Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
19,808
result(s) for
"home and community care"
Sort by:
Back on the map
By helping fix up an abandoned building in New Hope, North Carolina, Penny hopes that she and her brother, Parker, will be able to stay there rather than going into foster care.
Book
Challenges in Nursing Education and Research
The conference main theme is \"Overcoming Global Health Challenges through Nursing Education, Research and Technology\". It covers all theoretical and practical aspects of nursing and health sciences. This will provide knowledge and information across academicians and professionals to optimize healthcare quality and safety around the globe.
eBook
Almost Home
Almost Homeis a rich and comprehensive study of the policy questions underlying the shift in medical care from hospitals to homes and communities, a change that is reshaping Canadian health care policy and politics. Using document analysis, and interviews with government officials and other key stakeholders in the policy community, the authors analyze the policy content and process of five different attempts to reform home and community care in Ontario between 1985 and 1996, as introduced by governments from three different political parties.
As this study demonstrates, the ongoing shift from the Medicare 'mainstream' of physician and hospital care to the Medicare 'margins,' entails not only a shift in the site of care but an erosion of the post-war state's role in health care. While Medicare continues to resist political and ideological forces aimed at shrinking the state's role, cost constraints, demographic pressures and technological advancements are increasing pressure on home and community care.
The authors have made a significant contribution to research on policy development and change. Their rigorously analytical approach fills a major gap in book-length literature on long-term health care in Canada.
eBook
Effect of the Use of Home and Community Care Services on the Multidimensional Health of Older Adults
Home and community care is an important way to actively respond to population aging and to promote healthy aging. This study aims to estimate the effect of using home and community care services on the multidimensional health of older adults. We used data from the China Health and Retirement Longitudinal Study conducted in 2018 and relied mainly on the propensity score matching method for data analysis. The results showed that using home and community care increased the probability of maintaining and improving physical health by 2.9%, decreased the score of depression by 0.471, and improved the score of cognitive function by 0.704. Using home and community care also increased the probability of actively participating in life by 4.1% and elevated the score of life satisfaction by 0.088. The heterogeneity analysis showed that the use of home and community care had a significant effect on promoting all health indicators in rural older adults and a more obvious promoting effect on the social adaptation of urban older adults. Using home and community care significantly promoted the multidimensional health of people aged 60 to 79 years but had no impact among people aged ≥ 80 years. The use of home and community care significantly improved all health indicators in non-disabled older adults. Whereas, it only improved the levels of cognitive function and life satisfaction in disabled older people. Using this form of care significantly improved all health indicators in those with low socio-economic status, but it only had a partial positive effect on the multidimensional health of those with high socio-economic status. Our results are of importance to the government as they may be used to further improve the quality of home and community care services for the targeted older population.
Journal Article
Relationships between work outcomes, work attitudes and work environments of health support workers in Ontario long-term care and home and community care settings
Background
Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers’ work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care.
Methods
We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July–August 2015.
Results
HSWs’ work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their perceptions of supervisor support, and their perceptions of workplace safety.
Conclusions
HSWs’ work environments are within the power of managers to modify. Our analysis suggests that QWL, perceptions of supervisor support, and perceptions of workplace safety present particularly promising means by which to influence HSWs’ work attitudes and work outcomes. Furthermore, even modest changes to some aspects of the work environment stand to precipitate a cascade of positive effects on work outcomes through work attitudes.
Journal Article
Advancing home health nursing competencies in Canada to reflect a dynamic care environment and complex population health needs: a modified eDelphi study
Background
Home health nursing competencies outline the knowledge, skills and attributes home health nurses need for safe and ethical practice. Since the Canadian Home Health Nursing Competencies were first developed in 2010, several important contextual changes have occurred. To ensure competencies reflect current practice contexts, this study aimed to update Canada’s home health nursing competencies.
Methods
A four-phase modified eDelphi study was conducted using online surveys, consensus meetings and feedback forms. An environmental scan was conducted to identify home health competencies emerging since 2010, to create a comprehensive set of preexisting competencies to serve as the starting point for a 3-round modified eDelphi process. The eDelphi was conducted with a panel of home health nurses (
n
= 43) to identify core competencies relevant to current home health nursing practice environments. Broader consultations with home health nurses (
n
= 41) and interdisciplinary home care team members (
n
= 12) were held to validate eDelphi findings. An advisory working group (
n
= 24) of home health nursing leaders provided guidance on study decision-making and final recommendations.
Results
Three hundred fifty-nine preexisting competencies were consolidated into 96 unique home health nursing competencies. In Round 1 of the eDelphi, home health nurses reached consensus (agreement ≥ 75%) that 94 competencies were relevant to current practice environments and suggested five new competencies. Subsequent eDelphi rounds resulted in 93 competencies being brought forward as both relevant and essential for current home health nursing practice. Further consultations refined recommendations, resulting in a final set of 79 competencies. Qualitative feedback provided insights into the relevance and importance of competencies, opportunities for comprehension improvements, and implementation considerations.
Conclusions
The home health nursing competency set generated through this study incorporates core concepts in home health nursing practice, such as evidence-informed practice and interdisciplinary collaboration, along with several new concepts, such as trauma-informed care, data-driven decision-making, and provision of culturally safe care. This updated competency set can be used to inform prelicensure education and professional development opportunities to enhance home health workforce capacity. Future work exploring strategies to support competency uptake in education and home and community care organizations is needed.
