Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

Teaching Note—Integrating Prevention Content Into Clinical Social Work Practice Courses

Rapid changes in health care services and delivery suggest an upcoming paradigm shift in the field of mental health. Recent national reports, health care policy changes, and growing evidence support a shift toward prevention-focused mental health care. The social work profession is uniquely positioned to act as leaders in this shift as the profession’s values, goals, and hallmark practice approach are consistent with preventive care. Most social work students, however, do not receive training in prevention practice. The author’s development, implementation, and evaluation of a prevention-focused master of social work elective in the area of mental health is presented as an example of integrating prevention content into clinical social work practice courses. Implications for social work education are discussed.     

Ready or Not: Transitioning from Institutional Care to Community Care

Federal legislation has moved toward the support and expansion of home- and community-based alternatives to nursing home placement. Despite the seemingly positive nature of these efforts, the question remains as to whether individuals, families, and communities are prepared for this shift in long-term care. Furthermore, there has been a lack of attention to the impact of nursing home transition programs on family caregivers, community resources, and the availability of appropriate housing alternatives. Although nursing home transition programs offer a promising alternative to institutional care, the authors suggest a closer examination of the policies and practicality of these transitions is needed.     

Nursing Intervention on Sexual Health: A Multilevel Behavioral Survey of Senior Nursing Students in Clinical Practice

ABSTRACT. There are many diseases that may impact patients’ sexual health and psychological well-being. Despite the importance of sexual health care (SHC), insufficient SHC occurs across care settings and the patient population. Studies investigating the essential elements of SHC behaviors of nursing students in clinical practice have been scant. The aim of this study was to assess the frequency of senior nursing students’ multilevel interventions for patients’ SHC in primary clinical practice. An anonymous 19-item instrument entitled Nursing Intervention on Sexual Health was distributed among senior nursing students at two central Taiwan nursing schools. We analyzed overall nursing intervention in SHC in clinical practice by levels. The results of this study indicate that the frequency of nursing intervention in sexual health is low. Another important finding is that following the PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) model, from permission level to the specific-suggestion level, the behavioral frequency of nursing intervention shows a decrease along with the model. Nursing students omitted each level of SHC in clinical practice, even if they had sufficient time and extensive preceptor resource, in this study. The nursing students’ SHC on different levels would help educators to frame the sexuality education program.     

Two sides of the coin: the bully and the bullied

Bullying has become a worldwide phenomenon that produces serious individual and societal consequences when it is ignored. There are two sides of the coin that require consideration when psychiatric-mental health (PMH) nurses conduct assessments of situations that involve bullying behaviors. Both the bully and the bullied can incur serious, negative, and debilitating psychological effects. In some cases, physical injury and/or death occurs as a result of bullying. Deciphering the biopsychosocial mental health issues associated with bullying is challenging. PMH nurses have the clinical expertise to develop coping interventions and strategies that stop bullying, as well as enhance the mental health and wellness of both those who bully and who are bullied. This article presents PMH nursing biopsychosocial strategies for both sides of the bullying coin. Exemplars are provided to aid implementation of the strategies.     

Preventing spiritual distress in the dying client.

1. Nurses want to provide holistic care to all clients. Viewing spiritual development as a part of human growth and development is appropriate and essential to nursing practice. 2. Nursing care that is effective in maintaining the spiritual integrity of clients nearing death can be effective if placed within a theoretical framework. 3. Levels of spiritual development coupled with the transitional phases of the dying process lead to accurate assessments of clients. In turn, nursing strategies that are selected as a result of such theoretically based assessments are likely to be effective in preventing spiritual distress.     

Physical health problems of the psychiatric client

The psychiatric nurse can make significant contributions to the client's overall state of health by attending to the physical health care needs of clients in psychiatric settings. Psychiatric clients die at a younger age than the general population and their incidence of physical health problems tends to be higher. As major providers of psychiatric care, especially to the chronically mentally ill, nursing skills are crucial to the physical and mental health of vulnerable clients. The case reports provide examples of how the interaction between physical and psychological states influence care.     

An empirically derived typology of mentally ill group home residents.

The classification of clients in terms of psychiatric diagnosis or level of functioning is a logical prerequisite to the conduct of quality of care assessments in mental health care. This article reports on efforts to create a typology of mentally ill group home residents based on a variety of measures of functioning. Subjects for the study come from a probability sample of 253 group home residents in Michigan. A three group typology, derived through cluster analytic procedures, is presented along with-evidence supporting its validity. Implications of the typology for program evaluators and service system planners are briefly addressed.     

