• Home Care
  • Five guidelines help nursing and social care

    Increasing demand for healthcare has seen an expansion in the potential for community care to make a bigger contribution. Community care isn’t a new idea. It’s been part of many health systems for decades. Two of its features have been its underdeveloped role, so impact, and effective integration of community health services and social services. 

    A European Union (EU) project’s been seeking ways to improve this. Starting in December 2013 and ending in November 2015, ENS4Care presented its solutions at the EU’s 7th Innovation Summit. An overarching goal for ENS4Care is sharing good practices in nursing and social care. 

    ENS4Care’s five guidelines are for eHealth services for prevention, clinical practice for Chronic Obstructive Pulmonary Disease (COPD), integrated care, continuity of care and nurse ePrescribing and the design of advanced roles. Each of these is seen in a context of a vibrant, motivated and highly qualified health and social care workforce. eHealth’s role is clarified too.

    The guidelines are being deployed in Romania, Bulgaria and Poland. This is in parallel to additional effort with the European Nursing Research Foundation, known as HOTUS, to apply evidence-based policy-making in European health and social care policy. 

    ESN4Care’s guidelines offer Africa’s health systems an excellent step up in developing their community services as part of responses to severe health worker shortages. They also show numerous opportunities for eHealth’s contribution. A short summary of each guideline’s:

    Prevention

    Nurses and social workers with the right knowledge and skills will add considerable value to, and form an important link between, technological innovation, health promotion and disease prevention eHealth tools and technologies should be user friendly for patients, carers, the public, professionals and everyone else involved Choices of eHealth tools and technologies should be based on sound scientific principles eHealth interventions should be assessed for cost effectiveness Nurses and social workers should assess the health literacy levels of patients, carers, families and communities to ensure they’re enabled to harness and gain maximum benefit from changing eHealth technologies Nurses and social workers should have the knowledge, skills, opportunities and capacity to use the tools and technologies effectively eHealth tools and approaches must comply with local and national policies and structures for data protection, patient confidentiality and privacy and legal and governance requirements

    Clinical practice for COPD 

    All eHealth services must be supported by robust governance arrangements Planning for all eHealth services must include statements on how ICT components will benefit practices and citizens During eHealth implementation, consideration needs to be given to the disruption that it may cause to staff In a citizen self-monitored service, citizens should maintain their own records, such as data about symptom scores and vital measurements, and assume responsibility for sending the data to hospitals, GPs, primary care centres or call centres Biometric measuring devices, such as equipment that monitors heart rate, blood pressure, blood glucose levels, oxygen saturation, and weight should be considered for remote monitoring and management of citizens with acute and chronic illnesses in patients’ homes Secure transfer, access and storage of health and social care data’s essential Ethical principles and standards should guide the governance and risk management structures of services A strong leadership presence is essential through implementation of all eHealth services Consideration needs to be given to developing clear and accessible staff documentation such as instruction manuals, guidelines and protocols eHealth education and training should involve citizens, carers, health professionals and social workers Evaluation processes should identify changes in key indicators that reveal areas where the eHealth service has positive or negative impact Maintaining citizen privacy and safety are crucial to the long-term success of any eHealth service that hosts citizen and provider data eHealth should be user friendly eHealth should be well integrated with existing ICT systems so they can be easily accepted and used by health workers.

    Integrated care

    eHealth solutions should be considered for any health issue that requires an element of collaboration between primary and secondary healthcare and social workers All countries should have a common database-based network solution that can help with the coordination and communication between primary and secondary care providers, including nurses and social workers Integrated eHealth care needs equal involvement from primary and secondary care partners Outcome data and indicators of success that includes satisfaction with care, readmission rates and average length of hospital stays should be collected throughout the process Documentation should use the international standards of reference terminology model recommended by WHO Consideration should be given to establishing a single point of contact for staff support with a super-user who can respond to issues, troubleshoot and offer advice

    Nurse ePrescribing 

    Jurisdictional factors, including legislation and prescriptive authorities should be considered in the initial stages of planning for nurse ePrescribing Informatics infrastructure and platform should be considered in the initial stages of planning for nurse ePrescribing Competency in clinical decision-making should be considered in the initial stages of planning for nurse ePrescribing

    Advanced roles

    eHealth should not be seen as a substitute for face to face contact with health and social care professionals that citizens need at times of crisis and during acute phases of their illness Nurses and social workers should offer social prescriptions when it’s appropriate to offer citizens options of assistance to change their lifestyles as an alternative to medications or other clinical interventions Nurses and social workers should employ telehealth solutions to empower people living at home to assess their own state of health and enable health and social care professionals to remotely monitor their physiological data for diagnosis or disease management Nurses and social workers should employ telecare that uses a combination of sensors and other equipment, usually in the home environment, to help vulnerable and physically less able citizens to keep themselves safe and alert a control centre if help is required Nurses and social workers should empower service users to participate in implementing and monitoring their own service and treatment measures of care and the related decision-making processes.

    For each of these guidelines, the reports contain considerable detail about their deployment, use and benefits. They’re paths that Africa’s health systems can follow.

  • Diálisis 24H's app helps kidney treatment adherence

    Two nurses and an IT engineer joined forces to create the Diálisis 24H app, to improve adherence to kidney treatments. The team worked closely with renal patients to ensure the app design is user friendly and provides benefits.

    An article in Healthcocreation says Diálisis 24H is innovative in the way it supports kidney patients. It aims to motivate patients to manage their health and take control of their care. The app’s free and can be downloaded for iOS and Android.