Journal Article
Nurses’ experiences in transitioning to work in the long-term care and home and community care sectors: A phenomenological exploration
Background
Nurses in long-term care (LTC) and home and community care (HCC) are well acquainted with the high workloads and manifold job stressors that pervade these sectors, making it increasingly difficult to employ and retain a strong workforce. In response, nursing bridging education programs have been proposed to enhance recruitment and retention. While the efficacy of such programs is supported, the transition to practice experience of new nurse graduates is often associated with feelings of under-preparedness. Understanding the lived experience of nurses transitioning into new roles in LTC and HCC after completing a bridging program may highlight areas of emphasis for future retention efforts.
Methods
Hermeneutic phenomenology was employed to explore the experiences of new graduate Registered Practical Nurses (RPNs) and Registered Nurses (RNs) from a tuition reimbursement program supporting students enrolled in nursing bridging education from Personal Support Worker (PSW) to RPN/RN and/or RPN to RN in Ontario as they transitioned to practice within LTC and HCC. A series of in-depth semi-structured virtual interviews and iterative analysis explored the meaning of everyday experiences for nurse participants.
Results
From twenty individual interviews (12 initial, 8 follow-up), the experience was embedded in a sense of
fulfillment
, further considered through four themes – benevolence; growth, eagerness, and anticipation to learn; building from within; and work-life balance.
Discussion
This is the first phenomenological study to report on the meaning of the experience of transitioning to practice for new graduate nurses from bridging education programs as they (re)enter the workforce in LTC and HCC, offering rich insight into their experiences when moving into new roles.
Conclusions
By illuminating the nuances of this experience, the findings may encourage healthcare leaders to develop helpful policies, strategies, and workplace cultures in LTC and HCC that might better promote the recruitment and retention of nurses in these sectors.
Journal Article
Quality of life measurement in community-based aged care – understanding variation between clients and between care service providers
Background
Measuring person-centred outcomes and using this information to improve service delivery is a challenge for many care providers. We aimed to identify predictors of QoL among older adults receiving community-based aged care services and examine variation across different community care service outlets.
Methods
A retrospective sample of 1141 Australians aged ≥60 years receiving community-based care services from a large service provider within 19 service outlets. Clients’ QoL was captured using the ICEpop CAPability Index. QoL scores and predictors of QoL (i.e. sociodemographic, social participation and service use) were extracted from clients’ electronic records and examined using multivariable regression. Funnel plots were used to examine variation in risk-adjusted QoL scores across service outlets.
Results
Mean age was 81.5 years (SD = 8) and 75.5% were women. Clients had a mean QoL score of 0.81 (range 0–1, SD = 0.15). After accounting for other factors, being older (
p
< 0.01), having lower-level care needs (
p
< 0.01), receiving services which met needs for assistance with activities of daily living (
p
< 0.01), and having higher levels of social participation (
p
< 0.001) were associated with higher QoL scores. Of the 19 service outlets, 21% (
n
= 4) had lower mean risk-adjusted QoL scores than expected (< 95% control limits) and 16% (
n
= 3) had higher mean scores than expected.
Conclusion
Using QoL as an indicator to compare care quality may be feasible, with appropriate risk adjustment. Implementing QoL tools allows providers to measure and monitor their performance and service outcomes, as well as identify clients with poor quality of life who may need extra support.
Trial registration
Australian and New Zealand clinical trial registry number:
ACTRN12617001212347
. Registered 18/08/2017.
Journal Article
The evolving role of health care aides in the long-term care and home and community care sectors in Canada
Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this ‘profession’ is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise - these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians.
Journal Article
A mixed-methods study evaluating the impact of an excursion-based social group on quality of life of older adults
Background
Social isolation is an increasing concern for older adults who live in the community. Despite some availability of social support programs to address social isolation, their effectiveness is not routinely measured. This study aimed to evaluate an innovative excursion-based program offering unique social experiences to older adults receiving aged care services.
Methods
This six-month before and after mixed-methods study evaluated the outcomes of an Australian excursion-based program which offered social and physical outings to bring older adults receiving aged care services into the wider community. The study combined two parts: Part 1 was a pre-post survey assessing the quality of life of older adults who received the excursion-based program for 6 months (
n
= 56; two time-points, analysed using signed rank test) and Part 2 involved qualitative in-depth, semi-structured interviews (
n
= 24 aged care staff, older adults and carers; analysed using thematic analysis).
Results
Older adults experienced a significant increase in quality of life scores (
p
< 0.001) between baseline and 6 months. Interviews confirmed these observations and suggested that benefits of participation included increased opportunities for social participation, psychological wellbeing, physical function, and carer respite. Interviews also revealed being in a group setting, having tailored, convenient and accessible activities, alongside supportive staff were key drivers in improving the wellbeing of participants.
Conclusions
Participating in an excursion-based community program may improve wellbeing in older adults. Aging policy should focus on prioritizing initiatives that promote social connectivity with the wider community and assist in improving outcomes for older adults.
Journal Article