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Aim: To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway., Design: A qualitative descriptive study., Methods: Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data., Results: The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes., Conclusion: Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion., Impact: The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust., Implications: This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Although home healthcare(HHC) clinicians increasingly provide care to a homebound population with advanced illness and high symptom burden,  we know little about how HHC clinicians navigate discussions about hospice with patients and families in this setting., Objective: We sought to explore perspectives on transition from HHC to hospice among HHC nurses and social workers., Design: PQualitative study using semi-structured interviews and thematic analysis., Results: Fifteen nurses and 3 Social workers participated in the study. Four main themes emerged from the interviews: (1) Regulatory Forces of Hospice and HHC; (2) Structure of HHC; (3) Individual beliefs-Hospice means giving up; and (4) Dynamics of Communication in HHC to Facilitate Transitions to Hospice., Conclusion: Introducing the option of hospice to patients and families nearing end-of-life in the HHC setting is complex and challenging.  Facilitators of hospice discussions in the HHC setting  include interdisciplinary team-based clinical review, clinical decision support tools to identify patients who are hospice-eligible, and staff training.  These factors provide targets for future interventions.

Background: The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care., Aim: The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home-dwelling older patients and ensure safe home health care., Method: We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis., Findings: The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home-dwelling older patients and ensure patient safety in home health care., Conclusions: It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self-reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs., (© 2022 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Adequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse's encounters with resistance to care from home-dwelling persons with dementia., Research Aim: To get insight into how nurses experience resistance to care from home-dwelling persons with dementia., Methods: A qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021., Ethical Considerations: Approved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality., Results: Two main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices., Conclusion: Our findings indicate that nurses' responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care. A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake., (© 2022. The Author(s).)

Aim: To develop the nursing practice environment scale in home health care (NPES-HHC), which measures the attractiveness of nursing practice environments in Japan., Design: Cross-sectional study., Methods: The answers of 1,050 mail surveys conducted for nurses at 421 home-visit nursing agencies in Japan were analysed. Exploratory and confirmatory factor analyses of the NPES-HHC's candidate items were performed. Relationships between the newly developed NPES-HHC and participants' intention to remain at the workplace, job satisfaction and quality of care were also tested., Results: A seven-dimensional model with 37 items was obtained by exploratory factor analysis (Cronbach's alpha: 0.77-0.92). Confirmatory factor analysis supported this model. NPES-HHC scores had significant positive relations with participants' intention to remain at the workplace, job satisfaction and quality of care (p < .01). The NPES-HHC is a reliable and valid instrument to assess the attractiveness of the practice environment for home-visit nursing agencies., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Infection Prevention and Control (IPC) practices have been established in home health care. Adherence to IPC practices has been suboptimal with limited available evidence. The study aim was to examine the impact of individual, home environment, and organizational factors on IPC practices using human factors model., Methods: Three hundred and fifty-three nurses were surveyed across two large home care agencies to examine the relationship between IPC adherence and individual, home environment, and organizational factors., Results: Nurses reported multiple barriers to IPC practices in patients' homes (mean = 4.34, standard deviation = 2.53). Frequent barriers included clutter (reported by 74.5% of nurses) and a dirty environment (70.3%). Nurses also reported limited availability of some IPC supplies (mean = 7.76, standard deviation = 2.44), including personal protective equipment. Home environment factors were significant barriers, and availability of IPC supplies were significant enablers of IPC adherence. Agency-provided training and decision-making resources were not significant factors for IPC adherence in the presence of home environment barriers and IPC supplies., Conclusions: This study findings suggest that IPC adherence strategies point to addressing barriers in the home environment and increasing availability of IPC supplies. The relationship between the patient's home environment, organizational factors, and IPC practices among home health care nurses warrants further study., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: The purpose of this study was to explore home health care nurses' attitudes, perceptions, and experiences related to routine collection and documentation of sexual orientation and gender identity data. Methods: This was a qualitative descriptive study. Twenty-four nurses from a large home health care agency in the New York metropolitan area were interviewed between November 2014 and December 2015. Results: Three broad categories of themes emerged from the content analysis: (1) current practices that relate to or influence the assessment of sexual orientation or gender identity by home health care nurses, (2) attitudes and perceptions regarding perceived barriers and facilitators to discussing and documenting sexual orientation and gender identity, and (3) training and resources identified as helpful in preparing nurses to discuss sexual orientation and gender identity with their patients. Nurses emphasized wanting to provide everyone with the same quality of care and wanted documentation to inform the care. They felt unprepared to discuss sexual orientation or gender identity with their patients and indicated a need for training and education related to LGBT health disparities. Conclusions: Results from this study can help inform the development of training materials and resources to enable nurses to collect patients' sexual orientation and gender identity data routinely and in a sensitive and culturally competent manner.

