Search

Home visits are an important aspect of the art and science of medicine. The home visit experience during the third year family medicine clerkship at the University of Connecticut School of Medicine is designed to help students gain a richer understanding of where patients "are calling from" to quote the American writer Raymond Carver It challenges them to enhance their appreciation of the cultural diversity of patients and how a broadly defined culture affects their health. Students conduct a home visit, post reflections of the visit online for their colleagues and mentors to read, and participate in an end of rotation wrap-up discussion. The results show an improvement in student knowledge, confirmation that the experience is useful, and that students appreciate the provided resources. Furthermore, students discover that information gained in a home visit is vastly more relevant and succinct than that gained in an office setting. [ABSTRACT FROM AUTHOR]

A typical home care nurse is rarely taught a special structured method to do case management. During an orientation, nurses are told they are primary case managers and are oriented to all of the tasks for which they are responsible. However, there is no structured case management method taught. Nurses are typically told that they will develop their own style after observing others. This article describes an organized method of managing patients and their needs with three outcome objectives: to understand the importance of having a structured case management model, to be able to organize and manage all of the tasks for which a primary nurse case manager is responsible, and to increase efficiency with case management issues and decrease or eliminate additional time spent on case management outside of patient visits. [ABSTRACT FROM AUTHOR]

DATA ANALYSIS: and quality improvement activities in the home health industry are essential to achieving and maintaining the level of quality expected for each and every patient. Medicare-certified home health agencies have access to a wide variety of patient data and other quality indicators, which can form the foundation for proactive process improvement. This article provides a brief review of the available home health data, followed by two agency case studies demonstrating radically different approaches to using available data to improve their patient outcomes, including reducing avoidable hospitalizations. [ABSTRACT FROM AUTHOR]

Home care agencies are under pressure to deliver high-quality care with outcomes that demonstrate reduced patient rehospitalization. One approach found to be successful in reducing rehospitalization of heart failure patients is front loading visits. Our recent study showed front loading was effective for patients with heart failure, dramatically decreasing rehospitalization by more than one half (30.4% to 16%). Other methods utilized to enhance front loading are supplementation of visits with telehealth and/or telemonitoring and the use of established care paths. This article discusses the many challenges home care agencies face in implementing redesign and these best practice measures. [ABSTRACT FROM AUTHOR]

This article describes two collaborative approaches that have proven to be effective in improving oral medication management in the home care setting. The first approach to be discussed is one that began with the introduction of best practice tools and supporting resources through the Quality Medication Administration Project collaborative. A case study highlights the experience of a home health care agency in the implementation of the Q-MAP tools and resources. The second approach describes a pharmacist's perspective of a patient-centered medication therapy program that promotes direct collaboration between home health agencies and qualified pharmacists. This article developed by a team of authors provides approaches and application examples to present a broad picture of the initiative. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), an agency of the U.S. Department of Health and Human Services, has been committed to improving the quality of care to Medicare beneficiaries since the inception of the Medicare Program. This commitment is evident in the Quality Improvement Organization (QIO) Program. In 2003, the QIOs worked to promote public reporting and the Home Health Compare Web site and improving the performance on publicly reported quality measures. Beginning in 2005, the QIO work in home health expanded to include adult immunizations, telehealth, and organizational culture. Currently, the QIOs primarily focuses efforts on the home health national-priority topic of reducing avoidable hospitalizations as measured by the publicly reported measure of acute care hospitalization or ACH. The focus on reducing avoidable hospitalizations became heightened with the yearlong Home Health Quality Improvement National Campaign, which began in January 2007. [ABSTRACT FROM AUTHOR]

Risk identification has been identified as an essential best practice and the first step to building an organizational foundation for an acute care hospitalization (ACH) reduction program. This article focuses on the importance of identifying those at most risk for rehospitalization and/or emergent care. In an attempt to demonstrate the variation in approaches to ACH reduction and risk identification, the experiences of two home care agencies representing two distinct regions of the United States—California and Pennsylvania—are included. These agencies share risk assessment development/implementation strategies, lessons learned, and outcomes from the implementation of this best practice. [ABSTRACT FROM AUTHOR]

