logo logo
The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping. BMC health services research BACKGROUND:Care transitions have a significant impact on patient health outcomes and care experience. However, there is limited research on how clients receiving care in the home care sector experience the hospital-to-home transition. An essential strategy for improving client care and experience is through client engagement efforts. The study's aim was to provide insight into the care transition experiences and perspectives of home care clients and caregivers of those receiving home care who experienced a hospital admission and returned to home care services by thematically and illustratively mapping their collective journey. METHODS:This study applied a qualitative descriptive exploratory design using a patient journey mapping approach. Home care clients and their caregivers with a recent experience of a hospital discharge back to the community were recruited. A conventional inductive approach to analysis enabled the identification of categories and a collective patient journey map. Follow-up interviews supported the validation of the map. RESULTS:Seven participants (five clients and two caregivers) participated in 11 interviews. Participants contributed to the production of a collective journey map and the following four categories and themes: (1) Touchpoints as interactions with the health system; Life is changing; (2) Pain points as barriers in the health system: Sensing nobody is listening and Trying to find a good fit; (3) Facilitators to positive care transitions: Developing relationships and gaining some continuity and Trying to advocate, and (4) Emotional impact: Having only so much emotional capacity. CONCLUSIONS:The patient journey map enabled a collective illustration of the care transition depicted in touchpoints, pain points, enablers, and feelings experienced by home care recipients and their caregivers. Patient journey mapping offers an opportunity to acknowledge home care clients and their caregivers as critical to quality care delivery across the continuum. 10.1186/s12913-023-09899-2
Nursing practice in home care: an integrative literature review. Andrade Angélica Mônica,Silva Kênia Lara,Seixas Clarissa Terenzi,Braga Patrícia Pinto Revista brasileira de enfermagem OBJECTIVE::analyze scientific production on nursing practice in home care. METHOD::integrative review employing databases LILACS, BDENF, IBECS, and MEDLINE. Studies in Spanish, English, and Portuguese were included, regardless of publishing date. RESULTS::after analyzing 48 articles, it was found that nursing practice in home care is complex, employing a multitude of actions by using three technologies: soft; soft-hard especially; and hard. Challenges related to the home-care training process are reported in the literature. Nurses use knowledge from their experience and scientific recommendations in conjunction with their reflections on the practice. CONCLUSION::home nursing practice is fundamental and widespread. Relational and educational actions stand out as necessary even in technical care, with a predominant need for home-care training. 10.1590/0034-7167-2016-0214
Hiring and Retaining Home Care Nurses. Mitchell Leslie Jo,Oermann Marilyn Home healthcare now Home care agencies are tasked with finding increasingly cost-efficient care processes to improve the quality of patient care outcomes. Hiring and retaining nurses who are well suited for home care are important factors that can influence the cost and provision of quality care in the home. The purpose of this article is to identify characteristics of home healthcare nurses that enable them to be successful home healthcare team members and leaders. A search of the literature was conducted to compile a list of questions with which to screen home healthcare nurse applicants for the required knowledge and skills as well as to improve retention rates of nurses hired. The nature of home healthcare practice makes nurse qualification screening and interviewing a challenge. To assist hiring managers in the screening and interviewing of nurse applicants in this challenging environment, we identified targeted interview questions that will help discern those nurses who are most likely to succeed and be productive, long-term members of the home healthcare agency. 10.1097/NHH.0000000000000467
Colostomy Care: A Guide for Home Care Clinicians. Berti-Hearn Linda,Elliott Brenda Home healthcare now 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. 10.1097/NHH.0000000000000735
Experiences and challenges of home care nurses and general practitioners in home-based palliative care - a qualitative study. Danielsen Britt Viola,Sand Anne Marit,Rosland Jan Henrik,Førland Oddvar BMC palliative care BACKGROUND:Norway has one of the lowest home death rates in Europe. However, it is the health authorities´ ambition to increase this by facilitating palliative care at home. The aim of this study was to achieve more insight, through home care nurses and general practitioners, of conditions that facilitate or hamper more time at home and more home deaths for patients with terminal disease and short life expectancy. METHODS:We used a qualitative research design with four focus groups with a total of 19 participants, of either home care nurses or general practitioners, using semi-structured question guides. The data were processed by systematic text condensation and encompassed thematic analysis of meaning and content of data across cases, which included four steps of analysis. RESULTS:Three main themes were identified: 1) The importance of a good start for the patient and family with five sub-themes, 2) 'Passing the baton' - the importance of collaboration across the health system with four sub-themes, and 3) Avoiding new hospitalization by establishing collaboration and competence within primary health care with four sub-themes. CONCLUSIONS:This study demonstrates that optimum palliative care at home depends on close collaboration and dialogue between the patient, family, home care nurses and general practitioner. It suggests the need for safer discharge routines and planning when hospitals transfer patients with terminal disease to their homes. A good start for the patient and family, where the initial interdisciplinary collaboration meeting takes place in the patient's home, is crucial for a good result. The general practitioners' perception of their 'disconnection' during hospitalization and prior to discharge has the potential to reduce patient safety. The family seems to be fundamental in gaining more time at home for the patient and supporting the patient to eventually die at home. Home-based palliative care demands experience and competence as well as regular supportive mentoring. 10.1186/s12904-018-0350-0
