Measuring the Need for Nursing Care in Older Adults Living at Home

Abstract The Community Health Intensity Rating Scale (CHIRS) has been found to significantly explain variation in resources consumed by both home health care clients and high-risk public health nurse clients. Secondary analysis of CHIRS scores from two earlier retrospective studies provided insights into basic similarities and differences between older adults served by a home care program ( n = 208) and those served by a public health nursing program for frail elderly ( n = 47). CHIRS scores for both client groups demonstrated a substantial need for care, with a greater range of CHIRS global scores for home health care clients but significantly higher CHIRS total scores for the public health nurse clients ( t = -5.24, p < .001). These findings suggest that the public health nurse clients experienced needs across multiple areas whereas the home health care clients' needs were more narrowly focused and episodic. Representation of needs by an intensity rating such as CHIRS can foster more focused visit planning and more specific outcome assessment, assist in planning staffing and in-service education, and focus nursing education regarding care of older adults.     

A Checklist To Assess the Need for Home Health Care: Instrument Development and Validation

The development of a one-page checklist is described, and results of validity and reliability studies are reported. The purpose of the checklist is to help practitioners assess the health status of patients upon discharge from adult or pediatric stations. The form was designed and validated for routine use by nurses on in-patient stations. A pre-post study of the effect of the prospective reimbursement plan on a teaching hospital-based home health service in which the instrument is being used is described.     

专业人员对开展居家姑息照护服务内容必要性的认知调查

目的 针对晚期癌症患者家庭,探讨开展居家姑息照护服务具体内容的必要性。方法 采用自制问卷调查法,对64名社区专业人员和57名三级医院肿瘤科专业人员就开展居家姑息照护服务具体内容必要性进行了调查。两组研究对象平均年龄分别（39．02±10．66）岁、（29．82±5．36）岁;两组在年龄、工作时间、受教育水平均存在差异（P〈0．01）。结果 社区及医院医护人员均以女性为主;两组均积极支持社区开展姑息照护;在对姑息照护熟悉度方面,医院组以熟悉为主,社区组则以了解为主（χ^2=54．55,P〈0．01）;在对社区卫生熟悉度上,社区组以熟悉为主,医院组以了解为主（χ^2=21．31,P〈0．01）。两组在除气管切开护理、胸腹腔抽吸积液、协助处理善后事宜外的28项服务内容认为有必要开展的专业人员所占比例都在79％以上,两者在7项项目上差异有统计学意义（P〈0．05）。结论 社区组与医院组整体上认为有必要开展31项服务内容,但在部分具体内容上意见相左。提示在制定居家姑息照护服务内容相关政策和将其付诸实践时,要综合社区与医院肿瘤专业人员两者的意见。