Biomedical subjects
Publications and source records attributed to M R Zink.
The home care industry is undergoing tremendous changes in the reimbursement model presented in the Prospective Payment System (PPS). Case management is a model of care delivery that can provide the oversight required in this comprehensive prospective payment environment.
Although MCOs pose many challenges to the ethics of healthcare delivery, they also have the potential to minimize some previously existing unethical practices. The focus on maximum quality and cost-effectiveness places more demands on the provider with increased accountability. In the old unstructured, noncompetitive healthcare environment, providers were not as accountable to the patient for providing the best quality care at the best price. As home care agencies integrate with managed care networks, outcome measurement becomes increasingly important (National Association for Home Care, 1996). In the managed, integrated market, competition is strong and quality becomes a benchmark when alliances and mergers occur. Home care is in a prime position to be a major player in this new healthcare system and continue to expand services in a capitated environment while being challenged to uphold the ethical practice philosophy outlined in the basic moral principles discussed in this article.
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The CHAP accreditation process provides an external, objective marker for the clients served by an agency. This marker indicates that the agency has met national standards of organizational strength and quality. The process results in a detailed analysis of the organization's overall strengths and weaknesses and provides expert consultation regarding findings. This ongoing consultative relationship between CHAP staff members and/or site visitors and agency leadership provides a continued framework for organizational expansion and change to meet ever-changing health-care needs.
The purpose of this study was to continue research related to the identification of social support systems for an older adult homebound population of people who have diabetes compared to a control group of elder home care clients without diabetes, their knowledge level, and the significance of home health care intervention in these support networks. A sample of 11 older adult homebound people with diabetes and 11 older adult home care controls without diabetes from two home care agencies in Connecticut were used for this pilot study. A large sample was projected, but home-visiting scheduling difficulties arose. Eighty-two percent of both groups had adequate support systems. There was some difficulty with interpretation of the Homebound Diabetes Knowledge Level Questionnaire and further refinement is needed, especially in relationship to non-insulin-dependent diabetes mellitus client responses. Results from chart review, utilizing the Diabetes Clinical Indicator Tool, yielded a 59%-66% rate of the criteria met in the four categories outlined. It is evident that social support makes a significant contribution to the physical and psychological well-being of the home care elder, but further study is needed to examine the relationship between an individual's personal and professional network of support in this setting.
Little research has been done to document the value of using nursing diagnosis in home care and the impact that increased acuity levels have had in diagnostic selection. Nursing diagnosis documentation in home care was examined to see whether it had a relation to select client and visit pattern variables. This retrospective chart audit, which piloted a newly developed instrument called the Home Care Audit Tool, utilized a sample of 199 closed records of a large midwestern Visiting Nurse Association. The mean age of the client population was 76 years, with 64% female. There were 269 initial nursing diagnoses cited in the sample records, averaging 1.75 diagnoses per case. The number of recorded visits increased when select nursing diagnoses were cited together in a single case.
When establishing Nursing Ethics Committees (NECs), statewide nursing organizations play an important role in developing and disseminating resources. The Connecticut Nurses Association Ethics and Human Rights Committee surveyed 85 healthcare facilities to identify active NECs. Representatives facilitated other committees by providing guidelines and assistance to those agencies developing NECs--the ultimate goal.
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A statewide study was done with five associate degree (ADN) and five baccalaureate degree (BSN) nursing programs in Georgia to examine the similarities and differences in curriculum based on a nationally used model. From this overall study, select content related to community/home health care was evaluated in the sample programs. Professional standards for community and home health care nursing practice, as well as other published literature on the topic, provided a basis to determine competence to practice. Data were collected through a taped telephone interview to all program chairpersons (N = 10) and mailed questionnaires to faculty involved with all required courses (N = 110). Content analyses of responses allowed for evaluation of frequency of these learning activities between ADN and BSN programs and among BSN programs in the areas of family, teaching, interdisciplinary collaboration, physical assessment, and leadership. Overall, the results indicated lack of conclusive data to support a distinct difference in these educational components between the ADN and BSN sample or among BSN programs. The study was intended to service as a basis for home health care curriculum development in the future.
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Visiting nurse association staff nurses were surveyed to determine whether perceived use of nursing diagnosis had changed since the establishment of diagnosis-related groups and the extent to which diagnostic labeling was valued as part of home care practice. Little change in labeling was perceived, although the acuity level of patients in home care has increased during this time. Nurses found that they were comfortable, however, with their knowledge of the diagnostic process and believed nursing diagnosis provided an added dimension to care not provided by medical labels.
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