Home healthcare now

Gorski L.A.

The Infusion Therapy Standards of Practice provide evidence-based recommendations as published by the Infusion Nurses Society every 5 years. This article provides a brief overview of the development process and short summaries of selected standards with attention to highlighting the relevance to home care agencies and nurses. The Standards should be reviewed by any home care organization that provides home infusion therapy.

Foster C.C., Fuentes M.M., Wadlington L.A., Jacob-Files E., Desai A.D., Simon T.D., Mangione-Smith R.

Despite a growing population of children with medical complexity, little is known about the current quality of pediatric home healthcare. The objective of this study was to characterize the quality of pediatric home healthcare experienced by primary family caregivers (parents) and healthcare providers of children with medical complexity. Semistructured, in-depth key informant interviews of 20 caregivers and 20 providers were conducted and analyzed for factors affecting home healthcare quality using the Institute of Medicine's quality framework (effective, safe, patient-centered, timely, equitable, and efficient). System complexity, insurance denials, and workforce shortages affected patients' ability to establish and maintain access to home healthcare leading to hospital discharge delays and negative family impacts. When home healthcare was accessible, respondents experienced it as effective in improving patient and family daily life and minimizing use of emergency and hospital services. However, respondents identified a need for more pediatric-specific home healthcare training and increased efficiencies in care plan communication. Overall, home healthcare was not perceived as timely or equitable due to access barriers. This study provides a new conceptual framework representing the relationship between home healthcare quality and outcomes for children with medical complexity for future evaluations of quality improvement, research, and policy initiatives.

Kadir K., Syam Y., Yusuf S., Zainuddin M.

Diabetic foot ulcers (DFUs) are highly vulnerable to infection and pose risk for limb amputations. Studies have shown that ozone therapy reduces wound size and improves wound healing time better than standard treatments. We examined the effectiveness of combining standard wound care with ozone therapy to reduce bacterial colonization and accelerate healing of DFUs in the home care setting. The control group (n = 12) received standard wound care with antimicrobial dressings every 3 days for 21 days, and the intervention group (n = 15) received the same as control group plus ozone bagging therapy at 70 μg/mL for 10 minutes every 3 days for 21 days. Combining standard wound care with ozone therapy significantly decreased the number of bacterial colonies (p = 0.001). However, no significant difference in DFU assessment score was found between the intervention and control groups (p > 0.05). Combining standard wound care with ozone therapy reduced the number of bacteria in the DFUs but exerted no significant effect on wound healing. Future studies should examine the administration of ozone therapy with different concentrations and times of exposure to explore the right dose for healing DFUs.

Bien E., Davis K., Gillespie G.

Home healthcare workers (HHCWs) belong to one of the fastest growing industries and have an unpredictable work environment, potentiating their risk of exposures to occupational hazards. More patients seeking care for chronic health conditions, and improvements in technology and medical advancements are allowing more complex patient care to be provided at home. A comprehensive integrative review was completed, identifying nine articles that provide an overview of the occupational hazards HHCWs face. Analysis of the articles indicates occupational hazards are similar across studies. Occupational exposures reported by HHCWs align within all the studies and include exposures to blood, saliva, dangerous conditions walking to and within the home, secondhand smoke, aggressive pets, violence, and ergonomic concerns. These studies have been methodologically limited to self-reports, including surveys, interviews, and focus groups but include quantitative and qualitative data. Future research can further describe and identify specific occupational exposures and health hazards, subsequently leading to modifications to protect the health and safety of HHCWs, personal care workers, and the informal caregivers who provide care in the home.

Rafiei H., Vanaki Z., Mohammadi E., Hosseinzadeh K.

Considering the importance of family caregivers in injury prevention, it is necessary to clearly define their role in injury guidelines. We reviewed the contents of injury guidelines with the aim of defining the role of family caregivers. PubMed, Web of Science, Scopus, and Proquest were searched, as well as the internet, as some injury guidelines may not be published in professional journals. Literature published between 2000 and 2020 was searched using the keywords pressure pressure ulcer, bed sore, and prevention guideline. Ten guidelines related to injury were found. Of these, five guidelines mentioned the role of family caregivers in relation to injury, referring only to the training and empowerment of family caregivers. Of the five guidelines that mentioned caregiver training, only three determined the training content in detail. According to these guidelines, family caregivers should be trained on the risk factors of injuries, characteristics of injuries, intervention to prevent injuries, nutrition, sign and symptoms of injuries, complication such as infection and using protective equipment and devices. In the guidelines that focused on family caregivers, the attention is sometimes limited and vague. Limited attention to the role of family caregivers can lead to lack of awareness and reduced ability of family caregivers to prevent injury and ultimately increase the patient's risk of developing injury.

Augustine M.R., Siu A.L., Boockvar K.S., DeCherrie L.V., Leff B.A., Federman A.D.