Changing demography (people living longer and large cohorts aging) is a global phenomenon. American Indians are among the transitional groups with the proportion of elderly expected to double in the next 50 years. The excess burden of illness and health-status disparities between American Indians and the general population are well documented and have consequences affecting health status and functional abilities of American Indians. Health problems and functional limitations intensify the need for home- or community-based long-term-care services among older American Indians. Important considerations in providing these services include understanding historical and cultural influences on their family life, role expectations across generations, and aging as part of human development in contemporary life. In addition, poverty and changing federal policies influence how elders view health and health care delivery on reservations. This article provides an overview of the cultural influences and policy issues related to health care for American Indian elders on reservations. [ABSTRACT FROM AUTHOR]

Organizations, health systems, and interested individuals globally are assessing and investigating issues related to community health care services, home health management, and advanced nursing practice. Scarcity of financial and human resources has motivated health care policy makers to rise to the challenge to explore skill mix in the health care workforce in the hope of improving multidisciplinary collaboration in the provision of care for the world's populations. Nurses with advanced knowledge and skills are at the forefront of providing health care in home-based and community settings. This article describes the extent of this global phenomenon as it relates to advanced nursing practice and identifies a variety of international strategies utilized to introduce advanced practice nurses into health care systems. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 MEASURE:S: 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 → 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 → 1.37, p = 0.008) and physical therapists (mean = 1.16 → 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 [ABSTRACT FROM AUTHOR]

Facing an ethical dilemma in the health care setting can unfortunately be all too familiar. The ways in which a practitioner approaches ethical problem resolution are derived from many sources—including professional codes of ethics, personal values and morals, and employer influences. Pressures resulting from a business-oriented approach to health care delivery are common and can seriously affect patient safety and employee satisfaction. Essential ingredients for a principled approach, especially in the face of forces working against ethical behavior, are discussed, and implications for appropriate elements in ethics education addressed. This framework for thinking about ethical behavior recognizes and reviews the relationship between ethics and quality of health care. [ABSTRACT FROM AUTHOR]

On August 30, 2005, displaced New Orleanians first learned that the levees of their city had been overtopped and then breached by the storm surge from Hurricane Katrina. New Orleans would soon be 80% flooded. Within a month, Hurricane Rita arrived in New Orleans, making cleanup and recovery an even more difficult process. This article discusses the preparation and follow-up still going on today and the role of health care providers, particularly home care providers, in the aftermath of Katrina and Rita. [ABSTRACT FROM AUTHOR]

Many factors influence the quality and efficiency of the service provided by a hospice. In end-of-life care, the quality of service is measured by the experiences of patients and families. Although cost containment is important, there are many opportunities to save money and most do not involve cutting labor costs. Productivity and caseload affect the cost of labor and both measurements affect the quality of care. A review of all costs and processes including areas such as off-hours staffing can uncover areas for savings. Many factors must be considered. If customer responsiveness by the hospice agency is perceived as poor, referrals will drop. No matter what reductions are implemented, care quality as well as cost containment outcomes must be measured to determine the impact. Case management is one strategy that provides oversight for efficient and effective care but caseloads for professional staff must be established at reasonable levels. [ABSTRACT FROM AUTHOR]

This article determines the effectiveness of incorporating an aesthetic project into a nursing course in facilitating nursing students' understanding of patients'experiences with chronic illness. From fall 1999 through spring 2002, the authors collected data from 136 final-semester nursing students who were providing case management to chronically ill patients as part of their course work. Students engaged their patients in sharing the meaning of living with a chronic illness through any method the patient chose (poetry, song, drawing, etc). All students presented results in class and completed an evaluation questionnaire about the project. Of the students, 72.4% indicated that the project benefited their patients in some way and 55.6% stated that their nursing care changed because of what they discovered through the project} 68% also reported that the project changed them in some way. Nurses' holistic understanding of chronic illness can make their care more effective and satisfying. [ABSTRACT FROM AUTHOR]

This article reviews advances in conceptualization of cultural care and cultural competence in the nursing literature. First, three evaluative criteria are set forth (i.e., practice, education, and research). Second, the published conceptualizations of cultural care and cultural competence are assessed based on the three criteria. The review suggests that conceptualizations of cultural care and cultural competence have made noted progress in the past few decades both in quantitative and qualitative terms. Based on this initial assessment, areas for further development are suggested to facilitate the continued advances in conceptualization of cultural care and cultural competence in the future. [ABSTRACT FROM AUTHOR]

