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4.
Home Healthc Now ; 37(2): 88-96, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829786

RESUMO

Traditional home healthcare reimbursement models emphasize intervention after a medical or functional issue occurs, and there is little evidence of preventative home-based physical therapy services for those at highest risk of becoming homebound due to illness, injury, or functional limitation. The purpose of this study was to describe the development and initial pilot results of the Home-based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) Program. The prospective observational pilot study included five participants referred from a community center. The HOP-UP-PT Program utilized fall risk, functional, environmental, cognitive, and health-related assessments. Two males and three females aged 73 to 92 years were enrolled. Outcomes suggest that health, functional, and environmental benefits may be achieved when an older person participates in the HOP-UP-PT Program. Safety and health benefits gained by two individuals referred to the program, but who did not meet inclusion criteria, are also reported. Evidence emerging from this pilot study suggests trends toward improved functional outcomes associated with reduced fall risk and customized home-based safety recommendations among older adults participating in the HOP-UP-PT Program.


Assuntos
Terapia por Exercício/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Pacientes Domiciliares/reabilitação , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/organização & administração , Feminino , Avaliação Geriátrica , Humanos , Masculino , Prática Associada/organização & administração , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos , Ferimentos e Lesões/prevenção & controle
6.
Home Healthc Now ; 37(1): 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608467

RESUMO

The ability to maintain functional status is an essential aspect of self-care for older adults. Instrumental activities of daily living (IADLs) decline within hours of hospitalization and are often overlooked, underassessed, and underreported. The aim of this integrative review was to examine and compare methods used to assess IADLs to determine the best measure for use across the care continuum, especially during transitions of care. A literature search without date restrictions was conducted using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Embase databases. Twelve studies of moderate quality were included in this review. More than half (58%) of the studies utilized the Lawton and Brody Scale to measure IADL among home-based and hospitalized patients. Implementation of this scale as standard practice and sharing the results with healthcare providers would encourage continuity of care with the goal of supporting older adults aging in place and preventing rehospitalization. In turn, this communication process may improve the transition from the inpatient to home setting, where, since 1999, the Outcome and Assessment Information Set has been mandated.


Assuntos
Atividades Cotidianas , Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Idoso , Serviços de Saúde para Idosos/organização & administração , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Humanos , Masculino
7.
Health Care Manag Sci ; 22(1): 140-155, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29305681

RESUMO

The importance of home healthcare is growing rapidly since populations of developed and even developing countries are getting older and the number of hospitals, retirement homes, and medical staff do not increase at the same rate. We consider the Home Healthcare Nurse Scheduling Problem where patients arrive dynamically over time and acceptance and appointment time decisions have to be made as soon as patients arrive. The objective is to maximise the average number of daily visits for a single nurse. For the sake of service continuity, patients have to be visited at the same day and time each week during their episode of care. We propose a new heuristic based on generating several scenarios which include randomly generated and actual requests in the schedule, scheduling new customers with a simple but fast heuristic, and analysing results to decide whether to accept the new patient and at which appointment day/time. We compare our approach with two greedy heuristics from the literature, and empirically demonstrate that it achieves significantly better results compared to these other two methods.


Assuntos
Agendamento de Consultas , Enfermagem Domiciliar/organização & administração , Custos de Cuidados de Saúde/estatística & dados numéricos , Heurística , Enfermagem Domiciliar/economia , Enfermagem Domiciliar/estatística & dados numéricos , Humanos , Fatores de Tempo
8.
Acta Clin Belg ; 74(5): 326-333, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30235081

