Use of Home Care Nursing Resources by the Elderly

Abstract We explored the influence of nursing dependency over and above sociodemographic factors and medical conditions on the use of home care nursing resources by patients 65 years of age and older. Use measures were number of visits made by home care nurses, and length of nursing stay. Nurses' reports, direct observation of nursing care provided, patient interviews, and record abstraction were used to obtain data on 236 patients who were admitted to and discharged from a certified public home health agency. Nursing dependency explained a significant amount of variance over and above sociodemographic factors and medical conditions in number of visits made by nurses and length of nursing stay. Measures of nursing dependency should be incorporated into future studies that examine factors related to use of home care nursing resources.     

The relationship among medical diagnosis, nursing diagnosis, and nursing intervention and the implications for home health care.

The purpose of this study was to identify the most commonly used medical diagnoses, nursing diagnoses, and nursing interventions for home health care based on 244 patient records. Nursing interventions were categorized into three groups: assessment, instruction, and other. The results showed that for the three most commonly used medical diagnosis groups--"infectious and parasitic disease," "disease of the circulatory system," and "neoplasms"--the most related nursing diagnoses were "alteration in mobility," "alteration in cardiac status," and "alteration in comfort: pain." The most used nursing interventions were "instructions." The results indicated that nurses identified patients' physiological problems mostly in relation to medical diagnoses, and teaching was the most frequently used nursing intervention in home health care.     

Consensus‐Validation Study Identifies Relevant Nursing Diagnoses,Nursing Interventions,and Health Outcomes for People with Traumatic Brain Injuries

A consensus‐validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long‐term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA‐I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA‐I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3–11 of the more than 500 NIC interventions and 1–13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.     

The quality of nursing home care in Taiwan

This study describes the quality of care in nursing homes in Taiwan using demographic data, functional status measures, resident clinical care outcomes, and resident's ratings of satisfaction with nursing home care. Three hundred and eight randomly selected elderly residents in 13 nursing homes were interviewed through a structured interview process and demographic and medical information was collected from their nursing home records. Nursing home residents were younger and less functional than their counterparts in the United States. Stroke and dementia were the most common primary diagnoses and more than 27% of the residents had a history of urinary tract infections while more than 25% had been physically restrained within the past 3 months. There was no correlation between the number of nursing home staff per resident and the prevalence of selected clinical care outcomes. A moderate level of satisfaction with nursing home care was reported with acceptance of family visits and nursing home cleanliness rating highest, and loss of personal belongings and life as boring rating lowest. Level of satisfaction with nursing home care was positively correlated with the number of RNs and nursing assistants (NAs) on staff. Recommendations for improving the quality of nursing home care in Taiwan include increased recruitment of multidisciplinary professional and technical nursing home staff; restrictions in the use of restraints with development of alternatives; and use of standardized resident assessment, care planning, and evaluation tools. The authors recommend continuing education in geriatric nursing and continued nursing research focusing on identifying structure and process variables that affect clinical care outcomes and satisfaction with nursing home care.     

Factors influencing home care nursing problems and nursing care

This study was conducted to determine the contributions of sociodemographic factors, medical conditions, and nursing dependency to nursing problems identified and nursing care provided to patients during a home care nursing visit. Patient interviews, direct observation of nursing care, record abstraction, and nurses' reports were used to obtain data from 438 patients receiving nursing visits from a certified home health agency. Nursing dependency was the strongest predictor of the nursing problems of and nursing care provided to home care patients. Measures of nursing dependency should be incorporated in models to determine the extent of nursing problems and nursing care provided in the home and in models of home care nursing reimbursement. © 1993 John Wiley & Sons, Inc.     

