The objective of this study is to describe and understand the organizational culture and context in Home Health Nursing (HHNsg) practice. Participants consisted of a Licensed Practical Nurse (LPN), three Registered Nurses (RNs) and three Registered Nurse leaders. Using the methodology of ethnography, data collection methods included participant-observation, documenting fieldnotes, writing reflective memos, conducting individual interviews and examining organizational priorities. Home Health Nurses (HHNs) were observed and subsequently interviewed to illustrate routine practices and discourses that influence everyday HHNsg practice. Nurse leaders shared their perspectives of everyday contexts underpinning HHNsg practice, particularly professional claims of culturally-competent care. Geertz’s theoretical concepts of “thick descriptions and “texts” were applied to the analysis. My concluding discussion demonstrates how participants enacted cost-effective and efficient philosophies of organizing care despite claiming the importance of culturally-competent care with South Asian clients (India, Punjab). / Graduate

Across the US, 22% of Medicare patients hospitalized with a diagnosis of heart failure (HF) will be readmitted within 30-days of discharge. There is no one costeffective process identified to help patients transition home and maintain their own selfcare. The aim of this study is to compare readmission rates, HF knowledge, self-care, and quality of life for patients who transition home from the hospital under the care of a Heart Failure Nurse Navigator (HFNN) with patients who receive usual care. The HFNN is a home health RN with specialized training in HF care. The HFNN visited intervention group (IG) participants once in the hospital, followed by weekly home visits for one month. Control group (CG) participants received usual care, consisting of discharge teaching by their primary nurse and follow-up with their primary care provider (PCP) or cardiologist. Using a sequential mixed methods research design, this experimental randomized controlled trial measured HF knowledge, HF self-care, and HF quality of life (QOL) at enrollment and one month after discharge. Hospital readmissions and/or ED visits were tracked in both groups. IG participants were interviewed using semi-structured questions, findings of which were analyzed using conventional content analysis. There were fewer all-cause hospital readmissions in the IG (3 of 19) than the CG (6 of 21.) CG participants were 2.2 times more likely to be readmitted than the IG participants. [x(1)=.935, p=.334 O.R.=2.2219]. Due to limited enrollment, these results were underpowered and not statistically significant. There was improvement in HF knowledge (p=.06) and HF self-care maintenance (p=.07), approaching significance. HF self-care maintenance improved in both groups, although the IG was not significantly better (p=.48). There was significant improvement in the IG for HF confidence (p=.002) and HF QOL (p<.001). The qualitative findings revealed two main categories from the IG: (1) personal clarification of patient education, especially related to diet, exercise, and medications and (2) feelings of support, reassurance, and safety. The HFNN may be one role to meet the triple aim of improving patient quality care and health outcomes at a reduced cost, especially in areas where a comprehensive HF management program is not available. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

