The home care team approach to self-neglecting elders.

Elderly patients who neglect their own health present special challenges. This article describes techniques for establishing rapport, understanding the patient's world, using a team approach to care, and achieving closure. At each step the clinician must find a balance between respecting the elder's rights and meeting his or her healthcare needs.

From the field: a maternal-child health nursing competence validation model.

This group of Vermont community health nurses from different agencies collaborated to develop a competence validation framework for maternal and child health nursing in the practice areas of perinatal client teaching, breastfeeding, and prenatal, postpartum, and newborn nursing care. The framework is based on the work of Benner, using the "competent" level of nursing practice, and delineates three parameters of competence: technical skills, interpersonal skills, and critical thinking skills. Learning resource materials, including newborn and maternal assessment guidelines, were developed for each competence area.

Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.