Workload of home care nurses: Italian adaptation, validity, and reliability of the National Aeronautics and Space Administration Task Load Index questionnaire.

The aim of this study was to adapt the National Aeronautics and Space Administration Task Load Index (NASA-TLX) to the home care setting and translate and validate it in Italian. An online questionnaire containing the Italian version of the NASA-TLX adapted to the home care setting was administered to home care nurses to measure workload. Content Validity Index, Exploratory, and Confirmatory Factor Analyses were used to measure the psychometric characteristics of the modified NASA-TLX. The modified Italian version of NASA-TLX_HC-IT showed good psychometric characteristics in measuring the workload of home care nurses, with excellent fit indices. The reliability, calculated with Cronbach's alpha, was 0.73, indicating adequate reliability. A negative correlation between workload and job satisfaction among home care nurses, as well as a positive association between high workload and intention to leave the workplace, was verified. The modified Italian version of the NASA-TLX_HC-IT was confirmed to be a valid and reliable instrument to measure workload in home care nursing. Furthermore, the correlation between workload and the intention to leave the workplace among home care nurses was an important result that community nursing managers should consider preventing the shortage of home care nurses.

Facilitating planned home death: A qualitative study on home care nurses' experiences of enablers and barriers.

AIM: The aim of this study was to explore home care nurses' experience of enablers and barriers for planned home death in municipal health care. DESIGN: A focused ethnography. METHODS: This qualitative study collected data from 20 semi-structured interviews of home care nurses and 8.5 h of participant observations. Data was analyzed using thematic analysis. RESULTS: The findings in our study show that home care nurses consider supportive cultures, a commitment to safety and continuity when facilitating planned home deaths and family rotations to be enablers for planned home deaths. Barriers to planned home deaths involve a lack of palliative experience affecting confidence, shortages of nurses and medical supplies and night shift challenges. CONCLUSION: This study underscores the need for supportive organizational cultures, ongoing education and improved communication and staffing policies to enhance the quality of care and the experiences of patients and home care nurses, especially in the context of planned home deaths. IMPACT: The study adds knowledge to the evidence base of the practice of facilitating planned home deaths. The findings of the study could offer valuable insights for shaping future policies or devising effective implementation strategies. REPORTING METHOD: Adherence to the COREQ guidelines for reporting qualitative research was maintained. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Identified enablers and barriers provide a new perspective, contributing to a comprehensive understanding of planning home deaths. The study emphasizes supportive cultures, safety commitment and family rotations as crucial for planned home deaths, guiding healthcare professionals to adopt best practices and enhance palliative care quality.

Understanding moral distress in home-care nursing: An interview study.

BACKGROUND: Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. AIM: This study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. RESEARCH DESIGN: A qualitative interview study with reflexive thematic analysis was used. PARTICIPANTS AND RESEARCH CONTEXT: We conducted semi-structured interviews with 20 home-care nurses in Germany. ETHICAL CONSIDERATIONS: The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. FINDINGS: Twenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one's health, extended responsibility for the entire care arrangement, work-privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient's territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. CONCLUSIONS: In cases of tension between the service and billing system and the understanding of these nurses' care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients' quality of care.

Home care nurses facilitating planned home deaths. A focused ethnography.

BACKGROUND: Home care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses' facilitation of planned home death to better understand nursing practices. METHODS: Data were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography. RESULTS: Twenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients' needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated. CONCLUSION: Home care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients' homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.

Predictors and consequences of moral distress in home-care nursing: A cross-sectional survey.

BACKGROUND: Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. OBJECTIVE: This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. RESEARCH DESIGN: A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed. PARTICIPANTS AND RESEARCH CONTEXT: The invitation to participate was sent to every German home-care service (n = 16,608). ETHICAL CONSIDERATIONS: The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. RESULTS: A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. CONCLUSIONS: To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.

Evaluating end-of-life care capacity building training for home care nurses.

