Basic musculoskeletal assessment: tips for the home health nurse

Home care clients typically present with functional deficits that are frequently attributable to musculoskeletal abnormalities. This article teaches the home care nurse how to conduct a basic musculoskeletal assessment and how to use the findings to develop a thorough plan of care for the home care client.     

Is anybody home? Basic neurologic assessment of the home care client

Clients with strokes, Parkinson's disease, multiple sclerosis, brain injury, or other conditions that are neurologic in origin abound in home care. Other clients may have neurologic deficits that are not so obvious. This article describes basic neurologic assessment and how it can be performed in the home setting with minimal inconvenience to the client and the nurse. Using a catchy mnemonic, the home care nurse can ensure that valuable information is obtained during the visit.     

The art and science of teaching rounds. A strategy for staff development

Teaching rounds can be a highly interactive, fluid process for developing staff nurses' critical thinking, assessment, and interpersonal skills. In this article, the authors describe how to conduct and evaluate teaching rounds using the example of Pain Management Teaching Rounds conducted by an advanced practice nurse on medical-surgical units of a large medical center. Qualitative and quantitative outcomes of the pain management rounds are discussed.     

Pharmacologic pain. Management for cancer patients at home

Pain management is one of the most important responsibilities of the home care nurse serving cancer patients. Patients and caregivers often fear uncontrolled pain, and need frequent reassurance that effective pain control can be achieved. This article discusses the etiology and types of cancer pain, pain assessment, pharmacologic pain management interventions, and evaluation of pain management for home care patients.     

Discharge planning for the patient requiring home intravenous antimicrobial therapy

Home intravenous (IV) antimicrobial therapy is a well accepted and widely practiced form of home infusion therapy. Orthopaedic-related infections, often requiring long courses of therapy, are commonly treated in the home setting after a brief hospitalization. Hospital orthopaedic nurses play an important role in preparing patients for home care. This article addresses patient selection for home IV therapy, the discharge planning process, and educational preparation of the patient. The role of the home care nurse is briefly presented to enhance the orthopaedic nurse's knowledge of the continuum of care.     

Assessment and management of urinary incontinence among homebound older adults: a clinical trial protocol

Urinary incontinence is a common and costly problem among homebound older adults. This article describes the assessment and management protocols utilized in a clinical trial examining the effectiveness of behavioral interventions in treating urinary incontinence in homebound older adults. Individuals with urinary incontinence were identified and referred to the study by home care nurses from two large home health agencies. Following in-home assessment, eligible subjects were randomized to an immediate treatment group or a delayed treatment group (control group). Subjects who were cognitively intact were treated with biofeedback-assisted pelvic floor muscle training, while subjects with cognitive impairments were treated with a program of prompted voiding. Two nurse practitioners assessed and treated subjects participating in the study.     

Depression in elders with dementia: implications for home healthcare practice

In addition to severe cognitive decline, depressive symptoms occur in almost 50% of patients with dementia. Depressive symptoms can be treated successfully, thereby reducing clinical manifestations of coexisting dementia and improving quality of life for these patients and their families. Practical assessment, interventions, and referral guidelines are presented for home healthcare nurse generalists whose caseloads include elders with both cognitive decline and depressive symptoms.     

Evaluations by staff, residents, and community seniors of patronizing speech in the nursing home: Impact of passive, assertive, or humorous responses.

Two studies tested the impact of alternative communication in accommodation strategies. Nursing home staff and residents (and community-residing seniors in Study 2) rated nurse–resident conversational scenarios in which a resident responded passively, directly assertively, or humorously (indirectly assertively) to a patronizing nurse. The nurse then either maintained a patronizing manner or accommodated with a more respectful speech style. Even though all groups devalued the nurse who maintained a patronizing speech style, nursing home residents predictably showed the most acceptance. The directly assertive response by the resident elicited more devaluation of the nonaccommodating nurse than did either passive or humorous responses, but also the least favorable ratings of the resident. Ratings of the humorous response in Study 2 suggested that humor could be a good compromise response style for allowing the receiver of patronizing speech to express opposition to a request, yet still maintain an appearance of competence and politeness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating the elderly diabetic at a day hospital

Elderly people who develop diabetes should have an individual programme of education, tailor-made after assessing their physical and social needs. Avoid bombarding them with too much information, much of which may be inappropriate and even frightening. The Day Hospital, with its multidisciplinary team of nurse, doctor, social worker, physiotherapist and occupational therapist, is an ideal setting for educating and supervising the elderly diabetic. Ongoing assessment is provided through regular monitoring, education through games and group discussions, and home visits where necessary     

An Orientation Questionnaire.

