The Essence of Home Health Nursing

Introduction

Home health nursing differs from clinic-based care since the nurse finds herself in a different environment and makes more independent decisions. Home health nursing can be an enriching experience if the nurse has the knowledge and personality to provide effective and safe care. This paper aims to analyze home health nursing aspects, including nursing roles, responsibilities, the scope of practice, ethical considerations, and possible errors.

Nursing Theories

Home health nursing often involves communication with all members of the patient’s family. Therefore, when working as a nurse at home, Family Nursing Theories are most appropriate. One of the first Family Nursing Theories is Nightingale’s theory of 1859, which the family is perceived as an institution that can positively and negatively influence the patient (Kaakinen et al., 2018). This theory also implies that a family supports its members during the lifespan.

Another more recent theory is Denham’s Family Health Model of 2003. Here, family health is approached through contextual, functional, and structural domains. Besides, it admits the existence of family health routines, “behavioral patterns that reflect self-care, safety and prevention, mental health behaviors, family care, illness care, and family caregiving” (Kaakinen et al., 2018, p. 73). These theories can be applied to develop better treatment plans that consider health issues in the context of family support. The scientific guidance that the nursing theories provide for nursing practitioners allows them better understand their patients.

Historical Nursing Figures

Florence Nightingale was a British social reformer who founded modern nursing. She was deeply shocked by the conditions in which the wounded soldiers were held in the Crimean War, where she went to provide nursing care (Florence Nightingale, n.d.). Florence Nightingale has set the norm for nursing patient care, including standards for the hygiene, fresh air, daylight, and nutrition. She has made tremendous contributions to the science of wound care and trauma management. Nightingale presented her ideas and opinions in the books “Notes on the Hospital” and “Notes on Nursing.”

Margaret Sanger was an American nurse, birth control educator, and community activist. She popularized the term “birth control” among the United States’ indigenous people, contributed to the legalization of contraception, and spoke out against unsafe abortion (Margaret Sanger, n.d.). The contributions of both distinguished nurses cannot be overestimated. Today their ideas are applied in home health nursing: Nightingale’s standards of hygiene are used in caring for all patients, and her practices have become the foundation of the science of wound and trauma care. Sanger’s birth control methods are now widely used in family counseling, including home counseling.

Roles of ANA and State Board of Nursing

The mission, functions, and goals of the Minnesota State Board of Nursing include protecting public health and safety. These functions are carried out by regulating the training, licensing, and practice of nurses. The statutes of the Board govern licensing, discipline, and program approval. The Board promotes community awareness, nursing education, and community partnerships “including care consumers, nurses, employers, educators, government agencies and legislators” (Mission functions and goals of the Board, n.d.). One of the American Nurses Association (ANA) functions is promoting and advocating for the nursing profession (Scope of practice, n.d.). ANA is the institution representing registered nurses (RNs) in the US; it has 54 associations. Another function of the ANA is establishing standards in nursing practice, protecting the rights of nurses, and improving their welfare and economic security.

Home health nurses have to be licensed as required by the State Board of Nursing. The American Nursing Certification Center, a subsidiary of ANA, is the primary licensing and certification agency for nurses. The license is valid for two years, and nurses must complete 12 contact hours of continuing education during 24 months for LPNs and 24 contact hours for RNs to renew. Failure to renew the license before the expiration date may result in the license becoming lapse. In that case, the nurse has to complete the reinstatement application and pay additional fees.

The Nursing Licensure Compact allows nurses to practice in 34 compact states that signed the agreement. These are states: Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming (Gaines, 2020). Minnesota is not a compact state; therefore, the license obtained for practice in Minnesota is valid only within the state. There are no other differences between nursing license requirements between the compact and the non-compact states.

Advocating for Safety

The Food and Drug Administration (FDA) regulates the quality of food, prescription, and non-prescription drugs, vaccines for people, alcohol, tobacco, water, cosmetics, veterinary products, and medical devices (What does FDA regulate, 2020). Consumers may find FDA acronyms and abbreviations for FDA-tested products. Medicare and Medicaid Services are created for the population to get medical services. The Medicare A plan is hospital insurance that covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home health care. The Medicare B plan is medical insurance that covers doctor and other health care providers’ services, outpatient care, durable medical equipment, home health care, and some preventive services. Medicaid is a federal and states funding program that meets basic population medical needs. It covers the medical services for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities.

FDA is critical in ensuring that home health care nurses work with safe medical equipment and drugs. Medicare and Medicaid programs allow millions of Americans to receive the covered medical services, including home health care. Sometimes patients request alternative therapy that may include some herbal remedies, non-prescription drugs, or foods. In that case, the home health nurse has to check whether the treatments have FDA certification and will not cause side effects due to the patient’s health conditions.

