Práticas de cuidado e necessidades de saúde de homens em atenção domiciliar / Care practices and health needs of men in home care / Prácticas de cuidado y necesidades de salud de los hombres en el cuidado domiciliario

Objetivo: Analisar as práticas de cuidado desenvolvidas para atender às necessidades de saúde de homens em atenção domiciliar. Métodos: Pesquisa observacional e qualitativa, realizada com 34 cuidadores e 24 homens assistidos pelo serviço de atenção domiciliar do município de João Pessoa. A coleta de dados foi realizada por meio de um roteiro com variáveis sociodemográficas e perguntas abertas. A Análise Crítica do Discurso foi utilizada como método de análise, com destaque para os significados representacional e identificacional dos discursos. Resultados: As práticas de cuidado e necessidades de saúde foram apontadas com base na relação hegemônica entre os atores do cuidado, associação do cuidado ao processo de trabalho informal, atuação da família, da atividade corresponsabilizada, e prática da autonomia e autocuidado. Conclusão: Evidenciou-se um cuidado multifacetado e executado por diversos atores com suporte de equipes multiprofissionais de atenção domiciliar. (AU)

Objective: To analyze the care practices developed to meet the health needs of men in home care. Methods: Observational and qualitative research, carried out with 34 caregivers and 24 men assisted by the home care service in the city of João Pessoa. Data collection was performed through a script with sociodemographic variables and open questions. Critical Discourse Analysis was used as a method of analysis, with emphasis on the representational and identificational meanings of the discourses. The research was approved according to the opinion number 1.829.326. Results: Care practices and health needs were identified based on the hegemonic relationship between the care actors, association of care with the informal work process, family activities and co-responsibility activities, and the practice of autonomy and self-care. Conclusion: There was evidence of a multifaceted care performed by different subjects with the support of multidisciplinary home care teams. (AU)

Objetivo: Analizar las prácticas asistenciales desarrolladas para satisfacer las necesidades de salud de los hombres en la atención domiciliaria. Métodos: Investigación observacional y cualitativa, realizada con 34 cuidadores y 24 hombres asistidos por el servicio de atención domiciliaria en la ciudad de João Pessoa. La recolección de datos se realizó mediante un guión con variables sociodemográficas y preguntas abiertas. Se utilizó el Análisis Crítico del Discurso como método de análisis, con énfasis en los significados representativos e identificativos de los discursos. La investigación fue aprobada de acuerdo al dictamen número 1.829.326. Resultados: Se identificaron prácticas de cuidado y necesidades de salud a partir de la relación hegemónica entre los actores del cuidado, la asociación del cuidado con el proceso de trabajo informal, las actividades familiares y de corresponsabilidad, y la práctica de la autonomía y el autocuidado. Conclusión: Se evidenció una atención multifacética realizada por diferentes sujetos con el apoyo de equipos multidisciplinares de atención domiciliaria. (AU)

Perfil dos pacientes em cuidados paliativos atendidos pela fisioterapia na assistência domiciliar de um hospital oncológico / Profile of patients in palliative care treated by physiotherapy in home care at an oncology hospital

O envelhecimento populacional e o aumento das doenças crônicas não transmissíveis, dentre elas o câncer, têm exigido a incorporação dos Cuidados Paliativos (CP) às redes assistenciais em saúde. Assim, o objetivo deste estudo foi descrever o perfil dos pacientes em cuidados paliativos atendidos pela fisioterapia na assistência domiciliar de um hospital de referência em oncologia. Trata-se de um estudo transversal, quantitativo, retrospectivo e descritivo, da análise de 76 prontuários de pacientes assistidos pela fisioterapia na assistência domiciliar do hospital entre agosto de 2018 a agosto de 2019. A maioria dos pacientes era do sexo feminino (n=51, 67,11%), da raça/cor negra (n=46, 60,52%), na faixa etária de 60 a 80 anos (n=36, 47,37%). O câncer de mama (n= 22, 28,95%), pulmão (n=11, 14,47%) e próstata (n=8, 10,53%) foram os mais frequentes e a maioria apresentava progressão da doença. Por fim, o principal motivo para o acompanhamento pela fisioterapia estava relacionado a funcionalidade e mobilidade. A caracterização dos pacientes que necessitam de atendimento fisioterapêutico na assistência domiciliar de um hospital de referência em oncologia faz-se necessário para melhor planejamento do cuidado pois tais informações podem direcionar possibilidades terapêuticas, permitindo maior efetividade no tratamento.

Population aging and the increase in chronic non-communicable diseases, including cancer, have required the incorporation of Palliative Care (PC) into health care networks. Thus, the objective of this study was to describe the profile of patients in palliative care treated by physiotherapy in home care at an oncology reference hospital. This is a cross-sectional, quantitative, retrospective and descriptive study, analyzing 76 medical records of patients assisted by physiotherapy in the hospital's home care between August 2018 and August 2019. The majority of patients were female (n=51, 67.11%), of black race/color (n=46, 60.52%), aged between 60 and 80 years (n=36, 47, 37%). Breast (n=22, 28.95%), lung (n=11, 14.47%) and prostate (n=8, 10.53%) cancers were the most common and the majority showed disease progression. Finally, the main reason for physiotherapy monitoring was related to functionality and mobility. The characterization of patients who require physiotherapeutic care in home care at an oncology reference hospital is necessary for better care planning as such information can direct therapeutic possibilities, allowing greater effectiveness in treatment.