Bakgrund: Primärvård och hemsjukvård skiljer sig åt organisatoriskt och ledningsmässigt vilket kan påverka verksamhet och arbetsuppgifter, detta kan i sin tur påverka den psykologiska och sociala arbetsmiljön för distriktsköterskor/sjuksköterskor. Syftet med studien var att jämföra eventuella skillnader i den psykologiska och sociala arbetsmiljön hos distriktsköterskor/sjuksköterskor inom primärvården respektive hemsjukvården. Metoden var en kvantitativ jämförande tvärsnittsstudie med datainsamling via enkäten QPSNordic 34+. Enkäten administrerades till 159 utvalda deltagare inom primärvården och 148 utvalda deltagare inom hemsjukvården. Enkäten besvarades 39 distriktssköterskor/sjuksköterskor inom primärvården och 39 distriktsköterskor/sjuksköterskor inom hemsjukvården. Resultatet visade signifikanta skillnader i fyra av elva kategorier av den skattade psykologiska och sociala arbetsmiljön mellan primärvårdens distriktssköterskor/sjuksköterskor och hemsjukvårdens distriktssköterskor/sjuksköterskor. Skillnaderna fanns i ”arbetskrav”, ”kontroll i arbetet”, ”skicklighet i arbetet” och ”stress”. I samtliga av dessa fyra kategorier skattade primärvårdens deltagare sin psykologiska och sociala arbetsmiljö lägre jämfört med skattningen från hemsjukvårdens deltagare. Slutsatsen är att distriktsköterskor/sjuksköterskor inom primärvården skattar sin psykologiska och sociala arbetsmiljö lägre jämfört med distriktssköterskor/sjuksköterskor inom hemsjukvård. / Background: There is a different in management and organization in primary health care and in municipal home health nursing. This different may effect activities and tasks at work, which in turn can affect the psychological and social work environment of district nurses / nurses. The purpose of this study was to compare any differences in the psychological and social work environment of district nurses/nurses in primary health care and home health nursing. Method: A quantitative, comparative cross-sectional study was conducted and the data was collected with the survey QPSNordic 34+. The survey was administred to 159 participants in primary care and to 148 participants in home health nursing. The survey was answered by (n = 39) district nurses /nurses in primary health care and (n = 39) district nurses/nurses in home health nursing. The result showed significant differences in four out of eleven categories in the psychological and social work environment between the district nurses/nurses in primary care and the district nurses/nurses in home care. Differences were found in "work requirements", "control at work", "work skills" and "stress". In all of these four categories, district nurses/nurses in primary health care estimated their psychological and social work environment lower than the estimation from district nurses/nurses in home health nursing. The conclusion of this study was that district nurses/nurses in primary health care estimate their psychological and social work environment lower in comparison to the district nurses/nurses in home care nursing.

Bakgrund: Hjärtsvikt är en komplex sjukdom som i livets slut ger många svåra symtom. Den sjukes livskvalitet påverkas avsevärt och många vårdas i ordinärt eller särskilt boende den sista tiden i livet. Sjuksköterskan har ett stort ansvar och ska arbeta personcentrerat, ge symtomlindring och främja god livskvalitet. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda personer med hjärtsvikt i livets slut som bor i särskilt boende och ordinärt boende med stöd av hemsjukvård. Metod: Kvalitativ litteraturöversikt med induktiv ansats baserad på 11 vetenskapliga artiklar från databaserna PubMed och Cinahl Complete. Artiklarna kvalitetsgranskades utifrån Caldwells ramverk och analyserades med tematisk analys. Resultat: Sjuksköterskorna upplevde att de behövde mer kunskap om hjärtsviktsbehandling, symtomlindring och palliativt förhållningssätt. De efterfrågade bättre kommunikation och kontinuitet och upplevde att tvärprofessionellt arbete främjade planering och god vård. Vårdmiljön påverkade sjuksköterskornas förutsättning att arbeta personcentrerat.   Slutsats: Ett personcentrerat förhållningssätt möjliggörs av en god vårdrelation. Vårdmiljön är beroende av kommunikation, samarbete och kontinuitet. Det finns ett behov av ökade kunskaper kring hjärtsvikt och palliativ vård hos sjuksköterskor och deras förutsättningar är avgörande för god symtomlindring och patientens livskvalitet. / Background: Heart failure is a complex disease with many severe symptoms. The patient's quality of life is significantly affected and end of life care is often provided in nursing homes or in the patient's own home. The nurse has a great responsibility and is expected to work with a person centered approach, provide symptom relief and promote good quality of life. Aim: The purpose of this review was to describe nurses’ experiences of caring for people with heart failure at the end of life in nursing homes and home health nursing. Method: Literature review with an inductive approach based on 11 scientific articles from the databases PubMed and Cinahl Complete. The quality of the articles were reviewed with Caldwell's framework and analyzed with thematic analysis. Results: There is a need for more knowledge about heart failure treatment, symptom relief and palliative care. The nurses' expressed a need for better communication and continuity and felt that interprofessional work promoted planning and good care. The care environment affected the nurses' ability to work with person centered care. Conclusion: Person centered care is made possible by a good relationship between the nurse and patient. A caring environment is dependent on communication, cooperation and continuity. There is a need for increased knowledge about heart failure and palliative care among nurses and their work environment play a crucial part in managing the patients symptoms and enabling quality of life.