Scope of Practice

Nurse Practice Act in the state of Minnesota implies that registered nurses (RNs) have a wide scope of practice, including providing an assessment of the health status of a patient, collaborating with the team, developing nursing interventions, implementing nursing care, delegating nursing tasks, providing the safe care, promoting safe and therapeutic environment, advocating for patients’ interests. Noteworthy, the state of Minnesota defines delegation for the RN as “implementing interventions that are delegated, ordered, or prescribed by a licensed health care provider” or “delegating nursing tasks or assigning nursing activities to implement the plan of care” (Minnesota Board of Nursing, n.d.). Besides, RNs evaluate responses to interventions, design and implement teaching plans, and supervise nursing practice.

Roles of Nurses

Nursing research can be even more beneficial than medical research since nurses spend a lot of time with patients and have wide access to patient and nursing environment data. RNs’ duties include planning interventions and evaluating the responses. Since many RNs work in home health, they can collect the data, analyze them and develop better approaches to patient treatment. Interestingly, some nurses call themselves detectives since there is a lot in common in the work of detectives and LPNs, RNs, and APRNs.

Just like detectives, home health care nurses must be knowledgeable, have an eye for detail, read people’s faces, make notes, be tech-savvy and value their team. Another role of the home health care nurse is creating a healing environment. Nurses need to understand how the environment affects their patients and how changes in the environment can reduce stress and anxiety. A vast body of research confirms that a caring and healing environment allows patients to recover faster and be more satisfied with the healthcare services.

Ethical Considerations

American Nurses Association Code of Ethics for Nurses has nine provisions. Two of them are specifically connected with the practice of home health care nurses. The second provision says: “The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population” (ANA Code of Ethics for nurses, 2015). It means that nurses should consider their patients’ interests first and do everything to help patients meet the nursing goals. Then the fourth provision adds: “The nurse has authority, accountability, and responsibility for nursing practise; makes decisions; and takes action consistent with the obligation to provide optimal patient care” (ANA Code of Ethics for nurses, 2015). It means that in case of a nursing error, the nurse carries full responsibility for the consequences. For example, if a nurse accidentally prescribed the wrong dose of drugs, she may face criminal responsibility if the consequences were severe. However, the nursing practice usually attracts determined individuals who are very attentive to patients and nursing decisions.

Leadership Qualities

Nurses are responsible professionals who provide care for patients, and they are team players. Therefore, they should demonstrate leadership qualities like emotional intelligence, integrity, critical thinking, and communication skills. As a leader at the bedside, the nurse often has to demonstrate confidence to support patients and ease their worries (Becoming an effective nurse leader, 2021). Emotional intelligence allows the nurse to determine the patient’s emotional state and needs, and integrity is essential for trust relations. Besides, critical thinking allows the home health nurse to make the right interventions and provide comprehensive treatment. Finally, communication skills are necessary to communicate with patients and family members. The listed leadership qualities are also crucial if a home health nurse works with a nursing or interdisciplinary team. Emotional intelligence and communication skills ease the group communication, while integrity and critical thinking will provide well-thought-out treatment decisions.

Home health care implies that patients receive treatment in a specific environment, different from traditional hospitals and clinics. It may be challenging for nurses to demonstrate leadership in that case since she will be alone, without her colleagues’ support. Besides, it is harder to make decisions when there is no advice from the team members. On the other hand, nurses can find out more information about patients and their health issues. Fortunately, home health nursing can be a good platform for professional development since, in such a setting, the nurse has to take on more responsibilities and make independent decisions.

Conclusion

Thus, essential aspects of home health nursing were analyzed, including nursing roles, responsibilities, the scope of practice, ethical considerations, and possible errors. At home, nurses do the same work with patients as in clinics, but in an environment that may be challenging due to isolation from other members of nursing and interdisciplinary teams. Besides, home health nursing is characterized by more prolonged and more attentive contact with patients, which can be a positive factor in making better treatment decisions.

References

ANA Code of Ethics for nurses. (2015). Web.

Becoming an effective nurse leader. (2021). Web.

Florence Nightingale. (n.d.). Web.

Gaines, K. (2020). Compact nursing states list 2021. Web.

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.

Margaret Sanger. (n.d.). Web.

Minnesota Board of Nursing Nurse Practice Act. (n.d.). Web.

Mission functions and goals of the Board. (n.d.). Web.

Scope of practice. (n.d.). Web.

What does FDA regulate? (2020). Web.

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