Home Health Care Management & Practice

The human immunodeficiency virus (HIV) continuum of care within the Inova Health System (IHS) has three levels of management: individual case management, linkage management, and disease-state management. Individual case management takes place at each operating unit— physician's office, hospital, home health care setting, or hospice—and has a multidisciplinary team that addresses treatment, education, therapy, and counseling. Inova Home Health and Hospice of Northern Virginia developed a staging tool to objectively determine the appropriate level of care and to provide a seamless transition between home health care and hospice. Inova's HIV Services provides the disease management component, incorporating proactive and cost-effective management of patients through the disease life cycle and across all settings.

Medical nutrition therapy is a vital component of nutritional management of diabetes in home health care. Many studies document the cost-saving and therapeutic benefit of nutrition intervention in diabetes care. Home health care agencies need to have dietitians on staff for nutrition assessment, counseling, and development of individual patient care plans. Dietitians can help to train nurses and home health care aides in interdisciplinary patient care that incorporates the 1994 nutrition recommendations and principles for people with diabetes mellitus. There are benefits and barriers to home health care nutrition visits, and providing medical nutrition therapy to home health care patients with diabetes can bring about lasting, permanent change.

This article provides simplified direction for selecting appropriate dressings for open wounds by focusing on the phase of healing as evidenced by the predominant condition of the wound base. It has been well documented that inappropriate topical management can delay healing and, in today's age of scientific-based clinical practice, this is unacceptable. An immediate challenge for the clinician is to discern which product(s) should be used to achieve the ideal wound environment. As there is a proliferation of products in the market, this is no easy task. To simplify the selection process, clinical macroscopic indices that are representative of three classification systems have been combined to provide a generic protocol.

Between the 1940s and 1950s, over 250,000 persons survived the polio epidemic with a variety of disabilities. As varied as the "victims" involved in this epidemic, so were the resulting disabilities, ranging from total dependence on a ventilator to localized muscle weakness. Most polio "survivors" have led productive lives; however, in the past decade many survivors have reported a resurgence in muscle weakness, fatigue, difficulty in swallowing, insomnia, respiratory difficulties, and pain: postpolio syndrome. Darlene contracted polio at the age of 3 in 1955. Since this was at the "end" of the epidemic, she was a younger victim. This article is an overview of one woman's challenges and successes: the ability to live a full life with a disability.

As the use of clinical pathways spreads from the hospital setting to home care, it is tempting for home care agencies to aggressively implement their own clinical pathway programs. However, clinical pathway implementation without careful consideration of process issues and staff educational needs can be highly problematic. Pro-Health Home Nursing Services of Cincinnati, Ohio, presents the process support and educational program behind its total knee replacement clinical pathway. They conclude with their list of development and process guidelines for the implementation of clinical pathways in home care.

A retrospective chart audit of home health care clients with the primary diagnosis of insulin-dependent diabetes mellitus (IDDM) revealed that the average number of visits for care exceeded the average number of visits for teaching. Using Orem's Self-Care Deficit Theory of Nursing, a critical pathway was designed to extend the number of visits incorporating teaching and to sequence teaching so that the client/caregiver would not be overwhelmed with instruction at the beginning of care. Physiologic needs and safety are addressed first on the pathway, followed by health promotion and disease prevention. A flexible method for documentation minimizes variance.

Perceived quality of nocturnal sleep and levels of daytime sleepiness were measured using the S3Q and Nicholson Stone scales (sleep quality) and the Stanford Sleepiness scale (sleepiness). A sample of 15 elderly (mean age 72 [±8.9] years) women who were primary caregivers and who resided in the same household as the patient participated in the study for 3 consecutive days a week over a 9-week period. Results showed caregivers had "fair" sleep quality and a "moderate" level of daytime sleepiness.

Workplace safety and security are increasingly important issues for home health care agencies in the 1990s. This article seeks to inform home health care employees about safe home-visit practices, Occupational Safety and Health Administration (OSHA) standards on preventing exposure to infections, and prevention of sexual harassment. The article includes both legal and pragmatic strategies that will increase home health care employees' safety and security while at work.

Nursing's ultimate goal in intervening with families providing home care for a stroke victim or chronically ill member is to facilitate adaptation to the condition in a manner that results in optimal physical and mental health of the patient and of the family. Chronic illness can impose an immense burden on families unprepared to meet this challenge. This study examined the impact of pertinent information and anxiety on patterns of stress in families providing care at home for a stroke patient. The findings demonstrate support for the proposition that as knowledge of pertinent information regarding stroke increases, healthier patterns of dealing with stress will be observed.