Quality of life of older Australians receiving home nursing services for complex care needs.

Older Australians may live up to 10 years in ill health, most likely chronic disease-related. Those with multimorbidity report more healthcare visits, poorer health and take more medications compared with people with a single chronic disease. They are also at higher risk of hospital admission and poor quality of life. People living with multimorbidity are considered to have "complex care" needs. A person-centred approach to healthcare has led to increasing use of in-home nursing support, enabling older people to receive care at home. Our prospective observational study describes the profile and management of home-based care for older people with complex care needs and examines changes in their quality of life over 12 months. Routinely collected data were analysed, including demographics, medical history, medications and the visit activity of staff providing care to participants. Additional health-related quality of life and hospitalisation data were collected via quarterly surveys and analysed. Fifty-two participants (mean age 76.6 years, 54% female) with an average of eight diagnosed health conditions, received an average of four home care visits per week. Almost half the participants were hospitalised once during the 12-month period and experienced a significant decline in overall quality of life and in the dimensions measuring independent living and relationships over the study period. If ageing in place with good quality of life is to be realised by older adults with multimorbidity, support services including home nursing need to consider both the biomedical and social determinants perspectives when addressing health and social care needs.

Home-Based Phototherapy Versus Hospital-Based Phototherapy for Treatment of Neonatal Hyperbilirubinemia: A Systematic Review and Meta-Analysis.

Objective. Phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. We reviewed the current literature to determine whether home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Method. PubMed, Scopus, Embase, Cochrane library, CBM, CNKI, and Wanfang Data were searched to collect the comparative study of home-based phototherapy versus hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. All studies were found to be of low risk based on Cochrane Collaborative Risk of Bias Tool. Data were statistically extracted and evaluated by RevMan 5.3 software. Result. A total of 259 neonates were included in the meta-analysis. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference = 0.32, 95% confidence interval = -0.22 to 0.86, P = .04); however, there was no significant difference in duration of phototherapy (standard mean difference = 0.59, 95% confidence interval = 0.28 to 0.90, P = .06) in the 2 groups. Conclusion. Home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy is an effective, feasible, safe, and alternative to hospital-based phototherapy for neonatal hyperbilirubinemia.

Ensuring safe and optimal medication use in older community residents: Collaboration between a nurse and a pharmacist.

The purpose of this retrospective review is to describe 1) a nurse-pharmacist collaboration within a home based nurse-occupational therapist-handyman program called CAPABLE and 2) potential medication problems and 3) information communicated to participants and prescribers about those problems. A chart review was performed for each participant that one CAPABLE nurse referred to the pharmacists. We identified recommendations provided by pharmacists, synthesized common questions posed to the pharmacists' and developed exemplar cases of participant encounters. Fifty-nine participants were reviewed. The median number of total medications was 11 (IQR 9-14.5). Participants were most commonly taking antihypertensives (93%), statins (66%), and supplements/vitamins (61%). Pharmacists provided 83 unique recommendations for the 59 participants. The recommendations from the pharmacist were communicated for 49 of the 59 participants (83%), by the nurse. The nurse-pharmacist collaboration identified medication-related problems and solutions aimed at improving the quality of life for home-dwelling seniors with functional limitations.

The experiences and preparedness of family carers for best interest decision-making of a relative living with advanced dementia: A qualitative study.

AIM: To explore the experience and the preparedness of family carers in their caregiving role as best interest decision-makers of a relative living with advanced dementia. BACKGROUND: The prevalence of dementia is a global issue. The role of being a carer of a relative living with dementia does not necessarily lessen once they are admitted to a nursing home. Best interest decision-making including end-of-life care decisions need to be made and reaching these choices can be challenging. The preparedness of family carers in this role needs greater understanding. DESIGN: Descriptive qualitative study. METHODS: During 2015 twenty semi-structured interviews were conducted of family carers of nursing home residents living with advanced dementia, then analysed using Braun and Clarke's thematic analysis. RESULTS: Three themes were identified: (1) Caring for someone living with dementia. The impact on the carer's holistic well-being and their experience of being a best interest decision-maker; (2) Accessing support. The influential nature of formal and informal networks; (3) Perceived knowledge and understanding of the dementia trajectory of carers and nursing staff. CONCLUSION: The experiences and preparedness of informal carers is a reflection of their personal response, but the distress experienced highlights the significant need of adequate support availability and of enhancing nursing staffs' dementia expertise to maximize their role in facilitating best interest decision-making. This has significant implications for nursing practice and for service user and nursing staff education. Considering the global impact of dementia, our findings have international relevance to similar nursing homes across the world.

