Search

Accounting for a health care entity such as the Visiting Nurse Association (VNA) breaks the mold when it comes to typical business practice. Besides just accounting, other business practices surrounding a home health agency are quite unique compared to other industries. Idiosyncrasies are not isolated to the accounting and billing departments; they spread among nursing, human resources, and administrative personnel. Adapting, managing, and sharing these idiosyncrasies through commiseration and laughter enable an entire VNA team to strengthen their collective bond. VNA controllers and the like learn some valuable lessons during their first couple years, and now, knowing the instability of VNAs across the country, they should enthusiastically be challenged to continue in the field of home health accounting. It is vital that clinicians and administration continue to work together so that VNAs can survive and succeed in the future. [ABSTRACT FROM AUTHOR]

Wellness programs have become a valuable resource for individuals to acquire knowledge about their health and well-being. People are looking to stay healthy. Organized vaccine programs allow people to receive their vaccines quickly and easily. This article provides information on starting a vaccine program, maintaining the program through the years, and continuing the program into the future. Offering community based vaccine programs allows people the freedom to decide when to receive their vaccine. It is convenient and promotes community wellness. Learn about the who, what, where, why, and how of organizing a vaccine program. [ABSTRACT FROM AUTHOR]

Agencies must recognize the importance of providing ongoing educational opportunities that focus on personal growth and development for both participants and the person developing the programs. It is essential to recognize when specific programs should be offered to provide the support needed to help coworkers deal with the additional stress that required changes may produce. This reaction to change can have a negative effect on home life, work performance, and overall health. Developing programs and workshops that are agency specific can be accomplished in many different ways and does not have to be a high-cost endeavor. Utilizing the employees' existing skills helps to keep costs down and provides insights to problem resolution that may not be possible from an outside source. There is an untapped wealth of knowledge and talent at every workplace that can be mobilized to accomplish remarkable tasks when given the opportunity to do so. [ABSTRACT FROM AUTHOR]

The National Association for Home Care estimated 26% of all home health agencies (HHAs) have gone out of business since October 1997 when Medicare began to change the funding structure for home health care reimbursement. This study aims to answer two questions: Did HHAs that went out of business abandon patients? and Are HHAs that remained in business providing less-than-adequate services? Telephone interviews were conducted with 64 randomly selected elders receiving home care services during the funding transition from fee-for-service to an interim payment system. The findings indicate that HHAs that closed down primarily transferred their patients to other agencies and that 22% of patients experienced an increase in the number of hospital admissions following the funding structure transition. These preliminary results indicate that no substantial ill-effects have come to this sample of home health care patients as a result of the Balanced Budget Act of 1997. [ABSTRACT FROM AUTHOR]

One aim of this article was to inform readers about the organization of the public health system in Canada. Constitutional arrangements are such that provinces and territories are responsible for public health services. Unlike medical and hospital care, however, public health services are not bound by national standards. Consequently, the type and degree of health promotion and preventive services vary by region. Disease surveillance and health protection programs, however, appear to be the most uniform across the country. Another aim of this article was to situate the system against three current issues. The devolution of health care provides an opportunity for the public health community to examine and improve the public health infrastructure. The evidence-based medicine movement has already stimulated the systematic synthesis of public health interventions. The orientation to a global marketplace suggests frontline public health workers must work even harder to ensure local health needs remain heard. [ABSTRACT FROM AUTHOR]

Propelled into the national spotlight by unprecedented attention from governments, decision makers, and researchers, home care in Canada is evolving to make its maximum contribution to the health care system. Commencing with an overview of home care in Canada and its fit within the health system, this article showcases recent landmark events and initiatives in Canada's home care sector and describes the context for home care management and practice today. The article closes by identifying strategies to optimize home care's incredible potential to transform the health care system by leading innovations that maximize client access to customized and timely health knowledge, information, and care. [ABSTRACT FROM AUTHOR]

