Knowledge boundaries for implementation of quality improvement interventions; a qualitative study.

Introduction: Implementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services. Methods: An exploratory qualitative methodology was used for this study. The empirical data, including individual interviews (n = 10) and focus group interviews (n = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory. Results: The findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices. Discussion: This study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions.

Families' importance in nursing care-families' opinions: a cross-sectional survey study in the homecare setting.

BACKGROUND: Informal care is an essential part of support provided in the homecare setting. To ensure effective healthcare provision, good communication and collaboration between informal and formal care providers are crucial. To achieve this aim, it is necessary to have a clear understanding of the perspectives of all stakeholders. In the scientific literature, limited knowledge is available regarding family members' opinions about their involvement in care. To date, no instruments have been developed that accurately measure these opinions. This study aims to elucidate the opinions of family members about their involvement in nursing care. METHODS: A cross-sectional survey approach was employed. The methodological steps in this study were (1) convert the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) from a nurses' perspective to a family perspective and thus develop the Families' Importance in Nursing Care-Families' Opinions (FINC-FO) and (2) measure families' opinions regarding their involvement in home nursing care. The questionnaire was sent to 3,800 patients with activated patient portals, which accounts for about 17% of the total patient base. Responses were received from 1,339 family members, a response rate of 35%. RESULTS: The developed FINC-FO questionnaire showed homogeneity and internal consistency. The results of the questionnaire indicate that family members consider it important to be involved in care and that they wish to be acknowledged as participants in discussions about care (planning) but are less inclined to actively participate in the provision of care by nurses. Family members expressed less explicit opinions about their own support needs. Factors such as level of education, type of partnership, and amount of care provided are seemingly associated with these opinions. CONCLUSIONS: Family members in the homecare setting wish to be involved in discussions about care (planning). The transition in care from primarily formal to more informal care necessitates an awareness and clear definition-on part of both healthcare professionals and families-of their respective roles in the provision of care. Communication about wishes, expectations, and the need for support in care is essential to ensure quality of care and that the family can sustain caregiving.

Proud but Powerless: A Qualitative Study of Homecare Workers´ Work Experiences and Their Suggestions for How Care for Homebound Older Adults Can Be Improved.

Many older adults with complex care needs live at home due to ageing-in-place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care.

Quality of care during rural care transitions: a qualitative study on structural conditions.

BACKGROUND: Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. METHODS: We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care. RESULTS: The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. CONCLUSIONS: Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.

The role of local context for managers' strategies when adapting to the COVID-19 pandemic in Norwegian homecare services: a multiple case study.

BACKGROUND: The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers' capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers' experiences and strategies in homecare services during the COVID-19 pandemic. METHODS: A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. RESULTS: The analysis revealed variations in managers' strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. CONCLUSION: Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review.

BACKGROUND: Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. OBJECTIVE: The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. METHODS: A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. RESULTS: This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. CONCLUSIONS: Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/33305.

Survey of healthcare professionals' experiences of care delivery in patients with chronic intestinal failure: ATLAS of Variance.

BACKGROUND AND AIM: Chronic intestinal failure (IF) is a rare but life-altering condition, care delivery of which is complex. The ATLAS Programme was initiated in 2016 to increase disease awareness and address inconsistencies in delivery of care across Europe. We describe the results of a non-interventional study that aimed to explore how adult patients with chronic IF are managed across Europe. MATERIALS AND METHODS: This mixed-methods, non-interventional, cross-sectional study comprised a desk-based landscape assessment (Phase 1), qualitative interviews (Phase 2), and an online quantitative survey (Phase 3) completed by healthcare professionals (HCPs) involved in the management of adult patients with chronic IF during the period November 2020 to January 2021. Data were collected from 12 European countries. Survey data were anonymised and pooled for analysis at European and country level. Responses were summarised as frequencies, ranks and percentage. RESULTS: The quantitative survey was carried out on 119 HCPs across an estimated 58 centres. Gastroenterology was the most frequent specialty of respondents (45%). Three-quarters of HCPs (N = 119) reported that their department/unit had a multidisciplinary team for the management of patients with chronic IF. HCPs reported improving quality of life (QoL) to be the most important goal of treatment (39%), followed by reducing mortality (25%), intestinal rehabilitation (20%) and reducing morbidity (9%). Similarly, 63% of HCPs responded that improved QoL was the most important treatment goal from the perspective of their patients. Overall, 87% of HCPs reported that patients with chronic IF routinely receive home parenteral nutrition (HPN) in their country, which was more common in Western versus Eastern Europe. Meeting treatment goals (53%) and achieving better levels of support with HPN (44%) were reported as the main challenges faced by HCPs in the management of patients with chronic IF. A general lack of disease awareness of chronic IF among HCPs (46%), and insufficient accredited patient referral centres (41%) were considered the most important areas for improvement. CONCLUSIONS: HCPs specialising in treating chronic IF considered that improvement in QoL is needed for their patients. They reported a low level of awareness of chronic IF among non-specialist HCPs.

