Home Care Nursing PDF

Homecare Nursing Dr. Meryem ERCEYLAN Elderly population, Total, % of population, 2022 (OECD, 2024) Elderly population, Total, % of population, 2012 – 2022 (OECD, 2024) Elderly population, Total, % of population, 2012 – 2022 (OECD, 2024) Old-age dependency ratio (OECD, 2024) Old-age dependency ratio...

Homecare Nursing Dr. Meryem ERCEYLAN Elderly population, Total, % of population, 2022 (OECD, 2024) Elderly population, Total, % of population, 2012 – 2022 (OECD, 2024) Elderly population, Total, % of population, 2012 – 2022 (OECD, 2024) Old-age dependency ratio (OECD, 2024) Old-age dependency ratio (OECD, 2024) Cost effectiveness of home care versus hospital care: a retrospective analysis (Megido et al., 2023) Life expectancy at birth (years) (WHO, 2024) Social changes… Industrialization and urbanization, Change of family structures, transformation from extended family to nuclear family Increase in the number of women taking part in working life Decrease in caregiver roles in the family Historical Perspective William Rathbone (1819-1902), the Liverpool merchant and philanthropist, employed Mary Robinson to nurse his wife at home during her final illness. William Rathbone decided to try to extend the service started with Mary Robinson There was a lack of trained nurses. In 1860 he wrote to Florence Nightingale, who advised him to start a nurse training school and home for nurses The city was divided into 18 ‘districts’, Each district was under the charge of a Lady Superintendent drawn from wealthy families who were expected to underwrite the costs of the scheme and provide accommodation for nurses. Historical Perspective In 1893, Lillian Wald began home visiting in New York City and is famed for professionalizing visiting nursing. One of her most famous collaborations was with insurance companies for payment of home care services. Between 1909 and 1952, 100 million home visits were made to the policyholders of Metropolitan Life Insurance Company. By the end of the 19th century, urbanization, industrialization, immigration, and the constant danger of infectious diseases were transforming most large cities into increasingly unhealthy places to live. Historical Perspective After 1940, due to the great decrease in the number of nurse-health personnel in hospitals during World War II, home nursing increased qualitatively and quantitatively as those who needed hospital treatment were treated at home. Less expensive alternatives to hospital care were sought in the 20th century. Private home health agencies evolved from the demand to provide care for the chronically ill client in their home. Payment for home health care visits via Medicare and health insurances has allowed the individuals to rehabilitate at home, and that has proven to increase patient satisfaction and therefore promote positive outcomes while being cost-effective Historical Perspective Türkiye: 10.03.2005- Regulation on the Provision of Home Care Services 01.02.2010- Directive on the Implementation Procedures and Principles of Home Health Services Provided by the Ministry of Health 27.2.2015- Regulation on the Provision of Home Health Services by the Ministry of Health and Affiliated Institutions Home care services have been provided in the private sector since 2005 and in the public sector since 2010. Historical Perspective Türkiye: In 2017, the law on health organization was amended by the Decree Law. -With the amendments, the primary care pillar of home health services has been abolished. -It continues to be carried out by public hospitals. -Palliative care centers continue to serve in secondary and tertiary care hospitals. Ministry of Health, General Directorate of Public Hospitals, Department of Health Services - Ministry of Health Home Health Services Coordination Center: 444 38 33 - Applications received by the National Call Center reach the coordination center Istanbul Metropolitan Municipality- home health Application: Alo 153 http://www.ibb.gov.tr address Social pre-assessment teams visit their homes as soon as possible and determine the social status of the patient. As a result of the preliminary evaluation, the files of the individuals who are eligible for service are directed to the evaluation doctor and they are provided with Home Health Services. Home Health Care Users Orthopedics, traumatology patients, Diabetic patients, neurology patients Cardiovascular and hypertension patients New mothers and their babies Those who need laboratory examination and testing services Those who need all kinds of medical equipment at home Home Health Care Users Prematurely born infants on ventilators, Children with diabetes requiring insulin injections, Young adults with AIDS who must adhere to complicated medication regimens, Middle-aged adults with “silent” hypertension that requires medication with unpleasant side effects, Older adults with sleep apnea who must use uncomfortable equipment to maintain continuous positive airway pressure, People with renal failure who use home dialysis to avoid costly kidney transplants Children and adults also experience acute conditions such as infections (influenza) and injuries (broken bones) Characteristics of Caregivers