Access and equity are guiding principles for community care in Australia. Community care in Australia is universally provided through Australia's Medicare system, which assures all people access to needed services. The largest community care system, the Home and Community Care Program (HACC), serves frail older and disabled people. The HACC program is undergoing steady reform to provide more seamless transitions of care for people from home care to residential care whether permanent or for respite purposes. Community health services provide a wide range of center-based and outreach services that any person may access and that are provided on the basis of need. Nevertheless, pressures for greater privatization of services cause tensions, and access is jeopardized further by shortages, particularly in rural areas, of aged care nurses, allied health personnel, and medical practitioners. [ABSTRACT FROM AUTHOR]

Anderson's behavioral model was applied to examine predisposing, enabling, and need components that influence the use of home nursing services in southern Taiwan. The authors collected data from 10 hospital-based, profit-oriented home nursing agencies. There were 449 participants, and the mean of their ages was 71.9. The services provided were related to periodic indwelling catheter replacement and wound care. It was found that the mean of enrollment per client was 185.1 days and that about 60% of them received services within 4 months. Most of the clients (61.0%) received services less than five times, and the mean of total visits was 9.5 (range = 1 to 108). The intensity of the visits showed that about half of the clients (51.2%) received service every 14 to 30 days. Results of this study can be used as a reference in policy making to refine the national health insurance system in Taiwan. [ABSTRACT FROM AUTHOR]

The advent of the Prospective Payment System (PPS) caused the management of Johns Hopkins Home Care Group (JHHCG) to create new strategies for wound care. JHHCG estimated that approximately 25% of home care referrals involved wound management. Among these strategies included the role development of the wound ostomy continence nurse (WOCN). This role included project planning, organizing, implementing, and evaluation as well as direct patient care and clinical consultation. Other strategies that have been discussed in a previous article included the development of wound care TIERS and pathways. Wound Care 2000 education was conducted agency-wide for all clinical staff members and included detailed instruction in the use of the wound TIERS. A wound product vendor fair was included to provide clinical staff members with familiarity of wound care products. Outcome Based Quality Improvement (OBQI) activities at JHHCG have included wound care, particularly surgical wounds, as an initial project. [ABSTRACT FROM AUTHOR]

Home health patients are at substantial risk for medication problems and errors. A medication management model designed specifically for use by home health agencies proved effective in a recent study conducted by Vanderbilt University: Medication use improved in 50% of intervention participants compared with 38% of controls. The model uses a structured collaboration between a clinical pharmacist and a home health nurse. It can help providers meet federal standards for medication review and improve clinical outcomes by identifying and preventing medication errors in their patients. This article presents findings from the study and strategies for implementation so other home health providers can adopt the model for use in their practices. [ABSTRACT FROM AUTHOR]

Globally, the population is aging. In 2000, approximately 10% of the world's population was older than 60 years old. By 2050, 21.1% will be older than 60. The issues now confronting the United States and other developed nations will emerge for other nations as their populations age, demographics change, and populations become more urban. In the next 50 years, we will see three worlds of aging--those of the developed nations, the developing nations, and the nations whose economies are in transition. Each world will face unique challenges and also offer insights into the best ways to care for those at the end of life. [ABSTRACT FROM AUTHOR]

Home care agencies, hospitals, skilled nursing facilities, and other providers have varied standards and expectations regarding the care of someone who is dying. A patient in Home Health Care Agency X might receive excellent pain management and family support, whereas a patient in Home Care Agency Y might receive mediocre pain management and no other support services. The Minnesota Commission on End of Life Care, a state-government-sponsored task force comprising public and private decision makers, focused on the existence of these inconsistencies and created a broad framework for end of life care called The Five Guiding Principles. The principles address treatment preferences, pain and physical symptom management, suffering, preparation for death, and grief. This framework can provide guidance to home care agencies in staff training, competency, and improved quality of care for patients who are facing the end of life. [ABSTRACT FROM AUTHOR]