Factors influencing loneliness among older people using homecare services during the COVID-19 pandemic.

BACKGROUND: Elderly homecare service users may reduce their level of social participation and interpersonal interactions due to physiological loss, which may lead to loneliness and depression over the years. However, there is a lack of research on loneliness among older people who use homecare services. The purpose of this study was to examine the factors influencing loneliness among older people using homecare services. METHODS: This is a longitudinal study conducted in communities in Central Taiwan, and data were collected using a structured questionnaire. The questionnaire was first administered as a pre-test to obtain baseline information about the participants, and the same questionnaire was administered as a post-test after 6 months to follow-up. The pre- and post-test questionnaires included five sections, that is, participant demographics, Brief Symptom Rating Scale, Interpersonal Interaction Scale (IIS), Frenchay Activities Index, and UCLA Loneliness Scale (UCLA). RESULTS: A total of 178 participants were recruited in this study. Results indicated that gender, whether participants eat alone or with others at dinner, social media use, perceived economic status, and IIS score were significantly correlated with the loneliness score on the UCLA. Furthermore, there was a significant increase in the loneliness score among male participants in the low loneliness group from baseline to 6 months follow-up. CONCLUSIONS: Gender, presence of others at dinner, social media use, perceived economic status, and interpersonal interaction skills are significant factors that influence loneliness among older people using homecare services. Men tend to experience higher levels of loneliness over time.

Factors Associated With Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services: A Retrospective Chart Review From Southern Taiwan Regional Hospital.

BACKGROUND: The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments. However, scientific evidence regarding the association between home-based healthcare services and emergency department uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for emergency department visits among patients receiving publicly-funded homecare services. METHODS: The personal demographic and medical information, caregiver characteristics, and behaviours related to homecare services and emergency department visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan between January 1, 2020, and December 31, 2020, were collected. After screening the potential predictor variables using the preliminary univariate analyses, the multivariate logistic regression with best subset selection approach was conducted to identify best combination of determinants to predict unplanned emergency department utilizations. RESULTS: Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio (OR)=1.33, 95% CI=1.05 to 1.70), male caregiver (OR=0.18, 95% CI=0.05 to 0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95 to 1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of emergency department utilizations within previous past year before enrollment (OR=1.54, 95% CI=1.14 to 2.10) as significant determinants for unplanned emergency department visits. CONCLUSIONS: The present evidence may help government agencies propose supportive policies to improve access to integrated homecare resources and promote appropriate care recommendations to reduce unplanned or nonurgent emergency department visits among patients receiving homecare services.

Estudio de viabilidad de la ecografía abdominal con dispositivos portátiles en atención domiciliaria / Feasibility study of abdominal ultrasound using hand-held devices in homecare services

Antecedentes y objetivos:La miniaturización y portabilidad de dispositivos de ecografía permite al médico de familia aplicarlos en ámbitos como el domicilio del paciente. El presente estudio pretende demostrar que la realización de la ecografía abdominal en el domicilio de pacientes frágiles es factible, permite reducir la demora en la atención y reduce la incertidumbre diagnóstica.Pacientes y métodos:Estudio de casos y controles. Se estudió una muestra de 59 pacientes: 30 casos y 29 controles. Se realizó un análisis descriptivo del grupo casos y se comparó la variable demora entre ambos grupos.Resultados:Se observó una reducción relevante y significativa en la demora entre la ecografía practicada en atención domiciliaria y la realizada en el hospital, de hasta 10 veces menor. El 73,4% de los pacientes solo precisó control clínico por su médico de referencia. En aquellos pacientes que precisaron otras pruebas complementarias o derivación, el diagnóstico definitivo presentó una concordancia total con los resultados de la ecografía realizada al domicilio.Conclusiones:La implementación de la ecografía en atención domiciliaria es asequible y aporta beneficios clínicos relevantes para el paciente e incrementa la capacidad resolutiva del profesional. (AU)