BACKGROUND: With the rapidly aging population, the quality of end-of-life (EOL) care has become a significant issue. As the majority of deaths in Hong Kong (HK) currently occur in public hospitals, promoting palliative home care can relieve hospital burden and provide good deaths. There is a practical need to properly educate and train nurses on the skills to provide EOL care in home care settings. OBJECTIVES: To evaluate the effect of the first EOL care training program for nurses working in home care settings or nursing homes on quality of life at work, orientation toward dying and death, and self-competence in death work. DESIGN: A pre-experimental research design was utilized to conduct this study using a one-group pretest and posttest approach. SETTINGS AND PARTICIPANTS: A convenience sample of 153 nurses working in home care settings or nursing homes in HK was selected. METHODS: Participating nurses attended two-day entry-level and seven-day advanced-level courses. Quality of life at work, multidimensional orientation toward dying and death, and self-competence in death work were assessed using questionnaires at baseline and immediately after entry- and advanced-level training. RESULTS: The results revealed that nurses reported a higher level of compassion satisfaction (d = 2.52, p < 0.001), less burnout at work (d = -3.25, p = 0.045), less fear about their own death (d = -1.33, p = 0.019), and more acceptance of others' deaths (d = 1.07, p = 0.004) in post-advanced-level courses. In general, participants were satisfied with the delivery method, duration, and logistical arrangement of the courses. CONCLUSIONS: Nurses reported improved professional quality of life, less fear, and more acceptance toward death and dying after the training program. More educational strategies, such as role-play and case study discussions, are needed to improve the overall learning experience and effectiveness of the program. Future studies could add a qualitative component to yield deeper insights through the findings. As training programs allow nurses to cultivate their skills in clinical situations, there is an undeniable need to continue implementing standardized education and training for palliative care nurses to improve EOL care quality.

Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible solutions.

BACKGROUND: Home-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown. OBJECTIVE: To examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems. DESIGN: Qualitative descriptive research. SETTING: Communities across the Netherlands. PARTICIPANTS: Twenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community. METHODS: Semi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed. RESULTS: Ten subthemes emerged that were clustered into three main themes: 'dilemmas arise in choosing the right nursing care'; 'cooperation and an integrated approach are often necessary, but lacking'; 'home-care nurses have insufficient competencies'. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses. CONCLUSIONS: Care for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.

Work motivation and occupational self-efficacy belief to continue working among ageing home care nurses: a mixed methods study.

BACKGROUND: It is important to support ageing home care nurses (HCNs) to remain in work for longer, since the need for home care services is increasing. Personal resources such as self-efficacy belief contribute to work ability, as does work motivation. Few studies have targeted the ageing workers' self-efficacy belief to manage their final working years. This study explores ageing HCNs' work motivation, and occupational self-efficacy, i.e. belief in one's capabilities, to continue working until expected retirement age. METHODS: The design of the study is exploratory using a mixed method with a qualitative to quantitative approach. A total of 234 HCNs answered four open-ended questions from a cross-sectional survey, regarding their work motivation and self-efficacy beliefs. First, data was analysed using manifest qualitative content analysis. Next, a quantitative analysis was performed based on the results of the qualitative study, and the categories that emerged were quantitatively ranked. RESULTS: The open-ended questions yielded 2339 utterances. The findings showed that several categories concurrently affected both work motivation and self-efficacy belief. When they were well-functioning, they positively affected both work motivation and self-efficacy belief, and when they were insufficient, they negatively affected either or both motivation and/or belief. Meaningfulness, job satisfaction, social support, and work environmental and organizational characteristics affected work motivation most. Perceived health highly affected the self-efficacy belief to continue working until expected retirement age, as well as meaningfulness of work, support from colleagues and home care managers, and work characteristics. CONCLUSIONS: Through highlighting the meaningfulness of work, and supporting the perceived health, the work community and leadership, both work motivation and self-efficacy belief to continue working might be facilitated among ageing HCNs. However, the still present draining workload must be handled.

Home Care Patients' Experiences with Home Care Nurses' Support in Medication Adherence.

