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Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. RR2-10.2196/33305.

Background Cancer became a chronic disease that could be managed at home. Homecare supported person-centred care, which was guided by the Picker Principles defining key elements for care delivery. The study aimed to explore and appraise the dimensions underlying cancer patients' and caregivers' experience and expectations with Home Cancer Care, adopting a person-centerd care framework. Methods We carried out a scoping review of the literature using three databases, PubMed, Scopus, and WoS for a total of 703 articles. PRISMA guidelines were followed. 57 articles were included in the review. The extracted data were categorized according to the type of care (Palliative, Support, Therapeutic, Recovery after transplant, Rehabilitation), the target population (patients or caregivers), the study design, and the principles related to patients and caregivers’ experience, classified through the Picker framework. Results The most common type of care in the home setting was palliative care. According to the Picker Principles, most of the studies reported “Emotional support, empathy and respect,” followed by “Clear information, communication, and support for self-care,” as key consideration for both patients and caregivers. The findings from these studies indicate many positive experiences regarding treatments, services, and interactions with health professionals. Caregivers' needs were most frequently (29%) classified as relational and social. From the patient’s perspective, the most common needs fell under the category of “Health System And Information” (43%). Conclusion We could state that HCCs align with the PCC paradigm; however, careful attention is needed to ensure that the experience of both patients and caregivers remains positive. In our study, a strong need for psychological support does not emerge either for patients or caregivers, unlike previous studies in which psychological needs were among the most frequently cited. Given the growing role of technology in home care, a new category addressing the usefulness and ease of use of technology could be added to the person-centred framework. Recent articles have highlighted the growing use of telemedicine in the home care setting as a support tool for self-care.

Background Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients. Methods This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance. Results Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p  = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η 2  = 0.305, P  < 0.001). Conclusions Caregiver burden increased significantly after the discharge without proper interventions in the caregivers of stroke patients. Providing support for home care providers can help to decrease or prevent the intensification of caregiver burden.

Objectives: To identify interventions that aim to reduce dependency in activities of daily living (ADL) in homecare service users. To determine: content; effectiveness in improving ability to perform ADL; and whether delivery by qualified occupational therapists influences effectiveness. Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, OTseeker, PEDro, Web of Science, CIRRIE, and ASSIA. Review methods: We included: randomised controlled trials, non-randomised controlled trials and controlled before and after studies. Two reviewers independently screened studies for inclusion, assessed risk of bias and extracted data. A narrative synthesis of the findings was conducted. Results: Thirteen studies were included, totalling 4975 participants. Ten (77%) were judged to have risk of bias. Interventions were categorised as those termed ‘re-ablement’ or ‘restorative homecare’ (n=5/13); and those involving separate components which were not described using this terminology (n=8/13). Content of the intervention and level of health professional input varied within and between studies. Effectiveness on ADL: eight studies included an ADL outcome, five favoured the intervention group, only two with statistical significance, both these were controlled before and after studies judged at high risk of bias. ADL outcome was reported using seven different measures. Occupational therapy: there was insufficient evidence to determine whether involvement of qualified occupational therapists influenced effectiveness. Conclusion: There is limited evidence that interventions targeted at personal ADL can reduce homecare service users’ dependency with activities, the content of evaluated interventions varies greatly.

Background The concept of thriving at work (TAW) has received increased interest within health services research in recent years. TAW embraces employees’ experience of being energized and feeling alive when employed in an organization. However, previous research has been limited mainly to the investigation of factors that promote TAW. Consequently, there is a lack of research linking TAW to potential outcomes. Based on this knowledge gap, this study aimed to examine links between TAW and two potential outcomes: employees’ individual innovative behavior (IIB) and employee ambidexterity (EA). Thus, the study contributes to a relatively neglected area, homecare, within the domain of health services research. Methods In this cross-sectional study, N  = 258 Norwegian homecare professionals in nine municipalities were selected through convenience sampling. The conceptual model's results were analyzed using partial least-squares structural equation modeling with SmartPLS 3 software. The study tested both direct and indirect relationships. Indirect relationships were achieved through bootstrap. Results The main results from the empirical study can be summarized as follows: (i) TAW was found to be positively linked to both EA ( b  = 0.46) and IIB ( b  = 0.22); (ii) TAW and EA explained about 30% ( R 2 = 0.29) the variance in IIB; (iii) The relationship between TAW and IIB was found to be mediated by the EA; (iv) TAW was positively linked to each of the two dimensions that constitute EA. However, when comparing the individual strength of linkages, TAW was found to be most strongly linked to the exploitation dimension of EA ( b  = 0.50) and less strongly linked to the exploration dimension of EA ( b  = 0.35). Conclusions Employees’ level of TAW in homecare services is linked to desirable outcomes, as represented by EA and IIB in this study. Managers should be aware of the development and changes in their employees' TAW levels. Consequently, continuously monitoring and cultivating the TAW of individual employees to determine whether they experience a sense of being energized and feeling alive as members of the organization is an important practical implication. TAW is a key to essential outcomes. Managers should, therefore, strive to let all of their employees thrive.