Nursing workload, medical diagnosis related groups, and nursing diagnoses

Patient conditions associated with the relative amount of time nurses spent caring for patients were identified in this study. The patient conditions examined were: nursing condition using 37 nursing diagnoses, medical condition using diagnosis-related groups (DRGs), and demographic characteristics of age, sex, and race. Nursing time was estimated using the Rush-Medicus patient classification workload measurement tool. Data were gathered from checklists of nursing diagnoses and the discharge records of 2560 adult inpatients of an acute care community hospital. Using multiple regression analysis nursing condition explained twice the variation in daily nursing workload (52.4%) than medical condition (26.3%). The finding that nursing care time is predicted better by a patient's nursing condition than by either medical condition or demographic characteristics indicates that nursing care is not physician prescribed.     

The Use of the Nursing Interventions Classification (NIC) with Cardiac Patients Receiving Home Health Care

PURPOSE.  To identify Nursing Interventions Classification interventions (NICs) commonly provided to cardiac home care patients and to explore differences among patients with coronary artery disease, congestive heart failure, and patients with other cardiac disorders.
METHODS.  The NICs provided to cardiac home care patients were recorded and analyzed to determine differences in frequencies across cardiac diagnoses.
FINDINGS.  Frequent NICs provided in cardiac home care are similar across diagnoses, and include tissue perfusion management and patient education NICs. Variations can be detected and involve fluid monitoring/management, exercise promotion/teaching, and cardiac care NICs.
CONCLUSIONS.  Differences in nursing care among patients with similar medical diagnoses can be detected using NIC.
IMPLICATIONS FOR NURSING PRACTICE.  Relevant knowledge of nursing care can be gleaned from analyzing NIC data generated in practice and can be used to plan, evaluate, and determine the effectiveness of nursing care.     

Using nursing diagnoses to explain utilization in a community nursing center

The purpose of this study was to examine the usefulness of nursing diagnoses, based on the Omaha System framework, in explaining utilization of primary health care services in a Community Nursing Center (CNC). Utilization was defined as the number of client visits at the CNC. Data were obtained from a total of 331 client records where the Omaha System taxonomy was used in the documentation of nursing diagnoses with each nurse/client encounter. Hierarchic regression analysis was conducted to examine predictors of utilization. Nursing diagnoses were significant predictors of utilization at the CNC above and beyond client demographics. These findings suggest that nursing diagnoses data may be useful in explaining clients' use of CNCs. © 1996 John Wiley & Sons, Inc.     

Evaluating Home Health Care Nursing Outcomes With OASIS and NOC

PURPOSE: To determine the sensitivity and responsiveness of the Outcome and Assessment Information Set (OASIS) and the Nursing Outcomes Classification (NOC) to the effects of home healthcare nursing interventions. METHODS: A quasi-experimental before-after study was conducted using a sample of 106 home healthcare participants referred to one of seven participating Midwest home healthcare agencies for treatment of a cardiac condition. Patient outcomes data were collected at home healthcare admission and discharge using OASIS and NOC. Nursing intervention data were collected at each visit using the Nursing Interventions Classification (NIC). Intervention intensity was calculated by totaling the number of NIC interventions provided over the episode of care. FINDINGS: Neither OASIS nor NOC were sensitive to the effects of home healthcare nursing as measured by intervention intensity. The OASIS was not responsive to clinically discernable changes in patient outcomes; while the NOC was responsive to patient status change in the outcome categories including activities of daily living, cardiopulmonary status, coping, and illness management behavior. CONCLUSIONS: Outcome measures that are more condition-specific and discipline-specific are more responsive to the effects of home healthcare nursing. Further research is needed to identify and refine outcome measures that are sensitive and responsive to the effects of nursing care in home health and other nursing settings. Clinical Relevance: The use of outcome measures that are more sensitive and responsive to nursing are more effective in guiding nursing practice.     

Nursing diagnoses and interventions in bronchopulmonary dysplasia: a case study

Bronchopulmonary dysplasia (BPD) requires collaborative management in the pediatric health care setting. Because of the nature of the medical diagnoses, BPD can be viewed by nurses using selected nursing diagnoses. With the pediatric client, nursing diagnoses can assist the nurse to identify system alterations, and thereby address nursing interventions most appropriate for the child. Nursing interventions are based on collaborative decision making using both medical and nursing diagnoses. This case study will identify selected nursing diagnoses useful in the care of the child with BPD and nursing interventions used to treat frequently occurring health problems.     

