisfaction and quality of life.
Hirakawa, Y., Masuda, Y., Kuzuya, M., Iguchi, A., & Uemura, K. (2007). Age-related differences in care receipt and symptom experience of elderly cancer patients dying at home: Lessons from the DEATH project. Geriatrics & Gerontology International, 7(1), 34-40.
Background: Data on the differences between older and younger elderly cancer patients dying at home is sparse. To clarify age-related differences in symptom experience and care receipt of elderly cancer patients at end-of-life, we conducted a subanalysis study of the Dying Elderly at Home (DEATH) project, a multicenter study of 240 elderly aged 65 and older dying at home. Methods: We assessed the frequency of symptom experience and end-of-life care receipt in home elderly patients during the last 2 days of their lives and evaluated the differences between younger elderly (aged 65-74) and older elderly (aged 75+) cancer decedents. The general practitioners were asked to fill out a questionnaire immediately after the death of study patients. A total of 66 younger and 51 older elderly cancer decedents were included in the analysis. Results: Coma and dementia were common among younger and older elderly patients. Older decedents were less likely to experience anxiety, but, after adjustment for baseline characteristics, this age-related difference did not clearly appear. Older decedents were also less likely to receive opioids than younger decedents. There were no significant differences in volume of i.v. hydration between the two groups. Conclusions: Our results suggested that there were no differences in symptom experience and care receipt among older and younger decedents, except in opioid use, at end-of-life. These findings imply a similar need of end-of-life care for younger and older elderly cancer patients who opt for home death. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hogan, V. M., Lisy, E. D., Savannah, R. L., Henry, L., Kuo, F., & Fisher, G. S. (2004). Role Change Experienced by Family Caregivers of Adults with Alzheimer's Disease: Implications for Occupational Therapy. Physical & Occupational Therapy in Geriatrics, 22(1), 21-43.
Objective: This qualitative study explored the phenomenon of role change as experienced by in-home caregivers of individuals with Alzheimer's disease. Method: Fifteen caregivers of individuals with Alzheimer's disease received brief questionnaires, which included open-ended questions concerning their care-giving situations. Eight of these individuals volunteered for further preliminary evaluation with the Role Change Assessment (RCA) 2.0 (Rogers & Holm, 1995, 1999). The purpose of using the questionnaires and the RCA 2.0 was to familiarize the researchers with the care-giving situations of participants. Findings from the questionnaires and RCA 2.0 served as a basis for designing the questions for individualized phenomenological interviews. The phenomenological interviews with the eight volunteer participants were the primary means of data collection in this study. The goal of the phenomenological interview was to gain in-depth understanding of how the caregivers perceived their roles, and which roles had changed as a result of involvement in the care-giving experience. Field notes from caregiver support group meetings were also used as a data gathering tool. Results: Data analysis yielded themes which describe the role changes experienced by the caregivers. These themes demonstrate that the caregivers underwent significant changes in their participation in leisure, relationship, household management, and health and wellness roles. Conclusion: Findings suggest that caregivers experience significant life-altering role changes as a result of their care-giving responsibilities. These role changes are in important occupational performance areas, and may negatively influence caregiver quality of life. An understanding of these role alterations may allow occupational therapists to develop additional means of providing encouragement, support, and guidance when working with caregivers of individuals who have Alzheimer's disease. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hokenstad, A., Hart, A. Y., Gould, D. A., Halper, D., & Levine, C. (2006). Closing the home care case: home health aides' perspectives on family caregiving. Home Health Care Management & Practice, 18(4), 306-314.
A series of focus groups with home health aides experienced in caring for patients with stroke or brain injury provided insight into how they experience their work and their relationship to family caregivers. Two issues merit more attention. First, aides reported that they do not always have all of the information, including diagnosis or previous history, which they need to provide appropriate care. Second, aides said they often receive little advance notice about when the case would close. Abrupt transitions are hard for aides, families, and patients who have often built up a good relationship. Agencies should establish better lines of communication for relevant information, correct misunderstandings about privacy rules, provide additional guidance about how to respond to caregivers' questions, and provide adequate time for closure.
Holmberg, L. (2007). "Words that made a difference": Communication in bereavement. Journal of Loss & Trauma, 12(1), 9-29.
This article reports on a case study. The author is the mother to a son who, after having been cared for at home by his wife, mother, mother-in-law, and a palliative home care team, died from cancer when he was 38 years old. The mother's grief and bereavement symptoms during the first year of grief and the support given to her are described in a narrative that is interpreted and analyzed 2 years after her son's death. Information, control, empathy, and shared experiences and concepts that emerged out of the analysis are discussed. The findings point to a need for customizing bereavement support specifically for high-risk mourners. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Hopp, F., Woodbridge, P., Subramanian, U., Copeland, L., Smith, D., & Lowery, J. (2006). Outcomes Associated with a Home Care Telehealth Intervention. Telemedicine and e Health, 12(3), 297-307.
To determine whether adding telehealth technology to traditional home care services increases health-related quality of life (HRQOL) and home care satisfaction, and decreases resource utilization among home care patients. This trial included 37 home care patients receiving services in a Veterans Affairs medical center, randomized into intervention and control groups. Outcome measures included patient satisfaction and HRQOL at baseline and 6-month follow-up, and the use of inpatient and outpatient services before and during the 6-month study period. Intervention group patients reported greater improvement in the mental health component of HRQOL, (t = 2.27; df = 15; p = 0.04). Satisfaction with the telehealth equipment was high (means exceeded 4.0 on six measures ranging from 1-5). However, no statistically significant differences were observed between intervention and control groups in terms of changes in physical health, inpatient admissions, bed days of care, emergency department visits, or general satisfaction with home care services. Intervention group members did show a trend (p = 0.10) toward fewer overall outpatient visits (mean = 29.1; standard deviation [SD] +or- 30.1) compared to those receiving traditional home care services (mean = 38.9; SD +or- 28.9). The use of telehealth services as an adjunct to traditional home care is associated with greater improvements in mental health status and a trend toward lower use of inpatient and outpatient healthcare services. Further work, utilizing larger sample sizes, is needed to investigate the relationship between telehealth services, the use of healthcare resources, and other outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Horton, K. (2008). The use of telecare for people with chronic obstructive pulmonary disease: implications for management. Journal of Nursing Management, 16(2), 173-180.
Aim To evaluate the telecare service offered by Home Care teams to patients with chronic obstructive pulmonary disease (COPD). Background The use of telecare aims to support older people in remaining independent at home, reducing hospital admissions and improving the quality of life for older people and their informal carers. In the redesign of managed care for people with COPD using telecare, an evaluation of the implementation process is necessary. Method A focus group with Home Care teams and social care staff was conducted. Six case studies identified by nursing staff were used to examine key issues relating to telecare implementation. Findings The experience and expectation in telecare, the usability of equipment, and changes in practice can impact on COPD care. Case studies highlight that the rapid access to care, an increased sense of personal safety and security, and the continuity of care are perceived as benefits. However, the equipment was perceived as not 'user friendly' and bulky. Conclusion It is important that any service redesign to include telecare is evaluated and targeted at its specific role. Implications for nursing management Partnership working has to be negotiated, and leadership roles include addressing tensions and motivation within the team.
Hoy, J., Twigg, V., & Pearson, E. (2008). Occupational therapy home assessments: More than just a visit? An audit of occupational therapy practice in oncology and palliative care. British Journal of Occupational Therapy, 71(2), 59-63.
Occupational therapists at a specialist cancer centre found home assessments to be the most time-consuming intervention. To evaluate the breakdown of time and total time use for this intervention, 15 occupational therapists working in the area of oncology and palliative care participated in an audit. A total of 107 home assessments was audited. The results indicated that the total time for an average home assessment in the audit ranged between 3.31 hours and 5.59 hours. They also highlighted that the time spent in preparation and follow-up was similar to the time spent in travel and the visit itself. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Huddleston, M., & Kobb, R. (2004). Emerging technology for at-risk chronically ill veterans. Journal for Healthcare Quality: Promoting Excellence in Healthcare, 26(6), 12.
Patients are exposed to iatrogenic injury when hospitalized. In the Tech Care Coordination Program, older veterans with chronic diseases and high healthcare utilization were followed with an in-home technology device, the Health BUDDY, and risk management software. Program staff could identify at-risk patients based on their responses to a series of questions about symptoms, behavior, and knowledge. Patients followed in the program for at least 6 months experienced a 45% decrease in hospital admissions, 67% decrease in nursing home admissions, 54% decrease in emergency room visits, and 38% decrease in pharmacy prescriptions. The patients also demonstrated improved compliance with treatment regimens and both patients and providers reported high levels of program satisfaction.
Hussein, S., Manthorpe, J., & Penhale, B. (2007). Public perceptions of the neglect and mistreatment of older people: Findings of a United Kingdom survey. Ageing & Society, 27(6), 919-940.
Large surveys of the general population's perceptions of the neglect and mistreatment of older people are few. This article provides evidence about the public's awareness of 'elder abuse' at a time of considerable media and political interest in the subject in many countries. It presents the findings of a survey of 1,000 adults' knowledge of the neglect and mistreatment of older people in the UK. Descriptive and multivariate analyses were used to examine: variations in the perception of the existence of neglect or mistreatment of older people, the perceived relative prevalence of knowing an older person who had been subject to such experiences, the type and place of such experiences and knowledge of sources of help in such circumstances. The key findings are that older people believed that there is less neglect and mistreatment of older people than younger people, that women perceived more than men, and that there were regional variations in these perceptions. One-quarter said they knew an older person who had experienced neglect or mistreatment, and such reports were most likely among the middle aged and women. The most frequently reported locations of abuse were care homes and hospitals, and the most commonly reported form was inadequate or insufficient personal care. Most people said they would contact social services or paid carers if they encountered neglect or mistreatment. The findings are discussed in the light of increased policy attention to the safeguarding of vulnerable adults, and the implications for research, practice and campaigning organisations are considered. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Jamora, M. S., Brylske, P. D., Martens, P., Braxton, D., Colantuoni, E., & Belcher, H. M. E. (2009). Children in foster care: adverse childhood experiences and psychiatric diagnoses. Journal of Child & Adolescent Trauma, 2(3), 198-208.
Jarrott, S. E., Zarit, S. H., Stephens, M. A. P., Townsend, A., & Greene, R. (2005). Instrumental help and caregivers' distress: effects of change in informal and formal help. American Journal of Alzheimer's Disease & Other Dementias, 20(3), 181-190.
Family caregivers of persons with dementia rely on a range of resources to provide care and cope with caregiving stressors. Informal (unpaid) and formal (paid) instrumental support contribute to diverse caregiver outcomes. Previous research of caregiver support has focused on subjective measures of help or has compared caregivers receiving formal services to those who do not. We focused instead on the effects of change in the amount of formal and informal instrumental assistance on caregivers' distress. We expected that greater gains in assistance would be associated with greater reduction of caregivers' distress. Increases informal but not informal levels of assistance were associated with improvement in each measure of distress. Additional measures may be needed to fully understand the effects of informal and formal assistance.
Jarvis, A., & Talbot, L. (2004). Vascular disorders. Multiprofessional follow up of patients after subarachnoid haemorrhage. British Journal of Nursing (BJN), 13(21), 1262-1267.
Subarachnoid haemorrhage (SAH) is a life-threatening illness that affects people suddenly and without warning. Previous research has estimated that only 7% of SAH survivors suffer physical deficits (Stegan and Freckmann, 1991), whereas two-thirds of those classed as having made a good recovery actually experience a range of debilitating cognitive or emotional difficulties (Bindschaedler et al, 1997; Buchanan et al, 2000). At Hope Hospital, a structured system was set up to help support the survivors of SAH through follow-up via the neurovascular team providing patients with information, guidance and early intervention including screening for potential cognitive and emotional difficulties and fast-track referral to neuropsychology services. Behavioural indices demonstrated that patients experienced a range of difficulties in everyday functioning such as problems that prevent a return to work and excessive fatigue, among others. Although this innovative system does address follow-up need, improvements could be made to ensure that all patients receive an equitable service.
Jewels, T., & Albon, R. (2007). Supporting Arguments for Including the Teaching of Team Competency Principles in Higher Education. [Article]. International Journal of Information & Communication Technology Education, 3(1), 58-69.
The article emphasizes the need for teachers to apply team competency principles to address and accommodate the dynamic, fast-paced world in which knowledge management is a feature. A new team-centered pedagogy to team learning has been presented and supported by examples of successful teaching practices. A taxonomy for assessing team competencies at different levels of team maturity is proposed. Information technology educators have a responsibility to their graduates to prepare them to be managers of knowledge in an information-knowledge era.
Johansson, A., & Bjorklund, A. (2006). Occupational Adaptation or Well-Tried, Professional Experience in Rehabilitation of the Disabled Elderly at Home. Activities, Adaptation & Aging, 30(1), 1-20.
The aim of this pilot study was to examine whether the use of the Occupational Adaptation Model increases independence and experienced health for disabled elderly in home rehabilitation in primary care. The study had an integrated design, in which the data were collected through a quasi-experimental plan in combination with semi-structured interviews with disabled elderly. The data were analyzed both quantitatively and qualitatively. The results indicated that the use of the model increases experienced health and gives the occupational therapist a tool for helping the disabled elderly to understand and engage themselves in their life situations. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Jolly, K., Taylor, R., Lip, G. Y. H., Greenfield, S., Raftery, J., Mant, J., et al. (2007). The Birmingham Rehabilitation Uptake Maximisation Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technology Assessment, 11(35), iii.
OBJECTIVES: To evaluate the relative effectiveness and cost-effectiveness of a home-based programme of cardiac rehabilitation using the Heart Manual, with centre-based programmes. It also sought to explore the reasons for non-adherence to cardiac rehabilitation programmes. DESIGN: An individually randomised trial, with minimisation for age, gender, ethnicity, initial diagnosis and hospital of recruitment. Participants were followed up after 6, 12 and 24 months by questionnaire and clinical assessment. Individual semistructured interviews were undertaken in the homes of a purposive sample of patients who did not adhere to their allocated programme, and focus groups were undertaken with groups of patients who adhered to the programmes. SETTING: Four hospitals in predominantly inner-city, multi-ethnic, socio-economically deprived areas of the West Midlands in England, for 2 years from 1 February 2002. PARTICIPANTS: A total of 525 patients who had experienced a myocardial infarction (MI) or coronary revascularisation within the previous 12 weeks. INTERVENTIONS: All the rehabilitation programmes included exercise, relaxation, education and lifestyle counselling. All patients were seen by a cardiac rehabilitation nurse prior to hospital discharge and provided with information about their condition and counselling about risk factor modification. The four centre-based programmes varied in length from nine sessions at weekly intervals of education, relaxation and circuit training to 24 individualised sessions over 12 weeks of mainly walking, fixed cycling and rowing with group-based education. The home-based programme consisted of an appropriate version of the Heart Manual, home visits and telephone contact. The Heart Manual was introduced to patients on an individual basis, either in hospital or on a home visit. Home visits by a nurse took place at approximately 1, 6 and 12 weeks after recruitment, with a telephone call at 3 weeks. At the final visit, patients were encouraged to maintain their lifestyle changes and to continue with their exercise programme. Where needed, follow-up was made by a rehabilitation nurse who spoke Punjabi. An audiotape of an abridged version of the Heart Manual in Punjabi accompanied the manual for patients with a limited command of English. MAIN OUTCOME MEASURES: Primary outcomes were smoking cessation, blood pressure, total and high-density lipoprotein cholesterol, exercise capacity measured by the incremental shuttle walking test and psychological status measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included self-reported diet, physical activity, cardiac symptoms and quality of life. Health service resource use and costs of rehabilitation programmes from health service and societal perspectives were also measured. Adherence to the physical activity element of the rehabilitation programmes was measured by questionnaire 6, 9 and 12 weeks. RESULTS: No clinically or statistically significant differences were found in any of the primary or secondary outcome measures between the home- and centre-based groups. Significant improvements in total cholesterol, smoking prevalence, the HADS anxiety score, self-reported physical activity and diet were seen in both arms between baseline and the 6-month follow-up. Five or more contacts with a cardiac rehabilitation nurse were received by 96% of home-based participants, whereas only 56% of centre-based participants attended this many rehabilitation classes. The direct rehabilitation costs to the health service were significantly higher for the home-based programme (mean cost 198 pounds versus 157 pounds for the centre-based programme), but when patient costs were included the mean cost of the centre-based arm rose to 182 pounds. Patients' reasons for not taking up or adhering to cardiac rehabilitation were multifactorial and very individual. Other health problems limited some patients' ability to exercise. Most non-adherers found some aspects of their cardiac rehabilitation programme helpful. Many had adapted advice on rehab litation and were continuing to exercise in other ways and had made lifestyle changes, particularly to their diet. The home-based patients' lack of motivation to exercise on their own at home was a major factor in non-adherence. The focus groups revealed little diversity of views among patients from each programme. Patients in the hospital programme enjoyed the camaraderie of group exercise and the home-based patients valued the wealth of information and advice in the Heart Manual. CONCLUSIONS: A home-based cardiac rehabilitation programme for low- to moderate-risk patients does not produce inferior outcomes compared with the traditional centre-based programmes. With the level of home visiting in this trial, the home-based programme was more costly to the health service, but with the difference in costs borne by patients attending centre-based programmes. Different reasons were given by home and hospital cardiac rehabilitation patients for not taking up or adhering to cardiac rehabilitation, with home-based patients often citing a lack of motivation to exercise at home. Social characteristics, individual patient needs and the location of cardiac rehabilitation programmes need to be taken into account in programme design to maximise participation. Research is recommended into cardiac rehabilitation in patients from ethnic minority groups; measurement tools to assess physical activity and dietary change; evaluating the Heart Manual in patients who decline centre-based cardiac rehabilitation; the implementation of home-based programmes in the UK; and strategies that sustain physical activity in the long term. Executive summary and full-text available for free by visiting the document URL listed with this record. Executive summary and full-text available for free by visiting the document URL listed with this record.
Jones, M. I., Greenfield, S., & Jolly, K. (2009). Patients' experience of home and hospital based cardiac rehabilitation: a focus group study. European Journal of Cardiovascular Nursing, 8(1), 9-17.
BACKGROUND: New cardiac rehabilitation (CR) programmes, such as home programmes using the Heart Manual, are being introduced but little is known about patients' experiences of these. AIMS: To compare the views of patients who had completed a home or hospital-based CR programme and explore the benefits and problems of each programme. METHODS: 16 patients from 4 hospital programmes attended one of 3 focus groups; 10 home programme patients attended one of 2 focus groups. RESULTS: Some themes were common to all focus groups: loss of confidence; continuing to exercise and lifestyle changes; understanding of heart disease. Hospital programme patients particularly enjoyed exercising in a group and mixing with other people, and gained motivation and support from others. Home programme patients spoke very highly of the Heart Manual and valued the one-to-one support of the nurse facilitators. They described the home programme as a lifestyle change compared to the hospital programme which they suggested was more like a treatment. CONCLUSIONS: Patients in the hospital programme enjoyed the camaraderie of group exercise and patients in the home programme valued the wealth of information and advice in the Heart Manual and this gave them a feeling of being in control of their health.
Jordan, S., Jones, R., & Sargeant, M. P. (2009). Adverse drug reactions: managing the risk. Journal of Nursing Management, 17(2), 175-184.
Aim This study aims to assess the need to formalize medication monitoring strategies in electronic records in two crisis resolution home treatment (CRHT) teams in one UK NHS Trust. Background The management and monitoring of prescribed medications has long been a cause for concern. As a result of the potential adverse drug reactions associated with commonly prescribed medication, clients of mental health teams are vulnerable to iatrogenic risk linked to physical health problems. Method Electronic records for all clients receiving care in two CHRT teams in one UK mental health Trust in November 2007 were examined for evidence of monitoring for potential adverse drug reactions. Findings were compared with the sample of paper records submitted to a national audit. Results Electronic records omitted important aspects of medication monitoring, for example: 14 out of 57 clients had blood pressure recorded; 15 out of 57 had heart rate recorded; 13 out of 57 had weight recorded. However, the teams' paper records were significantly better than both the electronic records and a national audit sample at recording blood pressure and obesity. We found few differences between our two teams. Conclusions The format of our electronic records requires modification to ensure that systems are in place to document adverse drug reactions and the physical health of those with mental illness. Implications for nursing management The transition to electronic records needs to be carefully managed to ensure that information on adverse drug reactions is included. The West Wales Adverse Drug Reaction profile, version II, is one strategy to achieve this in mental health.
Kaasa, S., Jordhoy, M. S., & Haugen, D. F. (2007). Palliative care in Norway: A national public health model. Journal of Pain and Symptom Management, 33(5), 599-604.
Palliative care (PC) in Norway has evolved in close cooperation between the health authorities and health care professionals. A number of official reports and national plans have promoted a stepwise development of PC services on all levels of the public health care system: tertiary care, with palliative medicine units in university hospitals coupled with research groups and regional Units of Service Development; secondary care, with hospital-based consult teams, inpatient units, and outpatient clinics; and primary care, with home care and designated PC units in nursing homes. The regional Units of Service Development are specifically assigned to research, education, and audit, as well as to development and coordination of services. PC has been closely linked to cancer care and included in the national cancer strategy. Starting the organizational development at the tertiary level has been crucial for educational and audit purposes, and has provided an excellent basis for networking. The Norwegian strategy for PC has resulted in rapidly increasing quantity and quality of services, but several challenges are still pending. Further improvement of the financial reimbursement system is needed, in particular concerning the funding for PC units in nursing homes. There are also challenges related to expertise and training, including establishing a program for palliative nursing and getting palliative medicine recognized as a medical specialty. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kandsberger, D. (2007). Factors influencing the successful utilization of home health care in the treatment of children and adolescents with cancer. Home Health Care Management & Practice, 19(6), 450-455.
Because of ongoing developments in available therapies, supportive care, and medical technology, as well as psychosocial and financial considerations, children and adolescents with cancer are undergoing a greater variety of treatments in a greater variety of settings with a greater chance for cure of their diseases than ever before. Choice of venue for various components of an individual child's treatment must take into account the nature of the therapy, available resources, and burden for the child and family. This article will review recent literature illustrating factors to be considered for the successful utilization of home care services in the overall care of children and adolescents with cancer. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kars, M. C., Duijnstee, M. S., Pool, A., van Delden, J. J., & Grypdonck, M. H. (2008). Being there: Parenting the child with acute lymphoblastic leukaemia. Journal of Clinical Nursing, 17(12), 1553-1562.
Aims and objectives: To gain insight into the lived experience of parenting a child with leukaemia during treatment. Background: Diagnosis of leukaemia in children leads to an existential shock for parents and a reversal of normal family life. Today, in the Netherlands, after diagnosis, children stay at home most of the time. Therefore, their parents face considerable responsibilities for administering home-based treatment and for the support of their child during illness and treatment. Methods: A grounded theory study was undertaken at a Dutch University Hospital and involved one-time individual in-depth interviews with 12 mothers and 11 fathers (n = 23) of 12 children. Findings: 'Being there', was identified as the core concept. It means: 'I'll be there for you; I will never let you down'. 'Being there' is described as a parental response to the perceived vulnerability of the child and the parental need to give meaning to parenthood. It serves two purposes: protection and preservation. Protection means guarding the child against the negative aspects of illness and treatment. Preservation refers to the way parents influence the child's perception of his/her life, thus contributing to his/her coping and willingness to undergo treatment, to maximise the chances for survival. Six aspects were identified: a trusting relationship, presence, emotional support, advocacy, routines and rituals and effacing oneself. Conclusions: The concept provides a theoretical frame for parenting the child with cancer. It clarifies the actions and reactions of parents and increases insight into the underlying force that enables parents to provide continuing care despite their personal burden. Relevance to clinical practice: The concept offers an essential insight into parenting the child with acute lymphoblastic leukaemia and has relevance for nursing practice and education. Understanding of the concept would improve the ability to understand, communicate and work pro-actively in partnership with parents. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kautz, C. M., Gittell, J. H., Weinberg, D. B., Lusenhop, R. W., & Wright, J. (2007). Patient benefits from participating in an integrated delivery system: impact on coordination of care. Health Care Management Review, 32(3), 284-294.
BACKGROUND: Although the presumption in health services literature has been that integrated delivery systems (IDSs) should improve the coordination of care, the benefits have not yet been well established through empirical research. PURPOSES: This study assesses whether receiving care from providers who belong to the same IDS improves patient-perceived coordination of care; concurrently, we develop a new approach for assessing the performance of IDS. METHODOLOGY/APPROACH: A study was conducted of 222 patients who received primary unilateral total knee arthroplasty at a large IDS' acute care hospital. To isolate the effects of provider membership, we enrolled patients who received surgery from the same surgical department in the same acute care hospital in the IDS. We used baseline and 6-week postoperation patient surveys to assess the impact of the participation of the patients' providers in the IDS on patient-perceived coordination of care. FINDINGS: We found no consistent effects of IDS membership on patient-perceived coordination of care. Patients with in-network rehabilitation care experienced fewer problems than patients with out-of-network rehabilitation care did, while patients with in-network home care experienced more problems than patients with out-of-network home care did. Membership of a patient's primary care physician had no observed effects. PRACTICE IMPLICATIONS: Health care managers and administrators need to undertake a realistic examination of the care-coordinating mechanisms that exist in their IDS. This study has shown that the integration of financial, contractual, and administrative processes is not enough to improve care from the patient's perspective; to improve care, it is advised that an IDS take a patient-centered approach in its design and implementation. We discuss potential reasons for uneven integration of IDS, particularly with respect to the lack of coordinating mechanisms, and argue for the usefulness of the approach developed here for assessing IDS performance over time.
Keady, J., Ashcroft-Simpson, S., Halligan, K., & Williams, S. (2007). Admiral nursing and the family care of a parent with dementia: Using autobiographical narrative as grounding for negotiated clinical practice and decision-making. Scandinavian Journal of Caring Sciences, 21(3), 345-353.
Background: Providing family care at home for a person with a long-established diagnosis of dementia has been recognized for some time as a multifaceted and complex phenomenon where care roles alter during the course of the condition. Presently, the nursing response to meeting such need is currently poorly defined and documented in the literature and depends more upon descriptive illustrations of practice efficacy rather than any evaluated system of knowledge and skills transfer or framework utilization. Aim: The aim of the study was to capture an autobiographical account of a family carer's (Kath, co-author) journey through the experience of her mother's dementia and the reflexive dialogue and shared care planning that ensued with the Admiral Nurse (Susan, co-author). Design: Kath's narrative was captured using practitioner-research principles and 10 interview contacts; the autobiography was then used as the basis for therapeutic and clinical work, as reported and jointly negotiated between Kath and Susan. Results: The findings demonstrate the importance of constructing care from an autobiographical perspective and integrating lay knowledge within an overall professional response to family/carer need in dementia caregiving situations. The negotiated clinical response to Kath's grief process (the death of Kath's father, the main carer support to her mother with dementia) and Kath's subsequent adaptation process is illustrated through a shared sessional plan and agreed measures of effective care. Conclusion: Integrating narrative approaches into care practice demonstrates important new ways of working alongside families of people with dementia to help develop negotiated, transparent and shared systems of care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kealey, P., & McIntyre, I. (2005). An evaluation of the domiciliary occupational therapy service in palliative cancer care in a community trust: a patient and carers perspective. European Journal of Cancer Care, 14(3), 232-243.
In the past 20 years there has been considerable growth in the provision of palliative care services. The shift in emphasis from hospice and hospital care to the development of community services has been significant. This enables people to be cared for at home and is in keeping with Government agenda. While this may be beneficial for the patient and fit in with the wishes of the family, it is likely to put heavy demands on the coping resources of individual carers. The views of service users are of paramount importance when discussing service evaluation and patient, family and carer empowerment. This research presents the findings of an evaluation of the domiciliary occupational therapy service provided for patients in the palliative stage of cancer care in North and West Belfast from the perspective of the patients and carers. For the purpose of this study, the palliative stage of cancer care is defined as the point from which the patient is no longer responsive to curative treatment, until death. A sample of 30 patients and their primary informal carers were selected using purposive sampling. A structured interview was carried out with both the patients and their carers to obtain views. Results suggest that although both patients and their carers value the service provided and report high levels of satisfaction, there are gaps identified in service provision and a lack of clear information among patients and their carers about the role of the occupational therapist and the range of services they can provide. There is a need to build upon the good work being done by domiciliary occupational therapists in the area of palliative cancer care and increase education and resources to ensure that a patient-centred, holistic, approach to care is used, addressing both the needs of the patient and their carers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kelly, D., Pearce, S., Butters, E., Stevens, W., & Layzell, S. (2004). Achieving change in the NHS: A study to explore the feasibility of a home-based cancer chemotherapy service. International Journal of Nursing Studies, 41(2), 215-224.
A major focus of current health policy in the United Kingdom is the development of services that meet the public's expectations. To achieve this there is a need to evaluate current provision to ensure that the best use is made of finite resources. The study reported here adopted an interview approach to examine an existing outpatient chemotherapy service, and to consider the feasibility of introducing a home based model. Following a review of literature on this topic data were obtained from in-depth interviews with patients and professionals regarding the present service. These were then combined with an analysis of service contracts and financial estimates. The poor quality of much of the cost-related information limited the conclusions which could be drawn, and emphasised the need for access to more accessible and robust financial information upon which to base change. The study also illustrated the benefits of feasibility studies; especially when cost-effectiveness and patient satisfaction are the driving forces behind proposed changes to clinical services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kelly, K., & Christou, E. (2009). Policy, politics and family caregiving. Aging Today, 30(3), 7.
Kenneley, I. L. (2007). Infection control and prevention in home healthcare: prevention activities are the key to desired patient outcomes. Home Healthcare Nurse, 25(7), 459-469.
Approximately 88,000 people die annually from preventable healthcare-associated infections. These are preventable infections. Home healthcare clinicians experience many challenges related to infection control and prevention activities. Consequently, clinicians must do their best to provide comprehensive, safe patient care in a challenging and unpredictable environment
Khalifeh, H., Murgatroyd, C., Freeman, M., Johnson, S., & Killaspy, H. (2009). Home treatment as an alternative to hospital admission for mothers in a mental health crisis: A qualitative study. Psychiatric Services, 60(5), 634-639.
