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1.
Medicine (Baltimore) ; 99(8): e19229, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080122

RESUMO

OBJECTIVES: The aim of this meta-analysis is to investigate the comparative efficacy between supervised- and home-based programs in patients with ankylosing spondylitis (AS). METHOD: A systematic search in PubMed, Web of Science, EMBASE, and the Cochrane Library was electronically performed by 2 independent investigators in order to capture all potential studies comparing supervised- with home-based in patients with AS from inception to April 2018. After extracted essential information, apprised risk of bias, statistical analysis was performed with Review Manager (RevMan) software (version 5.3.0). The protocol was registered at PROSPERO platform with an identifier of CRD42018097046. RESULTS: A total of 7 studies comprising 271 patients were included finally. Meta-analyses showed that, compared to home-based program, supervised-based program was associated with reduced bath ankylosing spondylitis metrology index (BASMI) scores (mean difference [MD], -0.45; 95% confidence interval [CI], -0.73, -0.17), bath ankylosing spondylitis disease activity index (BASDAI) scores (MD, -0.48; 95% CI, -0.88, -0.08), and bath ankylosing spondylitis functional index (BASFI) scores (MD, -0.78; 95% CI, -1.19, -0.37). However, depression scores (standard mean difference, -0.22; 95% CI, -0.58, 0.14) between the 2 groups showed no significant defference. CONCLUSIONS: Both supervised- and home-based programs can benefit to reduce BASMI, BASDAI, and BASFI scores in AS patients. However, short-term, supervised exercise program may be more effective than home-based exercises at decreasing disease activity with AS.


Assuntos
Terapia por Exercício/métodos , Serviços de Assistência Domiciliar/organização & administração , Espondilite Anquilosante/reabilitação , Ensaios Clínicos como Assunto , Depressão/epidemiologia , Humanos , Índice de Gravidade de Doença , Espondilite Anquilosante/epidemiologia
2.
J Clin Nurs ; 29(1-2): 119-129, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532035

RESUMO

AIMS AND OBJECTIVES: To assess the effectiveness of a specific home care nursing programme in addition to standard care in patients (pts) receiving oral anticancer treatments. BACKGROUND: Oral anticancer therapy present challenges for pts since treatment is a home-based therapy. This study evaluates the potentiality of a home care nursing programme in decreasing hospital accesses for not severe toxicity. METHODS: This is an open-label, multicentre, randomised trial including pts who were receiving an anticancer oral drug. The study complies with the CONSORT checklist published in 2010. Concomitant use of radiation therapy, intravenous or metronomic therapies, or the intake of previous oral drugs was not allowed. Pts were randomly assigned to home care nursing programme (A) or standard care (B). In arm A, dedicated nurses provided information to pts, a daily record on which pts would take note of drugs and dosages and a telephone monitoring during the first two cycles of therapy. The primary outcome was the reduction in improper hospital accesses for grade 1-2 toxicity according to CTCAE v4.0. RESULTS: Out of 432 randomised pts, 378 were analysed (184 pts in arm A and 194 in arm B). Hospital accesses were observed in 41 pts in arm A and in 42 pts in arm B (22.3% vs. 21.6%, respectively). No difference was detected in proportion of improper accesses between arm A and arm B (29.3% vs. 23.8%, respectively). CONCLUSIONS: Our experience failed to support the role of a specific home care nursing programme for pts taking oral chemotherapy. An improved attention to specific educational practice and information offered to pts can explain these results. RELEVANCE TO CLINICAL PRACTICE: Our results underline the role of nurse educational practice and information offered to patients. A careful nurse information of patients about drugs is essential to reduce toxicities avoiding the opportunity of a specific home monitoring.


