Home Health Care Nursing Paper

Home Health Care Nursing Paper Home Health Care Nursing Paper 1, Please use the specific APA paper template for this assignment 2, Read the article carefully requirement.docx article.pdf nr443_w4_community_setti Home Health Care Nursing Paper. Requirement: 1, Please use the specific APA paper template for this assignment 2, Read the article carefully 3, Length: This paper is expected to be no more than 4 pages in length (not including the title page and reference list) 4, Quotations should be minimal—please paraphrase your sources. A maximum of one quotation should be used for this paper. Guidelines 1, The setting for this paper must be on Home Health Nursing 2, Application: Use Microsoft Word 2010™ or later to create this assignment on the template provided 528938 research-article2014 HHCXXX10.1177/1084822314528938Home Health Care Management & PracticeSaunders Original Article Home Health Care Nurses’ Perceptions of Heart Failure Home Health Care Home Health Care Management & Practice 2014, Vol. 26(4) 217­–222 © 2014 SAGE Publications Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1084822314528938 hhc.sagepub.com Mitzi M. Saunders, PhD, RN, ACNS-BC1 Abstract High-quality nursing care in the home setting is one approach to improving outcomes in patients with heart failure (HF). This study describes home health care nursing care of patients with HF from the perspectives of home health care nurses (HHNs). Using an emergent, qualitative design, 14 HHNs were interviewed and six major themes emerged: (1) HF care is unique, (2) HF patients’ needs exceed imposed limitations, (3) listening to HF patients is key, (4) HF education is critical, (5) eyes and ears of physicians, and (6) high reward/high commitment. Overall, HHNs felt that patients with HF have nursing care needs that exceed imposed limitations on HHN services. HHNs need time to educate patients and family caregivers about HF. Keywords heart failure, home care, nursing, qualitative inquiry, listening, patient education Introduction An estimated 5.1 million Americans have heart failure (HF) with figures expected to reach 7 million patients by 2030.1 One of every two patients with HF dies within 5 years of the diagnosis and 1 million HF-related hospitalizations occur each year.1 HF is the most common diagnosis of Medicare recipients supporting the need for interventions that will achieve optimal outcomes.2 Home health care may be the most viable and least costly of interventions to meet the needs of patients with HF.3 Home health care nursing is one important aspect of care rendered to patients with HF in the home setting. Thus, knowing home health care nurses’ (HHNs) perspectives of what is involved in HF home health care nursing may be an important step to improving outcomes in patients with HF.4 The HHN is regarded by some as the most important provider of care in the home setting.2,5 Home health care nursing has been associated with fewer patient emergency room visits, reduced hospital readmission rates,6 and increased levels of health-related quality of life in patients with HF.7 Patients regard HHNs as knowledgeable, competent, and caring.NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Home Health Care Nursing Paper. 2 Family caregivers of patients with HF have found the support and care rendered by HHNs crucial to their care experience and the one whom patients listen to and trust.8 Interestingly, very few studies have reported HHNs’ perceptions about their experience. In one study, HHNs described their role with patients and family caregivers immediately following a hospitalization.9 HHNs expressed difficulties in finding and translating the discharge plans and felt the family caregivers to be ill equipped in the caregiver role. In another study, the establishment of trust between HHNs and patients was the most critical factor in the nurse– patient relationship.10 By actively listening to patients, researchers established the evolution of a trusting and working relationship between HHNs and patients. However, HHNs need sufficient time with patients and families to develop working relationships. Pairing HHNs and patients together, over time and without time constraints, was associated with earlier recognition of changes in patient status.10 In another report, HHNs felt empowered and valued in their abilities in helping patients and caregivers achieve optimal care outcomes.11 These HHNs also found listening to be a critical skill of HHN practice, as well as patient education, achieving desired levels of patient comfort, and patient advocacy.11 HHNs’ viewpoints specific to home health care nursing of patients with HF are unknown. Knowing that gaps in care may contribute to the readmissions of 20% of all Medicare recipients, and often among patients with HF, calls for immediate action.12-14 HHNs are in an optimal position to articulate the needs of patients with HF.4,8 Communicating HHNs’ perspectives about HF home health care nursing may improve the care experience and HF patient outcomes. The purpose of this qualitative study was to describe home