Objective: This study explored the experiences, treatment preferences, and needs of mothers of dependent children who were treated at home as an alternative to hospital admission for an acute severe mental health crisis. Methods: In this qualitative study, mothers were recruited who were treated by one of four crisis resolution teams in two inner London boroughs. Semistructured interviews were conducted with 18 mothers and five of their children. Transcripts were coded by thematic analysis to extract relevant themes. Results: Home treatment provided good patient care, but most participants felt that they struggled to parent adequately and to meet their children's needs. Common difficulties included meeting the children's physical needs, feeling emotionally distant, being dependent on children during the crisis, and struggling to protect the children from exposure to symptoms or distress. Most mothers preferred home treatment to hospital admission, because they felt safer and better looked after at home. However, most children preferred parental hospital admission, because it relieved the children of distress and responsibility. Mothers were reluctant to seek help with parenting from professionals because of fears of custody loss. Conclusions: Home treatment for female patients with child care responsibility meets patients' needs, but their children may be exposed to additional risks and currently lack appropriate support. The needs of children should be considered in the planning of home treatment for psychiatric crises. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kietzman, K. G., Benjamin, A. E., & Matthias, R. E. (2008). Of family, friends, and strangers: caregiving satisfaction across three types of paid caregivers. Home Health Care Services Quarterly, 27(2), 100-120.
This study examines the experiences of 609 family, friend, and unrelated caregivers hired directly by clients under a consumer-directed model of home care. Using telephone survey data of clients and workers in California's In-Home Supportive Services program, this research compares outcomes and identifies predictors of caregiving work satisfaction across these three groups. In the total sample, feeling well prepared for the work predicted higher levels of satisfaction, while being Latino/Hispanic (as compared to being White or Black) predicted lower levels of satisfaction. Predictors varied depending on the caregiver's relationship with the client. In particular, friend caregivers who felt prepared were more satisfied than either strangers or family members. Understanding more about caregiver-client relationships and satisfaction is important to future workforce recruitment and retention efforts.
Kim, Y., & Schulz, R. (2008). Family caregivers' strains: Comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. Journal of Aging and Health, 20(5), 483-503.
Objectives: This study aimed to investigate the impact of cancer from family caregivers' perspective, based on a comparative analysis of caregiving burden and distress, among four types of caregivers. Methods: The sample included caregivers of persons with cancer, dementia, diabetes, or frail elderly from a nationally representative sample of 606 caregivers. Results: Although the four different types of caregivers were comparable in most sociodemographic characteristics, caregiving involvement and caregiving outcomes differed among the caregiving groups. Both cancer and dementia caregivers reported greater levels of physical burden and psychological distress than other caregivers, after controlling for sociodemographic and caregiving involvement (i.e., level of burden and caregiving duration) factors. Discussion: The comparative analysis provided a systematic review of cancer caregiving in the context of three other types of caregiving. Given the high levels of burden and distress, greater emphasis should be placed on developing social service policy and practice for cancer caregivers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kirk, T. W. (2007). Managing pain, managing ethics. Pain Management Nursing, 8(1), 25-34.
Noncompliance of family caregivers can present home hospice nurses with difficult ethical choices and powerful feelings about those choices. This is particularly so when family members do not adequately palliate their loved ones, resulting in treatable symptom distress during the dying process. This article presents a case study, moral analysis, and an evidence-based, practical plan of action for engaging family members of palliative care patients on a home hospice service. © 2007 by the American Society of Pain Management Nurses
Kirkpatrick, S., Barlow, J., Stewart-Brown, S., & Davis, H. (2007). Working in partnership: user perceptions of intensive home visiting. Child Abuse Review, 16(1), 32-46.
The aim of this study was to explore the perceptions of vulnerable women about the value of intensive home visiting in pregnancy and the first year of life delivered by health visitors trained to work in partnership with families. Twenty in-depth interviews were conducted with women who had completed the home visiting programme and agreed to be interviewed. The data were fully transcribed and analysed thematically. Despite initial concerns and negative preconceptions about health and social service professionals, participating women greatly valued the relationships that were established with their home visitors and identified a number of ways in which they had benefited. These included increased confidence, improved mental health, better parenting, improved relationships and changes in their attitudes toward professionals. These findings demonstrate the potential of intensive home visiting delivered in partnership with mothers in reaching and helping vulnerable and 'hard-to-reach' families. They highlight the importance of establishing a trusting relationship between helper and provider, and the need for home visitors to have the necessary skills and qualities to establish such relationships. Copyright © 2007 John Wiley & Sons, Ltd.
Klug, G., Hermann, G., Fuchs-Nieder, B., Stipacek, A., & Zapotoczky, H. G. (2008). Geriatric psychiatry home treatment (GHT): A pilot study on outcomes following hospital discharge for depressive and delusional patients. Archives of Gerontology and Geriatrics, 47(1), 109-120.
Elderly people with mental health problems receive much worse outpatient care than younger people. Although the health-promoting factors are known, there are hardly any studies on effective bio psychosocial care models. A 1-year longitudinal study examined the effectiveness of the GHT presented below. For this purpose, 12 depressive and delusional patients discharged from inpatient gerontopsychiatric care received mental and social treatment and care at home for 1 year. Functionality was surveyed by means of the Global Assessment of Functioning Scale (GAF) and psychiatric symptoms by means of the Brief Psychiatric Rating Scale (BPRS). Subjective quality of life (QoL) was surveyed by means of the WHOQOL-BREF self-report questionnaire. The main findings were as follows: (1) no patient had to receive inpatient psychiatric care or be admitted to a nursing home during the study period; (2) mental QoL had improved significantly after 1 year; (3) functionality remained stable; (4) the BPRS scores did not deteriorate. We see this as confirmation that GHT is an effective instrument for extramural care of elderly people with psychiatric disorders. The limitations of the pilot study necessitate further studies to back up the findings. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kneil, C., Pellow, H., & Potter, J. (2009). Long-term urethral catheter audit in patients' own homes. Journal of Infection Prevention, 10(2), 62-65.
Auditing of urinary catheter care generally occurs in clinical environments, either in acute trusts, community hospitals or general practices. This paper reports on an audit that sought to establish the quality of long-term urethral catheter care provided for patients in their own homes. The outcomes identify opportunities to improve the care of these long-term devices, through improved clinical practice by healthcare staff, and opportunites to improve the training and education of patients and their carers.
Knoche, L., Peterson, C. A., Edwards, C. P., & Jeon, H.-J. (2006). Child care for children with and without disabilities: The provider, observer, and parent perspectives. Early Childhood Research Quarterly, 21(1), 93-109.
This three-phase study, part of a larger study conducted by the Midwest Child Care Research Consortium (MCCRC), investigated the characteristics of child care providers in inclusive and non-inclusive center-based classrooms and family child care homes, the observed quality of care in a subset of these programs, and families' perceptions of quality and satisfaction with child care services. A telephone survey of 2022 randomly selected Midwestern providers, 36% of whom provided inclusive services, revealed that inclusive providers rated themselves higher on most quality-related indicators. Inclusion status was related to observed quality in family childcare homes (n = 132), with non-inclusive homes higher, while trends in the opposite direction were observed in preschool center-based classrooms (n = 112) but not in infant/toddler center-based classrooms (n = 105). Six percent of the 1325 parents surveyed reported parenting a child with a disability. These parents indicated less income, and more frequent changes in child care settings than other families, and reported the quality of their children's child care as good, particularly if center-based. Improved access to inclusive child care services and enhanced training opportunities related to serving children with disabilities and inclusion, especially for family child care providers, is recommended. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kobelt, G., Berg, J., Lindgren, P., Fredrikson, S., & Jonsson, B. (2006). Costs and quality of life of patients with multiple sclerosis in Europe. Journal of Neurology, Neurosurgery & Psychiatry, 77(8), 918-926.
Objective: To assess overall resource consumption, work capacity and quality of life of patients with multiple sclerosis in nine European countries. Methods: Information on resource consumption related to multiple sclerosis, informal care by relatives, productivity losses and overall quality of life (utility) was collected with a standardised pre-tested questionnaire from 13,186 patients enrolled in national multiple sclerosis societies or followed up in neurology clinics. Information on disease included disease duration, self-assessed disease severity and relapses. Mean annual costs per patient (Euro, 2005) were estimated from the societal perspective. Results: The mean age ranged from 45.1 to 53.4 years, and all levels of disease severity were represented. Between 16% and 29% of patients reported experiencing a relapse in the 3 months preceding data collection. The proportion of patients in early retirement because of multiple sclerosis ranged from 33% to 45%. The use of direct medical resources (eg, hospitalisation, consultations and drugs) varied considerably across countries, whereas the use of non-medical resources (eg, walking sticks, wheel chairs, modifications to house and car) and services (eg, home care and transportation) was comparable. Informal care use was highly correlated with disease severity, but was further influenced by healthcare systems and family structure. All types of costs increased with worsening disease. The total mean annual costs per patient (adjusted for gross domestic product purchasing power) were estimated at Euro 18,000 for mild disease (Expanded Disability Status Scale (EDSS) <4.0), Euro 36,500 for moderate disease (EDSS 4.0-6.5) and Euro 62,000 for severe disease (EDSS >7.0). Utility was similar across countries at around 0.70 for a patient with an EDSS of 2.0 and around 0.45 for a patient with an EDSS of 6.5. Intangible costs were estimated at around Euro 13,000 per patient. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Koroukian, S. M., Murray, P., & Madigan, E. (2006). Comorbidity, disability, and geriatric syndromes in elderly cancer patients receiving home health care. Journal of Clinical Oncology, 24(15), 2304-2310.
PURPOSE: To assess the prevalence of comorbidity, disability, and geriatric syndromes, or a combination thereof, in elders with cancer receiving home health care (HHC). PATIENTS AND METHODS: Using the Ohio Cancer Incidence Surveillance System, we identified Ohio residents 65 years of age or older who were diagnosed with incident breast (n = 952), prostate (n = 324), or colorectal cancer (n = 1,276) during the 28-month study period, August 1999 through November 2001. We used the Outcome and Assessment Information Set, a database compiling comprehensive assessment forms completed for all HHC patients, to group individuals in independent and overlapping categories of comorbidity, disability, and geriatric syndromes on the basis of the patients' clinical condition 14 days before the date of the assessment. RESULTS: The proportion with no comorbidity, disability, or geriatric syndromes was 26.4% in breast cancer patients, 12.0% in prostate cancer patients, and 14.0% in colorectal cancer patients. The proportion of patients presenting all three entities at once was 11.7%, 24.7%, and 15.7%, respectively, in three cancer sites. As expected, the proportion of patients with no comorbidity, disability, or geriatric syndromes declined gradually with increasing age, and that of patients with all three entities was highest among patients 85 years or older. CONCLUSION: The proposed taxonomy will help us gain a more nuanced understanding of older cancer patients' clinical presentation and may lead to a more accurate identification of older patients who might benefit from standard cancer treatment, and those who might experience adverse outcomes.
Kralik, D., & Anderson, B. (2008). Differences in home-based palliative care service utilisation of people with cancer and non-cancer conditions. Journal of Clinical Nursing, 17(11c), 429-435.
Aim: To identify home-based palliative care service utilisation by people with cancer and non-cancer conditions. Background: Palliative care knowledge and skill have been derived from working with people with cancer. People with chronic conditions are now referred for home-based palliative care; however, there has been few studies published that have explored the impact of service utilisation by people with end-stage chronic conditions. Design: The Australia-modified Karnofsky Performance Status (AKPS) scale was calculated for each person upon referral for home-based palliative care services to determine the functional capacity of the individual at the point of referral. Clients were divided into those with cancer diagnosis and those with non-cancer diagnosis. Service utilisation of the individual client was determined until separation from the palliative care service. The study was undertaken in 2007. Findings: The majority of people with cancer (63%) and non-cancer (71%) were assessed as having an AKPS score between 50-60. Thirty-one cancer clients (18.7%) and three non-cancer clients (7.1%) had an AKPS score between 70-90. This suggests that people with cancer are referred to palliative care services earlier than people with non-cancer conditions. People with non-cancer conditions were substantially higher users of home-based palliative care services over a longer period of time. Conclusions: Home-based palliative care service utilisation was higher for people with non-cancer conditions. Cost analysis research is recommended to delineate the actual costs of home-based palliative care service provision between people with cancer and non-cancer conditions. Relevance to clinical practice: There is growing awareness of the need for palliative care services for people with non-cancer conditions. However, these services are provided for longer periods of time for this client group. Implications for practice are that the palliative care needs of people with non-cancer conditions may not be met within current palliative care service provision. There may be funding implications for home-based palliative care services that intend to meet the needs of people at end of life with non-cancer conditions. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Kruger, C. J., & Snyman, M. M. M. (2005). Formulation of a strategic knowledge management maturity model. [Article]. SAJIM: South African Journal of Information Management, 7(2), 1-1.
This article is devoted to the formulation of a strategic knowledge management maturity model, one built on the progression and institutionalization of strategic business issues, which are believed to be of vital importance in the quest for the successful institutionalization of knowledge management. To formulate a knowledge management maturity model capable not only of addressing the objectives and issues of importance regarding knowledge management, but also of addressing limitations present in today's models, a qualitative research approach was followed. Relevant literature was studied and analysed to identify issues, policies and strategies that are often neglected in maturity models, but need to be addressed if knowledge is to be effectively and efficiently managed as a strategic resource. The selection of sources was driven by the need to assess knowledge and knowledge management's role in the process of speeding up the business evolutionary process. Institutionalizing knowledge management proposes that knowledge management requires the concurrent management of four domains, namely culture, content, process and infrastructure.
Kruger, C. J., & Snyman, M. M. M. (2007). Guidelines for assessing the knowledge management maturity of organizations. [Article]. SAJIM: South African Journal of Information Management, 9(3), 2-2.
In a recent article Kruger and Snyman hypothesized that progressions in knowledge management maturity (from a strategic perspective) are directly related to an increased ability to speed up the strategic cycle of imitation, consolidation and innovation. The arguments proposed, however, neglected to supply the reader with a practical toolkit or even a roadmap (a time-related matrix, or questionnaire) to successfully measure succession in knowledge management maturity. This article builds on the previous one and proposes a questionnaire consisting of six sections, containing 101 descriptive questions, to enable organizations to test and assess their knowledge management maturity empirically. The development of an instrument to measure knowledge management maturity required adhering to a research design that combined theoretical propositions with practical experimentation. As a point of departure, a knowledge management maturity matrix consisting of seven maturity levels was formulated. All questions contained within the matrix were benchmarked against a survey questionnaire developed by the public management service of the OECD (PUMA) and were also pre-tested and validated. This process of refinement led to the formulation of the Knowledge Management Maturity Questionnaire. To avoid any taint of this research being based only on theoretical propositions, the questionnaire was tested by 178 master students of the University of Pretoria, South Africa, in nine different industries. The proposed questionnaire provides a bridge between theoretical propositions and practical usability, not only enabling knowledge management practitioners to assess the level of knowledge management maturity reached successfully but, more importantly, also serving as a guideline to institutionalize further and future knowledge management endeavours. [ABSTRACT FROM AUTHOR]
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Kukeya, C. B. (2006). Home caring for spouses with terminal cancer in the last stages of their illness: A phenomenological study of middle-aged caregivers. Dissertation Abstracts International Section A: Humanities and Social Sciences, 67(3-A), 851.
This phenomenological study explored the lived experiences of middle-aged spouses who cared for their partners when their cancer diagnosis was termed terminal. The purpose was to obtain firsthand descriptions of personal lived experiences from the spouses, focusing on the perceived meaning these experiences held for them, as well as the impact of caregiving and the reported unmet needs, challenges, and coping strategies from the caregivers' perspective. Semi-structured interviews, field notes, and observations were used to collect data from participants, and findings were analyzed using Parse's human becoming theory. The findings revealed that caring for a terminally ill spouse with cancer is a very complex task, full of paradoxes. The experience can be satisfying and rewarding or completely frustrating. While caregivers initially experienced feelings of crushing uncertainty and saw caregiving as an emotional rollercoaster or life thrown into turmoil, they also experienced acceptance of lifestyle changes as they transitioned through the diagnosis of their ill spouses. Letting-go and gaining knowledge and information were identified as the key coping mechanisms that deemed helpful to caregivers. As the caregivers' needs for information and knowledge were met, there was a decrease in the negative aspects of caregiving, and caregivers were more inclined to see their experience as a gain, despite all the personal hardship involved in the process. The implications from this study suggest that professionals who are in a position of assisting families should be aware of the phases of caregiving development so that culturally and spiritually sensitive interventions can be designed to address individual needs they change along a patient's illness trajectory. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Kumamoto, K., Arai, Y., & Zarit, S. H. (2006). Use of home care services effectively reduces feelings of burden among family caregivers of disabled elderly in Japan: Preliminary results. International Journal of Geriatric Psychiatry, 21(2), 163-170.
Background: Relatively few observational studies have been conducted on the impact of home care services on burden or other aspects of the caregiver's experience. Objectives: To examine whether the use of care services reduces the feelings of burden among family caregivers in Japan. Specifically, the study was aimed at testing the following three hypotheses: (1) The severity of impairment and the dementia among the disabled elderly increases the feelings of burden among family caregivers and the support from family members decreases burden: (2) the amount of services used by older people and their caregivers is affected by the severity of dementia and ADL deficiencies among the disabled elderly and the amount of support from family members: and (3) controlling for severity, the use of care services under the LTC insurance program serves to reduce the feelings of burden among family caregivers. Methods: A structural equation model using the data obtained from 82 pairs of community-dwelling disabled elderly and their principal family caregivers. The model included the following variables: age of the disabled elderly; the severity of ADL deficiency and behavioral disturbances; use of formal (public) care services; support from family members; and feelings of burden among family caregivers. Results: The structural equation model revealed that, after controlling for the effects of severity on service use, home care services effectively reduce feelings of burden among family caregivers. Conclusions: The findings suggest that care services provided under the LTC insurance have been successfully reducing burden among family caregivers in the study area. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Lahat, M., & Muller, M. (2009). Striving for safety: a falls prevention initiative for home care clients with dementia. Caring, 28(8), 28-31.
The goal of helping vulnerable people to remain safe at home is often elusive, particularly when aides are only in the clients' homes for a limited number of hours each week. Add the complicating factor of Alzheimer's disease or other dementias among our clients, and the goal of safety becomes even harder to attain. This article focuses on falls among the elderly, particularly those with dementia.
Lakin, K., Hewitt, A., Larson, S. A., & Stancliffe, R. J. (2005). Home and Community-Based Services: Costs, Utilization, and Outcomes. Stancliffe, Roger J, 91-127.
(from the chapter) Medicaid Home and Community-Based Services (HCBS) Waiver programs have become the most widely used and by far the most rapidly growing programs for financing long-term services and supports for individuals with intellectual and developmental disabilities in the United States. HCBS Waiver programs are intended to support people in their homes and communities as an alternative to more costly institutional care. This chapter, based on comprehensive evaluation by the University of Minnesota, describes Minnesota's HCBS Waiver program and participants and those living in Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR), factors associated with variations in HCBS utilization and expenditures, and the association between service costs and quality-of-life outcomes. It discusses the implication of the findings for HCBS policy in Minnesota, in particular, and for long-term care systems, in general. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Lantz, M. S. (2007). An elderly male found malnourished and dehydrated: when healthcare systems fail. Clinical Geriatrics, 15(9), 13-16.
Older adults who are found in a helpless state have a mortality rate of up to 67% after being left for more than 72 hours. Among those who survive after being found and treated, only 34% of older adults are able to return to the community. Most older adults choose to remain in their own homes as long as possible. Fortunately, in the majority of cases, in-home services and assistance enables elderly people to remain in the community indefinitely. In this Psychiatry Rounds column, Dr. Lantz provides helpful information on home care services available for vulnerable and dependent older adults.
Larsson, B. W., Larsson, G., & Carlson, S. R. (2004). Advanced home care: patients' opinions on quality compared with those of family members. Journal of Clinical Nursing, 13(2), 226-233.
BACKGROUND: Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients' opinions congruent with those of family members? AIM: To explore and compare the relationship between patients' perception of the quality of care and close family members' perception of this care as well as their perception of the patients' perception. METHODS: Sixty-seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care. RESULTS: A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members' own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern. CONCLUSION: Patients' views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care-related experiences. The results can be understood in the light of empathic accuracy theory. RELEVANCE TO CLINICAL PRACTICE: The findings of this study have important implications for clinical nursing practice. Family members' perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care-related experiences, otherwise family members' perception tend to be more critical than those of the patients themselves.
Larsson, K., Thorslund, M., & Forsell, Y. (2004). Dementia and Depressive Symptoms as Predictors of Home Help Utilization Among the Oldest Old: Population-Based Study in an Urban Area of Sweden. Journal of Aging and Health, 16(5), 641-668.
Objectives: The objective of this article is to investigate predictors of public home help utilization, particularly mental health problems such as dementia and depressive symptoms. Methods: A population-based sample of community-dwelling people aged 81-100 was interviewed and assessed with medical examinations (N = 502). Results: Dementia increased the odds of receiving public home help among people residing alone. Among coresiding people, it increased the odds of receiving home help, but only among those who had extraresidential care. Depressive symptoms decreased the odds of receiving home help among people with lower levels of education who lived alone. Depressive symptoms among highly educated people who lived alone and among coresiding people of any educational level were not related to receipt of home help. Discussion: Improvement of screening activities for public home help needs of community-dwelling elders might allow better targeting of limited social resources to the most needy. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Lashlee, M., & Curry, J. O. H. (2007). Pediatric home chemotherapy: Infusing "quality of life". Journal of Pediatric Oncology Nursing, 24(5), 294-298.
A pediatric home chemotherapy program is described that has operated as part of the pediatric oncology services at the Children's Hospital at Montefiore since 2004. Currently the chemotherapy regimens include high-dose methotrexate; 5-day highdose ifosfamide and etoposide; cyclophosphamide, doxorubicin, and vincristine; ifosfamide, carboplatin, and etoposide; and cisplatin and doxorubicin. The pediatric hematology/oncology program provides care to children with blood disorders and cancer of Bronx, NY, and surrounding areas. By providing patients receiving chemotherapy treatment with this special type of home infusion capability, the child and his or her family are able to spend more time at home and have less disruption in their family schedule. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Lawton, S. (2005). Review of Talking about care. Disability & Society, 20(6), 687-689.
Reviews the book "Talking about care," by Liz Forbat (2005). This book introduces new ideas for the analysis of informal care relationships, with particular focus on how difficulties within such relationships may be constructed. It is aimed at researchers, trainees and professionals within a health and social care field. A review of earlier literature and research into care relationships is shown to falsely polarise the two identities of carer and caree (the term used in this book for the person receiving care). Further literature, it is discussed, has focused on abuse, with some of the literature focusing on the vulnerability of the caree and others focusing on the difficulties facing a carer. This book suggests that literature about care relationships rarely suggests that both partners may in fact be acting inappropriately. The focus of this book is the importance of listening to both sides of the story in relationships and how professionals need to be trained in the use of discourse analysis to gain a deeper understanding of how difficulties in care relationships are constructed. This book also shows how history in a relationship - particularly a lifetime relationship - can play an important role in how people explain or waive responsibility for behaviour. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Lee, B. R., Munson, M. R., Ware, N. C., Ollie, M. T., Scott, L. D., Jr., & McMillen, J. C. (2006). Experiences of and attitudes toward mental health services among older youths in foster care. Psychiatric Services, 57(4), 487-492.
OBJECTIVES: This study explored the experiences of youths in the Missouri foster care system who were receiving mental health services in order to identify characteristics that they valued in relationships with mental health professionals and in the services they received and to examine whether their attitudes toward services were associated with their experiences with services. METHODS: As part of a larger study, 389 youths aged 17 years were asked open-ended questions about their experiences with mental health providers. The qualitative responses were classified through thematic analysis, and the frequencies of themes were assessed. Service use was measured, and the confidence subscale of the Attitude Toward Seeking Professional Psychological Help scale was used to measure attitudes. RESULTS: Youths' comments generally centered on three aspects of their mental health care: their relationship with their mental health provider, the level of professionalism of their provider, and the effects of the treatment, including medication management. Youths who reported only negative experiences had less positive attitudes toward services than other youths, but they were not any more likely to have experienced changes in service use or medication six months later. CONCLUSIONS: Soliciting feedback from youths about mental health services is important to the provision of high-quality care. In addition to themes identified in similar studies, this study suggests that medication management plays an important role in the acceptability of the treatment that youths receive.
Lee, J. (2007). Music therapy with a woman who was hurt by a cowboy. Canadian Journal of Music Therapy, 13(1), 30-37.
This case study describes the use of songwriting in music therapy with a woman in her thirties living with multiple sclerosis in a care home and involved in a relationship with a verbally and physically abusive partner. Over the course of ten individual songwriting sessions with a music therapy student, she was able to explore some of her personal issues and develop some insight into her situation. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Leff, B., Burton, L., Mader, S., Naughton, B., Burl, J., Clark, R., et al. (2006). Satisfaction with hospital at home care. Journal of the American Geriatrics Society, 54(9), 1355-1363.
OBJECTIVES: To examine differences in satisfaction with acute care between patients who received treatment in a physician-led substitutive Hospital at Home program and those who received usual acute hospital care. DESIGN: Survey questionnaire of participants in prospective, nonrandomized clinical trial. SETTING: Three Medicare-managed care health systems and a Department of Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in Hospital at Home and 130 in the acute care hospital. INTERVENTION: Treatment in a Hospital at Home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS: A 40-question survey measuring nine domains of care for patients and a 37-question survey measuring eight domains of care for family members. RESULTS: A higher proportion of patients were satisfied with treatment in Hospital at Home than with the acute care hospital in eight of nine domains, and this difference was statistically different in four domains. Hospital at Home patients were more likely than acute hospital patients to be satisfied with their physician (adjusted odds ratio (AOR) = 3.84, 95% confidence interval (CI) = 1.32-11.19), comfort and convenience of care (AOR = 6.52, 95% CI = 1.97-21.56), admission processes (AOR = 5.90, 95% CI = 2.21-5.76), and the overall care experience (AOR = 2.98, 95% CI = 1.08-8.21). Family members of patients treated in Hospital at Home were also more likely to be satisfied with multiple domains of care. CONCLUSION: Hospital at Home care was associated with greater satisfaction than acute hospital inpatient care for patients and their family members. These findings support further dissemination of the Hospital at Home care model.
Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Greenough, W. B., et al. (2009). Comparison of functional outcomes associated with hospital at home care and traditional acute hospital care. Journal of the American Geriatrics Society, 57(2), 273-278.
OBJECTIVES: To compare differences in the functional outcomes experienced by patients cared for in Hospital at Home (HaH) and traditional acute hospital care. DESIGN: Survey questionnaire of participants in a prospective nonrandomized clinical trial. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbations of chronic heart failure or chronic obstructive pulmonary disease, or cellulitis, 84 of whom were treated in HaH and 130 in an acute care hospital. INTERVENTION: Treatment in a HaH care model that substitutes for care provided in the traditional acute care hospital. MEASUREMENTS: Change in activity of daily living (ADL) and instrumental activity of daily living (IADL) scores from 1 month before admission to 2 weeks post admission to HaH or acute hospital and the proportion of groups that experienced improvement, no change, or decline in ADL and IADL scores. RESULTS: Patients treated in HaH experienced modest improvements in performance scores, whereas those treated in the acute care hospital declined (ADL, 0.39 vs -0.60, P=.10, range -12.0 to 7.0; IADL 0.74 vs -0.70, P=.007, range -5.0 to 10.0); a greater proportion of HaH patients improved in function and smaller proportions declined or had no change in ADLs (44% vs 25%, P=.10) or IADLs (46% vs 17%, P=.04). CONCLUSION: HaH care is associated with modestly better improvements in IADL status and trends toward more improvement in ADL status than traditional acute hospital care.
Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Inouye, S. K., et al. (2005). Improving patient care. Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of Internal Medicine, 143(11), 798.
BACKGROUND: Acutely ill older persons often experience adverse events when cared for in the acute care hospital. OBJECTIVE: To assess the clinical feasibility and efficacy of providing acute hospital-level care in a patient's home in a hospital at home. DESIGN: Prospective quasi-experiment. SETTING: 3 Medicare-managed care (Medicare + Choice) health systems at 2 sites and a Veterans Administration medical center. PARTICIPANTS: 455 community-dwelling elderly patients who required admission to an acute care hospital for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. INTERVENTION: Treatment in a hospital-at-home model of care that substitutes for treatment in an acute care hospital. MEASUREMENTS: Clinical process measures, standards of care, clinical complications, satisfaction with care, functional status, and costs of care. RESULTS: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality standards at rates similar to those of acute hospital care. On an intention-to-treat basis, patients treated in hospital-at-home had a shorter length of stay (3.2 vs. 4.9 days) (P = 0.004), and there was some evidence that they also had fewer complications. The mean cost was lower for hospital-at-home care than for acute hospital care (5081 dollars vs. 7480 dollars) (P < 0.001). LIMITATIONS: Possible selection bias because of the quasi-experimental design and missing data, modest sample size, and study site differences. CONCLUSIONS: The hospital-at-home care model is feasible, safe, and efficacious for certain older patients with selected acute medical illnesses who require acute hospital-level care.
Leff, B., Burton, L., Mader, S. L., Naughton, B., Burl, J., Koehn, D., et al. (2008). Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care. Journal of the American Geriatrics Society, 56(1), 117-123.
OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care. DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model. SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center. PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. INTERVENTION: Treatment in a substitutive HaH model. MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care. RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean +/- standard deviation 1.7 +/- 1.8 vs 4.3 +/- 3.1, P<.001; median 1 vs 4, P<.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05-0.30). CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.
Leff, E. W., & Sonstegard-Gamm, J. (2006). The home care team approach to self-neglecting elders. Home Healthcare Nurse, 24(4), 249-257.
Elderly patients who neglect their own health present special challenges. This article describes techniques for establishing rapport, understanding the patient's world, using a team approach to care, and achieving closure. At each step the clinician must find a balance between respecting the elder's rights and meeting his or her healthcare needs.
Lehoux, P., Richard, L., Pineault, R., & Saint-Arnaud, J. (2006). Delivery of high-tech home care by hospital-based nursing units in Quebec: clinical and technical challenges. Canadian Journal of Nursing Leadership, 19(1), 44-55.
BACKGROUND: The role that hospital-based nurses should play in the delivery of high-tech home care, and how they should be supported in that role, are topics that remain understudied. Our research objective was to document how hospital-based nursing teams perceive and deal with the clinical and technical challenges associated with the provision of high-tech home care. METHODS: Four home care interventions were selected: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. A self-administered survey was sent to all hospital-based units providing these interventions in the province of Quebec, Canada (n = 154; response rate: 70.8%). We used descriptive statistical analyses to derive mean values for scores on either a five- or a six-level Likert scale. RESULTS: Despite variation across the four interventions, our results indicate that while nursing teams believe these interventions increase patients' autonomy, they also recognize that they generate anxiety and impose constraints on patients' lives. Nurses must increase efforts to deal with both clinical and technical challenges and help patients overcome the barriers to appropriate use of home care technologies. CONCLUSIONS: While nursing teams generally perceive high-tech home care as beneficial, they still experience significant technical and clinical challenges. Some of these challenges could be addressed by strengthening professional training initiatives, while others require broader home care policy interventions.