Assuntos
Antineoplásicos/administração & dosagem , Serviços de Assistência Domiciliar/organização & administração , Neoplasias , Enfermagem Oncológica/organização & administração , Administração Oral , Feminino , Humanos , Itália , Masculino , Oncologia/organização & administração , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/enfermagem , Terapêutica
3.
J Clin Nurs ; 29(1-2): 139-151, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31535417

RESUMO

AIMS AND OBJECTIVES: To explore palliative care nurses' work experiences caring for patients at the end of life in private homes. BACKGROUND: The home continues to be a desired place for care and dying; however, professional competence is needed and specialist palliative care nurses play a crucial role, often highly valued by patients and their family members. The private home as a physical work environment for nurses is explored, with both positive and negative aspects being described. To ensure future high-quality end-of-life care, there is a need to describe how palliative care nurses work in private homes. DESIGN: Interpretative descriptive. METHODS: Participant-generated photographs were used in conjunction with follow-up interviews with ten palliative home care nurses. Interpretive description was used for analysis. This study follows the COREQ checklist. RESULTS: The analysis process resulted in four constructed themes, presented here as strategies used by palliative care nurses: adjusting interactions and actions depending on the environment when entering each unique private home; supporting patients and family members in finding a balance between self-care, independence and safe care; guiding patients and family members towards and through environmental changes supporting end-of-life care at home; and using transitions between homes to reflect, recuperate and prepare. CONCLUSION: Working as a palliative care nurse in private homes clearly requires a variety of skills and competences, here operationalised in different strategies used to promote high-quality care. RELEVANCE TO CLINICAL PRACTICE: Palliative care nurses' considerations, insights and competence when performing end-of-life care in the diverse environments of private homes can contribute to the development of clinical practice. Knowledge about strategies can be used in nursing practice during everyday work, in nursing education and in the organisation of care, and can inform policy to ensure future high-quality palliative home care.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Cuidados Paliativos/métodos , Fotografação , Assistência Terminal/métodos , Adulto , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Relações Enfermeiro-Paciente , Pesquisa Qualitativa
4.
Hu Li Za Zhi ; 66(6): 74-81, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31802457

RESUMO

Taiwan is expected to become a "super-aged" nation in 2065. Modern medical advancements, while extending the average human lifespan, has led to higher incidence of patient suffering and greater medical expenses due to chronic disease and terminal illnesses. As the concept and services of hospice and palliative care have become increasingly accepted by the public, the issue of final care for a good death has become a priority concern for both patients and their families. Experiencing a good death at home is a common last wish for terminal patients. However, guidelines for good death at home are still unavailable in Taiwan. The promotion of this concept thus remains a challenge with many limitations. This article aims to explore: (1) the importance of hospice care; (2) the selection of a proper location for good death; (3) the requirements for nursing education in the care of dying patients; and (4) the challenges and strategies of a good death at home, including "the family dimension-connections with the family members" and "the education dimension-promotion of home-based dying in nursing education". The goal is to help terminal patients experience a good death at home, to assist family members embrace the good death of their loved ones, and, eventually, to facilitate peaceful and successful home-based dying for both the patient and their family members.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Idoso , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Humanos , Taiwan
5.
BMC Health Serv Res ; 19(1): 878, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752869

RESUMO

BACKGROUND: Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve. METHODS: A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation. RESULTS: Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily. CONCLUSION: The CHW's are "dedicated" mental health workers as opposed to being "generalists" and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde , Serviços de Assistência Domiciliar/organização & administração , Serviços de Saúde Mental/organização & administração , Estudos de Tempo e Movimento , Visita Domiciliar/estatística & dados numéricos , Humanos , Índia , Serviços de Saúde Rural/organização & administração , Fluxo de Trabalho
6.
S Afr Med J ; 109(9): 639-644, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31635587

RESUMO

BACKGROUND: Optimal care of patients with inherited bleeding disorders requires that bleeding episodes are treated early, or still better prevented, through extension of patient care beyond hospital-based treatment to home-based therapy. In South Africa (SA), adoption of home therapy is variable, in part owing to lack of consensus among healthcare providers on what constitutes home therapy, which patients should be candidates for it, how it should be monitored, and what the barriers to home therapy are. OBJECTIVES: To conduct a modified Delphi process in order to establish consensus on home therapy among haemophilia healthcare providers in SA. METHODS: Treaters experienced in haemophilia care were invited to participate in a consensus-seeking process conducted in three rounds. In round 1, provisional statements around home therapy were formulated as questions and collated in a structured list. In rounds 2 and 3, evolving versions of the questionnaire were administered to participants. Consensus was defined as ≥70% agreement among the participants. RESULTS: The panel composition included an equal number of physicians and non-physicians. The participation rate was 100% through all three consensus rounds. The group reached consensus for 92% of the statements. Consensus of 100% was reached on starting home therapy in paediatric patients, requiring all patients on home therapy to sign informed consent and indemnity, and providing round-the-clock support for patients on home therapy. CONCLUSIONS: The home therapy consensus statements in this report have the potential to translate to policy on home therapy and to guide the initiation, practice and evaluation of home therapy programmes in SA.