Bakgrund: Hjärtsvikt är en komplex sjukdom som i livets slut ger många svåra symtom. Den sjukes livskvalitet påverkas avsevärt och många vårdas i ordinärt eller särskilt boende den sista tiden i livet. Sjuksköterskan har ett stort ansvar och ska arbeta personcentrerat, ge symtomlindring och främja god livskvalitet. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att vårda personer med hjärtsvikt i livets slut som bor i särskilt boende och ordinärt boende med stöd av hemsjukvård. Metod: Kvalitativ litteraturöversikt med induktiv ansats baserad på 11 vetenskapliga artiklar från databaserna PubMed och Cinahl Complete. Artiklarna kvalitetsgranskades utifrån Caldwells ramverk och analyserades med tematisk analys. Resultat: Sjuksköterskorna upplevde att de behövde mer kunskap om hjärtsviktsbehandling, symtomlindring och palliativt förhållningssätt. De efterfrågade bättre kommunikation och kontinuitet och upplevde att tvärprofessionellt arbete främjade planering och god vård. Vårdmiljön påverkade sjuksköterskornas förutsättning att arbeta personcentrerat.   Slutsats: Ett personcentrerat förhållningssätt möjliggörs av en god vårdrelation. Vårdmiljön är beroende av kommunikation, samarbete och kontinuitet. Det finns ett behov av ökade kunskaper kring hjärtsvikt och palliativ vård hos sjuksköterskor och deras förutsättningar är avgörande för god symtomlindring och patientens livskvalitet. / Background: Heart failure is a complex disease with many severe symptoms. The patient's quality of life is significantly affected and end of life care is often provided in nursing homes or in the patient's own home. The nurse has a great responsibility and is expected to work with a person centered approach, provide symptom relief and promote good quality of life. Aim: The purpose of this review was to describe nurses’ experiences of caring for people with heart failure at the end of life in nursing homes and home health nursing. Method: Literature review with an inductive approach based on 11 scientific articles from the databases PubMed and Cinahl Complete. The quality of the articles were reviewed with Caldwell's framework and analyzed with thematic analysis. Results: There is a need for more knowledge about heart failure treatment, symptom relief and palliative care. The nurses' expressed a need for better communication and continuity and felt that interprofessional work promoted planning and good care. The care environment affected the nurses' ability to work with person centered care. Conclusion: Person centered care is made possible by a good relationship between the nurse and patient. A caring environment is dependent on communication, cooperation and continuity. There is a need for increased knowledge about heart failure and palliative care among nurses and their work environment play a crucial part in managing the patients symptoms and enabling quality of life.

The purpose of this study was to explore nurse-patient encounters from the perspective of the Home Healthcare Registered Nurse. A qualitative descriptive design was used to collect data from a purposive sample of 20 home healthcare registered nurses from Connecticut, Massachusetts, and Rhode Island currently or previously employed as a home healthcare nurse. Four themes and one interconnecting theme emerged from the data: Objective Language; Navigating the Unknown; Mitigating Risk; Looking for Reciprocality in the Encounter; and the interconnecting theme of Acknowledging Not All Nurse-Patient Encounters Go Well. One goal of the study was to propose an empirically informed definition of what constituted a difficult encounter. An important early finding was that the terms difficult patient and difficult encounter were not generally used by study participants. HHC RNs voiced a preference for objective and nonjudgmental language to communicate outcomes of nurse-patient encounters. Three types of HHC RN-patient interactions emerged from the data, with constructive encounters the norm and non-constructive or destructive encounters less frequent. A constructive encounter is when two or more human beings, the nurse on the one side, and the patient, caregiver, or both on the other, interact to achieve a mutually agreed upon outcome. A nonconstructive encounter is when one or more human beings obstruct efforts to achieve at least one positive outcome. A destructive encounter is when one or more human beings direct anger at or physically aggress toward another human being. Strategies to promote reciprocality are routinely employed during HHC RN-patient encounters, but HHC RNs who miss cues that a strategy is ineffective or failed may be at risk in the home. Study data lend support to key concepts, assumptions, and propositions of Travelbee’s (1971) Human-to-Human Relationship Model. Study results provide a foundation for further research to increase the understanding, recognition, and development of empirically derived responses to non-constructive or destructive encounters such that HHC RNs are safe and best able to meet patients’ healthcare needs.