Multi-ethnic, indigenous Mexican immigrants from Oaxaca, the poorest state in Mexico, have engaged in transnational migration to the United States in increasing numbers since the early 1980s and the economic crisis in Mexico. Indigenous women migrants constitute a significant segment of this population, significant to nursing because of their major role in watching over the health of their families. This article reports selected research findings of an exploratory study of the migration and health experiences of Mexican indigenous women from Oaxaca that focus on their strengths while recognizing their vulnerabilities for health problems. Implications for nursing practice and praxis are identified. [ABSTRACT FROM AUTHOR]

This article tells how a manager and her coach used creative change strategies including the FISH philosophy to help two companies bring together two billing departments. What resulted was a true fish tale. Through the effective use of persistence, humor, team building tools and techniques, and a healthy dose of asking for the right kind of help at the right time through coaching, the manager and the team stayed the course through the best and worst of times. This article presents lessons that can be applied to departments and organizations. [ABSTRACT FROM AUTHOR]

Home health (HH) is considered by many to be complementary to existing disease management (DM) programs, or even suitable as a stand-alone DM intervention. The advantage is thought to be with the face-to-face interaction, in contrast to the standard DM telephonic interview. However, much of the literature appears to indicate that telecommunication is as successful as face-to-face contact (typically referred to as "usual care") for administering health surveys, providing counseling, changing health behaviors, and monitoring physiologic functioning. Given the desire to expand into the area of DM, HH agencies will need to identify and demonstrate areas in which they have a clinical and competitive edge over traditional DM models. This article describes and provides examples of three research designs that may assist the HH industry in evaluating their effectiveness in delivering DM services: the randomized controlled trial, the regression-discontinuity design, and case-control matching on the propensity score. [ABSTRACT FROM AUTHOR]

Recent advances in health information technologies promise to significantly improve the quality of care and quality of life for individuals who are chronically ill. However, significant challenges exist in targeting Digital Divide populations who are likely to be older, less educated, and novice computer users. This article presents a framework for understanding and reducing barriers for older adults to effectively use health information systems designed for disease management. The research is illustrated in the context of the IDEATel project, a large-scale telemedicine diabetes management and education program. The framework has three interdependent foci: hardware and software systems, tasks supported by the system, and user profiles. These foci are addressed in the context of usability and training studies. The studies document the challenges faced in facilitating patients’ access to Web resources supporting disease management. The article discusses system design changes that are intended to increase participants’ productive use of system resources. [ABSTRACT FROM AUTHOR]

The community-based internist and geriatric primary care physicians (PCPs) or medical doctors (MDs) have long been the most prevalent providers of primary care to populations who have chronic illness and/or are elderly in the United States. This article addresses the strategies for disease management (DM) that physicians in nonmature health care markets are utilizing to address unmet needs and suggestions for improved collaboration to provide improved evidence-based care. Other primary care providers are involved in the care of populations who have chronic illness and/or are elderly (e.g., advanced practice nurses and physician assistants). This article focuses on physician practice and current market realities affecting physicians to provide DM in populations that have chronic illness and/or are elderly (need complex care management). [ABSTRACT FROM AUTHOR]

Chronic medical condition management challenges health care systems, which increasingly lack tools to resolve clinical, quality, and cost impacts of this population. Demand for care management increases as populations age and chronic illnesses increase. The chronically ill are vulnerable to safety errors, leading to poor health status and increased health care costs. Patient safety, the risk from errors of omission or commission, is an integral component of disease management (DM). DM programs address the dual problems of safety and affordability by keeping individuals in their homes, empowering self-management of chronic condition(s), reducing complications, and forestalling safety concerns. Within home health, the evolution of patient safety in chronic care management has moved from conception to a definition stage, allowing noting and "cataloguing" of best practices. Metrics will be developed promoting rigorous evaluation of DM program performance and fostering optimal wellness for the chronically ill in a cost-effective and satisfying home setting. [ABSTRACT FROM AUTHOR]

Recently, the Department of Nursing at the University of South Dakota was recognized by the National League for Nursing as one of three Centers of Excellence nationally, and the program was selected for study by the Carnegie Foundation. This associate’s degree educational program has achieved an elevated degree of excellence because it adopted a number of elements that are associated with success in the leadership and organizational literature: (a) strong and sustained positive leadership, (b) passionate and involved people and partners, (c) a far-reaching but realistic vision, (d) open and exhaustive communication, (e) focus and relevance, and (f) effective execution. This article examines those characteristics of success and presents examples from the nursing education program at the University of South Dakota. [ABSTRACT FROM AUTHOR]