Assuntos
Transtornos Herdados da Coagulação Sanguínea/terapia , Pessoal de Saúde/organização & administração , Hemofilia A/terapia , Serviços de Assistência Domiciliar/organização & administração , Adulto , Criança , Técnica Delfos , Humanos , África do Sul , Inquéritos e Questionários
7.
Rev Infirm ; 68(254): 33-35, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31587850

RESUMO

Many rural areas, far from hospitals, are seeing a decline in the number of general practitioners, making it more difficult for patients in these regions to access care. However, there are relevant solutions, as illustrated by the Dousopal network in Normandy, which, teaming up with home care providers, contributes to organising palliative care support for all, in optimal conditions.


Assuntos
Cuidados Paliativos/organização & administração , Serviços de Saúde Rural/organização & administração , França , Clínicos Gerais/provisão & distribução , Acesso aos Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Humanos
9.
Prof Inferm ; 72(2): 89-99, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31550425

RESUMO

INTRODUCTION: Comparison of the state of nursing in Italy with other countries has shown that theory development in Italian nursing remains quite undeveloped. Theory development in Italian nursing will need to consider local cultural and professional aspects, specific to the Italian practice context, by drawing on known health needs, experiences and nursing approa- ches. The aim of this investigation was to map current knowledge related to nursing in Italy, based on the experiences of patients, families and communities, to provide a basis on which nursing theories could be developed. METHODS: Scoping Review was selected as the best method for this knowledge mapping. Fawcett's nursing metaparadigm was chosen as a broad guide and means by which the litera- ture analysis could be structured. RESULTS: Twenty-two studies were retained and examined in this analysis, including contexts relating to acute care, chronic conditions, as well as emergency and home care services. We defined themes in line with the nursing metaparadigm. Although these definitions are partial, referring only to certain contexts specific to some aspects of nursing care, the original contributions of this investigation provides an important starting point for theory development in Italian nursing, based on the Italian context. CONCLUSION: Strong and credible theory development, that can be readily adapted to practice, requires a rigorous analysis of the points of view of all actors involved in the nursing care process.


Assuntos
Cuidados de Enfermagem/organização & administração , Teoria de Enfermagem , Enfermagem/organização & administração , Cuidadores/psicologia , Serviços de Assistência Domiciliar/organização & administração , Humanos , Itália
10.
Support Care Cancer ; 27(12): 4389-4391, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31511982

RESUMO

BACKGROUND: Currently the entire treatment of a child with cancer is carried out in a specialized hospital. It would be ideal to conduct part of the treatment at home. This can only be done with adequately trained personnel. In the Netherlands, specialized pediatric oncology home care nurse practitioners have been trained to deliver this kind of care. Therefore, a pilot study was conducted to administer intravenous chemotherapy at home. PURPOSE: This study aimed to safely administer chemotherapy intravenously (iv) at home by specialized nurse practitioners and aimed to increase the quality of life (QOL) of the child and decrease the social burden in families with a child with acute lymphoblastic leukemia (ALL). METHOD: The pilot study was performed by well-trained home care nurse practitioners. Low-dose methotrexate iv and low-dose cytarabine iv were administered to 11 included children with ALL in their home environment. RESULTS: QOL increased whereas social burden decreased for patients and parents. Chemotherapy administration in the home environment was safe with the help of well-trained nurse practitioners. CONCLUSION: It is feasible to administer intravenous chemotherapy at home in a safe and efficient way. The role of the specialized pediatric oncology nurse practitioner is an essential one.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Serviços de Assistência Domiciliar/organização & administração , Profissionais de Enfermagem , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/enfermagem , Administração Intravenosa , Antimetabólitos Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Citarabina/administração & dosagem , Citarabina/efeitos adversos , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Masculino , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Países Baixos , Projetos Piloto , Qualidade de Vida
11.
Home Healthc Now ; 37(5): 285-291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31483361

