Development of the Home Care Client Satisfaction Instrument

Abstract Client (patient) satisfaction has been studied extensively in the health care sector, yet those receiving home health care services have been the focus of few studies. The purpose of this study was to test the reliability and validity of the Home Care Client Satisfaction Instrument (HCCSI). A total of 400 clients, randomly selected from 20 randomly chosen home care agencies in one state, completed the HCCSI and demographic form. Most respondents were older adults with multiple health problems and their families or informal support systems. Since data were skewed, item analysis was used. The revised instrument (HCCSI-R) is unidimensional and includes 12 items rated on a 5-point Likert scale measuring specific aspects of care. In addition, there are three global measures of satisfaction rated on a 10-point scale. All items except one had significant item-total correlations greater than .59. The total score correlates with likeliness to recommend the agency to others (.37, p = .0001), showing some evidence for criterion-related validity.     

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.     

Public Health Nursing Costs in Home Care

This article discusses the measurement of costs, particularly the cost of public health nursing in the home health setting, and describes typical cost-accounting procedures. Alternatives are analyzed and four models for measuring costs are presented: per diem, acuity, hourly, and diagnoses. Since each model measures cost in a different way, selection of one over another will affect research results.     

Client Characteristics Associated with Not Keeping Appointments for Public Health Nursing Home Visits

Abstract Home visits have been identified as an intervention strategy for high-risk pregnant women. A necessary component of this intervention strategy is for the women to be home for the visit with the nurse. The purpose of this study was to identify factors associated with women not keeping their home visit appointments with a public health nurse. Subjects were 232 lowincome high-risk pregnant women who received at least one home visit by a public health nurse. Younger age, more stressful life events, receipt of medical assistance, inadequacy of prenatal care, noncompliance with health recommendations, and longer gestational time were associated with not keeping public health nursing appointments. While this study provides some insight into the factors associated with women not keeping their appointments with the public health nurse, further investigation is warranted to identify strategies to reduce the incidence of not-kept appointments.     

Health Patterns of Cardiac Surgery Clients Using Home Health Care Nursing Services

Abstract The purpose of this study was to examine the health patterns of cardiac surgical patients in the home health care population and their relationships to outcomes and duration of home health care using Gordon's Functional Health Pattern framework. Home health care records of 96 cardiac surgical clients were reviewed. Admission health pattern data, reasons for admission, duration and outcomes of home care services, characteristics of hospital experience, and demographic data were analyzed. Dysfunctional health patterns were primarily in the area of activity/exercise. The most common reasons for admission were monitoring of cardiopulmonary status, wound care, and instruction on diet, medications, and cardiac regimen. The mean duration of home care was 28.8 days. Thirty percent of the sample were readmitted to the hospital. Duration of home care was shorter for those who were married and for those who reported weakness, tiredness, or fatigue as a chief complaint. Readmission to the hospital was more likely for those who had complications during their initial hospital stay and those who required at least partial assistance with bathing, dressing, feeding, or toileting. Implications for practice and research are discussed.     

Public Health Nursing in Primary Care: Impact on Home Visits

A public health management data system was used by a country public health nursing administration to assess the impact of integrating primary care and public health nursing services on the allocation of nursing time to home visits. Two areas of the county were shown to be comparable in proxy indicators of need for these services. The t test of differences in means and calculation of confidence intervals were the methods of analysis. There was a significant decrease in the numbers of and time for home visits after integration of the two kinds of services. Using routinely collected personnel activity reports to indicate staff and client needs is discussed.     

Care Coordination: A Resource-Intensive Component of Home Health Nursing Practice

Coordinating patient care is an activity central to home health nursing practice. Nurses believe that this component of care contributes in a meaningful way to patient well-being. Yet changes in the home care environment at the patient, agency, and system levels could jeopardize nurses' care coordination activities. This study describes the nature of the care coordination activities delivered by home health nurses and explicates the amount of time expended in these activities. A convenience sample of 143 nurses, employed in 24 home health agencies in a southeastern state, participated. They recorded their time, in 15-minute intervals, for 10 consecutive working days. On average, they spent 29% of their time in direct care (i.e., home visits), 18% in travel, 18% in record-keeping activities, and 16% in care coordinating activities. New mechanisms to reimburse home care are on the horizon. Studies such as this that begin to explicate the nature of care requirements are critical if appropriate decisions are to be made about the structure of a reimbursement system for home health care.     