The experience of family caregivers caring for a terminal patient at home: A research review.

INTRODUCTION: One of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people's lives, it is necessary to comprehend their personal experience in a holistic way. OBJECTIVE: To reveal the experience of family caregivers who are caring for a terminal patient in their home. DESIGN: A qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them. RESULTS: The analysis permitted the caregivers' experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment. CONCLUSIONS: This review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family caregiver needs and to develop the knowledge necessary to meet the current demands of end-of-life health care in the home.

Observing women caregivers' everyday experiences: new ways of understanding and intervening.

This article discusses the practice implications of videographic research examining the everyday lived experiences of 5 women family caregivers of older adults with chronic illness. The women's nonverbal expressions and gestures revealed how caregiving is accomplished and lived on a daily basis, in particular through emotion and body management, abnegation, and performance. The findings from this microethnographic study suggest that observing women caregivers' everyday experiences can open new avenues for holistic intervention with this population. Observing nonverbal cues can offer a way for practitioners to better understand women caregivers' realities, to question their practice, and to adapt their interventions accordingly.

Newborn care practices at home and in health facilities in 4 regions of Ethiopia.

BACKGROUND: Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. METHODS: We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. RESULTS: The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. CONCLUSIONS: Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be successful, the coverage of counseling delivered by HEWs and other community volunteers should be increased.

Management of skin infections in Pacific children prior to hospitalisation.

INTRODUCTION: Hospital admissions for childhood skin infections in New Zealand (NZ) are on the increase. Pacific children make up a high number of those who are admitted. This study describes the parents of Pacific children's understanding and management of skin sores in the home prior to the sores becoming infected and requiring hospital admission. METHODS: A descriptive qualitative approach combined with the Pacific research frameworks of Fa'afaletui and the Metaphor of Kakala were used to elicit parents' understanding and management of children's skin sores in the home. The semi-structured interviews were conducted in English or Samoan, and all transcribed into English. FINDINGS: Mothers of 11 Pacific children admitted with skin infections between 2006 and 2008 were interviewed. The children's infections started with insect bites in some cases. Parents actively sought treatment to ensure children's optimal health was maintained. Initial management included a 'watch and see' approach for some, until deterioration was noted. CONCLUSION: This is the first known study in New Zealand that has captured children's experiences when sustaining a skin infection/s and the activities that took place while seeking treatment in the community. Although most of the children received medical attention in primary health care (PHC), this did not prevent the need for hospital admission. The acuteness and seriousness of children's health on admission shows that preventive efforts need to increase and the early management of infections in PHC settings needs to be better understood.

La carga del cuidado en cuidadores de niños con enfermedad crónica / Care burden in caregivers of children with chronic disease

Objetivo: explorar el nivel de producción y contenido de la información disponible a nivel mundial sobre la carga del cuidado en cuidadores de niños con enfermedad crónica. Métodos: análisis y categorización de la literatura reportada en las bases de datos CINAHL, Ovid, Scielo, Medline y PsycInfo, bajo los descriptores carga, costo de la enfermedad, cuidador familiar, niñez y enfermedad crónica cruzado con valoración, medición, intervención, atención, modelos y programas, con su traducción al inglés. Resultados: la producción científica sobre carga del cuidado en cuidadores de niños con enfermedad crónica es limitada, con 23 estudios reportados. Se reconoce en los estudios el impacto sobre la calidad de vida en los cuidadores familiares de niños con enfermedad crónica que afecta especialmente los aspectos psicosociales y socioeconómicos. Las mediciones de esta carga son diversas e incluyen entre otros, la situación financiera, la interacción social, la resistencia familiar, la calidad de vida y la satisfacción con el cuidado. Aunque se identifican algunas intervenciones para disminuir la ansiedad, y el estrés de los cuidadores familiares de niños con enfermedad crónica, estas son muy escasas y carecen de un modelo orientador y una medición sistemática. Conclusiones: la carga del cuidado en cuidadores de niños con enfermedad crónica es descrita en la literatura por su impacto en los cuidadores familiares. Esta carga se mide con diversas herramientas que señalan la necesidad de establecer intervenciones integrales. Se requiere avanzar en el desarrollo e implementación de un modelo integral de atención que alivie la carga del cuidado de los cuidadores de niños con enfermedad crónica(AU)

