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.     

Health care for the elderly: a social obligation

TOPIC: Ageism in the allocation of health care. PURPOSE: To explore the ethical bases for rationing health care according to age, and to make appropriate recommendations for nursing policy and practice. SOURCES: Published literature. CONCLUSIONS: Limiting access to resources and opportunities for older Americans simply because they are old is clearly a case of ageism. The authors opine that society has an obligation to provide an adequate level of health care to all, rationing on the basis of age is wrong, and nursing policy and practice should support this stance.     

Health technology assessment in critical care

Background Heath technology assessments (HTAs) evaluate the benefits and costs of devices for monitoring and therapy (and their associated requirements for human resources) which contribute to the high expense associated with ICU admission. Discussion Given the limited resources available for health care and increasing demands, funds spent inefficiently or unnecessarily on technologies in the ICU may threaten the sustainability of the health care system or prevent other potentially cost-effective devices from being introduced into clinical care. We discuss the factors impeding the conducting of HTAs in the ICU and suggest strategies for change. Conclusions Despite the need for HTAs of ICU devices only few have been conducted. They should be undertaken more frequently, and their results used to influence clinical practice and hospital and regional-level policy decisions. This article is dedicated to the memory of Dr. Bill Sibbald.     

Health and social care policy for the elderly in Belgium

Current Belgian health care policy for the elderly can be classified broadly into institutional care, community care, and home care. Economic restrictions, smaller families, increased employment among women, geographic distances between family members, and the preference of the elderly to remain at home are factors challenging Belgian policy makers and health professionals to restructure the current health care system and provide integrated holistic health and social care to the elderly. These challenges are being addressed through initiatives to customize care for the elderly at home, in the community, or in care environments by improving coordination of care, programs of support for geriatric care and dementia, and research into new accommodation and health solutions.     

Spiritual care in a multi-religious context

Spiritual care is an essential component of palliative care because spirituality is an important part of suffering and the relief of pain and suffering. It is especially important in the developing world where medical and comfort resources are limited. Spiritual resources in the context of many religions are described. Understanding pain from a spiritual perspective and approaches when spiritual resources appear ineffective are discussed. The role of spiritual resources in end-of-life care are described in the context of taking a spiritual inventory. The importance of all palliative care clinicians understanding these concepts is emphasized.     

Intercountry adoption and nursing care

AIMS AND OBJECTIVES: This paper is based on a Norwegian study that addressed the importance of nurses understanding adoptive families' particular needs. The study aimed to provide a diverse picture of adoptive families' challenges and resources. It addressed adoptive families' experiences with welfare professions, particularly public health nurse services, and explored their need for support before and after adoption. This paper focuses particularly on challenges confronting 'transracial' families. PARTICIPANTS AND METHOD: The qualitative research interview was used as the methodological approach. Nine couples of adoptive parents, four adoptive mothers, three public health nurses and four adult adoptees were interviewed. The analysis process was an ad hoc generation of meaning, and the data were systematically reviewed and categorized through an intuitive analysis style. RESULTS: The study indicates that adoptive families manage their 'most common' challenges on their own, but the informants also spoke about a need for professional support and assistance in many cases. Recurring themes in the study were challenges linked to 'attachment difficulties', 'external categorization', 'grief' and 'the meaning of biological heritage and roots'. Findings indicate that there is a substantial demand for increased knowledge of adoptive families' special needs, not least in the public health nurse services; there is also limited knowledge within other welfare professions. Nurses particularly need to strengthen their understanding on how external categorization affects transracial adoptive families. CONCLUSIONS: The study recommendations call for improved follow-up after adoptions. This can be met by establishing a special programme for adoptive families at maternity and child health centres. In addition, public health nurses can support adoptees in their teenage years through individual consultations.     

Health care technology: nursing's challenge and opportunity

The growth in health care technology is ubiquitous and has far reaching consequences both for users and providers. This paper explores how health care technology affects ours lives, presents the challenges inherent in its use, and also identifies some of the opportunities that it provides nurses.     

Health care and social service use among Chinese immigrant elders

We explored patterns and reasons for health and social service use among Chinese immigrant elders. Interviews were conducted with 27 Chinese immigrant elders, 11 adult care giving children, and 12 health and social service providers. Content analysis of these data indicated that participants across groups agreed that Chinese elders under-utilize services because of problems related to language, transportation, cost, long waits for appointments, and because of cultural norms/values related to need for care, preference for self-over professional care, fear, and distrust of western biomedicine, and the obligation to refrain from using formal services. These problems are complicated by geographical dispersion and dialect differences in the local Chinese immigrant community.     