Numerous textbooks on management define the responsibilities of a manager as planning, organizing, directing, coordinating, and controlling. One of the functions sometimes given short shrift is organizing. Corporations and agencies can run without being totally organized, but some would argue that a successful, efficient organization, and one that makes the best use of all of its resources, is one that is orderly, neat, has well-defined processes, has the tools to accomplish the agency's goals and objectives, and employs staff who know how to utilize these tools and perform the tasks for which they are held accountable. This article focuses on these aspects of organizing. [ABSTRACT FROM AUTHOR]

Home health nurses are at the forefront of protecting noninstitutionalized nursing patients and their caregivers from disasters. The September 11 terrorist attack on our nation magnifies the uncertainty of our lives and the need to be prepared through disaster planning education. Disasters—large or small, natural or man-made—can strike anywhere and anytime. The Neal Theory of Home Health Nursing posits that home health nurses progress through three stages (dependence, moderate dependence, and autonomy) as they spend time in home health nursing, adapting, gaining experience, and confidence. Neal's Theory can be applied to preparation for disasters that could confront home health nurses, providing the framework for planning, training, and oversight that the home health agency can use to ensure that the home health nurse is prepared. The role of collaborator is a cumulative result of the progression through Neal's three stages and positions the home health nurse to influence strategic disaster planning and education within the agency, community, state, and federal policy levels. [ABSTRACT FROM AUTHOR]

Historically, nurses have relied on traditions, clinical expertise, and expert opinion as a foundation for practice. Although these sources of knowledge are important and valued in nursing, the approach is unsystematic and not always based on scientific evidence. Although medicine used evidence-based practice (EBP) guidelines in their practice for decades, nurses have only recently embraced this concept. The purpose of this article is to describe the implementation of an EBP clinical practicum for graduate nursing students designed to (a) engage graduate nursing students in a collaborative relationship with a clinical nurse specialist (CNS) who is practicing in the home health care arenas, (b) provide CNS students with a framework for translating research to effect advanced clinical practice, and (c) provide opportunities for CNS students to critically evaluate the applicability and adaptability of evidence for the specific needs of the patient and the home health agency. [ABSTRACT FROM AUTHOR]

This article describes the author's preliminary fieldwork in the Russian culture, which took place during 10 days in November 1998 and 10 days in April 2000. During the time she spent in Russia, the author had two major goals. The first goal was to participate as part of a team of four American nursing faculty invited to teach at the Moscow Medical Academy, and her second goal was to learn about the culture of origin of the Russian immigrants who have migrated to the United States. With the aid of interpreters, the author participated in the culture, observed the activities around her, and learned from her Russian colleagues. This second goal reflected the author's preparation as a nurse-researcher to study the experiences of Russian immigrants. The article includes reflections and general impressions of the overall experience. [ABSTRACT FROM AUTHOR]

Trends in telehealth technologies have promoted a unique collaboration between nursing and biomedical engineering faculty in a training program at the Catholic University of America. The goal of the program is to prepare future nurses and biomedical engineers to collaborate in providing improved health care services for the elderly living at home. Nursing faculty provide graduate biomedical engineering students with information on nursing assessment, clinical foundations, and care of the elderly as a knowledge base to improve their designs of technology for this population. In return, undergraduate nursing students are given the opportunity to obtain a hands-on experience with new and emerging telehealth technologies in home care and to expand their therapeutic communication skills. [ABSTRACT FROM AUTHOR]

The delivery of home health and hospice care continues to grow and expand, outpacing both acute and long-term care services. Nurses working in these settings require case management and problem-solving skills that meet the care needs of the homebound, vulnerable elderly. This article describes a service-oriented research and educational project between the College of Nursing at Arizona State University and seven home health care agencies and hospices to provide an educational format, using CD-ROM technology, for nurses who care for the elderly in the community. Not only were the CD-ROMs viewed as an effective means in which to deliver educational information, but this continuing education project also promoted collaboration and partnerships between academia and the community-based agencies. [ABSTRACT FROM AUTHOR]

