HTM 038 LEC 6-7

INTRODUCTION TO HOME NURSING

Definition of nursing home

A public or private residential facility providing a high level of long-term personal or nursing

care for persons (such as the aged or the chronically ill) who are unable to care for themselves

properly

Scope and standards of practice

The scope of home health nursing is directly related to the nursing process. 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.

The nursing process

Definition: Nursing Process is a tool or method for organizing and delivering care or a deliberate

intellectual activity where by the practice of nursing is approached in an orderly systematic

manner. It is a systematic problem solving approach to client care. It is a series of planned steps

and actions directed toward meeting the need and solving problems of people and their

significant others; it is systematic, scientific problem solving in action

Purpose of Nursing Process:

1. To identify clients health care needs

2. To establish nursing care plan so as to meet those needs

4. To provide individualized care

Step of the Nursing Process

The nursing process has five steps:

1. Assessment – the systematic collection of data to determine the patient’s health status and to

identify any actual or potential health problems. In nursing assessment the best sources of

information about the client are the client and the family. Health professionals, previous client

records and significant others also act as information sources. Data collected about a client

generally fall into one of the two categories: objective or subjective

Objective data include all the measurable and observable pieces of information about the client

and his or her overall state of health. The term objective means that only precise, accurate

measurements or clear descriptions are used.

Subjective data consists the client’s opinions, feelings about what is happening. Only the client

can tell you that he/she is afraid or has pain. Sometimes the client can communicate

through body language: gesture, facial expressions and body posture. To obtain subjective data

you need sharp interviewing, listening, and observation skills.

Methods of data collection

A.Observation is an assessment tool that relies on the use of the five senses (sight, touch,

hearing, smell and taste) to discover information about client.

B .Health interview- the health interview is a way of soliciting information from the client. This

interview may also be called a nursing history.

(Analysis of data is included as part of the assessment. For those who wish to emphasize its

importance analysis may be identified as a separate step of the nursing process.)

2. Diagnosis – identification of the following two types of patient problems:

a) Nursing diagnosis – actual or potential health problems that can be managed by independent

nursing interventions.

Purposes of the Nursing Diagnosis- the nursing diagnosis serves the following purposes:

• Identifies nursing priorities

• Directs nursing interventions to meet the client’s high priority needs

• Provides a common language and forms a basis for communication and understanding between

nursing

professionals and health care team.

• Guides the formulation of expected outcomes for quality assurance requirements of third party

payer.

• Provides a basis for evaluation to determine if nursing care was beneficial to the client and cost

effective.

• Is of help when making staff assignment.

The diagnostic statement The client may present with more than one problem. Therefore, the

nursing diagnosis may be made up of multiple diagnostic statements. Each diagnostic statement

has two or three parts depending on the healthcare facility. The three-part statement

consists of the following components:

• Problem
• Etiology

• Signs and symptoms,

A two-part diagnostic statement consists of the problem, and signs

and symptoms.

Problem

The problem portion of a statement describes- clearly and concisely health problem a client is

having.

Etiology

The etiology part of the diagnostic statement is the cause the problem. Etiology may be

physiologic, psychological, sociologic, spiritual, or environmental.

Sign and symptoms

The third part of the diagnostic statement summarizes data. You may need to include several

signs and symptoms. For instance, the client with pneumonia had cough with

thick sputum, abnormal breath sounds, increased respiration, and difficulty breathing.

Writing the Diagnostic Statement

The diagnostic statement connects problem, etiology, and signs and symptoms. The first two

parts of the statement are linked by” related to,” sometimes abbreviated R/T. The last two parts

are linked by “as evidenced by,” sometimes abbreviated AEB.

E.G. Ineffective Airway Clearance related to physiologic effects of pneumonia as evidenced by

increased sputum, coughing, abnormal breath sounds, tachypnea, and dyspnea..

the diagnosed problems. Setting priorities, establishing expected outcomes, and selecting nursing

interventions result in plan of nursing care.

Setting priorities

Nursing diagnoses are ranked in order of importance. Survival needs or imminent life threatening

situations takes the highest priority. For example, the needs for air, water and food are survival

needs. Nursing diagnostic categories that reflect these high priorities needs include Ineffective

Airway Clearance and deficient fluid volume.

Establishing Expected Outcomes

An expected outcome is a measurable client behavior that indicates whether the person has

achieved the expected benefit of nursing care. It may also be called a goal or objective.

