Preceptorship in home care

Central to the orientation process is the role of the preceptor. The following is a methodological survey of clinical and administrative nursing staffs' current perceptions concerning the preceptorship process existing within a small New England home health agency. Recommendations are made for improvement using evidenced-based strategies found in the current literature.     

Research in home care

Past and present research in the home care setting predicts future trends. Home care research studies will continue to reflect social and economic issues of the future since research and researchers do not exist in a vacuum but are influenced by their era. Because of the generalized concern about economic stability and health care costs and the heightened interest in home care, investigations related to nursing interventions, client outcomes, and reimbursement will increase. As researchers search to identify long-term, positive client outcomes, the role of physical and psychosocial environmental factors will receive greater attention. Clients, too, do not exist in a vacuum but reflect the family and support systems which do, or do not, surround them. For home care research to serve as the scientific base for practice, continuing and increasing collaboration must occur between nursing service and education. More joint appointments or shared positions are likely as blending occurs in researchers' roles and nursing service staff assume more responsibility for research projects. The struggles involved with financial support of home care research will not cease. Home care researchers will continue to compete for funding with other nursing, health care, and research investigators. Specific strategies will enhance funding opportunities for home care nursing. These include: (1) increasing methodologic soundness, (2) increasing sophistication of studies and investigators, (3) publicizing findings and benefits of projects, and (4) developing a successful history of obtaining funding and conducting studies. Research in the home care setting will thrive if it attracts more and more nurses with scientific skills similar to those identified by Sir Medawar: "Among scientists are collectors, classifiers, and compulsive tidiers-up; many are detectives by temperament and many are explorers; some are artists and others artisans. There are poet-scientists and philosopher-scientists and even a few mystics."     

Improving end-of-life care education in home care

A training program for home care professionals, HOPE (Home care Outreach for Palliative care Education), was designed to improve the knowledge and skills of those providing care to patients and family caregivers at home. This article presents an overview of the pilot HOPE training program and a case study to illustrate the complex end-of-life (EOL) care needs in nonhospice home care settings. HOPE was designed as five training modules based on a needs assessment survey completed by 134 home care agencies. The training modules were composed of (a) General Overview of End of Life Care; (b) Pain Management; (c) Symptom Management; (d) Communication with Patients and Families; and (e) the Death Event. The program was implemented for clinical staff (N = 52), predominantly nurses, in two home care agencies and evaluated with pre- and postcourse surveys. Pre- and postcourse evaluations demonstrated an increase in the overall rating of EOL care from a mean rating of 5.97 to 7.42 for self-assessment and from 6.59 to 7.94 for agency assessment (on a scale of 0 = not at all effective to 10 = very effective). Future palliative care education should also include evaluation of the impact of such programs on patient care. We concluded that increasing palliative care knowledge of home care professionals is necessary to improve patient care at the EOL.     

Webcasting in home and hospice care services: virtual communication in home care

The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.     

Health care technology issues in home care

Every 2 years the Federal Bureau of Labor Statistics updates its employment outlook for the next decade. In its publication, The Occupational Outlook Handbook, 1998-1999 edition, the agency projects that employment in home health care is expected to grow the fastest of all health care sectors in the next decade. One of the main reasons for this trend is advances in health care technology that have allowed health care activities once performed only in hospitals or physicians' offices to be performed in clients' homes.     

Nutritional support in home care

Nutritional support was among the first of the high-tech therapies to make the transition from hospital to home. Growth in high-tech home care accelerated in the mid-1980s, following establishment of the prospective payment system. Rapid growth in home care continues amid acquisitions and mergers of home care companies. The HPN and HEN populations have both enlarged and evolved with time, and the current populations mirror changes in health care demographics--showing the largest increases in services to the elderly. Changes have occurred in the types of venous and enteral access devices, infusion systems, parenteral and enteral products, and infusion schedules used by HPN and HEN patients. As therapies have caused less disruption in patients' lifestyles and as services have become more widely available, adaptation to HPN and HEN has become somewhat less difficult. However, patients still report concerns over finances, respite services, and symptoms management. Nurses have a primary role in the preparation of patients for home nutritional support and in the provision of home care services. Nursing research can illuminate the unique contribution of nurses to safe, cost effective, and high quality home nutritional support.