Aims and Objectives: To describe the perceptions that municipal primary healthcare nurses and municipal registered nurses had about a web-based learning intervention concerning supportive family health conversations in municipal home health care., Background: Even though family health conversations are well grounded in theory with several reported benefits for patients and families, most working nurses have little or no training in practising family systems nursing including family health conversations. Continued learning is necessary for nurses, where web-based learning may be one answer of updating the professional skills and knowledge of nurses regarding supporting families., Design: The study used a descriptive design and followed the "Consolidated criteria for reporting qualitative research" (COREQ) checklist., Methods: Twenty-one nurses participated in an educational intervention that consisted of web-based learning and two face-to-face seminars about family systems nursing including family health conversations. The nurses were interviewed after completion, and the audio-recorded interviews were transcribed verbatim and analysed using qualitative content analysis., Results: The findings consist of nurses' perceptions regarding the disposition of instruction, the prerequisites for learning and a changed approach when working with families. The findings are further reflected on through Illeris' theory concerning learning triangle., Conclusions: The findings are encouraging for educating nurses in family health conversations at their workplace, with the purpose of supporting patients and families. However, it is important to be aware of the different dimensions of learning, in addition to the appraisal of social aspects and organisational circumstances when educating nurses as they influence the utilisation of the knowledge., Relevance to Clinical Practice: This web-based learning intervention seems to be suitable for educating nurses in family health conversations and could be an appropriate step towards implementing these conversations in home health care with the purpose of supporting families., (© 2018 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)

Aims: To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care., Background: Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost., Design: Theory synthesis., Data Sources: Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015)., Implications for Nursing: Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care., Conclusions: A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed., (© 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.)

Purpose of the Study: Psychosocial interventions alone or combined with antidepressant medication can effectively treat mild to moderate geriatric depression. However, most home health care patients with depression and disability do not receive these interventions. Moreover, relatively little is known about home health care nurse views about depression management. Therefore, our research purpose was to provide a deeper understanding about how home health care nurses perceive and experience depression detection and evaluation within the context of caring for geriatric patients with disabilities., Design and Methods: This qualitative descriptive study involved 2 focus groups and 16 semistructured interviews with nurses providing care to geriatric home health care patients followed by observation during 25 nurse home visits to geriatric patients who had depression and disability., Findings: Nurses demonstrated confidence in caring for elderly patients with disabilities. However, they expressed different views about the nature of depression and the integration of depression and disability care in daily practice. Evidence points to a need for advanced training that supports an enhanced role for generalist homecare nurses in providing depression care management for this vulnerable geriatric population., Implications: Policy challenges are associated with ways in which home health care is fiscally organized primarily to address patients' physical and acute skilled care needs and not depression., (© The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

To respond to the needs of home healthcare (HHC) patients, HHC professionals must use strategies to navigate the influence of the institutional context, that is, laws and regulations, the administration, and the organization of HHC services. However, no synthesis of those strategies exists. This review aimed to synthesize the strategies used by HHC professionals working with older adults to navigate the institutional context. An integrative review was undertaken in 5 databases, from 2011 to January 2023. The quality of documents was assessed based on an adapted version of the Critical Review Form—Qualitative Studies (Version 2.0) in which a score was calculated out of 25, and data was analyzed through coding, data display and comparison. Thirteen documents were included. The quality of studies ranged from 13 to 21.75. Strategies are often used to overcome limited resources (e.g., time, funding). Six types of strategies were identified: Deviating (bypassing rules or processes), taking on more and more (taking additional work), offering one's personal time (working without remuneration), reallocating resources (splitting HHC services between patients), limiting HHC visits (restricting interventions or actions) and relying on others (transferring responsibilities). The use of strategies could alleviate the discomfort felt by HHC professionals due to limited resources. However, as some strategies lead to a reduced scope of practice and to a loss of expertise, this could impede the quality of the care, resulting in non-responded needs for HHC patients. [ABSTRACT FROM AUTHOR]