Cuidados domiciliarios para personas mayores dependientes: Una revisión de alcance / Home care for dependent older people: A scoping review

INTRODUCCIÓN: Existe escasa evidencia que indague en los aspectos psicosociales del cuidado, considerando la perspectiva de quienes cuidan a personas mayores (PM) dependientes para diseñar intervenciones idóneas para los cuidadores informales y las PM. OBJETIVO: Sintetizar la evidencia disponible en torno a los cuidados domiciliarios disponibles para PM dependientes con un fuerte énfasis en los cuidadores informales. MATERIALES Y MÉTODOS: Se realizó una búsqueda de artículos publicados en los últimos 10 años (enero 2012 hasta enero 2022) en dos bases de datos revisadas por pares. Se identificaron un total de 116 artículos y 42 artículos fueron revisados. RESULTADOS: Los resultados identificados fueron agrupados en: (1) factores que influyen en la sobrecarga o calidad de vida del cuidador, (2) necesidades de cuidado en la diada, (3) intervenciones o recomendaciones de cuidados para la diada, (4) uso de redes de apoyo al cuidado (informal y formal). CONCLUSIONES: Las implicancias para la práctica clínica de esta revisión implican profundizar en las necesidades sentidas de los cuidadores y conexión con la red de estatal y territorial. Lo anterior impacta directamente en los factores que influyen en la percepción de sobrecarga del cuidador, así como también en su calidad de vida. Investigar el rol del cuidador a través de la generación de evidencia robusta es aún una tarea pendiente.

INTRODUCTION: There is little evidence that investigates the psychosocial aspects of care, considering the perspective of those who care for dependent older people (OP) to design suitable interventions for informal caregivers and OP. OBJECTIVE: To synthesize the available evidence around home care available for dependent older people with a strong emphasis on informal caregivers. MATERIALS AND METHODS: A search of articles published in the last 10 years (January 2012 to January 2022) was conducted in two peer-reviewed databases. A total of 116 articles were identified and 42 articles were reviewed. RESULTS: The identified results were grouped into: (1) factors that influence the burden or quality of life of the caregiver, (2) care needs in the dyad, (3) interventions or recommendations for care for the dyad, (4) use of care support networks (informal and formal). CONCLUSIONS: The implications for clinical practice of this review involve delving into the felt needs of caregivers and connection with the state and territorial network. This directly impacts the factors that influence the caregiver's perception of overload, as well as her quality of life. Investigating the role of the caregiver through the generation of robust evidence is still a pending task.

Qualidade de vida: sobrecarga e depressão entre cuidadores de idosos em atendimento domiciliar / Quality of life: overload and depression between caregivers of elderly people in home care / Calidad de vida: sobrecarga y depresión en cuidadores de ancianos en atención domiciliaria

Objetivo: avaliar prevalência e impacto da sobrecarga e da depressão na qualidade de vida de 102 cuidadores de idosos cadastrados no Programa Melhor em Casa. Método: estudo analítico transversal aprovado pelo Comitê de Ética e Pesquisa. Realizado entre junho e novembro 2022, em Juiz de Fora (MG/Brasil), com amostra censitária e aplicação de formulário sociodemográfico, da Escala de Zarit, do Inventário de Depressão de Beck e do questionário de qualidade de vida da Organização Mundial de Saúde (WHOQOL-bref). Foram utilizados Teste t de Student, Mann-Whitney e regressão linear múltipla, com nível de significância de 5%. Resultados: observou-se sobrecarga em 69,6% dos cuidadores, além da presença de sintomas sugestivos de depressão em 41,1% da população em estudo. Conclusão: a sobrecarga esteve associada a piora da qualidade de vida nos domínios físico, psicológico e de relação social, enquanto a depressão esteve associada a piora da qualidade de vida nos domínios psicológico e de avaliação geral.

Objective: to evaluate the prevalence and impact of overload and depression on the quality of life of 102 caregivers of elderly people registered in the Melhor em Casa Program. Method: cross-sectional analytical study approved by the Research Ethics Committee. Carried out between June and November 2022, in Juiz de Fora (MG/Brazil), with a census sample and application of a sociodemographic form, the Zarit Scale, the Beck Depression Inventory and the World Health Organization's quality of life questionnaire (WHOQOL-bref). Student's t-test, Mann-Whitney test and multiple linear regression were used, with a significance level of 5%. Results: overload was observed in 69.6% of caregivers, in addition to the presence of symptoms suggestive of depression in 41.1% of the study population. Conclusion: overload was associated with worsening quality of life in the physical, psychological and social relationship domains, while depression was associated with worsening quality of life in the psychological and general evaluation domains.

