Sleeping Conditions of Older Adults with Delirium Receiving Home Care

We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.

Assessment of Quality of Life, Family Function and Family Empowerment for Families Who Provide Home Care for a Child with Severe Motor and Intellectual Disabilities in Japan

Background: About 70% of Japanese children with severe motor and intellectual disabilities (SMID) live at home, and the number is increasing. Family members have an enormous burden of daily physical care for these children. A top priority is to understand quality of life (QoL), family function, and family empowerment to effectively support these families. We aimed to assess current living situations of families with a SMID child, and to reveal the relationships between QoL, family function, and family empowerment. Methods: Sixty-five family members from 34 families with a SMID child participated in this study. We assessed 5 parameters using the Japanese versions of the following instruments: World Health Organization Quality of Life 26 (WHOQOL26), Kinder Lebensqualitats Fragebogen (KINDL), Family Assessment Device (FAD), Family Adaptability and Cohesion Evaluation Scale KG-4 (FACESKG-4), and Family Empowerment Scale (FES). Correlation and multiple regression analyses were conducted;QoL score was the objective variable. Results: Participants included 54 parents (34 mothers, 20 fathers) and 11 siblings. The mean age of SMID children was 10.4 ± 5.03 years. Twenty-two children needed multiple types of medical care. The mean age of parents and siblings was 41.5 ± 6.16 years and 15.5 ± 2.35 years, respectively. The mean QoL score (3.28 ± 0.5) was similar to the Japanese average. The mean KINDL score (77.2 ± 12.1) was higher than those of previous studies. The mean FAD score was 1.97 ± 0.32. For FACEKG-4, the score of adaptability was correlated with WHOQOL score (r = 0.459, p < 0.05). The mean score of FES was 113.6 ± 14. As the result of multiple regression analysis, lower family FAD scores ([sb] = ?0.61, p < 0.01) indicated higher family function and greater age of participants (sb = 0.495, p < 0.01) was correlated with higher WHOQOL scores (F = 15.208, p < 0.01). Conclusions: Our results indicated that the individual QoL depended on the age of participants (equals the years of experience caring for a SMID child) and the recognition of family function as a whole. Thus, to improve family members’ QoL, we should focus on individuals and also approach the family as a whole.

Circumstances of falls and fall-related injuries among frail elderly under home care in China

This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.

Practical Experience in Home Care of Nursing Interns: A Qualitative Research

Purpose: To explore practical experience in home care of nursing interns. Methods: The phenomenological method for qualitative research was to interview 15 nursing interns in a semi-structured way, and then the collected data were analyzed and summarized by using the Colaizzi analysis method. Results: Interviewing results showed that there were five recurring themes, including: 1) personalized care;2) health education;3) humanistic care;4) solid professional foundation and sense of responsibility;5) expanded vision. Conclusion: Through home care practice, nursing interns deepened their cognitions of nursing connotation, stimulated their love for nursing and motivation of continuous learning, and improved their sense of identity to nursing career. In general, the practice of home care had a positive impact on nursing interns.

Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data

Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan;additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012;the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people;clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713;confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed;clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.

Investigating the Suitability of Agile Methods for Requirements Development of Home Care Systems

The ageing population in developed countries brings many benefits but also many challenges, particularly in terms of the development of appropriate technology to support their ability to remain in their own home environment. One particular challenge reported for such Home Care Systems (HCS) is the identification of an appropriate requirements development technique for dealing with the typical diverse stakeholders involved. Agile Methods (AMs) recognize this challenge and propose techniques that could be useful. This paper examines the desirable characteristics identified for requirements development in HCS and investigates the extent to which agile practices conform to these. It also sets out future work to improve the situation for the non compliant points found.

End-of-life home care of an interstitial pneumonia patient supported by high-flow nasal cannula therapy:A case report

BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.