Information management is growing in importance in health care delivery. Practitioners, case managers, third-party payers, and health care policy makers are increasingly basing their health care decisions on timely and relevant clinical data. Since 1997, San Jose State University nursing students have been using the Nightingale Tracker, a computerized clinical communication system, to document client care, electronically transfer clinical information to their instructors, and maintain a systematic method for storing clinical data for further use in program planning, prediction of health care trends, and other research endeavors. Clearly, the potential increase in quality care makes the investment in this information technology (IT) experience worthwhile. Faculty are changing the education paradigm to a learning paradigm, preparing practitioners who can use IT in the current managed care environment to monitor costs while improving care--valuable skills to possess in this ever-evolving health care delivery system. [ABSTRACT FROM AUTHOR]

The aging population growth, shortened hospital stays, reduction in home care services reimbursement, and the looming nursing shortage will all drastically increase community health care needs and caregiving challenges. Unique and traditional methods of care delivery provided via innovative interventions can be used to address these needs. Many research-based nursing interventions can be administered at a distance (e.g., video, telehealth, and even robotic “nurses”) or without the nurse being present through volunteers or delegation, thus increasing communitybased care. A model categorizing and guiding use of these nursing interventions is described herein. [ABSTRACT FROM PUBLISHER]

This study identified the salient issues of caregiving for family members of persons with dementia using computer-assisted content analysis followed by factor analysis. Differences in responses between caregivers in two treatment groups were also noted. Caregivers (N = 226) were interviewed on three occasions over 12 months. They consistently identified the following themes of caregiving in order of significance: (a) making meaning of the experience; (b) defining the caregiver role; (c) identifying specific caregiving strategies; (d) dealing with change, unpredictability, and vulnerability; (e) evaluating past and future decisions and quality of care; and (f) finding help and support. This representation of the caregiving experience is useful to home care nurses by providing a framework to address issues most important to caregivers and upon which therapeutic interventions can be developed. [ABSTRACT FROM PUBLISHER]

Consistency in answering the questions on the Outcomes Assessment Information Set (OASIS) remains a challenge to home health care professionals. It is a high stakes challenge because reimbursement under the prospective payment system rests largely on how the OASIS questions are answered. Answers to OASIS questions that pertain to activities of daily living (ADL) and instrumental activities of daily living (IADL) appear to be a particular source of inconsistency among health care professionals. The authors designed a tool to be used to assist the home care professional to answer the ADL and IADL questions with enhanced consistency. This article will discuss the importance of accurate functional assessment and implications for the use of a measurement tool by home health care professionals, describe the process of designing the tool, and propose a method for testing it. [ABSTRACT FROM PUBLISHER]

The home health care industry has recently undergone tremendous change. How providers of care are adapting to the changes in their environment and the effect this has on nurses’ job satisfaction has not been explored. Nurses’ job satisfaction provides an indicator of a change in the system’s ability to deliver quality patient care and to attract and retain staff. The purpose of this study is to describe the level of job satisfaction of home health care nurses in three regions of the country. Neal’s theory of becoming a home health nurse was used as a framework for understanding the findings. Nurses in this study were satisfied with aspects of their job related to professional autonomy, relationships with patients and peers, and a sense that their work is worthwhile and important. They are less satisfied with their relationship to administration and their ability to effect changes in the system. [ABSTRACT FROM PUBLISHER]

As health care plunges forward into the new century, the home care industry is met with greater challenges with respect to regulatory compliance and changes in reimbursement. Managed care continues to grow, and there is increased focus by payors on home care providers who can meet the needs of patients in a cost-effective manner. There is also the expectation that patients will experience quality outcomes. Using clinical case managers and applying the principles of case management are more essential to the survival of home care than ever before. [ABSTRACT FROM PUBLISHER]

