community response

Clinical reflection

Home health nursing is different from inpatient settings as in the nurse visits the patient at their residence to provide optimal care. Home health services are extended to patients disregard of their living conditions, socioeconomic status, race, color, employment or education.an important point to note is that they must be homebound in order to receive home health. Nurses visit the patients wherever they are, which even includes hotels, nursing homes, state school or hospice. The service usually covers a radius of 70-80-mile. The normal case load is about twelve. They do routine visits, twice a week or daily visits. They provide services like supplying medical equipment’s, medications, assessments of patient and living conditions optimal for patient health, education on medication adherence and health monitoring. They provide end of life care to patients as well as their family members. They also provide bereavement services. If the patient is young, they start it early in order to help family with better coping.

The population of clients the home health services serve are all patients who have 6 months or less to live or patients with chronic illness that are homebound. They reevaluate the client’s 90 days after the end of the 6 months period and then every other 60 days. The physician determines if the client is eligible for hospice and thereby home health. Hospice is care provided to terminally ill patients and once the symptoms of the disease are under control, they can live in their residency to promote more independence, privacy and comfort. As mentioned earlier, care is provided disregarding age, gender, color, ethnicity, socioeconomic background or education. The population mostly enrolled for this service are older adults above 65 years who are homebound with chronic illness.

Nurses visits the patients at their residency, does a physical, emotional and home assessment. They check vitals, prescriptions, ask pertinent information such as bowel habits, urination, intakes and outputs and so on. They even fill the medication/pill box ahead for two weeks. This helps the client with medication adherence, having difficulty memorizing all the meds and it also saves time.

The health-related problems the nurses at this service mostly see are end-stage cardiac diseases, cancers and end-stage respiratory diseases. The main goal of the nurses is to continue medications as prescribed and provide as much as end of life support. These patients are brought back to inpatient hospice when symptom management at home is not possible or there are IV medications needed which cannot be managed at home. The interprofessional team consist of nurses, case managers, social workers, nurse practioners or family doctor or hospice physicians, physical therapist, occupational therapist, speech therapist and pharmacist. The patients also get services like the chaplain, volunteers (to read, cook at home, help with groceries), aid services (bath, linen change, groom) and sitters. They sometimes do team visits.

The home health nurses are on a 24 hour on call when scheduled. Their working routine involves the following: checking the assigned patients’ diagnosis and needs, preparing meds and supplies to take for the clients, driving to their location and providing the necessary care. An average time the nurse takes to provide care is about 30-40 minutes. They have standing orders in place such as meds for constipation (enemas, milk of mag, laxatives), breathing treatments (albuterol, prednisone nebulizer), anxiety (lorazepam), nausea and vomiting (Zofran, Haldol), dry mouth (mouth wash) increased secretions (atropine drops) and wound care. They also teach caregivers about safety and check if they are compliant.

Home care services can be paid directly by patients and their families or through a variety of public and private sources. Sources for home health care funding include Medicare, Medicaid, the Older Americans Act, the Veterans Administration, and private insurance. Majority of the funding is from Medicare and then third-party insurance. Home health services is funded by the state.

There are some ethical dilemmas involved in home health nursing. As stated in the journal, “Four main ethical concerns emerged from the interviews with the visiting nurses who care for older people in community-based settings: quantitative performance rather than quality care, clients being invisible, tuning the level of the relationship with clients, and facing the visiting nurses’ own limitations” (Choe, Kim & Lee, 2015). This means that the service provided should not be based on the number of clients a nurse visits a day but instead the quality of care that the nurse provided. There are instances when it is not just patient centered care, but family centered. As the client is at home, the nurses need to acknowledge the family’s needs as well. It can be emotional or even decision making. It would be safer for nurses to have a tracking device or technologies like that for their self-protection. Some of the places are very secluded and has bad neighborhoods. This might ensure that the nurses are safe and has means for safety under emergency.

Reference

Choe, K., Kim, K., & Lee, K.-S. (2015). Ethical concerns of visiting nurses caring for older people in the community. Nursing Ethics, 22(6), 700–710. https://doi.org/10.1177/0969733014542676