Telehealth technologies can enhance patients' and their families' access to high-quality resources in home-based palliative care. Nurses are deeply involved in delivering telehealth in home-based palliative care. However, no previous integrative systematic reviews have synthesized evidence on nurses' roles, facilitators, and barriers to implementing nurse-delivered telehealth in home-based palliative care. This integrative systematic review aimed to provide a comprehensive understanding of the roles of nurses and the multilevel facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care, which could inform future policy development, research, and clinical practice. This integrative systematic review was conducted using Joanna Briggs Institute methodological guidance. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We systematically searched articles published from January 1, 2014, to May 2024 in PubMed, Embase, Web of Science, CINAHL, and Cochrane Library. We included English-language; peer-reviewed; original; and qualitative, quantitative, and mixed methods studies that centered on nurse-delivered telehealth in home-based palliative care. We used the Mixed Methods Appraisal Tool to assess the quality of the included articles. Furthermore, 3 authors independently assessed eligibility, extracted data, and assessed the quality of articles. The entities to extract were identified by research questions of interest regardless of the type of study. We applied a convergent synthesis approach to integrate quantitative and qualitative data. Guided by the updated Consolidated Framework for Implementation Research (CFIR) 2.0, we synthesized the facilitators and barriers to implementing nurse-delivered telehealth in home-based palliative care. This integrative systematic review identified 4819 unique articles, including 34 papers encompassing 29 unique primary research studies. Innovations were mainly delivered by nurses (n=8) and nurse-involved multiprofessional teams (n=18). The roles of nurses in telehealth home-based palliative care involve palliative care nurses, community nurses, nurse coordinators, nurse coaches or nurse navigators, and nurse case managers. Guided by CFIR 2.0, facilitators and barriers to implementing nurse-delivered, telehealth, home-based palliative care were identified to 6 implementation levels and 20 constructs. The key facilitators included the COVID-19 pandemic, cost avoidance to the health care system, engagement of patients and their family caregivers, and so on. The barriers included a lack of reimbursement and payment mechanisms, technical problems, insufficiently trained health care providers, and so on. This integrative systematic review synthesizes evidence on nurses' evolving roles in telehealth home-based palliative care and identifies multilevel facilitators and barriers to nurse-delivered, home-based palliative care implementation. With the empowerment of telehealth technologies, nurses could establish a stronger professional identity and develop leadership in home-based palliative care. Nurses should leverage influence to promote nursing practice, clinical management, and policy support in the implementation of telehealth home-based palliative care. PROSPERO CRD42024541038; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024541038.

Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration. The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation. The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces. Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.

Background The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers’ capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers’ experiences and strategies in homecare services during the COVID-19 pandemic. Methods A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. Results The analysis revealed variations in managers’ strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. Conclusion Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

Background/Objectives: Patients receiving professional homecare often require support in managing their medication. In Switzerland’s legislative system, medication logistics (ordering, delivery, pickup, storage) are regulated differently by each canton, making it challenging for professional homecare organisations to comply with provisions efficiently. The present study aimed to analyse the current international literature, Switzerland’s regulations about medication logistics for professional homecare, and the current practices. Methods: We conducted a systematic literature review of the PubMed, Embase and CINAHL databases to identify existing international research on medication logistics by professional homecare organisations published until February 2024. The results of a structured online survey on medication logistics by professional homecare organisations in Switzerland’s German-speaking regions were compared against the medication regulations currently in place. Results: Ten studies were included in the review. The medication logistics processes of homecare organisations have rarely been researched, especially short-term and long-term storage. Few regulations cover medication logistics in Switzerland’s legislation, and they are often formulated non-specifically and focus on inpatient facilities. Some cantons allow centralised medication storage, others prohibit it. Only one canton explicitly permits short-term medication storage under simplified requirements. We evaluated the answers of 105 homecare organisations responding to our survey; 73.7% (73/99) of them nevertheless stored medications in the short term before bringing them to patients’ homes. Switzerland’s professional homecare organisations generally fulfil their legal requirements well. There is potential to improve the formulation of standard operating procedures for each step of the homecare medication use process, especially for cleaning medication storage sites (12/31, 38.7%) and short-term storage processes (29/56, 51.8%). Conclusions: There are few studies or guidelines on professional homecare organisations’ medication logistics, and they generally fail to address medication storage. Short-term medication storage is common despite most cantonal requirements being strict or prohibiting it, or not regulating it all. There is an urgent need for unambiguous, practice-oriented recommendations specific to homecare, especially for short-term medication storage.

Aims The aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia. Design This study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data. Methods A convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017. Results Three main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.