Family caregivers play a critical role in preventing pressure injuries among patients receiving home care. This quasi-experimental pre- and post-test study evaluated the effect of teach-back training on caregivers' knowledge of pressure injury prevention in 2024 within the neurology department of a teaching hospital in Iran. A total of 110 family caregivers of patients requiring home care participated. A specialized wound care research nurse delivered structured education using the teach-back method. Caregivers' knowledge was measured before the intervention and 1 month after hospital discharge using a 23-item Family Caregivers' Knowledge Regarding Pressure Injuries Questionnaire. There was a statistically significant improvement in the mean knowledge score after the intervention. Findings indicate that teach-back is a practical, low-cost, and effective educational strategy for improving caregiver knowledge related to pressure injury prevention in home care settings. The results support integrating teach-back into caregiver education programs and highlight the need for additional studies to further evaluate its impact on caregiver competence and patient outcomes.
Heart failure (HF) is a complex chronic disease with multiple comorbidities, including diabetes. Patients with diabetes are at an increased risk of developing HF-a major adverse cardiovascular outcome-and the comorbidity of HF and diabetes is associated with worse outcomes than HF alone. Some HF studies show that diabetes contributed to increased risk for rehospitalizations, but there is limited evidence about risk factors for rehospitalization in home healthcare patients with both HF and diabetes. The purpose of this study was to identify risk factors for 60-day rehospitalization in home healthcare HF patients with diabetes. This study is a secondary data analysis of a retrospective cohort study conducted using the Outcome and Assessment Information Set (OASIS-C) version. In the final multivariable logistic regression model, the frequency of pain interfering with the patient's activity or movement and the patient's overall status were statistically significant. Patients with minimal pain interference (less often than daily) had about 60% lower odds of 60-day rehospitalization than those without pain interference (OR = 0.394), and patients facing temporary high health risk(s) had about 86% higher odds of rehospitalization than patients in stable conditions (OR = 1.861). Identifying risk factors for HF patients with diabetes in this study helps define their care needs in the home healthcare setting. However, future studies are warranted to use larger sample sizes to further assess which hidden factors drive rehospitalization among home healthcare HF patients with diabetes.
Home healthcare agencies, like other healthcare organizations, continue to face challenges with nurse burnout. Improved well-being has been shown to reduce burnout and support nurse retention. The purpose of this quality improvement project was to enhance nurse well-being through the introduction of a structured well-being bundle. The bundle included three low-cost, evidence-based strategies: breathing exercises, gratitude training, and a self-selected spiritual reading or practice. Sixteen home health nurses participated in this 6-week pre- and post-intervention project. The World Health Organization-Five Well-Being Index (WHO-5), a validated and reliable tool, was used to measure changes in well-being. Nurses attended a virtual training session on how to use the three interventions. Weekly reminders and a mid-point check-in email were sent to support continued engagement. Results showed a statistically significant improvement in well-being scores following the intervention. Qualitative feedback from three participants indicated plans to continue using the strategies beyond the project period. Participants described the interventions as simple, practical, and easy to incorporate into their workday. Findings suggest that a well-being bundle with simple, evidence-based strategies may support nurse well-being in home healthcare. Given the ongoing challenges of burnout, especially in independent care settings, this approach offers a practical way to support nurses. Future projects with larger samples are recommended.
Medication management for older adults receiving municipal home care services involves daily coordination between home care staff, general practitioners, pharmacies, and hospitals across frequent care transitions and regulatory requirements. Although regulations, guidelines, and safety approaches are intended to support safe medication practices, healthcare professionals (HCPs) in home care work under conditions marked by time pressure, limited resources, and frequently changing medication information. However, there is limited knowledge about how HCPs interpret and apply these regulatory frameworks in everyday home care practice. This study aims to explore how HCPs organize medication management to ensure patient safety in Norwegian home care services. A focused ethnographic design was employed in three purposively sampled Norwegian municipalities. Data were generated through 218 h of participant observation, informal interviews, photographs, and document collection involving 25 participants from various professional backgrounds. The data were analyzed via an iterative ethnographic method inspired by Roper and Shapira. The findings revealed an overarching cultural orientation, "the here and now," along with two interconnected pattern categories: "performing resilience: making the day run" and "enacting system integration: chasing the right information." Medication management was organized through continual coordination, task prioritization, and repeated efforts to obtain and verify medication information. Although HCPs adhered to regulations and guidelines, written procedures were inconsistently referenced in daily work. Instead, medication safety relies on locally organized practices, shared understandings, and adaptation to immediate demands. Medication safety in municipal home care is maintained through a continuous, interpretive process shaped by the practical realities of daily work. Regulations and guidelines function alongside locally organized coordination and information work rather than as linear instructions. Understanding medication management as it unfolds in the here and now provides insight into the gap between work-as-imagined and work-as-done. This study contributes to the analytical concept of "here and now" to explain how medication safety is enacted through real-time coordination and information work in municipal home care. These findings indicate that guidelines and digital systems require improvement to better support real-time coordination and information work, and safety interventions also need to address local sensemaking and cross-organizational communication.
