Cuidando en el hogar a una persona con enfermedad cerebrovascular:del desconocimiento a la satisfacción / Cuidando de uma pessoa com doença cerebrovascular em casa: da ignorância àsatisfação / Caring a Person with Cerebrovascular disease at home: from the lack knowledge to satisfaction

Introduction: cerebrovascular diseases generate disability and dependence. It is the familycaregiver who assumes responsibility for the daily care of the patient with sequelae of this disease.Assuming this new role is not an easy activity and requires preparation and accompaniment.295Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62Objective: to know the experience of the family caregiver when they first take care of a personwith sequelae of a stroke at home. Methodology: qualitative study with a grounded theoryapproach. 16 family caregivers participated. The information was collected through semistructured interviews. The data analysis was done with initial, focused, axial and theoreticalcoding. Results: five categories were identified: Taking care of my family: a new experience,Changing the environment: making the experience easier, Support from others: feeling companyin care, Feeling satisfaction: the result of care well done and Living care: between fear, faith andlove. The central category was called Caring at home: from lack of knowledge to satisfaction.Conclusions: the experience of caring for the first time represents a challenge for the familycaregiver to create new strategies that favor caring for the person. Nursing professionals have theresponsibility of designing nursing interventions that meet the specific needs of this population.

Introducción: las enfermedades cerebrovasculares generan discapacidad y dependencia. Es elcuidador familiar quien asume la responsabilidad del cuidado diario de la persona con secuelasde esta enfermedad. El asumir este nuevo rol no es una actividad sencilla y requiere de preparacióny acompañamiento. Objetivo: comprender la experiencia del cuidador familiar cuando asume porprimera vez el cuidado en el hogar de una persona con secuelas de un accidente cerebrovascular.Metodología: estudio cualitativo con enfoque de teoría fundamentada. Participaron 16 cuidadoresfamiliares. Se recolectó la información por entrevistas semiestructuradas. El análisis de los datosse hizo con codificación inicial, focalizada, axial y teórica. Resultados: se identificaron cincocategorías: Asumiendo el cuidado de mi familiar: una nueva experiencia, Cambiando el entorno:haciendo más fácil la experiencia, El apoyo de otros: sintiendo compañía en el cuidado, Sintiendosatisfacción: el resultado de un cuidado bien hecho y Viviendo el cuidado: entre el miedo, la fe yel amor. La categoría central se denominó Cuidando en el hogar: desde la falta de conocimientoa la satisfacción. Conclusiones: la experiencia de cuidar por primera vez representa para elcuidador familiar un reto para crear nuevas estrategias que favorezcan el cuidado de la persona.Los profesionales de enfermería tienen la responsabilidad de diseñar intervenciones de enfermeríaque atiendan las necesidades específicas de esta población.

Introdução: as doenças cerebrovasculares geram incapacidade e dependência. É ocuidador familiar que assume a responsabilidade pelo cuidado diário ao pessoa comsequelas desta doença. Assumir este novo papel não é uma atividade fácil e requerpreparação e acompanhamento. Objetivo: conhecer a vivência do cuidador familiar aocuidar pela primeira vez de uma pessoa com sequela de AVE no domicílio. Metodologia:estudo qualitativo com abordagem teórica fundamentada. Participaram 16 cuidadoresfamiliares. As informações foram coletadas por meio de entrevistas semiestruturadas. A análisedos dados foi realizada com codificação inicial, focada, axial e teórica. Resultados: foramidentificadas cinco categorias: Cuidar do meu familiar: uma nova experiência, Mudar o ambiente:296Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62tornar a experiência mais fácil, O apoio dos outros: sentir-se companhia no cuidado, Sentir-sesatisfeito: o resultado de um cuidado bem feito , Viver o cuidado: entre o medo, a fé e o amor.Conclusões: a experiência de cuidar pela primeira vez representa um desafio para o cuidadorfamiliar criar novas estratégias que favoreçam o cuidar da pessoa. Os profissionais deenfermagem têm a responsabilidade de projetar intervenções de enfermagem que atendam àsnecessidades específicas desta população.

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.

Enabling and constraining successful reablement: Individual and neighbourhood factors.

Using multilevel logistic regression to analyse management data of reablement episodes collected by Essex County Council, a UK local authority, this article identifies constraining and enabling factors for successful reablement. Overall, 59.5% of reablement clients were classed as able to care for themselves when assessed after 13 weeks following the reablement intervention (N = 8,118). Several age-related, disability, referral, and social factors were found to constrain reablement, but some of the largest constraining effects were neighbourhood deprivation as measured through the Index of Multiple Deprivation and, particularly, unfavourable geodemographic profiles as measured through Experian Mosaic consumer classifications. The results suggest that in order to optimise reablement, programmes should consider broader social and environmental influences on reablement rather than only individual and organisational aspects. Reablement might also be better tailored and intensified for client groups with particular underlying disabilities and for those displaying specific geodemographic characteristics.

