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  1. Marrelli, Tina MSN, MA, RN, FAAN
  2. Narayan, Mary Curry MSN, RN, HHCNS-BC, COS-C

Article Content

This issue of Home Healthcare Nurse could be seen as reflecting the larger vision of healthcare with the inpatient world being "incentivized" to think beyond the hospital buildings and address the care needs of people and many older adults where they live-in their homes. All these varying care settings have implications for transitions. As we well know, "home" may be as varied as the health challenges that confront our patients and the family and friends that help care for them. The first CE article in this issue, "Getting on With Living Life: Experiences of Older Adults After Home Care," authored by Dr. Bonnie L. Westra and colleagues, investigated the perceptions of chronically ill older adults recently discharged from home care. This is another piece in the transitions continuum that is often not addressed-by home care or hospitals or other care settings. After reading this article, we may be able to ask how they are doing, as they expressed it, or "getting on with living life"-and what a simple way to articulate what most patients seek after illness or inpatient stay and home care discharge. The pearls from this article are in the "Recommendations for Transitional Care after Home Care Discharge." This listing could be a great tool for both new and experienced home care team members. Many are items and queries that support older adults to remain engaged and safe at home.

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In the "Perceived Value of a Urinary Catheter Self-Management Program in the Home," Dr. Mary Wilde and colleagues provide catheter prevalence-and the numbers are eye-opening. Together, we have seven older adult friends who have been told they will have their catheter "for life." Because many of these patients are able to go get their catheter changed, they may not be counted in such surveys as the "National Home and Hospice Care Survey." This means that the number of people with urinary catheters may be larger than the staggeringly large numbers presented. Whatever the actual number, catheters are fraught with challenges for patients, their families, and caregivers. Infection control, dislodgment, pain, and discomfort have long been sources of concern for home care nurses caring for patients with catheters. Self-management in many aspects of care will become more the norm as patients who are able to become more engaged in their own care. This article provides a view of self-management and speaks to what patients identify and report. Very helpful tools in this article include "Basic Catheter Self-Management," a "Quick Guide to Catheter Problems," and a "Sample of an Educational Module," which identifies signs of a urinary tract infection and the things that patients can do. This kind of knowledge and empowerment is key to successfully help patients remain healthy.


Communicating is the only way that transitions are successful and in whatever means possible-electronic, phone, fax, and so on. Two articles in this issue speak on the importance of effective communication. One, "The Impact of Nursing Students' Use of Electronic Health Records [EHRs] in the Home Setting" by Carmen Jones and Elizabeth Richards, relates how nursing students perceived EHRs and how working with them prepared them for home visits. The use of EHRs early on in education can only bode well for a comfort level when in practice and is to be embraced in our professions!


"Using SBAR Communications in Efforts to Prevent Rehospitalizations" is a fundamental article all about SBAR, its use, and with example SBAR communications. This article, because of its interprofessional implications, is also the second CE of this issue. This article has information that could be very good for orientation and for use as an organization's "journal club" pick.


The third CE in this issue is "Medication Appropriateness at End-of-Life: A New Tool for Balancing Medicine and Communication for Optimal Outcomes-the BUILD Model" by Bridget Protus and colleagues. This article discusses how the BUILD model can help facilitate discussions with patients, family members, and team members about appropriate medications and when to discontinue medications.


The VNAA column addresses health models. In the VNAA column titled, "Partnerships in Home Care-One Agency's Journey with Accountable Care Organizations," Mary DeVeau articulates the opportunity that home care and hospice organizations may have in the redesigned healthcare delivery system. In the column, she lists some of the lessons learned from being an active participant in an ACO. We particularly liked the information presented about the identification of a "new, essential member of our team"-and why. We think you will also find this true and illuminating about the new healthcare world.


Self-care and health model changes all point toward more engagement of patients and families in their own care and management-be it chronic illness and symptom changes or other areas for catching "problems" early on. To that end, we want to tell you about a new, free resource from the AHRQ. This new tool is titled "Guide to Patient and Family Engagement in Hospital Quality and Safety." This evidence-based resource may help patients and families, as all seek to improve safety and quality. Although directed toward hospitals, there are four "strategies" that may have implications across the transition (back) to home: (a) working with patients and families as advisors; (b) communicating to improve quality (note: there is that communication term again!); (c) nurse bedside shift report; and (d) ideal discharge planning-which is about transitions and helping to reduce rehospitalizations and engaging patient and families. The URL link to this guide is http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyeng.


Speaking of self-management techniques, innovative care models remind us of the International Home Care Nurses Organization Inaugural Conference that took place June 25 to 28 at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland. With the theme of "The Future of Health Care Is at Home," the conference was attended by representatives of 13 countries, representing the four corners of the world!


On the first day of the conference, nurses from five countries-India, Qatar, Singapore, Thailand, and the United States-described the way home-based nursing care was delivered in their countries. Participants learned that they share many of the same challenges. For example, it seems that many countries have recently reformed, or are in the process of reforming, their healthcare systems. Nurses around the world struggle with changing reimbursement models and are trying to address the mandate to decrease hospitalization rates.


At the same time, they learned they have a lot to learn from one another. For instance, other countries have very different care models that seem to provide cost-effective and high-quality patient outcomes. It reminded me once again that the Medicare home care model has problems, and that home healthcare nurses should be seeking to set the standards for home healthcare nursing practice, rather than merely defining home healthcare nursing as adherence to Medicare standards. It was also interesting to compare educational requirements for home healthcare nursing practice. To provide home care in South Korea, a nurse not only needs a BSN but also a graduate education in home healthcare nursing!


More than 30 presentation and poster topics included research in home healthcare nursing, implementing specialty programs (e.g., mental health, HIV, diabetes, and pediatric and palliative care programs), clinical and educational programs, and many other topics. Networking activities and group meetings provided opportunities to envision the future of home-based nursing care and ways to educate nurses for this specialized area of nursing practice. Keep the International Home Care Nurses Organization on your radar screen. Visit the Web site http://www.ihcno.org or add your name to the e-mail list for information about the next conference by e-mailing mailto:mary.narayan@cox.net.

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