U.S. home healthcare agencies provide essential care to homebound patients, primarily older adults at high risk for infection. The COVID-19 pandemic intensified existing infection prevention and control challenges, particularly among marginalized communities. This qualitative study explored unique infection prevention and control challenges faced by agencies and differences in responses among those serving vulnerable populations. Ten agencies representing diverse geographic regions, ownership models, and patient characteristics participated; 25 staff across varied roles completed semi-structured interviews examining infection prevention and control policies, care coordination, and patient/caregiver communication during COVID-19. Thematic analysis identified four major themes: Into the Fray; Changing Relationships to Patients; Solutions Aimed at Care Provision Continuity; and Alleviating Fear and Providing Information. Staff experienced fear and stress from uncertainty and essential worker pressures, with urban infection prevention, quality, and education personnel particularly affected. Urban staff faced parking challenges and exposure risks in multi-generational homes; many rural staff contended with long drives and regional/county protocols that complicated patient access. Wearing full PPE in inclement weather further strained staff. Patient/caregiver hesitancy made trust building essential. Telehealth, education, remote work, and local partnerships supported care continuity, with corporately resourced agencies adapting more rapidly. Findings highlight the need for centralized guidance, telehealth investment, and stronger staff well-being supports in future public health crises.
Periodontitis is a common, chronic inflammatory disease that relies heavily on effective daily oral hygiene for long-term control. Light-based therapies have demonstrated strong antibacterial potential; however, their effectiveness in regular home use remains unexplored. Two hundred stage I-III periodontitis maintenance patients were randomized for supportive periodontal care (SPC) or SPC combined with adjunct home-applied dual-light therapy. Bleeding on probing (BOP), visible plaque index (VPI), and the number of sites with ≥4 mm periodontal probing depth (PPD) were measured at the baseline, at 3 and 6 months. Of the 200 randomized patients, 184 completed all visits. At baseline, the groups were similar for BOP, VPI, and pocket depth. At 3 and 6 months, adjunctive dual-light therapy achieved lower BOP (12.6 ±  0.7% and 12.0 ±  0.8%) than SPC alone (17.8 ±  0.8% and 17.3 ±  1.0%); p < 0.0001 and p = 0.0002 and lower VPI (8.5 ± 0.7% and 9.7 ± 0.8%) vs. (13.3 ± 0.8% and 14.2 ± 1.0%); p < 0.0005 and 0.0142. The dual-light group also had fewer sites with PPD ≥ 4 mm (5.6 ± 0.7 and 5.3 ± 0.6) vs. (7.6 ± 1.2 and 7.8 ± 0.9); p = 0.02 and p = 0.02. Regularly home-applied dual-light therapy may represent a promising addition to existing home-care strategies and a potential advance in adjunctive periodontal maintenance. Periodontitis is a common disease that damages the tissues supporting the teeth. Daily brushing and cleaning between the teeth are essential, but even with good routines, people can still develop plaque and gum inflammation. Light-based treatments are known to eliminate plaque bacteria effectively, but until now, they have mostly been used in dental offices, and their potential for home use has not been tested. In the HOPE-CP study, we enrolled 200 adults with periodontitis to receive routine supportive periodontal care. Half of them were randomized to use a light-based antibacterial device to support their daily oral hygiene at home. After 3 and 6 months, those using the device had less gum bleeding, less visible plaque, and fewer sites with deeper periodontal pockets than those who used routine care alone. These results show that using a daily antibacterial light treatment at home may help people better control inflammation and maintain healthier gums between dental visits.