Background and objective: Kurdish community have a long-standing history of looking after family members and loved one in times of sickness. Caring for COVID-19 patients at home is a huge responsibility and challenging. Despite fear of losing family members, relatives working in the health care system dedicated their time to care for their relatives affected by COVID-19. No studies have been done to investigate the care provided to the COVID-19 patients at home-setting by nurses. The purpose of this study is to investigate the health care services provided to COVID-19 patients at home-setting by nurses. Methods: This study is a descriptive quantitative study with a sample size of seventyfour nurses. The nurses claimed that they looked after more than 180 patients at the home setting. The data was collected through an online questionnaire format prepared by the researcher after an extensive literature review and discussion with the nurses who provided home care to COVID-19 patients. The researcher also utilized the guidelines and data published on the World Health Organization (WHO), National Institutes of Health (NIH) and Centers for Disease Control (CDC) websites for constructing the tool. Data was collected through Google Forms from 1st January 2022 to 29th March 2022. Results: Of the seventy-four nurses that completed the questionnaire, half held a bachelor's degree in nursing. The nurses reported caring for more than 180 patients in total with 37.8% of nurses caring for one patient. More than half (52.7%) of patients were aged 50-64 years. The results of the study showed that the home care included health assessment, nursing intervention, evaluation, reassessment, and practicing preventive measures. Conclusion: Depending on the data received from the nurses, COVID-19 patients in home setting received holistic nursing care and patients were under close and constant monitoring. [ABSTRACT FROM AUTHOR]

Most adverse events in health care are related to medication management and they are almost always preventable. Increased knowledge of patient safety related to medication management in home health care is an urgent issue to provide safe care for all patients regardless of where the health care takes place. This study explored patient safety within medication management in municipal home health care. Vignettes were used as stimulus during qualitative interviews with registered nurses. Three main themes with related subthemes were identified as challenges to patient safety within medication management in home health care: (1) challenges to information transfer, (2) challenges related to delegation, and (3) challenges of advanced medical treatments in the home. The issue of transfer of information permeated our findings. Coordinating medications, delegating tasks, along with more advanced care require clear communication between care providers to be compatible with patient safety within medication management in home health care. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is one of the common causes of rehospitalization in older people leading to an increase in the number of mortalities, disabilities, and readmission rates. However, there has been a lack of literature reviews on current evidence regarding the effects of transition care interventions (TCI) on rehospitalization before discharge from hospital to home. The current review aims to examine the effectiveness of transition care interventions on rehospitalization within 30-days for older patients with HF. The current review of international knowledge employs the PRISMA guidelines and includes primary studies published between 2011 and 2021 taken from PubMed, CINAHL, PsycINFO, Cochrane, and Scopus. Our review identified 15 relevant studies that together examined 10,701 patients with HF. We found that the effectiveness of TCIs could reduce rehospitalization rates and costs of care. The findings asserted that nurses, pharmacists, and multidisciplinary teams were predominantly provided transition care interventions. In principle, transition care intervention could inform policymakers to develop the current discharge planning practices in older HF patients. Therefore, interdisciplinary healthcare teams and caregivers should develop the transition care interventions with long-term periods before discharge from hospital to their home, particularly for older patients with HF in order to improve their capacity for self-care, quality of care, and promote continuing care. [ABSTRACT FROM AUTHOR]

We consider a home health care routing problem with scarce resources which is a variation of the vehicle routing problem with resource constraints. In this problem, the services are provided by nurses and aids at patients' homes. There are different types of patients that are categorized based on the services they demand and should be serviced by appropriate staff teams or single personnel where the teams are transported by rental vehicles. In this problem, the objective is to minimize the total transportation cost, by considering the patients' requirements and the qualification of the staff, as well as the resource limitations. In this paper, we present a mathematical formulation of the problem that is modeled similar to a vehicle routing problem and propose a branch-and-price algorithm to solve it. Our proposed algorithm utilizes speed up techniques from the literature to enhance the effectiveness of the proposed solution method. A comprehensive computational study is conducted on Solomon based instances and the results illustrate the efficiency of the algorithm and the effective use of available resources. [ABSTRACT FROM AUTHOR]

During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days. We examined admissions nurses' visit pattern decision-making and whether it is influenced by documentation available before and during the first home visit, agency standards, other disciplines being scheduled, and electronic health record (EHR) use. This observational mixed-methods study included admission document analysis, structured interviews, and a think-aloud protocol with 18 nurses from 3 diverse HHC agencies (6 at each) admitting 2 patients each (36 patients). Findings show that prior to entering the home, nurses had an information deficit; they either did not predict the patient's visit frequency and episode duration or stated them based on experience with similar patients. Following patient interaction in the home, nurses were able to make this decision. Completion of documentation using the EHR did not appear to influence visit pattern decisions. Patient condition and insurance restrictions were influential on both frequency and duration. Given the information deficit at admission, and the delay in visit pattern decision making, we offer health information technology recommendations on electronic communication of structured information, and EHR documentation and decision support. [ABSTRACT FROM AUTHOR]