Leiter, V. (2004). Dilemmas in sharing care: Maternal provision of professionally driven therapy for children with disabilities. Social Science & Medicine, 58(4), 837-849.
This paper explores some of the dilemmas that result when mothers and professionals collaborate in providing care to young children with disabilities within a US public program called Early Intervention. Successful collaboration between professionals and activist parents resulted in the program having a "family centered" approach, but the implementation of that approach is problematic. Professionals transmit therapeutic knowledge and skills to mothers of young children with special needs, urging them to perform therapeutic care work with their children. Through these efforts, professionals create a "therapeutic imperative" for mothers, expecting them to do therapeutic work that usually exceeds the amount of work that professionals do with their children. This paper explores the dilemmas mothers and professionals face when implementing family centered care and the ways in which mothers and professionals negotiate contested understandings of the optimal mixture of public (professional) and private (maternal) provision of therapeutic care to young children with disabilities. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Lemieux, L., Kaiser, S., Pereira, J., & Meadows, L. M. (2004). Sexuality in palliative care: Patient perspectives. Palliative Medicine, 18(7), 630-637.
This qualitative study investigated the meaning of sexuality to palliative patients. Face-to-face interviews were conducted with ten patients receiving care in a tertiary palliative care unit, a hospice or by palliative home care services in their homes. Several themes emerged. Emotional connection to others was an integral component of sexuality, taking precedence over physical expressions. Sexuality continues to be important at the end of life. Lack of privacy, shared rooms, staff intrusion and single beds were considered barriers to expressing sexuality in the hospital and hospice settings. Only one subject had previously been asked about sexuality as part of their clinical care, yet all felt that it should have been brought up, especially after the initial cancer treatments were completed. Home care nurses and physicians were seen as the appropriate caregivers to address this issue. Subjects unanimously mentioned that a holistic approach to palliative care would include opportunities to discuss the impact of their illness on their sexuality. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Leppänen, V. (2008). Coping with troublesome clients in home care. Qualitative Health Research, 18(9), 1195-1205.
I describe methods used by home carers to cope with troublesome clients and analyze how the organizational context affects their use. Empirical data consist of participant observation and field interviews with 14 home carers in three municipalities in southern Sweden. Home carers might try to avoid working with troublesome clients, prepare themselves mentally before visiting them, try to withhold them psychologically, try to understand them and explain their behavior, try to change their behavior, and vent experiences with colleagues. Although some of these methods are practiced frontstage, in interactions with clients, others take place backstage, only involving staff. Their use is influenced both by properties of frontstage work, for instance, the intimate nature of many tasks and the experienced need to keep up a "good" relationship with clients, and by the organization of backstage work, for instance, the organization of staff meetings and supervisors' understanding of coping processes.
Levine, C., Albert, S. M., Hokenstad, A., Halper, D. E., Hart, A. Y., & Gould, D. A. (2006). "This case is closed": family caregivers and the termination of home health care services for stroke patients. Milbank Quarterly, 84(2), 305-331.
Lewarski, J. S., & Gay, P. C. (2007). Current issues in home mechanical ventilation. CHEST, 132(2), 671-676.
As modern health care continues to evolve, we expect and are seeing that more sophisticated medical care will be provided outside the traditional acute care environments. Advances in home medical technology, economic pressures, health-care consumerism, and societal changes are all factors playing a role in this evolution. Medically fragile and technology-dependent individuals who were once limited to care in acute and subacute institutional settings are now frequently cared for at home, most often by their immediate family members. Mechanical ventilation has found its way into the patient's home such that physicians and other providers must be prepared for the challenges associated with managing the conditions of complex, ventilator-dependent individuals outside of the walls, controls, and safety of the institutional setting. With little published science and recognized standards of practice, there are fewer rules to guide clinicians through this process. Experience has shown, however, that successful home management of ventilator-dependent individuals can be traced to a smooth and collaborative discharge from the hospital to home. Reimbursement and coverage issues must also be well understood to avoid the aggravation of denials and challenges for necessary equipment and assistance. Once home, a streamlined, patient-centered process supported by effective communication between all care providers can result in a safe and appropriate long-term home ventilation success story.
Lewis, D. R., & Johnson, D. R. (2005). Costs of Family Care for Individuals with Developmental Disabilities. Stancliffe, Roger J, 63-89.
(from the chapter) This chapter reviews the literature since 1980 and focuses on several questions: 1)What are the social and family costs of care for family members with developmental disabilities?; 2) Are there costs of care beyond just financial resources?; 3) Who bears the financial burden of these costs?; and 4) How have these costs been allocated between families and society? (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Lewis, M., & Noyes, J. (2007). Risk management and clinical governance for complex home-based health care. Paediatric Nursing, 19(6), 23-28.
Healthcare professionals have an obligation to enable children with complex needs to lead 'ordinary lives' at home but the views of professionals and family members often diverge in relation to the management of risks. Nurses are increasingly taking on the clinical responsibility for children with complex needs within a multidisciplinary, multi-agency team, yet have little training or experience in adapting risk management and clinical governance frameworks to home-based settings. Risk management frameworks for home-based care for children with complex health and social care needs are introduced in this article. Best practice guidance and resources for adapting risk management frameworks are presented to meet this identified gap in knowledge and experience. Children, young people and their parents have increasing expectations relating to the type and quality of home-based support they receive. Developing and applying clinical governance and risk management frameworks are part of improving outcomes for children with complex needs and their families.
Leyva-Moral, J. M., & Mogeda-Marina, N. (2008). Psycho-social necessities for an informal caretaker [Spanish]. Revista Rol de Enfermería, 31(3), 36-39.
Of the many activities which nurses in primary attention care teams carry out, health promotion and prevention of diseases have a prominent place. These activities are not carried out only in Primary Attention Care Centers. For some time now, there has been a tendency to keep dependent patients in their homes as much as possible. For this reason, At Home Care has an important place in nurses' daily practices. This article reviews the concept of an informal caretaker and the main reasons which can cause an overload. At the same time, the authors show the tool which nurses use to know the emotional state of informal caretakers, as well as the environment and the circumstances where they are found. The authors propose to use nursing diagnoses as a planning tool for objectives and action strategies to overcome the shortages detected.
Li, L. W. (2005). Longitudinal Changes in the Amount of Informal Care Among Publicly Paid Home Care Recipients. The Gerontologist, 45(4), 465-473.
Purpose: This study examined how the amount of informal care received by disabled elders changes when they are receiving publicly paid home care, and whether formal service use, disability, caregiving arrangements, and demographic characteristics of older adults predict changes in the amount of informal care. Design and Methods: Hierarchical linear models were estimated, using 3-year data (12 repeated observations) collected from elderly participants (N = 888) in Michigan's Home- and Community-Based Medicaid Waiver Program. Results: The amount of informal care declined in the beginning period when publicly paid home care was received, and then it stabilized. Changes in activities and instrumental activities of daily living and caregiver residence predicted changes in the amount. The living arrangement and age of elders predicted different patterns of change over time. Neither formal service amount nor its change significantly predicted the amount of informal care. Implications: Informal caregivers do not relinquish caregiving when publicly paid home care is available. Expanding community-based long-term care is a means of fostering partnerships between formal and informal caregivers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Li, L. W., & Fries, B. E. (2005). Elder Disability as an Explanation for Racial Differences in Informal Home Care. The Gerontologist, 45(2), 206-215.
Purpose: Adjusting for sociodemographic characteristics and disability levels, this study examines whether differences exist in the structure and function of community-dwelling Black and White frail elders' informal care networks. Design and Methods: Data from in-person assessments of Michigan's Home and Community-Based Medicaid Waiver applicants were analyzed by using logistic and ordinary least squares regression. The sample consisted of 936 Black and 3,182 White frail elderly persons. Results: When sociodemographic characteristics were controlled for, racial differences were found in all informal care components except out-of-home chores. Differences in functional components (amount of care, scope of assistance, and personal care) were largely accounted for by disability, whereas racial differences in the structural components (source of care, living arrangement, and sole caregiver) and in-home chores were not. Implications: Findings suggest that Blacks are not better off than Whites in the receipt of informal care. Although Black elders receive more informal help, this difference is primarily because Blacks are more disabled. This study calls for heightened awareness of disability among low-income Blacks and the potential burden experienced by their caregivers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Lie, I., Arnesen, H., Sandvik, L., Hamilton, G., & Bunch, E. H. (2009). Health-related quality of life after coronary artery bypass grafting. The impact of a randomised controlled home-based intervention program. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 18(2), 201-207.
Objective: The aim of this study was to evaluate the impact of a home based intervention program (HBIP) on health related quality of life (HRQoL) after coronary artery bypass grafting (CABG). To strengthen the clinical interpretation, HRQoL data were compared to the general population. Methods: In a randomised controlled trial (RCT), a total of 185 CABG patients (93 vs 92) completed the study. The intervention group received a HBIP 2 and 4 weeks after surgery. HRQoL was measured by the Seattle Angina Questionnaire (SAQ) and the Short Form 36 (SF-36) in both patient groups before surgery, at 6 weeks and 6 months after surgery. Results: Significant improvements were found in both groups for the majority of subscales of HRQoL at 6-week and 6-month follow-up. However, these improvements did not differ significantly between the groups. Compared to the general population, significant differences (P < 0.05) were found for the SF-36 subscales: role physical, role emotional and bodily pain. Conclusions: HRQoL after CABG improved markedly over time, but no significant or clinically important differences were found when compared with controls. Thus, work to further develop and test the effect of a HBIP on HRQoL in patients undergoing rehabilitation following CABG is warranted. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Liebel, D. V. (2008). Process evaluation of a nurse home visiting intervention that postpones disability worsening in older adults. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(9-B), 5860.
Context. Since the vast majority of older adults experiencing and recovering from disability prefer to live in the community, nurse home visiting offers an effective method to deliver targeted geriatric strategies to maintain or improve disability status. The nurse intervention of the recently concluded Medicare Primary and Consumer-Directed Care Demonstration is one of only six nurse home visiting studies that have reported positive disability outcomes for community dwelling elders with disability. Purpose. The study purpose was to describe and evaluate the components of a nurse intervention responsible for disability maintenance/improvement among community dwelling older adults. Design setting and participants. The study was a process evaluation of the nurse intervention tested in a randomized controlled trial. The conceptual model of Mowbry based on the classic Donabedian model was employed to structure the evaluation. Outcomes were assessed using data from nurse notes, case studies, and Demonstration databases. Results. Results showed high levels of participation, dose, and fidelity for the intervention components. Nurse home visits were effective in maintaining/improving ADL dependence among 60% of the patients. These individuals were more limited in ADLs, younger, and had less cognitive impairment, higher SF-36 scores, and perceived their health as being unchanged. After adjusting for baseline characteristics, the number of intervention materials patients used and medication self-management were significantly associated with less disability and disability maintenance/improvement. Additionally, patients with more disability received significantly more nurse home visits, family conference visits, and nursing home visits, set more goals, and worked on more disease selfmanagement activities. Furthermore, sub-analyses revealed that patients receiving the prescribed dose of the intervention components (e.g., 20-30 nurse visits, set four goals, and engaged in three family conference visits) were more likely to maintain/improve disability. Conclusions. This evaluation identified a specific group of community living older adults for whom this type of expert community health nursing in the home was effective in reversing or at least maintaining disability. There is also considerable evidence to support the creation of a new home care model that integrates the significant intervention components found in this nurse intervention to maintain/improve disability into new and existing home care models. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Liebel, D. V., Friedman, B., Watson, N. M., & Powers, B. A. (2009). Review: review of nurse home visiting interventions for community-dwelling older persons with existing disability. Medical Care Research & Review, 66(2), 119-146.
Despite there being a considerable number of meta-analyses and reviews synthesizing the nurse in-home visiting literature, there have been no reviews examining nurse in-home visiting for patients who are already disabled. This article presents a literature review and synthesis of 10 trials targeted on older adults with disability. The review is organized into structure and process components related to the outcome variable disability based on the classic Donabedian model. The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use. In contrast, lack of process measures, physician collaboration, training, and specific intervention components targeting disability are associated with ineffective interventions. This review helps provide insight into variables that influence disability outcomes as well as the development of best-practice models of in-home visiting to older adults with existing disability.
Lin, C. J., & Meit, M. (2005). Changes in Medicare home health care use and practices in rural communities: 1997 to 2001. Journal of Aging & Health, 17(3), 351-362.
Objectives: This research was designed to examine the impact of the interim and prospective payment systems on home health agencies and Medicare beneficiaries in rural communities. Methods: Data were collected from two complementary studies: (a) fiscal and use data collected from 10 rural agencies in northwest Pennsylvania and (b) a statewide survey of rural home health agencies in Pennsylvania. Results: The findings show that the implementation of interim and prospective payment systems had a profound affect on the home health agencies' financial vulnerability, staffing management, and service delivery. As a result, Medicare beneficiaries were also affected. The total number of home health visits per episode in rural Pennsylvania was 16 visits, whereas the national estimate was 22 visits. Physical therapy services increased 8% and occupational therapy services increased 1%, whereas visits for other disciplines decreased or remain unchanged. Discussion: Future studies are needed to examine the health outcomes of beneficiaries in rural communities.
Lind, L., Karlsson, D., & Fridlund, B. (2007). Digital pens and pain diaries in palliative home health care: Professional caregivers' experiences. Medical Informatics & the Internet in Medicine, 32(4), 287-296.
Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.
Linde, C., & Oxford University, P. (2009). Working the past narrative and institutional memory. Oxford ; New York :: Oxford University Press.
Linden, D. (2006). Review of Caring for the Dying at Home: Companions on the Journey. Psycho Oncology, 15(12), 1099.
Reviews the book, Caring for the Dying at Home: Companions on the Journey by Keri Thomas (2003). The book contains useful advice on pain and symptom management in an easily read format based on tumor type as well as individual generic symptoms. The third section of the book compliments the paperwork available for the Gold Standards Framework (GSF) programme for community palliative care in the UK, and is essential reading for those practitioners who have not been able to gain instruction from others. The reader will find a well-researched methodical, yet practically based guide, to community palliative care and GSF in this book. The content is exhaustive but not immersed in unnecessary detail, ensuring that it is easy to read. Relevant sections are not difficult to find and for those who wish a quick refresher or who do wish information on where to obtain further detail, this is an ideal book for the shelf in the medical, nursing and allied health professional library. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Little, S. E., Ray, T., & Open, U. (2005). Managing knowledge : an essential reader. Thousand Oaks, CA :: SAGE Publications.
Liu, F. C. F., & Lam, C. C. W. (2005). Preparing cancer patients to die at home. Hong Kong Nursing Journal, 41(1), 7-14.
This paper discusses the issue of preparing terminal cancer patients to die at home and explore the possibility of promoting dying at home as one of the future strategies of the local health care system. Allowing patients to die at home is not a common practice in cities worldwide. However, it may be beneficial to both the patient and family members. Reasons include social and medical problems identified in people who do not die in their own homes. Studies reflect that carers who are committed to looking after patients, if supported by hospice care expertise, can take care of patients at home until death. In the past four years (1999 to 2003), the Hospice Home Care Team (HHCT) of Nam Long Hospital (NLH), prepared six terminal cancer patients to die at home. A preliminary conclusion on the factors determining whether patients can be cared for at home was also drawn according to the experience of the HHCT.
Loar, L. (2007). Increasing safety for at-risk adults: Screening in-home care providers. Social Work, 52(3), 271-273.
People wishing to work with children in health and mental health programs, schools, child care, foster care, group homes, and residential programs must submit fingerprints to their prospective employer who, in turn, sends them to the state's Department of justice for clearance. The clearance includes juvenile court and child protective services cases as well as criminal convictions. The former may be more relevant than a Department of Motor Vehicles (DMV) or criminal background check because the triggers that lead a parent to abuse a child are apt to abound in work with children. Child welfare is committed to preserving family ties for at-risk children and waives many requirements for relatives providing child and foster care that would be mandatory for nonrelatives doing the same work. This double standard aims to keep families together with minimal assurances of safety and raises the bar considerably for nonrelatives wishing to become foster parents or to work with children in day care centers, schools, and therapeutic programs. People seeking to hire strangers to provide care for themselves or their relatives would have guidelines to follow, and the cost of fingerprinting would come down, benefiting agencies that provide services to children as well as adults. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Locher, J. L., Kilgore, M. L., Morrisey, M. A., & Ritchie, C. S. (2006). Patterns and Predictors of Home Health and Hospice Use by Older Adults with Cancer. Journal of the American Geriatrics Society, 54(8), 1206-1211.
Objectives: To describe patterns of home health and hospice use by older cancer patients and a comparison group of older persons without cancer. To identify predictors of home care and hospice utilization. Design: Retrospective analysis using the Surveillance, Epidemiology and End Results (SEER)-Medicare Database, a linkage of the SEER Program of the National Cancer Institute (an epidemiological surveillance system of population-based tumor registries) and Medicare Claims. Setting: The SEER data used in this paper cover a service area that includes approximately 14% of the U.S. population, including the states of Connecticut, Hawaii, Iowa, and New Mexico and the metropolitan areas of Detroit, San Francisco-Oakland, Atlanta, Seattle-Puget Sound, Los Angeles County, and San Jose-Monterey. Participants: Five analytical samples were drawn. The first consisted of all cases with a diagnosis of cancer in 1997 to 1999 who were eligible for services in calendar year 1999 (n=120,072). The second and third were subsamples of these and consisted of cases with a new cancer diagnosis in 1999 (n=46,373) and cases who died in 1999 (n=41,483). The fourth consisted of a comparison sample without cancer (n=160,707). The fifth was a subsample of this and consisted of those who died in 1999 (n=6,639). Measurements: Utilization rates of home health and hospice services. Results: Twenty-nine percent of cancer patients used home health services, and 10.7% used hospice services, compared with 7.8% of noncancer patients who used home health and less than 1% who used hospice. Half (51.4%) of cancer patients who used home health did not have cancer listed as an admitting diagnosis for the use of those services. Home health utilization was lowest for unmarried men. Conclusion: This is the first study to evaluate community-based home health and hospice utilization by older cancer patients. Future studies must begin to address what constitutes appropriate utilization. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Madigan, E. A. (2007). A description of adverse events in home healthcare. Home Healthcare Nurse, 25(3), 191-197.
Patient safety has taken on increasing importance in the American healthcare system, yet there is little information on patient safety in home healthcare. The current study aimed to describe the most frequent adverse events defined by the Centers for Medicare & Medicaid Services among the national population of patients receiving home healthcare in 2003, and to compare characteristics between patients who experience adverse events and those who do not. The findings show that 13% of all home healthcare patients had an adverse event, with 80% experiencing only 1 adverse event. More than three fourths of the adverse events were associated with discharge to the community and required continued assistance. Patients who experienced adverse events were older, had more depressive symptoms and behavioral problems, and were more functionally impaired. Women had a slightly lower relative risk of an adverse event (.98), whereas patients of minority ethnicity had a slightly higher relative risk (1.06). These findings suggest that home healthcare agencies may need to spend more time on discharge planning after home healthcare and work with existing community providers. The findings also raise questions regarding the appropriateness of these adverse events and whether there are additional adverse events that warrant monitoring and follow-up evaluation.
Magill, L. (2009). The meaning of the music: The role of music in palliative care music therapy as perceived by bereaved caregivers of advanced cancer patients. American Journal of Hospice & Palliative Medicine, 26(1), 33-39.
In an earlier qualitative research study exploring the meaning of preloss music therapy to bereaved caregivers who participated in sessions through a home-based hospice program, various narrative accounts revealed the significance of music in music therapy sessions. In this study, the role of music in palliative care music therapy is examined and representatively summarized, followed by a review of strategies provided by this author to home hospice patients and their caregivers. The reported perceptions of the meaning of music to 7 bereaved caregivers are presented, including a review of themes and associated narrations that illustrated its significance. The caregivers described these aspects of music in sessions to have memorable and lasting effects as follows: "music is a conduit," "music gets inside us," "live music makes a difference," and "music is love." Findings support the benefits of preloss music therapy for bereaved caregivers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Mahoney, D. M., Mutschler, P. H., Tarlow, B., & Liss, E. (2008). Real world implementation lessons and outcomes from the Worker Interactive Networking (WIN) project: Workplace-based online caregiver support and remote monitoring of elders at home. Telemedicine and e Health, 14(3), 224-234.
The objective of this research was to determine the feasibility of and receptivity to the first computerized workplace-based direct caregiver intervention and to assess the effects on businesses, working family caregivers, and their elderly relatives. Working family caregivers, with at least one health and/or safety concern related to an elder residing alone at home during the workday, were recruited from five companies (n = 27). Caregivers received free computer access to the Worker Interactive Networking (WIN) Internet online caregiver support group and a remote elder monitoring system at home for 6 months. The remote monitoring system provided Web-based status reports and e-mail/pager alerts when individualized parameters were exceeded. Motion sensor signals were transmitted to a transponder that uploaded via wireless cellular communications to the project server, thereby not interfering with elders' telephone use. Formative qualitative analyses clarified acceptance and implementation issues. Summative quantitative evaluation determined pilot intervention effects and was conducted by external evaluators. Despite interoperability and cellular reception issues, the system was successfully deployed across four states to a variety of businesses and housing types. Positive results occurred on worker morale, productivity, and reduction of caregiver stress. Participants found it easy to learn and use. Elders did not find the technology "intrusive" or "isolating." Contrary to their expectations, managers reported no abuse of Internet access. Workers expressed a willingness to pay for a similar system in the future ranging from $10 to $130, depending on the features. They would pay the most for the option involving a geriatric nurse coach. The WIN system innovatively tailored to users' wants, and provided users customized control and personalized support. Use of the system was associated with positive outcomes. Enrollment response suggests a specific niche market for remote home monitoring, making it a manageable employee benefit. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Mansell, J., Beadle-Brown, J., Cambridge, P., Milne, A., & Whelton, B. (2009). Adult protection: Incidence of referrals, nature and risk factors in two English local authorities. Journal of Social Work, 9(1), 23-38.
Summary: This study focused on the incidence of adult protection referrals, the people involved as victims, perpetrators and referrers and the type of abuse in two local authorities in the south-east of England. Findings: The number of referrals increased over time; those for older people stabilized but those for younger adults were still rising. There was a clear association between location or setting, perpetrator and type of abuse. A referral about someone living in a care home was more likely to identify abuse by multiple staff and institutional abuse or neglect, especially if the individual was an older person with mental health problems. People with learning disabilities were more likely to experience sexual abuse, mainly from other service users or members of their family. Those living in a private home with others, primarily relatives, tended to be at risk of financial, physical or psychological abuse. Older people living alone were particularly vulnerable to financial abuse by family members or, less frequently, home care workers. Applications: This study suggests that well-developed adult protection procedures identify many more cases than previously estimated. Further research is needed to explain the low level of referrals from mental health services and variation between territories. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Marcellus, L. (2004). Foster families who care for infants with prenatal drug exposure: support during the transition from NICU to home. Neonatal Network, 23(6), 33-41.
Infants exposed prenatally to drugs and alcohol tend to enter the child welfare system at a younger age than many other foster children and often directly from the hospital following birth. This article examines three concepts from the postpartum family adaptation literature: transition to parenthood, maternal and paternal role identities, and attachment. It applies these concepts to the experiences of foster parents who care for infants with prenatal drug and alcohol exposure. Also reviewed are recommended strategies to promote development of the foster parent-infant relationship and to increase parental knowledge within the NICU setting and during the period of transition from hospital to home. Nurses within the NICU have a unique knowledge and experience of caring for infants in withdrawal. This knowledge needs to be shared beyond the hospital with community professionals, who may have limited training in infant health, mental health, or development.
Margolan, H., Fraser, J., & Lenton, S. (2004). Parental experience of services when their child requires long-term ventilation. Implications for commissioning and providing services. Child: Care, Health & Development, 30(3), 257-264.
AIMS: The aims of the study were to: (1) describe the families experience of the services they receive; (2) describe the care packages associated with long-term ventilation; and (3) identify both problems and good practice. SETTING: South West Region of England, 2001. METHODS: A cross-sectional survey of parents whose children had been ventilated for longer than 3 months. Fifteen families were interviewed. RESULTS: The following issues were identified: significant delays in hospital discharge [mean duration 513 days (range 14-1460 days)]; organizational fragmentation in commissioning services (12/15); problems with supply and maintenance of equipment (10/15); significant social morbidity-reduced family incomes, housing and social isolation (9/15); difficulties with respite care (5/15); loss of employment (9/15 mothers); and problems with access to education (12/15). CONCLUSIONS: There were significant delays in discharge from hospital largely caused by an inability to organize and fund provision in community settings. A wide variation in provision, not related to needs, was observed between families. Effective early discharge from hospital was more likely to be achieved where community children's nursing teams were already in existence. Adequate respite care was rarely available for these families.
Markkanen, P., Quinn, M., Galligan, C., Chalupka, S., Davis, L., & Laramie, A. (2007). There's no place like home: a qualitative study of the working conditions of home health care providers. Journal of Occupational & Environmental Medicine, 49(3), 327-337.
OBJECTIVE: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. METHODS: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. RESULTS: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. CONCLUSIONS: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.
Markle-Reid, M., Browne, G., Weir, R., Gafni, A., Roberts, J., & Henderson, S. (2008). Seniors at risk: The association between the six-month use of publicly funded home support services and quality of life and use of health services for older people. Canadian Journal on Aging, 27(2), 207-224.
This study examines the baseline characteristics and changes in health status and cost of use of health services associated with use of publicly funded home support services. The analysis includes 122 people 75 years of age or more who were eligible for home support services. Over a 6-month period, one third of the sample used home support services for more than 1 hr/week; these seniors had higher rates of depression and cognitive impairment, lower levels of physical and emotional functioning, and less effective coping styles than those who used fewer services. Cognitive impairment explained 17 per cent of the variation in use of home support services. At 6 months, use of home support services for more than 1 hr/week by seniors with higher levels of need was associated with lower cost of use of health services and lower levels of improvement in health status. These findings suggest the need for further research to identify efficacious ways of providing home support services to this population to enhance their health status using available resources. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Markley, J., & Winbery, S. (2008). Communicating with physicians: how agencies can be heard. Home Health Care Management & Practice, 20(2), 161-168.
Communication failure plays an important role in medical errors. Clinical communication is highly complex and prone to error especially during transitions of patient care and emergent situations. Standardized approaches and tools may provide potential solutions to improve the quality of communication and prevent subsequent patient harm. Maximizing nurse--physician collaboration holds promise for improving patient care and creating satisfying work roles. The purpose of this article is to describe strategies that will facilitate effective nurse--physician collaboration. First discussed is the clinician perspective with an emphasis on a model, situation, background, assessment, recommendation (SBAR). This shared mental model is for improving communication between clinicians. This introduction is integrated with actual experiences encountered by a Texas home health agency in implementing the SBAR technique. Finally, the physician perspective is presented with discussion of communication development strategies to enhance nurse-physician collaboration and communication in a home care setting.
Marrelli, T. (2009). Making the case for a "Discharge department" or visions of "Operation restore trust"? Home Healthcare Nurse, 27(7), 401-402.
Martens, P. J., Fransoo, R., Burland, E., Burchill, C., Prior, H. J., & Ekuma, O. (2007). Prevalence of mental illness and its impact on the use of home care and nursing homes: A population-based study of older adults in Manitoba. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 52(9), 581-590.
Objectives: To determine the prevalence of mental illness in older adults and its effect on home care and personal care home (PCH) use. Methods: Using non-identifying administrative records (fiscal years 1997-1998 to 2001-2002) from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, we determined the 5-year period prevalence for individuals aged 55 years and over (119,539 men and 145,752 women) for 3 mental illness categories: cumulative mental disorders (those having a diagnosis of depression, anxiety disorder, personality disorder, schizophrenia, and [or] substance abuse), any mental illness, and dementia. We calculated age-specific and age-adjusted rates of home care and PCH use and the prevalence of mental illness in PCH residents. Results: From the group aged 55 to 59 years to the group aged 90 years or older, the prevalence of mental illness increased with the population's age. The prevalence of any mental illness rose from 32.4% to 45.0% in men and from 42.6% to 51.9% in women, and dementia prevalence rose from 2.0% to 33.6% in men and from 1.3% to 40.3% in women. The age-adjusted annual rates of open home care cases per 1000 population aged 55 and older varied by mental illness grouping (no mental disorder, 57 for men and 91 for women; cumulative mental disorders, 162 for men and 191 for women; dementia, 300 for men and 338 for women). The age-adjusted rates of PCH use per 1000 population aged 75 years and older also varied by mental illness grouping (no mental disorder, 53 for men and 78 for women; cumulative mental disorders, 305 for men and 373 for women; dementia, 542 for men and 669 for women). Among patients admitted to (or resident in) a PCH in 2002-2003, 74.6% (87.1%) had a mental illness, and 46.0% (69.0%) had dementia. Conclusions: Mental illness affects the use of home care and nursing homes profoundly. Individuals with dementia used home care at 3 times the rate of those having no mental illness diagnosis, and they used PCHs at 8 times the rate. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Maxwell, C. J., Dalby, D. M., Slater, M., Patten, S. B., Hogan, D. B., Eliasziw, M., et al. (2008). The prevalence and management of current daily pain among older home care clients. Pain, 138(1), 208-216.
The aim of this cross-sectional study was to examine the prevalence and correlates of pharmacotherapy for current daily pain in older home care clients, focusing on analgesic type and potential contraindications to treatment. The sample included 2779 clients aged 65 + years receiving services from Community Care Access Centres in Ontario during 1999-2001. Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC). Prescription and over-the-counter (OTC) medications listed on the RAI-HC were used to categorize analgesic treatment into two groups (relative to no analgesic use): use of non-opioids (acetaminophen or non-steroidal anti-inflammatory drugs only); and, use of opioids alone or in combination with non-opioids. Associations between client characteristics and analgesic treatment among those in current daily pain were examined using multivariable multinomial logistic regression. Approximately 48% (n = 1,329) of clients had daily pain and one-fifth (21.6%) of this group received no analgesic. In multivariable analyses, clients aged 75 + years and those with congestive heart failure, diabetes, other disease-related contraindications, cognitive impairment and/or requiring an interpreter were significantly less likely to receive an opioid alone or in combination with a non-opioid. Clients with congestive heart failure and without a diagnosis of arthritis were significantly less likely to receive a non-opioid alone. A diagnosis of arthritis or cancer and use of nine or more medications were significantly associated with opioid use. The findings provide evidence of both rational prescribing practices and potential treatment bias in the pharmacotherapeutic management of daily pain in older home care clients. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
McCallion, P., Nickle, T., & McCarron, M. (2005). A comparison of reports of caregiver burden between foster family care providers and staff caregivers in other settings. Dementia (14713012), 4(3), 401-412.
