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Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

Home healthcare patients, who are members of minority, marginalized, or vulnerable patient populations, are at risk for healthcare disparities. Inadequate attention to the needs of the many different types of diverse patient populations seen by home health agencies could compromise an agency’s outcome indicators, reimbursement in value-based payment programs and responsibility to deliver equitable quality care. Culturally competent home health nurses may have a role in decreasing disparities and improving patient outcomes. This article discusses the incidence of disparities in home health care and highlights literature about the economic, regulatory, accrediting, policy, social justice, and ethical issues surrounding disparate and inequitable care for home healthcare patients. Patients in need of culturally competent care include those characterized by diversity related to race, ethnicity, language, religion, socioeconomic status, sexual orientation, gender identification, mental and physical disabilities, and stigmatized diagnoses (e.g., obesity and substance abuse). Home healthcare nurses who strengthen the cultural competence of their care may be able to decrease the incidence of disparate outcomes. By investing in the cultural competence of their home healthcare nurses, agencies may strengthen their commitment to their missions and the financial health of their agencies.

This article is an abridged version of a book chapter, Culturally and Linguistically Appropriate Services, published in the Handbook of Home Health Care Administration, Sixth Edition (Marilyn Harris, editor). The article describes the importance of culturally and linguistically competent care for the success of home health agencies. It uses the 15 standards of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) as an outline for identifying strategies that home health leaders can incorporate into their agencies’ practices to enhance their care to culturally and linguistically diverse patients. Providing services that produce equitable outcomes for diverse patients is likely to enhance agency Home Health Compare and HHCAHPS (Home Health Care Consumer Assessment of Healthcare Providers and Systems) scores, Star Ratings, and reimbursement in a value-based reimbursement model.

Situation-Background-Assessment-Recommendation (SBAR) communication has become the standard for communicating across disciplines. It has demonstrated its effectiveness at improving patient outcomes, enhancing patient and clinician satisfaction, and helping to control healthcare costs. It can help home healthcare clinicians with efforts to prevent avoidable hospitalizations. But how often and how well do home health clinicians use this method of shared communications with physicians? This article explores why communication between physicians and home health clinicians can be so problematic. It introduces the SBAR communication method, its origins, its features, and some of the published evidence that it provides effective and efficient communication, thereby promoting better patient outcomes.

Have you ever felt that the search for Outcome and Assessment Information Set (OASIS) accuracy is endless? In 2007, the administrators and clinical managers at Professional Healthcare Resources, Inc. (PHRI) looked at the agency’s functional outcome indicators (improvement in bathing, transferring, ambulation/locomotion, and management of medications) and shook our heads. Once again, the outcomes did not seem to capture our intuitive sense of the degree to which our patients actually did functionally improve under our care. Why were these outcomes not better? Our home health agency has 8 offices in the Maryland, Virginia, and the metro DC area. Each week, our administrators and clinical managers meet to discuss quality issues via a conference call. As we reviewed the most recent Home Health Compare outcomes for each office, we considered possible causes for outcome reports that did not match clinicians’ reports of patient progress. The clinical managers of PHRI review their teams’ patient outcomes at discharge. When patients do not improve, the managers frequently discuss the outcomes with the clithan a therapist would at admission. Nurses tend to overestimate patients’ functional abilities at admission, whereas therapists seem to capture the patient’s functional status adequately at discharge. This interrater variability leads to an erroneous “no improvement” when patients’ functional abilities actually have improved significantly.

Home care staff frequently become anxious when a patient with active infectious tuberculosis is referred for home care. Using a home care patient case study, this article reviews tuberculosis epidemiology, pathophysiology, treatment, and infection control. It also discusses home health staff's role in case finding because home care patients with chronic disease and immunosuppression conditions are at risk for active tuberculosis disease.

Your patient is a Catholic, and you are not. How can you be sensitive to the patient's spiritual needs? How do Catholics think about health and illness? What kind of spiritual resources do they draw upon when facing a health crisis?

