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Engaging family caregivers key to coordinated home health care

 

MU researcher identifies resources to support overburdened family caregivers

Dec. 1, 2020
Contact: Brian Consiglio, 573-882-9144, consigliob@missouri.edu

After Jo-Ana Chase heard her mother had successful heart surgery, she was relieved when her mom was finally discharged from the hospital and sent home to be cared for by her brother. However, Chase quickly learned from her brother that he felt lost on the best ways to care for their mom due to confusing discharge instructions from the hospital and logistical challenges related to home health care services like wound care and medication management.

This is a photo of Jo-Ana Chase.

Jo-Ana Chase is an associate professor in the MU Sinclair School of Nursing.

Motivated by her own family’s struggles navigating the often complicated American health care system, Chase, an associate professor in the University of Missouri’s Sinclair School of Nursing, is working with clinicians and health care providers to better engage family caregivers in providing coordinated care after a loved one is discharged home from the hospital. In a recent study, she sought to better understand the resources family caregivers currently use to help health care providers identify gaps in coverage and recommend resources to assist overburdened caregivers and ultimately improve and better coordinate care.

“The American health care system has been very patient-focused; however, we also need to remember that patients often rely on family for help with their care,” Chase said. “Now that we are starting to recognize how impactful the work is that family caregivers provide, my goal is to better engage these family caregivers and help them access the resources they need to better support the loved ones they care for.”

In her study, Chase interviewed family caregivers about the medical and nursing tasks they completed for a loved one after a hospital-to-home transition, such as treating wounds or giving medication. She found that family caregivers often struggle with these tasks and in navigating the complex health care system; and resources like home health care nurses or aides can serve as a central point-of-contact to improve coordinated care.

“After a patient is discharged from the hospital, a home health care nurse will often come to the patient’s home periodically to check in, make sure the medications are right, evaluate the home for safety, check the patient’s vital signs and assess wounds,” Chase said. “This is an excellent opportunity for the clinicians to work with caregivers to address any questions, challenges, or concerns family caregivers may be having.”

Chase added that while caregivers may receive discharge instructions for providing care after a patient leaves the hospital, the instructions may fail to consider caregivers’ preparedness and various environmental factors, such as what equipment is needed, or which room in a house is best for administering a specific task like changing a bandage. In addition to home health care nurses, primary care providers, social workers, nearby community centers and respite services can also help support and take the load off of overburdened caregivers.

“At some point in our lives, most of us will become a caregiver for someone, whether it is a child, spouse, parent or relative,” Chase said. “So, encouraging the health care system to effectively engage caregivers benefits us all. I hope one day when I am sick and someone has to take care of me, my caregiver doesn’t experience the same challenges my brother did caring for my mom.”

“Family caregivers managing medical and nursing tasks in the post-acute home health care setting” was recently published in the Journal of Applied Gerontology. Funding for the study was provided by the Eugenie and Joseph Doyle Research Partnership Fund of the Visiting Nurse Service of New York. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

MU School of Nursing programs assist more than 500 nursing homes statewide with COVID-19 response

 

July 27, 2020
Mizzou News article here
Brian Consiglio, 573-882-9144, consigliob@missouri.edu

COLUMBIA, Mo. – As the coronavirus pandemic continues to put a strain on health care systems, nursing homes have become overburdened with the challenge of keeping both patients and staff safe and healthy. Older residents in long-term care facilities are especially vulnerable to the effects of a respiratory illness like COVID-19, and nursing homes are not appropriately designed nor staffed to handle large numbers of infectious residents.

In response, two MU Sinclair School of Nursing support teams – the Quality Improvement Program for Missouri and the Missouri Quality Initiative – are working with the Missouri Department of Health and Senior Services to provide assistance to more than 500 nursing homes across the state.

“The main goal of our response efforts is to make sure nursing home residents are staying as safe as possible during this very traumatic and challenging experience,” said Lori Popejoy, associate professor in the MU Sinclair School of Nursing. “At the beginning of the pandemic, access to personal protective equipment (PPE) was a big concern for nursing home staff. We were able to collaborate with various community organizations to distribute more than 3,000 face shields to nursing homes throughout the state.”

In addition to securing and distributing PPE, other efforts include offering recommendations, guidance and support to nursing home staff and administrators as they navigate and implement the ever-changing COVID-19 infection control practices. As the Centers for Disease Control and Prevention and Missouri Department of Health and Senior Services continue to update their recommendations for mitigating the spread of COVID-19, the support teams are synthesizing, summarizing and organizing this information to help nursing homes establish and modify protocols for isolating sick patients, use PPE properly and notify the family members of infected patients.