Background and objectives:The miniaturisation and portability of ultrasound devices allow the family doctor to apply them in areas such as the patient's home. The present study aims to prove that performing an abdominal ultrasound in the home of frail patients is feasible, decreases the delay in care, and reduces diagnostic uncertainty.Patients and methods:Case-control study. A sample of 59 patients was studied: 30 cases and 29 controls. A descriptive analysis of the case group was carried out and the delay variable was compared between both groups.Results:A relevant and significant reduction, up to 10 times lower, was observed in the delay between the ultrasound performed in homecare compared those performed in the hospital. Of the patients, 73.4% only required clinical follow-up by their physician. In those patients who required other complementary tests or referrals, the definitive diagnosis was in complete agreement with the results of the ultrasound performed in homecare.Conclusions:The implementation of ultrasound in homecare services is feasible and provides relevant clinical benefits for the patient and increases the resolution capacity of the professional.

Occupational Therapy Practice in Palliative and End-of-Life Care in Québec.

Background. There is an emerging evidence base about the scope of occupational therapy in palliative and end-of-life care, but little is known about this practice in Québec or barriers impeding it. Purpose. To describe Québec occupational therapists' practice in palliative and end-of-life care and barriers they encounter. Method. Using the Québec regulatory board members list, we invited occupational therapists working in palliative and end-of-life care to answer an online survey comprising 24 closed- and 5 open-ended questions. We analyzed data using descriptive statistics and content analysis. Findings. The 67 survey participants mainly optimized comfort and safety in meaningful occupations such as mobility, transfers, and hygiene. Barriers to their practice included organizational obstacles and unfamiliarity with their role. Implications. Findings highlight the need to improve education and awareness among occupational therapists and other healthcare professionals about the scope of what occupational therapists can do in palliative and end-of-life care.

A qualitative study on promoting reablement among older people living at home in Norway: opportunities and constraints.

BACKGROUND: Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. METHODS: Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2-5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. RESULTS: Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people's functional status and needs (including for safe home environments), and to identify older people's wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of 'showing/doing with' versus 'doing for' the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. CONCLUSION: Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by 'showing/doing with' versus 'doing for them' when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

[Feasibility study of abdominal ultrasound using hand-held devices in homecare services]. / Estudio de viabilidad de la ecografía abdominal con dispositivos portátiles en atención domiciliaria.

BACKGROUND AND OBJECTIVES: The miniaturisation and portability of ultrasound devices allow the family doctor to apply them in areas such as the patient's home. The present study aims to prove that performing an abdominal ultrasound in the home of frail patients is feasible, decreases the delay in care, and reduces diagnostic uncertainty. PATIENTS AND METHODS: Case-control study. A sample of 59 patients was studied: 30 cases and 29 controls. A descriptive analysis of the case group was carried out and the delay variable was compared between both groups. RESULTS: A relevant and significant reduction, up to 10 times lower, was observed in the delay between the ultrasound performed in homecare compared those performed in the hospital. Of the patients, 73.4% only required clinical follow-up by their physician. In those patients who required other complementary tests or referrals, the definitive diagnosis was in complete agreement with the results of the ultrasound performed in homecare. CONCLUSIONS: The implementation of ultrasound in homecare services is feasible and provides relevant clinical benefits for the patient and increases the resolution capacity of the professional.

[Medication management in home care-The medication use process from the perspective of clients and their caregivers]. / Medikationsmanagement in der häuslichen Pflege ­ der Medikationsprozess aus der Perspektive von Klient:innen und ihren Angehörigen.

BACKGROUND: Professional home care nurses are often tasked with the medication management of older, polymedicated clients. The medication use process is often complex and prone to medication errors. From the perspective of professional caregivers, the interprofessional interfaces of care as well as the integration of clients and informal caregivers are a major challenge. AIM: With this study, we explored the perspective of home care clients and their informal caregivers on the medication use process supported by professional caregivers with a focus on medication safety. METHOD: We chose a qualitative research approach, using guideline-based interviews with eight clients and five caregivers. Data were analyzed applying the topical analysis according to Braun and Clarke. RESULTS AND DISCUSSION: Before engaging professional home care nurses in the medication use process, clients reached their physical, psychological and social limits. They were relieved when the professional home care organization took care of the overall coordination of the medication use process and felt safe. They trust professional caregivers and see limited need to be preoccupied with medication safety themselves, despite risks inherent in self-medication, adherence and transition of care. CONCLUSION: Through the relief provided by professional caregivers, home care clients and their informal caregivers no longer perceive themselves as active partners in maintaining medication safety. Healthcare professionals should keep an eye on self-medication as well as adherence and support the use of the medication plan.