When President Bush began the war against terrorism, it affected the lives of millions of people in the world. This article presents how the war on terrorism and the activation of troops affected nursing students. These students were from diverse parts of our country and, with this activation, experienced a very different clinical setting than was planned within nursing curricula. This article describes this unique situation from the perspective of the students who were activated, and how one student was able to complete both her theory and clinical experience while on active duty in Iraq. [ABSTRACT FROM AUTHOR]

During the course of the past few years, faculty members at the University of South Dakota, Department of Nursing, have developed and implemented a variety of creative and valuable community clinical experiences for nursing students. This article addresses different community clinical sites utilized for each of the four semesters in the program. By using a diverse approach to the clinical experience for students, it is the anticipation that graduate nurses will be better prepared to work within the community setting and require shortened preceptoring. Having available more graduate nurses with a broader understanding of the role of the community health nurse is one important aspect for addressing the need for nurses within the home health and other community care settings. [ABSTRACT FROM AUTHOR]

Home health care is a low-cost alternative to traditional inpatient care and an appealing alternative for developing countries such as Turkey, where financial resources for health care are particularly scarce. To gain insight into the concerns of physicians regarding this possibility, a survey was administered to 200 physicians sampled at a large academic medical center in central Turkey. The results of the study indicate that 14% of the participants think that home health care in general is not appropriate for Turkey; however, 58% of participants felt that being close to one’s family when ill can have a significant effect on the course of the illness and recovery. The results of the study suggest that home health care is seen as an economically appealing but somewhat medically controversial area that nonetheless shows promise for future development in Turkey and other similarly developing countries. [ABSTRACT FROM AUTHOR]

Home care managers today have to answer to many masters. Someone always wants something!—yesterday!! This article discusses some techniques that can be used to help control the many demands on the manager’s time and demonstrates how to plan and organize the completion of a multifaceted project by its due date in spite of the demands of day-to-day operations. In essence, this article reviews the basics of project management. [ABSTRACT FROM AUTHOR]

This article describes components of a qualitative research study that investigated the process of how acute care nurses successfully transition into home health nursing practice. The sequences of activities in choosing home health as a specialty to practice and the phases of successful transition from acute care practice to home health practice are described. The sequence of activities and phases of successful transition were developed and grounded in the practice of 14 home health nurses. Implications for home health nursing practice, administration, and education are discussed. [ABSTRACT FROM AUTHOR]

Developing and implementing communication strategies to counterbalance the obstacles to social interaction created by the separation of learners from one another present a challenge for Internet-based instructors. Sensitivity is required to accommodate ethnically diverse variations in communicative practices so that learners are neither penalized for their cultural differences nor impeded in their learning processes by those differences. The literate discourse style imbedded in the online threaded discussion may be a new way of communicating for learners with a culturally based oral discourse style. Ill-structured problems, facilitation, and explicit criteria for evaluation that is distinctly different from the directions for participating in the discussion help students make a successful transition from speaking in the classroom to writing in the online threaded discussion. [ABSTRACT FROM AUTHOR]

Resources are needed throughout the process of implementing evidence-based practice from the initial search for evidence through the evaluation of outcomes. Administrative support is a critical resource for any change to occur and be maintained. This article describes the resources that are available and that may be useful at different phases of the evidence-based practice process. For example, to find prepared literature syntheses and guidelines, nurses need either a medical librarian or expertise in using computerized bibliographic databases. Tools are described for use in (a) critical appraisal of literature and guidelines and (b) evaluation of the context in which a practice change is being considered. [ABSTRACT FROM AUTHOR]

Staff development specialists and certified wound, ostomy, continence nurses must be leaders in the design of orientation programs that will assist nurses new to the practice of home health care develop wound care management skills. An orientation developed on evidence-based practice is essential to ensure quality, safe patient outcomes, and positive fiscal outcomes. This article describes the basic elements essential to a comprehensive orientation and suggests several models to assist the orientee in developing competency in wound care. [ABSTRACT FROM AUTHOR]

Health care clinicians are practicing in a changed health care environment across practice settings. Physician-nurse (MD-RN), collaboration is a core issue that continues to affect care quality and cost as well as patient and clinician satisfaction. Current economic, reimbursement, regulatory/accrediting, technology infusion, practice innovation, and population trends affecting health care are discussed in the context of the need for improved MD-RN collaboration in home care. A brief summary of the current maturation of MD-RN research is discussed. The urgent need for collaboration improvement in the home care practice setting is illuminated. The prism used for examination is the need for improved care management in the prevalent and often complex wound care populations. Current MD-RN collaboration barriers and improvement strategies being tested and implemented are discussed. Suggestions for practice changes to achieve improved interdisciplinary care management and needed support are made. [ABSTRACT FROM AUTHOR]