Home healthcare workers (HHWs) are frequently exposed to occupational safety hazards when servicing clients in their homes. These hazards may take different forms, many of which could be broadly categorized as "Electric, Fire and Burn," "Environmental," or "Slip, Trip, and Lift" hazards. To address this issue, a home healthcare virtual simulation training system (HH-VSTS) was developed. Although prior studies have assessed the usability, usefulness, and desirability of the system, there was a need to determine if the knowledge gained through this training process generalizes to a real-world setting. Sixteen study participants completed one of the three training modules in the HH-VSTS consistent with the hazard categories listed above. Participants were then asked to walk through a one-bedroom apartment with 15 simulated hazards (5 electric/fire/burn, 5 environmental, and 5 slip/trip/lift) that are addressed in the HH-VSTS. Each participant served as a control for the two hazard categories for which they were not trained. Participants were asked what they would do about the hazards they identified in the simulated apartment during their walk through. Hazard mitigation strategies were categorized as successful, partially successful, or failed. Overall, participants identified 85% of the hazards that were included in the one module in which they trained versus identifying only 46% of the hazards in the two modules in which they were not trained. When they identified hazards on which they were trained, participants were more likely to voice successful mitigation strategies than for hazards upon which they had not been trained. Thus, the data indicate the HH-VSTS training facilitated hazard identification and hazard mitigation strategies in a non-virtual, simulated home setting, suggesting that this training approach should be effective for real home care settings.
Optimal cardiovascular health during pregnancy and postpartum is critical for reducing maternal morbidity and mortality. Although lifestyle interventions effectively promote cardiovascular health, strategies are needed to reach the maternal populations with the highest prevalence of cardiovascular disease risk factors. Evidence-based home visiting programs, though not initially developed to address cardiovascular health, offer a promising platform for reaching pregnant and postpartum women at high risk for later cardiovascular disease. This study explored home visitor perspectives on integrating cardiovascular health content into home visitation. Guided by the Social Ecological Model, semi-structured interviews (n = 10) and focus groups (n = 8) were conducted with home visitors, supervisors, and program managers (N = 33) from agencies in California and Rhode Island. Thematic analysis identified broad support for including heart health content, with participants emphasizing the value of culturally relevant, engaging, and flexible curricula that could be tailored to family needs. Organizational challenges included staff burden, training gaps, and funding for intervention sustainability. At the community level, strong relationships with healthcare providers and aligned messaging across systems were identified as key facilitators. Findings provide practical insights for the design and implementation of cardiovascular health interventions within home visiting and highlight the importance of addressing multi-level factors to support successful integration.
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Paediatric mechanical circulatory support with Berlin Heart-EXCOR® Paediatric is predominantly used as a bridge to transplant or recovery, specifically in children up to 30 kg. While survival with ventricular assist devices has improved, insights into morbidity and quality of life remain limited. Safely discharging children, particularly with the new driving unit EXCOR® Active (BH-EA), is now of clinical interest. Multidisciplinary and caregiver perspectives are needed to inform practice. Through semi-structured interviews with 22 professionals (physicians, nurses, psychologists, engineers, physiotherapists, social workers, child education specialists, chaplains) and three caregivers of hospitalised children on BH-EA, we explored: (1) device safety and daily care; (2) hospital environmental factors; (3) requirements for transitioning home with EXCOR® Active. Qualitative analysis yielded three main themes; of which two are explored in this publication: alarm management and home-discharge requirements for paediatric BH-EA patients. Participants described frequent low-priority alarms contributing to alarm fatigue. They called for clearer procedures, shared responsibilities, and enhanced caregiver training and identified prerequisites for safe discharge, including a 24/7 emergency hotline, remote monitoring, comprehensive system-wide support, caregiver training, and strong healthcare networks. The interviews highlight that the BH-EA alarm management is conceptualised for in-hospital care, which leads to reservations concerning reliable home monitoring during medical events, such as blood clot formation. Multidisciplinary efforts are essential to enhance device safety, empower caregivers, and develop effective discharge programmes for children on BH-EA. Furthermore, organ allocation systems should be adjusted to avoid disadvantages in organ waiting times following home discharge.