Inappropriate hospital stays and association with lack of homecare services.

BACKGROUND: Efforts to reduce inappropriate hospital stay, including alternatives such as homecare, are important to improve patient care and reduce health care costs. AIMS: This study evaluated inappropriate hospital stay in Shiraz, Islamic Republic of Iran and the extent to which these stays were due to lack of homecare services and others factors needed for homecare. METHODS: This cross-sectional study was conducted between January 2018 and September 2019 at two public hospitals in Shiraz. All adult patients hospitalized in these two hospitals in the study period were included, except patients in mental care wards. Appropriateness of patients' hospital stay was assessed on a daily basis using the Iranian version of the Appropriateness Evaluation Protocol. The chi-squared test was used to assess association between need for homecare and patient characteristics. RESULTS: Of 6458 hospitalization days assessed (for 1954 patients), 710 (11.0%) days were inappropriate. The greatest proportion of causes of inappropriate stay were physician-related (32.9%). Of the 710 inappropriate hospitalization days, 231 were due to lack of homecare services. Most patients who were inappropriately hospitalized because of lack of homecare services were insured through Salamat insurance (64.0%). A statistically significant relationship was found between the need for homecare services and the type of health insurance (P = 0.01). Of the patients admitted to hospital because of lack of homecare services, 36.8% had endocrine diseases, especially diabetes, and 21.8% needed oxygen services. CONCLUSION: Institutionalizing home health care in the Iranian health system could encourage more home health care referral and reduce inappropriate hospitalization, especially for diabetes.

Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data.

BACKGROUND: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally-despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. AIM: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. DESIGN: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. SETTINGS/PARTICIPANTS: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. RESULTS: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare (p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). CONCLUSION: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).

The effect of a supportive home care program on caregiver burden with stroke patients in Iran: an experimental study.

BACKGROUND: Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients. METHODS: This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance. RESULTS: Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P < 0.001). CONCLUSIONS: Caregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden.

Staff's perspectives on the organization of homecare services to people with dementia-A qualitative study.

AIMS: The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. DESIGN: This study has a qualitative, exploratory design based on a phenomenological-hermeneutic approach, using individual in-depth interviews with homecare staff to collect data. METHODS: A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. RESULTS: Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better-quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.

The safety challenges of therapeutic self-care and informal caregiving in home care: A qualitative descriptive study.

With an increasing number of older people who require homecare services, clients must develop a therapeutic self-care ability in order to manage their health safely in their homes. Therapeutic self-care is the ability to take medications as prescribed, and to recognize and manage symptoms that may be experienced, such as pain. This qualitative research study utilized one-on-one, in-depth, semi-structured interviews with the clients and their informal caregivers recruited from one homecare agency in Ontario, Canada. The goal of the interviews was to gain a better understanding of the relationship between client's therapeutic self-care ability and homecare safety outcomes, and the role of self-care and caregiving activities in supporting homecare safety in relation to chronic disease management. A total of fifteen older homecare clients (over the age of 65) and fifteen informal caregivers were interviewed in their homes. Qualitative description was the methodological approach used to guide the research study. Thematic analyses of the qualitative interview data revealed that homecare clients and their informal caregivers are struggling with multiple aspects of safety challenges. The study findings provided insight into safety problems related to therapeutic self-care at home, and this knowledge is vital to policy formulation related to the role of healthcare professionals in improving client's therapeutic self-care ability to reduce safety related risks and burden for older homecare recipients. Protocol Reference and REB approval (#27223) was obtained from University of Toronto Research Ethics Board.

Safety for older adults using telecare: Perceptions of homecare professionals.

AIM: The aim of this study was to explore homecare professionals' perceptions of safety related to the use of telecare by older adults. DESIGN: An exploratory qualitative design was employed. METHODS: Two focus group interviews with ten female homecare professionals (nine Registered Nurses and one occupational therapist) were carried out between June-December 2017. The participants were recruited from six community homecare services in two Norwegian municipalities. Data were analysed using qualitative content analysis. RESULTS: The participants perceived that the use of telecare protects older adults against injury and insecurity by preventing harm and giving them a feeling of safety. However, they also stated that the use of telecare involves challenges that could lead to harm to older adults due to technological limitations and difficulties managing and understanding the technology. Although telecare can enhance safety, it is necessary to develop reliable technology and adapt it to the user's abilities, skills and resources.