The Canadian perspective on postpartum home care. Gupton A,McKay M Journal of obstetric, gynecologic, and neonatal nursing : JOGNN Because of the unique nature of the Canadian health-care system, postpartum home care in Canada has taken on a distinctive form. The provision of postpartum home care is the responsibility of the individual provinces, and different approaches have been developed in each location. The most commonly observed pattern of postpartum care involves publicly funded services provided by public health nurses. Health-care reform and shortened hospital stays have led to changing patterns of care. In turn, these changes have precipitated issues for the mother-infant dyad, the family, and the community.
Understanding complex care for older adults within Canadian home care: a systematic literature review. Johnson Shanthi,Bacsu Juanita Home health care services quarterly In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults. 10.1080/01621424.2018.1456996
A new era in home care. Turk L,Parmley J,Ames A,Schumacher K L Seminars for nurse managers Profound changes in policy and reimbursement are ushering in a new era in home care. The transition from fee-for-service reimbursement to prospective payment/managed care and the mandate for outcomes assessment provide opportunities to expand innovative home care models. The authors describe 3 such models: community-based long-term care (exemplified by PACE, Program of All-inclusive Care for the Elderly), home-based primary care (exemplified by the Veterans Administration Home-Based Primary Care program), and disease management programs (exemplified by Group Health Cooperative of Puget Sound). Professional qualifications for the new era, including certification and graduate education for advanced practice nursing, also are described.
Home care for dying children: a nursing model. Lauer M E,Camitta B M The Journal of pediatrics A model is presented for providing home care services for children dying from cancer and for their families. Forty-two families whose children were patients at the Midwest Children's Cancer Center received home care during the first two years of this program. Variations in patient age, diagnosis, or family structure did not preclude successful participation in home care. In all families, the medical and nonmedical financial burdens of inpatient and outpatient hospital care were reduced when the child died at home. Since this program was initiated, terminal care has shifted from hospital-based medical management to nursing support in the home for the majority of children at our cancer center. 10.1016/s0022-3476(80)80452-5
Information needs in home care: a review and analysis. Helberg J L Public health nursing (Boston, Mass.) Before prospective payment can be implemented in home care, providers and administrators in home care agencies require information in a variety of areas. This article reviews the literature on several factors likely to influence the market for home care services, including hospital use trends, the response to diagnosis-related groups by home care agencies, proposed reimbursement patterns, patient disease and demographic profiles, and patient needs. Research must be conducted in several areas before prospective payment can be implemented in home care. 10.1111/j.1525-1446.1990.tb00614.x
Role of the oncology nurse in home care: family-centered practice. McEnroe L E Seminars in oncology nursing OBJECTIVES:To provide an overview of the role of the oncology nurse in home care with emphasis on family-centered practice. DATA SOURCES:Review articles, book chapters, and case records. CONCLUSIONS:The expansion of care from the hospital to the home has resulted in increasing complexity of cancer care at home. The goal of home health care is to initiate, manage, and evaluate the resources necessary to promote the patient's optimal level of wellness. The family as the unit of care is essential in achieving this goal. IMPLICATIONS FOR NURSING PRACTICE:The acuity level and complex needs of cancer patients at home requires home care nurses to have a broad knowledge base and to be efficient in high-technology skills. Competency in family assessment, teaching, counseling, supervising and coordinating community and family resources are essential to provide effective home care. 10.1016/s0749-2081(96)80036-2
Expanding the home care concept: blurring distinctions among home care, institutional care, and other long-term-care services. Kane R A The Milbank quarterly Distinctions between home care and residentially based care are blurring because of two trends: home care providers are offering services, including personal assistance, outside of the private, self-contained family home or apartment; and a market-driven movement is underway to develop group residential settings where long-term-care (LTC) consumers with substantial disability receive personal care and nursing in their own, fully equipped, apartments where they largely control the schedule. For the customers, such boundary blurring can lead to experiences of greater power and normality in their everyday lives. State regulations will help determine the extent to which new, "residentially" oriented models of LTC are feasible. Home care providers are challenged to develop flexible and creative paradigms for service that are built on a recognition that older adults with disabilities have the right to choose risks.
