Validity and reliability testing of home care stroke quality indicators

<p>It is disconcerting that until today there are no agencies or research to recommend the appropriate indicators of home nursing care of stroke patients according to Indonesian conditions. Hence, this research aimed to verify the validity and reliability of quality indicators of home nursing care for stroke patient that resulted from Delphy process. Confirmatory factor analysis was carried out for validity and reliability testing with data collected from 350 respondents. Based on the value of loading factors, 62 indicators were declared valid and five indicators were invalid. This study successfully proved the validity of 62 indicators of quality home care for stroke patients. Further research is needed to pilot project this indicator in a larger area.</p>

Support for Adjusting the Intentions of Family Members and Users Regarding Care Service Use: Aimed at Care Management

In Japan, there are key healthcare professionals for home nursing care for elderly people called Care Managers. The care manager coordinates the service while adjusting the family situation and the user’s intentions. The purpose of this study was to examine the practical structure of support for adjusting the intentions of family members and users regarding care service use. Data from seven cases, where family members and users have different intentions regarding care service use, were analyzed using the grounded theory approach. The phenomenon of “confirmation of discrepancies” was discovered with six sub-categories: adjusting the intentions of users and their families, effort to restore relationships, expression of intention to refuse involvement, expression of desire for adjustment, arrangement of opportunities for adjustment of intentions, and appropriate service adjustment. Four patterns occurred in the process of “confirmation of discrepancies”: smooth adjustment, restoration and promotion of mutual relationships, failure to reach an agreement, and negative feedback loops. These patterns were based on a combination of the care managers’ degree of understanding strength, the managers’ degree of insistence, the managers’ degree of representation of mutual feelings, the degree of managers’ prediction of life prospects, the degree of trust in care managers, and the degree of expression of family anxiety.

Using The Puzzle Teaching Method To Teach Home Nursing Care Concepts: An Evaluation Study

Background: One of the participatory learning approaches is the puzzle teaching method. Depending on the nature of the subject and the type of learners, this strategy can produce a variety of outcomes. The purpose of this study was to see how well the puzzle teaching style worked in the undergraduate nursing program's home nursing care course.Methods: This is a three-year evaluation study utilizing a qualitative methodology that took place between 2016 and 2019. The teaching technique was employed for a number of sessions of a home nursing care course during the first phase, and an evaluation was conducted at the end of the course using purposive sampling and focus group interviews with 11 students. The results of the first phase's evaluation led to changes in the procedure in the second phase, and at the end of that course, the evaluation was repeated with the 13 students. Further modifications to the teaching style were made, and a re-evaluation with ten students was conducted. MAXQDA10 software was used to conduct traditional content analysis on the data. Results The benefits of the puzzle method were confirmed by participants, but the findings of the first two phases of evaluation revealed obstacles such as "ineffective involvement," "inadequate teacher supervision," "offering unnecessary content," and "lack of final summarization" by the faculty member, "ineffective involvement", "crowded classroom", "the need for evaluation “and "piece learning" . Except for "ineffective involvement," the third phase's evaluation findings suggested that all flaws and obstacles had been addressed. Conclusion: The majority of the obstacles to implementing the puzzle teaching approach can be overcome by changing a few stages and procedures. However, ineffective involvement remains a significant roadblock. To overcome this stumbling block, more research is required.

Financial balance of home nursing care providers in the Czech Republic

Background To enable people to live in old age in their own homes often requires specialised home care services. Despite the high importance of these services, the finance of home nursing care (HNC) is still under-investigated in many countries. The aim of this paper was to describe the finance of HNC in the Czech Republic. Methods Balancing of revenues and costs was done using structured questionnaires from the closed accounting year 2018 as a monthly average. Nonparametric Kruskal-Wallis and Wilcoxon signed ranks tests were used to test hypotheses. Results Data from 62 providers were analysed. The data included information from a total of 2297 patients and 995 employees. The average of total costs were € 17,591.7 (95% CI 14,175.3 - 21,008.1) and average of total revenues were € 17,276.5 (95% CI 13,923.5 - 20,629.5). The average cost per a patient was € 516.0 (95% CI 465.9–566.1) and the average revenues were € 500.1 (95% CI 457.0–543.3). Conclusions The overall financial balance of HNC providers seems to be balanced in the Czech Republic. Nevertheless, insurance, although it should, did not cover all the costs. Micro- providers tended to be cheaper regarding the hours worked by nurses.

Factors Associated With Care Trajectory Following Acute Functional Decline in Older Home Nursing Care Patients: A Prospective Observational Study

Health policies and previous research highlight the importance of early identification and treatment of clinical deterioration in older patients to prevent frailty, higher levels of care, and mortality. This study explores older home nursing care patients’ care trajectories and factors associated with clinical response (type and level of intervention) from the health care services, final level of community care and death within 3 months after an incidence of acute functional decline. This observational study with a prospective, descriptive design includes a sample of 135 older home nursing care patients with acute functional decline. Demographic, health-related, and clinical characteristics were analyzed and prediction models for care trajectories were fitted using Bayesian generalized mixed models. Age ranged from 65 to 100, with a median age of 85. Hospital admission were registered for 13.33% ( T1) and 8.77% ( T2) of the participants. Nine patients (6.7%) were transferred to a higher level of community care, and 11 patients (8.1%) died. Frequent transitions between levels of care characterized care trajectories for patients experiencing more severe functional decline. Age, living in a private home, and increased Modified Early Warning Scores (MEWS) were associated with level of clinical responses throughout the care trajectory. Living in a private home was associated with the patients’ final level of community care. Female gender, hospital admission, and increased MEWS scores were associated with death. Health care personnel must be vigilant when MEWS scores rise even slightly, as this might be an indication of acute functional decline with possible increased risk of mortality.

Malnutrition Is Associated With Impaired Functional Status in Older People Receiving Home Care Nursing Service

Objective: This study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service.Method: In this cross-sectional study, 210 home-dwelling persons 65 years or older who received in-home nursing care service were evaluated. Demographic variables, nutritional status, comorbidities, and the dependency levels of activities of daily living were analyzed. To assess the correlation among the factors that influence nutritional status, a theoretical model was developed and adjusted using the path analysis model.Results: The primary finding is that functional status is directly associated with nutritional status (β = 0.32; p &lt; 0.001) and severity of comorbidities is indirectly associated with nutritional status (β = −0.07; p &lt; 0.017).Conclusion: The elicited outcomes in this study reinforce the concept that nutritional status is linked with functional status in older adults receiving in-home care nursing service.