“Now that the nursing homes are isolating residents in individual rooms, the residents are no longer dining in groups, attending group activities or inviting outside visitors into the facilities,” said Amy Vogelsmeier, associate professor in the MU Sinclair School of Nursing. “In order to continue providing support to these individuals, nursing homes have adopted creative practices, such as video chatting with family members so residents can see their loved ones, or assigning staff members to check in daily with residents who may be struggling to cope with the effects of social isolation.”

Given the shortage of nurses in Missouri, the pandemic has highlighted the importance of advanced practice registered nurses, who play a key role in identifying and managing illness in nursing homes to prevent avoidable hospitalizations. 

“This is a time where the public is really becoming aware of the value registered nurses bring to the health care industry,” Popejoy said. “It has been inspiring to see the impact they have had to mitigate the effects of this public health crisis.”

“A Coordinated Response to the COVID-19 Pandemic in Missouri Nursing Homes” was recently published in the Journal of Nursing Care Quality.

MU develops program to prepare for alternative care site staffing

 

COLUMBIA, Mo. – The University of Missouri is helping to lead a statewide effort to retrain and deploy retired nurses and other health care providers to alternative care sites (ACSs) for recovering COVID-19 patients. The coordinated response ensures that staff would be immediately available to assist whenever the need may arise.

The state has designated a site in Florissant and, if needed another possible site in the St. Louis area, Kansas City or Springfield to handle recovering COVID-19 patients and those with chronic conditions such as cardiac and pulmonary problems and diabetes. These sites ensure more hospital beds are available for patients who need higher levels of medical intervention and care.

Staffing these alternative care sites was an urgent challenge. About 800 retired nurses and other health care professionals, with and without active licenses, immediately answered the statewide call to volunteer. The varied group — from those long gone from nursing to those who had recently left the field — all required some level of vetting and retraining to prepare them to care for patients at these sites, said Shirley Farrah, assistant dean for Nursing Outreach at the MU Sinclair School of Nursing.

The Missouri governor’s office turned to the University of Missouri to provide that high-quality training — and to do so in record time.

Within days, MU Health Care, the MU School of Medicine and MU Extension Nursing Outreach, along with Missouri Disaster Medical Assistance Team (DMAT) leaders, coordinated a response.

The training needed to be online and streamlined, with additional on-site training by DMAT clinical staff once at the ACS. The curriculum had to cover essentials such as vital signs, oxygen administration, EKG testing and early recognition of declining patient status. Most important, all trainees have to be drilled in meticulous handling and wearing of personal protective equipment.

Clinical nursing educators from MU Health Care’s Center for Education and Development had recently developed their own mostly online training program for clinic nurses in inpatient medical-surgical settings. The clinic nurses were among 800 MU Health Care staff members receiving specialized training, including front office staff, unit clerks and others who were also trained for performing nonclinical COVID-19-related duties such as helping with meal delivery, transport and other needs.

With input from DMAT, MU educators swiftly adapted this program to alternative care site needs. MU Health Care reached out to Elsevier/Mosby, a publisher of nursing education materials, and arranged complimentary access to these resources for the ACS nurses. Should sicker patients need to be assigned to these sites, nurses would also have access to online training that covers more complex nursing skills.

Dena Higbee, executive director of simulation at the School of Medicine and School of Nursing, identified other training resources around competencies such as detecting early warning signs of a patient’s deteriorating condition. The MU Mobile Simulation Van, approved as a mass casualties training unit, would also be available for on-site training, if needed.

Since the initial request from the state, nearly 300 nurses have been or will be vetted by DMAT and assigned to the appropriate level of training based on licensing status and nursing experience, Farrah said.

“The situation remains very fluid regarding statewide need,” she said. No additional staff has been called to the Florissant site at this time.

“And we are ready,” Farrah added. “The level of rapid response, coordination and collaboration among state, university, health care and extension leaders was heartening. It demonstrates that we have the will, desire and capacity to bring the right experts and resources together to help our state and fellow Missourians in this and any crisis if we face it together.”

The MU training response was coordinated by the Sinclair School of Nursing (Shirley Farrah), School of Medicine (Kathleen Quinn, Dena Higbee) and MU Health Care (Stephanie Hunt, James Parsons), with MU Extension Nursing Outreach and Community Health assistance.