Objetivo: evaluar la prevalencia y el impacto de la sobrecarga y la depresión en la calidad de vida de 102 cuidadores de ancianos registrados en el Programa Melhor em Casa (Mejor en casa). Método: estudio analítico transversal aprobado por el Comité de Ética en Investigación. Realizado entre junio y noviembre de 2022, en Juiz de Fora (MG/Brasil), con muestra censal y aplicación de un formulario sociodemográfico, la Escala de Zarit, el Inventario de Depresión de Beck y el cuestionario de calidad de vida de la Organización Mundial de la Salud (WHOQOL-bref). Se utilizó la prueba t de Student, la prueba de Mann-Whitney y la regresión lineal múltiple, con un nivel de significancia del 5%. Resultados: se observó que el 69,6% de los cuidadores sentían sobrecarga, además de algunos síntomas sugestivos de depresión en el 41,1% de la población de estudio. Conclusión: la sobrecarga se asoció con un empeoramiento de la calidad de vida en los dominios físico, psicológico y de relaciones sociales, mientras que la depresión se asoció con un empeoramiento de la calidad de vida en los dominios psicológico y de evaluación general.

Teaching and learning strategies in Home Enteral Nutritional Therapy: Knowledge gains perceived by caregivers / Estratégias de ensino e aprendizagem na Terapia Enteral domiciliar: ganhos de conhecimentos percebidos por cuidadores / Estrategias de enseñanza y aprendizaje en Terapia Enteral domiciliaria: adquisición de conocimiento percibida por los cuidadores

Abstract Objective: to evaluate how different educational strategies contribute to knowledge gains perceived by caregivers of people using Enteral Nutritional Therapy. Method: a quasi-experimental study conducted in two stages: the first one included an interactive lecture class (LC) and the second was carried out in two groups: in-situ simulated skills training (ST) and reading of an educational booklet (EB). The caregivers answered a self-administered questionnaire to assess knowledge before and after the interventions; for the analysis, a generalized linear model with Poisson distribution was proposed and the comparisons were carried out using orthogonal contrasts. Results: the participants were 30 caregivers; evidence of a difference in knowledge between the t1and t0 moments is evidenced. The analysis of the final comparison about the knowledge gain between the EB and ST groups, according to Student's t, evidenced an estimated difference of -1,33, with 95% CI (-4.98; 2.31) and p-value=0.46. Conclusion: knowledge was further increased between the t1 and t0 moments, when compared to the t2 and t1 moments in both groups. When compared, we cannot conclude that one of the groups changed more than the other in relation to moment t0 and t2; thus, the study evidenced the knowledge gain after all the educational strategies in both groups.

Resumo Objetivo: avaliar como diferentes estratégias educativas contribuem para ganhos de conhecimento percebidos por cuidadores de pessoas em uso da Terapia Nutricional Enteral. Método: estudo quase-experimental realizado em duas etapas; a primeira contemplou uma aula expositiva dialogada (AE) e a segunda aconteceu em dois grupos: treino de habilidades (TH) simulado in situ e leitura da cartilha educativa (CE). Os cuidadores responderam um questionário autoaplicável para avaliação de conhecimentos em pré e pós-intervenções; para a análise foi proposto um modelo linear generalizado com distribuição Poisson e as comparações foram realizadas por contrastes ortogonais. Resultados: participaram 30 cuidadores, observou-se evidência de diferença de conhecimento entre os tempos t1 e t0. A análise da comparação final sobre o aumento do conhecimento entre os grupos CE e TH, por teste t-Student, evidenciou uma diferença estimada de -1,33, com IC 95% (-4,98; 2,31) e valor de p de 0,46. Conclusão: ocorreu uma maior elevação de conhecimento entre os tempos t1 e t0, quando comparada os tempos t2 e t1 em ambos os grupos. Quando comparados, não podemos concluir que um dos grupos mudou mais que o outro em relação aos tempos t0 e t2; assim, o estudo evidenciou o ganho de conhecimento após todas as estratégias educativas nos dois grupos.

Resumen Objetivo: evaluar cómo las diferentes estrategias educativas contribuyen a la adquisición de conocimiento percibida por los cuidadores de personas que utilizan Terapia Nutricional Enteral. Método: estudio cuasiexperimental realizado en dos etapas; la primera incluyó una clase expositiva dialogada (CE) y la segunda se desarrolló en dos grupos: entrenamiento de habilidades (EH) simuladas in situ y lectura del folleto educativo (FE). Los cuidadores respondieron un cuestionario autoadministrado para evaluar el conocimiento pre-posintervenciones; para el análisis se propuso un modelo lineal generalizado con distribución de Poisson y las comparaciones se realizaron mediante contrastes ortogonales. Resultados: participaron 30 cuidadores, había evidencias de la diferencia de conocimiento entre los tiempos t1 y t0. El análisis de la comparación final sobre el aumento de conocimientos entre los grupos FE y EH, mediante la prueba t de Student, mostró una diferencia estimada de -1,33, con un IC del 95% (-4,98; 2,31) y un valor de p de 0,46. Conclusión: hubo un mayor aumento del conocimiento entre los tiempos t1 y t0, que entre los tiempos t2 y t1 en ambos grupos. Al compararlos, no podemos concluir que uno de los grupos cambió más que el otro entre t0 y t2; por lo tanto, el estudio demostró que hubo adquisición de conocimiento después de todas las estrategias educativas en ambos grupos.

