Competências do enfermeiro para atuação na atenção domiciliar e situações que mobilizam as competências: estudo de caso / Nurse skills to work in home care and situations that mobilize skills: case study

Introdução: A assistência à saúde no domicílio configura-se como uma modalidade de cuidado em expansão no cenário mundial e a enfermagem integra a equipe multiprofissional, sendo a maior provedora de assistência domiciliar. No contexto de especificidades da atenção domiciliar, o enfermeiro é constantemente desafiado a mobilizar conhecimentos, habilidades e atitudes de forma inter-relacionada e espera-se que seja competente na prática profissional. O objetivo deste estudo foi analisar as competências mobilizadas por enfermeiros na atenção domiciliar no dia a dia do seu trabalho. Método: estudo de abordagem qualitativa com delineamento metodológico de estudo de caso único. A produção dos dados teve como cenário o serviço de atenção domiciliar do Sistema Único de Saúde do município de Belo Horizonte. Participaram da pesquisa 12 enfermeiros que compõem equipes multiprofissionais de atendimento domiciliar. As fontes de evidência foram a análise documental, entrevistas guiadas por um roteiro semiestruturado com foco em competências e grupo focal. Os dados foram submetidos à Análise de Discurso Crítica, na perspectiva de Fairclough, possibilitando a discussão de duas categorias empíricas: competências do enfermeiro para atuação na atenção domiciliar; e situações que promovem a mobilização das competências. Resultados: identificou-se um conjunto de dezessete competências mobilizadas pelos enfermeiros do serviço de atenção domiciliar, quais sejam: liderança, comunicação, tomada de decisão, avaliação holística do paciente e ambiente domiciliar, gestão do trabalho, gestão do cuidado, educação em saúde, sensibilidade cultural, assistência de enfermagem, trabalho em equipe, colaboração interdisciplinar, trabalho em rede, gestão de recursos materiais, gestão do tempo, desenvolvimento profissional, adaptação à tecnologia e segurança para o trabalho. Para cada uma das competências foram apontados e discutidos os atributos relacionados a conhecimentos, habilidades e atitudes. Os discursos revelaram que as competências são mobilizadas por situações relacionadas as particularidades da atenção domiciliar, singularidade do contexto domiciliar e demandas profissionais. Conclusão: a prática dos enfermeiros na atenção domiciliar mobiliza diversas competências compreendidas como uma necessidade no dia a dia do trabalho.

Introduction: Home health care is an expanding modality of care on the world stage and the nurse is part of the multidisciplinary team, being the largest provider of home care. In the context of specificities of home care, nurses are constantly challenged to mobilize knowledge, skills and attitudes in an interrelated way and are expected to be competent in professional practice. The objective of this study was to analyze the skills mobilized by nurses in home care in their day-to-day work. Method: qualitative approach study with a single case study methodological design. Data production took place in home care service of the Unified Health System in the city of Belo Horizonte. 12 nurses who make up multidisciplinary home care teams participated in the research. The sources of evidence were documents analysis, interviews guided by a semi-structured script focusing on skills and focus groups. The data were submitted to Critical Discourse Analysis, from Fairclough 's perspective, enabling the discussion of two empirical categories: nurse skills to work in home care; and situations that promotes the mobilization of skills. Results: a set of seventeen skills mobilized by nurses in home care service were identified, namely: leadership, communication, decision making, holistic assessment of the patient and home environment, work management, care management, health education, cultural sensitivity, nursing care, teamwork, interdisciplinary collaboration, networking, material resource management, time management, professional development, adaptation to technology and work safety. For each of the competencies, attributes related to knowledge, skills and attitudes were highlighted and discussed. The speeches revealed that skills are mobilized by situations related to the particularities of home care, the uniqueness of the home context and professional demands. Conclusion: the practice of nurses in home care mobilizes several skills understood as a necessity in day-to-day work.