Background: Homecare nurses play an important role in end-of-life care. A protocol is needed for the remote verification of expected deaths using information and communication technologies (ICT), that is consistent with Japanese guidelines. Aim: To clarify the processes that nurses use to verify deaths and to develop a tentative nursing protocol for verifying expected deaths, using home-based ICT. Methods: Using literature and semi-structured interviews, a tentative nursing protocol was developed for verifying expected deaths using home-based ICT. Findings: To protect the dignity of patients and their families, it is important that their understanding and consent is provided for the remote verification of expected deaths. Furthermore, the up-to-date legal and ethical responsibilities of nurses should be discussed regarding the verification of a patient's death to provide the best care for the patients and families when implementing the Death Certification Using Information and Communication Technology (DCUICT). Conclusion: This suggested protocol offers a framework for a new delivery of nursing care. It provides guidance for homecare nurses organising the care processes and nursing roles of DCUICT. Further revisions to this protocol must incorporate the specific requirement for the verification of nurses. [ABSTRACT FROM AUTHOR]

Background: Registered nurses are key figures in municipal home health care for older adults. Thus, registered nurses' leadership is crucial to a successful and preventive care process as well as a supportive organization in order to achieve safe care. However, there is limited research on what registered nurses' leadership implies close to older adults in municipal home health care. Thus, the aim is to compile and critically evaluate how international research results describe registered nurses' leadership close to older adults in municipal home health care. Methods: A systematic literature review was performed in accordance with a qualitative research study. The main search was conducted on 20 April 2018. The review was reported according to the PRISMA guidelines and is registered in the PROSPERO database (ID# CRD42019109206). Nine articles from PubMed and CINAHL meet the quality criteria. A synthesis of data was performed in four stages according to qualitative research synthesis. Results: Ten themes describe what registered nurses' leadership close to older adults in municipal home health care entails: trust and control; continuous learning; competence through knowledge and ability; nursing responsibility on an organizational level; application of skills; awareness of the individual's needs and wholeness; mutual support; mutual relationships; collaborating on organizational and interpersonal levels; and exposure to challenges. Conclusions: Registered nurses leading close to older adults in municipal home health care implies being multi-artists. Nursing education, including specialist education for registered nurses, should prepare individuals for their unique and complex leadership role as a multi-artist. Municipal employers require knowledge about what registered nurses' leadership implies in order to create adequate conditions for their leadership objectives to achieve safe care. Further research is warranted to explore registered nurses' leadership close to older adults in municipal home health care from different perspectives, such as older adults and next of kin. [ABSTRACT FROM AUTHOR]

Adverse events that occur in urban and rural adults during the posthospitalization period have become a major public health concern. However, postdischarge adverse events for patients receiving home health care have been understudied. The objective of this study was to identify the prevalence and risk factors associated with postdischarge adverse events for patients who received home health care services. We analyzed data from a prospective cohort study that was conducted among patients who were hospitalized in the Tallahassee Memorial Hospital from December 2011 to October 2012. Telephone interviews were conducted by trained nurses who contacted patients within 4 weeks after discharge. Physicians reviewed cases with possible adverse events that were triaged by the nurses. The adverse events that were identified were categorized as preventable, ameliorable, and nonpreventable/nonameliorable. Nearly 39% of 85 patients who received home health care experienced postdischarge adverse events that were predominantly preventable or ameliorable. The associated risk factors were living alone (odds ratio [OR] = 7.860, p =.020), insured by Medicare or Medicaid (OR = 6.402, p =.048), type 2 diabetes mellitus (OR = 6.323, p =.004), pneumonia (OR = 5.504, p =.004), and other infections (OR = 4.618, p =.031). This study was able to identify that nearly one in every two patients who received home health care after hospital discharge experienced an adverse event. Patient safety research needs to focus in the home by developing specific interventions to avert adverse events and improve patient safety during the delivery of home health care services. [ABSTRACT FROM AUTHOR]

Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides. A retrospective, cross-sectional analysis. The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018. We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0–16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution). Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses. The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health. [ABSTRACT FROM AUTHOR]

Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating chronic diseases, and comorbid depression among older adults, they have been slowly adopted by home health care (HHC) agencies. Therefore, this study aimed to identify factors that determine telehealth technology adoption. Twenty directors from the National Association for Homecare & Hospice member agencies completed a 45-min telephone interview. Questions were asked regarding their perceptions of telehealth, the key determinants of telehealth adoption and use, and recommendations they would give on telehealth adoption. The majority of the participants perceived telehealth as effective for managing symptoms and reducing cost. Meanwhile, some participants had a mixed feeling toward telehealth for depression care as they did not recognize their agency as equipped with the necessary resources and trained staff. Moreover, significant determinants of telehealth adoption included the agency-related characteristics, the patient-home environment, reimbursement and cost-related factors, and staff telehealth perception. Findings imply that there is a need for financial support both at the state and the federal levels to encourage telehealth adoption among HHC agencies. Future studies should consider exploring strategies used by successful programs to overcome barriers. [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process. Background: Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting. Design: Qualitative descriptive design. Methods: Semi‐structured interviews were conducted with 20 registered nurses who had >2 years of experience in home health and were employed by one of the three participating home health agencies in the mid‐Atlantic region of the United States. Data were analysed using conventional content analysis. Results: Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritise visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients. Conclusion: Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments. Relevance to clinical practice: Home health nurses plan their work schedules to provide high quality care that is patient‐centered and timely. The findings also highlight organisational priorities to facilitate continuity of care and support nurses while alleviating the burnout associated with high productivity requirements. [ABSTRACT FROM AUTHOR]

