The Nobel Prize for Nurses Marianne and Margaritha No abstract available

Letter to the Editor No abstract available

Systolic Heart Failure: An Update for Home Healthcare Clinicians Heart failure (HF) is a significant public health problem that is projected to increase in prevalence in the next 20 years due to a growing aged population and improved survival after acute cardiac events. The American College of Cardiology (2019) defines HF as a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood. In systolic HF, the left ventricular muscle has diminished contractility and ejection fraction is less than 40%. This article will review the pathophysiology and treatment of HF. Implications for home care clinicians are discussed.

Home Care Nurses' Perspectives Regarding Health Information Management Among Older Adults Aging is associated with comorbidities and increased utilization of healthcare services, which results in a large amount of personal health information (PHI) to manage. Older adults often have difficulty managing this increased load of health information. Although many home healthcare nurses (HCNs) provide assistance to older adults after discharge from medical facilities, little is known about HCNs' experiences with older adults regarding the management and transfer of PHI in their homes. The purpose of this qualitative study was to 1) determine how HCNs obtain and provide health information, 2) describe the perspective of HCNs regarding older adult PHI, and 3) identify the potential role of technology in older adult health information transfer. We conducted and analyzed semistructured phone interviews with 17 HCNs from two home healthcare agencies. Five thematic areas emerged from interviews with HCNs: 1) common practices of obtaining health information; 2) barriers to obtaining health information; 3) ideal ways to obtain and provide health information; 4) use of patient portals; and 5) HCNs' use of technology for health information exchange. Most HCNs reported that it would be difficult for older adult patients to update their PHI without assistance, but HCNs lack the time and resources to assist older adults in PHI management activities.

Informal Caregiver Decision-Making Factors Associated With Technology Adoption and Use in Home Healthcare: A Systematic Scoping Review Technology systems to alleviate the burden of caregiving are increasing in use. The home is a unique place where chronic disease management is often performed by informal caregivers, yet how caregivers make decisions about adopting a specific technology has not been thoroughly explored. This systematic scoping review mapped evidence on decision-making factors associated with technology adoption and use by caregivers of patients receiving care at home. We followed the recommendations developed by members of the Joanna Briggs Institute. Four electronic databases (PubMed, Medline, CINAHL, and Embase) were searched using both medical subject headings (MeSH terms) and key words. A total of six papers were included for data synthesis. Factors such as information, comprehension, motivation, time, perceived burden, and perceived caregiving competency were found to affect adoption of technology. There are other factors uniquely springing from the patient and technology, as well as shared issues between caregivers and patient, and caregivers and technology. Although some factors depend on technology type and patient diagnosis, there were some common factors across the research. Those factors can be carefully considered in referring technology use for caregivers. More focused study in this underinvestigated area is much needed.

Integration of an Advance Care Planning Model in Home Health: Favorable Outcomes in End-of-Life Discussions, POLST Rates, and 60-day Hospital Readmissions Only 2.3% of patients at a Midwest home healthcare (HH) agency had documented advance directives (ADs), compared with 28% nationally. Of concern, this HH agency lacked standardized procedures for advance care planning (ACP) leading to inadequate staff knowledge regarding end-of-life, avoidable hospital readmissions, and delayed transitions into hospice care. Lack of ADs is directly correlated to higher hospital readmission rates and lower hospice length of stay. The purpose of this initiative was to develop evidence-based procedures using the Respecting Choices® ACP model to: 1) educate staff, 2) increase ACP conversations offered and completed among high-risk patients, 3) increase Practitioner Orders for Life-Sustaining Treatment (POLST) rates, 4) reduce 60-day hospital readmissions, and 5) support hospice care admissions. Staff received discipline-specific education on ACP/ADs. The Knowledge-Attitudinal-Experiential Survey on Advance Directives (KAESAD), assessed staff ACP/AD knowledge, confidence, and experiences. Standardized electronic medical record tools were created to track ACP conversations, POLST rates, 60-day hospital readmissions, and hospice admissions. Paired t-test and chi-square analyses compared changes pre- and post implementation. The KAESAD survey was analyzed for 75 staff (100%) and demonstrates improvement in knowledge, confidence, and experiences. Data also demonstrate increases in: ACP offered 6% to 80% (p < .001); ACP conversations completed 4% to 31% (p < .001); POLST rates 26% to 43.6% (p = .059); decreased 60-day hospital readmissions 40% to 20% (p = .025); whereas hospice care admissions was not impacted ranging from 10% to 5.5% (p = .381). Respecting Choices® serves as an effective ACP framework to improve ACP conversations, POLST rates, and hospital readmissions.

The Use of Home Telemonitoring for Heart Failure Management Among Hispanics, Non-Hispanic Blacks, and Non-Hispanic Whites Heart failure (HF) is ranked as one of the leading causes of hospitalizations and mortality among adults of all racial/ethnic groups in the United States. Telemonitoring, as a home care intervention for HF management, has been used across all groups although the benefit for Hispanics has not been established. The purpose of this retrospective, quantitative study was to determine the differences in hospital readmission between Hispanic, non-Hispanic Black, and non-Hispanic White patients with HF who either received or did not receive home telemonitoring services from a home care agency in Connecticut. A purposive sample of 138 records of patients admitted between January 1, 2012, and June 30, 2017, with a diagnosis of HF provided the data for the study. Data were analyzed by conducting simple and multiple logistic regression analyses. The key findings showed that Hispanics who used telemonitoring were almost four times less likely to be readmitted to the hospital compared with Hispanics who did not use telemonitoring (p = .04). Race, age, gender, and insurance were not significant predictors of readmissions (p > .05). The findings from this study may provide healthcare providers with a better understanding of the outcomes of home telemonitoring for treating adult Hispanic patients with HF.

Opioid Crisis: Equianalgesia Dosing Considerations for Home Care Cancer Patients As a result of the opioid epidemic, strategies have been implemented to reduce opioid consumption. These include regulatory policies, reduced opioid production, and nonopioid approaches for pain management. Although these policies may reduce opioid prescribing, there has been an unintended consequence for patients with severe cancer pain. Opioids are foundational for cancer pain management and are often required for patients during end-of-life care. Shortages of some opioid medications require knowledge of equianalgesic dosing. Equianalgesia is the conversion of comparable pain-relieving effects from one medication to another. There is a lack of consensus with regard to conversion standardization so researchers have created dosing principles that clinicians can follow. This article will describe some of these dosing principles and provide readers with sources for on-line dosage calculators.

Depression and Loss in Older Adults No abstract available

BTrackS: A Low-Cost, Portable Force Plate for Objectively Measuring Balance Deficits and Fall Risk No abstract available