Atuação do Enfermeiro em Cuidados Paliativos na Atenção Primária à Saúde: Revisão Integrativa / Nursing Work in Palliative Care in Primary Health Care: Integration Review / Actuación del Enfermero en Cuidados Paliativos en la Atención Primaria a la Salud: Revisión Integrativa

Introdução: A atuação da enfermagem ao indivíduo em cuidados paliativos (CP) na Atenção Primária à Saúde (APS) visa a promover a qualidade de vida dos indivíduos e da sua família como garantia da assistência integral, para um cuidado humanizado e digno, melhorando a maneira de enfrentar a doença e minimizando o sofrimento. Objetivo: Analisar e sintetizar a produção científica relacionada à assistência do enfermeiro ao indivíduo em CP nas APS. Método: Revisão integrativa da literatura realizada nas bases de dados Literatura Latino- -Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) via PubMed, Base de Dados de Enfermagem (BDENF) e Scientific Electronic Library Online (SciELO), utilizando os descritores: Palliative Care, Nursing e Primary Health Care. Resultados: Foram analisados 17 artigos após seleção sistemática, sintetizados em um quadro com seus principais resultados e agrupados em três categorias: capacitação em CP: uma barreira para atuação do enfermeiro na APS; percepções, experiências e práticas dos enfermeiros nos CP; o papel do enfermeiro na equipe multiprofissional de CP. Conclusão: Notou-se que os enfermeiros possuíam conhecimento superficial acerca dos CP na APS, evidenciando a necessidade de educação continuada para promover a sua atuação em CP. Ademais, estudos com maior rigor metodológico com o foco no enfermeiro como agente disseminador da prática são necessários

Introduction: The role of nursing professionals in palliative care (PC) in Primary Health Care (PHC) aims to promote the quality of life of individuals and their families as a guarantee of comprehensive humanized and dignified care, improving the way to cope with the disease and minimizing suffering. Objective: To analyze and synthesize the scientific production related to the nurse's assistance to the individual in PC in PHC. Method: Integrative literature review carried out in the databases of Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed, Nursing Database (BDENF) and Scientific Electronic Library Online (SciELO), using the following descriptors: Palliative Care, Nursing and Primary Health Care. Results: 17 articles were analyzed after a systematic selection summarized in a table with their main results and grouped into three categories: training in PC: a barrier for nurses to work in PHC; perceptions, experiences, and practices of nurses regarding PC; the role of nurses in the multiprofessional PC team. Conclusion: It was noticed that nurses had superficial knowledge about PC in PHC, demonstrating the need for continuing education to promote their role in PC. Furthermore, thorough methodological studies targeted to the nurse as agent disseminating the practice are neededodológicos más rigurosos, con foco en lo enfermero como agente divulgador de la práctica

Introducción: El rol de los profesionales de enfermería en los cuidados paliativos (CP) en la Atención Primaria de Salud (APS) tiene como objetivo promover la calidad de vida de las personas y sus familias como garantía de una atención integral, humanizada y digna, mejorando la forma de afrontar la enfermedad y minimizando sufrimiento. Objetivo: Analizar y sintetizar la producción científica relacionada con la asistencia del enfermero al individuo en CP en APS. Método: Revisión integradora de la literatura realizada en las bases de datos de Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Medical Literature Analysis and Retrieval Sistem Online (MEDLINE) a través de PubMed, Banco de Datos de Enfermería (BDENF) y Scientific Electronic Library Online (SciELO), utilizando los descriptores: Palliative Care, Nursing y Primary Health Care. Resultados: Se analizaron 17 artículos después de una selección sistemática, resumidos en una tabla con sus principales resultados y agrupados en tres categorías: capacitación en CP: barrera para el trabajo de enfermería en APS; percepciones, experiencias y prácticas de enfermeros en CP; el papel de los enefermeros en el equipo multiprofesional de CP. Conclusión: Se observó que los enfermeros tenían conocimientos superficiales sobre CP en la APS, evidenciando la necesidad de una educación continua para promover su actuación en CP. Además, se necesitan estudios metodológicos más rigurosos, con foco en lo enfermero como agente divulgador de la práctica

Insights From Rapid Deployment of a "Virtual Hospital" as Standard Care During the COVID-19 Pandemic.