Caregiver and Provider Experiences of Home Healthcare Quality for Children With Medical Complexity.

Despite a growing population of children with medical complexity, little is known about the current quality of pediatric home healthcare. The objective of this study was to characterize the quality of pediatric home healthcare experienced by primary family caregivers (parents) and healthcare providers of children with medical complexity. Semistructured, in-depth key informant interviews of 20 caregivers and 20 providers were conducted and analyzed for factors affecting home healthcare quality using the Institute of Medicine's quality framework (effective, safe, patient-centered, timely, equitable, and efficient). System complexity, insurance denials, and workforce shortages affected patients' ability to establish and maintain access to home healthcare leading to hospital discharge delays and negative family impacts. When home healthcare was accessible, respondents experienced it as effective in improving patient and family daily life and minimizing use of emergency and hospital services. However, respondents identified a need for more pediatric-specific home healthcare training and increased efficiencies in care plan communication. Overall, home healthcare was not perceived as timely or equitable due to access barriers. This study provides a new conceptual framework representing the relationship between home healthcare quality and outcomes for children with medical complexity for future evaluations of quality improvement, research, and policy initiatives.

Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint.

Digital health tools and technologies are transforming health care and making significant impacts on how health and care information are collected, used, and shared to achieve best outcomes. As most of the efforts are still focused on clinical settings, the wealth of health information generated outside of clinical settings is not being fully tapped. This is especially true for children with medical complexity (CMC) and their families, as they frequently spend significant hours providing hands-on medical care within the home setting and coordinating activities among multiple providers and other caregivers. In this paper, a multidisciplinary team of stakeholders discusses the value of health information generated at home, how technology can enhance care coordination, and challenges of technology adoption from a patient-centered perspective. Voice interactive technology has been identified to have the potential to transform care coordination for CMC. This paper shares opinions on the promises, limitations, recommended approaches, and challenges of adopting voice technology in health care, especially for the targeted patient population of CMC.

Nursing impact on chronic disease Medicaid health home patients: A qualitative study.

BACKGROUND: Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the US health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. The Affordable Care Act provides opportunities to launch chronic disease Medicaid health homes (MHH) to address the existing health care gaps. Within a multidisciplinary team, the nurse serves an integral role as the main care manager and coordinator aimed to improve patient experiences, health outcomes, and lowering health care costs. AIMS: The aim of this qualitative study is to assess the nurse's perception of their MHH role and how they may impact patient health care utilization patterns. MATERIALS & METHODS: The qualitative study included a focus group of eleven nurses and individual interviews with seven nurses. RESULTS: Six themes were identified that focus on how nurses can use a wide range of effective communication strategies and interpersonal skills to establish and maintain a nurse-patient relationship. DISCUSSION: The six themes provided insight as to nurses' perceived role in an MHH and how they impact patient health outcomes. The overarching message addressed connecting with the patient and taking the time to find out what was important to them. CONCLUSION: Nurses were able to impact patient health care utilization patterns.

Home Care Nurses' Perspectives Regarding Health Information Management Among Older Adults.

Aging is associated with comorbidities and increased utilization of healthcare services, which results in a large amount of personal health information (PHI) to manage. Older adults often have difficulty managing this increased load of health information. Although many home healthcare nurses (HCNs) provide assistance to older adults after discharge from medical facilities, little is known about HCNs' experiences with older adults regarding the management and transfer of PHI in their homes. The purpose of this qualitative study was to 1) determine how HCNs obtain and provide health information, 2) describe the perspective of HCNs regarding older adult PHI, and 3) identify the potential role of technology in older adult health information transfer. We conducted and analyzed semistructured phone interviews with 17 HCNs from two home healthcare agencies. Five thematic areas emerged from interviews with HCNs: 1) common practices of obtaining health information; 2) barriers to obtaining health information; 3) ideal ways to obtain and provide health information; 4) use of patient portals; and 5) HCNs' use of technology for health information exchange. Most HCNs reported that it would be difficult for older adult patients to update their PHI without assistance, but HCNs lack the time and resources to assist older adults in PHI management activities.

Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care.

Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.

Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?

BACKGROUND: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. OBJECTIVE: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors. DESIGN: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis. SUBJECTS: Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care. MEASURES: The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission. RESULTS: Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12). CONCLUSIONS: Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.

Supporting older people with multimorbidity: The care burden of home health-care assistants in Ireland.

The treatment burden inherent in self-managing multiple chronic conditions (multimorbidity) is recognized, but there has been little examination of the care burden experienced by paid home health-care assistants (HCAs) who support older people with multimorbidity. Focus groups were conducted with HCAs in Ireland and data were coded using a thematic analysis approach. Care burden of HCAs was linked with lack of knowledge and information, poor communication, insufficient time and resources, gaps in medication support and work-related stress. Strategies are required to reduce the care burden of HCAs, who are essential stakeholders supporting growing numbers of older people with multimorbidity.