Health and social care management for older adults with multimorbidity: a multiperspective approach

Multimorbidity, a condition common among older adults, may be regarded as a failure of a complex system. The aim of this study was to describe the core components in health and social care management for older adults with multimorbidity. A cross‐sectional design included two methods: individual interviews and group discussions. A total of 105 participants included older adults with multimorbidity and their relatives, care staff and healthcare policymakers. Data were analysed using content analysis. The results show that seven core components comprise a multiperspective view of health and social care management for older adults with multimorbidity: political steering, leadership, cooperation, competence, support for relatives, availability and continuity. Steps should be taken to ensure that every older adult with multimorbidity has a treatment plan according to a multiperspective view to prevent fragmentation of their health care. This study provides relevant evidence developing a multiperspective model of health and social care management for older adults with multimorbidity.     

Using a simulated chaotic home environment for preparing nursing and social work students for interdisciplinary care delivery in a Scottish context

Communication with the patient's identified family is one of the most important and ongoing service to be provided by the inter-professional team in health care. Placing this importent service within the context of “attachment, security and trust” should help professional team members to learn how to configure patient's families into the circle of health care collaboration. The communication offered to the patient and patient's family is the most important aspect to inter-professionalism within health care. Breakdowns in this communication of trust can have drastic effects with long standing emotional impact.     

Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.     

Understanding variation in the adoption of a new technology in surgery

BACKGROUND: Despite data supporting the superiority of laparoscopy over conventional surgery for donor nephrectomy, prior work reveals that this technology's adoption has been slow. However, the underlying cause for its gradual adoption remains unclear. For this reason, a multilevel analysis was conducted using a population-based cohort to evaluate the amount of variation in laparoscopic donor nephrectomy use attributable to the individual, provider, and hospital levels. METHODS: Using the Nationwide Inpatient Sample (2000-2003), discharges for donor nephrectomies were identified, distinguishing between those surgeries performed by laparoscopic versus conventional approaches. To examine variation in laparoscopy use, we fitted generalized linear mixed models with random intercepts. The principal model had no explanatory variables included and allowed for an understanding of the basic partitioning of the data's variability. Patient-, provider-, and hospital-level factors were then added to the model to determine how much variability at each level might be explained by these covariates. RESULTS: In total, 974 conventional and 516 laparoscopic donor nephrectomies were performed by 157 surgeons at 46 hospitals. Among the different levels of care, the provider and hospital, combined, accounted for the majority of the variation in laparoscopy use (27.6% and 35.2%, respectively). After adjustment, the attributable variation at the provider level was largely unchanged (27.3%), whereas the hospital-level estimate decreased to 26.8%. CONCLUSIONS: These data reveal that the provider and hospital contribute substantially to the variability in laparoscopy use among kidney donors, suggesting that interventions focused at these levels would likely hasten laparoscopy's uptake in the community.     

Perioperative care of children in a transcultural context

As part of a large, comparative study of how children are cared for in developed and developing countries' hospitals, health care professionals and parents were asked questions relating to their beliefs about parental presence during anesthesia induction and in postanesthesia care units. Children were not questioned. The researcher compared parents' (n = 957) and staff members' (n = 780) responses between developed and developing countries. Results indicate that parents and staff members in developed and developing countries responded significantly differently (P < .000001) to whether they believe parents or relatives should stay with their children until anesthesia takes effect. More staff members in developing countries responded that parents should be present (P = .007). Cultural constructions (e.g., class) are believed to influence strongly how care is delivered in developing countries studied. Cultural constructions were not as important in the developed countries.     

International adoption families: a unique health care journey

The purpose of this study was to identify and describe the health care experiences of families with an internationally adopted child. Content analysis of data from 107 adoptive parents was used to identify themes that characterized health care experiences of the families. Four themes were identified: a) Coming home: Like a lobster thrown into a boiling pot; b) Vigilance: Is my child healthy today? Will my child be healthy tomorrow?; c) Unique health care needs of international adoption families: We are different; and d) Importance of support by health care providers: Do they know or care? Health care providers need to be aware of the unique experiences of the increasing number of international adoption families. The themes identified provide insight into the health care experiences of international adoption families and the crucial role of health care providers in helping international adoption families feel supported on their journey.     

Nursing care and context in Theresienstadt

Over the past 5 years, nurses'roles as caregivers in ghettos and concentration camps during the Third Reich increasingly have become the subject of interest. Historians have focused particularly on the ethical dilemmas of caregiving practices that often deviated from normal care standards and situations. This article examines nurses and their work in one concentration camp, Theresienstadt, to demonstrate that even under the unique and horrible conditions of camp existence, contextual differences between camps provided nurses with different difficulties and opportunities. Although an extreme example, this article demonstrates the critical link between care and context as nurses practice across various settings and situations.