Faculty Bibliography

Homes in dense urban areas can present unique challenges to community-dwelling older adults. This multi-method pilot study explored home environment barriers among lower-income urban community-dwelling older adults with functional difficulty using the In-Home Occupational Performance Evaluation (N = 15). Additional data were collected from interviews with community service providers (N = 7). Home environment barriers, including clutter and stairs, limited the ability of many community dwelling adults to perform routine tasks. Service providers felt that home assessments were helpful for identifying problematic activities and barriers early on before they became larger problems, especially for older adults with limited social supports and mental health problems. Our findings support interdisciplinary interventions to reduce barriers in the home environments of older adults.

AIM/OBJECTIVE:To develop and psychometrically test the Self-Care of Chronic Illness Inventory, a generic measure of self-care. BACKGROUND:Existing measures of self-care are disease-specific or behavior-specific; no generic measure of self-care exists. DESIGN/METHODS:Cross-sectional survey. METHODS:We developed a 20-item self-report instrument based on the Middle Range Theory of Self-Care of Chronic Illness, with three separate scales measuring Self-Care Maintenance, Self-Care Monitoring and Self-Care Management. Each of the three scales is scored separately and standardized 0 to 100 with higher scores indicating better self-care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from in-patient and out-patient settings at five sites in the United States and ResearchMatch. org. Dimensionality testing with confirmatory factor analysis preceded reliability testing. RESULTS:The Self-Care Maintenance scale (8 items, 2 dimensions: illness related and health promoting behavior) fit well when tested with a two-factor confirmatory model. Internal coherence reliability was estimated at .67. The Self-Care Monitoring scale (5 items, single factor) fit well and reliability was .81. The Self-Care Management scale (7 items, 2 factors: autonomous and consulting behavior), when tested with a two-factor confirmatory model, fit adequately. Internal coherence reliability was .71. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model. CONCLUSION/CONCLUSIONS:The Self-Care of Chronic Illness Inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.

Home care clinicians have an opportunity to improve care for post-hospitalization patients with cardiovascular disease. This mixed methods study examined the feasibility and acceptability of an adapted cardiac rehabilitation (CR) program for the home care setting. Surveys measuring patient self-care and knowledge were administered to patients (n = 46) at baseline and at 30-day follow-up. Semi-structured interviews were conducted with patients (n = 28) and home care clinicians (n = 11) at completion of the program. All survey indicators demonstrated a trend towards improvement, with a statistically significant increase in the self-care management subscale (p = 0.002). Qualitative analyses identified three patient themes (self-awareness, nutrition, motivation) and three clinician themes (systematic approach, motivation, patient selection process). Incorporating CR into the home care setting proved to be a feasible and acceptable approach to increasing access to CR services among elderly patients.

PURPOSE: There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease. METHODS: Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test. RESULTS: Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists. CONCLUSIONS: Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.