Despite patients referred to home health having diverse and complex needs, it is unknown how nurses develop personalized visit plans. In this qualitative descriptive study, we interviewed 26 nurses from three agencies about their decision-making process to determine visit intensity and analyzed data using directed content analysis. Following a multifactorial assessment of the patient, nurses relied on their experience and their agency’s protocols to develop the personalized visit plan. They revised the plan based on changes in the patient’s clinical condition, engagement, and caregiver availability. Findings suggest strategies to improve visit planning and positively influence outcomes of home health patients. [ABSTRACT FROM AUTHOR]

Routing and scheduling of home health care services usually focuses on the case where each nurse operates a separate vehicle. With increasing urbanisation, limited availability of parking spaces and stricter environmental regulations, service providers are starting to investigate car and trip sharing concepts as potential alternatives. This paper numerically investigates a car sharing concept as well as operating a transport system, which delivers and picks up nurses to and from clients combined with the additional option of walking. Different geographic distributions are investigated to identify beneficial settings for successful implementation considering various objectives of decision makers. The evaluation shows that trip sharing performs best if long service durations exist, long delays for parking occur and in areas where clients are both geographically distributed randomly and in clusters. Additionally, facilitating walking as well as trip or car sharing reduces the number of required vehicles substantially. Nevertheless, for walking and trip sharing, travel durations are prone to increase compared to classical planning approaches. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether communication failures between home health care nurses and physicians during an episode of home care after hospital discharge are associated with hospital readmission, stratified by patients at high and low risk of readmission.Data Source/study Setting: We linked Visiting Nurse Services of New York electronic medical records for patients with congestive heart failure in 2008 and 2009 to hospitalization claims data for Medicare fee-for-service beneficiaries.Study Design: Linear regression models and a propensity score matching approach were used to assess the relationship between communication failure and 30-day readmission, separately for patients with high-risk and low-risk readmission probabilities.Data Collection/extraction Methods: Natural language processing was applied to free-text data in electronic medical records to identify failures in communication between home health nurses and physicians.Principal Findings: Communication failure was associated with a statistically significant 9.7 percentage point increase in the probability of a patient readmission (32.6 percent of the mean) among high-risk patients.Conclusions: Poor communication between home health nurses and physicians is associated with an increased risk of hospital readmission among high-risk patients. Efforts to reduce readmissions among this population should consider focusing attention on this factor. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine whether professional collaboration in home health care is associated with clear boundaries between principals′ areas of responsibility and the professions areas of responsibility, respectively. Methods: Data were derived from a web‐based survey that was carried out in one county in the middle of Sweden during spring 2013. Participants were health professionals and managers from the county council and from all the municipalities in the county. Both structured and open‐ended questions were utilised. A total of 421 individuals (90% women) answered the structured questions, and 91 individuals (22% of the 421) answered the open‐ended questions. Quantitative data were analysed with descriptive statistics methods, tests of independence and of correlation strength. Qualitative data were analysed with content analysis. Results: The results from the structured questions showed that well‐functioning collaboration was associated with clear boundaries between principals in the county overall, and for respondents in two of three parts of the county. Association between clear boundaries between professions and well‐functioning collaboration was found in the county overall among the municipality population. However, in one part of the county, we did not find any correlations between well‐functioning collaboration and clear boundaries between professions or principals, with the exception of home help services. The analysis of the open questions gave similar results as the quantitative analysis, illustrated within three themes: The significance of concepts, trust and interdependence, and collaboration as a means for well‐being. Conclusion: The results indicate that, recently after an organisational change, clear boundaries between the principals′ areas of responsibility and professions' area of responsibility respectively are necessary for effective cooperation between professionals. If the organisation and professionals have previous positive experience of colocated activities, clear boundaries do not share the same importance. [ABSTRACT FROM AUTHOR]