Objetive: to explore the world wide literature advances and content on care burden in caregivers of children with chronic disease (EC). Methods: analysis and categorization of the results of a systematic review on data bases CINAHL, Ovid, Scielo, Medline y PsycInfo, under the key words burden, care cost, disease cost, family caregiver, children, childhood, chronic disease and chronic illness match with the key words assessment, measurement, intervention, care and application. Results: the scientific production about care burden in caregivers of children with chronic disease is limited. Only 23 studies were reported. The studies recognized the impact on the quality of life in the family caregivers of children with chronic disease that affect specially their psychosocial and socioeconomic aspects. Measurements of burden of care are diverse and they include among others the financial situation, the social interaction, the family resistance, the quality of life and the level of satisfaction with the care. Although some interventions devoted to diminish anxiety and stress in children with chronic disease caregivers, these are few in number and they do not have a conceptual framework, nor a systematic measurement. Conclusion: care burden in family caregiving of children with chronic disease has been described in the literature because of its impact in the caregivers. This burden is measure with different tools that point to the importance of establishing holistic interventions. It is required to continue in the development and implementation of a care holistic model that can relief care burden of family caregivers of children with chronic disease(AU)

Children of heroes: Alzheimer's disease--a path toward healing and wholeness for caregivers.

Conventional wisdom postulates that Alzheimer's steals personhood and destroys our opportunities to heal, reconcile, and deepen our relationships with persons who have this disease. In this article, children of Alzheimer's Heroes who have answered the call to love, challenge this conventional wisdom. With clarity, confidence, and courage, we bear witness to the mythic power of Alzheimer's and express gratitude for the surprising gifts that have transformed our lives.

Knowledge, attitude and practice of home management of childhood diarrhoea among caregivers of under-5 children with diarrhoeal disease in Northwestern Nigeria.

OBJECTIVES: Diarrhoeal diseases (DDs) constitute public health problem. Reduction in related mortality and morbidity hinges on active participation of home caregivers. It is pertinent to determine the degree of their empowerment. DESIGN: Cross-sectional study. SETTING: Randomly selected community primary health centres in northwestern Nigerian. SUBJECTS: Home caregivers presenting with children aged 1-59 months having DD. OUTCOME MEASURES: Knowledge, attitude and practice regards home management of DD. RESULTS: Less than 1% of caregivers was knowledgeable about home management of DD. Antibiotics and anti-diarrhoeal agents use was common at 36%. ORS use was abysmally low at 8.6%. Only 32% of caregivers were aware of the use of zinc in the management of DD. Adherence to 10-day zinc supplementation was encouraging at 75.5%. CONCLUSION: There is an urgent need to scale up educational and promotional activities with regards to the home management of DD if the millennium development goals are to be met.

Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: a pilot study.

OBJECTIVE: Oropharyngeal dysphagia is frequent in chronic neurological disorders and increases mortality, mainly due to pulmonary complications. Our aim was to show that submental sensitive transcutaneous electrical stimulation (SSTES) applied during swallowing at home can improve swallowing function in patients with chronic neurological disorders. METHODS: Thirteen patients were recruited for the study (4 f, 68 ± 12 years). They all suffered from neurogenic oropharyngeal dysphagia. We first compared the swallowing of paste and liquid with and without SSTES. Thereafter, the patients were asked to perform SSTES at home with each meal. Swallowing was evaluated before and after six weeks of SSTES using the SWAL-QoL questionnaire. RESULTS: With the stimulator switch turned on, swallowing coordination improved, with a decrease in swallow reaction time for the liquid (P<0.05) and paste boluses (P<0.01). Aspiration scores also decreased significantly with the electrical stimulations (P<0.05), with no change in stasis. At-home compliance was excellent and most patients tolerated the electrical stimulations with no discomfort. A comparison of the SWAL-QoL questionnaires after 6 weeks revealed an improvement in the burden (P=0.001), fatigue (P<0.05), and pharyngeal symptom (P<0.001) scales. CONCLUSION: The present study demonstrated that SSTES is easy to use at home and improves oropharyngeal dysphagia quality of life.