RESUMO

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Habitação Popular/organização & administração , Reforma Urbana/organização & administração , Humanos , Entrevistas como Assunto , Modelos Organizacionais , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Serviços Urbanos de Saúde/organização & administração
12.
BMC Palliat Care ; 18(1): 66, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387564

RESUMO

BACKGROUND: According to the World Health Organization, palliative care is one of the main components of healthcare. As the incidence of cancer is increasing in the world, home-based palliative care can be beneficial for many patients. This study was designed to explore health care providers' perceptions about home-based palliative care in terminally ill cancer patients. METHODS: This qualitative study was carried out using the conventional content analysis from October 2016 to September 2018 in Iran. Participants were home care providers who were selected using purposive sampling. The data were collected through 18 individual interviews, and a focus group meeting. Data were analyzed based on the method proposed by Lundman and Graneheim. RESULTS: from the data analysis, 511 initial codes were extracted, which were categorized into the two main categories of challenges and opportunities for home-based palliative care and 10 subcategories. The subcategories of challenges included deficiencies in inter-sectoral and inter-professional cooperation, lack of infrastructures for end-of-life care, challenges related to the management of death, challenges of transferring patients to home, providing non-academic palliative care, lack of political commitment of the government and Spiritual vacuum. The category of opportunities included subcategories of cost-effectiveness, moving towards socializing health, and structure of the health system. CONCLUSIONS: Home-based palliative care requires government and health system support. Structural and process modification in the healthcare can provide conditions in which terminally ill cancer patients receive appropriate care in home and experience death with dignity through support of family, friends and healthcare.


Assuntos
Pessoal de Saúde/psicologia , Serviços de Assistência Domiciliar/normas , Cuidados Paliativos/normas , Percepção , Adulto , Idoso , Feminino , Grupos Focais , Pessoal de Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Pesquisa Qualitativa , Doente Terminal/psicologia
14.
Int J Qual Stud Health Well-being ; 14(1): 1658333, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31451098

RESUMO

Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home.


Assuntos
Serviços de Saúde para Idosos/organização & administração , Envelhecimento Saudável/psicologia , Serviços de Assistência Domiciliar/organização & administração , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Grupos Focais , Teoria Fundamentada , Humanos , Masculino
15.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31467245

RESUMO

BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) often require pediatric home health care (PHHC) to meet their daily intensive care needs. Pediatricians are central to planning, implementing, and maintaining quality PHHC for CMC, yet a comprehensive road map for this process is lacking. With this national study, we aim to fill that gap. METHODS: Semistructured interviews were conducted with parents and professionals from the 10 US Health Resources and Services Administration regions. Parents were recruited via advocacy groups for families of CMC; professionals with experience with PHHC for CMC were identified by using purposive and snowball sampling. Interview transcripts were qualitatively analyzed for themes. RESULTS: A comprehensive process of prescribing, providing, and maintaining PHHC requires 5 steps: identifying needs, investigating options, developing plans of care, initiating services, and navigating evolving needs. The success of the PHHC process is built on knowledge, anticipation, and early identification of needs; communication; care-coordination infrastructure; skilled home health providers; and the parent-provider relationship. CONCLUSIONS: Many CMC require PHHC to live safely outside of the hospital. Although the PHHC process involves multiple steps and participants, pediatricians' understanding of the process is the foundation of PHHC success. Fostering interagency relationships, increasing longitudinal care coordination, and investing in the PHHC infrastructure may reduce the burden placed on families and CMC as they navigate the complex process of PHHC.