BACKGROUND: Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation. OBJECTIVE: To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system. DESIGN: Prospective case series. SETTING: Atrium Health, a large integrated health care organization in the southeastern United States. PATIENTS: 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH. INTERVENTION: A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19. MEASUREMENTS: Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data. RESULTS: 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission. LIMITATION: Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols. CONCLUSION: Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond. PRIMARY FUNDING SOURCE: Atrium Health.

Abordaje holístico de las lesiones por presión en la persona mayor: Caso clínico / Holistic approach to pressure injuries in the elderly: Clinical case

Se expone un caso clínico de una paciente de 88 años cursando una hospitalización domiciliaria de larga estadía, por múltiples lesiones por presión, tras su seguimiento presenta una merma en su recuperación, por lo que un profesional de enfermería de hospitalización domiciliaria realiza una visita domiciliaria integral que evidencia múltiples elementos que precisan un abordaje holístico de la situación. Para su abordaje se utilizó el marco teórico de Virginia Henderson, que facilitó la elección del diagnóstico en la cuidadora de Cansancio del rol de cuidador, lo cual permitió que la situación lograra ser abordada satisfactoriamente. CONCLUSIÓN: se relevó la importancia de un manejo holístico en las lesiones por presión, que debe considerar la dimensión social en la que está inmerso el paciente, junto a un manejo interdisciplinario, preparación profesional y abordaje precoz del probable impacto económico en estos pacientes.

A clinical case of an 88-year-old patient undergoing a long-term home hospitalization due to multiple pressure injuries is presented. After follow-up, she presents a decline in her recovery, so a home hospitalization nursing professional performs a comprehensive home visit that shows multiple elements that require a holistic approach to the situation. For its approach, the theoretical framework of Virginia Henderson was used, which facilitated the choice of the diagnosis in the caregiver of Tiredness from the caregiver role, which allowed the situation to be satisfactorily addressed. CONCLUSION: the importance of a holistic management of pressure injuries was highlighted, which must consider the social dimension in which the patient is immersed, together with an interdisciplinary management, professional preparation, and an early approach to the probable economic impact on these patients.

Development of Albumin Analyzer with Whole Blood and Application to Telemedicine for Patient Nutrition Management in Home Health Nursing.

Albumin level is q significant indicator of patient nutritional status. However, Point of Care Testing (POCT) devices and telemedicine system that nurses can operate easily in-home medical care is not developed. The aim of this work is the development of a POCT device for Albumin level and application to a telemedicine support system. The operability of our system was simple and easy for the nurse or patient. We believe our method is useful for Nutrition Support Team activities in-home medical care.

Disease-specific clinical pathways - are they feasible in primary care? A mixed-methods study.

OBJECTIVE: To explore the feasibility of disease-specific clinical pathways when used in primary care. DESIGN: A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings. SETTING: Primary care and specialist care collaborating to manage care coordination. RESULTS: Primary-care representatives expressed that their patients often have complex health and social needs that clinical pathways guidelines seldom consider. The representatives experienced that COPD, heart failure, stroke and hip fracture, frequently seen in hospitals, appear in low numbers in primary care. The quantitative study confirmed the extensive complexity among home healthcare nursing patients and demonstrated that, for each of the four selected diagnoses, a homecare nurse on average is responsible for preparing reception of the patient at home after discharge from hospital, less often than every other year. CONCLUSIONS: The feasibility of disease-specific pathways in primary care is limited, both from a clinical and organisational perspective, for patients with complex needs. The low prevalence in primary care of patients with important chronic conditions, needing coordinated care after hospital discharge, constricts transferring tasks from specialist care. Generic clinical pathways are likely to be more feasible and efficient for patients in this setting. Key points Clinical pathways in hospitals apply to single-disease guidelines, while more than 90% of the patients discharged to community health care for follow-up have multimorbidity. Primary care has to manage the health care of the patient holistically, with all his or her complex needs. Patients most frequently admitted to hospitals, i.e. patients with COPD, heart failure, stroke and hip fracture are infrequent in primary care and represent a minority among patients in need of coordinated community health care. In primary care, the low rate of receiving patients discharged from hospitals of major chronic diseases hampers maintenance of required specific skills, thus constricting the transfer of tasks to primary care. Generic clinical pathways are suggested to be more feasible than disease-specific pathways for most patients with complex needs.