Culturally competent care adapts care to the patient's cultural needs and preferences and begins with a cultural assessment that forms the care plan's foundation. Nurses who assess their patients' cultural beliefs, values, and practices are better able to individualize care and achieve positive outcomes. This article describes a cultural assessment tool, strategies for obtaining cultural assessment data, and a process for creating a culturally appropriate care plan.

In December 2000, the Office of Minority Health published the “National Standards on Culturally and Linguistically Appropriate Services in Health Care,” making cultural competence in home health clinical practice a critical competency. This article describes a six-step model that clinicians—nurses or therapists—can apply to provide culturally competent care to home care patients.

In December 2000, the Office of Minority Health published the National Standards on Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards), making cultural competence in home health clinical practice a critical competency. This article describes a six-step model clinicians—nurses or therapists—can apply to provide culturally competent care to home care patients.

Good morning, nurses and therapists! This is the education coordinator and this voice mail contains extremely important information for all clinicians! Not listening to this message carefully will put YOU in extreme jeopardy!(Well, I exaggerate; however, the consequences to you—and to this agency—ARE dire!) . . . Assuring accuracy and reliability in OASIS data collection is more than just a one-time orientation. This article describes a lively ongoing OASIS educational program creatively using the agency’s voice mail system. The article presents basic OASIS information and is a required reading for clinicians and managers who are interested in accurately collecting OASIS data.

Asian Americans are the most rapidly growing immigrant group in the United States today. Home care nurses will be caring for increasing numbers of patients originating from the Southeast Asian peninsula in the countries of Vietnam, Cambodia, and Laos. A Vietnamese case study explores some of the beliefs, values, and practices held by this group of Asian Americans. The case study highlights the problems that can occur when a nurse is unaware of the impact that culture has on a client from a different ethnic and cultural background. Six steps to provide culturally competent care are outlined.

As the nurse becomes adept at performing cultural assessments and culturally competent care, it will become clear that "although it is critical to conduct a cultural assessment with culturally and ethnically diverse groups, it is also important to realize that every client needs a cultural assessment. Every client has values, beliefs, and practices that must be considered when a clinician renders healthcare services. Therefore, cultural assessments are not limited to specific ethnic groups, but rather should be conducted on each individual" (Campinha-Bacote, 1995, p.148). Nurses who have been identified as good transcultural nurses have been found to be empathetic, caring, open, and flexible. They have a positive attitude toward cultural differences and have a genuine interest in learning from the client about the client's culture (Emerson, 1995). Talabere (1996) states that openness, appreciation of another's perspective, holistic communication, genuine interest, and a nonjudgmental attitude are central to cultural sensitivity. When a culturally sensitive nurse develops mutually agreeable goals with a patient from another culture, a kind of cultural synergy occurs, resulting in care that is "meaningful, satisfying and beneficial to clients" (Leininger, 1988, p.155).

Comprehensive night service by a home care agency has resulted in increased customer satisfaction and referrals to the agency. The description of this innovative night nurse program includes the job requirements and duties of a visiting night nurse and the tools the nurse uses to accomplish the task of nighttime care delivery. The use of self-directed work groups and mentorship to manage the demands of night service are discussed. Continuity of care, nurse safety, professional development, and program cost also are addressed.

Late yesterday, I received a terrible shock. I e-mailed a colleague in another one of our agency's offices, about 60 miles from the office where I work, asking her to review an educational plan I was developing for our agency's Outcome and Assessment Information Set-C follow-up training. She responded she didn't have time to do the review for at least several days because she was feeling overwhelmed, not only with work responsibilities, but because, as I may I have heard, "We lost Cathy Smith (not her real name) last night."

The significance, standard elements, components, and documentation of an environmental assessment in home care are discussed. This assessment is delineated within Maslow's Hierarchy of Needs and from a functional perspective. An Environmental Assessment Form that can be used as a documentation tool is included.