Abstract
Home Health Nursing has been a dedicated profession since the introduction of visiting health nursing profession in 1916. The practice has been widely appreciated; particularly in treating those patients who suffer with some chronic ailment and prefer their medical aid to be taken at their homes. Home health nurses visit their homes and meet their needs, as required and desired by them to soothe themselves. The profession is now supported with proper guidance teams which include physicians, social workers and technicians, and thus there is a good scope of home health nursing in the coming future too.
Meeting the Needs of Chronically Ill by Home Health Nurses
Nursing has been a dedicated profession ever since the medical technology was not devised or was incorporated appropriately. They provide efficient and effective care management to the patients suffering from any illness, trauma or an accident and get engaged in their problems as if these are their own. Since it entirely depends upon them to look after the patient in the hour of need or during routine, they must have to be as professional as a physician and must be equipped with essential knowledge of study and practice. Therefore, nursing practice educational programs are now being designed by universities so as to provide effective learning to the individuals who want to adapt nursing as a profession, which help them in developing and polishing their skills on the basis of knowledge along with their practical experience (Dyer and Taylor, 2011).
Apart of usual nursing practice at hospitals and clinics, nursing professionals are provided home health care management techniques for the treatment of those who have been suffering from any chronic ailment, need to keep their privacy and independence as well as for those who get discharged from the hospitals but need medical care for some period of time. There have been quite a large number of patients only in US who receive home health care services, out of whom a majority is comprised over those patients who are chronically ill. It is estimated that more than 75% of the total medical expenditure is only composed of chronic medical care of the patients at homes. The patients may vary according to their ailment; but typical chronically ill are those who have liver cirrhosis, chronic bronchitis and asthma, problems with circulatory system which congest the heart, depression or hypertension etc. almost half of the American population suffers with some of these chronic diseases and about one-third of them get disable because of these. It is miserable to note that a quarter of this population suffers with more than two chronic diseases. The statistics include 23% who have more than five chronic diseases and 43% who have three or more of such ailments. Therefore for the betterment and effective health management of these people, the profession of practicing home health nurse has been widely appreciated and needed all over US since they provide guidelines and expertise to such patients in the comfortable environment of their homes. It is because of their management strategies that patients suffering with chronic diseases live the terminating days of their lives in content, without suffering from much pain or problems (Improving Chronic Illness Care, 2013).
Role of Home Health Nurses in Treatment of Chronically Ill
Home health nurses keep visiting their patients regularly and provide medical care to their patients by keeping their desire and requirements in view; particularly those patients who are suffering with some chronic ailment and want to spend time with their families happily. Since the services and facilities which are provided in a hospital cannot be managed at home, therefore a home health nurse must have knowledge and information about treatments possible at home. Some common of these include medications, dressing, mild exercise and therapy, injections including both intra-muscular and intra-venous dose, preparation of effective diet plans, adjoining and removal of external equipment such as catheters, collection of blood, urine and other types of specimen for laboratory diagnosis etc. Apart of all these professional training techniques, a home health nurse does effectively counseling of both the patient and his/her family for home care strategies. The patient is advised with self-care and management techniques so that they become able to take care of them to some extent. For this purpose, a home health nurse must have sufficient communication skills and the ability to teach patient and the family members so that effective and active care could be taken of him/her (Home Health Nursing, 2013).
Benefits of Home Health Nursing in Treatment of Chronically Ill
A research conducted by University of South Australia reveals some astonishing facts about the patients who receive home health care. It becomes evident through research that there have been fewer deaths and hospital admissions of those chronically ill patients who receive home-based medical care instead of usual hospital care. Patients who have chronic bronchitis and heart congestion are likely to live more when they are served at homes. 528 patients were randomly selected for the research purpose for the overall period of 7.5 years, which include those who were discharged from the hospitals but were regularly attended by a home-health nurse and those who undergo usual checkups through appointments and visits by home nurse when required. Out of 528 patients, 260 received home-based interventions by a medical practicing nurse and the remaining 268 took usual medical care after getting discharge from the hospital. It was revealed that because of effective home-based strategies which include physical and psychological treatments, arising self-case behaviors within patients, strict adherence with both oral and injective medications and other related services; a 32% reduction in re-admissions in hospitals occurred as compared with those patients who received usual medical care (USA, 2009).
It was also revealed that home-based health care has proved to be less costly than health care provided at hospitals. The total cost over any unplanned home-based intervention HBI was $3.3 million, while it was $4.8 million in the case of hospitalization. Thus HBI proves to be cost effective and there must be more of such chronic disease management programs so as to serve those who are chronically ill and have lesser chances of survival. Although many of such patients are severely ill and cannot participate in self-care programs, yet HBI stresses on individual attention and take care along with sympathetic regards for the patient which helps him to gratify the surviving moments of his life (USA, 2009).
How Home Health Nurses can meet the needs of Chronically Ill?