An empirical test of the Nursing Role Effectiveness Model

AIMS OF THE STUDY: This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). RESEARCH METHODS: A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. RESULTS: Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. DISCUSSION: The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.     

Nursing care requirements and resource consumption in home health care.

Nursing care requirements provide the rationale for nursing practice. Two representations of nursing care requirements are nursing intensity and nursing diagnoses. In the present study, these two indicators each significantly explained variation in nursing resource consumption in home health care. Further study is needed to refine a measure of nursing intensity that has construct validity and a base in nursing theory. In addition, techniques are needed for grouping and weighting the various nursing diagnoses to reflect their contribution in explaining the amount of care provided to patients.     

Implementation and evaluation of a nursing process support system for long‐term care: a Taiwanese study

Aims. To (1) develop and implement a Nursing Process Support System in Chinese (NPSSC) enabling computerised documentation for nursing home residents, (2) evaluate the efficiency of NPSSC, (3) assess obstacles to the use of the NPSSC and (4) assess nurse users’ satisfaction with the NPSSC. Background. Long‐term care facilities in Taiwan have been slow to computerise resident’s medical records. The development and implementation of a computerised documentation system provides a way to enhance nursing documentation in long‐term care settings and can prevent hazards that result from documentation errors. Design. Quasi‐experimental. Methods. This study used one group pre/post‐test. Five nursing homes in Taiwan were included in the study. Twenty‐seven nurses used the NPSSC to computerise 396 residents’ medical records. Using the NPSSC allowed nurses to enter health assessment data into the computer system, which automatically triggered appropriate nursing diagnoses. The NPSSC included geriatric nursing interventions and the use of alternative Chinese therapies. Results. Obstacles that hindered nurses' use of the NPSSC were identified and possible solutions to overcome these hindering factors were discussed. The use of the NPSSC significantly improved nursing documentation in that resident’s records were organised and consistent and nurses were able to complete a comprehensive care plan within 48 hours. Nurses reported a higher satisfaction in nursing documentation after the implementation of the NPSSC than previously. Conclusions. This study suggested a pathway to develop and implement a computer‐based, user‐friendly nursing documentation system for nursing homes. This study may be used as a template for implementing computerised documentation worldwide. Relevance to clinical practice. Nursing home providers may consider implementing the NPSSC to replace the traditional hand‐written documentation system. An effective use of in‐service programs within the workplace helped ease the transition from hand‐written documentation to the computer‐based NPSSC.     

Utilizing Nurse Practitioners to Provide Health Care for Elderly Patients in Massachusetts Nursing Homes

This study evaluates the nursing contribution to the process of care utilizing nurse practitioners (NPs) to provide health care for nursing home patients in Massachusetts. Using magnetic tapes of data collected through retrospective chart reviews of 2,651 patient records in 110 Massachusetts nursing homes, comparisons were made of the process of care variables of NP/physician team and physician-only models of care. Results from discriminant function analysis revealed process of care variables did discriminate between the two models. The conclusion that NPs provide not only a substitutive role to that of medical care but also a complementary one should be instrumental in enabling policy decisions that encourage the full utilization of NPs.     

Development and validation of the Nursing Severity Index. A new method for measuring severity of illness using nursing diagnoses. Nurses of University Hospitals of Cleveland.