Care is provided under the direction of case managers within the Home Care Services division of the Calgary Regional Health Authority, Alberta, Canada. More than 90% of the case managers are registered nurses, with the other 10% being made up of physiotherapists and occupational therapists. Often, case managers delegate personal care and housekeeping to provider agency staff who have less professional education, whereas other tasks are given to family members, friends, and clients themselves. In light of the need to be cost-effective and yet for care to be delivered by the most appropriate provider, it is time to examine delegation by case managers. [ABSTRACT FROM PUBLISHER]

Improved quality of life for clients in the community is the goal of home care, but a strategy is needed to bring that goal to the forefront of service and to advance its focus in clinical practice. A model for advancing a quality-of-life focus in home care, developed as part of a research intervention, has been utilized in several large home care settings. The model addresses the planning and documentation of services, case conferences, and administrative issues. The intervention is directed at nurses involved in care planning. [ABSTRACT FROM PUBLISHER]

Tele HomeCare is a demonstration telemedicine project focused on the delivery of home health care to elderly homebound patients who are receiving care for either congestive heart failure, chronic obstructive pulmonary disease, or chronic wound healing. The telemedicine components of the study involve low-cost, standards-based videoconferencing and Internet access delivered over regular voice-grade telephone service and the patient’s television as well as physiological monitoring. This technology links the patient at home with a home care nurse at the home health agency. This is a randomized clinical trial with control and telemedicine intervention groups. Study design, technology details, and focus group and pilot study results are reported. Outcome measures, including quality of care, access, patient satisfaction, and cost factors, will be reported at the conclusion of the study. [ABSTRACT FROM PUBLISHER]

Multiple sclerosis (MS), a chronic disease of the central nervous system, had few treatment options until recently. Stem cell transplantation, originally used for cancer patients, may provide an opportunity for MS patients to stop the progressive course of their disease. This article describes the experience of an early participant in a stem cell transplant study at the Fred Hutchinson Cancer Research Center in Seattle. The procedure includes extensive outpatient evaluation, an inpatient stay, and a lengthy recovery period. A strong caregiver network and professional home care assistance provide the needed support system during this process. [ABSTRACT FROM PUBLISHER]

Sweeping changes in Medicare policy may have removed the last significant obstacle to the widespread implementation of telehealth. On October 1, 2000, the Health Care Finance Administration (HCFA) implemented the Prospective Payment System (PPS), a reimbursement system based on the average cost of Medicare patient care for 60 days. The HCFA has since clarified that home care organizations may utilize telehealth technology in addition to home visits. This change in reimbursement policy is a necessary development, designed to provide reasonable controls on government spending while opening new opportunities to utilize more cost-efficient processes and technologies. [ABSTRACT FROM PUBLISHER]

Successfully providing wound care to patients under the prospective payment reimbursement system can be considered a challenge or an opportunity. Home care organizations are seeking methods to provide cost-effective wound care with optimal clinical outcomes. This article will discuss specific strategies for surviving the upcoming changes while simultaneously meeting the goals of providing wound care in a cost-conscious environment. [ABSTRACT FROM PUBLISHER]

Home care directors find themselves in a quandary with prospective reimbursement: Should they withhold expensive services, such as social services, or should they pursue screening visits? This article explores the ill effects of social work underutilization and its potential financial impact on the home care organization. [ABSTRACT FROM PUBLISHER]

The West Virginia Health Care Authority is in the process of implementing a pilot project in several West Virginia counties to evaluate the appropriateness of a unique, computerized, and comprehensive assessment tool for West Virginia’s seniors and disabled populations. The pilot project objectives stem from West Virginia’s need to embrace a uniform assessment tool for entry into the long-term care system. The pilot includes four users from three home care service types, home health agencies, case management agencies, and county senior programs. The goal of the pilot is to expand the application of this innovative tool across the spectrum of services to build the necessary bridges between the acute and long-term care system. The results and recommendations that come from this cutting-edge project will provide efficient communication of confidential information across providers and enhanced clinical decision making to improve the quality of care delivered to each and every individual. [ABSTRACT FROM PUBLISHER]