Colostomy Care: A Guide for Home Care Clinicians.

Surgical creation of a colostomy can have significant physical, emotional, and social effects. Adapting to a new ostomy can be overwhelming and interventions aimed at decreasing barriers to self-care should be a priority for home care patients. Advances in surgical procedures, coupled with decreased length of hospital stays, require home care clinicians to have the skills and knowledge to care for this population through postoperative recovery and the initial phases of learning self-care. This article will focus on the care of patients with a colostomy in the home care setting.

Home Healthcare Nurses' Attitudes, Confidence, and Engagement in Evidence-Based Practice.

Evidence-based practice (EBP) is becoming standard in today's healthcare arena and home care organizations are not exempt from integrating evidence into practice to improve patient outcomes. There is a scarcity of research literature that examines the behaviors and attitudes of home healthcare nurses (HHNs) regarding EBP. In this study, a descriptive survey design was used to investigate HHNs' a) information-seeking behaviors when providing nursing care, b) administrative support for EBP (as perceived by HHNs), c) attitudes toward EBP, and d) EBP engagement and confidence in providing EBP nursing care. Self-reported data were collected by internet and paper survey. The survey consisted of a 65-item questionnaire that included the Nurses' Attitudes Toward Evidence-Based Practice Scale, which has previously established validity and reliability. A convenience sample of 95 HHNs participated in the study. Results suggest HHNs' EBP attitudes are positive. A positive and significant relationship was found between attitudes and hours worked (r = 0.21, p = 0.047) and educational level (r = 0.45, p = 0.0001); 95% confidence level. Confidence levels in providing EBP care were moderate, and HHNs did not perceive EBP as an agency priority. HHNs need to be supported and encouraged in the facilitation of EBP, a task made easier when they are knowledgeable about EBP, have confidence in their EBP skills, and have the support of their organizations.

Safe Medication Disposal.

Safe disposal of expired or unused medications is essential for individual and environmental safety, yet many patients report not having received education on proper medication disposal. Unused medications in homes and improper medication disposal create various risks including intentional or accidental misuse, overdose, addiction in humans, as well as toxic effects in pets. As part of their community health clinical experience, senior nursing students from the University of Pennsylvania School of Nursing visited patients of a large home care and hospice agency in a Philadelphia suburb throughout the semester. A survey conducted with a small number (N = 15) of home care patients suggested the majority of patients had inadequate knowledge about safe medication disposal. The nursing students created and presented a tip sheet on safe medication disposal and a list of local prescription medication disposal sites to home care patients. They also obtained and provided medication disposal bags for patients and caregivers who were unable to get to medication disposal sites.

Ensuring Safety When Pets Are in the Home.

This article discusses safety issues involved when home healthcare clinicians visit the homes of patients with pets, particularly cats and dogs. Threats to the safety of home care clinicians are explored and concerns such as animal bites, animal scratches, and infection control are detailed in this article. Although it is acknowledged that pets can provide positive health benefits to owners, the focus is on the responsibility of the pet owners to secure pets when clinicians visit in order to keep the clinician and patient safe during the home visit. A proposed Pet Policy Agreement is presented whereby the pet owner as patient bears some responsibility for ensuring the safety of home healthcare clinicians.

Conceptualisations on home care for pressure ulcers in Spain: perspectives of patients and their caregivers.

BACKGROUND: Pressure ulcers represent an important worldwide public health problem, which substantially decrease the quality of life of those affected. Yet, few studies to date have analysed the perceptions regarding home care for pressure ulcers. AIMS: To explore the conceptualisations regarding home care of pressure ulcers from the perspective of affected patients and their caregivers. METHODS: A qualitative study design based on Grounded Theory. In-depth interviews were conducted on a theoretical sample of 10 people currently suffering from a pressure ulcer, or who had experienced one in the past, and 15 caregivers of patients who had suffered from this pathology, all of whom came from the four health districts of Puertollano (Ciudad Real, Spain). FINDINGS: Two categories emerged to explain the conceptualisations regarding pressure ulcers: (a) Cause of the pressure ulcer with three subcategories (unavoidable injuries, caregiver's lack of knowledge and painful wounds) and (b) Preferences regarding caring for pressure ulcers with two subcategories (home care as the best approach to treatment and noninstitutionalisation). CONCLUSIONS: This research provides a novel perspective on the specific problems surrounding home care for pressure ulcers, including the perceptions of both patients and their caregivers. It is important to give a voice to patients and their caregivers as this will help understand their needs and improve the care provided. Further studies are required to improve current treatment protocols and clinical practice guidelines for the prevention and treatment of this pathology.