Formal caregivers: professionals include nurses, physicians, therapists (including physical therapists, speech and language therapists, and occupational therapists), dieticians, and social workers Direct-care workers: home health aides, companions Informal caregivers: family members ❖While physicians generally have the formal responsibility for ordering home care services, home care nurses or physical therapists often develop the plan of care, based on their knowledge and expertise, and send it to the physician for approval. ❖Direct-care workers’ responsibilities include personal care, housekeeping, companionship, and assistance with activities of daily living Homecare Providers American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 1-Assessment: family dynamics, knowledge of caregivers, patient values/goals/health beliefs 2-Diagnosis: validation of diagnosis with patient/family, actual and potential risks, health barriers 3- Outcomes identification: Collaboration with patient/family to identify goals, consideration of cultural, ethical, and personal beliefs and values American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 4- Planning: collaborating with patient/family on an individualized plan of care, strategies to address health promotion and restoration, prevention of injury/illness, pain relief/palliative care, interprofessional collaboration regarding care, planning for transitions to and from home health care. 5-Implementation collaboration on implementing plan of care, engaging patients in disease management, use of evidence-based practice interventions, providing holistic care, utilizing health care technologies and community resources, integrating complementary practices with traditional approaches, promoting problem solving behaviors in patients/families American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 6- Coordination of care: collaborating with team members, helping patients/families recognize alternative care options when plan of care no longer meets patient needs, works closely with patients/families during care transitions) 7- Health Teaching & Health Promotion: developmentally and culturally sensitive health promotion/teaching that promotes patient engagement with self-care, utilizes information and health care technologies as appropriate 8- Consultation: synthesizing evidence, clinical data and theory, involves patients/families in determining role responsibilities and in making decisions, offers education to the team of health care workers) American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 9-Evaluation: ongoing and systematic outcomes evaluation, engages the team and the patient/family to participate in the evaluation process, evaluates patient progress toward short-term goals/objectives, uses evaluation to redesign plan of care, provides results of the evaluation to patient/family and health care team members 10. Ethics 11- Education: Continuing professional education American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 12- Evidence-Based Practice & Research (including use of current findings to guide clinical nursing practice, sharing research findings with health care team members/peers) 13- Quality of Practice (including documentation, participation in quality improvement initiatives, collecting quality-related data, updating guidelines/procedures to improve quality of nursing practice and patient care outcomes) 14- Communication (including assessment of patient preferences/literacy/language skills, communicating effectively with interprofessional team members) American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 15- Leadership (including development of conflict resolution and communication skills, serving as a preceptor for new colleagues, participation on agency committees) 16- Collaboration (including partnering with others to promote change, helps build consensus, applying negotiation skills and group process techniques with patients/families/health care team, builds teamwork) 17- Professional practice evaluation (including evaluation of own practice and identification of strengths/areas needing professional growth, offers feedback to peers on performance) American Nurses Association (ANA) Scope and Standards of Practice for Home Health Nursing 18- Resource utilization (including resources available to patient/family in implementing plan of care, delegates to team members when appropriate, advocates for enhancement of nursing practice through use of technology and additional resources, helps patient/family find services needed for care and cost/benefits/risks of decisions) 19- Environmental health (including understanding of risks related to management of supplies (e.g., syringes, needles, medications, waste), assessment of home and neighborhood for unsafe/unsanitary conditions, works to reduce environmental risks that affect health of patient/family, promotes health communities) Home Health Nursing Caregiving Wheel Locating the Client and Getting Through the Door The first step in making a home visit is finding where the person lives, which might involve telephone instructions, or a global positioning system (GPS) unit. Sometimes, nurses drive agency cars, and