Nursing Partnerships Drive Care Home

Evidence-based research guides home-based care for older adults

Assistant Professor Melissa O'Connor exposes junior nursing students to transitional care through visits to older patients receiving home-based care.

Nothing about the men and women arriving at the Manhattan offices of the Visiting Nurse Service of New York in February 2014 attracted the attention of passersby. Yet this pivotal meeting of more than a dozen specialists accomplished a long-anticipated professional goal of Melissa O’Connor, PhD, MBA, RN, COS-C, assistant professor in the College of Nursing. Under her direction, these experts were embarking on what may be the first study of its kind to examine the key factors that determine a patient’s readiness for discharge from skilled home care.

Photo: Assistant Professor Melissa O'Connor, PhD, MBA, RN, COS-C (center) exposes junior nursing students, including Madeline Nocero (left) and Erica Peters (right), to transitional care through visits to older patients receiving home-based care.

GROUNDBREAKING PILOT STUDY

Until recently, few researchers studied home-based health care for older patients. This lack of research deprived caregivers of the evidence-based knowledge they need to make effective homecare decisions. The College of Nursing, in partnership with one of the nation’s premier visiting nurse services, is filling this gap, through the groundbreaking pilot study led by Dr. O’Connor, a nurse and researcher with more than 20 years of experience in home health care.

“We’re going to do extensive research on all aspects of decision-making in home health care,” Dr. O’Connor explains. “Even better, we’re going to include our students in the process, so they can get an up-close experience with nursing research in their clinical education. This is a promising breakthrough in nursing research, and it’s underway at Villanova.”

Key steps in the research were the New York focus groups. One overarching question drove the focus groups: How can new, evidence-based research help geriatric nurses and other skilled providers of home health care make the best decisions about clinical care for older-adult, home-based patients? The ultimate goal of Dr. O’Connor and her colleagues is to build a decision-support tool that will enable providers of home health care to better understand what patients need to thrive in a home setting—and, consequently, says Dr. O’Connor, “to do a better job of ensuring high-quality outcomes.”

During the daylong exchange, nurses, therapists, social workers and physicians explored problems that emerge in home-based health care for older adults. For example, an elderly man with chronic health conditions is discharged to professional home care in an apartment. But when the nurse arrives, she discovers that the patient is a diabetic amputee in a wheelchair and lives on the third floor. “Apparently, no one asked: What if there’s a fire?” Dr. O’Connor says.

In another case, a discharged patient is supposed to receive daily care from his daughter. But because she is overwhelmed with her own medical problems, she can’t care for her father, who ends up back in the hospital. “That’s a classic case of failing to make sure that the nonprofessional caregiver was capable of looking after the older adult,” Dr. O’Connor says. At the end of this opening phase of the study, Dr. O’Connor you how many participants said to me, ‘We’re really happy to be part of this study, because it’s going to help us down the road in our clinical practice.’” Their suggestions helped form a clearer picture of what this interdisciplinary field of home care needs: a decision-support tool that will help professional providers of home health care figure out when home-based patients need more care and when they are able to do well without it.

CRITICAL ROLE OF RESEARCH

As passionate about teaching as she is about researching the quality of outcomes in home care, Dr. O’Connor is thrilled to know that students will be part of this work. This semester, junior nursing students participate in home care visits, allowing them to combine research with clinical care. “A lot of health care is moving from the hospital setting to the home,” Dr. O’Connor says. “It’s our job to prepare students for that.” No one is better suited for the job than Dr. O’Connor, who has published extensively on home care outcomes and the need for more research on decision-making by providers of home health care.

The pilot study is bringing a new emphasis to research and nursing education at Villanova. “Research in home health care will be a big part of the future of such care,” says M. Louise Fitzpatrick, EdD, RN, FAAN, Connelly Endowed Dean and Professor, “and we are pleased to be leading the way.” Dr. O’Connor believes that Dean Fitzpatrick’s dedication to research influenced the decision of the Visiting Nurse Service of New York to partner with Villanova.

While she is anxious to publish the results of the pilot study, Dr. O’Connor is equally excited about the opportunity to initiate the students she has in both the clinical and the classroom settings into the world of nursing research. She thrives on introducing students to the scientific rigors and the demanding intellectual challenges of research as an essential component of good nursing practice.

“I’m determined to expose them to the cutting edge of research in home health care,” she says. “Increasingly, nurses who provide home care and make decisions about that care are going to need these research-related insights if they expect to become skilled practitioners who can achieve quality outcomes for home-care patients. Research is going to become more and more important in our efforts to reach the goal to which all nurses aspire: providing the best health care.” Given the College of Nursing’s visionary leadership, expert faculty and dedicated students, such a goal is well within reach. 

-Article from Villanova Magazine, Spring 2014