There has been increasing concern about the impact of dementia symptoms on the lives and on the care being provided for persons with intellectual disability (ID) in out-of-home settings. One such setting that has received little attention is foster family care homes. These settings in the USA replicate family living and while some supports and resources are provided, they are not designed to meet intensive care needs. As a preliminary step in understanding family experiences and to expand the range of interest in Alzheimer's disease (AD) in persons with ID beyond traditional out-of-home settings, a pilot study was initiated that included aging persons with ID and symptoms of AD who were living in foster family care settings in two regions of New York State as well as more traditional out-of-home care subjects. Comparisons of matched samples on subjective and objective burden measures suggest that there are few differences in experiences. The limitations of these findings are considered and recommendations made for future, related research.
McCann, S., Ryan, A. A., & McKenna, H. (2005). The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation. Health & Social Care in the Community, 13(5), 462-469.
The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.
McCauley, M., Bergin, A., Bannon, H., McDonald, B., Bedford, D., & Russell, V. (2005). How do GPs experience home-based treatment for acute psychiatric disorders? Primary Care & Community Psychiatry, 10(4), 159-163.
Objective: Home-based treatment (HBT) for acute mental illness has been increasingly implemented within mental health services. There are inevitable implications for general practitioners (GPs). To date, there are limited published findings describing GP's experiences of HBT. We sought to explore GPs' experience of and the extent to which they are satisfied with HBT.
Methods: The study took place in Cavan, a rural area in North East Ireland with a population of approximately 56,000. All GPs who had referred patients to an HBT programme over the past 2 years were contacted by telephone. A psychologist and research nurse (independent of the service) conducted face-to-face semi-structured interviews in the GP's surgery. The questionnaire explored GPs' use of, familiarity with, and suggestions for HBT.
Results: Thirty (79%) out of 38 GPs participated in the study. All 30 GPs described overall satisfaction as "good" (33.3%) or "very good" (66.6%). Ease of access and patients preference for treatment at home was most commonly reported as helpful. Concerns were expressed about communication with HBT and the time-limited nature of HBT.
Conclusions: GPs are satisfied with home-based treatment in mental health. There is room for improved communication. Suitability for HBT needs greater clarification. Ongoing review is necessary to ensure that any emerging concerns are tackled.
McCracken, G. I., Heasman, L., Stacey, F., Steen, N., deJager, M., & Heasman, P. A. (2004). A clinical comparison of an oscillating/rotating powered toothbrush and a manual toothbrush in patients with chronic periodontitis. Journal of Clinical Periodontology, 31(9), 805-812.
OBJECTIVES: PRIMARY OBJECTIVE: To compare the relative efficacy of an oscillating/rotating powered toothbrush to that of a conventional manual toothbrush in a group of periodontal patients over a 16-month period with respect to plaque control. SECONDARY OBJECTIVE: To compare differences in pocket depth (PD) and bleeding index (BI) between the two groups over a 16-month period. MATERIAL AND METHODS: Forty patients were recruited to a 16-month, single-blind, two-group, randomised, parallel group clinical trial to compare the effects of manual and oscillating/rotating powered toothbrushes in a cohort of patients with chronic periodontitis. None of the patients had previous experience of using an oscillating/rotating brush and had a mean plaque index (PI) of > 2.0 (modified Quigley and Hein index) at baseline. Patients were stratified by gender, age and smoking status then randomised to using a manual or an oscillating/rotating brush for the duration of the study. Conventional non-surgical periodontal therapy was undertaken within the first month after baseline. PI was the primary outcome measure with PDs and BI also recorded at baseline and months 3, 6, 10 and 16. RESULTS: Mean full-mouth (FM) scores at baseline for oscillating/rotating brushing and manual brushing groups were as follows: PI, 3.4 and 3.5; BI, 1.7 and 1.5; and PD, 3.4 and 3.3. The mean reduction in FM scores from baseline to 16 months were: PI, 0.72 and 0.75; PD, 0.43 and 0.57; and BI, 0.74 and 0.83, respectively. Repeated measures ANOVA were used to compare differences between groups (adjusted for baseline levels) at months 3, 6, 10 and 16 and showed no statistically significant difference between groups for PI and PD (p > 0.05). A difference of 0.2 BI units was detected in favour of the manual brushing group (p = 0.04). CONCLUSION: Over a 16-month period, there were no differences in PI reduction or PD reduction between patients who underwent non-surgical management of chronic periodontal disease and used either an oscillating/rotating powered toothbrush or a conventional manual toothbrush. A difference in gingival bleeding reduction was detected in favour of the patients allocated the manual brush.
McDonald, M. V., King, L. J., Moodie, M., & Feldman, P. H. (2008). Exploring diabetic care deficiencies and adverse events in home healthcare. Journal for Healthcare Quality: Promoting Excellence in Healthcare, 30(6), 5-12.
Little information is available about the strength of the relationship between home healthcare practices and the potential adverse events the Centers for Medicare and Medicaid Services tracks through its uniform reporting system. We examined charts of patients who experienced a hyperglycemic or hypoglycemic emergent event to learn more about how home healthcare processes may contribute to an adverse event and to explore other factors that may contribute to a patient's health outcome. Implicit peer review, informed by an explicit review process, determined that 10% of the emergent care events were probably avoidable if home care had been optimal, 56% were potentially avoidable, and 34% were unavoidable.
McGarry, J. (2009). Defining roles, relationships, boundaries and participation between elderly people and nurses within the home: an ethnographic study. Health & Social Care in the Community, 17(1), 83-91.
Recently there has been a marked shift in the location of nursing care in the UK from the hospital setting to the community and more particularly the home, with elderly people identified as key recipients of care in this setting. A number of commentators have highlighted the particular situation of elderly people with regard to care provision, illuminating the often disempowering nature of care interactions between nurses and elderly people. However, although there is clear evidence from a number of settings that care for elderly people has been less than optimal, to date there is little comparable evidence available regarding elderly people's experiences of nursing care within the home environment. Utilising an ethnographic approach, incorporating participant observation and semistructured interviews with nurses and elderly people (aged 65 years and over), the aim of this study was to explore the nature of the care relationship within the home setting. Thirteen elderly people who were receiving nursing care within the home and 16 community nurses within one Primary Care Trust in the UK took part in the study and data were collected over a period of 1 year. Three themes emerged from the data: the location of care; the nature of nurse-patient relationships; and the meaning of health and illness. These offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and elderly people in the home, illuminating the centrality of relationships between nurses and elderly people in defining the experiences and perceptions of both groups of the quality of care overall. As the location of care continues to move closer to home, it is crucial that the implicit qualities that are valued within nurse-patient relationships in this context are recognised and made more explicit at both the organisational and policy level.
McGuire, B. K., Crowe, T. K., Law, M., & VanLeit, B. (2004). Mothers of children with disabilities: Occupational concerns and solutions. OTJR: Occupation, Participation and Health, 24(2), 54-63.
Mothers of children with disabilities have identified multiple challenges associated with achieving occupational balance in their lives. Occupational therapists are just beginning to explore the occupational and time use strategies that mothers use to successfully care for their children and get through the day in a positive manner. The Person-Environment-Occupation model was used to guide an occupational therapy intervention program called "Project Bien Estar," which was designed to increase the satisfaction, time use, and occupational performance of mothers of school-aged children with disabilities. This article focuses on the rich content of the group discussions and individual reflections, providing insight into the world of women caring for children with disabilities. Thematic analysis was used to identify person, environment, and occupation factors that contribute positively and negatively to the mothers' well-being, and the effects of the occupational therapy intervention are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
McKee, J., Storrs, J., & Humphrey, S. (2007). Creating a continuum of care for chronically underserved children. Joint Commission Journal on Quality & Patient Safety, 33(4), 200-204.
Background: Grandfather Home for Children, a nonprofit residential treatment center in North Carolina, serves children with histories of abuse who exhibit sexual behavior problems and acute physical aggression. In June 2000, it launched an initiative to create placement resources for children who had been identified as chronically underserved--foster care, adoption services, and other appropriate community services.
Methods: A total of 638 children served by Grandfather Home for Children were included in this study. The data were collected during a six-year period (October 1999-September 2005). The data to assess the agency's goals was collected through the agency's general performance indicators that are gathered on a quarterly and yearly basis, based on the agency's fiscal year. Performance improvement activities included substantive changes in administrative, staffing, training, and information systems.
Results: Between 1999 and 2005 the agency's initiative achieved a 342% increase in the number of children it was able to serve, a 33% decrease in the average length of stay for children in care and a 721% increase in the percentage of children served in their home community, and 100% of the foster children had two or fewer placements.
Discussion: The initiative to create a continuum of care has enabled the agency to successfully provide step-down opportunities and serve more children in the least restrictive environment for a shorter period of time with fewer placement changes than observed in comparative statistics at both the federal or state level.
McMillan, S. C., & Rivera, H. R., Jr. (2009). The relationship between depressive symptoms and symptom distress in patients with cancer newly admitted to hospice home care. Journal of Hospice & Palliative Nursing, 11(1), 41-51.
The purpose of this project was to evaluate the relationship between depressive symptoms and symptom distress experienced by hospice patients with cancer. A total of 275 hospice patients with cancer were evaluated using the Memorial Symptom Assessment Scale (MSAS), the Center for Epidemiological Study-Depression (CES-D) Scale and a Demographic Data Form. Patients in the sample were mostly white and Christian with a variety of types of cancer with lung cancer being most common. Patients reported an average of 10 symptoms with fatigue, pain, dry mouth, drowsiness, loss of appetite and shortness of breath being reported most frequently. Among the most common symptoms, those with the highest intensity scores were pain and fatigue and with the highest distress scores were fatigue, pain, and shortness of breath. Depressive symptoms reached the cut-off score of 4 for 38% of patients indicating a likelihood of clinical depression. A moderate significant correlation (r = 0.45; P = .000) was found between CES-D scores and total number of symptoms reported and with total symptom distress (r = 0.49; P = .000). Results underscore the continued need for a focus on symptoms in cancer patients, and further delineates the need to ameliorate depressive symptoms in order to enhance quality of life near the end of life.
McMillan, S. C., & Small, B. J. (2007). Using the COPE intervention for family caregivers to improve symptoms of hospice homecare patients: A clinical trial. Oncology Nursing Forum, 34(2), 313-321.
Purpose/Objectives: To test an intervention for hospice caregivers designed to help them better manage symptoms experienced by patients with cancer. Design: A three-group comparative design with repeated measures. Setting: A large nonprofit hospice that primarily provides home care. Sample: 329 hospice homecare patients with cancer and their caregivers were randomized into three groups: a control group (n = 109) receiving standard care, a group (n = 109) receiving standard care plus friendly visits, and a group (n = 111) receiving standard care plus the COPE intervention. Methods: Caregivers received experimental training in the COPE intervention (creativity, optimism, planning, expert information) over nine days to assist with symptom management. Main Research Variables: Intensity of pain, dyspnea, and constipation, overall symptom distress, and quality of life (QOL). Data were collected on admission and days 16 and 30. Findings: Although symptom intensity for three target symptoms did not decrease, symptom distress was significantly improved (p = 0.009) in the COPE intervention group. QOL was not significantly different. Conclusions: Symptom distress, a measure that encompasses patient suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage patient symptoms. Implications for Nursing: The COPE intervention is effective and immediately translatable to the bedside for hospice homecare patients with advanced cancer. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
McMillen, J. C., & Raghavan, R. (2009). Pediatric to adult mental health service use of young people leaving the foster care system. Journal of Adolescent Health, 44(1), 7-13.
PURPOSE: To assess and predict changes in mental health service use as older youth leave the foster care system. METHODS: Participants were 325 19-year-olds participating in a longitudinal study of older youth leaving the foster care system in Missouri. All were in the foster care system at age 17. Participants were interviewed nine times between their 17th and 19th birthdays using the Service Assessment for Children and Adolescents and a history calendar to improve recall of service history. Analyses included Cox proportional hazards regression to predict time to service stoppage and McNemar's test to assess difference in rates of service use between age 17 and 19. RESULTS: Mental health service use dropped dramatically across the study period for all services. Service rates dropped most steeply for youth who left the foster care system. Service use rates declined by roughly 60% from the month prior to leaving the foster care system to the month after leaving the system. Most young adults who stopped pharmacotherapy following discharge from foster care reported they did so of their own volition. CONCLUSIONS: Practitioners should be aware of the possibility of patient-initiated mental health service discontinuation following exit from the foster care system and plan accordingly.
McNab, L., Smith, B., & Minardi, H. A. (2006). A new service in the intermediate care of older adults with mental health problems. Nursing Older People, 18(3), 22-26.
This article describes the new multidisciplinary, nurse-led service for older adults with mental health problems, the Home Treatment Team (HTT) which has just begun in the Older Adults Directorate of Central and North West London Mental Health Trust (CNWL). The team aims to provide mental health care and treatment in the home for adults aged over 65, offering an alternative to hospital admission and facilitating early discharge. These functions place the service in the intermediate care category (Department of Health (DH) 2001), an area which is not well documented in the care of older people with mental health needs.
McWilliam, C. L., Stewart, M., Vingilis, E., Hoch, J., Ward-Griffin, C., Donner, A., et al. (2004). Flexible client-driven in-home case management: an option to consider. Care Management Journals, 5(2), 73-86.
Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management, engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed, findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.
Mei, Y. M., Lee, S. T., & Al-Hawamdeh, S. (2004). Formulating a communication strategy for effective knowledge sharing. [Article]. Journal of Information Science, 30(1), 12-22.
Overcoming cultural resistance from a workforce and gaining sufficient buy-in from senior management are both critical to the successful implementation of Knowledge Management (KM) initiatives in any organization. The main purpose of this study is to identify an effective communication strategy at the onset of the implementation process, aimed at helping the workforce to comprehend the need for KM in the organization and to solicit maximum support from the senior management and staff alike. It is based on a case study of the KM initiatives in Singapore's Civil Service College, a training school for public officials. The strategy will also facilitate effective communication between staff so that effective knowledge sharing can take place and provide proactive and reactive communication, to achieve acceptance of and commitment to KM in the organization. The communication strategy was formulated using inputs collected from focus group discussions and observational field work. [ABSTRACT FROM AUTHOR]
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Meredith, S., Feldman, P. H., Frey, D., Hall, K., Arnold, K., Brown, N. J., et al. (2001). Possible medication errors in home healthcare patients. Journal of the American Geriatrics Society, 49(6), 719-724.
OBJECTIVE: To determine the frequency of possible medication errors in a population of older home healthcare patients according to expert panel objective criteria. DESIGN: A cross-sectional survey. SETTING: Two of the largest urban home healthcare agencies in the United States. PARTICIPANTS: Home healthcare patients age 65 and older admitted to selected offices of these agencies between October 1996 and September 1998. MEASUREMENTS: We used two sets of consensus-based expert panel criteria to define possible medication errors. The Home Health Criteria identify patients with patterns of medication use and signs and symptoms that indicate sufficient likelihood of a medication-related problem to warrant reevaluating the patient. The Beers criteria identify medications that experts have deemed generally inappropriate for older patients. RESULTS: The 6,718 study subjects took a median of five drugs; 19% were taking nine or more medications. A possible medication error was identified for 19% of patients according to Home Health Criteria, 17% according to the Beers criteria, and 30% according to either. Possible errors increased linearly with number of medications taken. When patients taking one to three medications were compared with those taking nine or more drugs, the percentages with possible errors were, respectively, 10% and 32% for the Home Health Criteria, 8% and 32% for the Beers criteria, and 16% and 50% for both. CONCLUSION: Nearly one-third of the home healthcare patients surveyed had evidence of a potential medication problem or were taking a drug considered inappropriate for older people. More-effective methods are needed to improve medication use in this vulnerable population.
Milberg, A., & Strang, P. (2004). Exploring Comprehensibility and Manageability in Palliative Home Care: An Interview Study of Dying Cancer Patients' Informal Carers. Psycho Oncology, 13(9), 605-618.
The presence of an informal carer is often a prerequisite for successful palliative home care, and the staffs ability to support informal carers' coping in such situations is important. Recent research has revealed that it is possible to achieve positive psychological states in palliative care despite the burdening situation. As there is a lack of theory-based coping studies, the aim of this study was to describe, within the context of palliative home care, two concepts in Antonovsky's theory of Sense of Coherence: comprehensibility (a perception that the challenge is understood) and manageability (a perception that the resources to cope are available). Tape-recorded semi-structured interviews with 19 informal carers during ongoing palliative home care were transcribed and analysed with a qualitative hermeneutic approach. Elements that facilitated comprehensibility included open information, symbolic information, basic life assumptions and previous knowledge. These were important for creating a congruent inner reality (as opposed to chaos). Resources contributing to manageability dealt with power, support, competence and accessibility, which on a more abstract level resulted in a feeling of togetherness (as opposed to isolation). The findings are discussed in relation to the complexity of communication between staff and carers within palliative care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Milberg, A., & Strang, P. (2007). What to do when 'there is nothing more to do'? A study within a salutogenic framework of family members' experience of palliative home care staff. Psycho Oncology, 16(8), 741-751.
The aim of this study was to develop a theoretical framework of family members' experience of palliative home care staff based on a secondary analysis of four previous studies. A salutogenic framework was used, i.e. with the origin of health in focus. Data had been collected (semi-structured tape-recorded interviews and postal questionnaires with open-ended questions) from 469 family members of mainly cancer patients referred to advanced palliative home care. Walker and Avant's strategies for theory construction were used. The secondary analysis generated three theoretical blocks: (1) general components of staff input (including five generalized resistance resources (GRRs): competence, support, spectrum of services, continuity, and accessibility); (2) specific interactions with staff (including two GRRs: being in the centre and sharing caring); (3) emotional and existential consequences of staff support (including six health-disease continuums: security-insecurity, hope-hopelessness, congruent inner reality-chaos, togetherness-isolation, self-transcendence-feelings of insufficiency and retained everyday life-disrupted everyday life). It seems important that all three aspects of family members' experience of palliative care staff are to be considered in evaluations of palliative care, in goal-setting and in teaching role models. The study is specific to the Swedish model of palliative home care and replication of the work in other countries is recommended. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Millard, A., & McAuley, A. (2008). Alcohol and the over 65s: Service gaps seen from home care in Scotland. Journal of Social Work Practice in the Addictions, 8(3), 417-420.
As research officers we were asked by a Health Board and Alcohol Action Team in a large city in western Scotland to assess the needs and evaluate home care services being provided to elderly clients. Working with a local social work department as partners, we conducted 13 focus groups with 90 staff and managers providing home, day, and residential care to explore: How clients' alcohol problems were identified; Was it the home care providers' work role to raise a possible alcohol problem with a client?; Whether home care providers had sought help for a client with alcohol problems, and if there were any barriers?; Were there any gaps in services for older people with alcohol problems and if so how might they be filled? Our most interesting findings involved the trusting relationship that developed between the home care worker and the client, their perceptions regarding the client's alcohol consumption, and the existence of barriers to involvement in day care or residential settings secondary to the client's alcohol usage. Additionally, we believe that Scottish culture is also relevant to our findings. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Miller, E. A., & Rosenheck, R. A. (2007). Mental illness and use of home care nationally in the U.S. Department of Veterans Affairs. The American Journal of Geriatric Psychiatry, 15(12), 1046-1056.
Objective: To determine whether patients with mental health diagnoses are more likely to utilize home-based primary care (HBPC), and to identify characteristics associated with HBPC admission among elderly and non-elderly veterans, specifically. Methods: Patients receiving treatment during fiscal year (FY) 2003 and having no evidence of home care utilization during FY2002 were followed through FY2005 using administrative claims data of the Veterans Health Administration of the U.S. Department of Veterans Affairs (VA). Participants were 4,411,677 VA patients with no prior HBPC use. Cox proportional hazard models were developed to identify correlates of HBPC use. Results: Of VA patients with no prior use of HBPC, 24.2% received a mental health diagnosis, of whom 1.5% eventually used HBPC. Two in five new HBPC admissions were diagnosed with mental illness. Patients diagnosed with dementia were 66% more likely to be admitted. Patients diagnosed with non-schizophrenia psychoses (hazard ratio [HR]: 1.30), miscellaneous affective disorders (HR: 1.22), and schizophrenia (HR: 1.21) had the next highest probabilities. Risk of admission was highest for >=3 outpatient medical visits (HR: 2.61), followed by any inpatient medical/surgical days (HR: 1.79) or outpatient mental health visits (HR: 1.30). Elderly patients with any inpatient mental health days were less likely to be admitted; younger patients with nursing home use, community residential care, and mental health intensive care management were more likely to be admitted. Conclusion: Given that mental illness is independently associated with the likelihood of admission, it is critical that providers develop the skills and resources necessary to meet the psychiatric needs of home care recipients. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Miller, F. G. (2004). End-of-Life Care for Patients with Dementia: Comment. The New England Journal of Medicine, 350(7), 733-733.
Presents a letter to the editor on "End-of-life care and the effects of bereavement on family caregivers of persons with dementia" by Schulz et al (see record 2003-09949-003). They have done a service in drawing attention to the substantial burdens experienced by caregivers of patients with dementia. Missing from the discussion section of their report and from the perspective article by Prigerson, however, is any mention of the extent to which life-prolonging therapies in patients with profound dementia, such as artificial feeding and antibiotics, may have contributed to the suffering of both patients and caregivers. The fact that about 40 percent of the patients cared for by the participants in the study died in the hospital suggests that, at least at the end of life, patients suffering and the burden on caregivers might have been reduced by decisions to forgo life-sustaining treatment and comfort-care plans. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Miller, T. W., Elliott, B., Long, K., Mazenac, C., & Moder, M. (2006). Telehealth Home Health Applications for Adults with Developmental Disabilities. Telemedicine and e Health, 12(2), 137-145.
Telehealth technology for application in home healthcare for adult persons with developmental disabilities was examined. Utilization of telehealth by clinicians, including the physician, nurse and physician assistant, physical therapist, occupational therapist, speech language pathologist, the dietitian, and psychologist for the healthcare needs of adults with developmental disabilities is discussed. Such utilization results in improved access to needed health services by reducing time and distance for this population. A telehealth model is offered, as are shifts in healthcare using telehealth technology in home health. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Misko, M. D., & Bousso, R. S. (2007). Managing cancer and its intercurrences: The family deciding to seek emergency care for the child. Revista Latino Americana de Enfermagem, 15(1), 48-54.
This study aimed to understand how the family of a child with cancer manages the illness and its intercurrences at home, and how it makes the decision of taking the child to an emergency care service. Oral History was used as the methodological strategy and data analysis was based on the "Family Management Style Framework". Participants were six mothers between 28 and 47 years old, who were experiencing their child's cancer treatment. The possible need for emergency care is incorporated into the family routine as a resource to manage the illness whenever it goes beyond the mother's capacity to keep control over the symptoms, which is permeated by suffering, derived from the uncertainties this creates. Helping the mother to develop skills to get stronger and reduce the suffering resulting from the situations that generate uncertainties and insecurities in her daily life with the child with cancer is a challenge. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Missotten, P., Ylieff, M., Di Notte, D., Paquay, L., De Lepeleire, J., Buntinx, F., et al. (2007). Quality of life in dementia: A 2-year follow-up study. International Journal of Geriatric Psychiatry, 22(12), 1201-1207.
Objectives: To examine the evolution of quality of life (QOL) in demented subjects at base-line, one and 2 years later and to determine clinical variables associated with QOL. Method: Longitudinal study of a cohort of 127 subjects living at home or in a long-term care institution. A QOL measure (Alzheimer Disease Related Quality of Life; ADRQL) was administered three times. In addition, several clinical instruments (MMSE, IADL, ADL and CDR/M) were also administered. Results: ADRQL data analysis did not reveal significant modifications of QOL over the 2-year period, whereas results from clinical instruments showed a significant deterioration. On the group, the variations of ADRQL scores were limited, with some improvement after the first year followed by some deterioration after the second year. On the other hand, ADRQL scores fluctuated every year by at least 10 points for more than 50% of subjects. With dementia evolution, it was observed that the clinical variables were more strongly correlated with ADRQL scores and were more significant predictors. This varied from 5.9% (MMSE) in 2002 to 40.01% in 2004 (MMSE and CDR/M). Conclusions: QOL did not develop in a strictly linear manner following the deterioration of clinical state. This suggests that the evolution of QOL is also determined by other variables relating to the physical and social environment of the patients. Their role seems particularly important for the mild to moderate stages of dementia. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Moadel, A. B., Skamai, A., Carter, J., Carey, J. V., & Morgan, C. (2005). Cancer Education for Home Health Care Workers: A Process Evaluation. Journal of Cancer Education, 20(4), 229-234.
Background: In this article, we evaluate adoption of cancer education into the mandatory in-service training of home health attendants (HHA) comprised predominantly of African American and Hispanic women. Methods: Three home health care training agencies in Bronx, NY, incorporated cancer prevention and outreach education into HHA training. Results: Across 3 years, 87% (n = 2513) of HHAs received the intervention and disseminated it to 1600 clients/family/friends. HHAs reported high program satisfaction (98%) and interest (82%) in cancer outreach. Agency staff reported more benefits than costs to implementation. Conclusions: The home health care training agency appears an accessible and effective bridge for disseminating cancer education to the underserved. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Modin, S., Törnkvist, L., Furhoff, A., & Hylander, I. (2009). Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study. BMC Family Practice, 10, 13p.
BACKGROUND: District nurses (DNs) provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs) have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions. METHODS: Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM) was used in the analyses. RESULTS: The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment. CONCLUSION: The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to stay in charge of the medical treatment. The complexity of the situation made it problematic for the FP to make adequate decisions about the goal of the medical treatment. The goal of the treatment had to be constantly evaluated based on information from the DN and other care providers, and thus this information was absolutely crucial.
Morales-Asencio, J. M., Morilla-Herrera, J. C., Martín-Santos, F. J., Gonzalo-Jiménez, E., Cuevas-Fernández-Gallego, M., Nieves, C. L., et al. (2009). The association between nursing diagnoses, resource utilisation and patient and caregiver outcomes in a nurse-led home care service: longitudinal study. International Journal of Nursing Studies, 46(2), 189-196.
Morin, D., Aubin, M., Vezina, L., Gagnon, J., Racine, S., Reinharz, D., et al. (2009). From hospital to home after cardiac surgery: evaluation of a community nursing care management model. Professional Case Management, 14(4), 167-177.
PURPOSE/OBJECTIVES: This quasi-experimental research aims to (1) evaluate the implementation process of a community nursing care management model and (2) assess the effects of this model on patients followed at home. PRIMARY PRACTICE SETTING: Two community healthcare centers had introduced a community nursing care management model in their practice (experimental groups), whereas another health community care center with no experience with such a model served as a control group. The community nursing care management model included clinical pathways designed for a clientele who had been hospitalized for cardiac surgery. FINDINGS/CONCLUSIONS: Even though the implementation process was challenging, the community nursing care management model was found useful enough to be integrated into routine nursing home care practice after cardiac surgery. Although the effects produced by this systematic home care program on the clientele did not differ significantly from those produced by usual nursing care, there was a positive effect for the clientele recorded on all measurement indicators used. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The introduction of the nursing care management model enabled nurses to structure the care provided and reduced interindividual variation. The application of this program also proved to be an opportunity to initiate and assimilate new professional roles. Additional studies should be conducted to assess its effectiveness in home care for other health problems.
Motiwala, S. S., Croxford, R., Guerriere, D. N., & Coyte, P. C. (2006). Predictors of place of death for seniors in Ontario: A population-based cohort analysis. Canadian Journal on Aging, 25(4), 363-371.
Place of death was determined for all 58,689 seniors (age >= 66 years) in Ontario who died during; fiscal year 2001/2002. The relationship of place of death to medical and socio-demographic characteristics was examined using a multinomial logit model. Half (49.2%) of these individuals died in hospital, 30.5 per cent died in a long-term care facility, 9.6 per cent died at home while receiving home care, and 10.7 per cent died at home without home care. Co-morbidities were the strongest predictors of place of death (p < 0.0001). A cancer diagnosis increased the chances of death at home while receiving home care; seniors with dementia were most likely to die in LTC facilities; and those with major acute conditions were most likely to die in hospitals. Higher socio-economic status was associated with greater probability of dying at home but contributed little to the model. Appropriate planning and resource allocation may help move place of death from hospitals to nursing homes or the community, in accordance with individual preferences. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Moultry, A. M., & Poon, I. O. (2008). Perceived value of a home-based medication therapy management program for the elderly. Consultant Pharmacist, 23(11), 877-885.
Muir-Cochrane, E., Fereday, J., Jureidini, J., Drummond, A., & Darbyshire, P. (2006). Self-management of medication for mental health problems by homeless young people. International Journal of Mental Health Nursing, 15(3), 163-170.
Youth homelessness is a growing Australian and international concern associated with considerable health disadvantage, including serious mental health problems. This paper reports findings of a qualitative study that explored young homeless people's experiences of mental health and well-being through in-depth interviews. Thematic analysis identified medication use and management as a central issue for the young people. Reasons identified for medication non-adherence included unwanted side-effects, issues of access and storage, and lack of support from health and social agencies. These problems were compounded by everyday stresses of homelessness. Medication adherence was facilitated by social support, consistent contact with supportive health services, and regular medication supply, often resulting in improved mental health and well-being. For these young people, prioritizing management of medication helped stabilize one aspect of their lives. Health professionals can play an important role in helping them achieving this goal.
Munck, B., Fridlund, B., & Martensson, J. (2008). Next-of-kin caregivers in palliative home care--From control to loss of control. Journal of Advanced Nursing, 64(6), 578-586.
Aim: This paper is a report of a study to describe situations influencing next-of-kin caregivers' ability to manage palliative care in the home. Background: Palliative home care often involves major resources from next-of-kin, municipal and county personnel. Next-of-kin caregivers' situation is depicted as so demanding and exhausting that it can affect their mental health and limit their ability to continue as a caregiver. Methods: A qualitative study using the Critical Incident Technique was conducted. Nine next-of-kin caregivers from palliative home care were strategically chosen and data were collected using audiotaped interviews in 2005. Findings: The analysis resulted in two main areas: 'Maintaining control' and 'Losing control'. Next-of-kin caregivers wanted to maintain control over their lives by being continuously available 24 hours a day and by supporting and taking complete responsibility for all of the patient's needs. They lost this control when professional assistance was lacking and they described feelings of inadequacy when their physical energy or time was insufficient. They felt incapable as the patient's physical or mental persona metamorphosed or as serious symptoms developed that they could not control. Conclusion: Next-of-kin caregivers and the patients must feel free to choose where palliative home care will be provided and that their choice at any time can be re-evaluated, due to insecurity or workload changes. When planning for palliative care, they should be informed that having only one caregiver reduces the chances of completing palliative care in the home. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Murray, S. (2007). Families' care of their children with severe disabilities in Australia: Social policy and support. Community, Work & Family, 10(2), 215-230.