Idosos Domiciliados: Saúde Geral x Higiene Bucal / Elderly People Living at Home: General Health x Oral Hygiene

O Serviço Integrado da Assistência Domiciliar (SIAD) foi criado a fim de prestar atendimento integral domiciliar a idosos que apresentam incapacidade de se locomover para as unidades de atendimento de saúde da Marinha do Brasil (MB). Com a finalidade de avaliar o perfil de saúde geral e de higiene dental desses pacientes, foi realizado um estudo transversal, quantitativo e descritivo, no qual foram incluídos idosos com 60 anos ou mais, assistidos entre fevereiro de 2017 a dezembro de 2022. Pode-se observar que a maioria dos idosos eram longevos, com média de idade de 82,52 anos (±8,66), mulheres (63,52%) e possuíam dependência total para realizar atividades básicas de vida diária (88,9%). Conclui-se que a síndrome demencial foi o diagnóstico principal mais encontrado (44,3%), a maioria possuía comorbidade associada (71,9%), sendo a Hipertensão Arterial Sistêmica (59,2%) e o Diabetes Mellitus (28,9%) as mais recorrentes. Foi encontrada uma elevada prevalência de idosos domiciliados com higiene bucal insatisfatória (34,7%) ou irregular (57,2%). No entanto, não houve associação entre higiene dental, comorbidades e grau de dependência. Assim sendo, é imprescindível que os idosos domiciliados recebam orientações e sejam submetidos a um acompanhamento rigoroso e constante, juntamente com seus cuidadores, a fim de promover a melhoria da higiene oral desses pacientes.

The Integrated Home Assistance Service (IHAS) was created to provide integral home care for elderly people who are unable to go to the health care units of the Brazilian Navy. A cross-sectional, quantitative, and descriptive study was carried out to evaluate the general health and dental hygiene profile of these patients. The study included elderly people aged 60 years or older who were assisted between February 2017 and December 2022. Most of them were long-lived, with a mean age of 82.52 (±8.66) years, women (63.52%) and totally dependent on performing basic activities of daily living (88.9%). The most common diagnosis among them was dementia syndrome, accounting for 44.3% of cases. Additionally, a large portion of the elderly had associated comorbidities (71.9%), with Systemic Arterial Hypertension (59.2%) and Diabetes Mellitus (28.9%) as the most recurrent conditions. The study found a high prevalence of elderly with unsatisfactory (34.7%) or irregular (57.2%) oral hygiene. Nevertheless, there was no significant association between dental hygiene and comorbidities or the degree of dependence. Therefore, it is imperative that elderly people living at home receive guidance and undergo meticulous and ongoing monitoring, in conjunction with their caregivers to promote improvements in the oral hygiene of these patients.

Elaboração de um protocolo de classificação de risco para pacientes oncológicos em Cuidados Paliativos Domiciliares / Development of a risk classification protocol for cancer patients in Home-based Palliative Care

RESUMO Os serviços de Cuidados Paliativos Domiciliares especializados no tratamento de pacientes oncológicos têm como objetivo identificar e controlar sintomas físicos, psicossociais e espirituais em domicílio. Alguns desafios encontrados são a complexidade de sintomas, a sobrevida reduzida dos pacientes com câncer avançado e limitações do sistema de saúde. Para estratificar a prioridade de atendimento dos pacientes com câncer avançado em Cuidados Paliativos Domiciliares, foi elaborado um protocolo de classificação de risco. Este artigo é um relato de experiência sobre o processo de elaboração de um protocolo de classificação de risco para pacientes com câncer avançado atendidos em um serviço de Cuidados Paliativos Domiciliares no Rio de Janeiro. A etapa inicial envolveu reuniões da equipe da Assistência Domiciliar de um hospital oncológico e buscas estruturadas na literatura. Depois, foram listadas as situações clínicas de manejo mais complexo no domicílio, chamadas de sinais e sintomas de alerta: dor, falta de ar, náuseas/ vômitos, sangramento e confusão mental aguda. Elaborou-se um protocolo de avaliação e classificação de risco com cinco categorias/cores, para determinar a prioridade de atendimento dos pacientes. O sistema de triagem desenvolvido possui fácil aplicabilidade e requer um treinamento breve do profissional de saúde para que possa ser utilizado durante os atendimentos domiciliares.

ABSTRACT Home-based Palliative Care services specialized in the treatment of cancer patients aim to identify and control physical, psychosocial, and spiritual symptoms at home. Some challenges encountered are the complexity of symptoms, reduced survival of patients with advanced cancer, and limitations of the health care system. To stratify the priority of care for patients with advanced cancer in home Palliative Care, a risk classification protocol was developed. This article is an experience report on the process of creating a risk classification protocol for patients with advanced cancer treated at a home Palliative Care service in Rio de Janeiro. The initial stage involved meetings of the home care team at an oncology hospital and structured searches in the literature. Afterwards, the clinical situations of more complex management at home were listed and named as warning signs and symptoms: pain, shortness of breath, nausea/ vomiting, bleeding, and acute mental confusion. An assessment and triage protocol was developed with five categories/colors to determine the priority of patient care. The developed triage system has easy applicability and requires a brief training of the health professional so that it can be used during home visits.