health care nursing of patients with HF from the perspectives of HHNs. 1 University of Detroit Mercy, MI, USA Corresponding Author: Mitzi M. Saunders, College of Health Professions, University of Detroit Mercy, 4001 W. McNichols Road, Detroit, MI 48221-3038, USA. Email: [email protected] 218 Home Health Care Management & Practice 26(4) Table 1. Home Health Care Nurse Participants’ Characteristics (N = 14). Variables Age (years) 30-39 40-49 50-59 >60 Gender Female Ethnicity White Biracial Marital status Single Married Divorced Nursing education Associate’s degree Bachelor’s degree Master’s degree Employment status Part-time Full-time Time in home care (years) M (SD) n (%) 52 (10.7) 2 (14) 5 (36) 4 (29) 3 (21) 14 (100) 13 (93) 1 (7) 3 (21) 3 (21) 8 (58) 5 (36) 7 (50) 2 (14) 4 (29) 10 (71) 13 (7.7) Methods Design and Sample This study used a qualitative, emergent design. An emergent design allowed inquiry from the researcher’s viewpoint as the study was being conducted.15 This study was approved by an institutional review board. HHNs had a minimum of 6 months in home health care nursing and in providing care to patients with a primary diagnosis of HF. Exclusion criterion of HHNs was not being in active practice at the time of the study. Following email notifications of the study to home health care agencies in Michigan, New York, and Missouri, 10 HHNs volunteered by email correspondence. NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper Home Health Care Nursing Paper. Using the snowball technique, 4 HHNs recommended 4 other HHNs as good informants. The researcher contacted the additional 4 HHNs by email and all agreed to participate. This expanded the sample to include 14 HHNs across seven home health care agencies. Sample characteristics are given in Table 1. Data Collection and Analysis Interviews were private, conducted by telephone for 10 HHNs due to geographical distance from the researcher, and face-to-face with four HHNs. Each interview ranged between 45 and 60 minutes and was audio-recorded. HHNs received a cash incentive of US$40.00. Data were collected from June 2012 to January 2012. Interviews began with the collection of demographic information. The researcher then used an interview guide to promote consistency in asking the same questions and in the same order with each HHN (see Table 2). HHNs received the interview guide in advance of their scheduled interview. Following each interview, the researcher noted the interview setting, events or interruptions that occurred during the interview, and patterns that emerged as the study progressed. Patterns enabled the researcher to ask additional probing questions to gain clarity of emerging themes and to observe for informational redundancy. When informational redundancy was observed, audiotapes were transcribed verbatim and transcriptions were confirmed with the audiotapes. A line-by-line method of analysis was used to code, categorize, analyze data, and identify main themes.16 A second reader with expertise in qualitative research confirmed the themes with 90% consistency. Strict confidentiality of HHN information and data was maintained throughout the study. Results Data were collected from 14 female HHNs ranging in home health care nursing experience from 3 to 32 years (M = 3, SD = 7.7). The HHNs’ ages ranged from 38 to 78 years (M = 52, SD = 10.7). The majority were Caucasian (93%), divorced (58%), employed full-time (71%), and had a bachelorette degree or higher in nursing (64%). All HHNs were working in agencies that used telehealth technology in some capacity. All HHNs had a caseload of patients with HF but were seeing a variety of other patient types in the areas of oncology, orthopedics, pulmonary, diabetes, and wound care. None of the agencies were HF specific. Six themes emerged from the data: (1) HF care is unique, (2) HF patients’ needs exceed imposed limitations, (3) listening to HF patients is key, (4) HF education is critical, (5) eyes and ears of physicians, and (6) high reward/high commitment. Each theme will be discussed with supportive testimonies from the HHNs. HF Care Is Unique HHNs regarded patients with HF to have greater care needs than other patient types. HF patients were referred to as “a more brittle population” or being “touchy.” In comparison with cancer patients, one HHN stated, “Even with the chemo, you have this many treatments and then you have time off. With HF, it is constant.” Another HHN compared HF patients with orthopedic patients, “You know they (orthopedic patients) are going to progress to the next level, but HF is complex, it’s progressive and at some point, hospice.” HF care was more time-consuming than nursing care of other patients. “NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper Home Health Care Nursing Paper. A lot of nurses shy away (from taking a HF patient). You have a lot more work with the HF patient. There are just more questions and more follow up . . . they 219 Saunders Table 2. Interview Guide. (1)?Please describe one or more of the most rewarding and possibly touching/emotional experience(s) you have had in working with