The care manager (CM) has the unique ability to engage the force that will promote a collaborative health care team approach to the home care patient customer (PC). Broader collaboration between various business partners and health care providers is needed. This collaboration ensures that real or imagined care barriers are resolved timely and safely. By uniting a model of collaboration with innovation, an optimal level of health may be achieved for PCs. The primary diagnosis dictates only a portion of PC care. Unaddressed or inadequately addressed comorbidities and environmental or psychosocial factors negatively affect home care outcomesfor example, chronic wounds that do not heal or worsen under care when wound healing is the goal. By assuming the global-holistic view of the PC and/or familys needs, the CM will be the link to other health team members to identify any resource or service to operate at a best practice level. [ABSTRACT FROM AUTHOR]

Quality, cost, and patient access are critical to a home health care agencys success in a competitive market. Creating a learning environment is key to both staff satisfaction and positive patient care outcomes. Preventing adverse events and providing evidence-based care management for high-volume populations are key to an agencys reputation for quality, cost-efficient care. This article describes the implementation of evidence-based guidelines for pressure ulcer prevention and wound care utilizing the continuous quality improvement process in performance improvement (PI) via Skin Care Resource Team (SCRT) implementation. Factors addressed are clinical quality, cost, staff motivation, productivity, and documentation burden. Effective and efficient strategies described in PI are SCRT support and rollout and integration of consistent appropriate wound, ostomy, and continence nurse consults via telehealth. The importance of linking evidence-based practice with the agencys vision, goals, resources, and employee incentives is discussed. [ABSTRACT FROM AUTHOR]

Home health nurse malpractice litigation and judgments are increasing. The legal and home health practice environments are evolving in streams of tumultuous change. The legal view of nurse practice lags behind the realities of nurse practice. Evidence-based practice is evolving and becoming the expected standard of practice. This article summarizes the current home health malpractice trends and identifies current factors affecting change in both the legal and home health environments. Strategies and resources to reduce nurse malpractice risk in home care are discussed. [ABSTRACT FROM AUTHOR]

This study examined job satisfaction among nurses in China. A nationwide survey was conducted with 403 nurses employed at hospitals in 16 provinces in China using the Job Descriptive Index Scale. The findings indicated that, overall, nurses were dissatisfied with work, pay, and promotions. Pay was rated as the least satisfying aspect of work followed by promotions. Nurses with more years of experience, higher professional titles, and more opportunities to attend continuing education programs were more likely to have a high level of job satisfaction than nurses with fewer years of experience, lower professional titles, and fewer opportunities to attend continuing education programs. Nurse managers should pay close attention to nursespay, career advancement opportunities, and promotions. They should recognize nurses achievements and provide opportunities for continuing education programs and independent work with emphasis on critical thinking and decision making, autonomy, accountability, and delegation. [ABSTRACT FROM AUTHOR]

Reaching Asian Americans with cancer awareness messages is critical to improving cancer detection and reducing risk. Two separate targeted media campaigns, sponsored by the Asian Tobacco Education, Cancer Awareness, and Research (ATECAR), were implemented to increase cancer awareness among Chinese, Koreans, Vietnamese, and Cambodians residing in Philadelphia and the surrounding counties. These campaigns, based on Rogerss diffusion and innovation theoretical model, were culturally sensitive, multilingual, and implemented over an extended time frame using print articles and a radio series under the respective general headings ATECAR Link and Voice of ATECAR. The series covered a range of topics that included tobacco smoking and health, cervical and breast cancer, clinical trials, and cancer information. Despite a reputation for noninvolvement in mainstream cancerrelated media issues, results of the campaigns reflected an exceptional response from the targeted communities. The results suggest that wellplanned, community-based media campaigns can have positive impacts on cancer awareness in Asian communities. [ABSTRACT FROM AUTHOR]

Nursing programs have seen an increase in multicultural students entering into the profession. One challenge is that of communicating clearly among groups of people including majority Americans and those for whom English is a second language. This article addresses the effectiveness of metaphors that bridge the gap between a known concept and one that is new to the learner. This study found that students from the majority culture and those for whom English is a second language misunderstand metaphors. Therefore, faculty members who seek to communicate clearly should pay special attention to the use of metaphors. One challenge to the nurse is effective communication, as the client may not yet have acquired the ability to understand common metaphors. The student who has been educated to be sensitive to these concerns will provide better care for these clients. [ABSTRACT FROM AUTHOR]