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Device-aided therapies (DAT) have significantly improved the management of Parkinson's disease (PD). They now include deep brain stimulation (DBS), levodopa-carbidopa intestinal gel (LCIG) infusion, continuous subcutaneous apomorphine infusion (CSAI), subcutaneous foslevodopa/foscarbidopa and levodopa-entacapone-carbidopa intestinal gel (LECIG) infusions. Despite established clinical benefits, disparities in DAT access and use have been reported across Europe and the USA. The PARKinson's Device-Aided-Therapies (PARK-DAT) study aimed to evaluate access to and use of DAT (DBS, LCIG and CSAI) for PD in France between 2015 and 2021 using data from the French national administrative healthcare database (Système National des Données de Santé, SNDS). PARK-DAT is a nationwide, retrospective observational study. Patients with PD who initiated any DAT for the first time between 2015 and 2021 were identified using an established algorithm and codes within the SNDS. Standardised incidences of DAT initiation were calculated by study period and geographical region. Between 2015 and 2021 8829 patients with PD (mean age 68.7±10.3 years; 43.4% women) initiated DAT representing a 41.8% overall increase between 2015 and 2021. CSAI was the most frequently initiated therapy (6873 patients; +58.9%), followed by DBS (1592 patients; -20.7%) and LCIG (364 patients; +152.9%). Most DAT prescriptions originated from hospital centres (74.6%). Few therapy switches or combinations were observed, mainly involving CSAI. Regional analyses suggest incidence disparities in DAT access. Unlike patterns observed in other countries, CSAI was the predominant DAT in France, while DBS use declined. Features of the French healthcare system, including favourable reimbursement and broad access to home nursing services, may account for this distinctive distribution.
This study aimed to examine the satisfaction with, and feasibility and acceptability of, a virtual home safety assessment implemented for people living with dementia and their caregivers by a trained Occupational Therapist (OT). Seventeen assessments were conducted. Nine caregivers and one patient completed a satisfaction survey. Ten caregivers and the OT assessor completed semi-structured interviews, which were analyzed using qualitative content analysis. Survey respondents reported high levels of satisfaction with the virtual assessment; the majority (90%) reported being comfortable with the virtual modality. Caregivers perceived that their assistance was required to conduct the assessment virtually, and care recipients responded well to technology. In comparison to in-person visits, the virtual assessment was considered easier for people living with dementia, easier to access, and equivalent to an in-person visit. Virtual home assessments are easy to implement, feasible, acceptable, and an effective way to identify and manage safety risks. Given the health system pressures that have led to long wait times for in-home safety assessments, virtual administration can build capacity for home safety assessments, allowing more patients to be assessed sooner, particularly in rural and underserviced areas where travel distances impede timely access to assessment.
Pulmonary hypertension (PH) is a progressive condition associated with reduced physical activity and impaired quality of life. While exercise training is now recognised as a safe and beneficial adjunct to PH management, opportunities for supervised programmes remain limited. There is a growing need for person-centred, acceptable interventions that enable patients to engage safely and meaningfully in physical activity within their own environment. The aim of this study was to explore the lived experiences of individuals with PH who participated in a 10-week, home-based exercise programme, and to evaluate its acceptability, utility, and perceived impact. Semi-structured interviews were conducted with participants (N = 13) diagnosed with precapillary PH, specifically pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), who completed the intervention. Data was analysed thematically to identify core themes reflecting patient experiences and perceived changes. Thematic analysis revealed four key themes: convenience and accessibility, development of exercise self-regulation skills, support and accountability, and perceived improvements in physical fitness and well-being. Person-centred, behaviourally informed home-based exercise interventions can help individuals with PH exercise safely, overcome fear, enhance self-efficacy, and re-engage with physical activity. These findings provide patient-driven insights to guide the design and implementation of scalable exercise models for the PH population.
