Home care Nursing information and overview
Home care enables the patient and his family to maintain dignity and independence. According to the National Association for Home Care, there are more than 7 million people in the United States who require home health nursing services because of acute illness, long-term health problems, permanent disability or terminal illness.
Basic principles of home care
Nurses practice in a number of locations: hospital environments, nursing homes, residential care centers and home care. Home care nursing is a growing phenomenon as more and more patients and their families want to receive home care. The history of home health care stems from Public Health Nursing, where public health nurses conducted home visits to promote health education and provide treatment as part of community programs. Today, academic programs train home care nurses and institutions place home care nurses with sick individuals and their families, depending on the nurse’s experience and qualifications. In many cases, there is a shared relationship between the agency and the academic institution.
Many changes have taken place in the field of home care. These include Medicare and Medicaid, and long-term care insurance reimbursement and documentation. It is important for the nurse and nursing agency to be aware of the many factors that go into these rules and regulations arising from these organizations. Demographic and population changes are also taking place. Baby boomers are approaching retirement and are posing new challenges for the home care industry. Technology and medical care in hospitals have led to shorter hospital stays and more home rehabilitation. More and more medical outpatient procedures are also taking place with aftercare at home. This has resulted in a reduction in mortality from these technologies and medical care has led to an increase in morbidity and chronic disease, making the need for home health care a higher priority.
Job Description Home Care Nurse
Due to a range of skills and experience, home care nurses specialize in a wide variety of treatments; emotional support, education for patients recovering from illnesses and injuries for young children and adults, for women who have recently given birth, for the elderly who need palliative care for a chronic illness.
A practicing nurse must have the skills to provide care in a unique environment, such as someone’s home. The nurse works with the patient and family and must understand the communication skills for such a dynamic. Reporting is evident in all nursing positions, but working in a patient’s own living space requires a different level of skill and understanding. Decision making is autonomous as the nurse no longer works as a team with other nurses in a structured environment, but now as a member of the “family” team. The host family has cultural values that are important and different for each patient and should be treated with extreme sensitivity. Other skills include critical thinking, coordination, assessment, communication and documentation.
Home care nurses also specialize in caring for children with disabilities that require additional skills such as patience and understanding of the family’s needs. Children today live with disabilities that would have led to death just 20 years ago. Genetic disorders, congenital physical disabilities and injuries are just a few. Many families are familiar with managing the needs of the child, but still require expert care that only a home nurse can provide. To provide good care for the child, it is important that a home nurse is aware of the family’s expertise on the child’s condition. There are many complexities involved, but most importantly, a positive attitude and positive reinforcement are paramount to the child’s development.
Medication coordination between the home care nurse, doctor and pharmacist ensures proper management of the exact science behind giving the right dose, timing of administration and combinations to the patient. Home care nurses should be familiar with pharmacology and should be educated in training about various medications used by patients in the clinical setting.
Many advanced practicing nurses are familiar with medication regiments. They have completed graduate level programs. Home care agencies believe that a nurse should have at least one year of clinical experience before entering home care. Advanced practicing nurses can accelerate that training by helping new nurses understand the home health care market and education.
Employment and Salary
According to the U.S. Department of Labor, there were 2.4 million nurses in America, the largest health care profession, yet many academic and hospital organizations believe there is a major nursing shortage. The nurse shortage was 6% in 2000 and is expected to be 10% in 2010. The median hospital nursing salary is $53,450 with 3 out of 5 hospital nursing jobs. For home care, the salary is $49,000. For nursing homes, they were the lowest at $48,200.
Training and continuing education
Most home health nurses receive their training through accredited nursing schools around the country with an associate degree in nursing (ADN), a bachelor of science degree in nursing (BSN), or a master’s degree in nursing (MSN). According to the United States Department of Labor, in 2004 there were 674 BSN nursing programs, 846 ADN programs. In 2004 there were also 417 Master’s degree programmes, 93 doctoral programs and 46 joint BSN doctoral programmes. The associate degree program takes 2 to 3 years while the bachelor’s degree program takes 4 years. Nurses can also earn specialized professional certificates in Geriatric Care or Life Care Planning online.
In addition, a bachelor’s degree is often essential for nurses who choose to advance into administrative positions or research, consulting and teaching. A bachelor’s degree is also important to become a clinical nurse specialist, nurse anesthetist, nurse midwife, and nurse specialist (US Department of Labor, 2004).
All home health nurses have supervised clinical experience during their training, but as previously mentioned, advanced practicing nurses hold a master’s degree and unlike bachelor’s and associate degrees have a minimum of two years of post-clinical experience. Course work includes anatomy, physiology, chemistry, microbiology, nutrition, psychology and behavioral sciences and liberal arts. Many of these programs have training in nursing homes, public health departments, home health agencies, and outpatient clinics. (U.S. Department of Labor, 2004).
Whether a nurse is training in a hospital, nursing facility, or home care, continuing education is necessary. Healthcare is changing rapidly and keeping abreast of the latest developments improves patient care and health procedures. Universities, continuing education programs, and Internet sites all offer continuing education. One such organization that provides continuing education is the American Nurses Association (ANA) or through the American Nurses Credentialing Center (ANCC).
There are many rewards for becoming a home care nurse. Some rewards include the relationship with a patient and his family, autonomy, independence, and critical thinking. The 21st century brings many opportunities and challenges. We must face these challenges – there is an aging baby boom population, a growing morbidity factor due to increased medical technology and patient care, and the growing shortage of nursing care.
Becoming a home nurse today is exciting and an opportunity to make a life-to-life difference. With clinical experience and proper training, a home nurse will lead the future of medical care.