PURPOSE: To describe nurses' support interventions for medication adherence, and patients' experiences and desired improvements with this care. PATIENTS AND METHODS: A two-phase study was performed, including an analysis of questionnaire data and conducted interviews with members of the care panel of the Netherlands Patients Federation. The questionnaire assessed 14 types of interventions, satisfaction (score 0-10) with received interventions, needs, experiences, and desired improvements in nurses' support. Interviews further explored experiences and improvements. Data were analyzed using descriptive statistics and a thematic analysis approach. RESULTS: Fifty-nine participants completed the questionnaire, and 14 of the 59 participants were interviewed. The satisfaction score for interventions was 7.9 (IQR 7-9). The most common interventions were: "noticing when I don't take medication as prescribed" (n = 35), "helping me to find solutions to overcome problems with using medications" (n = 32), "helping me with taking medication" (n = 32), and "explaining the importance of taking medication at the right moment" (n = 32). Fifteen participants missed ≥1 of the 14 interventions. Most mentioned the following: "regularly asking about potential problems with medication use" (33%), "regularly discussing whether using medication is going well" (29%), and "explaining the importance of taking medication at the right moment" (27%). Twenty-two participants experienced the following as positive: improved self-management of adequate medication taking, a professional patient-nurse relationship to discuss adherence problems, and nurses' proactive attitude to arrange practical support for medication use. Thirteen patients experienced the following as negative: insufficient timing of home visits, rushed appearance of nurses, and insufficient expertise about side effects and taking medication. Suggested improvements included performing home visits on time, more time for providing support in medication use, and more expertise about side effects and administering medication. CONCLUSION: Overall, participants were satisfied, and few participants wanted more interventions. Nurses' support improved participants' self-management of medication taking and enabled patients to discuss their adherence problems. Adequately timed home visits, more time for support, and accurate medication-related knowledge are desired.

Hospital and home care nurses' experiences and perceptions regarding nutritional care for older adults to prevent and treat malnutrition: A cross-sectional study.

AIMS AND OBJECTIVES: To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. BACKGROUND: In-depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. DESIGN: Multicentre cross-sectional descriptive study. METHOD: A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. RESULTS: The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. CONCLUSION: Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. RELEVANCE TO CLINICAL PRACTICE: Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well-positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home.

Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study.

AIMS AND OBJECTIVES: This study aimed to (1) describe the development of integrated services between hospital-based heart failure nursing services and municipally located home care nurses' services and (2) identify the benefits of this collaboration for the development of home care nursing services. BACKGROUND: Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved. DESIGN: A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure. METHODS: Data were field notes from observations at meetings of the steering group designing the services, visits to patients' homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist. RESULTS: In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients' homes. A clinical pathway was developed to assure effective assessment of patients' condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition. CONCLUSIONS: The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services. RELEVANCE TO CLINICAL PRACTICE: The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.

The Experiences of Home Care Nurses in Regard to the Care of Vulnerable Populations: A Qualitative Study.

Home care nurses have become the main references in home care for vulnerable patients. In patients' homes they offer comprehensive and continuous care to both the vulnerable population and their families. The aim of this qualitative study was to explore experiences and perspectives of home care nurses regarding the care of vulnerable patients in Spain. We conducted in-depth semi-structured interviews with 15 home care nurses working with a vulnerable population. From a data analysis, two themes and four subthemes emerged: (1) "barriers to providing home care to vulnerable populations", with the following subthemes: "the particularities of the patient and their home caregivers" and "perceived barriers for the involvement of home care nurses in the care"; and (2) "the emotional cost of home care" with the subthemes "home care is draining for caregivers" and "the impact of home care on the home care nurses". These findings show us that nurses face a number of difficulties in home care for vulnerable patients. The training of nurses in certain competencies and skills by the social health services would enhance the quality of care offered to these patients.

A Questionnaire Survey of Home Care Nurses’ Attitudes, Difficulties, and Self-reported Practices for Palliative Care in a Community without Specialists to Identify Interventional Targets of Palliative Care Outreach

Palliative care outreach in communities without specialists is important, but its effectiveness has not yet been clarified in Japan. The current study aimed to identify interventional targets of palliative care outreach in home care in a community without specialists. We conducted a questionnaire survey (five-point scale) of home care nurses’ attitudes, difficulties, and practices for palliative care among 39 nurses working at five visiting nurse stations in Tome city. Difficulties in “symptom palliation” and “communication with medical practitioners” were high. Nurses tended to have low confidence and high motivation. Items with particularly low confidence were “communication with home care physicians” and “staff support”. Practices in “communication with physicians” and “coordination with care person” were low. Our survey identified enhancement of face to face relationships and support for home care nurses to improve their skills and confidence as interventional targets for palliative care outreach.