Rural residents have been experiencing higher stroke mortality than urban residents, and the gap has widened. Disparity in postacute care after stroke may increase the rural-urban gaps of mortality and disability. We aimed to examine whether rural patients with stroke receive the same postacute care and achieve comparable outcomes to urban patients. We conducted a cohort study of Medicare beneficiaries aged ≥65 years treated in the Get With The Guidelines-Stroke participating hospitals for acute ischemic stroke during 2017 to 2022. We used restricted mean home-time to compare 1-year home-time among patients discharged from rural versus urban hospitals and the Cox proportional hazards model for all-cause mortality and readmission, adjusting for patient and hospital characteristics. The analysis included 29 734 patients treated in rural hospitals and 478 122 in urban hospitals, with a mean age of 79 years, and 55.5% were women. Compared with patients in urban hospitals, patients in rural hospitals were less commonly discharged to inpatient rehabilitation facilities (20.1% versus 25.1%; adjusted odds ratio, 0.76 [95% CI, 0.69-0.84]) and more frequently to skilled nursing facilities (24.5% versus 20.9%; adjusted odds ratio, 1.21 [95% CI, 1.11-1.32]). Compared with urban patients, rural patients had 1.8 fewer days of home-time (95% CI, -3.2 to -0.3) overall; rural patients discharged to skilled nursing facilities had 5.7 fewer days of home-time (95% CI, -9.0 to -2.3), and those discharged home had 2.2 fewer days of home-time (95% CI, -3.7 to -0.7). Rural patients overall had comparable all-cause mortality with urban patients (adjusted hazard ratio, 1.01 [95% CI, 0.98-1.05]) and lower all-cause readmission (adjusted hazard ratio, 0.92 [95% CI, 0.90-0.95]). However, rural patients who were discharged home had higher all-cause mortality than urban patients (adjusted hazard ratio, 1.11 [95% CI, 1.05-1.17]). Compared with urban patients, rural patients with stroke had less inpatient rehabilitation facility and more skilled nursing facility utilization, less home-time, but similar mortality. Further efforts are needed to ensure equitable postacute care in rural areas.
The incidence of pediatric sleep disordered breathing has increased in the last decade because of many factors, such as childhood obesity, metabolic syndrome, and access to better diagnostic methods. OSA peaks between 2 and 8 years in children. Early diagnosis is recommended to prevent long-term complications. While PSG is the gold standard for diagnosis, it may not be feasible in certain circumstances; hence, HSAT is now being increasingly used to screen and diagnose OSA. This review was conducted using the methodology in the "Cochrane handbook on systematic reviews". PRISMA flowchart was used to report the results. The risk of bias assessment was done using the "Cochrane handbook for systematic review reviews tool for Interventional studies". All studies were analysed using the Joanna Briggs Institute's critical appraisal tool. A total of nine studies were included in this review. Of these, only three studies employed simultaneous HSAT and PSG testing to evaluate the validity of HSAT indices. In one of the largest studies comparing HSAT with PSG, the mean AHI observed was 2.5 ± 3 for HSAT and 2.7 ± 2.9 for PSG (p > 0.05), indicating that the diagnostic yields of both methods were nearly equivalent. In studies utilizing HSAT alone, the mean apnea-hypopnea index (AHI) ranged from 0.8 to 10.3 events per hour in healthy children, compared to 2.2 to 13 events per hour in children with Down syndrome. Diagnosing sleep disordered breathing in children can be challenging in a laboratory setting. HSAT is cost-effective and better tolerated in the younger population compared to PSG. It is a reliable alternative to PSG when used with multiple channels, including EEG and capnography.
This study serves as a review of quality outcome scores for graduates of accredited nurse residency programs (NRP) compared with their case management peers. Although accredited NRPs have been shown to provide organizational benefits, the focus of this study centers on patient outcomes. We reviewed outcomes including Total Normalized Change (TNC) mobility, TNC self-care, Potential Preventable Hospitalization (PPH), 60 Day Acute Care Hospitalization (ACH), Discharge Function Score (DFS), Oral Meds, Ambulation, Dyspnea, Bed Transfers, and Bathing to determine the effectiveness of NRP graduates. Through our review and comparison, we determined that graduates of an accredited NRP perform at the same level or better than their case manager peers who have more experience in nursing. Our study indicates that organizations that benefit from improved retention and job satisfaction related to NRPs may also benefit from improved outcomes.