Home Care: Essential for Dependent People and Caregivers - Essay Sample

Introduction

Home care is essential for dependent people, for those who bear high morbidity loads, for the elderly, and also for their caregivers, because they allow patients to continue in their usual environment as long as possible, fulfilling the express desire of the Majority of the population. Home care is the activity that best represents the essential attributes (longitudinality, integrality, continuity, coordination) of primary care and the one that suffers most when these attributes do not impregnate the activity carried out by primary care teams or when policies are applied clipping. Home care, due to its position of proximity to healthy or sick people, is destined to provide the services and health benefits of the assigned population, widely deploying all the possibilities of longitudinality, especially the commitment of professionals to the population. This commitment implies the establishment of personal relationships over time, allowing nurses to have a broad knowledge of people and their family and social environment, essential knowledge in the context of home care and chronicity care, because it allows a better identification of health problems and a faster application of proactive care, so demanded for this type of patients (Perry, Rassekh, Gupta, Wilhelm & Freeman, 2017).

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Home visits model of healthcare delivery systems solves some of the challenges posed by common healthcare concerns such as the aging of the population, the increase of chronicity, the shortage of beds in clinical settings and rising costs of hospitalization (Clark, 2015). In response to these challenges, home health care becomes an integral part of the healthcare delivery system by reducing the costs of healthcare and increasing the efficiency and the effectiveness of healthcare delivery. In the context of EBP, the effectiveness of homecare is based on clinical evidence as a healthcare model with criteria for efficiency, sustainability, security, and satisfaction. EBP has also indicated that in the current health challenges scenario, where the approach to the patient and the disease are turning from the traditional centralism of the hospital to other models that make the patient the main manager of its care process, home hospitalization plays a fundamental role. Health professionals should, therefore, be committed to home hospitalization and determined to support this very important healthcare delivery model with the conviction that it is necessary to adapt health policies to the inevitable demographic challenge and chronicity that is already a global reality.

The Leadership Role of the Graduate Nurse in the Home Health Setting

Registered nurses (RN) have the obligation of integrating relevant research findings into their nursing practice to provide best practices and optimize the standards of care (Tomblin-Murphy & Rose, 2016). This pertains undertaking, review, and evaluation of the current research and interventions proven effective through systematic reviews and analyzes, randomized controlled trials and studies, non-randomized studies, etc. (Clark, 2015). The International Council of Nurses (CIE) states that nurses must develop and implement health policies at both national and international local levels through the performance of management and leadership functions. It gives them the responsibility to contribute to the planning of health policies, and in the coordination and management of the services of the area. For the CIE, nurse managers must be directly responsible for the management of nursing services because they have the skills to direct these and other health services (American Academy of Ambulatory Care Nursing, 2015). Also, they propose other functions that nurse managers can perform, such as advising other managers on issues that correspond to professional nursing. In this regards, home visitation programs have been advocated as effective strategies in delivering care services to at-risk populations such as women and children.

Graduate nurses are qualified to play a leading role in solving common health challenges. The professionals also understand the significance of collaborating with other healthcare professionals, scientific societies, communities and families in ensuring effective delivery of healthcare. Home care management is incorporated at the core of professional obligation, understood as the professional practice of the nurse based on their professional role and the science of caring (CMSA, 2016). Managing nursing care processes implies that health care is delivered rationally, timely, equitably, and in an economic manner that minimizes risks both to the patient, care team, the community, and that of the patient family.

Contribution of Research and EBP in Effective Home Healthcare Delivery

Home care is characterized by the type and nature of assistance or care provided at the home of patients who, due to their state of health or mobility difficulties, cannot travel to the corresponding Health Center. The technical development that makes available the "mobile" technology (such as oxygen therapy, intravenous devices, monitors, etc.), allows to offer health care at home outside the Health Center or Hospital Centers and to treat the patient comprehensively at different times of the illness (Perry et al., 2017). Also, it helps to know the lifestyles within the family environment, to detect risk situations and to improve the quality of life of the patients. Health care at home means that the health professional carries out their activities outside the Health Center setting, in many cases requiring the revision and updating of the protocols for action in each of the situations that could occur.