[Care of Korean elderly in need of care : Tendency to strengthen the role of integrated care for the elderly in communities]. / Versorgung der älteren Pflegebedürftigen in Korea : Tendenz zur Verstärkung der Rolle der integrierten Altenpflege in den Kommunen.

Since the introduction of long-term nursing care insurance in 2008, the Korean elderly in need of care are entitled to residential care or home based care services, as in the other welfare states. This article initially introduces the Korean nursing care insurance (PfV) for the elderly to give an overview of the healthcare system. Subsequently, the latest model project "Community based comprehensive care system" is introduced. The confusing care and social services should be networked and provided in a manner customized to the needs of the elderly, so that home based care before residential care can be realized.

Intervenção de enfermagem no estresse do cuidador familiar do idoso com dependência: estudo piloto / Intervención de enfermería en el estrés del cuidador familiar del anciano con dependencia: estudio piloto / Nursing intervention for stress management in family caregivers of dependent older adults: a pilot study

Objetivo avaliar a eficácia de uma intervenção de enfermagem estruturada com base num programa psicoeducativo de gestão do estresse sobre estressores primários (sobrecarga), recursos (coping) e resultados (bem-estar emocional) do cuidador, e avaliação realizada pelos cuidadores e pelos enfermeiros sobre a ajuda da intervenção e sobre o material de apoio ao programa. Método estudo piloto com 13 cuidadores de idosos em Portugal durante 5 semanas. Realizaram-se entrevistas para avaliar a intervenção e o material de apoio. Resultados depois da intervenção, houve melhoria no coping, no bem-estar e na sobrecarga com diferença estatisticamente significativa na sobrecarga; dificuldades com a implementação da intervenção e uso do material de apoio. Conclusão os cuidadores familiares revelaram que a intervenção ajudou-os na aprendizagem de novas estratégias de coping. Por parte dos enfermeiros, a intervenção ajudou-os a conhecer as dificuldades do cuidador, facilitando a abordagem holística do cuidado centrado no cuidador e no idoso.

Objetivo evaluar la eficacia de una intervención de enfermería estructurada con base en un programa psicoeducativo de gestión del estrés sobre estresores primarios (sobrecarga), recursos (coping) y resultados (bienestar emocional) del cuidador, y evaluación realizada por cuidadores y enfermeros sobre la ayuda de la intervención y el material de apoyo al programa. Método estudio piloto con 13 cuidadores de ancianos en Portugal, durante cinco semanas. Se realizaron entrevistas para evaluar intervención y material de apoyo. Resultados después de la intervención, hubo mejora en el coping, bienestar y sobrecarga, con diferencia estadísticamente significativa en la sobrecarga; dificultades con la implementación de la intervención y uso del material de apoyo. Conclusión los cuidadores familiares revelaron que la intervención ayudó en el aprendizaje de nuevas estrategias de coping. Para los enfermeros, ayudó a conocer las dificultades del cuidador, facilitando el abordaje holístico de la atención centrada en el cuidador y anciano.