Prospective Payment Systems all share certain common attributes. It is therefore useful for home care to look back at the experiences of hospitals in adapting to PPS. Among the lessons to be learned is the critical role of information technology, and its use in the direct clinical care process. The ultimate goal must be real business process improvement. This is greatly facilitated in an environment where all departments of the business collect and share useful information in a timely manner. The care of patients in the home must be viewed as one of these departments and must use information technology in a manner that is fully integrated with the rest of the business. In time, patients in their home will come to be viewed as a legitimate target for information systems with many of the same objectives we now have for the information systems used by our skilled clinicians. [ABSTRACT FROM PUBLISHER]

A government search and seizure can be devastating to a home health care business, but do not assume that government agents always follow the law. Government agents make mistakes too. This article describes an actual search and seizure, its flaws, and the fight by the target company to win vindication. The article details how the company remained in business after losing an estimated 5 million documents including records and charts. The article also offers advice about actions one can take in the event of such a search and seizure. [ABSTRACT FROM PUBLISHER]

There are close to 560 different tribes in the United States of America and to be able to understand the complexity of the different tribes and cultures, there is a need to understand that while most tribes have differences they share certain values. These differences do not, for the most part, conflict with some of the values we will discuss later in this article. They are mostly of language and cultural practices, but the basic values remain the same. Even though many of the American Indian tribes have been viewed as having become acculturated, many American Indians have retained ties to their culture through language, spiritual practices, and family. These spiritual values will be discussed in relation to infant care practice. [ABSTRACT FROM PUBLISHER]

The literature shows that alternative health care is increasingly acceptable to consumers in the western world. Services such as therapeutic massage, acupuncture, yoga, and meditation have helped treat individuals suffering from everything from the common cold to HIV. This article describes some of the more common, complementary alternative medicine services being provided in the United States today. It also provides information for consideration by organizations regarding the appropriateness of expanding their product lines to include complementary health services. Issues to evaluate during the development of such services are suggested for the interested reader. [ABSTRACT FROM PUBLISHER]

A clinical nurse specialist (CNS) adds value to home care by improving care outcomes- clinical, quality of life, satisfaction, and costs. A model of CNS implementation in home care is the Center of Excellence model. This model affords a broad scope of influence in roles and programs and is enhanced through the use of electronic charting and forms of telehealth. Data analysis—demographic and clinical— related to high-volume, problem-prone, and high-cost diagnoses, is an excellent way for CNSs to add value in planning for a disease- management, or care-management, approach to home care. Disease-management principles are discussed and examples given in a continuum-of-care context. Ongoing data outcome analysis related to CNS intervention and programs is enhanced by new data available in home care. Data include Outcome Assessment Instrument Set outcome data, improved ease of data access—via data importing/exporting—and data warehousing. Current CNS role benefits are discussed, and the need for quantitative and qualitative data specific to the home care practice setting identified. [ABSTRACT FROM PUBLISHER]

Private duty services take on new dimensions with the PPS home care reimbursement system and the Balanced Budget Act of 1997. Families seeking to keep loved ones at home are reaching out and searching for quality private care alternatives. Home health is poised to meet these increasing needs. Accreditation and marketing are two important ingredients in the success of private duty home care services. [ABSTRACT FROM PUBLISHER]

The same demographic trends and cultural changes that have caused government agencies and private sector businesses to train their associates to be culturally competent are affecting the nursing profession. The patient-centered orientation of nurses makes it essential that they also be culturally competent by accessing cultural knowledge and developing cultural skills. What follows are vignettes and personal experiences based on a study by the author in which nurses were observed providing home care to newly admitted, culturally diverse patients. Tools for cultural assessment are described and included, along with recommendations to enhance the cultural competence of home care nurses and home care agencies. [ABSTRACT FROM PUBLISHER]

