Joanne M. Dalton

The Influence of Social Environmental Factors on Rehospitalization Among Patients Receiving Home Health Care Services

Guided by Orems theory, this study examined the influence of social environmental factors on rehospitalization among home health care patients. Living arrangement, frequency of caregiving, and type of primary informal care were found to be related to functional ability. Measurable differences in clinical status and functional ability were related to the duration that patients received home health care services until rehospitalization, with the likelihood of rehospitalization increasing proportionately to the magnitude of the differences. Social environmental factors contributed to rehospitalization (self-care deficit) through functional ability (self-care agency) by altering the balance between self-care demand (clinical status) and self-care agency.

Evaluation of a Diabetes Disease Management Home Care Program

Diabetes disease management home care programs provide education, promote self-care, and empower patients. Guided by Orem’s self-care deficit nursing theory, this program evaluation project examined outcomes of home care for patients with diabetes. Three groups of diabetes patients were studied. Group 1 (n = 50) and 2 (n = 51) participants received traditional diabetes home care. Group 3 (n = 65) participants received experimental diabetes disease management. Patient data were obtained from medical records, a computerized billing system, and the Outcomes Assessment Information Set (OASIS). No statistically significant group differences in outcomes were found. A clinically significant finding was that approximately 50% of patients in each group were discharged with glucose levels that did not meet American Diabetes Association criteria. The project extends application of OASIS to Orem’s theory and raises questions about outcomes included in program evaluations. Larger samples are required to determine the best approach for diabetes disease management in home care.

Collaboration with Master’s Students in Home Health Care Research

Changes in health care have created an increasingly complex home health care environment, one in which knowledge derived from research is essential to provide patient care. The development of knowledge is enhanced when nurse researchers, nurse providers, and graduate nursing students collaborate to conduct research. Collaboration in research has many benefits. It benefits graduate students by providing opportunities to gain the skills needed for the advance practice role. It benefits academic researchers by advancing their programs of research, providing additional student resources and a fresh perspective. It benefits providers and the nursing profession by expanding knowledge that defines the profession, drives practice, and holds nurses accountable. Most important, collaborative research efforts benefit patients by assuring that nurses in the future are experienced in research and have the abilities to design, implement, and evaluate nursing care based on scientific evidence, ensuring access to safe and effective care.

Diabetes Disease Management in a Home Care Setting

The purpose of this Orem’s Self-Care Deficit Theory of Nursing guided project was to extend a program evaluation project to examine the effects of three different approaches to home health care diabetes care on patient self-care behaviors. Group 1 (n = 64) received an experimental Diabetes Disease Management Program, group 2 (n = 167) received a Diabetes Learning Collaborative program, and group 3 (n = 132) received standard diabetes home care. No statistically significant group differences were found for self-care behaviors. Statistically significant associations in group 2 between emergent care and patients who met American Diabetes Association criteria for glucose control regarding discharge management of injectable medication management were found. A significant clinical finding was that 46% of patients (n = 117) did not meet the glucose criteria.

Designing a Project to Evaluate a Home Care Diabetes Disease Management Program

to provide high quality and costefficient services for patients who have chronic illnesses such as diabetes. Home health agencies may implement diabetes disease management programs in an attempt to decrease the number of home visits and, therefore, reduce costs while attempting to improve the quality of care. Program evaluation is required to determine whether those outcomes are attained. The purpose of this article is to describe the process used to design and implement a program evaluation project designed to evaluate the diabetes disease management program at a large home health agency. The positive and negative aspects of using existing clinical data for research purposes are emphasized. DIABETES DISEASE