The evaluation of social support within hospital at home (HaH) programs has been limited. We performed a secondary analysis of a prospective cohort evaluation of 295 participants receiving HaH care and 212 patients undergoing traditional hospitalization from November of 2014 to August of 2017. We examined the confounding and moderating effects of instrumental and informational social support upon length of stay and 30-day rehospitalization, emergency department (ED) visit, and skilled nursing facility admission. Instrumental social support attenuated the effects of HaH upon any ED visit (base model: OR 0.61, p = 0.037; controlling for social support: OR 0.71, p = 0.15). The association of HaH with other outcomes remained unchanged. Interactions between HaH and informational or instrumental social support for all outcomes were not significant. Lack of high levels of social support had little effect on the positive outcomes of HaH care, suggesting similar benefits of HaH services for patients with lower levels of social support.

Small T.F., Gillespie G.L., Kean E.B., Hutton S.

The threat of workplace violence (WPV) is a significant occupational hazard for home healthcare workers (HHCWs). The purpose of this integrative review is to examine WPV interventions used by HHCWs to stay safe while working in the patient's home and community. The methodology used was the integrative review by , which allows for inclusion of experimental and non-experimental research, reflecting the state of the science on interventions used by HHCWs to mitigate and prevent WPV. A total of 17 articles pertained to interventions used by HHCWs. Interventions were further categorized by WPV Type. There are a number of interventions used for Type I and II WPV. However, interventions for Type III WPV are minimal and interventions for Type IV WPV are obsolete. Safety and health training were shown to be significant in increasing HHCWs' confidence and knowledge about WPV prevention. Researchers demonstrated safety and health training are effective in promoting a safe work environment and reducing incidents of WPV. This review begins to fill the gap in the literature on interventions used by HHCWs to mitigate and prevent WPV.

Hirakawa Y., Aita K., Nishikawa M., Arai H., Miura H.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity worldwide. Patients with severe COPD often fail to receive adequate palliative care and are subject to undesired hospital transfers and cardiopulmonary resuscitation. Although promoting advance care planning (ACP) in the community can help ensure the optimal delivery of palliative care for patients with COPD, the key challenges to routinely implementing ACP are not known. The aim of this study was to identify the perception of healthcare professionals with regard to ACP for adults living with severe COPD and the challenges to facilitating ACP. A multicenter qualitative study design was used. In-depth semistructured interviews were held involving 38 healthcare professionals from 19 institutions in Japan. Text data were analyzed by content analysis. Five main themes capturing the challenges to routine implementation of ACP were identified: daily decision-making; sense of ethical decision-making; in-depth interviewing skills; collaborative information sharing among team members; and knowledge dissemination regarding ACP. The model demonstrates the complexity inherent in ACP facilitation for community-dwelling adults with severe COPD, with all the elements required for successful ACP implementation. We recommend an approach that recognizes the importance of stakeholder education, particularly educating professionals to develop the knowledge, attitudes, and skills required for ACP facilitation: in-depth interviewing, collaborative information sharing, and ethical analysis, focusing on decision-making concerning everyday life support.

Wilson C., Arena S.K., Starceski R., Swanson K.

The purpose of this study was to describe self-reported outcomes and perceptions of community-dwelling older adults who participated in a 6-month prevention-focused home care physical therapy program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). A 17-question telephone survey was offered 1 to 3 months after program completion to HOP-UP-PT participants who completed a minimum of three visits. Self-reported fall outcomes, healthcare utilization outcomes, perceptions of interventions, and financial perceptions were descriptively analyzed. There were 18 survey respondents (9 male, 9 female, mean age = 79 years). No falls were reported by 15 respondents and 3 reported 1 to 2 falls without injury. Seventeen participants reported no hospitalizations, one reported only overnight emergency room observation, and no participants reported requiring physical therapy. Participants reported benefits of: activity trackers (18/18), fall-prevention exercises (17/18), and electronic blood pressure monitor use (13/18). Despite reported benefits, participants indicated an inability/unwillingness to privately pay for the program with fixed incomes identified as the rationale for this response. Future considerations for third-party reimbursement warrants examination given older adults may have limitations in disposable income. The findings of this study suggest efficacy of HOP-UP-PT may translate to participant satisfaction and positive health and behavior changes after participation.

Garza J.A., Taliaferro D.

Understanding the experiences of home healthcare nurses and exploring the factors that influence job satisfaction is important in reducing costly staff turnover. The purpose of the qualitative case study was to describe experiences related to job satisfaction among home healthcare nurses. Herzberg's Two Factor theory was used to frame the study. Twelve home healthcare nurses from an agency in South Texas volunteered to participate in in-depth interviews. Four themes emerged from the data: 1) patients contribute to job satisfaction, 2) autonomy promotes job satisfaction, 3) occupational stressors negatively influenced job satisfaction, and 4) leadership impacts job satisfaction. Home healthcare leadership should take safety concerns seriously and explore innovative ways to promote communication between field nurses and physicians. Further research is needed with a larger and more diverse sample of home healthcare nurses in order to be able to generalize findings.