In Australia, from the 1980s, the processes of de-institutionalization and non-institutionalization have resulted in most children with severe disabilities being cared for at home. Current Australian government policy suggests that care increasingly will be undertaken in the home. The needs of families, then, is an area that requires attention. The findings in this paper are drawn from a series of qualitative in-depth interviews with parents of children with severe disabilities and, in particular, I highlight issues raised in relation to income, work, leisure and social relationships. Typically, despite the provision of formal (and informal) support services, participation in the wider community is limited. I argue that the provision of support services has been inadequate to enable engagement in activities that other families take for granted and that greater social policy attention is warranted. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Naylor, M. D., Hill-Milbourne, V. R., Knoble, S. R., Robinson, K. M., Bowles, K. H., & Maislin, G. (2007). Community-based care model for high-risk adults with severe disabilities. Home Health Care Management & Practice, 19(4), 255-266.
Objective: Evaluate the effectiveness of a home-based intervention for adults with serious physical disabilities at high risk for poor health outcomes. Design: A pretest/post-test design; content analysis of case studies. Setting: Five-county Philadelphia metropolitan area. Patients and Other Participants: Forty-nine community-dwelling adults aged 20-55. Intervention: Six-month comprehensive care management intervention implemented by Advanced Practice Nurses (APNs) focused on improvement of functional status or prevention of functional decline; management of health problems; and enhancement of self-direction of care by subjects and caregivers. Main Outcome Measures: Functional status; total hospitalizations, emergency department (ED) and acute care physician visits; symptom management; depression; quality of life; and satisfaction with care. Results: Between baseline assessment and nine months post-APN intervention, functional status improved (mean = 33.42 rightwards-arrow 24.97, p = 0.014). There was a trend toward reductions in average hospitalization rate from 1.10 at baseline to 0.68 nine months post-APN intervention and ED rates from 0.90 to 0.50. Acute care visits to physicians increased from 0.52 to 0.95 from baseline to nine months post-APN intervention. The use of home health aides (mean = 2.72 rightwards-arrow 1.37, p = 0.008) and physical therapists (mean = 1.16 rightwards-arrow 0.42, p = 0.001) also decreased from baseline to nine months post-APN intervention. Facilitators and barriers to care are identified. Conclusions: Findings suggest potential benefit of a comprehensive, individualized intervention coordinated by APNs in improving health and functional outcomes and decreasing the use of high-cost, acute care resources among severely disabled adults living in the community. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Ndiwane, A. (2005). Research briefs. Teaching with the Nightingale Tracker technology in community-based nursing education: a pilot study. Journal of Nursing Education, 44(1), 40-42.
Changes in health care delivery are becoming increasingly focused on technology. Nursing students are often expected to travel long distances to suitable community sites for clinical experiences, which challenges nurse educators to design and implement instructional strategies to provide students with optimal clinical practice opportunities, while maintaining preceptor-student supervision and vital communication links. This article reports a pilot evaluation of the Nightingale Tracker system, which included both a server and an innovative, hand-held device designed to accommodate multiple forms of data input and allow timely communication between clinical faculty and students in community-based clinical settings. A sample of 5 nursing students reported that the Nightingale Tracker enhanced learning, particularly in performing and documenting physical assessments, data input and transmissions, and autonomous clinical practice.
Novick, J. G. (2008). Social work in home care and adult day settings: a comparative study. Home Health Care Management & Practice, 20(3), 260-264.
This article explores the job characteristics of social work practice in the home health care field versus the adult day care arena. In many ways, the two positions are very similar; the types of clients or patients serviced, the multidisciplinary nature of the work, and the issues faced when working with this population are examples of similarities. This comparison helps readers understand how the transition from fieldwork to the center setting can be achieved. This exploration represents the personal experiences of the author, who, after almost 25 years in the home health care field, now works in adult day care.
Okamoto, K., Hasebe, Y., & Harasawa, Y. (2007). Caregiver psychological characteristics predict discontinuation of care for disabled elderly at home. International Journal of Geriatric Psychiatry, 22(11), 1110-1114.
Objective: This study sought to determine the predictors of discontinuation of care for the disabled elderly at home using multivariate regression analysis. Methods: In January to February 2005, using a self-administered questionnaire, data were collected from 193 caregivers of frail elderly listed on a roster for utilization of day service or short stay service from two Home Visit Nursing Care Stations. Family caregivers were defined as co-resident family members who provided a minimum of 1 h of daily care for at least 3 months. Multiple stepwise logistic regression analysis was performed to detect predictors of a discontinuation for the disabled elderly at home. Results: The mean age of caregivers was around 59.0 years, accounting for about 80% of the women among caregivers. Of those caregivers, the proportion of desire to institutionalization (high DI) (56.8%) was higher than that of desire to care at home (low DI) (43.2%). Among the following three factors selected by multivariate stepwise logistic regression analysis, the strength of the relationship was stronger in frequent mood swings and irritability as carerecipient characteristic (adjusted OR = 5.93; 95% CI, 2.09-16.8) than in no advanced or skilled care (adjusted OR = 3.13; 95% CI, 1.41-7.14) and a high caregiver burden (adjusted OR = 1.12; 95% CI, 1.03-1.23) as caregiver's one. Conclusions: Our results suggest that the carerecipients' psychological characteristics may be more strongly related to the decision to continue care for disabled elderly at home than that of the caregivers'. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Oktay, J. S., & Tompkins, C. J. (2004). Personal assistance providers' mistreatment of disabled adults. Health & Social Work, 29(3), 177-188.
This article describes a survey of 84 adults with disabilities who received personal assistance with activities of daily living from family members, informal providers, or agency personnel. Results showed that 30% reported mistreatment from their primary provider, and 61% reported mistreatment by another provider. Verbal abuse, neglect, poor care, and theft were the most common forms of mistreatment by other providers. Adults with lower incomes were the most likely to experience mistreatment. Male providers were more likely to mistreat as were providers who were inexperienced and who provided more than 50 hours of care per week. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Olson, C. A., & Moseman, S. S. (1997). Overworked? Understaffed? Don't stop marketing! Information Outlook, 1(3), 20.
Discusses how savvy marketing can streamline library operations, decrease workload while increasing visibility and customer support. Basics of marketing; Understanding of customers; Packaging of products; Pricing of customer services; Support of promotion efforts; Public relations messages and library's image
Ostgathe, C., Gaertner, J., Nauck, F., & Voltz, R. (2008). High dose levo-methadone treatment for cancer pain in a patient with a history of drug addiction. Journal of Pain and Symptom Management, 35(3), 229-231.
A 39-year-old woman had been receiving levo-methadone maintenance therapy (3 mg/day) for 12 years because of heroin addiction. Within these 12 years, her state of health and social situation stabilized. Two years before admission, a squamous cell carcinoma of the uterine cervix was diagnosed. On admission, the patient suffered from moderate to severe cancer-related somatic, nociceptive, and neuropathic pain. During the inpatient stay on the surgical ward, levo-methadone had been increased up to 40 mg/day. Within the next three weeks, pain intensity declined successively. The daily opioid dosage stabilized at 180 mg levo-methadone, and the patient rated pain intensity as NRS 1 at rest and 4 on movement. The patient was discharged home and supported by a specialized palliative home care service. The patient was almost pain-free for the rest of her stay and required only 15 mg/ day of levo-methadone. She was discharged to a hospice. To our knowledge the maximum levo-methadone doses needed for the treatment of pain in the case presented exceeds all methadone doses published so far. Levo-methadone is an enantiomer and used as a second or third-line opioid in cancer pain management in Germany. This case illustrates how challenging pain management in terminally ill levo-methadone maintained patients can be. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Pakenham, K. I. (2009). Children who care for their parents: The impact of parental disability on young lives. Marshall, Catherine A, 2, 39-60.
(from the chapter) This chapter addresses an emerging global social priority: the potential adverse impacts on children and adolescents of caring for a family member with a disability. Unpaid caregiving represents an important economic resource and carers a vital labor force. For example, in the United States in 2004, family carers contributed an estimated $306 billion of unpaid caregiving (Becker, 2007). There are no such estimates in any country of the hidden economic or social costs of children's unpaid caregiving. However, the research to date does suggest that many young carers suffer in ways that compromise their well-being. This chapter provides an overview of research, theory, and practice regarding children and adolescents caring for a parent who has a physical or mental disability and/or illness. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Palm, I., & Friedrichsen, M. (2008). The lived experience of closeness in partners of cancer patients in the home care setting. International Journal of Palliative Nursing, 14(1), 6-13.
At present there are few data available on the experiences of closeness in partners of patients with advanced cancer. The aim of this study was to explore the lived experience of closeness in partners of patients with advanced cancer in palliative home care. Ten partners of patients admitted to a palliative, hospital-based home care unit participated in this study. Tape-recorded interviews were conducted and Giorgi's phenomenological analysis was used. Three themes emerged: dimensions of closeness, such as togetherness, sharing and daily concern; prerequisites for closeness; and obstacles that hindered closeness. In essence, closeness was described as a changing process that was expected to end. This study has revealed the importance of closeness in the partners of patients with advanced cancer. Experiencing closeness is of great importance when the disease is no longer curable and time is limited. Partners need professional help to facilitate this experience.
Papastavrou, E., Kalokerinou, A., Papacostas, S. S., Tsangari, H., & Sourtzi, P. (2007). Caring for a relative with dementia: Family caregiver burden. Journal of Advanced Nursing, 58(5), 446-457.
Aim: This paper is a report of part of a study to investigate the burden experienced by families giving care to a relative with dementia, the consequences of care for the mental health of the primary caregiver and the strategies families use to cope with the care giving stressors. Background: The cost of caring for people with dementia is enormous, both monetary and psychological. Partners, relatives and friends who take care of patients experience emotional, physical and financial stress, and care giving demands are central to decisions on patient institutionalization. Method: A volunteer sample of 172 caregiver/care recipient dyads participated in the study in Cyprus in 2004-2005. All patients were suffering from probable Alzheimer's type dementia and were recruited from neurology clinics. Data were collected using the Memory and Behaviour Problem Checklist, Burden Interview, Center for Epidemiological Studies-Depression scale and Ways of Coping Questionnaire. Findings: The results showed that 68.02% of caregivers were highly burdened and 65% exhibited depressive symptoms. Burden was related to patient psychopathology and caregiver sex, income and level of education. There was no statistically significant difference in level of burden or depression when patients lived in the community or in institutions. High scores in the burden scale were associated with use of emotional-focused coping strategies, while less burdened relatives used more problem-solving approaches to care-giving demands. Conclusion: Caregivers, especially women, need individualized, specific training in how to understand and manage the behaviour of relatives with dementia and how to cope with their own feelings. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Peisah, C. (2006). Practical application of family and systems theory in old age psychiatry: Three case reports. International Psychogeriatrics, 18(2), 345-353.
The role of the family or carer in old age psychiatry is well acknowledged. However, carer interventions are often focused on addressing carer burden alone and are usually individually rather than family based. Interpersonal conflict and family dynamics are rarely addressed. This is not surprising as there is a paucity of literature in family and systems theory applied to the older person, and clinicians are often skeptical about the efficacy of this treatment mode or daunted by the complexity of family and systems theory. Three cases are presented to illustrate the potential benefits of family-based interventions in the setting of commonly encountered clinical situations: (i) the treatment of chronically depressed older people in the community; (ii) the management of behavioral and psychological symptoms of dementia (BPSD) in residential care; and (iii) home-based support and care of the older patient with dementia. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Peters, L., & Sellick, K. (2006). Quality of life of cancer patients receiving inpatient and home-based palliative care. Journal of Advanced Nursing, 53(5), 524-533.
Aims: This paper reports a comparative study of the symptom experience, physical and psychological health, perceived control of the effects of cancer and quality of life of terminally ill cancer patients receiving inpatient and home-based palliative care, and the factors that predict quality of life. Background: Quality of life is a major goal in the care of patients with terminal cancer. In addition to symptom management, psychological care and provision of support, being cared for at home is considered an important determinant of patient well-being. A more comprehensive understanding of the impact of cancer on patients and their families will inform the delivery of palliative care services. Methods: Fifty-eight patients with terminal cancer (32 inpatients, 26 home-based) were recruited from major palliative care centres in Australia in 1999. A structured questionnaire designed to obtain sociodemographic information, medical details and standard measures of symptoms, physical and psychological health, personal control and quality of life was administered by personal interview. Results: The two groups were similar on most demographic measures, although more home-care patients were married, of Australian descent and had private health insurance cover. The most prevalent symptoms reported were weakness, fatigue, sleeping during the day and pain. Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores, and better physical health and quality of life than those receiving inpatient care. Home-care patients also reported statistically significantly more control over the effects of their illness, medical care and treatment received, and the course of the disease. Multiple regression analyses showed that better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher quality of life. Conclusions: The main issues arising from the findings for nurses are the early detection and management of both physical and psychological symptoms, particularly fatigue, pain, anxiety and depression, and the need to use strategies that will empower patients to have a greater sense of control over their illness and treatment. Research is needed to identify other factors that may impact on quality of life, and to establish the extent to which inpatient and home-based care meets the needs of both the patient with terminal cancer and their family. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Piat, M., Ricard, N., Sabetti, J., & Beauvais, L. (2007). The values and qualities of being a good helper: a qualitative study of adult foster home caregivers for persons with serious mental illness. International Journal of Nursing Studies, 44(8), 1418-1429.
BACKGROUND: Canadian foster homes for adults with serious mental illness are operated by non-professional caregivers, usually women, whose mandate is to support residents and reintegrate them into the community. While mental health professionals recognize that adult foster homes are an important service for this population, there is little understanding of how caregivers impact on the lives of their residents. AIMS AND OBJECTIVES: This article draws on the findings of a larger study which examined both caregiver and resident perspectives on the helping relationship in adult foster homes. Caregiver perspectives on the values and qualities required to help people living in foster homes are reported. DESIGN AND METHODS: With no pre-set theoretical framework, this qualitative study employed an inductive approach within a naturalistic paradigm. Semi-structured interviews were conducted with 20 caregivers. Data analysis was an ongoing, 2-year process, involving the identification of categories and themes through several distinct stages. SETTING: The study included Montreal adult foster homes (n=242) for persons with serious mental illness, supervised by two university-affiliated psychiatric hospitals. PARTICIPANTS: Twenty caregivers, selected according to years of experience and number of residents in the home, were diverse in terms of age, cultural background, family composition, education and occupational background. RESULTS: Caregivers possess a clearly articulated value system, and 21 specific qualities which reflect the attributes of both professional and informal helpers. These values and qualities provide caregivers with a "professional" or "vocational" orientation. CONCLUSIONS: A deeply held system of values and qualities is critically important to caregiver effectiveness and job satisfaction. Findings suggest that caregivers are highly motivated, and should be recognized as full participants in the mental health system at both policy and practice levels.
Picton, T. (2008). Learning disabilities and the new mental health act. Psychiatric Bulletin, 32(8), 316.
The new Mental Health Act 2007 creates more rights for people with learning disabilities through its amendment of the Mental Capacity Act 2005, It introduces safeguards for deprivation of liberty, both for patients lacking capacity in hospital and residents of care homes. This is surely a good thing, and may finally end the confusion following the Bournewood case, where the case of a patient without capacity being kept in hospital was challenged. The private sector has perhaps stolen a march on much of the National Health Service by creating expensive specialist services for these people. With the advent of the new Act, is it time to start catching up? (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Pieper, R., & Vaarama, M. (2008). The concept of care-related quality of life. Vaarama, Marja, 65-101.
(from the chapter) In gerontology, there is a substantial and increasing body of theoretical and empirical research on quality of life (QoL) in old age, especially in psychology and health-related research. However, a specific focus on QoL of frail older persons or older persons with permanent need of external help is rare, and even more neglected is the role of care for their QoL. In addition, the question of how much the existing definitions really reflect the opinions of older people themselves has got too little attention (Bowling, Gabriel, Banister, & Sutton, 2002). These notions motivated the Care Keys research to search for a better understanding of the role of homecare and institutional care for the QoL of frail older persons. Applying the production of welfare approach, the aim was to produce information on the specific life situations of these older persons, and on the linkages between care and QoL. By providing a model of care-related QoL we aimed at a concept that would allow for the evaluation of care practices in view of their outcomes for frail older persons, thus supporting development of care practices as well as quality management of (long-term) care. Searching for a theoretical model of QoL of frail older persons we found suitable starting points, but also encountered unresolved issues and open questions. This situation prompted the Care Keys research to proceed in two directions. First, we selected concepts and instruments that were available in the literature, introduced some preliminary adaptations to the life circumstances of frail older persons receiving care, and investigated the relation of care quality to QoL as an outcome. Second, we took a closer look at the theoretical issues and their relevance for a concept of care-related QoL. The results of the theoretical reflections on QoL are presented and discussed in this chapter. We will distinguish three different sub-models that combine objective circumstances and subjective interpretations (structural model), ask for the role of the client and the role of care (production model) and reflect on the "negotiation of order" in care processes (normative model). (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Pieper, R., Vaarama, M., Ljunggren, G., & Emilsson, T. (2008). The Care Keys toolkit. Vaarama, Marja, 281-298.
(from the chapter) The Care Keys project was the result of a European research initiative which addressed quality of life (QoL) issues among frail, care-dependent seniors, taking their social as well as health needs into account. The aim of the Care Keys project was to make a contribution to the improvement of long-term care on the level of the theory of care and care-related quality of life, on the level of empirical enquiry into the relationships between care and care outcomes, and on the level of practical instruments and tools for care quality management. This chapter will briefly describe the practical outcomes of the research, The main objective was to develop a set of "key indicators" that could be used to guide care quality management, and to take the first steps in developing instruments and tools for practitioners using these indicators. Combining a practical approach with the research objectives was motivated by two considerations. First, it is increasingly recognised that research has to look into the prospects and problems of dissemination and implementation of its results, if it wants to have an impact on practice. Second, many of the partners in the Care Keys project were directly involved in social and health care services and were well aware of the pressing need for practical improvements within their own arenas. The pursuit of being able to disseminate the Care Keys research findings to the practice resulted in development of a "Toolkit" intended for use primarily by care and quality managers in long-term care of older people, but also researchers and consultants in the field may benefit of it. The Care Keys Toolkit comprises a number of tools that were developed and validated within the Care Keys research: data collection tools, key indicators and a number of analytical tools. The different parts of the toolkit can be used at different levels: some at a locality or provider level, some at a community level and some at the national level. The Care Keys Toolkit will support efforts to monitor, plan and develop high-quality care for clients of long-term care in both institutional settings and homecare. The functionality of the toolkit aims at the evaluation and management of: 1. quality of long-term homecare and institutional care of older persons; 2. effectiveness of care in contributing to the quality of life of the clients; 3. comprehensiveness of care in contributing to diverse domains of the client's QoL; 4. efficiency of resource use in terms of meeting the client needs and targeting care resources according to their needs; 5. equity of distribution of the care resources; and 6. quality management in facilitating the achievement of the goals already mentioned. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Piercy, K. W., & Dunkley, G. J. (2004). What quality paid home care means to family caregivers. Journal of Applied Gerontology, 23(3), 175-192.
The authors investigate the meanings of paid home care for family caregivers to frail older adults, comparing and contrasting what good and poor quality home care means to their caregiving efforts. Semistructured interviews were conducted with caregivers and were analyzed qualitatively, using McCracken's (1988) five-step method for analysis of long interviews. Data from two studies were combined because of similarities in sample characteristics and interview questions and because data from the second study included both positive and negative experiences with home care providers. The authors find that caregivers perceived that good-quality paid home care facilitated enhanced quality of life for care recipients and improved perceptions of their performances as caregivers. When paid home care was of poor quality, caregivers felt more stress and increased their monitoring of providers. Caregiver circumstances, as well as care recipient needs, should be considered in making decisions about who receives formal home care services.
Porter, E. J. (2007). Actions taken by frail older widows to allow home care providers access to their homes. Clinical Nursing Research, 16(1), 44-57.
Nurses have been advised to encourage older persons to keep their doors locked, but there is little guidance about how home care providers should best gain access to the homes of clients. During a descriptive phenomenological study of the experience of home care (N = 25), 9 frail older women explained their strategies for allowing providers access to their homes. Women who typically left their doors open for their own reasons were not uncomfortable leaving the door open when a provider was expected. However, women who left the door unlocked at the request of a provider expressed misgivings about doing so. Older women need personalized counseling about ensuring access to care providers while maximizing safety. For practical, ethical, and legal reasons, home care providers who ask older women to leave their doors open should reconsider that strategy.
Porter, E. J. (2008). Home care as a complex experience: a chronological case study. Home Health Care Services Quarterly, 27(3), 167-186.
This case study of an older woman with macular degeneration describes her experience of dispensing daily medications over a 3-year period, during which a home care nurse began and continued visits. Using a phenomenological method, I analyzed data of 9 interviews, discerning the structure of her experience and depicting it in 7 diagrams. The home care experience can have unintended outcomes influenced by family and provider perceptions of clients' abilities, especially when family members and practitioners assume tasks that older women have managed alone. Minimizing intergenerational ambivalence about the need for home care and maximizing client agency should be preeminent foci of home care providers.
Porter, E. J., & Ganong, L. H. (2005). Filling in the helper-gap: the intentions of frail older widows. Holistic Nursing Practice, 19(5), 229-235.
Despite marked interest in continuity of care and transitions experienced by older persons, there is little information available about the intentions of older women regarding changes that occur in their support networks. This article reports the findings of a descriptive phenomenological study of older widows' experience of home care and describes the experiences of 10 women who lost a key helper during the 3-year study Compared with theories of continuity of care or transition, the findings are in keeping with the focus of nonequilibrium systems theory: bringing order out of disorder. Findings imply the need for holistic nursing interventions with older women who hope to continue living alone for as long as possible.
Porter, E. J., & Ganong, L. H. (2005). Older widows' speculations and expectancies concerning professional home-care providers. Nursing Ethics, 12(5), 507-521.
Little is known about older persons' expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women's experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were 'finding that someone has the job of helping me here' and 'determining where the helper's field lies'. Two subsets within a category of expectancies were differentiated: speculations about helpers' possible actions and expectancies about outcomes of helpers' actions. As parameters of relational ethics, clients' speculations and expectancies are appropriate bases for dialogue about older widows' relationships with home-care professionals and the foci of home-care policies.
Power, A. (2008). Caring for independent lives: Geographies of caring for young adults with intellectual disabilities. Social Science & Medicine, 67(5), 834-843.
This paper engages with the emerging disciplinary clash between 'care' and 'independence' within disability studies by examining the geography of home care for young adults with intellectual disabilities. The care system as a whole is viewed as central to disablist structures within disability studies (see Thomas, C. (2007). Sociologies of disability and illness: Contested ideas in disability studies and medical sociology. Hampshire: Palgrave Macmillan.). However, despite the theorisation of dependency as being in antipathy to the goals of the disability movement, caregiving at home still continues to dominate community care. The paper attempts to address how family carers are 'caught-in-the-middle' between their 'duty' to care and at the same time, perpetuating dependency; the reality being that parents have to deal with issues of being overprotective and confronting various social assumptions about disability. It examines the narratives from 25 family caregivers in Ireland who provide personal assistance to young adults with intellectual disabilities. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Preville, M., Cote, G., Boyer, R., & Hebert, R. (2004). Detection of depression and anxiety disorders by home care nurses. Aging & Mental Health, 8(5), 400-409.
Several studies have reported that psychiatric disorders, mainly depression and anxiety disorders, were masked and undiagnosed among older adults, particularly frail elderly. This phenomenon could have a significant impact on elderly quality of life. In this study, we assessed the utility of three measures for detecting mental health disorders among frail elderly receiving home care services: (1) the PRIME-MD; (2) a standard psychological distress measure (PDI-29), and (3) the health care case manager's a priori judgment on the subject's mental health status. Results obtained by home care nurses were compared to those obtained by clinical psychologists using a structured diagnostic interview (SCID for DSM-IV). The study was conducted in two community health service centres. During the study's period, all patients in the health care workers' caseload without cognitive impairment and not reporting significant stressful life events during the six-week period preceding the interview (n = 315) were asked to participate in the study. Results showed that 42.9% of the volunteers that agreed to meet a psychologist at home (n= 177) had a current SCID-IV diagnosis. The specificity of the PRIME-MD test performed by nurses was 83.8% and its sensitivity was 41.7%. The correct classification rate was 66.7%. Results indicated that the PDI-29 items showed better performance characteristics than the PRIME-MD in identifying current cases. The specificity of the PDI-29 was 59.0% and its sensitivity was 73.6%. These results lead us to the conclusion that the PRIMEMD to help physicians in primary care clinics, could be less appropriate man the PDI-29 when used by home care nurses in identifying undiagnosed menial health disorders in frail older adults living at home. Moreover, this study showed that the health care case manager's a priori judgment on the care receiver's mental health status is not sufficient in identifying frail elderly mental health services needs. A two-stage screening procedure is proposed to help home care nurses. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Radensky, L., & Parikh, D. (2008). Developing a "Train the Trainer" program to identify elder abuse and neglect: The Jewish home lifecare system model. Home Health Care Management & Practice, 20(3), 254-259.
Numerous elders are victims of abuse and neglect. Although in a better position than most health care staff to observe and report abuse and neglect in the home, many in the home health care services are not adequately equipped to identify the signs of abuse, much less know how to effectively navigate the vast web of available resources. Many staff are unclear regarding how to report and to whom, and often there is fear of the ramifications of reporting. In addition, in many instances the elder does not wish to seek interventions. The Jewish Home and Hospital Lifecare System's Elder Abuse "train the trainer" model focuses on providing in-service training for clinical and nonclinical members of the organization, with the hopes that personnel will improve their ability to take appropriate action when identifying elder abuse and neglect. In addition, the program prepares home care personnel to act as mentors to paraprofessional home health aides. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Raghavan, R., & McMillen, J. C. (2008). Use of multiple psychotropic medications among adolescents aging out of foster care. Psychiatric Services, 59(9), 1052-1055.
OBJECTIVES: This study described the prevalence of and risk factors for using multiple concurrent psychotropics among adolescents leaving foster care. METHODS: In-person interviews were conducted with 406 adolescents who were aged 17 years and were leaving foster care in a Midwestern state. RESULTS: Of the 403 who had complete records, most (N=257, or 64%) did not report taking any psychotropic medications, while 46 (10%) were on three or more concurrent psychotropics. A history of physical or sexual abuse and a diagnosis of major depressive disorder or manic episode were significantly associated with the use of three or more concurrent medications. Between 19% and 41% of adolescents with diagnoses for which psychotropics are indicated were not taking any medications. CONCLUSIONS: This local cohort of adolescents aging out of foster care seemed to display both overuse and underuse of psychotropics. Research on larger and more representative cohorts of youths leaving foster care is necessary in order to understand the appropriateness of psychotropic prescribing among these adolescents.
Ratchford, A. M., Hamman, R. F., Regensteiner, J. G., Magid, D. J., Gallagher, S. B., & Merenich, J. A. (2004). Attendance and graduation patterns in a group-model health maintenance organization alternative cardiac rehabilitation program. Journal of Cardiopulmonary Rehabilitation, 24(3), 150-156.
PURPOSE: Poor rates of participation in cardiac rehabilitation programs are well documented, especially among women and older patients. The Colorado Kaiser Permanente Cardiac Rehabilitation (KPCR) program is a home-based, case-managed, goal-oriented program with an active recruitment process and unlimited program length. This study evaluated the participation rates for the program and the predictors of attendance and graduation. METHODS: Patients hospitalized with acute myocardial infarction, coronary artery bypass graft, and percutaneous coronary intervention from June 1999 to May 2000 (n = 1030) were identified from the administrative database, and the proportion captured by the KPCR staff was determined. Subsequent attendance and graduation patterns were evaluated. RESULTS: Nearly 94% of patients with one of the three aforementioned conditions were identified by the rehabilitation staff, and 41% of all patients attended the KPCR program. More than 75% of the patients who participated went on to graduate from the program. Gender comparisons showed no difference in participation between men (66.8%) and women (59.7%) (P =.07). Participation rates were inversely associated with age, yet age was not associated with graduation from the program. Surgical interventions and two or more events experienced within the first 4 weeks of the index event were the strongest predictors of attendance and graduation from the KPCR program. CONCLUSIONS: Innovative approaches for the capture and retention of patients in cardiac rehabilitation programs are urgently needed. The alternative program evaluated in this study showed little difference in participation between men and women, yet participation among older patients remained poor. Overall, patients who underwent surgical interventions or multiple events were more likely to attend and graduate from the program.
Raveis, V. H. (2007). The challenges and issues confronting family caregivers to elderly cancer patients. Carmel, Sara, 85-97.
(create) Life expectancy has increased dramatically in recent decades, producing an equally dramatic expansion in the size of the elderly population. Cancer is a major cause of morbidity and mortality in older adults, its incidence rising appreciably with age. Cancer is now more frequently screened for, detected earlier, and aggressively treated in older adults. From a caregiving perspective, these developments mean that elderly patients and their families are living with the effects of cancer and its treatment for an extended time interval. Age-related physical infirmities can complicate cancer care and the management of symptoms in older cancer patients. Symptom control approaches that work well in younger adults may not readily translate for older adults. The trend in U.S. health care towards "de-hospitalization," in combination with advances in cancer treatment, is making it possible for many elderly cancer patients to be managed on an outpatient basis and remain in the community while in treatment. This shift from the hospital to community or home-based care means that family members, traditional sources of informal support and aid, are being increasingly prevailed upon to attend to a majority of the health-care and personal needs of elderly cancer patients. Age adds a layer of complexity to cancer caregiving not present in other cancer-care situations. The elderly are likely to have more extensive, complex, and long-term care giving needs, exacerbated by the shift from inpatient to outpatient care and shortened inpatient stays. Families face a shared set of psychosocial challenges imposed by their elderly relative's illness: coping with uncertainty, adapting to the losses and changes engendered by the illness, and dealing with care provision responsibilities. Caregivers are challenged in varying degrees in each of these areas at every phase of the illness. Treatments for cancer create multiple demands for caregivers as they assist patients in dealing with the physical and psychological consequences of surgery, chemotherapy, and radiation, in addition to disease-related needs. With the advances in cancer treatment and the advent of managed care, families frequently need to function as their elderly relative's advocate, negotiating the health-care system and advocating for the best care. The family is an integral component of an elderly patient's support system. The constant concern to meet their relative's needs for assistance and support can engender stress. While the practical and emotional benefits to elderly cancer patients of family support and assistance are readily acknowledged, the experience can be burdensome to the caregiver. Perhaps the most significant consequences for the cancer caregiver are those in the psychological realm because of their implications for impaired social and role functioning. For some cancers, such as breast or colon cancer, a family history of the disease is indicative of heightened susceptibility to the disease. Care provision may become more complex when at-risk family members are caring for a relative with cancer. Understanding of the complex ways in which cancer impacts upon the family is still evolving. There is a pressing need to focus more attention on the many different and connected issues and challenges that families encounter while caring for elderly relatives with cancer. Thus, in addition to the programs and services that attend to the challenges of cancer care provision to an aging population, consideration needs to be given to developing support and counseling efforts that address the psychosocial impact of cancer on family members. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Riedijk, S. R., Duivenvoorden, H. J., Van Oostrom, I., Rosso, S. M., Van Swieten, J., Niermeijer, M. F., et al. (2009). Frontotemporal dementia (FTD) patients living at home and their spousal caregivers compared with institutionalized FTD patients and their spousal caregivers: Which characteristics are associated with in-home care? Dementia: The International Journal of Social Research and Practice, 8(1), 61-77.