Assuntos
Serviços de Saúde da Criança/organização & administração , Doença Crônica/terapia , Serviços de Assistência Domiciliar/organização & administração , Pediatras , Papel do Médico , Criança , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Multimorbidade , Pais , Relações Médico-Paciente , Pesquisa Qualitativa , Participação dos Interessados
16.
N Z Med J ; 132(1501): 21-32, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465324

RESUMO

AIM: Outpatient parenteral antimicrobial therapy (OPAT) has become an established option for management infections requiring intravenous therapy. As the uptake of OPAT has increased, the clinical governance has changed and is now managed via virtual clinics and increased use of district nurses in addition to specialist outpatient review. The aim of this study was to report the characteristics, diagnoses, treatment and outcomes of patients managed by the service over 12 months in 2015/6 and compared these features with those of patients treated with OPAT in 1999. METHODS: Cases for 2015/6 were identified from the OPAT service database which records prospectively all information on diagnosis, antibiotic choice and duration of treatment, complications and requirement for review by the ID physicians and OPAT nurses prospectively. The outcomes, complications and readmissions were found by reviewing computerised records of Christchurch Hospital. All results were entered into a Microsoft® Excel database for analysis. Statistical analyses were performed using OpenEpi software. Data for 1999 was taken from an earlier publication. RESULTS: OPAT treatment in 12 months from 1 July 2015 was administered 407 times to 385 patients, which represented a 2.7 times increase in treatment courses than in 1999. The median age was 55 years in 1999 and 61 in 2015/6. There was a substantial increase in the proportion of bone and joint, abdominal and urinary tract infections but a fall in cellulitis and soft tissue infection. The number and proportion of patients treated with broad spectrum agents including piperacillin + tazobactam, ceftriaxone and carbapenems increased from 1% in 1999 to 20% in 2015/6. Unplanned readmission to hospital increased from 15 (10%) in 1999 to 62 patients (15%) in 2015/6. The most common reason for readmission in 2015/6 was for ongoing symptoms or progression of the infection requiring OPAT. Eight patients (2%) required readmission from adverse reactions to antimicrobial therapy. Two patients on palliative care died while on OPAT and 35 (9%) within 12 months of the index admission. CONCLUSION: OPAT use has increased and is used to treat patients with comorbidities, who are older, and with a different case-mix than 1999. Safety has not been compromised but the risk of treatment failure has increased. A better understanding of the reasons for treatment failure would improve patient selection and management with OPAT.


Assuntos
Assistência Ambulatorial , Anti-Infecciosos , Doenças Ósseas Infecciosas/tratamento farmacológico , Supervisão de Enfermagem/organização & administração , Dermatopatias Infecciosas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Assistência ao Convalescente/métodos , Idoso , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/classificação , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Readmissão do Paciente/estatística & dados numéricos , Autoadministração/métodos , Resultado do Tratamento
17.
Neonatal Netw ; 38(2): 69-79, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470369

RESUMO

PURPOSE: The transition from the NICU to home is a complicated, challenging process for mothers of infants dependent on lifesaving medical technology, such as feeding tubes, supplemental oxygen, tracheostomies, and mechanical ventilation. The study purpose was to explore how these mothers perceive their transition experiences just prior to and during the first three months after initial NICU discharge. DESIGN: A qualitative, descriptive, longitudinal design was employed. SAMPLE: Nineteen mothers of infants dependent on lifesaving technology were recruited from a large Midwest NICU. MAIN OUTCOME VARIABLE: Description of mothers' transition experience. RESULTS: Three themes were identified pretransition: negative emotions, positive cognitive-behavioral efforts, and preparation for life at home. Two posttransition themes were negative and positive transition experiences. Throughout the transition, the mothers expressed heightened anxiety, fear, and stress about life-threatening situations that did not abate over time despite the discharge education received.


Assuntos
Serviços de Assistência Domiciliar/organização & administração , Cuidados para Prolongar a Vida , Mães/psicologia , Alta do Paciente , Adulto , Tecnologia Biomédica/instrumentação , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Cuidados para Prolongar a Vida/métodos , Cuidados para Prolongar a Vida/organização & administração , Cuidados para Prolongar a Vida/psicologia , Estudos Longitudinais , Papel do Profissional de Enfermagem , Pesquisa Qualitativa , Percepção Social , Cuidado Transicional/organização & administração
18.
BMC Public Health ; 19(1): 912, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288792

RESUMO

BACKGROUND: Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS: The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS: When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS: This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.


Assuntos
Asma/etnologia , Hispano-Americanos/educação , Serviços de Assistência Domiciliar/organização & administração , Educação de Pacientes como Assunto/métodos , Adolescente , Criança , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Masculino , México , Áreas de Pobreza , Avaliação de Programas e Projetos de Saúde , Texas
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