Writer: Katherine Foran

Happy Birthday Florence Nightingale

Affectionately known as “the lady with the lamp,” Nightingale remains a role model for nurses in the 21st century. Her care of soldiers during the Crimean War is legendary, and her thoughts on nursing, ethics and various other topics still resonate today in her published works and letters.

Timeline of important moments in Nightingale’s life:

  • May 12, 1820 —– Nightingale experiences a “Christian calling” to become a nurse while living at Embley Park in Wellow, England.
 
  • Feb. 7, 1837—– Nightingale begins to visit hospitals.
 
  • 1844 —– Nightingale becomes the leading advocate for improved medical care in the infirmaries through the reform of the so-called Poor Laws.
 
  • December 1844 —– Nightingale declares her intention to become a nurse. She visits St. Vincent de Paul Sisters of Charity convent, where she learns nursing theory.
 
  • 1845 —– Nightingale makes her first visit to Protestant Deaconess at Kaiserwerth, which cared for the poor and later became a training school for nurses and teachers.
 
  • 1850 —– Nightingale spends three months training as a sick nurse at Kaiserwerth.
 
  • 1851 —– Nightingale accepts a job as post of superintendent at the Institute for the Care of Sick Gentlewomen in Upper Harley Street, London.
 
  • Aug. 22, 1853 —– Nightingale arrives in Turkey with 38 nurses and is stationed at Selimiye Barracks in Scutari (Istanbul).
 
  • 1854 —– Nightingale nurses British soldiers through outbreaks of cholera and typhus fever.
 
  • 1855 —– A public meeting to give recognition to Nightingale for her work during the war leads to the establishment of the Nightingale Fund for the training of nurses.
 
  • Nov. 29, 1855 —– After every patient had returned to Britain, Nightingale follows. She meets with Queen Victoria at Balmoral and tells her about the defects in military hospitals and needed nursing reforms. Nightingale plays a central role in the establishment of the Royal Commission on the Health of the Army.
 
  • Aug. 7, 1856 —– After collapsing, Nightingale is sent to Malvern, a healthcare resort, where she is put on bed rest for exhaustion.
 
  • August 1857 —– In her report “Notes on Matters Affecting the Health of the British Army,” Nightingale creates statistical charts to show the number of men who died from the conditions in the hospitals compared with those who died from their wounds.
 
  • 1858 —– Nightingale is elected the first female member of the Royal Statistical Society and becomes an honorary member of the American Statistical Association. Nightingale’s 136-page introduction to nursing titled “Notes on Nursing” is published.
 
  • 1860 —– Nightingale’s attention turns to the mortality and sickness rates of British troops and citizens in India. She gathers statistics and recommends sanitation procedures.
 
  • 1860 —– The Nightingale Fund is used to set up the Nightingale Training School at St. Thomas’ Hospital.
 
  • July 9, 1860 —– The first trained Nightingale nurses begin work at the Liverpool Workhouse Infirmary.
 
  • May 16, 1865 —– Dr. Elizabeth Blackwell and Nightingale open the Women’s Medical College.
 
  • 1869 —– Queen Victoria honors Nightingale with the Royal Red Cross.
 
  • 1883 —– With the help of the County Council Technical Instruction Committee, Nightingale organizes a health crusade in Buckinghamshire.
 
  • 1892 —- Nightingale is bedridden again, but continues to work on hospital plans.
 
  • 1896 —– Nightingale becomes the first woman to receive the Order of Merit from King Edward VII.
 
  • 1907 —- Nightingale passes away at age 90 in London. She is buried in the graveyard at St. Margaret Church in East Wellow, Hampshire, England.

Sources: Florence Nightingale Museum, Encyclopedia Britannica

Information found at Nurse.com

Florence Nightingale was a trailblazer and champion for the nursing profession. Her efforts established some of the first modern schools of nursing, and even now, her name is synonymous with compassion and philanthropy.

Our Nightingale Society members share that dedication and reverence for the education of nurses. Today, on what would have been Florence Nightingale’s 200th birthday, we thank them for their support and ongoing commitment to the future of the Sinclair School of Nursing.If you would like to become a Nightingale member, please consider here.

2020 Virtual Awards Banquet

Due to the COVID-19 pandemic causing us to cancel this year’s annual awards banquet, we invite you to view a virtual presentation of our award nominees and recipients. Please take a moment to read about our award winners here.

We hope you will make plans to attend next year’s banquet so we can celebrate our school and the wonderful achievements of faculty, staff, students, and alumni.

Stay healthy and safe until we can gather together again.

Sincerely,

Sarah Thompson, PhD, RN, FAAN
Dean and Professor

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