Home health care nursing research priorities

The purpose of this study was to determine research priorities for home health care nursing. A Delphi study was undertaken to generate and prioritize research topics. The first round consisted of members of the Home Health Nurses Association Research Committee (n = 27); subsequent rounds also included nurse researchers who had conducted research in home health care (n = 17). Consensus emerged after three rounds, with the four most important priorities identified as outcomes, health policy, the use of advanced practice nurses, and models of care/best practice. These areas are consistent with the regulatory events in home health care in the last 10 years.     

Home health care and rehabilitation nursing

Health care is increasingly being delivered on an outpatient and a home care basis than ever before. The Medicare Prospective Payment System, along with the implementation of DRGs, has caused an intense scrutiny of the need for and the length of hospitalization. Thus, hospitals have increased profit incentives to reduce costs and to discharge patients more quickly. Community awareness of the availability and effectiveness of home health care is now growing dramatically. Concurrently, the delivery of rehabilitation services is also rapidly expanding. These combined forces enable the rehabilitation nurse to be a significant member of the home health care interdisciplinary team.     

Home nursing care of a woman with a malignant wound in a primary health care setting

The gradual increase in life expectancy in the Spanish population has led to an increase cancer episodes (the second leading cause of mortality in Spain), and an increase in wounds of neoplastic origin, which have a different healing time from other wounds. This article describes the case of an 85 year-old woman with a malignant wound, due to a recurrent skin lymphangiosarcoma, and her inclusion in the Primary Care home care program with the home care support team (PADES). The overall assessment of the person and not just "the wound", and an individualised nursing care plan led to pain control, wound healing and prevention of complications (constipation, worsening of the injury). Tumour wound care using the process of moist wound healing has been effective even in a fragile tissue. Monitoring and surrounding skin care is essential for the wound not to deteriorate further. In addition, hospitalisation of the patient, with the negative impact it could have on the quality of life of both the patient and her family, was avoided.     

Electronic nursing documentation in primary health care

The aim of this study was to describe and analyse nursing documentation based on an electronic patient record (EPR) system in primary health care (PHC) with emphasis on the nurses' opinions and what, according to the nursing process and the use of the keywords, the nurses documented. The study was performed in one county council in the south of Sweden and included 42 Primary Health Care Centres (PHCC). It consisted of a survey, an audit of nursing records with the Cat-ch-Ing instrument and calculation of frequencies of keywords used during a 1-year period. For the survey, district nurses received a postal questionnaire. The results from the survey indicated an overall positive tendency concerning the district nurses' opinions on documentation. Lack of in-service training in nursing documentation was noted and requested from the district nurses. All three parts of the study showed that the keywords nursing interventions and status were frequently used while nursing diagnosis and goal were infrequent. From the audit, it was noted that medical status and interventions appeared more often than nursing status. The study demonstrated limitations in the nursing documentation that inhibited the possibility of using it to evaluate the care given. In order to develop the nursing documentation, there is a need for support and education to strengthen the district nurses' professional identity. Involvement from the heads of the PHCC and the manufactures of the EPR system is necessary, in cooperation with the district nurses, to render the nursing documentation suitable for future use in the evaluation and development of care.     

Mental health nursing in New Zealand primary health care

International literature and New Zealand health policy is giving increased emphasis to the role of the primary health care sector in responding to mental health issues. These issues include the need for health promotion, improved detection and treatment of mild to moderate mental illness, and provision of mental health care to some of those with severe mental illness who traditionally receive care in secondary services. These developments challenge specialist mental health nurses to develop new roles which extend their practice into primary health care. In some parts of New Zealand this process has been under way for some time in the form of shared care projects. However developments currently are ad hoc. There is room for considerable development of specialist mental health nursing roles, including roles for nurse practitioners in primary mental health care.     

Home health nursing care agenda based on health policy in Korea

Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer-focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier-oriented model, is moving to a consumer-oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy-making in a systematic manner and to present implementation strategies clearly.     

Home care nursing informatic guidelines.

Technology presents benefits and special challenges to home care nurses in their attempt to safeguard patients' rights. This article presents a set of home care informatic standards that can assist nurses in managing patient-sensitive information in computer networks and suggests ways to avoid risks while using informatics.     

The primary care role in occupational health nursing

Primary care is a valid, legal responsibility of the practicing occupational health nurse and accounts for a high percentage of the occupational health nurse's daily activities when considered on a local, national, and international level. Historically, the varying definitions of primary care presented have led to confusion among practitioners who are attempting to categorize their services. The author attempts to express a workable interrelationship among these numerous terms including, "primary care," "health promotion," and "disease prevention." The legal, economic, and professional climate is right for the occupational health nurse to assert her role in primary care; the scope and depth in which the occupational health nurse may currently provide primary care has greatly expanded with two current examples being the Employee Assistance Programs (EAP) and safety and accident prevention programs.     

Mobilizing nursing leadership in primary health care research

Noting the dearth of nurses with doctorates, the author calls for more practical and faster ways of preparing nurses to conduct research, especially primary health care research. The author explains that there is a need for information on how to apply primary health care to local conditions, and that nurses are in the best position to conduct this type of research. But not only do nurses seldom conduct research, most of the research they do conduct is hospital rather than community-based. Establishing a doctoral program for nurses would mean a wait of 5-10 years before any results can have an impact on public health policy. But as the experiences of the College of Nursing of Saint Louis University (SLU) in Baguio City, Philippines indicate, doctoral training is not necessary when it comes to conducting primary health research. In 1979, SLU launched a Mobile Nursing Clinic, a primarily staffed by nurses. SLU then proceeded to study the effectiveness of the MNC model in providing primary health care. While the study has not yet influenced national health policy, the research team (composed mostly of baccalaureate nursing graduates with only one introductory course in research) believes that it has positively affected the perception of the nurse's role in the community. In order to meet the need for nursing research, the author recommends that countries pull their resources together and conduct intensive research training workshops for nurses. In the Philippines, the Association of Dean of Colleges of Nursing has revised its programs to support nursing research. The curriculum is now more community-oriented and community-based, and it includes courses in other disciplines. Furthermore, students are encouraged to conduct action research in the community.