Patients with frontotemporal dementia (FTD) need complete care in the final stages of the disease. Some informal caregivers continue the in-home care whereas others institutionalize. This study identifies differences between in-home FTD patients and their caregivers (FTDH) and institutionalized FTD patients (FTDN) and their caregivers. Twelve in-home and 24 institutionalized FTD patients in the final stages of the disease, and their spousal caregivers, were observed. Neuropsychiatric function disorders, dementia duration and severity, burden, mental and physical health, quality of the current and premorbid relationship and caregiver motivation were analyzed. The majority of FTDH patients had dementia of shorter duration and showed residual independence. In FTDH patients, neuropsychiatric symptoms were more often present whereas apathy and disinhibition were more intense in FTDN patients. FTDH caregivers felt more emotionally burdened but had better mental health. Caregiver motivations were similarly present in FTDH and FTDN caregivers, while the love-motivated caregivers had worse physical and mental health. Our data suggest that all FTD caregivers could benefit from psychological support. Motivation for caregiving has intervention potential. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Riquelme, L. F., Soyfer, A., Engelman, J., Palma, G. L., Stein, L., & Chao, J. L. (2008). Understanding oropharyngeal dysphagia: from hospital to home. Home Health Care Management & Practice, 20(6), 462-473.
Providing services in the home to a patient with oropharyngeal dysphagia remains a clinical challenge. All health care providers involved in the care of patients with dysphagia need to understand the complexities of swallow physiology, its impact on the patient's overall well-being, and the experience the patient has recently undergone. Namely, it is important to know if the patient is returning home after an acute care stay, if the patient is returning home after a stay at a rehabilitation center, or if simply the patient has become increasingly decompensated while at home. This will allow the clinician working in the home to understand the work-up and possible treatments the patient has thus far undergone, and possibly better understand the overall etiology. Furthermore, it is important to understand that while returning home may be one of the most exciting moments for the patient and his/her family, it may also be the most stressful, as the patient is probably returning home with a different set of needs. This article provides an in-depth approach and discussion of the subject of swallow physiology, diagnosis, and treatment, and provides a resource for all members of the patient care team. It concentrates on the experience of older adults diagnosed with oropharyngeal dysphagia who are returning home.
Rolf, C., & Pool, G. (2006). Concerns of terminally ill cancer patients in their home environment. Palliative Medicine, 20(4), 481-482.
In this letter to the editor, the authors reveal their findings about the concerns of Dutch terminally ill cancer patients who stayed in their home environment to pass away. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Russell, R. (2007). The Work of Elderly Men Caregivers: From Public Careers to an Unseen World. Men and Masculinities, 9(3), 298-314.
Approximately 1,000,000 men currently care for spouses with cognitive impairment after leaving market-economy careers through normative or early retirement. In the process, they made the difficult transition from work in the public arena to the private, largely invisible world of family care. This article explores how elderly men caregivers adapt to such drastic changes in social location, what resources they call upon to ameliorate the impact of those changes, and what we can learn from their experiences that will inform future research and practice. Data are from a qualitative study of thirty elderly men caregivers in Rochester, New York. Two major themes emerged, demonstrating both struggle and success. The most significant struggle was coping with the isolation of home care; by contrast, many men were able to successfully make the transition through the use of a style of caregiving that incorporated a combination of management and nurturing skills. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Rydé, K., Strang, P., & Friedrichsen, M. (2008). Crying in solitude or with someone for support and consolation -- experiences from family members in palliative home care. Cancer Nursing, 31(5), 345-353.
Crying has not been studied from the perspective of family members of patients in palliative care. The aim of this study was to explore the significance of family members crying in a palliative care context with special reference to factors that influence crying. Interviews were carried out with 14 family members of patients admitted to palliative care. A hermeneutic approach according to Gadamer was used. Three main categories emerged. (1) Before the start of crying, some prerequisites for crying had to be fulfilled, such as an allowing attitude and courage, time, feeling secure, honesty, and trusting relationships. These prerequisites did not cause crying themselves; rather crying emerged when triggering factors occurred. (2) Triggers for crying were circumstances that created uncertainty and turbulence (bad news), exhaustion due to lack of own time, and sympathy from others. (3) Family members tried to do the best possible by adopting or hiding their crying, to ease the patient's burden and to create a positive counterbalance to suffering and grief. As an interpretation of the whole, crying could be expressed as being shared with someone for support and consolation or escape to solitude for integrity and respite. As a conclusion, crying may be an efficient strategy for family members in palliative care to express their suffering and to gain new energy to continue.
Sabata, D., Bruce, C., & Sanford, J. (2006). Preparing Home Health Clients for Work Opportunities With Workplace Accommodation. Home Health Care Management & Practice, 19(1), 12-18.
Few people with chronic health conditions actively engage in work activities. Yet workplace accommodations including assistive technologies and more accessible environments are creating the potential for more employment opportunities. Occupational therapists are trained to assist clients in maximizing participation in self-care, work activities, and leisure. Home health services often address self-care and leisure; however, little attention is given to home health discharge planning directed at transitions to work. This article explores some of the policies that affect work opportunities for people with disabilities, some workplace accommodations that can be used to increase access to the workplace and maximize capacities of persons with disabilities to complete job tasks, and implications for how home health occupational therapy practitioners can facilitate referrals and inform client decisions about workplace accommodations. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Sabourin, P. (Spring 2001). Constructing a Function-Based Records Classification System: Business Activity Structure Classification System. Archivaria, 51, 18.
Saks, K., & Tiit, E.-M. (2008). Subjective quality of life of care-dependent older people in five European Union countries. Vaarama, Marja, 153-167.
(from the chapter) The main aim of the present study was to compare quality of life (QoL) of older people receiving long-term care--clients of home-based or institutional care--in different regions of the European Union (EU): Estonia, United Kingdom, Sweden, Finland and Germany. Estonia is a "new" EU member and other four countries are "old" members. During the study Estonia had been a member of EU less than 2 years while others more than 10 years. Estonia differed from other project countries in several socio-economic areas. The mean life expectancy in Estonia was significantly lower (Estonia 71.8, UK 84.1, Sweden 86.3, Finland 81.4, Germany 82.3 years) (List of countries by life expectancy, 2005), general life satisfaction and happiness were poorer, security and state of repair of houses were more problematic and people were less satisfied with their homes, social life and health services (InfobaseEUROPE Database Record No. 7530, 2004). An additional aim of the study was to search, pilot and validate suitable tools for evaluating subjective QoL of older care-dependent persons. Although the need for comprehensive approach to QoL in long-term care is generally recognized there are no standardized measures available. Some QoL questionnaires, such as the World Health Organization Quality of Life Bref questionnaire (WHOQOL-Bref) (WHOQOL group, 1998) and the Philadelphia Geriatric Morale Scale (PGCMS) (Lawton, 1991) are well validated in the general older population (Skevington, Lofty, Oconnell, & The WHOQOL Group, 2004; von Heideken Wagert et al., 2005; Wong, Woo, Hui, & Ho, 2004) but in less extent with long-term care clients. Persons in long-term care probably have different needs and expectations compared with healthy older people or with patients in hospitals, rehabilitation and primary care settings. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Sand, L., Olsson, M., & Strang, P. (2009). Coping strategies in the presence of one's own impending death from cancer. Journal of Pain and Symptom Management, 37(1), 13-22.
An incurable cancer is a threat to life itself. This study focused on how native-born Swedes, who define themselves as nonreligious, actually reflect and act when they try to create helpful strategies in the presence of their own impending deaths and how the strategies serve their purposes. Twenty patients were interviewed in depth. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed and analyzed with a qualitative, hermeneutic interpretative method. The informants' efforts to develop useful strategies to restrain death could be symbolized as a cognitive and emotional pendulum, swinging between the extremes of life and death. During the swings of the pendulum, the informants used every means available: their own resources, other people, animals, nature, a transcendent power, hope, imagination and magical thinking. They strove to find factors that fitted their conceptual system and supported their inner balance and structure, all to keep death at a discreet distance and preserve their links to life. These links were togetherness, involvement, hope and continuance, and they served as a shield against hurtful feelings connected to their impending death. The new knowledge about how strategies in the presence of one's own impending death can develop and be used is perhaps the most novel and clinically relevant contribution of this study. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Sand, L., & Strang, P. (2006). Existential loneliness in a palliative home care setting [corrected] [published erratum appears in J PALLIAT MED 2008 May;11(4):665]. Journal of Palliative Medicine, 9(6), 1376-1387.
Background: The diagnosis of an incurable disease implies an existential crisis. This study focused on the emotions, perceptions, and experiences of existential isolation in palliative patients with cancer and their families. Materials and methods: A total of 40 respondents (20 patients and 20 family members) were interviewed in depth. All were Swedes who defined themselves as nonreligious. The patients were enrolled in an advanced hospital-based home care team. The interviews were taped, transcribed, and analyzed with a qualitative, hermeneutic method. Results: The data revealed experiences of existential loneliness with the impending death as a primary source. Experiences of being alone in "a world of one's own" were common. The changes in everyday life and the increasingly restricted social interaction because of the illness meant that the patient partly lost the protection against isolation that the spirit of community normally provides. Other situations that had a triggered the existential isolation were, for example, when a patient in need of support was left alone, when he or she was treated disrespectfully or in a way that made him or her feel invisible, or when people avoided contact because of uneasiness or fear. Changes in one's own body and mood gave rise to feelings of loneliness and unfamiliarity toward oneself. When a staff member touched the patient's body in a nonempathic way, this could induce feelings of being treated like an animal.
Sasaki, M., Arai, A., & Arai, Y. (2008). Factors related to institutionalization among disabled older people; A two-year longitudinal study. International Journal of Geriatric Psychiatry, 23(1), 113-115.
Nursing home placement among disabled older people means discontinuing home care provision by family caregivers. The present study is a two-year follow-up study. This longitudinal study aimed to identify factors related to institutionalization among community-dwelling disabled older people. Four hundred and twelve pairs of community-dwelling disabled older adults who used visiting nursing services under the public Long-Term Care insurance system in Japan and their co-residing family caregivers participated in the study. In the present study, potentially harmful behaviors (PHB) towards disabled older people by family caregivers at the previous time point was the only factor associated with institutionalization among disabled older people at the follow-up. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Satzinger, W., Courté-Wienecke, S., Wenng, S., & Herkert, B. (2005). Bridging the information gap between hospitals and home care services: experience with a patient admission and discharge form. Journal of Nursing Management, 13(3), 257-264.
Hospital care and ambulatory care are institutionally and financially so deeply separated in Germany that discontinuity of individual treatment and, hence, losses in both the quality and efficiency of care are all too often the consequences of this widely deplored systemic defect. In order to improve the communication between home care services and hospitals during admission or discharge of patients in need of long-term nursing care, the research project 'aski' has developed an innovative instrument and procedure for the reciprocal transfer of information between these institutions. After successful testing, the Patient Accompanying Form was offered for public use. Two years later, a written and telephone survey was conducted among the somewhat disappointingly small number of its users. Based on their experience, issues surrounding the implementation of such instruments in the health care system are discussed as well as the chances of enhancing integrative care by promoting coordinated communication between the providers.
Schmidt, M. H., Lay, B., Göpel, C., Naab, S., & Blanz, B. (2006). Home treatment for children and adolescents with psychiatric disorders. European Child & Adolescent Psychiatry, 15(5), 265-276.
The study examines the effectiveness of home treatment in 70 children and adolescents (aged 6-17 years) with heterogeneous psychiatric disorders. Home treatment was offered to parents/children as an alternative to inpatient treatment (no randomized group assignment). Interventions were carried out by psychiatric nurses (n = 38) and medical students (n = 32) under the supervision of experienced child psychiatrists. Assessment of treatment effects was based on a structured parent interview and parents', children's and therapists' ratings of various aspects of psychosocial functioning. Pre- or post-treatment comparisons indicate significant improvement of psychiatric symptoms, severity of the disorder, and psychosocial adjustment after three months of home-based interventions. Outcome of behavioral interventions carried out by experienced nurses was superior, compared to treatment effects achieved by advanced medical students. Post-treatment comparison of home-based (n = 70) and inpatient-based (n = 35) treatment effects suggests that inpatient treatment all in all was more effective. At one-year follow-up, however, the effects of home treatment were maintained in a higher number of patients, compared to the stability of effects seen after psychiatric hospitalization. Thus, home treatment appears to be an effective treatment setting. Motivation and compliance of patient and parents, and high skills of the therapists are key ingredients for the success of a home-based treatment program.
Schulz, R., Weiner, D., & Martire, L. (2004). End-of-Life Care for Patients with Dementia: Reply. The New England Journal of Medicine, 350(7), 734-734.
Replies by Schulz et al. (see record 2003-09949-003) on the remarks made by Franklin G. Miller (see record 2004-11074-002) on their article "End-of-life care and the effects of bereavement on family caregivers of persons with dementia." The authors say that they had no direct data regarding the use of life-prolonging therapies among patients who died in the hospital as compared with those who died elsewhere. However, we found no association between caregivers' reports of patients' pain or relief and the place of death, a result suggesting that suffering was common among all the patients, regardless of where they died. They agree that minimizing suffering should take priority in the care of patients with dementia. The constituents of comfort care for patients with dementia must be informed by knowledge of the underlying source of suffering. The constituents of comfort care for patients with dementia must be informed by knowledge of the underlying source of suffering. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Schumacher, K. L., Stewart, B. J., & Archbold, P. G. (2007). Mutuality and preparedness moderate the effects of caregiving demand on cancer family caregiver outcomes. Nursing Research, 56(6), 425-433.
Background: Family caregiving researchers have explored the moderating or stress-buffering effects of variables such as coping and social support. However, the quality of the family caregiver-patient relationship and preparedness for caregiving have received little attention as potential moderators. Objective: To explore whether relationship quality and preparedness moderate the effects of caregiving demand on caregiver outcomes during cancer treatment. Methods: Eighty-seven family caregivers of patients receiving treatment for cancer completed the Demand and Difficulty subscales of the Caregiving Burden Scale, Mutuality and Preparedness Scales of the Family Care Inventory, and the short form of the Profile of Mood States. Using hierarchical multiple regression analyses, caregiving difficulty and total mood disturbance were regressed on two- and three-way interaction terms for demand, mutuality, and preparedness, controlling for caregiver age and gender, and the simple effect of each independent variable. Results: Negligible effects for two-way interactions were found. However, the three-way interaction between demand, mutuality, and preparedness explained statistically significant variance in both perceived difficulty of caregiving and total mood disturbance. High mutuality in combination with high preparedness protected caregivers from adverse outcomes when demand was high. When either mutuality or preparedness was low, caregivers were at greater risk for negative outcomes when demand was high, but not when demand was low. When both mutuality and preparedness were low, caregivers were at risk for mood disturbance even when demand was low. Discussion: Analysis of three-way interactions provided new theoretical insights into the protective effects of mutuality and preparedness and demonstrated conditions under which caregivers are at increased risk for negative outcomes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Schwien, T., Gilbert, J., & Lang, C. (2005). Pressure ulcer prevalence and the role of negative pressure wound therapy in home health quality outcomes. Ostomy Wound Management, 51(9), 47.
Home health agencies, challenged to demonstrate quality while containing costs, are motivated to find best practices for managing patient and wound care. The effects of different wound therapies on frequency of hospitalization and emergent care, two prominent quality measures, have not been studied. A retrospective study was conducted to determine the prevalence of Stage III and Stage IV pressure ulcers in the home health population and to quantify the impact of negative pressure wound therapy in reducing acute care hospitalizations and emergent care in general, and wound infection or deteriorating wound status in particular. Data from 1.94 million OASIS start-of-care assessments in 2003 and 2004 were evaluated to estimate pressure ulcer prevalence and a retrospective matched group analysis compared patients using (n = 60) and not using (n = 2,288) negative pressure wound therapy. In 2003, 6.9% and in 2004, 7% of patients had pressure ulcers at start of care. Of these, 23% were Stage III or Stage IV and 31% were 'not healing.' In the matched analysis group, it was found that compared to comparison group patients, those receiving negative pressure wound therapy experienced lower rates of hospitalization (35% versus 48%, P <.05), hospitalization due to wound problems (5% versus 14%, P < .01), and emergent care for wound problems (0% versus 8%, P = .01). To offset potential limitations in generalizability and increase practical application of these results, further research is needed with a larger, nationally representative sample to compare other quality outcomes as well as the cost of providing negative pressure wound therapy to other specific wound care modalities.
Scott, L. D., & Arslanian-Engoren, C. (2005). The decision to care: a life-altering experience. Home Health Care Management & Practice, 17(2), 130-135.
The decision to care is often mandated by unavoidable alterations within the family, requiring a primary caregiver. One population that often requires complex community-based care is survivors of prolonged mechanical ventilation (PMV). This investigation explored the choices and challenges of eight family caregivers of PMV survivors. Using content analysis, several mutually exclusive themes emerged describing the caregiving experience as a physically exhausting, emotionally stressful decision that required a lifestyle change to actualize. Even with the burdensome challenges and overwhelming nature of the caregiving experience, participants identified positive rewards associated with the caregiving role. Home health care nurses are in a unique position to facilitate an effective transition to the caregiving role, serving as conduits for caregiver education and skill acquisition and advocating for the development of vital infrastructures that will provide resources, reassurance, and respite from burdensome caregiving challenges.
Shepherd, A., Stewart, H., & Murchland, S. (2007). Mothers' perceptions of the introduction of a hoist into the family home of children with physical disabilities. Disability and Rehabilitation: Assistive Technology, 2(2), 117-125.
Purpose: This study examined the perspectives of three mothers who used a hoist in the home to assist in the care of a child with a severe physical disability. It sought to identify the effects of hoist introduction on the family as well as factors which influence hoist usage. Method: A qualitative methodology was used to analyse semi-structured interviews with three mothers of teenagers with a disability. Results: The findings from this study have highlighted the positive impact of hoist introduction on the parent and child's quality of life as a result of improved management of care, increased options for the child and increased respite for the parent. Conclusions: Early positive outcomes of hoist use were influential in long-term hoist use and acceptance. The factors of consultation for acquisition of the hoist, early introduction to enable a gradual transition into regular use, appropriate fit in the home, sensitivity to grief and loss, and negotiation with parents about changes in care provision were all important in the introduction of the hoist. The importance of occupational therapists to advocate for early introduction of a hoist with in-depth consultation into the environmental impact prior to prescription, along with close monitoring of use once supplied are explored and implications for practice discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Sherman, M. F., Gershon, R. R., Samar, S. M., Pearson, J. M., Canton, A. N., & Damsky, M. R. (2008). Safety factors predictive of job satisfaction and job retention among home healthcare aides. Journal of Occupational and Environmental Medicine, 50(12), 1430-1441.
Objectives: Although many of the well known work characteristics associated with job satisfaction in home health care have been documented, a unique aspect of the home health care aides' (HHA) work environment that might also affect job satisfaction is the fact that their workplace is a household. To obtain a better understanding of the potential impact of the risks/exposures/hazards within the household environment on job satisfaction and job retention in home care, we recently conducted a risk assessment study. Methods: Survey data from a convenience sample of 823 New York City HHAs were obtained and analyzed. Results: Household/job-related risks, environmental exposures, transportation issues, threats/verbal and physical abuse, and potential for violence were significantly correlated with HHA job satisfaction and job retention. Conclusions: Addressing the modifiable risk factors in the home health care household may improve job satisfaction and reduce job turnover in this work population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Shinji, S., Shingeru, M., Ryusei, U., Mitsuru, M., & Shigehiro, K. (2007). Adherence to a home-based experience program and incidence of cardiovascular disease in type 2 diabetes patients. International Journal of Sports Medicine, 28(10), 877-879.
The aim of this study was to examine the association between adherence to a home-based exercise program and the incidence of cardiovascular disease (CVD) in patients with type 2 diabetes. We investigated 102 patients with type 2 diabetes aged 35 to 75 years, and followed them prospectively for 17.2 months. Before enrollment, all patients received a traditional exercise prescription. The exercise program consisted of a daily walking exercise at home for 20 - 30 minutes. Self-reported adherence to the exercise program and the incidence of CVD were confirmed by information obtained from telephone interviews. There were 38 dropouts among the patients in the exercise program. Dropouts were significantly younger than completers. The rate of obesity was significantly higher among the dropouts than among the completers. No differences were observed between the two groups for gender, history of CVD and other clinical characteristics. During the follow-up, we documented 8 new cases of CVD. The incidence of CVD during the follow-up was 1.56 percent among the program completers and 18.4 percent among the dropouts. Adherence to the home-based exercise was inversely related to the incidence of CVD (p < 0.01). These associations persisted after adjustment for age and other covariates. In conclusion, adherence to an exercise program is associated with a reduced incidence of CVD among patients with type 2 diabetes.
Sienkiewicz, J., Wilkinson, G., & Emr, K. D. (2008). Infection control. The quest for best practice in caring for the home care patient with an indwelling urinary catheter: the New Jersey experience. Home Healthcare Nurse, 26(2), 121-130.
This article describes the development of a urinary tract infection (UTI) benchmarking project by the Home Care Association of New Jersey for New Jersey's home care agencies. In the quest for best practice in caring for the home care client with an indwelling urinary catheter, identification of an acceptable UTI rate for indwelling catheter patients was needed to use as a benchmark for care practices. A literature search showed a paucity of evidence. Therefore, the Association agreed to lead a project aimed at identifying what was currently happening in home care settings as a beginning benchmark.
Simon, M., Tackenberg, P., Nienhaus, A., Estryn-Behar, M., Conway, P. M., & Hasselhorn, H. (2008). Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries--results from the European NEXT-Study. International Journal of Nursing Studies, 45(1), 24-34.
Background: Musculoskeletal disorders are a widespread affliction in the nursing profession. Back or neck-pain-related disability of nursing staff is mainly attributed to physical and psychosocial risk factors. Objectives: To investigate which--and to what extent--physical and psychosocial risk factors are associated with neck/back-pain-related disability in nursing, and to assess the role of the type of health care institution (hospitals, nursing homes and home care institutions) within different countries in this problem. Design: Cross-sectional secondary analysis of multinational data of nurses and auxiliary staff in hospitals (n = 16,770), nursing homes (n = 2140) and home care institutions (n = 2606) in seven countries from the European NEXT-Study. Methods: Multinomial logistic regression analysis with raw models for each factor and mutually adjusted with all analysed variables. Results: Analysis of the pooled data revealed effort-reward imbalance as the predominant risk factor for disability in all settings (odds ratios for high disability by effort-reward ratio: hospital 5.05 [4.30-5.93]; nursing home 6.52 [4.04-10.52] and home care 6.4 [3.83-10.70] [after mutual adjustment of psychosocial and physical risk factors]). In contrast, physical exposure to lifting and bending showed only limited associations with odds ratios below 1.6; the availability and use of lifting aids was--after mutual adjustment--not or only marginally associated with disability. These findings were basically confirmed in separate analyses for all seven countries and types of institutions. Conclusions: The findings show a pronounced association between psychosocial factors and back or neck-pain-related disability. Further research should consider psychosocial factors and should take the setting where nurses work into account. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Sinding, C. (2004). Informal care--Two-tiered care? The work of family members and friends in hospitals and cancer centres. Journal of Sociology & Social Welfare, 31(3), 69-87.
In a qualitative study conducted in Ontario, Canada, family members and friends of ill people defined a normal territory in which care from health professionals could not be counted on to be timely, effective or empathic. Under these conditions relatives and friends took on considerable responsibility, both for providing care and for securing care from health professionals. Yet considerable variation was apparent in this study in the sense respondents had of their own capacities to provide and secure care. Findings from this study suggest that service tiers exist in the institutional care system, linked to the time, knowledge and resources of informal carers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Singer, Y., Bachner, Y. G., Shvartzman, P., & Carmel, S. (2005). Home Death-The Caregivers' Experiences. Journal of Pain and Symptom Management, 30(1), 70-74.
The objectives of this study were to evaluate caregivers' experiences concerning the care of a terminally ill loved one at home, and to compare the death experiences of caregivers with and without access to homecare programs. The primary caregivers of all the patients who died of cancer 6-18 months before the study period (1999-2001) in the Negev area were contacted. This group included 240 caregivers of patients who died in the home palliative care program and 404 caregivers of patients who died with no access to a home palliative care program. A total of 159 caregivers were interviewed, 76 from the home palliative program and 83 who had no access to a palliative care program. Death at home occurred for 80.3% of patients with access to homecare and 20.5% of those without access. Despite the fact that caring for a loved one at home was a greater financial and emotional burden, there was a greater overall satisfaction with the caring experience of those whose loved ones died at home and had access to the homecare program. Given appropriate professional support systems, home-based care at the end of life is preferable to most caregivers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Slater, S. G., Neander, L., & Carey, G. (2006). Measuring Quality of Life Outcomes Through the Use of Home Telehealth: Using a Case Study Model in a Terminal Heart Failure Patient. Home Health Care Management & Practice, 18(4), 333-335.
The practice of home telehealth is defined as the use of any form of telecommunications to remotely augment care in the home setting or other place of dwelling. This case study will illustrate just how much support can be done in the home setting through augmentation with telehealth. The patient was a 93-year-old male with a primary diagnosis of heart failure and comorbidities of chronic obstructive pulmonary disease, chronic renal insufficiency, hypertension, and a history of abdominal cancer. The patient's skilled needs were a foley catheter and medication adjustments with his Lasix, and he had also developed a stage II decubitus ulcer that his caregivers took care of and the home care nurse looked at using the remote telehealth camera. This patient responded very well to interactive video conferencing. The telehealth monitoring had a very positive effect on his quality of life. He got to age in place and was able to live out his last days in his own home. The elderly patients who have been supported with telehealth interactive video visits for any length of time become very attached to their telehealth units and do not want to be discharged from the service. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Smith, K. L., Ornstein, K., Soriano, T., Muller, D., & Boal, J. (2006). A multidisciplinary program for delivering primary care to the underserved urban homebound: looking back, moving forward. Journal of the American Geriatrics Society, 54(8), 1283-1289.
The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth. Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader. These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost-benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program.
Snayde, F., & Moriarty, J. (2009). Person-centred home care for people with dementia: Developing a specialist service in an ethnically diverse community. Dementia: The International Journal of Social Research and Practice, 8(1), 148-152.
This article describes some of the unique features of Jack Dawe Home Care Support, highlighting the benefits of providing multidisciplinary care, and describing the efforts that have been made to provide a service in an ethnically diverse city. The service has always aimed to provide long term support for people with dementia and their families. It has also tried to move away from a 'traditional' service that only provides support with activities of daily living, such as washing, and instrumental activities of living, such as help with shopping, to identifying how the person with dementia's quality of life can be improved. In many ways, the Jack Dawe Home Care Service with its emphasis on health and social care services working together and flexible services in which support is provided in partnership with people with dementia and their carers mean that it is well positioned to develop further. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Snyder, D. C., Morey, M. C., Sloane, R., Stull, V., Cohen, H. J., Peterson, B., et al. (2009). Reach out to ENhancE Wellness in older cancer survivors (RENEW): Design, methods and recruitment challenges of a home-based exercise and diet intervention to improve physical function among long-term survivors of breast, prostate, and colorectal cancer. Psycho Oncology, 18(4), 429-439.
Objective: Cure rates for cancer are increasing, especially for breast, prostate, and colorectal cancer. Despite positive trends in survivorship, a cancer diagnosis can trigger accelerated functional decline that can threaten independence, reduce quality-of-life and increase healthcare costs, especially among the elderly who comprise the majority of survivors. Lifestyle interventions may hold promise in reorienting functional decline in older cancer survivors, but few studies have been conducted. Methods: We describe the design and methods of a randomized controlled trial, RENEW (Reach out to ENhancE Wellness), that tests whether a home-based multi-behavior intervention focused on exercise, and including a low saturated fat, plant-based diet, would improve physical functioning among 641 older, long-term (>=5 years post-diagnosis) survivors of breast, prostate, or colorectal cancer. Challenges to recruitment are examined. Results: Twenty thousand and fifteen cases were approached, and screened using a two-step screening process to assure eligibility. This population of long-term, elderly cancer survivors had lower rates of response (similar to 11%) and higher rates of ineligibility (similar to 70%) than our previous intervention studies conducted on adults with newly diagnosed cancer. Significantly higher response rates were noted among survivors who were White, younger, and more proximal to diagnosis and breast cancer survivors (p-values < 0.001). Conclusion: Older cancer survivors represent a vulnerable population for whom lifestyle interventions may hold promise. RENEW may provide guidance in allocating limited resources in order to maximize recruitment efforts aimed at this needy, but hard-to-reach population. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Soldato, M., Liperoti, R., Landi, F., Finne-Sovery, H., Carpenter, I., Fialova, D., et al. (2007). Non malignant daily pain and risk of disability among older adults in home care in Europe. Pain, 129(3), 304-310.
