Wednesday, December 24, 2008

Home Care Nursing or Restaurant Planning Guide

Home Care Nursing: Using an Accreditation Approach

Author: Patsy Anderson

Home Care Nursing: Using an Accreditation Approach, is an overview of home care, from the time a client enters the home care system to the time the client is discharged. You can be confident that Home Care Nursing offers you the solid foundation you need, as the entire book is based on the categories of The Joint Commission (formerly JCAHO), which sets forth accreditation standards for all home care organizations. This comprehensive resource is organized into two parts. Part I, Clinical Operations and Client Care, covers the history of home care and hospice, outlines the home care visit, and includes such topics as safety, infection control, and client and family education. Part II, Administrative Operations, addresses the essential topics of a successful home care organization. This section begins with leadership and progresses to topics related to legal and ethical issues, quality improvement, and technology.



Table of Contents:
Foreword     xv
Preface     xix
Acknowledgements     xxi
Contributors     xxii
Reviewers     xxiii
About the Authors     xxiv
Clinical Operations & Client Care     1
Home Care: A Long and Proud History     3
Main Factors Underlying the Growth of Home Care     4
Home Care: A Proud History     6
Definitions of Home Care     9
Governmental and Accreditation Organizations     10
Home Care Today     11
Hospice     12
Medicare and Hospice     13
The Newest Home Care Services     14
Summary     17
Care and Services     19
Disciplines and Roles     20
Physicians     20
Registered Nurses     20
Licensed Practical or Vocational Nurses     21
Therapists     21
Physical Therapists     21
Occupational Therapists     22
Speech/Language Therapists     22
Social Workers     22
Home Care Aides     22
Durable Medical Equipment Companies     23
Plan of Care and Physician's Orders     23
Coordination of Services     26
Outcomes and Assessment Information Set (OASIS)     28
The Home Care Nurse Visit     30
Conducting the Home Care Nurse Visit     30
Organizing the Visit     30
Safety     30
Assessment     31
Implementation of Procedures/Treatments     32
Monitoring Medication Therapy     33
Teaching     33
Documentation     34
Medications and the Elderly     34
Medication Use and Misuse     35
Guidelines for Enhancing Compliance     36
Working with Clients' Caregivers     36
Identify High-Risk Areas     37
Psychological and Emotional Strain     37
Physical Strain     38
Set Priorities     38
Educate the Caregiver     38
Discharge Planning     39
Continuity of Care     39
Use of the Nursing Process in Discharge Planning     40
Assessment     40
Nursing Diagnosis     40
Planning     40
Implementation     40
Evaluation     41
Summary     41
Client Education      43
The Home Care Nurse-Educator     43
Theories of Learning/Teaching     45
Adult Learning Theory     45
Teaching/Learning Needs Assessment     46
Mental Status     47
Physical Status     47
Vision     47
Hearing     49
Motor Function     50
Literacy     50
Literacy Level     51
Determining Literacy Level     51
Cultural Background     51
Teaching     55
Development of a Teaching/Learning Plan     55
Assessing Learning Needs and Readiness to Learn     56
Identifying Goals and Developing Learning Objectives     56
Implementing the Plan     57
Evaluation of the Teaching/Learning Plan     57
Documentation of the Teaching/Learning Plan     60
Technology and Teaching     60
Summary     61
Infection Control     64
Chain of Infection     65
Infection-Control Program     66
Focused or Targeted Infection Surveillance     66
Employee Health     66
Infectious Organisms in Home Care     67
Pulmonary Tuberculosis      67
Pertussis     72
Influenza and Avian Influenza     72
HIV/AIDS and Hepatitis     73
Severe Acute Respiratory Syndrome (SARS)     73
Multidrug-Resistant Organisms     73
Methicillin-Resistant Staphylococcus Aureus (MRSA)     73
Community-Acquired Methicillin-Resistant Staphylococcus Aureus     74
Vancomycin-Resistant Enterococcus     74
Pediculosis and Scabies     75
Tools for Infection Control in Home Care     75
Hand Hygiene     76
Gloves     76
Transmission-Based Precautions     77
General Precautionary Guidelines     77
Contact Precautions     77
Droplet Precautions     78
Airborne Precautions     79
Airborne NIOSH-Approved Respirator/Mask     79
Immunocompromised Precautions     79
Home Care Bag Technique     80
Hazardous Waste and Contaminated Items     83
Equipment Cleaning and Biomedical Spills     84
Employee Evaluations     84
Client Care Procedures     85
Infection Reporting     85
Client Teaching     87
Summary     90
Safety and Environment     93
Conceptualizing Safety in Home Care     94
Who Makes Home Visits     95
Perception of Safety     95
Contributors to Safety     95
Phases of the Home Visit     97
Antecedent Phase     97
Getting to the Client's Home     99
Environmental Assessment     99
Client Assessment     101
Risky Diagnoses     102
Supplies and Equipment     102
Ergonomics     102
Medications     103
Pets     105
Nurse Self-Assessment     105
Agency Assessment     107
Making the Home Visit     108
Activities of Daily Living     109
Home Conditions     110
Leaving the Home and Returning to the Agency     111
The Threat of Violence     111
Summary     113
Infusion Therapy: High-Tech Home Care Concerns and Issues     116
Clinician Safeguards     117
Setting Priorities     118
Client Assessment for Home Infusion Therapy     118
Condition of the Client and the Environment     118
Therapy Administration     119
Health Care Provider     120
Infusion Access Devices     120
Subcutaneous Infusion Devices     122
Peripheral Intravenous Access Devices     122
Complications     122
Central Venous Access Devices     122
Peripherally Inserted Central Catheter     123
Non-Tunneled CVAD     123
Tunneled CVAD     123
Implanted CVAD (Implanted Port)     124
Pumps and Infusion-Delivery Systems     125
Intravenous Push (IV Push) Medications     125
Medication Delivery via Gravity or Dial-a-Flow Pumps     126
Stationary (Pole-Mounted) Pumps     126
Elastomeric Pumps     127
Ambulatory Pumps     127