An Introduction to Home Care for Esophageal Cancer

Esophageal cancer is a common tumor of the digestive tract and is a malignant tumor which affect one’s health and is potentially life threatening.The incidence and mortality rate of esophageal cancer in China is relatively high,with the incidence rate being the sixth highest and the mortality rate being the fourth highest among all malignant tumors.The lesion often occurs in the middle segment of the epithelium of the esophagus,often showing a family tendency,and is more likely to occur in middle-aged and elderly men.The typical symptom of esophageal cancer is progressive dysphagia,first with dry food,then with semi-liquid food,and finally with water and saliva.Treatment is divided into surgical treatment,radiotherapy,chemotherapy,and combination therapy.Apart from malnutrition and pain,the treatment can also cause great psychological stress to patients with esophageal cancer.Therefore,diet,pain,and psychological care for patients with esophageal cancer are crucial.Therefore,it more care is given to the patients by medical and nursing staff during hospitalization.However,not much have been discussed about home care for patients with esophageal cancer.In this article,we will talk about the home care of esophageal cancer patients from the following aspects:dietary,pain management,and psychological care.

ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响

目的探讨ICARE理念对县级敬老院养老护理员失能照护能力及职业精神与态度的影响。方法将2023年1—6月绵阳市4家县级敬老院的养老护理员作为研究对象,采用便利抽样法抽取其中两家的40名养老护理员作为观察组,另外两家的40名养老护理员作为对照组。对照组采用常规培训模式,观察组则在对照组基础上以ICARE理念为指引实施养老护理员培训。干预前后,对两组失能照护能力、职业精神与态度进行评价。结果干预前,两组失能照护能力、职业精神与态度比较差异无统计学意义。干预后,两组失能照护能力、职业精神与态度比较差异有统计学意义,观察组优于对照组。结论融入ICARE理念的养老护理员培训能提高养老护理员失能照护能力,转变其职业态度,有利于养老护理队伍整体水平提升。

The Practical Dilemma and Optimization Path of Smart Home-Based Care in Hengshui City, China

Smart home-based care for elderly is the product of the “Internet+” era, along with the information technology and the growing needs for a better elderly life. In order to understand the influencing factors of smart home care in Hengshui city, this paper selected 183 elderly people through a questionnaire survey. The conclusion of the study showed that education level, economic status, sleep quality and residence conditions are the influencing factors affecting the needs of smart home care of the elderly (p 0.05). Smart home care products for the elderly have a high willingness to use them, especially in terms of life care, medical services and emotional talk, but the compliance still needs to be improved. Development countermeasures suitable for Hengshui city can be put forward through the publicity of smart elderly care services, promoting the construction of demand-oriented big data, and promoting the participation of various forces.

Home visits in brain tumor patient: how nurse and family members cooperate in tumor patient's family self-care

Purposes： We reported the roles and fimctions of nurses in home visits for brain tumor patients using the family health assessment guide in the study. Methods： One patient of brain glioma was chosen as the case illustration. The nurses assessed the patients＇ situation, their families and living environment individually. All these factors were analyzed together. Results： The nurses then implemented their knowledge and skills to adopt different measures in different conditions, investigated the patients＇ health problems and carried out personalized effective actions. Conclusions： Nurses should put effort into community nursing to allow patients to live in a safe environment, to satisfy the health needs of human being and their needs for health knowledge, and enhance their self-care abilities.

Management of chronic heart failure:Role of home echocardiography in monitoring care programs

AIM:To identify a possible role of home echocardiography for monitoring chronic heart failure(CHF)patients.METHODS:We prospectively investigated 118 patients hospitalized during the last year for CHF who could not easily reach the pertaining District Healthcare Center.The patients were followed up with 2 home management programs:one including clinical and electrocardiographic evaluations and also periodic home echocardiographic examinations(group A),the other including clinical and electrocardiographic evaluations only(group B).RESULTS:At the end of the 18-mo follow-up no significant differences were observed between the 2 groups as regards the primary endpoint:rehospitalization occurred in 4 patients of the group A and in 6 patients of the group B;major cardiovascular events occurred in 2 and in 3 patients,respectively.No significant differences were observed with respect to the secondary endpoints:one vascular event appeared in both the groups,3 cardiovascular deaths occurred in group A and 2 in group B.No significant differences were observed between the 2 groups as regards the composite endpoint of death plus hospitalization.CONCLUSION:Home echocardiography for monitoring of CHF patients does not improve the cardiovascular endpoints.In our CHF patients,a low incidence of vascular events was observed.

