title: Barriers and facilitators to optimize function and prevent disability worsening: a content analysis of a nurse home visit intervention.
abstract: OBJECTIVE
  This paper is a report of an analysis of how to better understand the results of the nurse home visit intervention in the Medicare Primary and Consumer-Directed Care Demonstration in terms of facilitators and barriers to disability improvement/maintenance as compared with disability worsening.
  
  
  BACKGROUND
  There is a lack of literature describing how nurse home visit interventions are able to maintain/improve disability among older persons with disability. The present study is one of only six reporting beneficial disability outcomes.
  
  
  METHODS
  Cases were purposefully sampled to represent change in the disability construct leading to selection of ten cases each of disability maintenance/improvement (no change or decrease in total Activities of Daily Living score from baseline) and worsening (an increase in total Activities of Daily Living score from baseline). Data from nurses' progress notes and case studies (collected in March 1998-June 2002) were analysed using qualitative descriptive analysis (May 2009). These results remain relevant because the present study is one of the few studies to identify select nurse activities instrumental in postponing/minimizing disability worsening.
  
  
  RESULTS
  Three primary themes captured the facilitators and barriers to effective disability maintenance/improvement: (1) building and maintaining patient-centred working relationships, (2) negotiating delivery of intervention components and (3) establishing balance between patients' acute and chronic care needs. Sub-themes illustrate nurse, patient and system factors associated with effective disability maintenance/improvement (e.g. nurse caring, communicating, facilitating interdisciplinary communication) and barriers associated with disability worsening (e.g. dementia, depression and recurring acute illnesses).
  
  
  CONCLUSIONS
  This study provides new insights about the facilitators and barriers to effective disability maintenance/improvement experienced by patients receiving home visits. Potential opportunities exist to integrate these insights into best-practice models of nurse home visiting.
authors.affiliation: School of Nursing, University of Rochester, New York, USA. dianne_liebel@urmc.rochester.edu
authors.forename: Dianne V
authors.initials: DV
authors.lastname: Liebel
authors.forename: Bethel Ann
authors.initials: BA
authors.lastname: Powers
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Watson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000458:organization & administration*; D006233:Persons with Disabilities; D019468:Disease Management; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D006278:Medicare; D008962:Models, Theoretical; D009723:Nurse-Patient Relations; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D014481:United States