Home-based rehabilitation of severely malnourished children in resource poor setting.

OBJECTIVE: To evaluate the feasibility and outcome of home-based rehabilitation of severely malnourished children. DESIGN: Prospective and observational. SETTING: Rehabilitation at home (16 weeks) following initial assessment or/and stabilization at hospital. PARTICIPANTS: Thirty-four severely malnourished (weight for length < 70% of WHO reference) children between the ages of 6 months to 5 years. INTERVENTION: Initial assessment of the patient was done in hospital. Those with complications or loss of appetite were admitted in hospital and managed as per WHO guidelines. After discharge, they were managed at home using home based diets. Those without complications and with preserved appetite were directly eligible for home-based rehabilitation. Follow up was done in hospital up to 16 weeks. Dietary intake, anthropometry and morbidities were recorded during follow-up. RESULTS: Of the enrolled 34 children, 19 children were admitted in hospital and 15 children were sent home after initial assessment in hospital. Five did not clear the initial stabilization phase (2 died, 3 left hospital). Finally 29 children qualified for home based rehabilitation out of which 26 completed 16 week follow-up. During the home based management phase, the reported mean (±SD) calorie intake increased from 100 (± 5) kcal/kg/d at entry point to 243 (± 13) kcal/kg/d at 16 weeks (P=0.000). Similarly, reported protein intake increased from 1.1 (± 0.3) g/kg/d to 4.8 (± 0.3) g/kg/d (P=0.000). During hospital stay (n=19), children had weight gain of 9.0 (±5.3) g/kg/d, while during home based follow up (n=29), weight gain was 3.2 (± 1.5) g/kg/d only. During home based rehabilitation, only 3 (11.5%) children had weight gain of more than 5 g/kg/d by the end of 16 weeks. Weight for height percent increased from an average (± SD) of 62.9% (± 6.0%) to 80.3% (± 5.7%) after the completion of 16 weeks (P=0.000). Thirteen (45%) children recovered completely from malnutrition achieving a weight for length of >80; % whereas 15 (51.7%) recovered partly achieving weight for length >70;%. There was no death during the home stabilization. CONCLUSION: Home based management using home prepared food and hospital based follow up is associated with sub-optimal and slower recovery.

Efficacy and safety of therapeutic nutrition products for home based therapeutic nutrition for severe acute malnutrition a systematic review.

CONTEXT: Severe acute malnutrition (SAM) in children is a significant public health problem in India with associated increased morbidity and mortality. The current WHO recommendations on management of SAM are based on facility based treatment. Given the large number of children with SAM in India and the involved costs to the care-provider as well as the care-seeker, incorporation of alternative strategies like home based management of uncomplicated SAM is important. The present review assesses (a) the efficacy and safety of home based management of SAM using therapeutic nutrition products or ready to use therapeutic foods (RUTF); and (b) efficacy of these products in comparison with F-100 and home-based diet. EVIDENCE ACQUISITION: Electronic database (Pubmed and Cochrane Controlled Trials Register) were scanned using keywords severe malnutrition, therapy, diet, ready to use foods and RUTF. Bibliographics of identified articles, reviews and books were scanned. The information was extracted from the identified papers and graded according to the CEBM guidelines. RESULTS: Eighteen published papers (2 systematic reviews, 7 controlled trials, 7 observational trials and 2 consensus statements) were identified. Systematic reviews and RCTs showed RUTF to be at least as efficacious as F-100 in increasing weight (WMD=3.0 g/kg/day; 95% CI -1.70, 7.70) and more effective in comparison to home based dietary therapies. Locally made RUTFs were as effective as imported RUTFs (WMD=0.07 g/kg/d; 95% CI=-0.15, 0.29). Data from observational studies showed the energy intake with RUTF to be comparable to F-100. The pooled recovery rate, mortality and default in treatment with RUTF was 88.3%, 0.7% and 3.6%, respectively with a mean weight gain of 3.2 g/kg/day. The two consensus statements supported the use of RUTF for home based management of uncomplicated SAM. CONCLUSIONS: The use of therapeutic nutrition products like RUTF for home based management of uncomplicated SAM appears to be safe and efficacious. However, most of the evidence on this promising strategy has emerged from observational studies conducted in emergency settings in Africa. There is need to generate more robust evidence, design similar products locally and establish their efficacy and cost-effectiveness in a non-emergency setting, particularly in the Indian context.