Survey on Perceptions of Home Care Physicians and Nurses Regarding Home Medical Care and Expectations to Pharmacists / 社会薬学

Objective: We search valuable information in home medical care settings that impede smooth collaboration among pharmacists, home care physicians, and home care nurses. Methods: We conducted an online survey on 120 physicians and 118 nurses on “areas perceived as overloaded with tasks,” “quality of life (QOL) evaluation of patients,” and “expectations to pharmacists.” We analyzed data using the Mann-Whitney U test and conducted the customer satisfaction (CS) analysis on “stress.” Results: Physicians answered that they had a significantly higher stress on “at night-time/holidays and weekends works” than nurses (p < 0.05). Nurses experienced significantly more stress during “inter-professional collaboration” than physicians (p < 0.01). CS analysis revealed that nurses experienced more stress for items such as “having patients with dementia self-inject correctly,” etc. Both physicians and nurses evaluated QOL items at a high frequency. Majority of physicians and nurses held high “expectations to pharmacists,” particularly for the eight items related to providing information, managing drugs, and making pharmacological judgments. Nurses had significantly high expectations to pharmacists for “management of supplements taken by the patient” (p < 0.01), “explaining drug effects” (p < 0.001), and “explaining the necessity of prescription revision” (p < 0.01). Discussion: Pharmacists should utilize information on physicians and nurses’ stress as well as understand their expectations to pharmacists to facilitate stronger coordination between both professions and contribute to patient care. In particular, many items were found to cause stress, indicating that support for nurses, who have many expectations to pharmacists, needs to be enhanced.

Survey on Perceptions of Home Care Physicians and Nurses Regarding Home Medical Care and Expectations to Pharmacists / 社会薬学

Objective: We search valuable information in home medical care settings that impede smooth collaboration among pharmacists, home care physicians, and home care nurses. Methods: We conducted an online survey on 120 physicians and 118 nurses on “areas perceived as overloaded with tasks,” “quality of life (QOL) evaluation of patients,” and “expectations to pharmacists.” We analyzed data using the Mann-Whitney U test and conducted the customer satisfaction (CS) analysis on “stress.” Results: Physicians answered that they had a significantly higher stress on “at night-time/holidays and weekends works” than nurses (p < 0.05). Nurses experienced significantly more stress during “inter-professional collaboration” than physicians (p < 0.01). CS analysis revealed that nurses experienced more stress for items such as “having patients with dementia self-inject correctly,” etc. Both physicians and nurses evaluated QOL items at a high frequency. Majority of physicians and nurses held high “expectations to pharmacists,” particularly for the eight items related to providing information, managing drugs, and making pharmacological judgments. Nurses had significantly high expectations to pharmacists for “management of supplements taken by the patient” (p < 0.01), “explaining drug effects” (p < 0.001), and “explaining the necessity of prescription revision” (p < 0.01). Discussion: Pharmacists should utilize information on physicians and nurses’ stress as well as understand their expectations to pharmacists to facilitate stronger coordination between both professions and contribute to patient care. In particular, many items were found to cause stress, indicating that support for nurses, who have many expectations to pharmacists, needs to be enhanced.

Barriers to information exchange during older patients' transfer: nurses' experiences.

AIMS AND OBJECTIVES: To describe nurses' experiences of barriers that influence their information exchange during the transfer of older patients between hospital and home care. BACKGROUND: The successful transfer of an older patient across health organisations requires good communication and coordination between providers. Despite an increased focus on the need for cooperation among providers across healthcare organisations, researchers still report problems in the exchange of information between the hospitals and the healthcare systems in the municipalities. DESIGN: A qualitative study using focus group methodology. METHODS: Three focus group interviews using topic guides were conducted and interpreted. The study included registered nurses (n = 14) from hospital and home care. The data were analysed through content analysis. RESULTS: Three main themes were identified: barriers associated with the nurse, barriers associated with interpersonal processes and barriers associated with the organisation. These themes included several subthemes. CONCLUSIONS: The findings highlight the challenges that nurses encounter in ensuring a successful information exchange during older patients' transfer through the healthcare system. The barriers negatively influence the nurses' information exchange and may put the patients in a vulnerable and exposed situation. In order for nurses to conduct a successful exchange of information, it is critical that hospital and home care systems facilitate this through adequate resources, clear missions and responsibilities, and understandable policies. RELEVANCE TO CLINICAL PRACTICE: Recognition of the barriers that affect nurses' exchange of information is important to ensure patient safety and successful transitions. The barriers described here should help both nurses in practice and their leaders to be more attentive to the prerequisites needed to achieve a satisfactory nursing information exchange and enhance informational continuity.

Cultural diversity between hospital and community nurses: implications for continuity of care.

INTRODUCTION: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. CHALLENGES: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be 'ready to be discharged'. DISCUSSION: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.