Background: Medication management is the most challenging component of a successful transition from hospital to home, a challenge of growing complexity as the number of older persons living with chronic conditions grows, along with increasingly specialised and accelerated hospital treatment plans. Thus, many patients are discharged with complex medication regimen instructions, accentuating the risk of medication errors that may cause readmission, adverse drug events and a need for further health care. Aim: The aim of this study was to explore visiting nurses’ medication management in home health care after hospital discharge and to identify key elements in patient medication for improved patient safety. Method: Inspired by the ethnographic research cycle, participant observations and informal interviews were conducted at 12 initial visits by a nurse in a patient's home after hospital discharge. Data consisted of field notes and photographs from the patients’ homes, medication lists and medical records. Field notes were analysed in four steps. Findings: The analysis showed 12 stages in medication management in which nurses strove to adjust medication management to the patients’ actual health status by mediating on knowledge of the patient, information to the patient and on rules and regulations and by establishing order in medication lists and medications in the home. Conclusion: The nurse–patient relationship, the integration of care and the context of care challenged patient safety in visiting nurses’ medication management in patients’ homes after hospital discharge. The implications for practice were the following: to ensure nurses’ opportunities to continuously evolve their observation skills and skills in making sound clinical judgements; to establish interprofessional working processes which support the continuous assessment of patients’ needs and the adjustment of care and treatment; to clarify expectations to nurses’ responsibility and patients’ privacy. [ABSTRACT FROM AUTHOR]

Background: In 2012, nearly one-third of adults 65 years or older with Medicare discharged to home after hospitalization were referred for home health care (HHC) services. Care coordination between the hospital and HHC is frequently inadequate and may contribute to medication errors and readmissions. Insights from HHC nurses could inform improvements to care coordination.Objective: To describe HHC nurse perspectives about challenges and solutions to coordinating care for recently discharged patients.Design/participants: We conducted a descriptive qualitative study with six focus groups of HHC nurses and staff (n = 56) recruited from six agencies in Colorado. Focus groups were recorded, transcribed, and analyzed using a mixed deductive/inductive approach to theme analysis with a team-based iterative method.Key Results: HHC nurses described challenges and solutions within domains of Accountability, Communication, Assessing Needs & Goals, and Medication Management. One additional domain of Safety, for both patients and HHC nurses, emerged from the analysis. Within each domain, solutions for improving care coordination included the following: 1) Accountability-hospital physicians willing to manage HHC orders until primary care follow-up, potential legislation allowing physician assistants and nurse practitioners to write HHC orders; 2) Communication-enhanced access to hospital records and direct telephone lines for HHC; 3) Assessing Needs & Goals-liaisons from HHC agencies meeting with patients in hospital; 4) Medication Management-HHC coordinating directly with clinician or pharmacist to resolve discrepancies; and 5) Safety-HHC nurses contributing non-reimbursable services for patients, and ensuring that cognitive and behavioral health information is shared with HHC.Conclusions: In an era of shared accountability for patient outcomes across settings, solutions for improving care coordination with HHC are needed. Efforts to improve care coordination with HHC should focus on clearly defining accountability for orders, enhanced communication, improved alignment of expectations for HHC between clinicians and patients, a focus on reducing medication discrepancies, and prioritizing safety for both patients and HHC nurses. [ABSTRACT FROM AUTHOR]

Approximately one in five households in the United States speaks a language other than English at home. This exploratory, descriptive study sought to examine language-concordant visit patterns in an urban home health care agency serving a diverse and multilingual population. Patient care record data combined with administrative data facilitated the exploratory work. In a 2-year period, results showed that among the 238,513 visits with 18,132 limited English proficiency patients, only 20% of visits were language concordant. The study suggests that home health care services may not be meeting the demand for language services, but more research is needed to determine the right "dose" of bilingual home care visits to optimize home care outcomes and establish a standard for care. [ABSTRACT FROM AUTHOR]

The article focuses on development of 90-day model of care in home care for congestive heart failure for bundled episodic payments. Topics discussed include importance of pay for performance for transforming fragmented health care delivery system in the U.S. toward ideal performance which has been supported by the Affordable Care Act (ACA), development of innovative payment models for bringing improvements in health care system and emphasis was given need for quality improvement.

Rationale, aims and objectives To assess the outcomes of a clinical decision support ( CDS) intervention designed for home care patients with high medication regimen complexity ( MRC) and to examine correlates of CDS use. Method The CDS consisted of a computerized algorithm that identified high MRC patients, electronic alerts and a care management module. Nurses were randomized upon identification of an eligible patient. Full intention to treat and intervention group-only analyses were completed. Regression-adjusted outcomes were hospitalization, emergency department use and reduction in MRC. Results Five hundred nurses were randomized with 7919 of their patients. Approximately 20% of the intervention group was hospitalized versus 21% in the control group; 16.5% versus 16.7% had an emergency department visit; and 6% in each group dropped below the high MRC threshold. No statistically significant differences were found in the intention to treat analysis. Eighty-two percent of intervention nurses used the CDS but for only 42% of their patients. Among intervention patients, CDS use (vs. non-use) was associated with reduced MRC and hospitalization. CDS use was associated with various clinician and patient characteristics. Conclusion CDS use was limited, negating the impact of the intervention overall. Findings on correlates of CDS use and the relationship between CDS use and positive outcomes suggest that CDS use and outcomes could be enhanced by avoiding short patient lengths of stay, improving continuity of care, increasing reliance on salaried nurses and/or increasing per diem nurses' incentives to use CDS. [ABSTRACT FROM AUTHOR]