Adherence and Cost Effectivity of Home-Based Prophylaxis Over Institutionalized Prophylaxis in Patients with Hemophilia

Purpose: Home-based prophylaxis in hemophilia facilitates the treatment of patients with hemophilia (PwH) at home resulting in an improved quality of life, experiencing less pain and greater flexibility in daily activities. This literature studies the cost effectivity and adherence to prophylaxis treatment after the implementation of home-based prophylaxis therapy in PwH registered under the Hemophilia Treatment Centre (HTC) of Assam Medical College and Hospital. Materials and Methods:?PwH and their parents were advised for self/home infusion after being trained by a medical professional for 6 months. Data were collected on the skip in prophylaxis treatment by PwH and their traveling cost to access the prophylaxis treatment before and after the implementation of home infusion, through questionnaire and telephonic interview. Results:?The mean number of days of skip in prophylaxis was significantly reduced from 25 (±11) to 4 (±2) days after implementation of home infusion. The mean transportation cost was also found to be significantly decreased from Rs. 3297 (±2251) to 440 (±279). Before home/self-infusion, 77% of the registered PwH were found to skip prophylaxis doses more than 12 times a year but after home infusion, no PwH were found to skip more than 12 doses a year. Conclusion:?Home therapy facilitates the PwH to strictly adhere to the prophylaxis regime significantly reducing the skipping of doses to be administered to the PwH. The risks of regular traveling and the burden of transportation expenditure to avail the prophylaxis treatment was also found to be reduced significantly.

Evaluation of malnutrition frequency and related factors of geriatric patients in need of home healthcare

SUMMARY OBJECTIVE: The nutritional status of frail elderly people receiving home health services should be evaluated. This study aimed to determine the nutritional status of patients aged ≥65 years registered in the Home Healthcare Services unit and investigate the factors that may be associated with malnutrition. METHODS: This cross-sectional descriptive study was conducted during routine visits to patients and their caregivers. A total of 161 patients were asked to fill in surveys asking about sociodemographic characteristics, patient history, and clinical status. Anthropometric measurements were taken from all patients. The Mini Nutritional Assessment Short Form was applied to the patients for screening purposes. Patients who scored ≤11 on the Mini Nutritional Assessment Short Form were then asked to complete the full Mini Nutritional Assessment form. RESULTS: According to the Mini Nutritional Assessment Short Form and Mini Nutritional Assessment tests, almost half of the elderly patients included in the study (49.7%, n=161) were malnourished or at risk of malnutrition. Analyses showed that those who had COVID-19 [odds ratio (OR): 9.423, 95%CI 2.448-36.273) and those diagnosed with dementia/depression (OR: 8.688, 95%CI 3.246-23.255) were more likely to be malnourished, whereas those with diabetes (OR: 0.235, 95%CI 0.084-0.657) were less likely to have malnutrition. Strikingly, those who were fed by caregivers (OR: 15.061, 95%CI 3.617-62.710) were also more likely to be malnourished than those with self-feeding ability. CONCLUSION: Malnutrition or the risk of malnutrition is common in elderly patients receiving home care services. Many factors can have an impact on malnutrition.

Competências do enfermeiro para atuação na atenção domiciliar e situações que mobilizam as competências: estudo de caso / Nurse skills to work in home care and situations that mobilize skills: case study

Introdução: A assistência à saúde no domicílio configura-se como uma modalidade de cuidado em expansão no cenário mundial e a enfermagem integra a equipe multiprofissional, sendo a maior provedora de assistência domiciliar. No contexto de especificidades da atenção domiciliar, o enfermeiro é constantemente desafiado a mobilizar conhecimentos, habilidades e atitudes de forma inter-relacionada e espera-se que seja competente na prática profissional. O objetivo deste estudo foi analisar as competências mobilizadas por enfermeiros na atenção domiciliar no dia a dia do seu trabalho. Método: estudo de abordagem qualitativa com delineamento metodológico de estudo de caso único. A produção dos dados teve como cenário o serviço de atenção domiciliar do Sistema Único de Saúde do município de Belo Horizonte. Participaram da pesquisa 12 enfermeiros que compõem equipes multiprofissionais de atendimento domiciliar. As fontes de evidência foram a análise documental, entrevistas guiadas por um roteiro semiestruturado com foco em competências e grupo focal. Os dados foram submetidos à Análise de Discurso Crítica, na perspectiva de Fairclough, possibilitando a discussão de duas categorias empíricas: competências do enfermeiro para atuação na atenção domiciliar; e situações que promovem a mobilização das competências. Resultados: identificou-se um conjunto de dezessete competências mobilizadas pelos enfermeiros do serviço de atenção domiciliar, quais sejam: liderança, comunicação, tomada de decisão, avaliação holística do paciente e ambiente domiciliar, gestão do trabalho, gestão do cuidado, educação em saúde, sensibilidade cultural, assistência de enfermagem, trabalho em equipe, colaboração interdisciplinar, trabalho em rede, gestão de recursos materiais, gestão do tempo, desenvolvimento profissional, adaptação à tecnologia e segurança para o trabalho. Para cada uma das competências foram apontados e discutidos os atributos relacionados a conhecimentos, habilidades e atitudes. Os discursos revelaram que as competências são mobilizadas por situações relacionadas as particularidades da atenção domiciliar, singularidade do contexto domiciliar e demandas profissionais. Conclusão: a prática dos enfermeiros na atenção domiciliar mobiliza diversas competências compreendidas como uma necessidade no dia a dia do trabalho.