We describe the development of an Orientation Questionnaire (OQ), a standardized measure of the impairment of an older person's ability to communicate orientation information. Starting with a pool of selected items, we made a series of revisions that resulted in a 17-item questionnaire with a score range from 0 through 40 points. In additional studies we determined that OQ scores evidence adequate reliability (test–retest r?=?.969) and adequate validity (r with nurse ratings?=?.798 and .793; r with behavioral assessment?=?.807). The OQ scores discriminated groups on the basis of environmental structure (community vs. nursing home vs. neuropsychiatric hospital) and psychiatric diagnosis (organic vs. schizophrenic vs. no diagnosis). Tentative classification data are presented, and uses of the OQ are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expanding the scope of clinical practice: The physical examination.

Five clinical health psychologists at a major medical center successfully completed a 36-hr, graduate-level nurse practitioner course in advanced health assessment. The psychologists were trained to conduct thorough physical examinations and evaluate medical histories. All psychologists successfully completed the course and reported high levels of comfort with their ability to (a) conduct physical examinations, (b) describe physical examination findings, (c) provisionally identify medical problems and generally abnormal conditions, and (d) make appropriate referrals to medical specialists, when necessary. The nurse practitioner instructors reported high levels of satisfaction with student mastery of course content. The psychologists and nurses both reported high levels of satisfaction with the student–faculty relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methodology and feasibility of a home-based examination in disabled older women: the Women's Health and Aging Study

BACKGROUND: To ascertain disease and functional capacity in community-resident disabled older women in the Women's Health and Aging Study (WHAS), a prospective investigation of the causes and course of disability, a home-based standardized physical examination and performance test battery were developed. Thirty-nine tests were administered, 9 by a lay interviewer and 30 by a nurse. This scope and intensity of testing had not been performed previously in a home environment or on such a functionally limited population. Thus, substantial developmental work was required. This report describes the administrative procedures and field experience for each exam component, highlighting innovations pertinent to home administration. METHODS: Exclusion criteria, safety issues, administration time, completion rates, and reasons for incomplete data are reported. Administration time is based on 30 exams conducted over a 3-week period 90% of the way through baseline data collection. Completion status was determined using all 1,002 participants and is categorized as follows: complete; partial; not done, health; not done, other; and refused. RESULTS: Seventy-two percent of the screened, eligible respondents completed the 30-min interviewer-administered physical assessment and the 2-hr, 10-min nurse examination. Classifiable data were obtained for 90% of participants on 36 examination items. Lower completion rates were obtained on the other three tests primarily due to exclusions for health-related conditions; environmental constraints and participant refusal were minimal. CONCLUSION: Extensive, research-oriented physical evaluation can be successfully and safely performed in a home setting. In future studies, home-based examination may be preferable, as participation in the WHAS examination substantially exceeded rates for clinic-based exams in similar populations.     

The geropsychiatric clinical nurse specialist in home care

Home care nurses often are asked to provide care to older adults with multiple problems, including psychiatric diagnoses. This article identifies areas of knowledge a general nurse needs to provide care for geropsychiatric patients and describes the role of the geropsychiatric clinical nurse specialist as part of a home care team.     

Pharmacophore and pseudoreceptor modelling of class Ib antiarrhythmic and local anaesthetic lidocaine analogues

Teaching is an integral part of the home care nursing role and has assumed increasing importance as a cost-saving intervention. This article gives the home health nurse insight into the importance of thoroughly assessing the patient's learning style before developing and implementing the teaching plan.     