occasionally transportation may involve a bus, subway, boat, or airplane. When families are unstable, clients may not be staying in households designated on the nurse’s paperwork. They may have moved in with relatives or friends or be back home alone despite major care needs. Locating is especially challenging when neighbors or even family members are not cooperative, for whatever reason. Locating the Client and Getting Through the Door Always remember that you are a guest in the home. Respect and attentive listening The nurse must take into account the spiritual, cultural, and developmental, as well as environmental, realms of the client in order to be able to develop individualized plans of care to promote health The home health nurse is aware that the client is the driver of the plan of care. The nurse must develop a therapeutic relationship The nurse must emphasize positives to the extent possible, rather than telling people what they are doing wrong Locating the Client and Getting Through the Door The nurse must be up front and truthful regarding the medical and nursing problems that need resolution. For example: a nurse might say, “You might lose your foot if we cannot work together to figure out a plan of care that you can live with. Let’s think together about what we can do to prevent it.” Hub of the Family Caregiving Wheel: Promoting Self- Management Home health nursing involves home visits to promote independence rather than dependence on the home health team. The challenge to the home health nurse is often assisting the severely chronically ill client be able to adapt in the community to be safe and functional. Health improvement is only possible when the home health nurse works with the client/family to make decisions that are truly their own. Hub of the Family Caregiving Wheel: Promoting Self- Management Coordination with other professionals must often be instituted to provide comprehensive quality care. Doctors, dieticians, social workers, clergy, physical therapists occupational therapists, as well as mental health professionals… The home health nurse must utilize interprofessional collaboration to agency social workers to mobilize resources to care after the agency leaves. Rim of the Home Health Caregiving Wheel: Detecting Nurses in the home are challenged by an extraordinarily complex environment Detecting is a continuing assessment process as the nurse seeks to understand the client’s health in the context of home. ❖Who lives in the home? ❖How do they interact? ❖Who are the caregivers, and how do they care? ❖What is the relevance of culture and religion in the life of the household? ❖How does the physical environment impact patient safety and security? Example: Case: the client whose refrigerator no longer chills and whose impaired vision prevents awareness of the expanding family of roaches in the kitchen. Upon each visit the nurse is assessing: 1- Client safety: Is the client in a safe environment where the outcome can be reached? Are there safety devices available for client safety? Are essential services (food, power, water, housing, security) available and sufficient for the client to function safely independently in the home? Example: Case: the client whose refrigerator no longer chills and whose impaired vision prevents awareness of the expanding family of roaches in the kitchen. Upon each visit the nurse is assessing: 2-Caregivers: Are the caregivers attentive, knowledgeable, and willing to provide care to the client in the absence of the nurse? Is the caregiver competent in providing care? Example: Case: the client whose refrigerator no longer chills and whose impaired vision prevents awareness of the expanding family of roaches in the kitchen. Upon each visit the nurse is assessing: 3-Material resources: Does the client have the necessary material resources to support the interventions? Are the medications, dressings, and supplies accessible? Does the patient have the financial support to obtain the equipment? Spokes of the Home Health Caregiving Wheel: Collaborating, Mobilizing, Strengthening, Teaching, Solving Problems Home health nursing competencies include collaborating with multiple team members and mobilizing resources in the community that can sustain the client after discharge. The home health care nurse usually is the coordinator People learn that they can manage IV lines, safely take complex drug regimens, provide rehabilitation for loved ones after stroke, and perform countless other skills that they do not believe possible until a nurse shows them and they discover that they can do it themselves. Spokes of the Home Health Caregiving Wheel: Collaborating, Mobilizing, Strengthening, Teaching, Solving Problems The home health nurse is constantly teaching clients and/or family caregivers Health coaching, also called motivational interviewing, is useful. Instead of telling people what to do, this involves asking people how they would like to change For instance: “What worries you the most?” Those concerns and relevant feelings must be validated, and the nurse leads the person to consider options for change. The solution develops through a mutual, participatory process. Ultimately, people are responsible