Abstract [from journal]
Social, economic, and environmental factors contribute to patients' recovery following hospitalization. However, little is known about how home health nurses make decisions based on their assessment of these factors. The purpose of the current study was to explore the nonclinical factors that home health nurses evaluate and describe how these factors influence care planning decisions. Semi-structured interviews conducted with 20 visiting nurses from three home health agencies were analyzed using conventional content analysis. Three nonclinical factor themes emerged: Social Support, Home Environment and Neighborhood, and Finances and Insurance Barriers. Nurses' assessments guided them to include family caregivers in the plan of care, evaluate their own safety to complete home visits, and refer patients to useful resources. Findings highlight the role of home health nurses in supporting older adults with limited resources and the need to address the social determinants of health across the care continuum.