HOME CARE NURSE: THE CENTRAL FOCUS OF HOME HEALTH CARE by OMOLOLA Adams O

HOME CARE NURSE: THE CENTRAL FOCUS OF HOME HEALTH CARE

Author: OMOLOLA Adams O. RPHN. Public Health Strategist & Expert

Home care nurses provide in-home health services for patients and their families. Their visits not only allow patients to remain in the comfort of their home but also help family caregivers stay abreast of their loved ones' health. Working in alliance with a physician, they coordinate and manage patients’ at-home care plan (Luther 2018).Home health nursing is a nursing specialty in which nurses provide multidimensional home care to patients of all ages (De Vliegher, et al 2015).

Home Care Nursing Services focused on personalised care, attention to detail and an unmatched standard of nursing and caring excellence. Home care nurses are largely on in-home caring and private home nursing services.

HISTORICAL PERSPECTIVE

Professor Christopoulou Ioanna, in his article titled home nursing care described the history of home care nursing as thus;                                                                                                                                                                                                             

1.                   Early Christian Church: In year 58 after Christ, deaconesses Phoebe and Tavitha are referred to as the first nurses, offered nursing care in the community.
2.              The   Company of the Daughters of Charity of Saint Vincent de Paul: sometimes simply referred to as Daughters of Charity, it was founded in 1633 and devoted to serving Jesus Christ in persons who are poor through corporal and spiritual works of mercy.
3.                       Theodor Fliedner: A German Lutheran minister was the founder of “Lutheran deaconess” training. In 1821 he assumed the pastorate in the poor municipality of Kaiserswerth (now an official region of Dusseldorf).
4. .                   William Rathbone VI: British politician, noted for his philanthropic and public work. The care of his dying first wife in 1859, by a nurse, prompted him to campaign for a system of district nursing to enable the poor to benefit from similar care (Christopoulou, 1993; Rice, 2001).

Professor Christopoulou Ioanna further explored the history of home care nursing in Europe. In Europe, since 1860, “home care” has developed in three stages:

Stage 1: 1860-1900: Voluntary home health care is organised and offered to the poor (district nursing).

Stage 2: 1900-1970: “Public health” is organised and focuses on the health care of the individual patient, in the context of his own family (public health nursing).

Stage 3: 1970- to date: Home health care focuses on the total of the population of the community, individuals and families (community nursing) (Christopoulou, 1993; Rice, 2001; WHO, 2008).

Home care nursing is unique. It has been named as a specialty nursing practice (American Nurses Association, 2008; Canadian Nurses Association, 2010; Smith-Stoner, 2004), and requires specific clinical care nursing competencies not utilized by hospital nurses (Benefield, 1998; Benefield, 2000; Community Health Nurses of Canada, 2010; Guthaus and White, 2002; Humphrey and Milone-Nuzzo, 2005). A reasonable workload is important to home care nurses and was one of the factors found to influence home care nurse job retention (Armstrong-Stassen and Cameron, 2005; Flynn and Deatrick, 2003; Neal-Boylan, 2006; Smith-Stoner, 2004).

The Home Care Team

The members of the home health care team may include: physician, nurse, medical social worker, home health aide, physician's assistant, psychologist, paid homemaker, dentist, rehabilitation personnel, dietician, optometrist, volunteer, friend, and family caregiver. Each professional from each discipline brings a special set of knowledge, attitudes, and skills to home care. The patient's needs and the requirements outlined in the home care plan are the bases of the level of involvement of each professional in the home care. There may be overlapping of functions because of patient's needs and the intermittent, part-time nature of professional home care services (American Medical Association 1998). The home care professional is alone in the patient home with the patient, and most often provide, in addition to the planned professional interventions, a general view of the entire team's home care program. The shared tasks are brief assessment of the overall effectiveness of the comprehensive home care plan; assessment of patient and caregiver interactions and satisfaction with the home care program; identification of any new problem; notification of appropriate team member(s) for follow-up of new problems; and encouragement and reinforcement of instructions from other team members (American Medical Association 1998). Each team's composition depends on each patient's needs and on its responsibilities to take care of these needs.