The purpose of the study was to validate and refine the Neal Theory of Home Health Nursing Practice. A triangulated methodology of focus groups and a descriptive self-report survey were used to elicit data from home health nurses. Six focus groups with 20 participants total were held in three agencies in Virginia and Maryland. A stratified random sample of 68 members of the Home Health Nurses Association responded to a mailed survey. Nurses pass through three stages in attaining autonomy of home health nursing practice: dependence, moderate dependence, and autonomy. Role changes and process changes temporarily move the autonomous nurse back to dependence. Adaptation is key to home health nursing practice. Home health nursing is a specialty practice. Nurses require specific qualities and characteristics to practice effectively and successfully in home health. The findings support the Neal Theory of Home Health Nursing Practice. [ABSTRACT FROM PUBLISHER]

Risk management is an objective strategy that seeks to eliminate or decrease the chances of financial loss and legal action. Risk management focuses on an actual mistake, an accident, or a potential similar occurrence. Risks occur in nursing in a variety of practice settings. Nursing has identified several key areas in which systematic change has improved and decreased the risk factor encountered in practice. This article targets medication usage and administration and the methods introduced in quality improvement processes to decrease risks and potentially reduce financial and legal risk. [ABSTRACT FROM PUBLISHER]

A rural county survey of rural health care providers indicates overall lack of knowledge about telemedicine and telehealth. Participants indicate they believe telehealth will improve quality of care but do not understand what it is. Providers defined telehealth as one function provided by one telecommunications medium. Most health providers did not equate the Internet with telehealth and could not envision its use in their work environments. Provider lack of understanding reinforces barriers to the universal application of telehealth in rural areas. [ABSTRACT FROM PUBLISHER]

The residents of senior-focused housing typify the phenomenon of aging-in-place. Older people are living longer than expected with a subsequent increase in health problems. However, with accessible health promotion and wellness services, these individuals are able to live independently for a longer period of time. This article will describe the background and implementation of the nurse-managed wellness clinic model developed by the faculty of the Duquesne University School of Nursing. [ABSTRACT FROM PUBLISHER]

Lack of knowledge about diet and medications by patients with congestive heart failure is a major factor contributing to noncompliance with treatment regimens, and subsequent high hospital readmission rates. The Learning Needs Assessment Tool (LNAT) was developed to include three key assessment areas: family/environment, current knowledge, and learning style. Feasibility of adding the LNAT to the practice of home health care was tested with a sample of seven home health nurses during a 5-month field test. Content validity was established through initial expert review and postfield-testing evaluations through interviews and questionnaires with the participants. Replication of the study with a larger sample is needed to establish reliability and utility of the tool. [ABSTRACT FROM PUBLISHER]

Recent technological advances make it possible for nurses working in home health to record patient information on a variety of devices, such as laptop computers. There are now many implementation guides and corporate briefs available that concern bottom-line issues such as productivity and back-office cost reduction. Even though nurses generally are recognized for being innovative and willing to accept new challenges in order to improve patient care, no one asks how these changes are affecting nurses' self-perceptions about their expertise. Benner's theory, Novice to Expert, is utilized here to explore and establish expectations for both staff and administration. [ABSTRACT FROM PUBLISHER]

An effective retention plan will be a critical component of a home health care agency's leap into the year 2000. Assessing current turnover and retention rates for your agency, surveying exiting and current staff, identifying the internal factors that lead to turnover, addressing these factors, and measuring the effects of your action plan at regular intervals are all key components of a retention plan. The agency should place as much emphasis on retention as they would on any other business plan, since the shrinking pool of available nurses places a very high premium on retaining current staff. [ABSTRACT FROM PUBLISHER]

It is not unusual for organizations to have growing pains, especially following a period of rapid growth. These growing pains may appear in the form of documentation errors that are now starting to impact adversely the finances of the organization. This article is designed for quality managers, directors of clinical services, or any staff member with quality improvement interests or responsibilities. This article will provide the reader with examples of common documentation errors and ways to help staff appreciate the importance of their documentation. Two teaching tools are provided, as well as suggestions regarding ways to reward employees for their efforts. [ABSTRACT FROM PUBLISHER]