Aim of the present observational study was to evaluate the association between daily pain and incident disability in elderly subjects living in the community. We used data from the Aged in Home Care (AD-HOC) project, a 1 year longitudinal study enrolling subjects aged 65 or older receiving home care in 11 European countries. Daily pain was defined as any type of pain or discomfort in any part of the body manifested every day in the seven days before the baseline assessment. Disability performing activities of daily living (ADLs) was defined as the need of assistance in 1 or more of the following ADL: eating, dressing, transferring, mobility in bed, personal hygiene and toileting. Mean age of 1,520 subjects participating the study was 82.1 (standard deviation 6.9) years, and 1,178 (77.5%) were women and 695 (45.7%) reported daily pain at the baseline assessment. Overall, 123/825 participants (19.0%) with daily pain and 132/695 (14.9%) without daily pain reported incident disability during the 1 year follow up of the study. After adjustment for potential confounders, participants with daily pain had a significantly higher risk of developing disability, compared with other participants (hazard ratio 1.36; 95% CI: 1.05-1.78). The risk of disability increased with pain severity and with number of painful sites. In conclusion among old subjects living in the community, daily pain is associated with an increased risk of disability. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Solloway, M., LaFrance, S., Bakitas, M., & Gerken, M. (2005). A chart review of seven hundred eighty-two deaths in hospitals, nursing homes, and hospice/home care. Journal of Palliative Medicine, 8(4), 789-796.
BACKGROUND: While most people die in the hospital or a nursing home, surveys indicate that more than 70% of people would prefer to die at home. Expert panel recommendations have called for epidemiologic studies to document the nature of dying in America. OBJECTIVE: To determine if the experience of dying differed among settings in New Hampshire. DESIGN: A voluntary, statewide medical record audit of adult deaths in hospitals, nursing homes and home care/hospice agencies was conducted for February and March 2002. MEASUREMENTS: Records were examined for place of death, patient decision-making capacity and advance directives (ADs). Information was collected on demographic characteristics, primary and secondary diagnoses, presence of a "values history" (documented discussion with patient about their values and end-of-life care) and whether emotional and spiritual support was provided to patients and their families. Medical chart notes for the 48 hours preceding death were reviewed for "pain" and "other symptoms routinely assessed, treated and documented," and for whether the patient had undergone any of the following "treatments": surgery, ventilator, cardiopulmonary resuscitation, or extubation. RESULTS: Nearly one third (32%) of health care organizations in the state reported on 782 deaths (424 hospital, 148 nursing home, and 210 home care/hospice) representing 44% of the adult deaths during this period. Significant differences among settings (p < 0.001) were found for mean age, gender, marital status, primary insurance, diagnosis, ADs, symptom assessment, and provision of emotional and spiritual support for patients and families. Among hospital decedents, 56% were in acute care beds, 30% were in intensive care units, and 4% were in palliative care beds. Nineteen percent of decedents received interventions such as extubation, placed on a ventilator or surgery in the 48 hours preceding death. Over 80% had a do-not-resuscitate (DNR) order, 45% had a Durable Power of Attorney for Health Care, and 37% had a Living Will. Age and setting were significant factors in the presence of ADs. CONCLUSIONS: This information provides a benchmark for different care systems to identify areas for improvements in end-of-life care.
Sorensen, L., Stokes, J. A., Purdie, D. M., Woodward, M., & Roberts, M. S. (2005). Medication management at home: medication-related risk factors associated with poor health outcomes. Age & Ageing, 34(6), 626-632.
Background: some patients may have medication-related risk factors only identified by home visits, but the extent to which those risk factors are associated with poor health outcomes remains unclear.
Objective: to determine the association between medication-related risk factors and poor patient health outcomes from observations in the patients' homes.
Design: cross-sectional study.
Setting: patients' homes.
Subjects: 204 general practice patients living in their own homes and at risk of medication-related poor health outcomes.
Methods: medications and medication-related risk factors were identified in the patients' homes by community pharmacists and general practitioners (GPs). The medication-related risk factors were examined as determinants of patients' self-reported health related quality of life (SF-36) and their medication use, as well as physicians' impression of patient adverse drug events and health status.
Results: key medication-related risk factors associated with poor health outcomes included: Lack of any medication administration routine, therapeutic duplication, hoarding, confusion between generic and trade names, multiple prescribers, discontinued medication repeats retained and multiple storage locations. Older age and female gender were associated with some poorer health outcomes. In addition, expired medication and poor adherence were also associated with poor health outcomes, however, not independently.
Conclusion: the findings support the theory that polypharmacy and medication-related risk factors as a result of polypharmacy are correlated to poor health outcomes.
Spitz, B., Fraker, C., Meyer, C. P., & Peterson, T. (2007). Evolution of evidence-based guidelines for home care: Wisconsin's experience. Home Healthcare Nurse, 25(5), 327-334.
In a pay-for-performance home health system, achieving superior patient outcomes becomes the key to agency success. Evidence-based guidelines help in the achievement of exceptional patient outcomes. In this article, the Wisconsin Homecare Organization (WHO) describes its journey toward basing its home health practice on evidence-based guidelines.
Stabinski, J. W. (2007). Asthma home visit program: A valuable piece to a complex puzzle. Home Health Care Management & Practice, 19(6), 445-446.
This article provides an update on the status of asthma and its impact on the quality of life, as well as the financial impacts. Alternatives to care are discussed that address the decreased use of health care dollars that concurrently enhance the quality of life for children with asthma and their families. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Stajduhar, K. I., Martin, W. L., Barwich, D., & Fyles, G. (2008). Factors influencing family caregivers' ability to cope with providing end-of-life cancer care at home. Cancer Nursing, 31(1), 77-85.
Dying at home is a goal promoted by many healthcare providers and governments as a way to enhance the dying experience for cancer patients and their family members. A key element to realizing this goal is the availability of a family member who is willing to provide care at home. Little research has been conducted on the factors that influence family caregivers' ability to cope with providing end-of-life cancer care at home. The purpose of this qualitative study was to describe factors influencing family caregivers' ability to cope with providing such care. An interpretive descriptive research design guided this study. Semistructured interviews with 29 active family caregivers were conducted and thematically analyzed. Our findings suggest 5 factors that influenced the caregivers' ability to cope: (1) the caregiver's approach to life, (2) the patient's illness experience, (3) the patient's recognition of the caregiver's contribution to his or her care, (4) the quality of the relationship between the caregiver and the dying person, and (5) the caregiver's sense of security. Findings provide important information to assist in informing health services and policies directed at enhancing family caregivers' coping abilities. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Steadman, P. L., Tremont, G., & Davis, J. D. (2007). Premorbid relationship satisfaction and caregiver burden in dementia caregivers. Journal of Geriatric Psychiatry and Neurology, 20(2), 115-119.
Dementia caregiver appraisal of the quality of their current and premorbid relationship with the care recipient is associated with caregiving behaviors, caregiver mood, and the decision to end home care. This study examined the contribution of premorbid relationship satisfaction to caregiver burden in dementia caregivers. Live-in dementia caregivers (n = 72) completed several psychosocial measures. Caregiver responses were used to divide them into low premorbid relationship satisfaction group (low) versus high premorbid relationship satisfaction group (high). Results indicate that premorbid relationship satisfaction is negatively associated with caregiver burden and quality of family functioning. Caregivers with high satisfaction demonstrated significantly less burden and less reactivity to memory and behavior problems, and better problem solving skills and more effective communication compared with the low caregivers. Findings are independent of length of caregiving, disease severity, care recipient daily functioning, and relationship type. Relationship satisfaction may be an important contributor to caregiver burden. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Steinman, M. A., Maaravi, Y., Walter, L. C., Hammerman-Rozenberg, R., & Stessman, J. (2007). Evolution of medication use in Jerusalem elders: results from the Jerusalem Longitudinal Study. Drugs & Aging, 24(2), 133-145.
BACKGROUND: While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age. OBJECTIVE: The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years. METHODS: The study was a community-based, longitudinal, cohort study. The study group consisted of 280 patients from the Jerusalem Longitudinal Study, a population-based sample of Jerusalem residents born in 1920-1 who underwent extensive evaluation in 1990-1 and again in 1997-8. The main outcome measure of the study was the change in the total number of medications taken between baseline and follow-up. Medication use was assessed by home interviews. RESULTS: Half of the sample were men. Medication use more than doubled over the 7-year study period, from a mean of 2.0 to 5.3 medications per patient (p < 0.001), and 57 patients (20%) increased their total drug use by six or more medications. Vitamins, minerals and cardiovascular medications were the most commonly prescribed medications at follow-up, and accounted for approximately half of the total increase in medication use. On multivariable logistic regression analyses, decline in self-rated health was the strongest predictor of above-median increases in medication use (odds ratio [OR] 3.2; 95% CI 1.8, 6.2). The only nonclinical predictor of above-median increases in medication use was good social engagement at baseline (OR 1.8; 95% CI 1.1, 3.1). CONCLUSION: Medication use in Jerusalem elders grew rapidly over the 1990s, more than doubling in volume over a 7-year period. While health status was the factor most strongly predictive of the degree of change, the magnitude of increase for elders as a whole suggests major changes in prescribing practices over this interval.
Stevens, B., Croxford, R., McKeever, P., Yamada, J., Booth, M., Daub, S., et al. (2006). Hospital and home chemotherapy for children with leukemia: a randomized cross-over study. Pediatric Blood & Cancer, 47(3), 285-292.
Background. The study objective was to compare a hospital-based and a home-based chemotherapy program for children with acute lymphoblastic leukemia (ALL) in relation to Quality of Life (QOL), safety, caregiver burden, and costs.
Procedure. A randomized cross-over trial (RCT) design with repeated measures was conducted with 23 children with ALL who attended the oncology outpatient clinic of a metropolitan university affiliated tertiary level pediatric hospital and who also received home visits from a community health services care provider in central Canada.
Results. During the home-treatment phase, children were more capable of maintaining their usual routines than when receiving hospital chemotherapy (Wilcoxon statistic = 80, P = 0.023), but they appeared to experience greater emotional distress (Wilcoxon sign rank statistic S = 66, P = 0.043) according to parental report. Treatment location had no effect on caregiver burden and adverse effects. No significant differences between groups existed with respect to societal costs of care. As the child's age increased, QOL improved relative to younger children (t = -2.37, P = 0.02), the time burden related to child care tasks was reduced (t = -3.56, P = 0.002), caregiver effort/difficulty in physical and behavioral support decreased (t = -2.09, P = 0.049) and the odds of experiencing one or more adverse events decreased (OR = 0.79, CI = (0.63-1.00), chi 2= 4.01, P = 0.045).
ConclusionsWith few differences noted between groups, these results indicate preliminary support for administrating some or all of a child's chemotherapy at home. Home chemotherapy was associated with specific improvements and decrements in parent reported QOL. No effects were seen on burden of care, adverse events, or cost. Overall, young age adversely affected QOL, burden of care, and adverse events. These data provide important information to families and caregivers as they consider home or hospital-based therapy in childhood ALL.
Stevens, B., McKeever, P., Law, M. P., Booth, M., Greenberg, M., Daub, S., et al. (2006). Children Receiving Chemotherapy at Home: Perceptions of Children and Parents. Journal of Pediatric Oncology Nursing, 23(5), 276-285.
The aim of this descriptive exploratory study was to determine the perspectives of parents and children with cancer on a home chemotherapy program. Qualitative analyses were used to organize data from 24 parents and 14 children into emerging themes. Themes included (1) financial and time costs, (2) disruption to daily routines, (3) psychological and physical effects, (4) recommendations and caveats, and (5) preference for home chemotherapy. When home chemotherapy was compared with hospital clinic-based chemotherapy, parents reported fewer financial and time costs and less disruption to their work and family schedules, and children reported more time to play/study, improved school attendance, and engagement in normal activities. Although some parents felt more secure with hospital chemotherapy, most found it more exhausting and stressful. At home, children selected places for their treatment and some experienced fewer side effects. Although some coordination/communication problems existed, the majority of parents and children preferred home chemotherapy. Home chemotherapy treatment is a viable, acceptable, and positive health care delivery alternative from the perspective of parents and children with cancer. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Stevenson, D. G., Huskamp, H. A., Grabowski, D. C., & Keating, N. L. (2007). Differences in hospice care between home and institutional settings. Journal of Palliative Medicine, 10(5), 1040-1047.
Objective: To compare hospice care delivered at home with hospice care delivered in institutional settings, such as the nursing home. Data Source: Secondary data from the 1994, 1996, 1998, and 2000 waves of the National Home and Hospice Care Survey, a nationally representative survey of home health and hospice care agencies in the United States and their current and discharged patients. Study Design: We describe recipients, use of services, and length of enrollment for hospice received at home compared to hospice received in institutional settings. Comparisons of service use and lengths of enrollment are adjusted for age, gender, race/ethnicity, location, Charlson score, payer status, and linear time trends. Principal Findings: Hospice use in the United States has grown considerably over the last decade, especially among individuals in institutional settings. Institutional hospice users were older than home hospice users; more likely to be female, unmarried, and dually eligible for Medicare and Medicaid; and more likely to have primary diagnoses other than cancer. Although institutional hospice users were more likely to have received certain types of services compared to recipients at home, they were much more likely to be enrolled for 1 week or less. Conclusions: These national data point to significant differences across hospice settings and a growing need to analyze their implications. Yet, these data also leave many questions about hospice use across settings unanswered, including whether agency costs differ in institutional compared to home settings. As policymakers seek to assess the quality and appropriateness of hospice utilization and the methods used for its payment, further empirical work is needed, including how the growing use of hospice outside the home affects options for reform. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Stevenson, L., McRae, C., & Mughal, W. (2008). Moving to a culture of safety in community home health care. Journal of Health Services Research & Policy, 13, 20-24.
OBJECTIVE: Community home health care workers and their clients are faced with a mixture of occupational health and safety challenges that are not typically experienced by health care providers or patients in the acute care sector. The aim of this project was to explore the concept of safety in community home health in one health care authority in British Columbia. METHODS: A participatory action research approach was employed to explore staff and client safety risks in this environment. In the first phase, three focus groups were held with staff (n = 39) and the data analysed to identify themes. These were validated by additional focus groups. In the second phase, interviews were held with staff followed by chart reviews. Finally, in phase three, an interdisciplinary working group developed a risk identification tool for staff which was subsequently piloted. The exploration focused on answering the following questions: What constitutes safety in community home health care? What are the priority areas for action in relation to safety? What type of risk identification would be most helpful to community health workers to prepare them adequately to meet their clients' and their own safety needs? RESULTS: Risk themes identified included: poor communication, acute care staff not understanding the needs of community staff, working alone, mobility, medication concerns, lack of pre-screening of clients' homes, and community health workers accepting a high degree of risk. CONCLUSIONS: Findings suggest that typical notions of safety and risk in acute care are not easily translated into the community sector, that staff and clients' safety concerns are intertwined, and staff require better and more timely information from acute care staff when patients are discharged home.
Surkan, P. J., Dickman, P. W., Steineck, G., Onelov, E., & Kreicbergs, U. (2006). Home care of a child dying of a malignancy and parental awareness of a child's impending death. Palliative Medicine, 20(3), 161-169.
In this population-based study, we found that parents who are aware that their child will die from a malignancy are more likely to care for their child at home during the child's last month of life compared to parents who are not aware. End-of-life home care was comparable to hospital care for satisfactory pain relief, access to pain relief and access to medications for other physical symptoms. Using an anonymous postal questionnaire, we obtained information from 449 parents in Sweden who had lost a child due to a malignancy between 1992 and 1997, 4 to 9 years before participating in our study. The prevalence of dying at home and being cared for at home during the last month of life was 23.7% when parents realized intellectually more than 1 month in advance that the child would die (versus 12% who did not), 28.7% for parents who sensed that the child was aware of his or her imminent death (versus 7.8% who did not sense this) and 21.9% for those who received information that the child's illness was incurable (versus 9.4% who did not receive the information). Prevalence of children's unrelieved pain was 11.6% for those receiving home care and 15.3% for those receiving care outside the home. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Suter, P., Hennessey, B., Harrison, G., Fagan, M., Norman, B., & Suter, W. N. (2008). Home-based chronic care: an expanded integrative model for home health professionals. Home Healthcare Nurse, 26(4), 222-229.
The Chronic Care Model (CCM) developed by is an influential and accepted guide for the care of patients with chronic disease. Wagner acknowledges a current healthcare focus on acute care needs that often circumvents chronic care coordination. He identifies the need for a "division of labor" to assist the primary care physician with this neglected function. This article posits that the role of chronic care coordination assistance and disease management fits within the purview of home healthcare and should be central to home health chronic care delivery. An expanded Home-Based Chronic Care Model (HBCCM) is described that builds on Wagner's model and integrates salient theories from fields beyond medicine. The expanded model maximizes the potential for disease self-management success and is intended to provide a foundation for home health's integral role in chronic disease management.
Sutton, M. J. D. (2007). Examination of the historical sensemaking processes representing the development of knowledge management programs in universities : case studies associated with an emergent discipline.
Szilagyi, M. (2009). Children with special health care needs in foster care in the United States. Burns, Claire, 114-121.
(from the chapter) The United States (USA), like the United Kingdom (UK), has children for whom out-of-home care is deemed essential for issues of safety or health. Out-of-home care in both countries is intended to be a time of healing for children and families and a window of opportunity during which families can acquire services they need to successfully reunite with their children. The governments of both countries have responded in recent years to the growing body of evidence about what children need to thrive, passing legislation intended to provide for the needs of children in out-of-home care, protect them and foster permanency for them. In the USA, there is, of course, a subset of children and adolescents in foster care whose health issues are so significant as to place them in that unique category, called for the purposes of this book, disabled children. As in the UK, the number of children with severe developmental, behavioural and/or emotional conditions dwarfs those with complex physical health issues, sometimes also referred to as multiply-disabling conditions. The overall health status of the 510 000 children and adolescents in foster care in the USA is so poor that the American Academy of Pediatrics (AAP) now recognizes the entire foster care population as a population of 'children with special health care needs'. Given the high prevalence of chronic medical (35-60%), mental health (60-80% of children over age 4 years), developmental (60% of children under age 5 years), educational (45% of children 6-11 years) and dental (30-40%) health conditions, this designation is well-warranted, although it has yet to be translated into coherent policy or result in any re-allocation of health resources. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Tamir, O., Singer, Y., & Shvartzman, P. (2007). Taking care of terminally-ill patients at home: The economic perspective revisited. Palliative Medicine, 21(6), 537-541.
End-of-life care can be delivered in a variety of settings, whereby the majority of terminally-ill cancer patients prefer to die at home. The aim of our study is to evaluate health services utilisation during the last year of life, and to compare terminally ill patients who have received home-specialised palliative care services (HSPCS) with patients who died receiving home non-specialised palliative care services. The study included 120 and 515 patients, respectively, who died between 1999-2000. Age and gender distribution were similar in both groups. During the last year of life, mean health services cost per person among the HSPCS group was lower by more then 30% (P < 0.005). The median cost per patient was as low as one-fifth in the last month. Men and the older age group of 65 and above, cost significantly less compared with women and younger patients, respectively, regardless of provider setting. The main differences in health services utilisation were in hospitalisations and oncology treatments (P < 0.01 and P < 0.05, respectively). (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Tate, J., Mein, J., Freeman, H., & Maguire, G. (2006). Grey nomads--health and health preparation of older travellers in remote Australia. Australian Family Physician, 35(1/2), 70-72.
BACKGROUND: Many older Australians now tour remote Australia (so called 'grey nomads'). Anecdote suggests they place a burden on limited remote health services, however, this burden is poorly documented. METHODS: Two groups were approached to participate in the survey: travellers aged 50 years or over and staying in caravans, motor homes or tents at Fitzroy Crossing, Western Australia; and local primary health care providers. RESULTS: All 260 travellers approached responded. The prevalence of chronic diseases in those aged 65 years or over was 68%; 57% had sufficient chronic medications for the entire trip; 19% had a list of long term medications; and 9% of those with chronic diseases had a health summary from their usual general practitioner. Sixty-four local health providers responded: 95% rated health summaries highly (particularly if they included an active problem list, past history, current medications, and allergies). DISCUSSION: Older patients are poorly prepared for travel in remote Australia. They have a chronic disease rate no less than the national prevalence and could represent a drain on local health resources. Solutions might include GP review before travel, bringing sufficient medication for the trip, review of vaccination requirements, and a health summary.
Taylor, D. M., & Capamagian, L. (2007). Experience with planned and coordinated care using telemedicine. Journal of Telemedicine & Telecare, 13, S3:86-87.
In 2006 a telehealth project was implemented in Medway for people with multi-morbidity problems, such as unstable blood pressure. Home monitors were provided to measure vital signs. The information was transmitted to a secure server where an electronic patient record was accessed by clinicians. If the monitored variables exceeded preset limits, an automatic alert was sent to the monitoring centre where trained operators took appropriate action, for example notifying a patient's clinician. In nursing home settings, monitoring was thought to have saved 127 hospital bed days and 112 nursing hours. In participants' own homes, monitoring was thought to have saved 133 hospital days and 117 nursing hours. There were also cost- and time-savings for general practitioners (GPs), practice and community nurses. Increased involvement in their own management gives patients a better understanding of their condition, resulting in increased reassurance and reducing the need for GP visits.
Thobaben, M. (2006). Elderly Home Health Clients Who Abuse Alcohol. Home Health Care Management & Practice, 18(5), 413-414.
This article examines the issues of elderly home health care clients who abuse alcohol. The author discusses both early onset and late onset alcoholism. This is followed by a discussion on the need of health care staff to aware of alcoholism in the elderly and the need to screen for it. Recommendations for home care nurses working with alcohol abusing clients are provided. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Tibaldi, V., Aimonino, N., Ponzetto, M., Stasi, M. F., Amati, D., Raspo, S., et al. (2004). A randomized controlled trial of a home hospital intervention for frail elderly demented patients: behavioral disturbances and caregiver's stress. Archives of Gerontology & Geriatrics, 431-436.
Törnkvist, L., & Hegefjärd, C. (2008). Evaluation of interprofessional training in home care. Journal of Interprofessional Care, 22(5), 509-520.
The increasing number of patients in home care and the importance of teamwork make it important to provide successful ways of interprofessional learning for students. The aim of this study was to evaluate a group of undergraduate students' experiences of a one-day interprofessional home care training in a realistic setting. A study group comprised of 88 students and a control group with 182 students answered the questionnaire. In the study group the students practised interprofessional learning for a fictitious case in a real flat. The clinical education was performed in five steps. A group of local instructors supported the students during the day. The result showed that compared to the students in the control group the students in the study group had received a higher level of understanding or satisfaction in all comparable questions. The training day seemed to be especially important for the physiotherapy students. The students also gave feedback which can be used for future improvements. The arranged one-day home care training seemed to be a successful platform for interprofessional learning in primary health care. Nonetheless, certain logistics problems and the participation of medical students are two areas where improvement is necessary.
Tucker, A. L. (2004). A case study of operational failure in home healthcare. Journal for Healthcare Quality: Promoting Excellence in Healthcare, 26(3), 38-43.
Examination of operational failures in home healthcare could yield important insights into improving patient safety. This article presents a case study of work system breakdowns observed in the home healthcare setting. The findings suggest that the biggest areas of opportunity are failures stemming from (a) insufficient support from home health agencies and (b) inadequate coordination with patients and their families. Factors that impede organizations from learning from employees' experiences with operational failures and steps that managers may take to overcome these hurdles are discussed.
Tyrera, F., & Exley, C. (2005). Receiving care at home at end of life: Characteristics of patients receiving Hospice at Home care. Family Practice, 22(6), 644-646.
Background: Specialist Hospice at Home (HAH) services play an important role in the provision of care for people who choose to die at home. Methods: A pilot evaluation of a new HAH scheme in East Midlands, UK was carried out between January and December 2003, in which routine data were collected and analysed. Results: In 2003,155 people received the HAH service. Most patients (83%) were over the age of 60 and had a cancer diagnosis (92%). Almost one-third of patients waited for 2 days or longer to receive care from the HAH scheme. These patients were around three times as likely to be in an inpatient hospice (RR = 3.27; 95% CI = 1.19-8.95) or an acute hospital (RR = 2.85; 95% CI = 1.33- 6.09) when they were referred. The median length of service use was 4 days. Conclusions: The HAH service enabled people to die at home in the last days of life. Given the aging population, we would expect the demand for such services to further increase. Shortcomings identified included delay in receiving care for people moving to home from hospices and acute hospitals. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vaarama, M. (2009). Care-related quality of life in old age. European Journal of Ageing, 6(2), 113-125.
Promoting quality of life is a central theme in recent ageing policies, but what quality of life means in concrete terms for people in different stages of old age is rather unclear. This study presents a multi-dimensional model of care-related quality of life (crQoL) and, based on analyses of three Finnish cross-sectional datasets from the years 2004-2007, examines the distinctions between dimensions of QoL by age and gender, with a special focus on older home care clients. Correlation analyses (Pearson) and stepwise linear regression were applied to analyse variation in QoL by age group and the association between QoL and perceived quality of home care. The results suggest that individual QoL and the priorities of (physical, psychical, social, and environmental) dimensions in the assessment of QoL by older persons vary considerably and exhibit distinct profiles in different stages of ageing. In addition, four dimensions for good care corresponding to the crQoL model were identified and their empirical relevance demonstrated. From the perspective of older people in need of help, home care is not just about giving them the instrumental help they need to perform their daily activities, but rather about giving responsive care that reflects their personal preferences or their view on a "good life", and treats them with dignity and respect. The criteria for the evaluation of quality of home care should reflect these insights, and policy measures should take these differences into account. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vaarama, M., & Tiit, E.-M. (2008). Quality of life of older homecare clients. Vaarama, Marja, 168-195.
(from the chapter) The Care Keys project was the result of a European research initiative which addressed quality of life (QoL) issues among frail, care-dependent seniors, taking their social as well as health needs into account. The aim of the research presented in this chapter was to investigate: (i) the determinants of subjective QoL among old homecare clients and the role of homecare in the production of their QoL; (ii) the determinants of homecare quality that have most impact on the QoL of the clients; (iii) the management inputs that provide best care outcomes; and (iv) the key variables for evaluation of care outcomes from the perspectives of the clients, professionals and management. The Care Keys research has a multi-dimensional approach to life quality and, following Lawton (1991), a model of care-related QoL has been developed to highlight the special conditions and needs of care-dependent old people. This model was used as a reference model in the research presented in this chapter, more specifically, a "production of welfare model" was used, where subjective QoL was considered as the "final outcome" and the driving objective of homecare, whereas the quality of care (QoC) as reflected in the care documentation (docQoC) and care management (QoM) were seen as the means (intermediate outcomes) to realise this goal (see Davies, Bebbington, & Charnley, 1990; Chapter 1). The evaluation was client centred and the intermediate outcomes were evaluated against their effectiveness in having a positive impact on QoL of old clients (Fig. 1.3). Although it is difficult to evaluate the role of care in the production of QoL without a longitudinal design, it is still worth examining variation in QoL to identify the role that care plays in shaping QoL. The aim is also to try to bridge the differences and boundaries between care systems by searching for key determinants of homecare quality that the Care Keys data might suggest as being "universal" or common among the different project countries representing different care systems. The focus is on the identification of key indicators, therefore, the investigation of the four-dimensional structure of care and management quality was not a priority, although the results provide some evidence supporting the general four-dimensional model and identifying key indicators in all dimensions. (PsycINFO Database Record (c) 2009 APA, all rights reserved).
Valimaki, T., Vehvilainen-Julkunen, K., & Pietila, A.-M. (2007). Diaries as research data in a study on family caregivers of people with Alzheimer's disease: Methodological issues. Journal of Advanced Nursing, 59(1), 68-76.
Aim: This paper is a discussion of the use of unstructured diaries and their benefits and limitations as primary research data in a study of family caregivers of people with Alzheimer's disease. Background: Caregivers' diaries have rarely been used to study family caregivers' subjective knowledge of life with a family member with Alzheimer's disease. Method: Family caregivers wrote unstructured diaries for 2 weeks during the period 2002-2004, starting within 6 months after the diagnosis of Alzheimer's disease in a family member. The family caregivers (n = 83) were voluntary participants in an ongoing intervention study (patients n = 241 and caregivers n = 241). The diaries were analysed using content analysis. Findings: The diary data were categorized into the following four different types: meagre, reporting, descriptive and reflective. They described the family caregivers' experiential world and the changes taking place in it. Family caregivers found diary-writing a therapeutic and pleasant experience. The use of written diaries involves some limitations concerning high dependency on writers, and data solely in written form. An effort to confirm the quality of data should be made by personal contacts. Conclusion: Diaries can be used as a primary method of data collection in nursing research, as they produce subjective knowledge of the experiences, emotions and meanings associated with caregiving. Their use can result in a high level of motivation, and ability to reflect on life promotes successful writing. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Valle, R., Yamada, A., & Barrio, C. (2004). Ethnic differences in social network help-seeking strategies among Latino and Euro-American dementia caregivers. Aging & Mental Health, 8(6), 535-543.
This research explores the help-seeking behavior of Euro-American and Latino caregivers who provide homecare assistance to an older adult with dementia. A community sample of 89 caregiver-care recipient pairs (39 Latino and 50 Euro-American) was interviewed. Descriptive, bivariate, and multivariate analyses were conducted to examine ethnic differences in use of an informal social network for help with caregiving tasks. Caregiver experiences that may impact help-seeking behaviors such as perceived availability of support network, satisfaction with support received and caregiver distress were also considered. Latino caregivers reported less help-seeking than did the Euro-American caregivers. Overall, ethnicity accounted for 16% of the variation in help-seeking behaviors. Ethnicity accounted for a significant portion of the variation in most of the help-seeking characteristics examined even after adjusting for socioeconomic variables. In the multivariate model, the effects of ethnicity on help-seeking persisted, while the effects of other likely predictors did not. The size of social network may not be synonymous with the seeking of support by caregivers. Likewise, higher levels of distress among Latino caregivers did not result in increased help-seeking behaviors. There remains a need to identity what other factors may contribute to the cultural variability in caregivers' use of informal support. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vallerand, A. H., Collins-Bohler, D., Templin, T., & Hasenau, S. M. (2007). Knowledge of and Barriers to Pain Management in Caregivers of Cancer Patients Receiving Homecare. Cancer Nursing, 30(1), 31-37.
Cancer treatment is increasingly being provided in outpatient settings, requiring many of the responsibilities for patient care to be undertaken by family caregivers. Pain is one of the most frequent and distressing symptoms experienced by cancer patients and is a primary concern for the family caregiver. Caregivers struggle with many issues that lead to inadequate management of cancer pain. The purpose of this study was to determine pain management knowledge and examine concerns about reporting pain and using analgesics in a sample of primary family caregivers of cancer patients receiving homecare. The Barriers Questionnaire and the Family Pain Questionnaire were administered to 46 primary caregivers. Between 46% and 94% of the caregivers reported having at least some agreement with the various concerns that are barriers to reporting pain and using analgesics, and up to 15% reported having strong agreement. The areas of greatest concern were about opioid-related side effects, fears of addiction, and the belief that pain meant disease progression. Results showed that caregivers with higher pain management knowledge had significantly fewer barriers to cancer pain management, supporting the importance of increasing caregiver's knowledge of management of cancer pain. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vallerand, A. H., Saunders, M. M., & Anthony, M. (2007). Perceptions of control over pain by patients with cancer and their caregivers. Pain Management Nursing, 8(2), 55-63.