Introduction: Home health care is an expanding modality of care on the world stage and the nurse is part of the multidisciplinary team, being the largest provider of home care. In the context of specificities of home care, nurses are constantly challenged to mobilize knowledge, skills and attitudes in an interrelated way and are expected to be competent in professional practice. The objective of this study was to analyze the skills mobilized by nurses in home care in their day-to-day work. Method: qualitative approach study with a single case study methodological design. Data production took place in home care service of the Unified Health System in the city of Belo Horizonte. 12 nurses who make up multidisciplinary home care teams participated in the research. The sources of evidence were documents analysis, interviews guided by a semi-structured script focusing on skills and focus groups. The data were submitted to Critical Discourse Analysis, from Fairclough 's perspective, enabling the discussion of two empirical categories: nurse skills to work in home care; and situations that promotes the mobilization of skills. Results: a set of seventeen skills mobilized by nurses in home care service were identified, namely: leadership, communication, decision making, holistic assessment of the patient and home environment, work management, care management, health education, cultural sensitivity, nursing care, teamwork, interdisciplinary collaboration, networking, material resource management, time management, professional development, adaptation to technology and work safety. For each of the competencies, attributes related to knowledge, skills and attitudes were highlighted and discussed. The speeches revealed that skills are mobilized by situations related to the particularities of home care, the uniqueness of the home context and professional demands. Conclusion: the practice of nurses in home care mobilizes several skills understood as a necessity in day-to-day work.

Impact of IMADOKO, a Tool for Confirming the Current Status, in Decision-Making Support for Better Recuperation Places for Terminal Cancer Patients and Their Families

We devised IMADOKO as a tool to confirm the current status of terminal cancer patients and are using it in the home care team. In this study, we retrospectively investigated the actual state of end-of-life care to clarify the impact of IMADOKO on decision-making support for terminal cancer patients and their families. The subjects were 64patients (male/female, 38/26) before IMADOKO introduction, and 140 patients (male/female, 78/62) after the introduction, with an average age of 74 years in both cases and the primary lesions were the pancreas, lung, and the gastrointestinal tract. The rate of death at home increased significantly after the introduction of IMADOKO, compared to before. In the IMADOKO introduced group, IMADOKO was used in 108 patients and all their families. The use of IMADOKO for the patient was not related to the location of death, but it significantly improved communication between the patient and family, and between patient/patient's family and medical staff. It was shown that IMADOKO may be useful for decision-making support in choosing a better place of recuperation.

Sheeted Mohs Paste for Alleviating Symptoms of Malignant Tumors in Home Care

Mohs paste (MP) is a topical treatment that can help relieve the symptoms of self-destructive skin lesions caused by malignant tumors. Despite the potential benefits of MP in improving the quality of life of patients, its use in home-based care is limited due to various obstacles. In this study, we developed a 1-mm-thick MP gauze sheet, which allowed us to apply the MP treatment at home to a patient with breast cancer. After three weekly treatments, the patient’s main symptoms, including itchiness, odor caused by exudates, and mobility issues, showed improvement. By using MP as a sheet, we overcame the obstacles associated with its use, such as alterations in the physical properties and the risk of damage to healthy skin tissue. Additionally, we reduced the treatment duration and need for trained personnel. Our findings suggest that the MP treatment can effectively control the symptoms of patients in home-based care, consistent with prior research.

Difficulties in Home-Visit Rehabilitation for Elderly Foreign Residents: Interviews with Physical Therapists / 国際保健医療

Introduction  With the increase in the number of foreign residents in Japan and the aging of the population, it is expected that there will be more opportunities to provide home-visit rehabilitation to foreign residents are increasing. The purpose of this study was to clarify the difficulties that physical therapists (PTs) face when providing home-visit rehabilitation to elderly foreign residents.Methods  A qualitative descriptive study using semi-structured interviews was conducted with PTs who have experience in providing home-visit rehabilitation to elderly foreign residents.Results  The subjects were 11 PTs (9 males and 2 females), with an average age of 39.3 years and the average years of PT experience 13.7 years. The analysis revealed that the difficulties faced by PTs included 10 categories; [Differences in rehabilitation concepts with foreign elderly], [Difficulty in goal setting], [Lack of multilingual support and access to information on support], [Burden of dealing with non-rehabilitation work], [Building trust through daily communication], [Detailed communication in different languages], [Dealing with cultural differences], [Differences in religion and sensitivity to this topic], [Dealing with elderly foreign residents who are hesitant to contact with Japanese people] and [Anxiety about conducting home-visit rehabilitation due to PT’s preconceived notions about foreigners].Conclusions  Differences in the rehabilitation concepts between Japan and some foreign countries were found as a difficulty faced by PTs. Difficulties due to language differences were significant, and institutional difficulties also existed, such as lack of multilingual support and access to information on support. In addition, by visiting private homes and providing individualized services, PTs sometimes had to deal with problems faced by elderly foreign people other than rehabilitation work. These were considered to make it difficult to implement goal-oriented rehabilitation.