RESUMO

Background and objective: An accurate medication scheme may be a useful tool to improve medication safety in primary care. This study aimed to identify (1) pharmacists' alterations to nurse medication schemes and (2) potential improvements to the contribution of the community pharmacist to a shared medication scheme within a multidisciplinary collaboration. Dosing frequency, potentially incorrect moments of intake, drug-drug interactions and medication complexity (quantified by the Medication Regimen Complexity Index, MRCI) were investigated. Setting and method: Observational study in community dwelling older patients (≥70 years) with polypharmacy receiving home health care (i.e. medications being prepared and/or administered by home care nurses). Home care nurses provided the community pharmacist with the original medication scheme ('nurse medication scheme'), subsequently the community pharmacist generated a standardized 'pharmacist medication scheme' which was uploaded on an electronic health platform (Vitalink). The researcher recorded all pharmacists' alterations and looked for possible additional improvements ('researcher medication scheme'). Results: Pharmacists made 482 alterations to the nurse medication schemes of 31 patients. Most important alterations included adding indication (61%), generic or brand name (18%) and moment of intake (9%). Pharmacists did not reduce dosing frequency. MRCI scores (median [IQR]) significantly differed between pharmacist (38 [15]) and nurse medication schemes (32 [11]) (p < 0.001) and between nurse (32 [11]) and researcher medication schemes (40 [15]) (p < 0.001). Conclusion: Alterations made by the community pharmacists enable more complete and accurate medication schemes; however, there is room for improvement in optimizing the patient's medication scheme in a multidisciplinary collaboration.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Assistência à Saúde/organização & administração , Enfermagem Domiciliar/organização & administração , Polimedicação , Papel Profissional , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Estudos Transversais , Assistência à Saúde/métodos , Feminino , Humanos , Vida Independente , Masculino , Equipe de Assistência ao Paciente , Farmacêuticos
10.
Nurse Educ Pract ; 30: 48-55, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29550503

RESUMO

Home-dwelling rehabilitation has expanded in the last years in Norway. The goal is to strengthen self-care for those who have suffered acute impairment or has due to chronic diseases. The purpose of this study was to explore whether nursing students in home-based nursing care (HBNC) can contribute to patients' rehabilitation and mastery work during clinical placement. The study considered 121 undergraduate nursing students' HBNC clinical placements where they, in collaboration with patients, have designed and applied a rehabilitation plan. The duration of the clinical placements were 8 weeks and took place in the municipality of Oslo. Prior to the clinic placement, the students have followed an introductory course rehabilitation plan development. During the initial phase of the placement, the students an eight-step model for mapping the patient's values: 1) home, 2) close relatives, 3) physical activities, 4) friends, 5) job, 6) leisure activities, 7) body and appearance, and 8) spiritual and philosophical values. The students scaled the intensity of each value on a scale from 1 to 10. Through their clinical training a teacher and clinical supervisors have coached the students. The clinical placements have been followed by a written exam. Based on patients' values and resources, the students coached patients in self-care activities that brought the patients closer to their targets, whether it was on an activation or a participation level. The principal finding of this study was that the students in HBNC were adequately prepared to plan and carry out rehabilitation activities with patients.


Assuntos
Competência Clínica , Enfermagem Domiciliar/educação , Enfermagem em Reabilitação/educação , Estudantes de Enfermagem/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacharelado em Enfermagem , Feminino , Enfermagem Domiciliar/organização & administração , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Noruega , Relações Enfermeiro-Paciente , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Enfermagem em Reabilitação/organização & administração , Estudantes de Enfermagem/estatística & dados numéricos , Adulto Jovem
11.
Home Healthc Now ; 36(1): 10-19, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29298192

RESUMO

In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Comunicação Interdisciplinar , Reconciliação de Medicamentos/organização & administração , Relações Médico-Enfermeiro , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Adesão à Medicação , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Medição de Risco , Estados Unidos
12.
Home Healthc Now ; 36(1): 20-28, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29298193