a HF family? (2) Please describe a time when you faced adversity in patient care and specific to the HF patient/family caregiver? (3)?In what ways do you attempt to make the HF patient’s environment one that supports healing? How does the HF family caregiver fit into your work in creating a restorative environment at home? (4)?Do you feel the current system allows you to care for the HF patients and their family caregiver physically, emotionally, and spiritually? (Why or why not) (5) Does the care you provide for HF patients and the family caregiver change from one family to the next? (Please explain) (6) How important is health education for HF patients and their family caregivers? (7)?Do you feel you have adequate authority in determining nursing practice for HF patients and their family caregivers? Are there obstacles or barriers? (8)?Are you comfortable in confronting others (physicians, etc.) when you feel an order is not in the best interest of the HF patient and/or family caregiver? (Examples of why or why not) (9) How would you define “excellent home-based HF family care?” Is your description different from how you practice today? (10) How do you take care of your own personal needs (physically, emotionally, and spiritually)? (11) Is there anything I should have asked you that I did not? Note. HF = heart failure. might have 3-4 different doctors.” In addition, HF care meant higher numbers of medications to review. “A patient may have 20 (medications) and it’s real important to go through them all . . . they might be taking the same pill twice but it has a different name.” HHNs felt that patients with HF and their family caregivers had greater emotional needs. Depressive symptoms, as described by one HHN, were as common as “every 9 out of 10 HF patients.” Family caregivers of patients with HF were described as “overwhelmed” and in need of “lots of emotional support.” When describing the needs of the HF family in general, one HHN stated, “If the family had the support of a HHN, then so fewer patients would be placed in nursing homes.” Regardless of high care needs and the extra time needed to deliver HF care, HHNs reported personal gain and satisfaction. As one HHN stated, “With HF, you spend more time, you develop a closer relationship, and they think of you as a family member . . . the patients love you, but the family caregivers depend on you more.” HF Patients’ Needs Exceed Imposed Limitations HHNs agreed that rules and regulations that imposed limits on their services were a major problem. HHNs claimed that they needed more visits and more time for follow-up telephone calls. One HHN commented, “Two years ago we had unlimited visits for 8 to 9 weeks. Now, we have five visits in 3 weeks.” Another HHN stated, “You want to call them but you know it won’t be simple and a simple question can have you on the phone for the next 20 minutes.” HHNs voiced a mismatch in care in that patient needs were rising and time to spend with patients was shrinking. One HHN stated, “The hospitals are sending them home quicker and sicker with higher needs. It is a challenge.”NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper Home Health Care Nursing Paper. HHNs conveyed seeing more instability in patients with HF and reported how “you can see them one day and hear they are back in the hospital the next.” HHNs advocated for telehealth technology for homebound HF patients to monitor them between HHN visits. Most HHNs felt that a higher usage of telehealth technology would prevent hospital readmissions, “Through telehealth, we caught it (patient symptoms) early.” The assessment information gleaned through telehealth technology for HF patients might lead to interventions that prevent serious complications from occurring. HHNs agreed that in the absence of telehealth, the current system of care was reactive rather than proactive. Overall, HHNs felt existing time constraints for home health care nursing visits and telephone calls and a lack of telehealth technology to be the root causes of why patients with HF were rehospitalized. Listening to HF Patients Is Key Although HHNs felt they were in a hurry when seeing patients with HF, taking the necessary time to listen to patients was highly valued and practiced. One HHN described it this way, “If I had one thing to tell nurses, it is to listen to the patients and do so very carefully.” HHNs described the skill of listening as being more important and more common in their work in home health care than their previous nursing roles in acute care settings. Listening was the vehicle for building trust and a working relationship with HF patients and families. The phrase “being on the patient’s turf” was used by several HHNs to suggest how the setting of care heightened the need for active listening. One HHN stated, “The major thing for me in finding an environment that supports healing is one of trust. I think when patients are listened to, they begin to trust. When they trust you, they listen too, and follow through.” 