Nursing research in home health care: endangered species?

An information revolution is occurring in home health care documentation processes and systems. The federally mandated Outcomes and Assessment Information Set (OASIS) for patient assessment and the use of electronic patient medical records will significantly affect the conduct of nursing research in home health care. The purposes of this article are to inform potential home care nurse researchers about the standardization of patient information as exemplified by OASIS and electronic patient medical records and recommend strategies to accommodate these changes. The potential for meaningful, scholarly studies in home care has never been greater, but researchers must address new challenges and adapt investigations accordingly.

The use of LPNs in Ohio home care agencies.

A rapid rate of change in the home care arena has been widely documented and many more changes are likely to continue. This article presents the results of a descriptive study to characterize the use of licensed practical nurses (LPNs) within Ohio home care agencies. Among the findings were that that agencies use LPNs primarily in medical-surgical cases and that the use of LPNs is expected to increase.

Rehospitalization among home healthcare patients: results of a prospective study.

Reduction in rehospitalization is an outcome measure used to evaluate home care services, especially in Outcome Based Quality Management using OASIS data; however, practitioners and managers must carefully analyze the reasons patients return to the hospital. This study examines events leading to rehospitalization of patients with CHF, whether it is possible to determine upon admission which patients are at risk, and whether the readmissions were necessary and/or preventable. Among the study's important findings are that half of the patients developed a new problem that required the rehospitalization. This and other research outcomes should be considered when analyzing adverse event reports.

Comparison of home health care outcomes and service use for patients with wound/skin diagnoses.

The purpose of this comparative study was to evaluate patient outcomes for wound healing and home health care service use for patients whose care was paid for by the traditional Medicare program versus a Medicare managed care organization (MCO). Results showed that there were no differences between the groups in wound healing at discharge, functional ability at discharge, or the numbers of home visits. Changes in the Medicare reimbursement system for home health care may have provided an equalizing effect between Medicare MCO and traditional Medicare patients with wound/skin diagnoses in home health care agencies in the Midwest.

Employment patterns and timing of birth in women with high-risk pregnancies.

OBJECTIVE: To describe the characteristics of employed women with high-risk pregnancies, their pattern of employment prenatally and postpartum, and the relationship of prenatal employment to preterm or full-term birth. DESIGN: Secondary analysis with a sample of 171 women with high-risk pregnancies. SETTING: Women's homes and a tertiary care hospital. PARTICIPANTS: Women who were primarily single, African American, and poor; 33% worked or attended school during their pregnancies. MAIN OUTCOME MEASURES: Gestational age at birth, employment, and school attendance. RESULTS: Preterm delivery was not related to when the women stopped working or attending school or were prescribed bed rest. Women employed prenatally were older, had higher incomes, and were more likely to be white or of ethnicity other than African American. Fifty-seven percent of women with a history of prenatal employment and 85% of the women who intended to work after delivery returned to work during the first postpartum year. CONCLUSIONS: Women employed during high-risk pregnancies are similar demographically to women with low-risk pregnancies in other studies. Most of the women stopped working or attending school because of prescribed bed rest. Bed rest, however, was not related to preterm delivery. Most women who planned to return to work did so. Factors other than the women's high-risk pregnancies, such as attitudes toward employment, employability, and family circumstances, most likely influenced their employment status. Current welfare reform initiatives will increase the number of women working while pregnant. This article provides pre-welfare-reform baseline data concerning patterns and effects of employment for women with high-risk pregnancies. These data will enable nurses to examine the effects of welfare reform on employment during pregnancy and preterm birth.

Resource use & patient outcomes in Medicare home care.

To what extent are patient outcomes associated with the amount of home care resources used by patients over episodes of Medicare home care? How can we use the Outcome and Assessment Information Set (OASIS) to improve planning and practical knowledge about the relationship between resource use and patient outcomes? This article addresses the questions and provides readers with some insightful answers.

Additional psychometric evaluation of the Outcomes and Assessment Information Set (OASIS).

The OASIS represents a rich opportunity for researchers interested in home health care outcomes. However, little psychometric information has been published. The purpose of this study was to provide additional psychometric data for selected portions of the OASIS using a sub-set of 201 subjects from a previously published study. Conceptual domains were identified-functional, affect, behavioral and clinical. Reliability was evaluated using Cronbach's alpha and the kappa coefficient for intra-rater reliability. Construct validity was evaluated by principal axis factor analysis within each domain. The functional domain had the best reliability and validity. The affect and behavioral domains had adequate kappa scores, but the alphas and the factor analyses were problematic. Two of the clinical items did not perform well with kappa scores. Recommendations and suggestions for use of the OASIS are made.

Prescreening cardiothoracic surgical patient population for post acute care services.

For the postoperative cardiothoracic patient, the first 2 weeks during recovery is the most difficult time. Initiating discharge planning at the earliest opportunity aids in identifying those patients at risk for functional status disability. The purpose of this study was to examine the results of a pilot preadmission screening program to determine whether cardiothoracic surgical patients could be accurately identified for postoperative needs during preadmission testing.

Evidence-based practice and the home care nurse's bag.

How safe is the home care nurse's bag anyway? What kind of precautions and procedures should an agency and nurses adopt to ensure that contamination does not occur? This article uses the evolving theory of evidence-based practice to suggest the best approaches to these challenging questions.

Service delivery challenges of nursing research in home health care.

For nurse researchers interested in patient care and delivery systems, home health care is an area of increasing focus. Compared to institutional sites, however, there are challenges in conducting research in home health care that are a function of the organizational and operational environment. In addition to the unique environment, current regulatory and legislative changes also are having an impact on home health care nurses and agencies. Finally, home health care is an area that has not historically been involved with research of any kind. This article presents an overview of selected challenges of research in home health agencies and recommendations for nurse researchers.

