Home health nursing is a nursing specialty in which

nurses Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ca ...

provide multidimensional

home care Homecare (also spelled as home care) is health care or supportive care provided by a professional caregiver in the individual home where the patient or client is living, as opposed to care provided in group accommodations like clinics or nursing ho ...

to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise

certified nursing assistant Unlicensed assistive personnel (UAP) are paraprofessionals who assist individuals with physical disabilities, mental impairments, and other health care needs with their activities of daily living (ADLs). UAPs also provide bedside care—includi ...

s. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.

History

Lillian Wald Lillian D. Wald (March 10, 1867 – September 1, 1940) was an American nurse, humanitarian and author. She was known for contributions to human rights and was the founder of American community nursing. She founded the Henry Street Settlement in N ...

is recognized as the pioneer of

public health nursing Public health nursing, also known as community health nursing is a nursing specialty focused on public health. The term was coined by Lillian Wald of the Henry Street Settlement, or, Public health nurses (PHNs) or community health nurses "integrat ...

. She established the

Henry Street Settlement The Henry Street Settlement is a not-for-profit social service agency in the Lower East Side neighborhood of Manhattan, New York City that provides social services, arts programs and health care services to New Yorkers of all ages. It was founde ...

which served underprivileged individuals and families. Nurses and social workers that worked at the Henry Street Settlement visited patients in their homes, assessed their health needs, and provided support with hygiene, nutrition, immunizations and more. Wald was able to convince Metropolitan Life Insurance Company to cover home care services. This allowed public health nursing to shift from charitable work to profitable work.

Roles and responsibilities

There is a wide range of services that are performed by many different professionals, services include wound care, disease management, medical equipment, therapy, medical social services, and patient education. Home health nurses have a wide range of duties and services provided, and in addition to services provided nurses also consult with doctors on the status of the patient and provide feedback on any potential changes that need to be made to the care plan. Some responsibilities that home health nurses take on include promoting health and disease prevention, medication administration, educating patients on their current diagnosis, providing emotional support, and providing basic care such as personal hygiene. Nurses also step into the role of case managers, meaning that they coordinate services from different disciplines for the patient. This can include rehabilitation, pharmacy, community resources and more. Providing the most up-to-date and effective care for a patient is also a very important part of a home health nurse's job. They do this by continually keeping up to date on the latest research and

Evidence-Based Practice Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indiv ...

Education and certification

Home health nurses can have a

nursing diploma A Diploma in Nursing or Nursing Diploma is an entry-level tertiary education nursing credential. Background In the United States, this diploma is usually awarded by hospital-based nursing schools. Diploma programs in the United States require ...

, be a

licensed practical nurse A licensed practical nurse (LPN), in much of the United States and Canada, is a nurse who cares for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitio ...

, have an

associate of science in nursing An Associate of Science in Nursing (ASN) is a tertiary education nursing degree which typically takes 2–3 years to complete. In the United States, this type of degree is usually awarded by community colleges or similar nursing schools. Some f ...

, a

bachelor of science in nursing The Bachelor of Science in Nursing (BSN, BScN) also known in some countries as a Bachelor of Nursing (BN) or Bachelor of Science (BS) with a Major in Nursing is an academic degree in the science and principles of nursing, granted by an accredited ...

, or higher. Some executive home health nursing positions such as those in administration or nursing management could require master's level education. Some organizations, like the

American Nurses Credentialing Center The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is a certification body for nursing board certification and the largest certification body for advanced practice registered nurses in the U ...

offer certifications in home health care.

Scope and standards of practice

The scope of home health nursing is directly related to the

nursing process The nursing process is a modified scientific method. Nursing practise was first described as a four-stage nursing process by Ida Jean Orlando in 1958. It should not be confused with nursing theories or health informatics. The diagnosis phase was ...

. This includes assessment, diagnosis, planning, implementation, and evaluation. The standards of home health nursing integrate research, education, proper use of resources, the quality of care provided, team collaboration, and ethical principles.

Pediatric Home Health Nursing

To help reduce cost and improve quality of care for increasing numbers of children with chronic conditions, pediatric medicine is transitioning many patients from hospitalized care to home health management. Home Health Care is often a less expensive and more convenient option for pediatric patients, and discharge to home with home health care has been shown to reduce hospital readmission rates and length of hospital stays, ultimately reducing costs for the patient. There are 2 types of pediatric home health nursing: 1) Skilled Nursing Visits (SNV): intermittent, short visits by nurses to a patients home with the goal of helping the patient and caregivers reach total independence at home. Nurses typically visit the patient to provide monitoring, perform lab work, and administer medications. 2) Private Duty Nursing (PDN): extended, 24-hour care services to patients at home to satisfy long-term care needs of patients who cannot safely live at home with their caregivers without medical care supervision. In a recent study of 2783 hospitalized pediatric patients who were discharged home with home health nursing, 92% of the patients received PDN services, while 8% received SNV, suggesting that PDN is more common in the pediatric population.

Barriers in home health nursing

Home health nursing is a unique field considering the obstacles faced by healthcare professionals. When out visiting clients, the nurse is alone and cannot rely on others most of the time. Nurses in home health care must learn to be

autonomous In developmental psychology and moral, political, and bioethical philosophy, autonomy, from , ''autonomos'', from αὐτο- ''auto-'' "self" and νόμος ''nomos'', "law", hence when combined understood to mean "one who gives oneself one's ow ...

. The variety of home conditions that a nurse will step into can also present problems. Cleanliness and safety play large roles in client care. Not all homes are equipped to provide a clean environment for the client. Environmental issues in the home include unsanitary conditions that allow for bacterial growth and conditions that may increase the risk of falling for the client, such as poor lighting and area rugs. Education regarding this is important for the nurse to share with the client. Medication adherence is also more complicated at home. Unlike in a hospital setting, the medication is scheduled around the clock and readily available. It is really dependent on the client's resources and financial situation. Also, client compliance, or client adherence to the plan of care, factors into client health outcomes.

Eligibility

Home health care is generally less expensive and more convenient then in the hospital. When possible home health care helps regain independence, become more self-sufficient, and maintain current level of function. The primary payer for home health care is Medicare dependent on meeting certain eligibility criteria. Home health services are covered when all of the following criteria are met: # Patient is under the care of a doctor, and getting services under a plan of care established. # A doctor certifies that the patient needs, one or more of the following: intermittent skilled nursing care, physical therapy, speech-language pathology, and continued occupational therapy # Home health agency caring for patient is approved by Medicare # Doctor certifies that patient is homebound # As part of eligibility, a doctor or health care professional must document that they have had a face to face encounter within required timeframe and the reason was related to need for home health care Eligibility for home health care is determined by intermittent skilled nursing care that is needed fewer than 7 days each week and daily less than 8 hours each day for up to 21 days. If skilled nursing care is needed more than this over extended period of time it would not qualify for home health benefits under Medicare guidelines.

References

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