For professionals to develop their wide range of activities in professional nursing practice following the scientific and technological advances, Evidence-Based Practice (EBP) is a recognized approach that has shown notoriety to improve effectiveness and support the professional in decision making (CMSA, 2016). From this perspective, the role of the nursing practice in the scope of home care goes beyond the user's health demand and assumes the health responsibility for a given population, and a role of organizing local demand, requiring professionals to have a greater capacity for analysis, intervention and autonomy, closer links between understanding and doing nursing work . Homecare programs such as Nurse-Family Partnerships (NFP) have shown great success in contributing to effective care for low-income mothers (Clark, 2015). EBP combines the best scientific evidence with clinical experience and patient choice. Several authors emphasize that EBP is important to support professional practice, and describe that its implementation is fundamental to achieve efficacy, reliability, and safety in healthcare practices (Clark, 2015). Moreover, results found in systematic reviews demonstrate that EBP contributes to improved quality of care and clinical outcomes of patients, even if several barriers to its use have been identified. NFP programs, for instance, have seen a reduction of neglect and abuse cases and a positive intellectual and behavioral development for both mothers and their children enrolled in the programs compared to other groups (Clark, 2015).

Biomedical advances in the treatments available and the chronification of previously incurable diseases in increasingly long-lived populations lead to an increase in comorbidity, with important consequences both for the health and autonomy of patients and for health systems (Buerhaus, DesRoches, Dittus & Donelan, 2015). These have to face greater organizational complications so that the population receives without interruptions the most appropriate care and in the most pertinent health field. Precisely, comorbidity and advanced age stand out among the epidemiological features of a good part of the population treated in primary care. At an older age, there are more disease burdens. Likewise, the greater the number of chronic diseases, the greater the dependence and need for more assistance. More than 85% of patients receiving home care have a life expectancy of more than 6 months, suffer from incurable chronic diseases and a high prevalence of functional disability (Buerhaus et al., 2015). Some patients have more than 2 chronic diseases in their health biography, depend on different medical specialties, and are subject to frequent diagnostic tests, receive multiple treatments, support more hospitalizations and use more emergency services. Also, the social determinants of health add to the vulnerability of these patients, reducing their autonomy and that of their family. This situation is aggravated at the present time due to the economic crisis and the policies to cut social and health expenditure, which make part of the costs of aid and benefits intended to facilitate care in the home and community environment, with the consequent impact on the health of patients and caregivers, especially the most economically disadvantaged, who are also the ones with the worst health and worst equipment. Home care allows these patients located in the community to receive in their family environment, and their own home, the assistance they need, without fragmentation of care.

Conclusion

Home care models of health delivery have emerged to address the complexity of care involved in the chronicity situation. This healthcare assistance model bases its strategies on the continuity of care, on coordination and the intensive and proactive offer of care within the home setting. Evidence-based practice brings together the best scientific knowledge with the professional's clinical experience and the patient's choice, resulting in a higher resoluteness in health care delivery within the home settings. EBP strategy allows the sustenance of quality care management by making informed decisions through critical analyses, guidelines, and recommendations based on available evidence. EBP uses modern and best-practice evidence to determine the care of individual patients in a serious, clear, sensible, and rational manner with the core idea that medical decision-making should be based on the best clinical research available, while also focusing on the individual's clinical experience. Within the context of home care, it is an emphasis on evidence-based healthcare, mainly to compensate for the shortcomings of the empirical medical model that has long dominated the field of clinical medicine. The approach avoids too many subjective inferences, intuitions, and assumptions, thus making nursing practice more effective and efficient.

References

American Academy of Ambulatory Care Nursing. (2015). SCOPE AND STANDARDS OF PRACTICE FOR REGISTERED NURSES IN CARE COORDINATION AND TRANSITION MANAGEMENT. AMERICAN ACADEMY OF AMBUL.

Buerhaus, P. I., DesRoches, C. M., Dittus, R., & Donelan, K. (2015). Practice characteristics of primary care nurse practitioners and physicians. Nursing Outlook, 63(2), 144-153. Retrieved from < http://dx.doi.org/10.1016/j.outlook.2014.08.008>

Clark, M. J. (2015). Community health nursing. Prentice Hall.

CMSA (2016). Standards of Practice for Case Management. Retrieved from <https://www.miccsi.org/wp-content/uploads/2017/03/CMSA-Standards-2016.pdf>

Perry, H. B., Rassekh, B. M., Gupta, S., Wilhelm, J., & Freeman, P. A. (2017). Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 1. rationale, methods and database description. Journal of global health, 7(1). Retrieved from < doi: 10.7189/jogh.07.010901>

Tomblin-Murphy, G., & Rose, A. E. (2016). ICN Policy Brief Nursing Leadership in Primary Health Care for the achievement of Sustainable Development Goals and Human Resources for Health Global Strategies. Retrieved from...