The Home Care Nurse (H.C.N) has a huge and enormous responsibilities to discharge at the front line of home care services, these responsibilities are quite astonished and different from what is obtained in the hospital arena. The Home Care Nurse is the overall officer that delegates responsibilities to co-workers and coordinates health care activities of other professionals and the patient. She is the gateway to home health care services, every other professionals relied on the information given by the home health nurse, and pass through the home health nurse to discharge their respective duties.

This enormous task for H.C.N ranges from core nursing duties to the home care administration. The workload is significant and overburden on the H.C.N., the administration is the overall activities that takes place in the home with sole goal of total and complete well-being of the patient. As part of the administrative responsibilities is booking appointment with other professionals and do a thorough follow-up to ensure the appointments were not missed. Other activities also include the indoor activities, family visit, recreation and relaxation time and many more. The laboratories investigations are initiated by the H.C.N. based on the need of the patient as well review of the medications.  Family participation is also coordinated by the nurse such that the immediate members are carried along in the care as well the visiting families.

The hierarchy in the hospital provides a complex and multidisciplinary team work with subunit saddled with different tasks and responsibilities. The hierarchical ladder communicate from down to top or vice versa. This enhances interdisciplinary team work such that no one is over burden with administrative functions. The H.C.N.is basically over loaded with many responsibilities, she’s the central focus among the peer professionals working together. The goal is very simple – attain maximal health of the patient. The diagram above shows how the nurse work as the coordinator linking up with other professionals.

REFERNCE

Al Kurashi N.Y. (2006). Home Health Care Team Members Middle East Journal of Family Medicine. http://mejfm.com/journal/july2006/HOME%20HEALTH%20CARE%20TEAM%20MEMBERS.htm

American Medical Association (1998). Medical management of the home care patient: guidelines for physicians. 2nd edition. Chicago.

American Nurses Association. (2008). Home health nursing: Scope and standards of practice. Maryland.

Armstrong-Stassen, M., & Cameron, S.J. (2005). Concerns, satisfaction and retention of Canadian community health nurses. Journal of Community Health Nursing, 22 (4), 181-194.

Benefield, L.E. (1998). Competencies of effective and efficient home care nurses. Home Care Manager, 2(3), 25-28.

Benefield, L.E. (2000). Critical competencies for nurses in the new millennium. Home Healthcare Nurse, 18(1), 17-21.

Canadian Nurses Association. (2010a). Community health nursing certification: Summary and competencies. Ottawa. http://www.cnaaiic.ca/CNA/documents/pdf/publications/CERT_Comm_Health_2009_e.pdf

Christopoulou I. (1993). Home nursing: Historical evolution, aim and content. General Family Medicine, 183-8.

Christopoulou I. (2010). Home nursing care. Health Science Journal. http://www.hsj.gr/medicine/home-nursing-care.php?aid=5295

Community Health Nurses Association of Canada. (2003). Canadian Community Health Nursing Standards of Practice. Toronto: Author. Available from http://www.chnc.ca/nursingstandards-of-practice.cfm

De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Moons, Philip (2015). "Exploring the activity profile of health care assistants and nurses in home nursing". British Journal of Community Nursing. 20 (12): 608–614. doi:10.12968/bjcn.2015.20.12.608.

Flynn, L. & Deatrick, J.A. (2003). Home care nurses’ descriptions of important agency attributes. Journal of Nursing Scholarship. 35(4), 385-390.

Guthaus, M.A. & White, D. (2002). Blending the roles of home care nursing and cardiovascular specialties: A model for nursing practice in the community. Home Health Care Management and Practice. 14(4), 255-261.

Humphrey, C.J. & Milone-Nuzzo, P. (2005). Transitioning nurses to home care. In M.D. Harris, (Ed.), Handbook of Home Health Care Administration, (4th ed., pp. 484-494). Sudbury, MD: Jones and Bartlett.

Luther C. (2018). Role & Duties of a Home Care Nurse. Chron. https://work.chron.com/role-duties-home-care-nurse-13396.html

Neal Boylan, L. (2006). Job satisfaction: An analysis of the differences between hospital and home healthcare nurse. Home Healthcare Nurse, 24(8), 505-512.

Rice, R. (2001). Home Care Nursing Practice: Concepts and Application, 3rd edition. St. Louis, MO: Mosby.

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