for their own health decisions Spokes of the Home Health Caregiving Wheel: Collaborating, Mobilizing, Strengthening, Teaching, Solving Problems The home health nurse must often be creative in obtaining supplies and adjusting to conditions in the home. For example: How do patients and families with no running water wash their hands before providing care, such as dressing changes? This may lead the home health nurse to contact social agencies to provide services or teach the patient and family the use of alcohol-based gels to clean their hands. The home health nurse must be nonjudgmental, but work with the patient and family to help them understand the need to keep areas clean. Nursing Challenges in the Home INFECTION CONTROL MEDICATION SAFETY RISK OF FALLİNG TECHNOLOGY AT HOME NURSE SAFETY Infection Control Nurses are challenged to consider how to protect the home health care team, family, and community from a client with contagious disease. In such cases, all people living in the home will need instruction. Some households have inadequate facilities to control disease transmission. no access to running water, no heating unit to boil equipment, or inadequate facilities to dispose of contaminated equipment. These conditions necessitate the development of creative solutions to control infection. Infection Control Complexities of the home environment require the nurse to carefully consider exactly how microorganisms are likely to exit the body, how might they be transmitted, and how are they likely to enter the body of another individual. Medication Safety The home health client taking multiple medications is at particular risk of multiple errors in self-administration, including incorrect medication, dose, time, interval, or route. Often, doses are missed or doubled. Clients may discontinue a drug or not complete the full course. In a study, 38% of 3,124 home health patients were taking at least one potentially inappropriate medications (Bao et al, 2012). Medication Safety Prescriptions may have originated from several providers over time and may have contradictory side effects. Although weekly medication organizers can helpfully put medications in order, they can also confuse new or impaired users. Distraction, visual impairment, forgetfulness, depression, and cognitive impairment are noncompliance… common causes of unintentional medication Medication Safety The home health nurse investigates how the medication is taken by reviewing and reconciling the current list of medications and having the patient explain and demonstrate the process he goes through. Intervention requires: ❖clear and repeated instruction, ❖updating the medication list, ❖charting or diagramming the schedule for medication taking, ❖assuring that the client or caregiver knows how to use the medication box. Risk of Falling Falls are a serious issue especially for the elderly. Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Clients should be observed as they move through their home and carry out activities of daily living. Home care clients require environmental adjustments in their home to reduce or eliminate the possibility of falling. Technology at Home Home health nurses teach patients and their family to manage a wide array of complex technologies. Home regimens often require mini-intensive care units. The household becomes home to dialysis, ventilators, isolation suites, enteric and IV nutrition, and vasopressors Nurses teach clients and families to manage it all Medical devices have caused injuries and deaths, so careful instructions on use in the home and oversight are needed Nurse Safety Home health nurses face risks not only dealing with driving to their client’s homes but also because of environmental hazards: the nurses must be constantly aware of personal safety and surroundings. Nurses may face instances of family violence, illegal drug activity, or weapons may be present. References Bao, Y., Shao, H., Bishop, T. F., Schackman, B. R., & Bruce, M. L. (2012). Inappropriate medication in a national sample of US elderly patients receiving home health care. Journal of general internal medicine, 27(3), 304–310. https://doi.org/10.1007/s11606-011-1905-4 Manis, D.R., McArthur, C. & Costa, A.P. (2020). Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study. BMC Geriatr 20, 80. https://doi.org/10.1186/s12877-020-1483-6 Megido, I., Sela, Y. & Grinberg, K. (2023). Cost effectiveness of home care versus hospital care: a retrospective analysis. Cost Eff Resour Alloc, 21, 13. https://doi.org/10.1186/s12962-023-00424-0 National Research Council (US) Committee on the Role of Human Factors in Home Health Care. (2010). The Role of Human Factors in Home Health Care: Workshop Summary. Washington (DC): National Academies Press (US); Available from: https://www.ncbi.nlm.nih.gov/books/NBK210063/ OECD (2024), Old-age dependency ratio (indicator). doi: 10.1787/e0255c98-en (Accessed on 07 January 2024) Rector, C. (2018). Community and public health nursing : promoting the public’s health. Wolters Kluwer World Health Organization (WHO). (2024). Life expectancy at birth (years). https://www.who.int/data/gho/data/indicators/indicator-details/GHO/life-expectancy-at-birth-(years)