Taking regard of all these advantages and benefits of home-health care services, it is important to understand how such miracles could be done with chronically ill patients. Typically, a home-health nurse is provided with guided-care strategies to incorporate with the patient so as to ensure maximum possible positive outcomes. After successful discharge from the hospitals, home-health nurses are responsible for educating patient about self-care and disease management at their homes and to collaborate with other people of the community so that the patient is provided with a better environment as compared with a hospital. Home-health nursing has been in the scenario for decades, but today they home health service providers with the collaboration of corresponding physician to manage the condition of chronically ill more effectively. Since physician cannot go door to door for educating patients and to provide them with necessary support and guidance, this duty is performed by home-health nurses, who not only take care of the patient but also act as eyes and ears of the physician to reduce the chances of hospitalization and severe illness (Zabell, 2009).
In nursing practice for chronic care, the best considered Chronic Care Model CCM was devised by Edward H. Wagner, M.D. Wagner served as the senior investigator at Group Health Research Institute, Seattle and as director of chronic health care innovation programs. CCM has proved its efficiency in the health care settings since it saves the cost of hospitalization and at the same time effectively improves health condition. The key points of this model are:
1) Providing effective self-management support
2) Redesigning the delivery system such that the need for a physician becomes as much less as possible
3) Providing effective guidelines which must be evidence-based and fit to the condition of the patient
4) Collecting information from patients themselves for the purpose of monitoring and evaluation
5) Communicating with patient’s family and community to provide resources which can encourage healthy living for the patient
6) Lastly, home health nurses must be provided with incentives for the purpose of information and monitoring, so that they perform their duty efficiently (PHA, 2013).
The CCM by Wagner, along with other related models have proved their effectiveness and are implemented on a large scale to achieve best results, by improving the condition of chronically ill. With the intervention of new and modern technologies and revised medical strategies, home-health care has also reformed its shape. Now, it is not the sole duty of the nurse to provide medical assistance and support to the patient, rather a team of professionals is accompanied by him/her to provide coordinated care. Hence the well-familiar phenomenon of division of labor is now being incorporated into the field of medical practice as well. The team consists of physicians, nurses, therapists, social workers and other technicians to serve the chronically ill as much as possible and to do effective chronic care management. In this way, the patient has been made comfortable with a one-on-one setting in the home-environment and almost all of the facilities present at hospitals are taken at his/her door-step (PHA, 2013).
Future of Home Health Nursing
Thus to conclude, the future of home-health nursing is overall promising since there have always been a need for someone sympathetic and supportive with the information of necessary guidelines to serve the ill. And when there has been a significant number of chronically ill throughout the country and in entire world, home-health nursing is being praised and appreciated on a large scale. More incentives are now being awarded to individuals associated with this profession and there is a wide scope of knowledge and information; since now the nurse is not alone to handle the entire matters of the patient. They are now a part of the team for effective chronic care management so as to maximize its benefits. In this way, the practice has now become patient-centered and remarkable improvement has been observed in the health outcomes of chronically ill individuals. It is expected that the next ten years will bring certain and drastic changes in home health nursing practice, since there has been an invoke of technology and people from different professional backgrounds such as technicians, social workers and psychologists in the field of home health care, which can make the whole impression quite positive and overwhelmed. The practicing operations are now being conducted in easier ways than in the past, and with the incoming of more technological gadgets over the course of time, home health nursing will be impacted in an overall positive way (Madigan, 2012).
References
Dyer, M. A. and Taylor, S. M. (2011) Supporting professional identity in novice practitioners through reflective practice. In: Paper presentations of the 2010 University of Huddersfield Annual Learning and Teaching Conference. University of Huddersfield, Huddersfield, pp. 21-33.
Home Health Nursing. (2013). Nursing Degree Guide. Retrieved on June 1, 2013 from
<http://www.nursingdegreeguide.org/articles/specialties/home_health_nursing/>
Improving Chronic Illness Care. (2013). Improving Chronic Care: Helping the Chronically Ill through Quality Improvement and Research. Retrieved on June 1, 2013 from
<http://www.improvingchroniccare.org/>
Madigan, E. A. (January 01, 2012). Views on the future of nursing and home healthcare: the future of nursing for home healthcare. Home Healthcare Nurse, 30, 3, 149-51.
PHA: Pennsylvania Home Care Association. (n.d). Home Health’s Role in Chronic Care Management’. Retrieved on June 1, 2013 from <www.pahomecare.org/pdf/Whitepaper_Final.pdf>
USA: University of South Australia. (2009). Proven benefits for chronically ill treated at home. Retrieved on June 1, 2013 from <http://w3.unisa.edu.au/researcher/issue/2006march/story4.asp>
Zabell, P. (January 01, 2009). Positioning Your Agency With Value And Collaboration For Chronic Care Models. Remington Report, 17, 4, 5-7.