Alternative measures of resource consumption in home care episodes.

Expected changes in home health care reimbursement will require a shift in focus from a visit-based unit to some other yet-to-be-defined unit of resource consumption. Little research has been done to understand other measures of resource consumption, however, especially those examining disciplinary differences. The purpose of this study was to provide empirical evidence on other measures of resource consumption as a way to frame discussions on alternative measures. Information is presented from a study of 102 home health care patients from 10 agencies in Ohio who completed an episode of care and remained at home. While the mean time per visit was similar for all disciplines (46 to 55 minutes), there were differences in the number of visits provided by various disciplines (home care aide services had the highest mean number of visits with 11.8). The mean cost per day for all services was $43.80 while the mean cost per episode was $1,160. Recommendations for further research include similar examinations using a more rigorous sampling methodology and including disparate populations of patients.

Some lousy questions for home health nurses.

Pediculosis continues to be a widespread problem for both the public and health care professionals, including home health nurses. Dealing with this problem is complicated by a number of factors, including questions concerning the efficacy and safety of the medications used and the level of knowledge of about this condition. Because pediculosis often is considered more as an embarrassing annoyance than a serious threat, it has a relatively low priority on the list of contemporary health care concerns. This article addresses several practical questions concerning the character and treatment of pediculosis that are of special concern to home health nurses.

Evidence-based practice in home healthcare. A springboard for discussion.

Nursing has an increasing interest in EBP, and home healthcare nurses cannot afford to be left out of the loop. A variety of sources exist for home healthcare nurses to use in determining whether there is sufficient information for EBP. There are also various methods that can be used to develop EBP guidelines in home healthcare. Finally, home healthcare nurses have an ethical obligation to provide patient care that is effective and most likely to result in positive outcomes. Relying on tradition, intuition, and experimentation is no longer enough. It is hoped that this article will serve as a springboard, not the final word, for the development of EBP initiatives for home healthcare nurses. It is important also to "share the wealth" so that nurses and their patients can benefit. One way of doing this is to convene a group to evaluate current practice and publish the group consensus on the clinical issue of interest to home healthcare nurses. For example, Janet Steele, concerned about EBP, convenes a group of interested nurses from the agency to decide how the AHCRP guidelines can be incorporated into operations. This group rewrites the policies and procedures based on the CPGs, retrains the nursing and home care aide staff, and uses the patient information from AHCPR as the handouts for patients. Aside from the initial confusion relative to operational changes, EBP has enabled the nursing staff to be more consistent from patient to patient, and there is less confusion regarding what works for specific patient conditions. Evaluation of care 6 months after the change to EBP shows that patients have shorter times for healing, and fewer nursing visits are needed. This information is used by the agency administration in negotiations with payers on the quality of the care provided by the agency and is published in a peer reviewed journal such as Home Healthcare Nurse. Best of all, patient care no longer relies on tradition, intuition, and experimentation as colleagues throughout the country use these findings in their own agencies.

Maternal employment and parent-child relationships in single-parent families of low-birth-weight preschoolers.

BACKGROUND: The influence of premature birth of an infant in female-headed, single-parent families together or in conjunction with family environment factors, such as employment of the mother, on the mother-premature child relationship has not been considered in past studies. OBJECTIVES: To explore differences in parent-child and family relationships for employed and nonemployed single mothers of low-birth-weight (LBW) and full-term preschool children and to describe the relationships of the mother's employment status, employment history, and employment attitude-behavior consistency to parent-child and family relationships. METHODS: Single mothers with LBW (n = 60) and full-term (n = 61) preschool children provided data on their employment situation, the Parenting Stress Index, the Feetham Family Functioning Survey, and the Home Observation for Measurement of the Environment. RESULTS: Employed mothers had more positive perceptions and provided more enriching home environments for their children. Greater attitude-behavior consistency was associated with more positive perceptions of the parental role. CONCLUSION: Thus, in single-parent families, employment and consistency are positive influences on the mother-child relationship.

Home care of high risk pregnant women by advanced practice nurses: nurse time consumed.

This study examined the time spent by advanced practice nurses (APNs) in providing prenatal care to women with high risk pregnancies. The results indicate that the overall mean APN time spent in providing prenatal care was 51.3 hours per woman. The greatest amount of time was spent in the clinic and women with pregestational diabetes consumed the most APN time and required the most contacts. Historically, home care services have been measured by number of visits or contacts. This study assists home care nurses and administrators to consider additional measurements including time spent.

Home care resource consumption and patient outcomes: what are the relationships?

This study examined empirical relationships between measures of home care resource consumption and patient outcome measures in a sample of 201 patients who began new episodes of home care with one of ten Medicare-certified home care agencies in Ohio. We found that, while the total volume of home care resource consumption (i.e., total visits and costs) was similar for patients whose episodes ended with discharge at home vs. hospitalization, patients discharged to hospitals consumed home care resources in a much shorter period of time. We also found that resource consumption patterns were very similar regardless of whether patients improved or declined in clinical and functional health during the episode of home care. Results suggest that home care agencies should carefully project both resource consumption and patient outcome targets when negotiating service contracts with managed care organizations, especially for Medicare patients.

An introduction to pediatric home health care.

PURPOSE: To provide an overview of the delivery of home health care services to pediatric patients. POPULATION: All pediatric patients. CONCLUSIONS: Institution-based nurses are integral in making referrals for home health care services and assuring home health care agencies have the needed information for providing seamless services. PRACTICE IMPLICATIONS: Institution-based nurses are the first line in the transition to home and are key members in making the transition happen without unnecessary difficulty for the child and family. This article presents pragmatic information about home health care agencies and how they operate so that institution-based nurses can maximize the benefit their pediatric patients receive from home health care.