Objective assess the effectiveness of a structured nursing intervention for caregivers based on a psychoeducational stress management program in relation to primary stressors (overload), resources (coping) and results (emotional well-being), as well as an assessment by caregivers and care recipients as to the helpfulness of the intervention and the program's support material. Method a pilot study was conducted with 13 caregivers of older adults in Portugal during five weeks. Interviews were conducted to assess the intervention and support material. Results after the intervention, there was an improvement in coping, well-being and overload, with a statistically significant difference in overload; difficulties implementing the intervention and using the support material. Conclusion the family caregivers stated that the intervention helped them learn new coping strategies. On the part of the nurses, the intervention helped them understand the difficulties faced by caregivers, facilitating a holistic care approach based on the caregiver and elderly person.

The future of community nursing: Hospital in the Home.

With an increasing ageing population who often have multiple long-term conditions, there is a growing need to provide an alternative type of care to the traditional hospital-based model. 'Hospital in the Home' is a model that provides integrated care for patients in their home. The @home service was established in 2013 by Guy's and St Thomas' NHS Foundation Trust. The service provides health care in patients' home, supporting early discharge from hospital as well as preventing avoidable admissions and readmissions saving valuable hospital bed days and reducing length of stay. This article describes the service available with the use of a case study of a 78-year-old lady who was referred by the London Ambulance Service with exacerbation of chronic obstructive pulmonary disease (COPD). This case study highlights the ability to assess, treat and manage an acutely unwell patient with newly diagnosed heart failure in the community without the need for hospitalisation. This type of integrated care model with a multidisciplinary team is a feasible alternative to the traditional models of care in both the acute and community settings.

Integrating Preventive Cardiovascular Healthcare Into Home Health: A Pilot Study.

The viability of measuring and integrating preventive cardiovascular care into home healthcare was investigated through a pilot study fielded during 2013 and 2014. The study tested the feasibility of using a data registry to measure preventive cardiovascular care delivered in home healthcare, examined opportunities for quality improvement, and looked at the association between exposure to evidence-based tools and improvement in aspirin use and blood pressure screening and control among a convenience sample of 20 agencies. Based on promising results, the home healthcare cardiovascular quality initiative continues in alignment with Million Hearts® and offers tools that clinicians can use to understand the risks for heart attack and stroke within their agency's population of patients and respond with best practices.

Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives.

BACKGROUND: Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. OBJECTIVE: We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. METHODS: Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. RESULTS: We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. CONCLUSIONS: Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.

Terapia larval. Caso clínico en atención domiciliaria / Maggot therapy: case study in home care

Introducción. La terapia larval es un método de preparación del lecho de la herida de utilización ancestral. Su uso quedó relegado con la aparición de los antibióticos, hasta nuestros días, donde está resurgiendo como opción en el tratamiento de heridas crónicas. Metodología. Presentamos un caso clínico, donde una herida en pie diabético de seis meses de evolución tórpida y con varios cambios de tratamiento poco efectivos mejora en 3-4 días tras la utilización de terapia larval en el domicilio. El lecho de la herida queda preparado para el proceso de granulación. Resultados. Se puede apreciar cómo, tras cuatro días de tratamiento con la terapia larval, el lecho de la herida queda libre de esfacelos y disminuye también el exudado y el edema. Se consigue una herida en óptimas condiciones para la cicatrización. Se objetivó, aplicando la escala EVA, una clara disminución del dolor tras la terapia. Se demostró que la terapia larval puede utilizarse en atención domiciliaria o comunitaria sin inconvenientes. Conclusión. La terapia larval es un método de desbridamiento rápido, efectivo y seguro, que se puede aplicar en el domicilio del usuario (AU)

Introduction. Maggot therapy is a wound bed preparation method of ancestral use. Its use was relegated with the emergence of antibiotics, until today, where is reemerging as an option in the treatment of chronic wounds. Methodology. We report a case study where a six months wound in diabetic foot with torpid evolution and with several changes of ineffective treatment, improved in 3-4 days after the use of maggot therapy at home; leaving the wound bed prepared for the process of granulation. Results. As could see, after four days from the application of maggot therapy, the wound bed was free of slough, also decreasing exudation and edema. Leaving the optimal conditions for wound healing. It was assessed by the VAS scale decreased pain after dressing changes. It was demonstrated that maggot therapy can be used in home or community care without inconvenience. Conclusion. The maggot therapy is a method of debridement fast, effective and safe, this method can be used in home care (AU)

Rethinking Care Coordination: Paradigm Shifting From Volume to Value.

