Home Based Care (HBC) is the provision of basic nursing care needs by formal or informal caregivers to people in their own homes. This service is available to people who have mental, physical, emotional and social needs. Among people who qualify for this care are those who have had strokes, who are living with HIV/Aids, who are physically or mentally challenged, frail older persons, or those who are terminally ill. The care given is meant to restore and maintain the individual’s maximum level of comfort, function and health, including care towards a dignified death.
Registered nurses constitute the largest health care occupation with 2. 4 million jobs in the US. Services provided Visiting registered nurses provide skilled care at home for those who are ill or recovering from an illness or injury. These nurses specialize in IV care, diabetic care, hypertension and congestive heart failure management and forced CVA (Stroke) care. The Visiting Nurse Service Wound Care Management Program is designed for patients with wounds who are discharged from the hospital or referred by their doctors for home care.
Some of the services provided are for patients who have Pressure ulcers, Venous ulcers, Arterial ulcers, Diabetic and Neuropathic ulcers, Abdominal stomas, Drains, Fistulas, Incontinence, Percutaneous tubes, Surgical wounds. In addition to these services physical therapists, occupational therapist, registered dieticians, homemaking/ companions, medical social workers, home health aides and home health assistants are also provided. Procedures The procedures that the Wound Care Team offers to patients are:
? Evaluation of patient and family support systems in the home ? Case management of complex wound patients ? Consultation and evaluation of the wound healing process ? Risk assessment for prevention of skin breakdown ? Skin and wound care management training ? Non-surgical assessment of blood vessels in the lower leg ? Medication teaching ? Documentation of wound’s progress towards healing with use of digital cameras ? Ongoing communication with the physician ? State-of-the-art topical treatment for wounds (Visiting Nurse Service).
Duties and Responsibilities of Homecare / Visiting Registered Nurses Preparation of Nursing Care Plans: This includes assessing the patient’s psychological and physical condition. Assessing treatment needs and developing a nursing care plan including such things as physical care, psychological care, teaching plan and discharge plan. Prioritizing and carrying out therapeutic treatment prescribed by the nursing care plan and evaluating response to treatment. Direct or Indirect Patient Care. Typical tasks include preparing appropriate equipment for patient care (i.
e. IV’s monitors), assessing patient’s physical and emotional condition and initiating interventions according to identified nursing care priorities. Collaborating with others in providing client services, administering medical and nursing regimens including medication, treatments, dressings, IV’s, traction, assisting with surgery, monitor log and evaluating vital signs. Placing a variety of catheters and suctioning. Assessing potential transplant donors and make “accept or reject” decision, operating and monitoring sophisticated medical equipment.
Assisting the patient in activities of daily living, evaluating effectiveness of care and adjusting accordingly. Initiating cardiopulmonary resuscitation or other emergency response activities, evaluating and carrying out physician’s orders, coordinating all patient health services by communicating with nurses, doctors, pharmacy, laboratories, physical therapy, occupational therapy, respiratory therapy, dietary, and social services; may have some security responsibility over mentally ill patients.
Responding to calls. 3. Documentation/Agency Duties. Typical tasks include keeping accurate legal written records through charting, nursing care plans, and case records of such things as: patients’ health status and any changes; treatments; medications administered; unusual incidents involving patients and patient education; all data pertaining to surgery such as time patient entered operating room, time operation begins.
Position of patient during surgery, diagnosis, supply counts for billing purposes; objective data such as patient requests or instructions to nursing staff on following shift; laboratory data, known allergies; height; weight; vital signs; documentation of preoperative care and procedures. Attending and participating in meetings with State and county health officials and Department Directors, physicians, staff to discuss current issues; reviews and audits agency and departmental techniques and procedures being followed. 4. Education.
Typical tasks include educating patients and their families about their Illness or disease process, pre and post operative process and orientation. Educating patients and/or their families in post operation care such as how to bathe, clean wounds and change dressings, feedings, suction and care for tracheotomies, care for sutures and catheters, taking vital signs and glucose levels, mobility, skin care, pain control, medication administration such as insulin or antibiotics, operation of home monitors, CPR for parents of premature babies, parenting skills, breast feeding, contraception, nutrition, and diet.
Participating in providing learning experiences for nursing students and students from other health disciplines when appropriate. Facilitating orientation of new nursing staff, giving presentations in staff meetings or in-service training sessions on new or specialized procedures or health care techniques; may speak to hospitals, community groups, health care agencies, church groups and schools to provide education on current practices, procedures and medical breakthroughs. 5. Charge Responsibilities.
Typical tasks include making patient assignments to nurses and other health care staff matching the level of skill with the illness of the patient and distributing the patient caseloads as evenly as possible. Observing staff performance; resolves interpersonal problems between staff; assigns new patients to rooms, adjusts staff according to changing workloads; projects staffing needs for oncoming shift; verifies hours for payroll; transcribes and verifies physicians’ orders. (Visiting Nurse Services)
Importance of Homecare / Visiting Registered Nurses In terms of cost to government, it was found that home care costs less than residential care for all levels of care. The potential savings are even greater for home care clients who are in a stable health condition. In terms of overall societal costs, it was found that home care costs less than residential care for all levels of care even taking into account the out-of-pocket expenses of clients, family members and other caregivers as well as the time of family caregivers.
The clients were also satisfied with their quality of life and with the services, they received. The Johnson & Johnson Home-based Care Program, developed and implemented with HIV South Africa, helps the greater Soweto region cope with the increasing number of HIV patients being cared for at home. With the pace of today’s world, the aged and children are left behind, as they are the ones who need the most care. Home based care provides services for the aged and the children, which goes a long way in freeing up time for loved ones.
In addition to this, there is the cost advantage when it compared to a full time stay in the hospital. This also frees up hospital beds for patients in need of critical care. Thus, homecare and visiting registered nurses provide a vital service to society and are an important part of it.
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