RESUMO

This chapter is an excerpt from Home Care Nursing: Surviving in an Ever-Changing Care published by Sigma Theta Tau International (Marrelli and Associates, Inc., 2017) and has been significantly condensed for purpose of publication in Home Healthcare Now. For more information about this book, Home Care Nursing: Surviving in an Ever-Changing Care Environment. Please visit Nursing Knowledge International at https://www.nursingknowledge.org/home-care-nursing-surviving-in-an-ever-changing-care-environment.html.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Liderança , Seleção de Pessoal/organização & administração , Competência Profissional , Escolha da Profissão , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Supervisão de Enfermagem , Inovação Organizacional , Gestão da Qualidade Total , Estados Unidos
13.
Home Healthc Now ; 36(1): 43-49, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29298196

RESUMO

Clinical management of patients with an ostomy can be complex and stressful. With only 10% of Wound Ostomy Incontinence Nurses working in home health, home healthcare nurses need to be knowledgeable about care of patients with new ostomies. This article provides an overview of the resources available to guide nurses caring for ostomy patients. In addition, resources nurses can share with patients as they transition into the community are provided.


Assuntos
Serviços de Assistência Domiciliar/economia , Enfermagem Domiciliar/economia , Estomia/enfermagem , Transferência de Pacientes/economia , Autocuidado/economia , Feminino , Guias como Assunto , Recursos em Saúde/economia , Serviços de Assistência Domiciliar/organização & administração , Enfermagem Domiciliar/organização & administração , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Estomia/economia , Transferência de Pacientes/organização & administração , Autocuidado/métodos , Estados Unidos
15.
Home Healthc Now ; 35(9): 494-506, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28953540

RESUMO

Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.


Assuntos
Enfermagem Domiciliar/normas , Guias de Prática Clínica como Assunto , Competência Clínica/normas , Enfermagem Domiciliar/métodos , Enfermagem Domiciliar/organização & administração , Humanos , Cooperação Internacional , Guias de Prática Clínica como Assunto/normas
20.
Index enferm ; 26(3): 210-214, jul.-sept. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168621

RESUMO

Introducción: El trabajo que se presenta tiene como objetivo profundizar en el conocimiento de la situación de fragilidad y vulnerabilidad de las personas atendidas en su hogar por el Servicio de Ayuda a Domicilio en Andalucía (SAD), para mejorar las intervenciones que se realizan y detectar posibles necesidades no cubiertas. Metodología: Se han recogido datos de una muestra representativa de 391 personas mayores a través de un cuestionario elaborado para este estudio. Se han incluido variables sociodemográficas, apoyo familiar, problemas de salud, necesidades atendidas y no atendidas y entorno. Resultados: El perfil de usuario del SAD es mujer, de 81 años, con bajo nivel educativo cuya fuente principal de ingresos es una pensión. Vive con su cónyuge en un domicilio que tiene algunos problemas de accesibilidad y utiliza dispositivos de apoyo para la movilidad. Presenta problemas de salud crónicos y tiene un sentimiento de soledad. Conclusiones: A pesar de que el SAD cubre múltiples necesidades que tienen las personas mayores, se han detectado una serie de lagunas en algunas áreas y necesidades de mejora en la coordinación entre el ámbito sanitario y social


Introduction: The work presented aims to deepen the understanding of the situation of fragility and vulnerability of the person cared for in home help service in Andalusia, to improve interventions carried out and to detect possible needs not covered. Methods: We have collected data from a representative sample of 391 older people through a questionnaire developed for this study. We have included socio-demographic variables, support family, problems of health, served and unmet needs and environment. Results: The user profile of home help service is as follows: woman, 81 years, with low level of education whose main source of income is a pension. She lives with her spouse in a domicile, with some problems of accessibility and she uses assistive mobility devices. She has chronic health problems and has a feeling of loneliness. Conclusions: While the home help service covers a multiple needs of older persons, they have been detected a number of gaps in some areas and needs for improvement in the coordination between the health and social fields


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Enfermagem Domiciliar/organização & administração , Serviços de Assistência Domiciliar , Assistência à Saúde , Assistência à Saúde/organização & administração , Estudos Transversais/métodos , Planejamento em Saúde/métodos
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