Psychoeducational groups for young adults with genital herpes: training group facilitators

Genital herpes is one of the sexually transmitted diseases that can have serious long-term psychological and physical consequences for young adults who contract the disease. Because of the chronic, reoccurring nature of genital herpes, these young adults need education about the transmission of the herpes virus and about safer sexual practices in addition to emotional support. Psychoeducational groups have shown to be a nursing intervention that can effectively provide this education and support. Yet community health nurses may not be knowledgeable about or comfortable with using this type of intervention. In this article we explain the process of training community health nurses to be nurse facilitators who conduct psychoeducational groups for young adults with genital herpes. The training consisted of a 1-day workshop and three follow-up sessions. The content and format of this training workshop and the follow-up sessions is presented in addition to recommendations to enhance this nursing intervention.     

Advancing nursing practice: acute care nurse practitioners meet challenges at and beyond the health care horizon

Preparation of advanced practice nurses (APNs) with acute care skills relevant to today's health care environment is a challenge faced by nurse educators, care providers, professional organizations, and regulatory agencies. The acute care nurse practitioner (ACNP) is prepared to provide multidimensional, risk-appropriate management of medically vulnerable patients with serious illness in a variety of settings. ACNPs conduct comprehensive health assessments, order and interpret diagnostic tests, diagnose and manage health problems and disease-related symptoms, prescribe and evaluate drugs and treatments, and coordinate care during setting transitions. Working independently and collaboratively the ACNP enhances access to care and quality of care for patients and families through cost-effective, outcome-oriented practice. This article describes health care market factors fostering ACNP practice, ACNP practice domain, the University of Washington ACNP program, and collaborative contributions from educators, care providers, professional organizations, and regulatory groups needed to implement the role.     

Painless dentistry. Fact or fiction?

The complex chronic health problems and functional limitations common in the elderly population place them at risk for complicated hospitalizations and discharge planning. The purpose of this study was to investigate the effectiveness of a discharge planning protocol in identifying elderly patients' home care needs. The sample in this quasiexperimental study consisted of 507 hospitalized patients age 65 years or older. The control group received the usual hospital discharge planning protocol. In the experimental group, nurse/social worker teams coordinated the discharge planning process, using an adapted form of the Discharge Planning Questionnaire (DPQ) to identify the home care needs of elderly patients. Thirty days after hospital discharge, both patient groups participated in a telephone survey to obtain information about health care problems they experienced during home recovery and their use of health care resources. The findings indicated that the majority of the elderly patients had functional dependencies, which required the help of another person to carry out daily household duties and provide assistance with basic needs, especially ambulation. These functionally dependent patients only received home care referrals about 50% of the time. These findings raise questions about current reimbursable services. Logistic regression analysis indicated that patients with increased functional dependency and patient problems during home recovery had a greater likelihood of rehospitalization and emergency department usage. This information about the home care of elderly patients after hospitalization supports the need for comprehensive functional assessment as part of discharge planning. This study also suggests that the nurse/social worker team can provide effective screening and discharge planning coordination of home care. Physician involvement and effective communication networks must be in place.     

An analysis of risk assessment tools for falls in the elderly

The authors entered into a collaborative project with the staff of a visiting nurse service to evaluate the utility of a risk assessment inventory (RAI) in identifying factors that lead to falls in elderly persons receiving home care. Although no clear pattern emerged among personal factors, the majority of patients who experienced a fall used one or more assistive devices for ambulation.     

The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role

The purpose of this article is to provide an historical overview of the clinical nurse specialist and nurse practitioner roles in psychiatric nursing. This article is written as a follow-up to that of Dyer, Hammill, Regan-Kubinski, Yurick, & Kobert, (1997), Archives of Psychiatric Nursing, 11, 2-11, in which a new paradigm for delivering comprehensive mental and general health services is conceptualized, i.e., the psychiatric-primary care nurse practitioner role. In this article an alternative model is presented: the psychiatric clinical nurse specialist/nurse practitioner role. Similarities and differences in the two roles are discussed.