Home health care faces challenges that could affect job satisfaction and quality of care. The aim of the study was to describe nurses’ experiences of competence in home health care. The study sample comprised of interviews with six nurses and was analyzed using manifest qualitative content analysis. The category “Being prepared” and subcategories “Importance of leadership strategies,” “Training promotes safety and independence,” and “Co-operation for professional development” were identified. Organizing and planning continuous learning activities at a managerial level, such as collaborations with a focus on supervision and sense of coherence (SOC) training, could develop patient safety within home health care. The results demonstrate that professionally competent nurses working in home health care environments contribute to safe working practices to meet quality care outcomes. [ABSTRACT FROM PUBLISHER]

The planning of home health care services is still done manually in many industrial countries. However, efficient decision support is necessary to improve the working plans and relieve the nurses from this time consuming task. The problem can be summarized as follows: clients need to be visited one or several times during the week by appropriately skilled nurses; their treatments have predefined time windows. Additionally, working time requirements for the nurses such as breaks, maximum working time per day, and daily as well as weekly rest times have to be considered. We propose a Branch-Price-and-Cut solution approach to solve this problem exactly, using the solutions of a variable neighborhood search solution approach as upper bounds. The algorithm is capable of solving to optimality real-life based test instances with up to nine nurses, 45 clients, and 203 visits during the week. © 2014 Wiley Periodicals, Inc. NETWORKS, Vol. 64(3), 143-159 2014 [ABSTRACT FROM AUTHOR]

To support home health care nurses in their efforts to optimize the management of patients with wounds complicated by diabetes, an initiative was introduced that incorporated a standardized assessment tool, electronic data entry, and the provision of written treatment recommendations with supporting rationale prepared by nurses with expertise in diabetes and wound care. A pilot study was conducted that provided preliminary evidence of the feasibility of this initiative as well as its potential effect on outcomes for patients, nurses, and the home care program. [ABSTRACT FROM PUBLISHER]

Summary: Background: This study examined the satisfaction of primary caregivers of home health care services and its related factors. Methods: The design of the questionnaire was based on the concept of PZB service quality with SERVQUAL scale. The content of the questionnaire was divided into the expectations and actual perceptions of the home health care service with six dimensions, including reliability, tangibility, responsiveness, assurance, empathy, and information giving, as well as the overall satisfaction. The questionnaire was mailed to the primary caregivers. A total of 146 valid questionnaires were obtained. Results: The mean age of the patients is 79.7 years. The mean total score of the primary caregivers on expected service level is 27.38 (standard deviation=3.02, total score=30) and 27.62 (standard deviation=3.13, total=30) for the actual perception. The primary caregivers showed a significantly higher score of perceived performances in the variables of home health care nurses being reliable, informing when to provide services, and being kind and friendly but had significantly lower score of perceived performance with the variable of home health care nurses completing the promised tasks. The overall satisfaction levels of home health care nurses are higher for those primary caregiver older than 30 years than those who were younger. The primary caregivers who are older than 30 years and had lower education level are more satisfied with the physicians. The siblings who served as the primary caregiver had the lowest perceived performance than others. The variables of “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs” were within the improvement zone in the “caregiver expectation and perceived performance matrix.” Conclusion: This study showed that the overall perceived performance is higher than expectation for home health care service provided. The primary caregiver who was older than 30 years, who had lower education level, and other than siblings showed higher satisfaction. The four items that need improving included “home health care nurses will provide detailed description of services,” “home health care nurses will provide knowledge of illness,” “home health care nurses can complete the promised tasks,” and “home health care nurses will actively inquire patient’s conditions and needs.” [Copyright &y& Elsevier]