Although care coordination is not a new concept, it has been fraught with a myriad of definitions. Among these, core themes can be gleaned to help the home healthcare clinician understand their role and responsibilities as part of a high-functioning team. For a shift from volume to value to occur, in a way that is meaningful to the patient, a holistic paradigm needs to be fully embraced by all members of the interdisciplinary team. As healthcare continues to shift to a fair-market demand for services system, transparency becomes a driver for patient information and choice. Care coordination, clinical outcomes, and consumerism in this new era become integrally linked. Home care clinicians have a higher level of accountability to deliver patient-centered care that necessitates shifting from a "disease state" mentality to a view that encompasses mind, body, and spirit in totality. Home healthcare agencies will need to view their own organization as occurring within a maturation cycle of interdisciplinary team development and continually strive for exceptional care delivery, transparency in outcomes, and full team collaboration with a holistic mindset, in order to make the shift from volume to value that will be necessary to thrive.

Comparison of effects between home visits with telephone calls and telephone calls only for transitional discharge support: a randomised controlled trial.

BACKGROUND: home visits and telephone calls are two often used approaches in transitional care but their differential effects are unknown. OBJECTIVE: to examine the overall effects of a transitional care programme for discharged medical patients and the differential effects of telephone calls only. DESIGN: randomised controlled trial. SETTING: a regional hospital in Hong Kong. PARTICIPANTS: patients discharged from medical units fitting the inclusion criteria (n = 610) were randomly assigned to: control ('control', n = 210), home visits with calls ('home', n = 196) and calls only ('call', n = 204). INTERVENTION: the home groups received alternative home visits and calls and the call groups calls only for 4 weeks. The control group received two placebo calls. The nurse case manager was supported by nursing students in delivering the interventions. RESULTS: the home visit group (after 4 weeks 10.7%, after 12 weeks 21.4%) and the call group (11.8, 20.6%) had lower readmission rates than the control group (17.6, 25.7%). Significance differences were detected in intention-to-treat (ITT) analysis for the home and intervention group (home and call combined) at 4 weeks. In the per-protocol analysis (PPA) results, significant differences were found in all groups at 4 weeks. There was significant improvement in quality of life, self-efficacy and satisfaction in both ITT and PPA for the study groups. CONCLUSIONS: this study has found that bundled interventions involving both home visits and calls are more effective in reducing readmissions. Many of the transitional care programmes use all-qualified nurses, and this study reveals that a mixed skills model seems to bring about positive effects as well.

[Proper acknowledgement of the global care provided by nurses in patients' homes]. / Mieux reconnaître les prises en charge globales effectuées par les infirmièrs.

The richness of nursing practice is expressed notably by the holistic character of the care provided. In their practice in patients' homes, nurses sometimes come up against regulatory constraints which determine the refunding of patients' treatment and take insufficient account of the global nature of the treatment carried out.

O campo de cuidar: uma abordagem quântica e transpessoal do cuidado de enfermagem / The field of care: a quantum and transpersonal approach of nursing care / El campo de cuidar: un abordaje quántico y transpersonal del cuidado de enfermería

Descobertas recentes da física quântica mencionam que existe um campo de energia que se forma durante um encontro entre duas pessoas. Esse campo é resultante da interação entre a consciência de ambos. Nessa linha de pensamento a teoria do cuidado transpessoal de Jean Watson, afirma que a pessoa é mais que sua expressão objetiva revelada no corpo físico, possuindo também sutis manifestações de luz e energia conectada ao cosmo. Este texto objetiva refletir, a partir dos conceitos da física quântica e da teoria do cuidado transpessoal acerca de um campo de cuidado que se forma entre a consciência do cuidador e da pessoa que recebe o cuidado. Destaca-se o papel da consciência na instalação de um biocampo que se qualifica por meio da atenção e da intencionalidade das pessoas envolvidas no encontro de cuidado. Levanta-se a hipótese de que seja possível que o padrão mental de quem cuida possa influenciar os resultados de quem recebe o cuidado e vice-versa. Conclui-se que o estudo do intercâmbio entre a matéria/energia/consciência, sobretudo nas ações de cuidado, abre um amplo leque de possibilidades para a utilização consciente desse recurso no planejamento, implementação e avaliação dos resultados das intervenções na enfermagem e saúde.

