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Home Health Care
Home Health Care
and the Value of the Registered Nurse
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Home Health Care
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Home Health Care
and the Value of the Registered Nurse
The home health care system is one of the fastest growing industries in
America. Today, there has been a vast growth of services with approximately
7.6 million clients receiving care from about 83,000 providers (National
Association for Home Care and Hospice, 2008, pg 1). This is an increase of
63,000 suppliers since 2004. Factors affecting these figures are; an aging
population, rising health care costs, reimbursement plans, advances in
technology, and a trend of clients desiring this avenue of care for various health
related restrictions. Home health care encompasses the collaborative efforts of
various professionals all seeking the common goal of determining the needs of
the client and their families. When understanding the importance of the
Registered Nurse in the home health care setting, it is beneficial to consider the
pros and cons as well as the various functions of the nurse as caregiver,
educator, and case manager.
Home health care nurses require advanced knowledge and skills, usually
at the Baccalaureate level, in the delivery of either generalized or specialized
care for the client in this setting. Common areas of concern include cardiac,
respiratory, permanent disabilities such as Alzheimer’s and Multiple Sclerosis,
hospice, and dialysis to name a few. Nursing in the home care industry has
many advantages as compared to nursing in the hospital environment. For one,
Nurses claim a greater sense of self-government. The RN must demonstrate a
high level of competency in areas such as, assessments, problem-solving, critical
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thinking, and organization skills. (Anderson, Mignor, 2008, p. 20). Studies also
show that nurses claim a greater sense of belonging in this setting as it fosters
more trust and connectedness with the client and their family due to the
psychological intimacy and security of the home environment. Families’ display
more natural behavior at home and cultural values may be practiced without
inhibition. When choosing styles of leadership, Nurses regard themselves to a
greater degree as patient advocates compared to methods used in the hospital,
using a more democratic approach which encourages group discussion and
collaborative decision-making.
There are some disadvantages to home health nursing. In fact, the risk for
injury to the home healthcare nurse is greater than the hazards incurred by
servicing a client in a hospital. Occupational hazards such as back injuries, risk
for falls from tight, cluttered home environments, transmission of pathogens, risk
for domestic violence, and sharps injuries are serious concerns to this
specialized field of care (Chalupka, 2008, p. 15). There may be a lack of medical
equipment, for example, a patient lift, availability of clean linens, and
accommodations for infection control such as running water and a clean home
environment. As expected, the home health nurse must utilize strict adherence
to agency protocol regarding aseptic technique in controlling the transmission of
pathogens throughout the home and from one family member to the next.
Driving time on the road, sometimes to unfamiliar areas, increases the nurse’s
risk for automobile accidents or violence from the surrounding community. A
careful plan of safety prior to visitation should be put into place in order to avoid
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unforeseen problems. Mapping out the next day’s route, having an extra set of
car keys, a full tank of gas, parking in well-lit areas, keeping a charged cell phone
at hand, and informing the agency of the daily itinerary are some of the ways to
maintain safety for the visiting nurse.
As providers of care, the role of patient advocate is essential to the
development of the home relationship. Nurses advocate for the client by having
discussions about their individual rights of health care. The patient’s wishes,
which may be disclosed in Advanced Directives such as Living Wills, or Powers
of Attorneys, are always protected. Another major function of the RN is to
perform a comprehensive assessment that not only includes the patient, but their
family or caregiver, the home environment, and the surrounding community. A
plan of care is then formulated by such collective information including
physician’s orders, third-party payer reimbursement, treatment required, and
collaborative efforts of other healthcare professionals needed for the delivery of
care. Advances in technology have made it easier for the home health nurse to
communicate with the home health agency and update a client’s information on a
daily basis via computer systems.
The role of patient teaching in home health care nursing cannot be
overemphasized. Nurses in this field are highly educated in preventing diseaserelated problems, promoting optimal health and encouraging independence
within the client to their fullest potential. The goal is to maximize the patient’s
ability to function at home with the hope of reintegrating them back into society.
Areas of teaching may include proper use of dialysis equipment, ostomy care,
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diabetes management, wound care, signs and symptoms of infection, how to
take a pulse or blood pressure, medication scheduling and compliance, and
when to call the doctor should complications or adverse reactions occur.
Instructions on hand washing and prevention of disease transmission is
paramount for all patient teaching. Emphasizing the effects of caregiver role
strain and methods of reducing stress can be a rewarding area of teaching focus.
It is beneficial for the nurse to know what the community has to offer in forms of
assistance to caregivers by knowing the local support groups, religious
organizations, or volunteer respite care programs in the area (Assessment
Technologies Institute, LLC, 2006, p. 92).
Many agencies require a Registered Nurse to function as their own case
manager. The nurse in this setting supervises and coordinates the activities of
various professionals involved in the client’s treatment plan (Berman, Erb, Kozier,
Snyder, 2007, ch. 8). Assistance by such professionals as Dieticians,
Respiratory Therapists, Physical Therapists, Primary Care Physician, or
collaboration with the Advanced Practiced Nurse, may all be incorporated in the
ongoing care of the client. The original plan of care may need revision at any
time during visitation. Medicare or third-party payers require accurate
documentation according to insurance protocol that must be available in order to
obtain proper reimbursement.
The American Nurses Association has incorporated guidelines for home
care nursing practice in order to ensure that quality nursing care is delivered to
the client at all times. Home care nursing has a scope of practice that is unique
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from any other form of nursing care and carries a greater sense of autonomy.
Higher forms of education and competency in advance skills enable the nurse to
manage sophisticated equipment along with intricate disease processes and
physical limitations. The future of home care nursing will continue to offer great
opportunity as millions of Americans demand health care in the comfort and
security of their own homes.
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References
Anderson, Patsy, & Mignor, Deolinda. (2008). Home Health Care Nursing, Using an
Accreditation Approach. (pp. 20-25). New York: Thomson Delmar Learning.
Assessment Technologies Institute, LLC. (2006). Community Health Nursing. (RN ed.
3.1, pp. 92.). USA: Author.
Chalupka, Stephanie M., Markkanen, Pia., Galligan, Catherine., Quinn, Margaret. (2008,
January). Properties of the AAOHN Journal. Sharps Injuries and Bloodborne
Pathogen Exposures in Home Health Care. (Vol 56, No. 1, p. 15). Retrieved July 19,
2008, from <http://www.AAOHN.com>
Kozier, Barbara., Erb, Glenora., Berman, Audrey., & Snyder, Shirlee. (2007).
Fundamentals of Nursing. (8th ed., ch 8). New Jersey: Pearson/Prentice Hall.
National Association for home Care and Hospice. (2008). Basic statistics about home
care. Retrieved July 17,2008, from <http://www.nahc.org>