Discussion on the collaborative dilemmas and integrated mode of family bed service in China / 中华医院管理杂志

In recent years, the aging process of China′s population has accelerated, and the number of disabled people has skyrocketed. It is urgent to improve the health benefits of family bed services. The author found that there was a lack of synergy in policies, service subjects and content, and service concepts in the practical process of family bed services in various regions of China, which limited the effectiveness of services. The author put forward the theoretical framework of integrated family bed service, combined the service practice experience of six cities, namely Guangzhou, Shanghai, Beijing, Shenzhen, Nanjing and Hohhot, and put forward specific suggestions on building integrated family bed service. Among them, department collaboration could be the source power of system integration, institutional linkage could improve service continuity, service concept and incentive mechanism could promote each other, and modern technology could promote functional integration.

Status quo of home care for community-dwelling elderly from the perspective of family doctor teams: a qualitative study / 中华全科医师杂志

Objective:To investigate the perspective of family doctor teams on the status quo of home care for community-dwelling elderly.Methods:The focus group interviews on the status quo of home care for community-dwelling elderly were conducted from August 19 to December 28, 2021. One urban area and 1 suburban area of Beijing was selected by purpose sampling method as target areas. Five community health service centers were selected from each area, and 5 family doctor team members were selected as interviewees in each center. The outline of interviews was as follows: what kinds of home care does the family doctor team provide for the community-dwelling elderly; how does the family doctor team evaluate the existing community-based home care; what suggestions on developing community-based home care for the elderly in the future. The data of the interview were analyzed by the thematic framework.Results:Xicheng district and Miyun district were selected as the study sites in the urban and suburban areas of Beijing, and 41 family doctor team members were interviewed. Three themes and 6 sub-themes were extracted. The study showed that: (1) the family doctor contracted service for the elderly was carried out smoothly in the community; (2) the current situation of home care for the elderly in the community varied, the chronic disease management for the elderly was effective, the health education in the community was popular, the implementation of free annual health check for the elderly in urban areas was more difficult than that in suburban areas, and the family doctor team provided home visits as needed and required; (3) the members of family doctor team usually undertook multiple tasks due to the insufficiency of auxiliary staff, and the incentive mechanism of the home visit was not perfect, which needed to be improved.Conclusion:From the perspective of family doctor teams, the contract service for the elderly is generally carried out smoothly in Beijing communities, but it varies in different types of home care for the elderly, and the work and incentive mechanism of family doctor team need to be improved.

Demand and supply of community-based care services for the elderly in China and its influencing factors / 中华老年医学杂志

Objective:To explore the demand and actual supply of community-based care services for the elderly residents and the factors that affecting care mode for them in the context of rapid urbanization and population aging in China.Methods:Based on the cross-sectional data of the seventh China Longitudinal Survey on Health and Longevity(CLHLS)(2018), 15 854 elderly residents aged 60 and above were selected as the research population.Logistic regression method was used to analyze the patterns of community-based care services and their influencing factors.Results:Among 15 854 elderly residents, 6 912(43.60%)were male and 8 942(56.40%)were female.The results of activities of daily living(ADL)evaluation showed that 11 109 elderly residents could take care of themselves completely, and 3 889 elderly residents were disabled.The disability rate was 25.93%.The proportion of social services that elderly town dwellers expect the community to provide is higher than those living in cities and rural areas in terms of daily care, spiritual care, providing health care knowledge, and dealing with neighborhood disputes.From the perspective of social services actually provided by the community, in addition to providing home-based care, the proportion of community services available to the elderly living in towns and rural areas are similar, but significantly lower than the proportion of social services provided for elderly city dwellers.Age, marital status, residence, cultural differences, health status, source of life and living preference had significant impacts on the choice of care demand patterns.Those of older age( OR=2.29, 95% CI: 1.04-5.03 for 70-79 years old; OR=2.94, 95% CI: 1.38-6.25 for elderly 80 years old or above), having no spouse( OR=3.50, 95% CI: 2.49-4.92), and with higher levels of disability( OR=4.24, 95% CI: 3.12-5.77 for mild disability; OR=7.54, 95% CI: 5.19-10.95 for moderate disability; OR=10.50, 95% CI: 7.59-14.53 for severe disability)are more inclined to choose socialized care. Conclusions:In the process of rapid urbanization in China, the demands for care services of elderly living in towns has increased, but the actual care services provided for them by the communities are yet to be improved.Moreover, elderly town dwellers are still inclined to family care, the same as those of elderly rural dwellers.