Nursing Diagnoses and Home Care Nursing Utilization

Abstract The purpose of this study was to identify, from routinely collected health care record data, patient characteristics that describe home care clients' health care needs and explain variation in home health care utilization. Retrospective data were obtained from a total of 317 home health care patient records from one home health care agency. Outcome variables of care included number of visits and hours of care. Predictor variables included nursing diagnoses, medical diagnoses, and patient demographic variables. Nursing diagnoses were classified by the Omaha System. Nursing diagnoses explained a significant amount of variance over and above the demographic and medical diagnosis variables in both the number of nursing visits and hours of nursing care. The results of this study suggest that data related to nursing diagnoses are a valuable source of information when examining home health care nursing resource use.     

The Relationship Between Demographic Characteristics and Nursing Problems in Home Health Care

Abstract The delivery of home health services that are accessible and cost effective is contingent on understanding the characteristics and needs of the aggregates who use the services. This study examined the relationship between socio-demographic characteristics and nursing problems among a sample of home health patients. Data were gathered by retrospective record review of all 209 patients with medical-surgical problems who were discharged from home health services during a six-week period. Nursing diagnoses were identified by nurses at the time of the admission assessment. Impaired mobility, the most frequent nursing diagnosis, occurred in 73% of the sample, cardiovascular problems in 52%, and respiratory problems in 48%. Analysis of the data revealed a relationship between source of payment and age with nursing diagnosis. No significant relationship was found between nursing diagnosis and gender, although a weak relationship was identified with living arrangement. Results have important implications for the planning, delivery, and reimbursement of home care services that equitably address populations with the greatest nursing needs. If patients with specific predisposing characteristics have different needs, it may be possible to evaluate patients more accurately early in care delivery so that these needs can be more effectively met.     

Nursing and Home Care in Europe

The demographic trend of a rapidly ageing society becomes increasingly persuasive. More chronically ill patients will be discharged to home care. More people with psychotic problems and debilitating diseases will be living in communities. All require nursing care. This situation is recognized everywhere and no boundaries can change this future.     

The Practice of Home Care Nursing

In the March, 1987 issue of PUBLIC HEALTH NURSING , three physicians offered their views of the home care industry. In this issue we present the opinions of two nurses on this subject.     

急性心肌梗死病人的护理及健康教育

目前 ,急性心肌梗死在我国发病率呈上升趋势 ,尤其在老年男性中增长较快[1] 。心肌梗死早期病死率较高。因此 ,一旦确诊 ,应立即采取紧急处理 ,实施有效的护理 ,以改善病人的预后。现将急性心肌梗死病人的护理介绍如下。1　临床资料　　我院 1998年 8月— 2 0 0 1年 5月收治心肌梗死住院病人2 73例 ,其中男 182例 ,女 91例 ;年龄 3 8岁～ 70岁 ,平均年龄 5 4岁 ;住院日最短为 2 4d ,最长为 5 8d ,平均住院日 3 9d。2　护理2 .1　溶栓治疗的护理　通过溶解冠状动脉内血栓 ,使梗塞相关动脉再通 ,恢复对缺血心肌的再灌注 ,缩小梗死面积 ,保存心…     

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

BackgroundPain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD).AimsExamine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population.DesignAnalysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data.Settings/Participants6,153 patients ≥65 years receiving care from a nonprofit HH agency in 2017.MethodsStudy outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission.ResultsPatients with ADRD (n = 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] = 1.35, p = .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD.ConclusionsHH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.     

Reconceptualizing Compliance in Home Health Care

The term "compliance" and its traditional definitions frequently are criticized in the literature. Although a number of authors advocate a collaborative model of compliance, with compliance decisions and responsibilities for health outcomes shared by provider and patient, few describe this model in practice. This study investigated compliance communication in two home care agencies. Findings from interviews with 6 nurses and observation during home visits to 25 patients (N = 31) revealed a prosocial, collaborative model of compliance that coincides with the participative model of medical care (Smith, 1989) and a redefinition of compliance advanced by Kontz (1989).