The lived experience of informal African American male caregivers.

Informal caregivers play a major role in providing care to loved ones within the home and demands for dependent care are likely to increase. Informal caregivers are likely to continue to be responsible for the majority of care for loved ones living well into late stages of life. This article describes the lived experience of African American men providing care to a relative within the home and explores their definition of caregiver distress. The phenomenological study was conducted using face-to-face interviews with 10 Christian African American men. Demographic data about the caregiver and the care recipient were collected. Common themes included: commitment, support (family support and formal health-related support), spirituality, and caregiver burden (stress, time strain and financial strain). Implications include the need for health care providers to expand their knowledge related to the diversity of caregivers and to use culturally relevant comprehensive assessments of caregivers and recipients, discharge planning tools, and community resources.

Use of multisensory environments in the home for people with dementia.

The purpose of this pilot study was to explore the feasibility and effectiveness of using multisensory environments (MSE) in the home of people with dementia. A qualitative research design was used, which included semi-structured interviews and self-rated caregiver observation checklists. Field notes and audio recorded interviews were transcribed for data analysis. Data were reduced and coded for theme identification. Positive and negative effects of the use of MSE in the home on the behaviors of the person with dementia, caregiver burden, and family interpersonal relationships were revealed. Overall, MSE was discovered to promote a relaxing and calm environment in the home, which helped the person with dementia attend more to their immediate surroundings, and to improve family interactions. Although the majority of caregivers reported they enjoyed the MSE, they acknowledged their disappointment in the MSE as not providing more caregiver respite.

La perspectiva comunitaria en la fisioterapia domiciliaria: una revisión / The community approach in home physiotherapy: a review

Introducción: debido a diferentes razones, como los cambios en las estructuras sociodemográficas y familiares, las administraciones de los diferentes estados necesitan reforzar la atención domiciliaria y la fisioterapia domiciliaria. Objetivo: identificar el tipo de estudios relacionados con la fisioterapia domiciliaria, y analizar de qué manera se incluyen los aspectos comunitarios. Metodología: revisión bibliográfica. Resultados: la mayoría de los estudios encontrados sobre la fisioterapia domiciliaria se relacionan con intervenciones con pacientes con afectaciones neurológicas o respiratorias crónicas, musculoesqueléticas o cirugía protésica. De modo muy frecuente, los estudios analizan estrategias que surgen desde hospitales y, en muchos casos, el interés se centra en el coste-beneficio. Los aspectos comunitarios se incluyen como referencias teóricas, y sólo unos pocos estudios tienen esta perspectiva comunitaria durante la intervención de fisioterapia domiciliaria. Discusión: se considera que el domicilio tiene diferentes significados sociales, familiares y culturales para las personas. El domicilio es un entorno comunitario y, desde esta perspectiva, estos significados deberían incluirse al planificar una intervención y analizar sus resultados(AU)

Introduction: due to many reasons as changes in the socio-demografic and familystructures, administrations from different states need to reinforce home care and home physiotherapy.Aim: to identify the type of studies related to home physiotherapy, analysing in what waythe community approach is included.Methodology: bibliographic review.Results: most of the studies founded are related to interventions with patients withneurological or respiratory chronic diseases, musculoesqueletical disorders or jointreplacements. Quite often, the studies analyse strategies that are put forward byhospitals, and in many cases, the interest is focussed on the cost-benefit. The communityaspects are included as theoretical references, and just a few studies have this approachduring home physiotherapy intervention.Discussion: home is considered to have different social, familiar and cultural meanings topeople. Home is a community setting and under this consideration, these meanings shouldbe included when planning an intervention and analysing its results(AU)