CMSA Today - Issue 7, 2017 - 14

"One of the most common
and most unrecognized
experiences of nurses and
other clinicians in the home,
whether home healthcare
or hospice, is the always
surprising continuum of
how different people do the
same thing."

gap and highlighted the need for careful,
planned education for patients and caregivers prior to discharge. It challenged the
assumptions professionals made about
what people already knew and pushed for
active confirmation of critical knowledge.
These needs have been built into care transition tools to help remind professionals to
illuminate and focus on issues of safety.
When home is the next setting, nurses
are growing increasingly attentive to
including the caregiver as an equal partner in education. Case managers regularly
assess caregivers to evaluate their ability
to perform the skills required to care for
the patient at home. Beyond the physical
capacity, case managers must assess if the
caregiver has the knowledge to perform
the skills safely and ensure the answer is
yes prior to the discharge.
This focus has resulted in non-professional caregivers providing expert dressing changes and flawless intravenous
medication administration in the home.
These advanced skills are an obvious new
challenge for non-professional caregivers
and easily recognized as an educational
need. Case managers now need to apply
this process to skills which are not as obvious. The need to ensure advanced skills are
developed in caregivers doesn't negate the
importance of the basic skills. Without the
ability to ensure core activities of daily living
are performed safely, the more advanced
14

CMSA TODAY

skills can be negated. Care transition planning frequently fails to focus on these basic
components of personal care.
A referral to home healthcare is an important step to helping people recover. Best
practice in home healthcare and hospice is
to make a visit to the patient's home within
a day of discharge. But for new caregivers
or people with very different capacity than
prior to the facility stay, even a day can
be too long. When even simple activities
of daily living like standing or eating are
difficult, being home can be terrifying. As
data continues to reveal when patients have
readmissions and why, new strategies will
be defined to continue to improve patient
safety and improve the ability to stay home.
Even before this data exists, though, nurses
can apply what is known and invest greater
resources into the basics of personal care.
Literature about preparing new parents
to take care of infants demonstrates the
importance of caregiver confidence. When
caregivers are confident and prepared for
the job ahead of them, it is reasonable that
the job will be more successful. If worry,
fear and anxiety surround skills as basic as
standing up or cleaning up after urinating, energy and focus are distracted from
more complex skills, like medication safety.
Nursing school demonstrates the need to
start with the hands-on skills before progressing. Each nursing student starts by
mastering personal care before tackling
medication administration. The same progression is typically forgotten for hospitalized patients. The focus on more complex
aspects of care cannot be sacrificed, but
time for the basics needs to be found.
Before the formal care transition pathway or care plan can start, facility nurses
can start to support caregivers by partnering with them for personal care skills. The
continuous nature of care in facility allows
countless opportunities to teach, support
and encourage caregivers to learn and practice these basic, critical skills. Home healthcare and hospice nurses do not have the
same exposure or access. Opportunities to
teach and coach are limited to several times
a week or perhaps daily. If the principles of
patient education, including teach back and
demonstration, are applied to the activities

Issue 7 * 2017 * DIGITAL

of daily living, care transitions can only grow
safer and caregivers more confident.
Case managers can include assessment
of the ability to perform activities of daily
living as an active part of readiness for
discharge assessments. Strategies and
mechanisms used to prepare caregivers
for advanced care needs can be utilized to
ensure the basic skills are mastered as well.
Promoting active engagement between
caregivers and hospital or facility staff during caregiving activities forms a natural
teachable moment. When true partnership
is achieved, learning can be robust. Many
caregivers have invaluable tips and inventive
solutions to share when we take the time to
learn what they know and support healthy
solutions to daily challenges.
For resources regarding the topics discussed in this article, please
visit http://www.vnaa.org/ and
http://elevatinghome.org/. ■
Danielle Pierotti,
RN, PhD, CENP, is
the vice president,
Quality and Research,
with ElevatingHOME
and the Visiting Nurse
Associations of America (VNAA). She leads the development and
integration of evidence into all aspects of
home-based care in support of the national
quality agenda. Dr. Pierotti's clinical practice
included adult medical-surgical, oncology, hospice and leadership in hospitals, clinics and
homes. She pioneered a new role specializing
in nursing quality, leading and developing initiatives across a community hospital system,
including both in and outpatient care. As
chief nurse for a rural hospice provider with a
25,000-square-mile service area, she translated
the Magnet Model for clinical excellence into
the interdisciplinary environment of homebased care. Dr. Pierotti's primary research interest is patient outcomes and the intersection
between practitioner knowledge, practice and
outcome. As an educator, author, presenter
and researcher, Dr. Pierotti strives to actively
promote and develop the practice of nursing
as a central strategy to maximize human health
through the application of knowledge and use
of measurement.


http://www.vnaa.org/ http://www.elevatinghome.org/

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2017

President's Letter
Association News
CMSA Corporate Partners
Care Transitions: Remember the Basics
Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
Development and Implementation of Relational Building in the Virtual Work Environment
Patient and Provider Satisfaction
The Case Management Model Act: Professional Case Managers Transforming Health Care
Index of Advertisers
CMSA Today - Issue 7, 2017 - Intro
CMSA Today - Issue 7, 2017 - cover1
CMSA Today - Issue 7, 2017 - cover2
CMSA Today - Issue 7, 2017 - 3
CMSA Today - Issue 7, 2017 - 4
CMSA Today - Issue 7, 2017 - 5
CMSA Today - Issue 7, 2017 - President's Letter
CMSA Today - Issue 7, 2017 - 7
CMSA Today - Issue 7, 2017 - Association News
CMSA Today - Issue 7, 2017 - 9
CMSA Today - Issue 7, 2017 - CMSA Corporate Partners
CMSA Today - Issue 7, 2017 - 11
CMSA Today - Issue 7, 2017 - Care Transitions: Remember the Basics
CMSA Today - Issue 7, 2017 - 13
CMSA Today - Issue 7, 2017 - 14
CMSA Today - Issue 7, 2017 - Leveraging Family Caregivers, Clinical Protocols and Technology to Improve Person-Centered Care
CMSA Today - Issue 7, 2017 - 16
CMSA Today - Issue 7, 2017 - 17
CMSA Today - Issue 7, 2017 - Development and Implementation of Relational Building in the Virtual Work Environment
CMSA Today - Issue 7, 2017 - 19
CMSA Today - Issue 7, 2017 - Patient and Provider Satisfaction
CMSA Today - Issue 7, 2017 - 21
CMSA Today - Issue 7, 2017 - The Case Management Model Act: Professional Case Managers Transforming Health Care
CMSA Today - Issue 7, 2017 - 23
CMSA Today - Issue 7, 2017 - 24
CMSA Today - Issue 7, 2017 - 25
CMSA Today - Issue 7, 2017 - 26
CMSA Today - Issue 7, 2017 - 27
CMSA Today - Issue 7, 2017 - 28
CMSA Today - Issue 7, 2017 - 29
CMSA Today - Issue 7, 2017 - Index of Advertisers
CMSA Today - Issue 7, 2017 - cover3
CMSA Today - Issue 7, 2017 - cover4
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