The purpose of this study was to develop and validate the Nursing Severity Index, a new method used to measure the admission severity of illness of hospital patients using nursing diagnoses, which categorize biologic, functional, cognitive, and psychosocial abnormalities. This retrospective cohort study with independent development and testing phases was conducted at a U.S. academic medical center. In the development phase, data regarding 14,183 adult medical-surgical patients admitted to the medical center in 1985 and 1986 was used. In the testing phase, data regarding 7,302 patients admitted in 1987 and 1988 was used. Primary nurses prospectively recorded the presence or absence of 61 nursing diagnoses on admission. Demographic and clinical data were obtained from hospital data bases. In the development phase, the number of admission nursing diagnoses was highly related (P < 0.001) to in-hospital mortality. Using multiple logistic regression, 34 nursing diagnoses were identified as independent predictors of mortality; the Nursing Severity Index equals the number of these 34 diagnoses. In the testing phase of 7,302 patients, the Nursing Severity Index was related (P < 0.001) to mortality rates, which were 0.5%, 1%, 2%, 6%, 13%, 22%, and 31% in seven hierarchical strata defined by the Index. The Index was as accurate in predicting mortality as MedisGroups (receiver-operating-characteristic curve areas, 0.814 +/- 0.016 vs. 0.845 +/- 0.015, respectively, P = 0.12). Furthermore, the Nursing Severity Index and MedisGroups together (receiver operating characteristic curve area 0.880 +/- 0.014), were more accurate (P < 0.01) than either measure alone. The Nursing Severity Index assesses multiple dimensions of illness, can be easily measured during routine patient care, accurately predicts the risk of in-hospital death, and has similar prognostic accuracy as MedisGroups. Its usefulness in outcomes assessment, quality assurance, and case management merits further study.     

Nursing interventions and other factors associated with discharge disposition in older patients after hip fractures

BACKGROUND: The research on hip fractures has been focused on surgical procedures for hip fracture repair; little is known about the contribution of nursing interventions to outcomes. OBJECTIVES: To investigate factors, including nursing interventions, associated with the discharge destination of an older patient population hospitalized for a fractured hip or an elective hip procedure. Nursing interventions used during the hospitalized period are identified. METHODS: A design model composed of patient characteristics; clinical conditions; nursing unit characteristics; and medical, pharmacy, and nursing interventions related to the outcome of discharge disposition was tested using generalized estimating equations analysis. A total of 116 variables were examined in a sample of 569 hospitalizations from 524 patients aged 60 years and older admitted for treatment of a hip fracture or elective hip procedure in one tertiary care agency over a 4-year period. Data were obtained retrospectively from five clinical databases. RESULTS: Fifty-four percent of the population was discharged to a location other than to home. The predictors of discharge to home were a younger age, admission from home, and having a spouse, as well as receipt of intravenous solutions, diagnostic ultrasound, a lower number of medications, and moderate use of the nursing intervention of bathing. The identification of nursing interventions indicates that those who received routine nursing care for this condition returned home while those who required interventions for complications or prevention of complications were discharged to an institution. DISCUSSION: Using a standardized nursing language with the hospital's information system can provide nurses and others with information that demonstrates the contribution of nursing care to outcomes, including the outcome of discharge to home.     

Nursing care in multifunctional small group homes providing day,visiting and overnight services for older people living at home

Home care programs for older people have been developed around the world. Nurses are key to these programs. The aim of this study is to explore details of the nursing activities used in group homes to provide a basis for describing effective nursing practices in such facilities. A self‐administered questionnaire was sent to 240 randomly selected facilities throughout Japan in 2013. Responses indicated that the activities of nurses in managing the health of older people included determining the need for medical consultations, dealing with emergencies, and making arrangements for the use of flexible care services. Nursing activities were directly related to the percentage of older people in each facility with diagnoses such as dementia or heart disease. Nurses reported low general self‐efficacy for some of the more specialized nursing activities they performed. Nursing activities are performed with the aim of supporting older people with high health care needs to continue living at home; are tailored to the characteristics of residents and contribute to the provision of timely health examinations and flexible arrangement of services. Findings indicate that it might be advantageous to increase the nursing staffing at these facilities, to provide care guidelines and training opportunities to increase nurse self‐efficacy.