Intraspinal Infusions     127
Infusion Adapters and Caps     128
Client and Caregiver Education     128
Summary     129
Administrative Operations     131
Leadership     133
Governance     134
Advisory Group     134
The Leadership Team     135
Home Care Administrator     135
Director of Nurses     135
Financial Services Leader     136
Information Management Leader     136
Performance Improvement and Quality Manager     136
Specialty Leadership Positions     136
Organizational Structure     138
Organizational Charts     138
Policies and Procedures     139
Policies Related to Client Safety     139
Planning, Designing, and Providing Services     140
Providing Services     140
Provision of Resources     140
Staffing Plans and the Provision of Care     141
Information Management Planning     141
Emergency Management Planning     142
Strategic Planning     142
Annual Program Evaluation     143
Evaluation of Scope of Care     143
Evaluation of Client Care     144
Financial Planning and Management     144
Prospective Payment System     144
Development of the Financial Plan     144
Budget Formats     145
Contracts     145
Contracts with Other Entities     145
Contract to Provide Services     146
Quality Management and Performance Improvement     146
Performance Improvement Plan     146
Compliance Plan      147
Summary     147
Legal Issues     149
Nursing Practice and Licensure     150
A Brief History of Licensure     150
Nurse Practice Acts     151
Standards of Practice     151
Regulatory Agents     152
Client Rights     153
Client Bill of Rights     153
Health Insurance Portability and Accountability Act (HIPAA)     154
Confidentiality     155
Client     155
Records     155
Informed Consent     155
Written Consent     155
Implied Consent     156
Informed Refusal     156
Client Self-Determination Act     156
Advance Directives     156
Living Will     157
Durable Power of Attorney for Health Care     157
Issues of Concern     157
Negligence and Neglect     157
Malpractice     158
Abuse     158
Abandonment     159
Tele-Health     160
Impact of the Legislative Process     161
Summary     162
Ethics in Home Care and Hospice     164
Overview of Ethics and Morality      165
Virtue and Communitarian Ethics     166
Communitarian Ethics     166
Virtue Ethics     166
Truthfulness     168
Compassion     168
Moral Courage     169
Equanimity     170
Just Generosity     170
Moral Agency     171
Autonomy     171
Vulnerability and Dependability     172
Competence     172
Dignity and Dementia     173
End of Life     174
Death Anxiety     174
Withholding and Withdrawing Life Support     175
Voluntary Stopping Eating and Drinking     175
Rule of Double Effect     176
Terminal Sedation     176
Physician-Assisted Suicide     177
Rational Suicide     177
Summary     178
Quality Improvement     181
Quality     182
Perspectives on Quality     182
Quality Improvement     183
Quality Experts     183
W. Edwards Deming     183
Joseph Juran     183
Philip Cosby     184
Health Care's History of Quality      186
Performance Improvement     186
Performance-Improvement Methods     187
Plan-Do-Check-Act     187
Focus     187
Joint Commission Model     187
Six Sigma     188
Performance Improvement Tools     189
Control Charts     190
Histograms     191
Run Charts     191
Line Graphs     192
Scatter Diagrams     193
Cause and Effect, Fishbone, or Ishikawa Diagrams     194
Flowcharts     195
Outcome-Based Quality Improvement Systems     196
Home Health Compare     197
Summary     206
Management of Human Resources     208
Recruitment of Staff     209
Orientation, Training, and Education     210
Organization Mission Statement     210
General Organization Policies     211
Competencies     211
Preceptorship     212
Retention of Staff     212
Exit Interview     213
Employment Satisfaction Survey     214
Management Visibility     215
Personnel Records     216
Summary     216
Informatics and Technology     218
History of Informatics in Health Care     219
Assessment of Client Needs     219
Types of Tnformatics/Technology in Home Care     220
Noncomputer Technologies     220
Tele-Home Care     220
Telemonitors and Videophones     220
Messaging Devices     220
Digital Cameras     221
Point-of-Care Documentation     221
Personal Digital Assistants     223
Advantages of Information Technology in Home Care     224
Clients     224
Caregivers     225
Home Care Professionals     226
Disadvantages of Information Technology in Home Care     226
Looking to the Future     227
Governmental Influences     227
Nongovernmental Influences     227
Summary     228
Glossary     231
Index     235

Interesting book:

Restaurant Planning Guide

Author: Peter Rainsford

This book gives authoritative advice on how to parley a strong business plan into a food service success story.
The Restaurant Planning Guide helps you with the business side of the house. Its clear, direct style and many useful checklists, question sets, and forms will make financing, managing and controlling your restaurant much easier. Topics covered include description of business, product/service, the market, location of business, the competition, and management.

Library Journal

Those contemplating becoming a restaurant owner will need information sources to help make the dream a reality, and one such source is this highly practical guide. Authors Rainsford, a professor at the Cornell School of Hotel Administration and the owner of a restaurant, and Bangs, a writer of small-business management books, describe the necessary steps to plan and manage the enterprise through the use of a case study for the fictional Stefanie's Restaurant. The authors cover such topics as evaluating the competition, buying equipment and supplies, hiring personnel, and finding the right location. Included are a sample business plan, the financing proposal, a glossary of restaurant terms, a list of resources, and worksheets for cash-flow projecting, credit inquiry, etc. This source should serve as a useful starting point for those wishing to be restaurant owners and a reference for those already in the business. Recommended to public libraries.-- Lucy Heckman, St. John's Univ. Lib., Jamaica, N.Y.



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