Health Issues of Homeless Youth

The purpose of this paper is to provide an overview of what is currently known about the health issues of homeless youth, focusing on risk-taking behaviors, health status, and access to care. The paper addresses the health issues of homeless youth in the U.S. within an international context. Existing data suggest that homeless adolescents exhibit high rates of risk-taking behaviors, face additional barriers to access of health care, and suffer from a high burden of poor health. However, most research on the health of homeless youth has been cross-sectional and has relied on convenience sampling. Future research should focus on conducting more methodologically rigorous studies on the specific health needs of homeless youth. Research should include eliciting information directly from the youth about their preferred health care interventions.     

Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Person-centeredness may suffer in nursing homes (NHs) with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011 and 2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April to June 2012. Dependent variables were overall care rating (scale 1–10), percentage of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (p = .001). NH managers and policy makers should consider strategies to improve patient-centeredness after ownership change.     

The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

Social aspects of health care in Igbo-Ora, Nigeria

The philosophy and aims of a health care scheme in Igbo-Ora, Nigeria, are outlined. Some of the problems related to creating a data base from which work can proceed are set out and discussed. Social factors are mentioned, and attention is drawn to the need for seeing health problems against general settings specific to a given area rather than measuring upto some abstract or "scientific" standards. The uncharted ground in many Third World practices make this particularly important.     

Top 10 reasons to take your graduate program in psychiatric nursing online

1. Removing barriers to graduate psychiatric nursing education is possible by delivering courses via the Internet. 2. The Internet is full of valuable resources for graduate psychiatric nursing education. 3. Successful online learning environments involve a paradigm shift on the part of faculty from traditional teaching to facilitating the learning of adult students. 4. Increasing the number of advanced practice psychiatric nurses through Web-based education will transform the delivery of mental health care.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Promoting self-management of urinary incontinence in a geropsychiatric day treatment program

As the number of older adults in the United States increases, the number of older adults with mental illnesses also will increase. There will be a corresponding increase in prevalence of UI and its associated problems--medical problems, loss of independence or need for institutionalized care, diminished quality of life, and increased costs. Psychiatric nurses are in a position to help older adults with mental illnesses improve their overall health and quality of life by preventing the problems associated with untreated UI. Within their practice, psychiatric nurses have the opportunity to ensure clients receive the comprehensive assessments needed to establish their functional, physical, behavioral, emotional, and social support status--information that forms the foundation for developing individualized treatment interventions. Psychiatric nurses have the expertise to integrate physical and mental health care for older adults with mental illnesses and co-occurring conditions, such as UI. Promoting self-management of UI among older adults with mental illnesses potentially will enable them to participate in psychiatric rehabilitation programs; improve their overall health and quality of life; prevent falls and fractures that often cause them to lose their independent community living status and to be admitted to long-term care facilities; and reduce the cost to mental health care providers of managing UI in the treatment setting.     

Intersecting Contexts: Understanding Rural Utah Veterans’ Experiences with Accessing VA Health Care

Since the passage of the Rural Veterans Care Act of 2006 research has focused on health care provider issues with less attention given to individual and contextual factors that contribute to the remaining service gap. Adopting the health care user's viewpoint, we focus on two questions: How do health care users perceive access to health care, and which contextual factors are relevant to explaining the failure of recent efforts to increase access by rural veterans? We collected detailed data through focus groups and individual interviews involving veterans and knowledgeable community members in four rural areas of Utah. Framing the analysis of interview data using the sociospatial approach reveals key dimensions of several contexts that affect rural veterans’ access to health care: the historical period of military service that influences attitudes toward use of Veterans Administration health care and access to specialists, regulations of regionally and locally organized insurance coverage that affects access to and coordination of health care, and local social aspects of rural communities that inform use of specific health care sources. These dimensions provide new insights into the conditions that contribute to variations in the vulnerability of rural Utah veterans.     

Effect of childlessness on nursing home and home health care use

This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: (1) Are the childless elderly at a greater risk of nursing home and home health care use? (2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? (3) Does having additional children beyond the first one have a significant effect on the use of these services? (4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old Survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed.     

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.