Study on home care needs and care resource integration expectations of elderly patients after hip fracture surgery: a mixed-method study / 中国实用护理杂志

Objective:To investigate the home care needs and home resource integration expectations of elderly patients after hip fracture surgery so as to provide health care guidance after discharge.Methods:A mixed study method of consistent parallel design was used to conduct semi-structured interviews in 15 elderly patients after hip fracture surgery. Meanwhile, convenient sampling method was used to select elderly patients after hip fracture surgery to conduct health survey with interRAI-HC(International Resident Assessment Instrument Home Care), and comprehensive data results were analyzed.Results:Through the analysis and induction of the interview data, two main themes were extracted: the diversification of home care needs and the lack of integration of home service resources. There were 25 health problems in the elderly after hip fracture surgery. Health problems mainly focus on ADL limitation, insufficient social activity, limited social interaction, clinical health problems (fall risk, malnutrition, pain, cardiovascular and respiratory problems, weakness, fatigue), etc.Conclusions:For elderly patients after hip fracture surgery, it is necessary to strengthen the rehabilitation guidance at discharge, integrate home care resources to provide diversified nursing services in the transitional stage, promote the formation and continuity of patients' rehabilitation behavior, and improve the clinical outcome of patients.

Research on the demand and influencing factors of home care social support services for the elderly with dementia in cities / 中国实用护理杂志

Objective:To investigate the demand and influencing factors of home care social support services for the elderly with dementia in urban areas, and provide a decision-making basis for improving home care social support services for the elderly with dementia.Methods:This was a cross-sectional study. From March 2021 to March 2022, 386 family caregivers of elderly people with dementia were randomly selected from tertiary hospitals in four central urban areas of Wuhan by stratified sampling method. A questionnaire was used to investigate the current situation and attributes of the demand for home care social support services for the elderly with dementia in urban areas. The importance of the demand for home care social support services for the elderly with dementia in urban areas was calculated by the Better-Worse coefficient method and sensitivity formula method. The optimal scale regression model was used to analyze the influencing factors and influencing forces of independent variables on service demand.Results:The score of social support service demand for home care was (88.6 ± 29.71) points. The Better coefficient of demand for all social support services was greater than the absolute value of the Worse coefficient. One requirement (pressure ulcer prevention and treatment guidance) was a one-dimensional attribute, and the remaining 29 items were charm attributes. The top 6 items in importance ranking were 2 items of informational support (pressure ulcer prevention and treatment guidance; telephone counselling guidance for family caregivers), 1 items of instrumental support (financial assistance for family caregivers) and 3 items of social companionship support(cultural recreation/physical activity activities, door-to-door accompaniment, accompany the elderly to social activities). Optimal scale regression model test: all four models of social support service demand were statistically significant ( F values were 2.75-4.23, all P <0.01). The gender, education level, number of children of the elderly with dementia, age,education level, self rated physical condition of family caregivers, the average monthly income of families, and the relationship between family caregivers and the elderly with dementia were the influencing factors of self-esteem support (all P<0.05). The educational level, marital status, type of dementia of the elderly with dementia, educational level, self rated physical condition of family caregivers, the average monthly income of the family, and the relationship between family caregivers and the elderly with dementia were the influencing factors of informational support (all P <0.05). The educational level and type of dementia of the elderly with dementia, the educational level, self rated physical condition of family caregivers, and the average monthly income of families were the influencing factors of social companionship support (all P <0.05). The type of dementia of the elderly with dementia, the self rated physical condition of family caregivers, the average monthly income of families, and the relationship between family caregivers and elderly relatives were the influencing factors of instrumental support (all P <0.05). Five times for caregiver human resources, 3 times for family economic resources and 3 times for the elderly with dementia, and 1 time for relatives resource factors were the top 3 times of independent variable influence force entered the ranking. Conclusions:The demand for social support services for home care of the elderly with dementia is low, with the characteristics of expectant tendency and centralized demand. The provision of home-based care social support services should give priority to meeting the needs of "pressure ulcer prevention and treatment guidance", and provide financial assistance, counseling and guidance, social companionship and other services as much as possible. Caregiver human resources are the key factors affecting home care social support services, family economic resources and the elderly with dementia are important factors, it is recommended to fully tap the potential of relatives resources and community resources.

Palliative Radiotherapy in Home Care

Palliative radiotherapy, when properly administered, contributes to improving the quality of life of patients. Although the usefulness of radiotherapy has been increasingly recognized, the need for palliative radiotherapy from home healthcare institutions has not yet been met. Although there are patients undergoing home care who would benefit from radiotherapy to improve their quality of life, it is difficult to determine the indication in the home care setting, where diagnostic imaging tests are not readily available. In addition, patients undergoing treatment at home often have a lowered performance status, making frequent visits to the hospital difficult and limiting their means of transportation. Under these circumstances, we have been providing palliative radiotherapy in cooperation with home care clinics.

Home Care in the Era of COVID-19 —Results from the Bereaved Families of Terminal Cancer Patients Survey—

The purpose of this study was to examine the impact of COVID-19 on home care at the end of life and the satisfaction of bereaved families. A questionnaire survey was conducted on 100 bereaved families of terminal cancer patients who were receiving home care. The effects of the COVID-19 on at-home medical treatment and the rate of satisfaction of bereaved families were examined. The response rate for this survey was 72.0%. Of the respondents, 52.8% of the bereaved families answered that the COVID-19 had an effect on their decision to choose home care. The rate of satisfaction of bereaved families was 98.6%. Even for terminal cancer patients who chose home care in the era of COVID-19 at our hospital, we were able to achieve high level of satisfaction for bereaved families.