This article aims to reflect, from the discoveries of quantum physics, about the presence of a field of caring formed between the caregiver and the consciousness of the person receiving care. According to the quantum physics, the consciousness of people involved in the care process can influence matter and create a healing reality. This approach meets the transpersonal caring theory of Jean Watson. According to this theory, the therapeutic results arising from the interaction established between the professional and patient can help the patient gain a sense of inner harmony, generating power in self-healing processes by facilitating access to inner healing. The role of consciousness in the installation of a biofield qualifies itself through attention and intentionality of those involved in the care meeting. In this scenario, the care of nursing staff sets up apart from the implementation of techniques and use of technology, so the professional should take into account a genuine attention, intention and willingness to care/to heal. We concluded that the study of the exchange among matter/energy/consciousness, especially in the care actions, opens a wide range of possibilities for the use of this feature in the planning, implementation and evaluation of results of health interventions.

Descubiertas recientes de la física cuántica mencionan que existe un campo de energía que se forma durante un encuentro entre dos personas. Este campo es resultante de la interacción entre la consciencia de ambos. En esta línea de pensamiento la teoría del cuidado transpersonal de Jean Watson, afirma que la persona es más que su expresión objetiva revelada en el cuerpo físico, poseyendo también sutiles manifestaciones de luz y energía conectada al cosmos. Este texto tiene el objetivo de reflexionar, a partir de los conceptos de la física cuántica y de la teoría del cuidado transpersonal acerca de un campo de cuidado que se forma entre la consciencia del cuidador y de la persona que recibe el cuidado. Se destaca el papel de la consciencia en la instalación de un biocampo que se califica por medio de la atención y de la intencionalidad de las personas involucradas en el encuentro de cuidado. Se propone la hipótesis de que sea posible que el patrón mental de quien cuida pueda influenciar los resultados de quien recibe el cuidado y viceversa. Se concluye que el estudio del intercambio entre la materia/energía/consciencia, sobre todo en las acciones de cuidado, abre un amplio abanico de posibilidades para la utilización consciente de este recurso en la planificación, implementación y evaluación de los resultados de las intervenciones en la enfermería y salud.

Spirituality in nursing: nurses' perceptions about providing spiritual care.

Providing spiritual care is an important foundation of nursing and is a requirement mandated by accreditation organizations. Spiritual care is essential in all clinical areas but particularly in home care and hospice. Clinicians may be unable to respond to spiritual needs because of inadequate education or the assumption that spiritual needs should be addressed by clergy, chaplains, or other "spiritual" care providers. In reality, clinicians in the home may be in the best position to offer spiritual support when caring for patients at home at end of life. The purpose of this pilot study was to examine relationships between spirituality and nurses' providing spiritual care. Professional nurses (n = 69) working in 2 large healthcare organizations completed the Perceptions of Spiritual Care Questionnaire. Approximately, 33% of the nurses worked in home care. Significant correlations were found among those nurses whose reported nursing education programs adequately prepared them to meet spiritual needs and taught ways to incorporate spiritual care into practice and those who did not.

The challenges patients experience in speaking about death: a guide for home healthcare and hospice clinicians.

Clinicians caring for people with a life-limiting illness may aspire to speak about the patient's approaching death as part of the holistic care being provided. However, the intensity of the illness may affect the patient's ability to express his or her thoughts about dying. This article explores the challenges that the patient experiences in communicating at this time.