Staff characteristics and care in Chinese nursing homes: A systematic literature review

The need for institutional long-term care(LTC)services,including nursing homes(NHs),is increasing in China's Mainland in part due to the aging population and changing family structures.In developing NH staff training programs,a review is needed to synthesize knowledge about staff and resident characteristics,and care provided in NHs.This systematic review aims to describe,in Chinese NHs,(1)NH staff characteristics and the care they provide,(2)resident characteristics and care needs,and (3)the role of family members.The 45 articles included in this review covered both urban and rural areas of China's Mainland.We found that staff in Chinese NHs were older and had lower education levels in comparison with those in western countries.Most direct caregivers in urban areas were migratory workers from rural area.Chinese NHs had few qualification standards for staff preparation for their roles in NHs.Also,functional levels of residents in Chinese NHs were higher compared to NH residents in western countries.In addition,family members played important roles in caring for NH residents.These findings suggest a need for staff development programs that tailor for lower educated NH staff and care needs of residents with widely varying levels in function from independent to bedbound in China's Mainland.The findings also suggest that staff qualification standards require critically policy development to improve the capacity of Chinese NHs to provide competent and safe care.

Testing of the Content Validity of a Modified OPCq Instrument—A Pilot Study in Norwegian Home Health Care

Aim: To test the content validity of a modified Oulu Patient Classification instrument (OPCq), part of the RAFAELA Nursing Intensity and Staffing system in home health care (HHC) in Norway. Background: Due to the growing number of patients in HHC, a Patient Classification System (PCS) whereby the systematic registration of patients’ care needs, nursing intensity (NI) and the allocation of nursing staff can occur is needed. The validity and reliability of the OPCq instrument have been tested with good outcomes in hospital settings, but only once in an HHC setting. In this study, the OPCq is tested for the first time in HHC in Norway. Methods: A pilot study with a descriptive design. The data were collected through a questionnaire (n = 44). Both qualitative and quantitative analyses were used. Results: The OPCq fulfills the requirements for validity in HHC, but the manual may need some minor adjustments. Discussion: The OPCq seems to be useful for measuring nursing intensity in HHC. Staff training and guidance, high-quality technological solutions and that all technology works satisfactorily are important when implementing a new PCS. Further research is needed in regard to NI and the optimal allocation of nursing staff in an HHC setting.

Users’ Perception and Satisfaction of Current Situation of Home Health Care Services in Jordan

Background: The healthcare system in Jordan is evolving and has to continuously respond to the changing risk profile of the population. The purpose of this study was to examine perception of users and providers of the quality of home health care services. Methods: A descriptive design was used to collect data from a convenience sample of 82 users of home health care services. Results: Users had low to fair satisfaction (30.5% - 69.5%) about the quality of care provided, had moderate satisfaction (72.0% to 81.7%) about the information received, and had low to fair satisfaction about education related to goal of treatment and medication (46.4% - 53.3%). Users had high level of agreement (>70%) that health agencies provided interpersonal care. Conclusion: The ability of the frail people to choose from a variety of cost-effective long-term care services is limited.

Lifestyle Adjustment Process to Maintain Family Life for Mothers with Children Who Need Home Medical Care

This aim is to clarify lifestyle adjustment process to maintain family life for mothers with children who need home medical care. We conducted semi-structured interviews with the mothers of children who required home medical care comprising procedures such as suction of sputum and respiratory management over a period of several years since the initiation of home medical care, and analyzed the results using the modified grounded theory approach (M-GTA). We found the process to be composed of nine categories. Immediately after their child who required home medical care began living at home, mothers were concerned about the protection of their unstable child and, therefore, made care of the child a priority. However, they gradually started experiencing the need to engage services for the child in the course of their daily lives and live their lives with assistance. In the course of this new lifestyle, mothers began to regulate their fluctuating feelings and discover a new lifestyle for the family by making the father’s role clear and having him take on some responsibilities, such as dealing with people outside the household. As a result, once making home medical care consistent with the family’s lifestyle, even if this care was not at the same level as that provided while the child was hospitalized, mothers felt they found a way that allowed them to spend time with their other children. In addition, they began to perceive the necessity of maintaining their health, which is crucial to the child’s care. Overall, this facilitated incorporation of prospects for the family’s future life because they tended to pay more attention to their health and the health of their other children. Further, this contributed in coordination of the selection of services that would benefit the entire family, thereby maintaining the family’s lifestyle.