An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms.

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926

Enhancement of a body area network to support smart health monitoring at the digital home

The deployment of home-based smart health services requires effective and reliable systems for personal and environmental data management. ooperation between Home Area Networks (HAN) and Body Area Networks (BAN) can provide smart systems with ad hoc reasoning information to support health care. This paper details the implementation of an architecture that integrates BAN, HAN and intelligent agents to manage physiological and environmental data to proactively detect risk situations at the digital home. The system monitors dynamic situations and timely adjusts its behavior to detect user risks concerning to health. Thus, this work provides a reasoning framework to infer appropriate solutions in cases of health risk episodes. Proposed smart health monitoring approach integrates complex reasoning according to home environment, user profile and physiological parameters defined by a scalable ontology. As a result, health care demands can be detected to activate adequate internal mechanisms and report public health services for requested actions

Case management for child protection services:A multi-level evaluation study

This article presents an evaluation study of a case management method for child protection services, the Delta Method for Family Supervision, in terms of supervision order duration and occurrence and duration of out-of-home placements. Additionally, case and case manager characteristics were examined. Data was collected about 224 cases, 58 case managers and 30 team managers of all 15 offices of the Child and Youth Protection Services in the Netherlands. In all cases the Delta Method was applied. Data were obtained by interviews, questionnaires and case files. Multi-level analysis was performed to study the influence of independent variables on supervision order duration, and the occurrence and duration of out-of-home placements. Case characteristics related to 87% of the differences in the duration of supervision order, case manager characteristics to 13% of the differences. Some case manager characteristics about applying the Delta Method were significantly related to shorter duration of the supervision order and the occurrence and duration of out-of-home placement. Case characteristics also showed strong relations. Together with the more general aspects of case management supported by this study, such as a one family and one worker approach, this contributes to a more effective practice of case management for child protection services

A Business Plan for a Case Management and Home Health Agency

This thesis will focus on the changes in health care delivery in the United States and how case management and home health care agencies have impacted upon it. The quality and cost-effectiveness of case management and home health care delivery will also be explored. As we approach the twenty-first century, the focus of health care delivery is changing rapidly. The health care delivery system has undergone major changes and has had a tremendous impact on the development of case management and home health care agencies. These changes are affecting, and will affect health care consumers and the delivery of home care services. ln general, research attributes those changes as including: the evolution of rapidly advancing technology, scientific breakthroughs, the implementation of governmentally-imposed policies, changes in the economy, and altered lifestyles of health care consumers. In addition, research has indicated that there is a significant rise in the costs of health care today. Because of the multitudinous changes within our health care delivery system and the rising costs of health care, enormous interest has been created. Health care professionals, tl1e federal government, insurance companies, and consumers are primarily interested in the establishment of comprehensive programs and methods designed to facilitate the improved delivery of cost-effective health care. The quest for finding solutions to the delivery of quality health care while simultaneously containing cost has also extended to Wall Street investors, independent providers, and health care consumers. Similarly, health care consumers are searching for new alternatives for regaining, restoring and maintaining health, or minimizing the effects of illness. Based upon research and consumer health needs, the necessity becomes evident of: developing a structural and educational framework for establishing a case management and home health care agency; designing programs to target special health problems and high risk populations; discussing the elements of program or service expenses which can be considered; illustration of the magnitude of cost savings which can be achieved; provision of an ongoing system for monitoring the economic and quality impacts of a case management and home health care agency; and, the offering of a methodology for reproducing the cost savings data in other case management and home care settings. The purpose of this study is to develop a business plan for a case management and home health care agency positioned within a large city in a metropolitan area. It is anticipated that the business plan will illustrate the requirements for operating a case management and home health care agency while epitomizing quality, cost-effective health care services. Journal articles and published studies were the primary source of secondary data. Guidelines from the United States Small Business Administration and Missouri Department of Home Health Licensing and Certification requirements were utilized. It is hoped that those who utilize the case management and home health care agency will benefit from its services

Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

Abstract Background Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. Trial Registration ClinicalTrials.gov: NCT0140792

Hearing the voices of older adult patients: processes and findings to inform health services research

Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples’ voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new “Community PPIE Elders Panel” to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination

WoundsWest: delivering comprehensive strategies to improve wound management in Western Australian Health Services

It is well known that prudent, supported, early discharge of patients back to their home environment facilitates recuperation, rehabilitation or palliation. Patients with wounds are no exception to this.The provision of effective ambulatory wound care is gaining increasing attention and importance worldwide as health services seek to provide efficient and effective services to growing numbers of patients with wounds, often under burgeoning fiscal constraints. The lack of, or poor utilisation of, evidence-based clinical practice guidelines and protocols for wound care and inequities in terms of access to resources, whether wound dressings or education, are causal factors leading to inconsistencies in the clinical management of wounds that contribute to less than optimal outcomes for patients with wounds.Health services and health managers' ability to strategically plan and rationalise wound management services is often further hindered by a lack of data on the epidemiology and potential burden of acute or chronic wounds within and on local or state health services. Furthermore, where there is an absence of clinical governance in relation to wounds, these wounds are not subject to the same scrutiny as other medical conditions and, therefore, opportunities to improve service delivery in relation to wound management are missed.This article describes a tripartite and multidimensional approach to providing West Australian public health services and employees with a sustainable system for the prediction, prevention and management of wounds. WoundsWest (WW), a partnership between WA Department of Health (WA Health), Silver Chain Nursing Association (Silver Chain) and Curtin University of Technology (Curtin University) is a novel, 6-year project and a first for Australia. WW aims to facilitate clinical governance of wounds within health services, enhance clinicians? knowledge, skill and competence in wound management, improve clinical outcomes for patients with wounds and increase health services' ability to decrease the burden of wounds in Western Australian public hospitals.In order to achieve these aims, WW established a number of subprojects to ascertain the prevalence of wounds within WA public hospitals, improve access to educational resources for wounds, improve access to expertise in wound management and provide a repository for wound-related data for the purpose of ongoing research

Are Existing Security Models Suitable for Teleworking?

The availability of high performance broadband services from the home will allow a growing number of organisations to offer teleworking as an employee work practice. Teleworking delivers cost savings, improved productivity and provides a recruitment policy to attract and retain personnel. Information security is one of the management considerations necessary before an effective organisational teleworking policy can be implemented. The teleworking computing environment presents a different set of security threats to those present in an office environment. Teleworking requires a security model to provide security policy enforcement to counter the set of security threats present in the teleworking computing environment. This paper considers four existing security models and assesses each model’s suitability to define security policy enforcement for telework. The approach taken is to identify the information security threats that exist in a teleworking environment and to categorise the threats based upon their impact upon confidentiality of data, system and data integrity, and availability of service in the teleworking environment. It is found that risks exist to the confidentiality, integrity and availability of information in a teleworking environment and therefore a security model is required that provides appropriate policy enforcement. A set of security policy enforcement mechanisms to counter the identified information security threats is proposed. Using an abstraction of the identified threats and the security policy enforcement mechanisms, a set of attributes for a security model for teleworking is proposed. Each of the four existing security models is assessed against this set of attributes to determine its suitability to specify policy enforcement for telework. Although the four existing models were selected based upon their perceived suitability it is found that none provide the required policy enforcement for telework