    It has a number of self-monitoring features. First, it has a calculator for hydric balance, a crucial value for renal self-care. Most people aren’t aware of the influence of specific foods and liquids and the importance of maintaining a healthy balance to achieve an appropriate water flow. The app helps to address this. It includes a food catalogue that informs patients about the amounts of potassium, sodium and water, certain foods contain. In an interview with Healthcocreation, the team says “We want our dialysis patients to be able to eat all kinds of food but in a healthy manner. It is not about prohibiting, it is about giving the tools to allow patients to eat what they like taking into account the quantity and the portions.”

    Diálisis 24H has a gaming component to encourage learning. Users can play the quiz alone or with other users to solve challenges. There’s a digital pillbox too, to remind users to take their medications.

    The healthcare advice section provides patients and relatives with information on nutrition, lifestyles, dialysis, care on vascular accesses, vaccines and many other issues. It’s updated regularly to keep up with latest findings and developments.

    Historical dialysis records also promote treatment success. With this information patients get a powerful tool for self-care, and can share the information with their healthcare professionals. 

    The app’s currently available in Spanish, but’s easily translated. Renal patients in Africa, who don’t have easy access to clinics or healthcare facilities, could benefit from it. Diálisis 24H would allow them to monitor and manage their care from home and could reduce the frequency of the need to see health workers.  

  • Telemedicine helps type 2 diabetics

    As the cases of diabetes type 2 increase, a systematic review by Dr Rashid Bashur from the E-Health Center, University of Michigan Health System, and his colleagues, published by Liebert, says telemedicine can help. Its findings are “The major contributions point to telemedicine’s potential for changing behaviors important to diabetes control and prevention, especially type 2 and gestational diabetes. Similarly, screening and monitoring for retinopathy can detect symptoms early that may be controlled or treated … Overall, there is strong and consistent evidence of improved glycemic control among persons with type 2 and gestational diabetes as well as effective screening and monitoring of diabetic retinopathy.”

    The study reviewed 73 research articles on the outcomes of telehealth use for diabetes control. It analysed different patient populations, technologies, resources and research protocols. Other findings were:

    Telemedicine for diabetes can be effective for rural patients A 29% increase in adherence to prescribed glycemic tests by patients when nurses called patients to remind them Decreases in A1c levels and cardiovascular risk factors with an electronic disease management system and a home care link to send messages for Type 1 or Type 2 diabetes.

    The study provides evidence for African countries to use in assigning priorities to their telemedicine initiatives. It could overlap as good practices for some mHealth projects too.

  • How will Google's robots help healthcare?

    What’s the difference between a Google executive and the Star Trek crew? “Star Trek characters never go shopping” said Douglas Coupland, the Canadian novelist. Google’s been on a massive shopping spree and buying robots by the tonne.

    The Guardian, a UK broadsheet, says Google’s bought Boston Dynamics, Nest Labs, DeepMind, Bot & Dolly, Meka Robotics, Holomni, Redwood Robotics, Schaft and DNNresearch. It must have a massive shopping basket and a credit card limit to match. What can healthcare expect to gain from it?

    Robotics already play a major role in clinical work, such as surgery and imaging. The Da Vinci Surgical Robot is a well-established example.  But healthcare depends on a wide range of activities. It’s not beyond sci-fi to imagine robots with hospital cleaning roles, providing some catering services, some portering services and helping patients in their homes. They could help with some hospital engineering tasks. They already manage and dispense drugs in pharmacies, so smaller versions could do it on hospital wards. Health Robotics is a large supplier of intra-venous medication preparation, compounding, and dispensing.

    Paro is more like a cuddly harp seal with a diurnal rhythm, but it’s an advanced interactive therapeutic robot developed by Japan’s National Institute of Advanced Industrial Science and Technology (AIST).  He, she or it, provides patients with proven animal therapy benefits in hospitals and extended care facilities. It could do this in patients’ homes too. It’s claimed that Paro has:

    Helped to reduce patients’ and carers’ stress Stimulated interaction between patients and carers Improved patients relaxation and motivation Improved the patients’ socialiasation with each other and with their carers A Guinness World Records’ certificate saying it’s World’s Most Therapeutic Robot.

    Paro is the eighth generation of a design used in Japan and throughout Europe since 2003, so not exactly sci-fi.

    It’s not difficult to envisage the benefits of an expanded role for robots in healthcare. There are costs too. Robots need regulation, especially for health and safety. They can contain information about patients, so need to comply with eHealth regulations for topics such as privacy, confidentiality, informatics, cyber-security, standards and information sharing. These are not insurmountable tasks.

    With the immense demand for healthcare in Africa and the mismatched supply of health workers, robots may have an important contribution. Affordability is always a constraint, so any take-up will be gradual. One thing that distinguishes robots from the Star Trek crew is that robots can go shopping, which could be handy for home care.

  • First home care conference for Nigeria

    Better awareness of home care and bringing stakeholders together were the conference aims. Blue Torch Home Care, a Nigerian healthcare agency set up the conference in Enugu State.

    Dr Oluka represented Dr Fidelia Ugwu Hon. Commissioner for Health Enugu State. His perspective is that home care is a tradition, and the need is changing as the social lives of Africans moves from rural to urban and a less extended family. It must also cope with ever-growing non-communicable diseases and chronic illness that do not need everlasting hospitalization.

    The call from the conference is for stakeholders to take home care to the next level by consulting the agencies in the country to work together towards stable operational guidelines like in European, American and some African countries. This is a challenge to track over the coming months and years.

    The International Society for Telemedicine and eHealth (ISfTeH) published the proceedings.