220 HF Education Is Critical HHNs thought that patient and family caregiver education was the most important nursing intervention: “Education is the number one key with HF patients and their families. They have to know what to look for, what to go to the hospital for, what an emergency is, and what is not.” HHNs expressed the uniqueness in educational needs from patient to patient and the importance of tailoring content to fit the needs of patients and household members. One HHN stated, “You have to think of feeding the whole family in that it is a whole culture change for the family and not just the patient.” HHNs described how assessing family diets and patterns were crucial to learning what triggered problems such as a routine diet of “pizza rolls” that were leading toward “his (the patient’s) weight gain” and consequential “readmissions for HF.” It was important to know patients well enough to contrive ways to make diet changes last. For example, one HHN who learned of a patient’s passion for gardening encouraged growing and eating vegetables for heart health. HHNs described creative approaches and ways to tailor teaching to meet patient and family caregiver needs. For example, a HHN called the doctor in the presence of the patient and the family to reinforce teaching and role model how one talks to the doctor: I call right in front of the patient so they hear the way I talk to the doctor and afterward I will say, now did you hear how I said that? That’s why you are watching your weight every day, why you check your legs every day for edema, so when you notice it, you can call them (the doctor’s office) instead of calling an ambulance. HHNs described using visual aids when teaching to include HF-specific self-care booklets or packets. One HHN described the process this way: “I have them read over the HF booklet. NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper Home Health Care Nursing Paper. Then, I ask, what are three things that you think are important? It’s really good with older patients because we can then go back and do it again and again.” Eyes and Ears of Physicians HHNs were confident in saying that they were the “eyes and ears of physicians.” One HHN stated, I go in and assess the patient and find they are filling up with fluid. They are short of breath and I make the call right away and suggest that we change the Lasix. Or, do you want them to go to your office. Or, do they need to be sent for a chest X-ray? This example also demonstrates how HHNs felt the need to “lead the physician” so the right medication(s) or test(s) got ordered for patients. In the words of one HHN, Often the doctor says, have them come into my office. But, the patient then says, “I don’t have transportation,” or “it’s too cold,” and doesn’t want to. So I say, “Why don’t we discontinue Home Health Care Management & Practice 26(4) the medication and I’ll monitor the patient and call you in 3 days to let you know what is going on. The physician agreed.” Overall, HHNs expressed confidence in their abilities to detect problems, know and articulate patient care needs to physicians, and negotiate treatment plans to suit all parties involved. High Reward/High Commitment HHNs found their roles to be highly rewarding for many reasons: “You can actually sit down and talk (to the patient),” “they know who their nurse is,” “I do more nursing care in home health care than in the hospital,” “patients actually smile, say thank you, and enjoy your visit,” and “every day is just totally different.” HHNs felt special being in the patient’s home, “When you see these patients in their home, you really get personable with them. When you see them in the hospital, you say ‘that’s a HF patient.’ In the home, they are a person.” HHNs verbalized pride in working independently and thinking critically. One HHN stated, “In home care, I have to be vigilant and aware of every aspect of care and not just carrying out an order in the hospital. I am a better nurse now being a HHN.” It was also rewarding to see patients with HF improve over time. One HHN expressed, I started to see the demonstration of what I was teaching and actually happening in the home and before it was every 6 weeks this patient would be back in the hospital. So we get to 6 weeks, then 8 weeks, 9 weeks, and no more hospital stays. The family was so grateful. That was one of the most rewarding experiences I can think of. If the patients did well, HHNs felt, “you know you’ve done your job.” HHNs voiced their commitment to their roles by giving out their personal telephone numbers to patients and family caregivers to avert problems. One HHN stated, One time one of our HF patients went into the hospital and then home and we (the agency) didn’t know yet. The wife called me at 7 p.m. (when I was off work of course) to see who was going to change his bag. It was also a holiday weekend and there was a bad storm out too. Over the phone, I told her how to change the bag and she did it. If she would have called the agency, they would have told her to go …NR 443 Chamberlain College of Nursing Home Health Care Nursing Paper Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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