True and therapeutic aromatherapy has many uses for personal care. Essential oils work on the psychological and physiological to balance mind, body, and spirit. Pure oils with the Latin binomial are the key to achieving the desired results in care. Uses are explained, and a suggested list of safe essential oils and hydrosols are included. Safety, storage, purchasing guidelines, as well as resources for education, oils, reading materials, and a research database conclude the article. [ABSTRACT FROM AUTHOR]

Since 1889, when the role of the nurse anesthetist as an advanced practice nurse was first recognized in the United States, the roles and utilization of the advanced practice nurse in general and that of the nurse practitioner in particular have expanded significantly. Nurse practitioners are moving into the home health care setting and practice in a variety of specialties within home care. This article discusses the need for the nurse practitioner role in home care, the benefits of the role, and the potential for the role in home care for the future. [ABSTRACT FROM AUTHOR]

Home health aides, home care workers, and personal care attendants form the core of the formal home care system by providing assistance with activities of daily living and the personal interaction that is essential to quality of life and quality of care for their clients. High turnover and long vacancy periods are costly for providers, consumers, their families, and workers themselves. In 2002, 37 states identified worker recruitment and retention as major priority issues. Demographic and economic trends do not augur well for the future availability of quality home care workers. Policy makers in the areas of health, long-term care, labor, welfare, and immigration must partner with providers, worker organizations, and researchers to identify and implement the most successful interventions for developing and sustaining this workforce at both policy and practice levels. The future of home care will depend, in large part, on this third rail of long-term care policy. [ABSTRACT FROM AUTHOR]

Excessively narrow definitions of health care quality do not identify certain important components of health care for clinicians, providers, or patients. Excessively broad definitions drive up health care costs and encourage unjustified interventions. This article proposes a framework for examining health care quality that distinguishes between what patients need, want, and deserve, and it advances the idea that deserved care is the relevant concept of care to inform health policy debates. [ABSTRACT FROM AUTHOR]

This article outlines an approach to developing and submitting manuscripts for professional publications. Authors are encouraged to individualize and use those steps appropriate to their needs in the pursuit of manuscript development and information sharing. [ABSTRACT FROM AUTHOR]

Increased data reporting requirements, reimbursement changes, and automation capabilities provide new challenges for home health care and public health agencies today. These factors have become the impetus for computerization of practitioner documentation. Standardized documentation systems such as the Omaha System allow agencies to describe client needs, service delivery, and related client outcomes and to generate powerful data when used consistently and reliably in practice settings. This article offers practical suggestions for assuring data quality as well as simple, effective analysis and reporting strategies. Several figures depicting Omaha System documentation data from diverse programs are included as examples. [ABSTRACT FROM AUTHOR]

The Public Health Nursing Outreach for New Americans (PHNONA) faculty practice serves refugee and immigrant populations in the Denver metropolitan area. The practice provides health education and home visits for children within the Head Start program and their families. Nursing students in the baccalaureate program have the opportunity to rotate through this practice during their Public Health Nursing course. The Omaha System is used as a tool to facilitate student documentation. Data from 27 closed cases were analyzed. Common problems in the environmental domain were income and residence; in the physiological domain, dentition; in the psychosocial domain, communication with community resources; and in the health-related behaviors domain, health care supervision and nutrition. The majority of interventions were in the Case Management and Health Teaching, Guidance, and Counseling categories. The Problem Rating Scale for Outcomes showed statistically significant improvement from admission to discharge in the areas of knowledge, behavior, and status. [ABSTRACT FROM AUTHOR]

There is evidence of an evolution in documentation in home health that has its roots in government agencies and mandates. Agencies from Medicare and Medicaid to the Health Insurance Portability and Accountability Act supervised by the Department of Health and Human Services have made clinicians accountable for the care they give and the personal health information they collect. The need for in-home care, the care provided, and the outcomes of the care given are evidenced by documentation. The documentation allows for reimbursement. Patient care and the time needed to complete and document that care have become complicated and timely. Has this affected patient care? Clinicians vary in their opinions. However, all agree that the criteria and methods of documentation have evolved from the simple to the complex. [ABSTRACT FROM AUTHOR]