The purpose of this qualitative inquiry was to broaden the context for understanding perceived control as a concept related to the cancer pain response in the homecare setting. Ten patient/caregiver dyads participated in semistructured interviews focused on questions pertaining to the patients' perceived control over their own pain as well as the caregivers' control over the patients' pain. Line-by-line analysis was used to code, categorize, and analyze the data. Six themes emerged among patients: feeling robbed of the simplest of tasks and pleasures, the pain is hungry, feeling desperate, the pain is winning, fatigue/sleep disturbances, and perceived control is soothing. For the caregivers, four main themes emerged: monitoring the suffering, feeling like an outsider, inability to control the interventions, and importance of resources. Overall, patients and their caregivers were eager to discuss how their perceived lack of control over pain affected their daily lives. The results suggest perceived control over pain is an important aspect of the pain response in the homecare setting. Nurses should evaluate perceived control over pain in patients with cancer and their caregivers and implement and test potential methods for increasing perception of control over pain. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Van Amerongen, A. (2005). Psychiatry and history. Contribution of the family association. Annales Medico Psychologiques, 163(3-4), 250-254.
In France, the concept of family association in the area of psychiatry and mental health began in 1963, with the creation of UNAFAM (association of friends and parents with a mentally ill relative). Support to professionals was seen as a complement to the association's statutory goals (mutual help, training and advocacy for patients and families). Since then, patients, families, health and social care professionals, decision makers and elected representatives have been working together. This partnership has led to define the concept of "psychological" handicap as well as to rediscover and rebuild the "club house" scheme for patients. Despite theoretical and socio-economic problems, UNAFAM aims to promote patients' autonomy, help for families, and it also intends to participate in the quality of care. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
van Otterloo, S. G., van der Leij, A., & Henrichs, L. F. (2009). Early home-based intervention in the Netherlands for children at familial risk of dyslexia. Dyslexia: An International Journal of Research and Practice, 15(3), 187-217.
Dutch children at higher familial risk of reading disability received a home-based intervention programme before formal reading instruction started to investigate whether this would reduce the risk of dyslexia. The experimental group (n = 23) received a specific training in phoneme awareness and letter knowledge. A control group (n = 25) received a non-specific training in morphology, syntax, and vocabulary. Both interventions were designed to take 10 min a day, 5 days a week for 10 weeks. Most parents were sufficiently able to work with the programme properly At post-test the experimental group had gained more on phoneme awareness than the control group. The control group gained more on one of the morphology measures. On average, these specific training results did not lead to significant group differences in first-grade reading and spelling measures. However, fewer experimental children scored below 10th percentile on word recognition. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vik, K., Nygård, L., Borell, L., & Josephsson, S. (2008). Agency and engagement: older adults' experiences of participation in occupation during home-based rehabilitation. Canadian Journal of Occupational Therapy, 75(5), 262-271.
BACKGROUND: Participation is considered the main goal of rehabilitation and occupational therapy intervention. This study focuses on older adults'participation in occupations in daily life when receiving home-based rehabilitation. PURPOSE: To explore how older adults with disabilities participate in daily life subsequent to hospitalization. METHODS: A prospective case-orientated design was used, with repeated interviews with three older adults and a constant comparative method of analysis. FINDINGS: Two main categories emerged as the participants' experience of participation: "Continuing to be an agent in daily life"captured the participants' decision making, choosing, and acting in daily life. "Life itself is the agent" identified how the participants, despite their strong wishes to be agents, also could let their participation be directed by their engagement in ongoing daily life. IMPLICATIONS: The findings identified participation as a dynamic engagement ranging from individual agency, including decision-making, choosing, and acting in daily life, to letting life itself be the agent. The emphasis on agency in the participants' experiences challenges rehabilitation professionals to find further means of facilitating the clients' possibilities of being agents in their daily lives.
Vik, K., Nygård, L., & Lilja, M. (2009). Encountering staff in the home: three older adults' experience during six months of home-based rehabilitation. Disability & Rehabilitation, 31(8), 619-629.
Purpose. The purpose of the present study was to explore and describe how older adults who received home-based rehabilitation perceived the staff during a period of 6 months when they received rehabilitation. Specifically, the study focused on how the participants collaborated with and made use of the services from the staff. Method. In this case-oriented study, three older adults were interviewed continuously during the 6-month period they received home-based rehabilitation. The interviews were analysed continuously using a grounded theory approach. Results. Five different modes of perceiving the staff were identified among the participants: as small talk persons, as discussions partners, as instructors and advisors, as teachers and as persons who carry out tasks efficiently. The three conditions that most came to influence the way the participants perceived collaborated with the staff were as follows: 'experience and encounters with the staff', 'expectations for the future daily life', and 'the participants' needs and tasks related to their disability'. Conclusions. To achieve collaboration and user involvement, the staffs have to encounter each client differently in accordance with the various tasks that must be carried out during rehabilitation. Our findings indicate that this is particularly important for older adults during home-based rehabilitation, since older adults often have changing needs because of comorbidity.
Vikstrom, S., Borell, L., Stigsdotter-Neely, A., & Josephsson, S. (2005). Caregivers' self-initiated support towards their partners with dementia when performing and everyday occupation together at home. OTJR: Occupation, Participation and Health, 25(4), 149-159.
The aim of this study was to identify the support caregivers provide by their own initiative when performing an everyday occupation together with their partner who has dementia. This is to identify what type of self-initiated caregiver support enhances or limits the performance of the person with dementia. Thirty cohabitating couples participated. One of the spouses in each couple was the primary caregiver for a partner with mild to moderate dementia. Observational data were collected in the participants' homes, where each couple was asked to prepare afternoon tea together. The performances were documented by video and supplementary field notes. Data were analyzed using a qualitative comparative approach. The results of the analyses identified two major themes related to support the caregivers provided: provision of a supportive working climate and provision of practical support. A third theme was related to negative aspects of caregiver support. The results of this study have implications for how occupational therapists and caregivers in dementia care can support and guide primary caregivers in their homes. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Vikstrom, S., Josephsson, S., Stigsdotter-Neely, A., & Nygard, L. (2008). Engagement in activities: Experiences of persons with dementia and their caregiving spouses. Dementia: The International Journal of Social Research and Practice, 7(2), 251-270.
This study identifies how persons with dementia and their caregiving spouses individually perceive their own, their spouse's and their mutual engagements in everyday activities. Fifty-two cohabiting spouses, half of whom were diagnosed with dementia, were interviewed. A qualitative constant comparative analysis was performed, identifying four major themes: perceived changes in activity engagements; consequences of experienced changes; dilemmas experienced by the caregivers; and management approaches to handle a changed everyday life. Each individual described their activities to include loss of social engagements and changes in the relationship. Dilemmas experienced by the caregivers included 'interfering with the spouse's engagement or not' and 'placing the spouse's or one's own needs first'. The caregiver management approaches identified included 'taking over' or 'encouraging initiative'; 'lowering demands or avoiding problematic engagements'; and 'managing through collaboration'. Findings provide insight into everyday engagements for persons with dementia and their caregivers, important to healthcare support providers. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Virnig, B. A., Ma, H., Hartman, L. K., Moscovice, I., & Carlin, B. (2006). Access to home-based hospice care for rural populations: Identification of areas lacking service. Journal of Palliative Medicine, 9(6), 1292-1299.
Background: Many persons dying of cancer enroll in home-based hospice prior to death. It is established in the literature that persons in rural settings are less likely to use hospice than persons living in urban areas. We examine whether this is due, in part, to a lack of hospice providers serving rural areas. Methods: The 100% Medicare enrollment and hospice files for 2000-2002 were the basis for this study. We used a Bayesian smoothing technique to estimate the ZIP-code-level service area for each Medicare-certified hospice in the United States. These service areas were combined to identify ZIP codes not served by any hospice. Results: Overall, approximately 332,000 elders (7.5% of ZIP codes) reside in areas not served by home-based hospice. Each year over 15,000 deaths occur in these unserved areas. There was a strong association between lack of service and urban/rural gradient. One hundred percent of the ZIP codes in the most urban areas (>1,000,000 people) are served by hospice and only 2.8% of the ZIP codes in urban areas of less than 1,000,000 are unserved. In rural areas adjacent to urban areas, over 9% of ZIP codes are unserved and in rural areas not adjacent to an urban area almost 24% of ZIP codes are not served by hospice. Conclusions: While the majority of the elderly population of the US resides in areas currently served by Medicare-certified hospice, there is a geographically large area that lacks home-based hospice services. Current payment policies may need to be adjusted to facilitate hospice availability to these rural populations. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
von Kanel, R., Mausbach, B. T., Patterson, T. L., Dimsdale, J. E., Aschbacher, K., Mills, P. J., et al. (2008). Increased framingham coronary heart disease risk score in dementia caregivers relative to non-caregiving controls. Gerontology, 54(3), 131-137.
Background: Elderly individuals who provide care to a spouse suffering from dementia bear an increased risk of coronary heart disease (CHD). Objective: To test the hypothesis that the Framingham CHD Risk Score would be higher in dementia caregivers relative to non-caregiving controls. Methods: We investigated 64 caregivers providing in-home care for their spouse with Alzheimer's disease and 41 gender-matched non-caregiving controls. All subjects (mean age 70 +or- 8 years, 75% women, 93% Caucasian) had a negative history of CHD and cerebrovascular disease. The original Framingham CHD Risk Score was computed adding up categorical scores for age, blood lipids, blood pressure, diabetes, and smoking with adjustment made for sex. Results: The average CHD risk score was higher in caregivers than in controls even when co-varying for socioeconomic status, health habits, medication, and psychological distress (8.0 +or- 2.9 vs. 6.3 +or- 3.0 points, p = 0.013). The difference showed a medium effect size (Cohen's d = 0.57). A relatively higher blood pressure in caregivers than in controls made the greatest contribution to this difference. The probability (area under the receiver operator curve) that a randomly selected caregiver had a greater CHD risk score than a randomly selected non-caregiver was 65.5%. Conclusions: Based on the Framingham CHD Risk Score, the potential to develop overt CHD in the following 10 years was predicted to be greater in dementia caregivers than in non-caregiving controls. The magnitude of the difference in the CHD risk between caregivers and controls appears to be clinically relevant. Clinicians may want to monitor caregiving status as a routine part of standard evaluation of their elderly patients' cardiovascular risk. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Wadensten, B., & Ahlstrom, G. (2009). The struggle for dignity by people with severe functional disabilities. Nursing Ethics, 16(4), 453-465.
The purpose of this study was to investigate what strategies people with severe functional disabilities who receive personal assistance in their homes use in their daily life to achieve autonomy, integrity, influence and participation. Qualitative interviews were carried out and subjected to qualitative latent content analysis. The main finding was expressed in terms of six subthemes: trying to keep a private sphere; striving to communicate; searching for possibilities; taking the initiative; striving to gain insight; and using one's temperament. These generated the overall theme: maintaining dignity in close relationships. This study contributes an understanding of the strategies used by people who are dependent on personal assistance. Future efforts in nursing must focus on supporting personal assistants with ethical knowledge and guidance in order that people with severe functional disabilities are empowered to achieve autonomy, integrity, influence and participation in their daily lives. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Walsh, M., & Coleman, J. R. (2005). Nutrition and well-being. Trials and tribulations: a small pilot telehealth home care program for Medicare patients. Geriatric Nursing, 26(6), 343-346.
This article describes a home care agency's experience initiating the technology of a telehealth program for a selected view of its home care patients. The goal of the telehealth program was to improve patient outcomes by augmenting patients' regularly scheduled in-home skilled nursing visits with video-conferencing encounters. Patient selection, costs, projected savings, patient satisfaction, and the technical, clinical, and patient problems with the telehealth system are discussed.
Walsh, M., & Coleman, J. R. (2005). Telehealth. Developing a pilot telehealth program: one agency's experience. Home Healthcare Nurse, 23(3), 188-191.
This article explores one home care agency's experience launching a pilot telehealth program. Patient selection, costs, projected savings, and patient satisfaction with the telehealth program are discussed.
Wanden-Berghe, C., Nolasco, A., Sanz-Valero, J., Planas, M., & Cuerda, C. (2009). Health-related quality of life in patients with home nutritional support. Journal of Human Nutrition and Dietetics, 22(3), 219-225.
Background: Home nutritional support (HNS) aims to improve or maintain the patient's quality of life. Given the high social cost of such treatment, however, it is important to investigate whether the perceived quality of life of patients receiving HNS does in fact reflect these objectives. The present study aimed to evaluate the health-related quality of life (HRQoL) of patients who receive HNS. Methods: A multicentre, cross-sectional study of 267 patients was carried out. HRQoL was evaluated using the EuroQoL-5-Dimensions (EQ-5D) questionnaire. The Visual Analogue Scale (VAS) was used to complement the EQ-5D, aiming to provide an overall estimation of patient quality of life. Results: The EQ-5D questionnaire showed that 25% of the subjects valued their HRQoL at between )0.08 and 0.15, 50% at between 0.16 and 0.69 and 25% at between 0.70 and 1. Results from the VAS showed that 75% of patients claimed to have a HRQoL > 40. The median for the VAS was 50. Pathologies were oncological (44.0%), neurological (36.6%) and others (19.3%). The results obtained demonstrate that neurological patients placed a lower value on their HRQoL compared to those of other groups (P < 0.001). In addition, women rated their quality of life lower than men in all pathologies (P = 0.006). Conclusions: Perceived HRQoL varied depending on pathology and sex. It was difficult to draw conclusions concerning the impact of HNS because of a lack of baseline data and relevant validated measurement tools. The present study highlights the need for more research into the relationship between HNS and HRQoL. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Wang, K. K., & Barnard, A. (2004). Technology-dependent children and their families: a review. Journal of Advanced Nursing, 45(1), 36-46.
BACKGROUND: Advances in medical technology and nursing care have enabled children who rely on long-term medical and technical support to reunite with their families and community. The impact of discharging these children into the community involves a number of unprecedented social implications that warrant policy consideration. To begin with, an effort must be made to understand the phenomenon of caring for technology-dependent children living at home. AIM: The aim of this paper is to provide a comprehensive literature review on caring for technology-dependent children living at home. METHODS: The review was conducted via keyword searches using various electronic databases. These included CINAHL, MEDLINE, Social Science Index, Sociological Abstracts, Australian Family and Society Abstracts, and the Australian Bureau of Statistics. The articles and books found were examined for commonality and difference, significant themes were extracted, and the strength of the research methods and subsequent evidence were critiqued. FINDINGS: In this paper, themes relating to home care for technology-dependent children and their families are elucidated and summarized. These are: chronic illness and children; the impact of paediatric home care on children; the uniqueness of technology-dependent children and their families; and parents' experience of paediatric home care. DISCUSSION: Contentious issues, relevant to the social life of these children and their families, are raised and are discussed with the intention of extending awareness and provoking further debate among key stakeholders. These issues include: the changed meaning of home; family dynamics; social isolation; saving costs for whom?; shifts in responsibility; and parent-professional relationships. CONCLUSION: More research is needed in the arena of paediatric home care, to facilitate relevant policy formation and implementation.
Ward-Griffin, C., Bol, N., & Oudshoorn, A. (2006). Perspectives of Women with Dementia Receiving Care from Their Adult Daughters. CJNR: Canadian Journal of Nursing Research, 38(1), 121-146.
The caregiving experience within Alzheimer disease is fairly well documented. However, little research has been conducted from the perspective of the person living with dementia. The purpose of this study, part of a larger qualitative investigation of mother-daughter relationships within the care process of dementia, was to elicit the perceptions and experiences of mothers receiving care from their adult daughters. Guided by feminist and life-course perspectives, the researchers conducted in-depth, semi-structured interviews with a diverse sample of 10 community-dwelling women with mild to moderate cognitive impairment. In general, the health perceptions and experiences of the women were shaped by gender and how its meaning is constructed. While mothers reported mostly positive relationships with their daughters, cultural ideologies of individualism and familism manifested in feelings of "grateful guilt." Participants managed their contradictory experiences of receiving care from their daughters by doing care, undemanding care, determining care, and accepting care. The authors recommend changes in practice, policy, and research, with the aim of addressing relevant social determinants of health such as gender and social support, thereby promoting the health and well-being of women with dementia. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Webb, N. M., & Tucker, D. (2009). Young adults' opinions about hospice and home death. Journal of Palliative Medicine, 12(4), 337-342.
BACKGROUND: Exploring preferences for and barriers to quality end-of-life care is essential to improving care for dying individuals. Young adults often are involved or will be involved in decisions about the care of a loved one, and little research has examined opinions about end-of-life care among this population. RESEARCH OBJECTIVES: The current study examined factors that may affect young adults' opinions about hospice care and home death. METHODS: Participants were 1035 introductory psychology students at a southeastern university. The sample was 66% female and 60% Caucasian. The study questionnaire assessed participants' knowledge about hospice, experience with the death of a loved one, and opinions about hospice care and home death. RESULTS: Approximately 44% of the sample reported experience with the death of a loved one from a terminal illness. Hospice knowledge was higher among females, and females were more likely to report a positive opinion about hospice care as well as a greater likelihood of recommending hospice services for a loved one. Caucasians had a more positive opinion of home death than African Americans. Individuals describing their prior experience with the death of a loved one as negative had a more positive opinion of home death than those with no prior experience or a non-negative experience. CONCLUSIONS: Young adults' opinions about hospice and home death vary significantly with respect to gender and race. Large percentages of neutral responses suggest that interventions targeted at young adults could significantly impact their views of and ultimate choices about of end-of-life care.
Weisman, S. (2004). Policy page. Income tax breaks for caregivers: know your entitlements. Caring, 23(4), 38-38.
Wilkinson, H., Kerr, D., & Cunningham, C. (2005). Equipping staff to support people with an intellectual disability and dementia in care home settings. Dementia: The International Journal of Social Research and Practice, 4(3), 387-400.
The knowledge, experiences and skills of direct care staff working in care home settings are essential in ensuring a good quality of life and care for a person with an intellectual disability (ID) who develops dementia. Drawing on the findings of a wider study, the issues of training, support and the wider needs of staff when trying to support a resident who develops dementia are explored, specifically as relating to the role played by staff and the need to determine their experiences and related training needs. Following an introduction to the policy and practice context for working with people with an ID and dementia, and a brief description of the research method, the authors discuss the attitudes and practices of staff; supportive changes at an organizational level; and the knowledge and training needs of staff and specific gaps in knowledge. The authors argue that, within the policy and practice context of aiming to support residents to 'age in place', support for staff is a crucial aspect of ensuring that such an approach is effective and provides a coordinated approach to planning, resourcing and support. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Williams, B. R., & Lopez, S. (2005). Reaching the homebound elderly: the Prescription Intervention and Lifelong Learning (PILL) program. Home Health Care Services Quarterly, 24(1/2), 61-72.
This article describes the Prescription Intervention and Lifelong Learning (PILL) program, a three-year pilot project to develop in-home pharmacy care services to clients of a community-based social service agency. Clients who were homebound, at least 62 years of age, and taking at least five medications were eligible for inclusion. Potential participants were referred by care managers to the pharmacist, who conducted an in-home evaluation of the medication regimen and assessed the risk for medication-related problems. The pharmacist provided instruction for hypertension and diabetes mellitus self-monitoring, extensive medication counseling for clients with complex medications regimens, and conducted other activities to promote positive medicationrelated outcomes. The clients served were primarily female, between 70 and 90 years of age, and almost one-half lived alone. They were taking an average of more than nine medications daily, and had at least one chronic disease. The clients of the social service agency were highly vulnerable to medication-related problems and were in need of in-home pharmacy care services.
Winters, J. M. (2007). Videoconferencing and telehealth technologies can provide a reliable approach to remote assessment and teaching without compromising quality. Journal of Cardiovascular Nursing, 22(1), 51-57.
Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists. Telehealth technologies provide opportunities to meet the rapidly growing needs of consumers and healthcare practitioners. Many in need of services have limited access to high-end technologies. An argument has been made that the lowest level of technology needed to carryout a task should be used, if it is capable of providing the necessary services. Videoconferencing capabilities allow healthcare practitioners to engage in virtual face-to-face encounters with patients or other healthcare providers. A variety of levels of sophistication in these videoconferencing systems are available. In an effort to evaluate the effectiveness and consumer satisfaction with videoconferencing, 3 pilot studies were conducted to compare face-to-face, low-bandwidth, and high-bandwidth approaches to performing common assessments and patient education activities. In one study, a variety of experienced healthcare practitioners performed functional assessments of stroke subjects using a collection of validated scales by varying approaches (face-to-face, low-bandwidth, and high-bandwidth videoconferencing) in a randomized order. In a second study, undergraduate nursing students performed similar performance measures and taught an unfamiliar individual how to program and use an intravenous pump device, take a tympanic temperature, or to draw up insulin in a syringe. In the third study, advanced practice nursing students assessed vital signs and performed cardiopulmonary assessments on community-dwelling subjects using low-bandwidth and face-to-face approaches. Healthcare practitioners and students generally preferred high-bandwidth approaches over low-bandwidth alternatives when videoconferencing was performed; however, most participants and practitioners were satisfied with the encounters, regardless of the level of technology used.
Wood, D. L., McCaskill, Q. E., Winterbauer, N., Jobli, E., Hou, T., Wludyka, P., et al. (2009). A multi-method assessment of satisfaction with services in the medical home by parents of children and youth with special health care needs (CYSHCN). Maternal & Child Health Journal, 13(1), 5-17.
Objective: To assess satisfaction of parents of children with special health care needs with treatment by office staff, communication with the pediatrician, involvement in decision-making and coordination of services outside the practice. Patients and Methods: We used a mixed-method (qualitative and quantitative) approach to collect parental perceptions of the Medical Home services provided by their pediatricians. Six practices were selected to participate in the study based on geographic and patient demographic characteristics. In total, 262 (75% response rate) families completed surveys, and 28 families of these participated in focus groups. The Family Survey collected information (corroborated and enriched with focus group interviews) on parent and child demographics, severity of the child's condition and the burden on parents. We assessed parental satisfaction with treatment by office staff, communication with the pediatrician, involvement in decision-making, and connection to services outside the practice. Survey responses were analyzed using SAS with all associations considered significant at the P < 0.05 level. Focus groups were recorded, transcribed into EZ-Text and analyzed by a team of three researchers to identify patterns and themes inherent in the data. Results: Families reported in focus group interviews that they experienced significant stress due to the demands of caring for a child with special health care needs. Overall, only a small percentage of families reported being dissatisfied with their treatment by office staff (13-14%), communication with the pediatrician (10%), and involvement in decision-making (15-16%). However, a majority of families (approximately 58%) were dissatisfied with the ability of the pediatrician and his/her office to connect the families with resources outside the pediatric office. Families whose children had more severe conditions, or whose conditions had more of an impact on the families, reported being less satisfied with all aspects of communication and care coordination Families of youth with special health care needs (>12 years of age) were less satisfied than families of younger children with the practice's ability to connect them to resources outside the practice. Conclusions: Both the focus groups and surveys demonstrated that families of children with special needs are under very significant stress. Pediatricians must become better equipped to identify and communicate more proactively with families of CYSHCN that are experiencing significant parent burden. Pediatricians and their staff also need to improve their knowledge of community resources and proactively make referrals to community services needed by families of CYSHCN.
Woodward, C. A., Abelson, J., Tedford, S., & Hutchison, B. (2004). What is important to continuity in home care? Perspectives of key stakeholders. Social Science & Medicine, 58(1), 177-192.
In Canada, home care is growing rapidly. Each province takes a somewhat different approach to its delivery. Ontario uses a competitive bidding model to award contracts to community agencies that bid for service delivery rights. Contracts are to be awarded based on quality and price. However, the attributes thought to contribute to high quality, such as continuity of care, are not clearly defined and are not measured. We sought to identify factors that were important to experiencing continuity of care in home care. We interviewed home care clients and their caregivers, workers in the home care system (nursing and homemaking service providers, case managers) and physicians whose patients use home care. During in-depth interviews with these key stakeholders, they described the conditions that led to continuity of care in home care. Service providers and case managers were also asked about the types of clients who need a high level of care continuity. Care that is experienced as running smoothly, that responds to clients' needs and requires no special effort for clients to maintain, was seen as having continuity. The attributes of care experienced as facilitating continuity could be grouped under two dimensions of care-managing care (care planning, monitoring and review; and care coordination) and direct service provision (uninterrupted service delivery; consistent, appropriate knowledge and skills; ongoing accurate observation; trusting relationship between service provider and client/caregiver; rapport among team members; and consistent timing). Different stakeholders emphasized different attributes of care as most important to continuity. Clients included consistency of timing of service delivery while rarely mentioning care management issues. They emphasized the importance of consistent knowledge and skills in the workers and trusting relationships as important to experiencing care continuity. The description of attributes of continuity of home care that emerged from this study is compared to definitions found in the nursing, mental health and primary care literature.
Wu, P. A., Kerner, J. A., & Berquist, W. E. (2006). Parenteral nutrition-associated cholestasis related to parental care. Nutrition in Clinical Practice, 21(3), 291-295.
Parenteral nutrition-associated cholestasis (PNAC) is a complication not uncommon in the pediatric population. In severe cases, patients require a liver transplant. To our knowledge, we report the only case of PNAC with end-stage liver failure in a child with short bowel syndrome that resolved with a change in caretaker. Until his care was transferred from his abusive parents, he was frequently admitted for infection and sepsis. His liver function vastly improved from aspartate aminotransferase (AST) 3139 units/L, conjugated bilirubin 25.9 mg/dL to AST 47 units/L, direct bilirubin 0.3 mg/dL under the care of his attentive foster mother, and a liver transplant was no longer necessary. Bacterial infection and sepsis are risk factors correlated with patients with PNAC requiring liver transplant. Prevention of infection by a good caregiver may be a means to reduce the incidence of PNAC.
Wyatt, G. K., Donze, L. F., & Beckrow, K. C. (2004). Efficacy of an in-home nursing intervention following short-stay breast cancer surgery. Research in Nursing & Health, 27(5), 322-331.
This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing career or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p < .001) and report improved social/family QOL (p < .05), with fewer home visits (p < .001). These findings suggest that a targeted nursing protocol may, at reasonable cost, improve QOL and enhance health-related knowledge. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Yan, S., & Kin-Fong, C. (2006). Quality of Life of Patients With Terminal Cancer Receiving Palliative Home Care. Journal of Palliative Care, 22(4), 261-266.
The purpose of this study was to determine the levels of quality of life of patients with terminal cancer who received palliative care in home settings. Data were collected from 85 cancer patients with a life expectancy of less than 12 months using the McGill Quality of Life Questionnaire-Hong Kong version (MQOL-HK). The mean total quality of life score was 6.36 +or- 1.37 out of 10. Among the various domains, the physical and existential domains scored relatively low with mean scores of 4.9 +or- 1.28 and 6.12 +or- 1.6 out of 10, respectively. Conversely, the subscales of sexual functioning and support yielded the highest scores with mean values of 7.45 +or- 4 and 6.8 +or- 1.9, respectively. There was a significant moderate correlation between age and the mean total quality of life scores (r = 0.53, p < 0.01). In addition, a moderate negative correlation was found between pain intensity and physical subscale (r = -0.57, p < 0.01). In conclusion, patients with terminal cancer receiving palliative home care experienced a moderately high level of quality of life, especially in the sphere of support. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Yip, K.-S. (2006). A suggested push model for interpreting the dilemmas of institutional care, community care and family care of mental-health consumers. International Social Work, 49(6), 805-817.
This article suggests a push model for analyzing dilemmas between institutional care, community care and family care of mental-health consumers. In the USA community care is overloaded by inappropriate de-institutionalization. In Hong Kong, family caregivers are severely burdened by poor community care and highly institutionalized services. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Young, W., McShane, J., O'Connor, T., Rewa, G., Goodman, S., Jaglal, S. B., et al. (2004). Registered nurses' experiences with an evidence-based home care pathway for myocardial infarction clients. Canadian Journal of Cardiovascular Nursing, 14(3), 24-31.
Objectives: To obtain home health nurses' comments on an evidence-based care pathway for post myocardial infarction.
Design: A qualitative design was used.
Setting: Culturally diverse, lower income area of a large city.
Participants: All home health nurses from one nursing agency who participated in a comparative study on the impact of the evidence-based care pathway.
Results: The largest number of comments made by the nurses were related to the beneficial impact of the pathway on the provision of quality nursing care and on increased job satisfaction. The home health nurses reported that the pathway increased clients' knowledge of medications and diet. In addition, they commented that they were able to use the pathway effectively because of the training they received from the inpatient cardiac nurses.
Conclusions: This qualitative study demonstrates the benefits of investing in the implementation of best practice guidelines by home health nurses. However, nursing associations, such as the Canadian Community Health Nurses Initiatives Group, will need to continue to champion for additional funds to support the additional expenses incurred.
Zauszniewski, J. A., Bekhet, A. K., & Suresky, M. (2009). Relationships among perceived burden, depressive cognitions, resourcefulness, and quality of life in female relatives of seriously mentally ill adults. Issues in Mental Health Nursing, 30(3), 142-150.
Providing care and support to a seriously mentally ill (SMI) family member can have deleterious effects on one's health and quality of life. This study explored relationships among perceived burden, depressive cognitions, resourcefulness, and quality of life in 60 African-American and Caucasian women family members of SMI adults. Caucasians reported greater burden than African-Americans; the groups were similar in depressive cognitions, resourcefulness, and quality of life. In Caucasians and African-Americans, burden correlated with depressive cognitions and both correlated with poorer mental health. In African-Americans, burden also correlated with lower personal resourcefulness and both correlated with poorer mental health. The findings suggest a mediating role by depressive cognitions for both groups and by resourcefulness in African-Americans. Thus, both groups of women may benefit from positive thinking while African-Americans also may benefit from learning personal resourcefulness skills. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).
Zeltzer, B. B., & Kohn, R. (2006). Mental health services for homebound elders from home health nursing agencies and home care agencies. Psychiatric Services, 57(4), 567-569.
Objective: This study examined the practices of home care agencies and home health nursing agencies in the management and treatment of homebound clients with behavioral problems, dementia, and undiagnosed mental illnesses. Methods: A survey was mailed to all 54 directors of agencies in Rhode Island in 2003; 53 responded, either by mail or telephone. Results: Data indicated a lack of psychiatric services, a reluctance to address behavioral problems, and a failure to identify undiagnosed disorders. There was also a bias against accepting individuals with primary psychiatric disorders. Conclusions: Although the population of homebound elders with mental illness is increasing, their needs are not being met by these agencies. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (journal abstract).