The impact of health care changes on home health. Seeber S,Baird S B Seminars in oncology nursing OBJECTIVES:To provide an overview of the economic impact of changes on home care services. DATA SOURCES:Published articles and organizational and government reports pertaining to home care and health care economics. CONCLUSIONS:In general, home care organizations are struggling to survive and retain fiscal stability. Understanding the economic impact of change on home care services is facilitated by a better understanding of three major components: the insurance company, the home health service agency, and the client. IMPLICATIONS FOR NURSING PRACTICE:The home health nurse who chose this care setting for role autonomy and family-centered direct care must now be concerned about productivity, costs, and reimbursement. Oncology nurses need to provide administrators and financial officers with the information to provide services in the most cost-effective manner, and be advocates for the provision of quality care. 10.1016/s0749-2081(96)80035-0
Home care in the older person. Repetto L,Granetto C,Venturino A Clinics in geriatric medicine Life expectancy has progressively increased in Western countries over the last few decades. The number of individuals over age 65 also has increased. Home health care, as an alternative to hospital and ambulatory care, is currently one of the fastest growing sectors of the health care market and has met the favor of most patients and families.
Unmet home care needs in Canada. Gilmour Heather Health reports BACKGROUND:Unmet home care needs have been linked to poor health, increased use of other health services, admission to nursing homes and reduced emotional well-being. DATA AND METHODS:Using data from the 2015/2016 Canadian Community Health Survey, this article describes home care use and unmet home care needs by type (i.e., home health care [HHC] and support services) in community-dwelling adults. Among the population with home care needs, the degree to which needs were met, partially met or unmet is presented, as well as information about the barriers to obtaining home care services and the places services were sought. Multivariate analysis was used to examine factors associated with unmet home care needs by type, while controlling for predisposing, enabling and needs-related factors. RESULTS:In 2015/2016, just over one-third (35.4%) of people with home care needs, an estimated 433,000 people, did not have those needs met. This was more prevalent among those with support needs than those with HHC needs. Availability of services was most often cited as a barrier to obtaining home care services, particularly for those with an unmet need for HHC services. Age group, household type, long-term care insurance and health status factors were associated with perceiving an unmet home care need, with few differences by type of unmet need. DISCUSSION:The degree to which needs were met and the perceived barriers to obtaining home care services varied by type of unmet home care need. The results indicate proportionally higher unmet needs for home care services among adults aged 35 to 49. This suggests a possible service gap.
Home care in the 1990s. Council on Scientific Affairs. JAMA Home care is a rapidly growing field that is beginning to attract greater physician interest and participation. Cost-containment pressures have led to reduced institutionalization in hospitals and nursing homes and to more patients, both acutely and chronically ill, being cared for in their own homes. Undergraduate and graduate medical education programs are developing home care curricula, and academic medicine is beginning to develop a research agenda, particularly in the area of clinical outcome measurements. Medical care in the home is highly diversified and innovative. The areas of preventive, diagnostic, therapeutic, rehabilitative, and long-term maintenance care are all well represented as physicians develop new practice patterns in home care.