Home health care is the delivery of predominantly medically related services to patients in a home setting rather than in a medical facility. It provides substantial benefits over traditional, hospital-based health care, such as supporting older adults'' independence and quality of life, as well as being more cost-effective. This aspect of the health care industry could be enhanced through increased technological supports. When providing health care in a home setting, formal caregivers, such as certified nursing assistants (CNAs), registered nurses (RNs), physical therapists (PTs), and occupational therapists (OTs), are faced with many challenges that impede their ability to perform their jobs. Technological interventions have the potential to alleviate many of these challenges. However, to achieve this potential, new technologies must be created to meet the needs of home health care providers. To date, these providers'' specific and most critical needs are not thoroughly understood. This understanding can be gained by conducting a detailed needs assessment that captures the common challenges and difficulties that home health care providers encounter. We conducted a needs assessment comprising three phases: (a) an extensive literature review of research regarding the needs of home health providers, both hospital and home-based (CNAs, RNs, PTs, and OTs); (b) subject matter expert interviews with experienced individuals from home health care; and (c) structured interviews with CNAs. We identified several significant sources of frustration and difficulty faced by CNAs including medical device usage, patient education, family involvement, provider isolation, and barriers to communication. This analysis provides an understanding of the challenges confronting home health care providers that can provide guidance for interventions. Future home health care technology can be developed to specifically target these workers'' most urgent needs and allow them to perform their jobs with greater ease. Moreover, RNs, PTs, and OTs can benefit from understanding some of the challenges faced by their teammates in the home health care process. [ABSTRACT FROM AUTHOR]

Interest is growing for information on recently qualified nurses' initial meeting with working life. This study aims to shed light on recently qualified nurses' experience working in home health care. The authors chose to design the study using a phenomenological hermeneutical approach with narrative interviews and text analysis. The respondents consist of a group of four recently qualified nurses. The results show that they are surprised by the many competence requirements and expectations, that they experience feeling alone, and that they also bear large responsibility. At the same time, they enjoy their work, in which they seek to influence the working conditions for their professional practice. They do experience the anxiety of not being able to cope with the challenge of nursing practice, but they are not marked by the shock of reality. [ABSTRACT FROM AUTHOR]

Aims. The present study explores how community nurses addressed patient care in the EPR and the comprehensiveness of their documentation. Background. The need for comprehensive nursing documentation in home health care is considerable and quality is regarded as a prerequisite for continuity of care. Documentation according to the nursing process is considered to be of good quality due to its logical structure. Nurses in home health care face different challenges than nurses in institutionalised care because of long-term patient situations and a focus on chronic illness rather than acute disease. Design. Retrospective study. Method. The study was performed on a sample of 91 patient records. Data were analysed in three phases: (1) systematising the unstructured text, (2) structuring the text according to the nursing process and (3) assessing the comprehensiveness using a validated instrument. Results. The home care nurses documented patient care chronologically along a time axis rather than using a logical structure according to the nursing process. The documentation reflected today’s overall emphasis on patient participation, as more than 70% of the notes on nursing status were connected to subjective nursing status. Paradoxically, the nurses showed a lack of attention to the patients’ ability to communicate. Only two of 264 documented nursing diagnoses were connected to communication. The comprehensiveness of the documentation, however, was incomplete. Conclusions. Home health care nurses are attentive to patient participation but fail to address patients’ needs with regard to communication. The documentation is incomplete when assessed according to the steps of the nursing process. A question that arises is whether the nursing process may be a limitation for the quality of the nursing documentation. Relevance to clinical practice. The study contributes to identifying areas of improvement in documentation by nurses in home health care. [ABSTRACT FROM AUTHOR]

Recent national and regional public health workforce development efforts have been conducted through a framework of public health services research. Public health nurses (PHNs) are the single largest professional group in the formal public health system, and thus have the greatest potential for positively impacting our community health systems. Effective public health workforce development is contingent on examination of how PHNs themselves make meaning of their practice. This paper suggests that a nursing perspective should be used from which to conduct research surrounding PHN practice. Literature describing PHN practice and recent workforce assessment efforts are reviewed. Assumptions are identified regarding the nature of nursing knowledge, and a theoretical perspective for inquiry about PHN praxis is developed. Finally, a model is offered to illustrate the reciprocal influence of nursing science and public health nursing practice. [ABSTRACT FROM AUTHOR]

The nursing bag has been a vital tool for public and community health nurses since the early 1900s. However, the practice of utilizing the nursing bag has declined. This study sought to determine whether the practice of teaching students to use a public health nursing bag when making home visits should continue. Deans and directors of all schools of nursing with baccalaureate programs listed on the Commission on Collegiate Nursing Education Web site ( n=437) were e-mailed an exploratory, descriptive self-report survey. Although 32% of responding schools continued to utilize a standard public health bag during home visits, the majority did not. Lack of use of the bags was primarily related to cost and the lack of research demonstrating its efficiency in enhancing the home visit and its value in promoting infection control. The researchers concluded that they would continue to teach the use of the public health nursing bag. It provides a receptacle for equipment and supplies, reinforces the need to be prepared for a variety of situations, and serves as a reminder that handwashing is a routine part of every client's care, regardless of the setting. [ABSTRACT FROM AUTHOR]