An expected outcome has the following characteristics:

• Client oriented

• Specific

• Reasonable

• Measurable

Selecting Nursing Intervention

Nursing intervention is also called nursing orders or nursing actions, are activities that will most

likely produce the desired outcomes (short-term or long-term). To achieve this outcome, one

should select nursing interventions such as the following examples:

• Offering fluids frequently

• Positioning frequently

• Teaching deep breathing exercise

• Administering oxygen, etc. accordingly.

4. Implementation – actualization of the plan of care through nursing interventions.

5. Evaluation – determination of the patient’s responses to the nursing intervention and the

extent to which the goals have been achieved.

Importance of Home Nursing

Home nursing is important because it is a more personal and intimate form of care. The

professional caregiver provides the patient with customized care that specifically satisfies the

needs of the person. Home nursing allows the caregiver to spend more quality time with the

patient.

Home is the best place for many people, so patients feel much better when taken care of at home.

It provides a warm and safe environment and a reminder of comfort and love. Unlike in health

care facilities, home care is more personalized and readily available to the sick person. Patients

under home care may not necessarily have to wait, as is the case with institutional centers where

a caregiver is responsible for several patients.

This form of nursing is also convenient for family members, as they don’t have to patronize the

hospitals to see their loved ones. At the same time, family members ensure that the sick person

receives standard level care at home. The amount of support provided by family members may

help the patient to recover and assume his independence faster than in health care centers.

Home nursing refers to caring for a sick person from home. A family member, friend, relative or

professional caregiver commits himself to look after the patient and to aid him do things by
himself to improve his confidence and recuperation. It focuses on the general welfare of the

patient including the overall health and needs of the sick.

Fundamentals of home Nursing

The art and science of modern nursing encompasses fundamental nursing concepts that include

health, illness, stress and health promotion. Nurses work with physicians and other medical staff

in a wide variety of medical and community settings. They provide preventive, primary, acute

and chronic care for sick and injured patients with health information, restorative care,

medication administration and emergency care. Nursing care focuses on protecting and

promoting physical and mental health for patients and for the community.

a.Health

Health is the absence of illness, injury and disease. Health as a fundamental nursing concept

involves both mental and physiological well-being, and it changes over a patient's lifetime.

Nurses work in health care to promote and protect health by instructing patients about self-care,

and about how lifestyle and behavior affects their health. They help people to recover from

physical and mental illness, and they tend to sick and injured patients to restore health.

b. Illness

Illness is a fundamental nursing concept that defines a deviation from health with three stages:

the onset of illness, the acceptance of the state of illness and the convalescence or recovery stage.

A nurse’s role in illness includes monitoring and interpreting symptoms, administering

such as administering intravenous fluids to a patient dehydrated from fever and vomiting.

c. Stress

Nurses work to make patients more comfortable, and a big part of nursing care includes reducing

patient stress. Nurses care for patients who experience stress from being weakened due to illness

or injury, being removed from a familiar environment and taken to a hospital or emergency

room, waiting for test results, undergoing uncomfortable or painful procedures and not knowing

what is happening to them. Nurses explain procedures to patients, listen to patient concerns and

answer questions, protect patients' privacy and ask how patients are feeling. The goal is to calm

them and make them feel more physically and emotionally comfortable.

d. Health Promotion

In “Fundamental Concepts and Skills for Nursing,” Susan de Wit and Patricia O’Neill explain

that it’s the responsibility of every nurse to promote better health by informing patients of things

such as illness prevention methods, safe health practices and healthy lifestyle choices. Nurses

promote health by discussing weight and exercise issues, nutrition, the risks of drinking, smoking

and drug use, and other self-care that increases their quality and length of life.
Roles and responsibilities of a home nurse

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.

Key responsibilities of a home nurse

-wound care, disease management, medical equipment, therapy, medical social services,

-patient education.

-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.

- 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

Role & Duties of a Home Care Nurse

Home care nurses provide in-home health services for patients and their families. Their visits not

only allow patients to remain in the comfort of their home but also help family caregivers stay

abreast of their loved ones' health. Working under the supervision of a physician, they coordinate

and manage patients’ at-home care plan.

Job Description

Patient needs are the focus of the home health nurse responsibilities. Like other nurses, she

provides care in coordination with a physician and other health care workers. When she visits a

patient’s home, she assesses the patient's condition, takes vital signs, such as blood pressure and

manages wound care, as needed. Home health nurses often manage and administer prescription

medicines when patients need it. She might also check bedridden patients for bed sores and

muscle weakness. She writes and sends reports about each visit to the patient's physician. She

identifies care issues and makes recommendations about changes to the patient's care plan. She
talks to family caregivers who are present during her visits, listens to their concerns and updates

them on the patient’s condition.

The Characteristics/qualities of a Home Nurse

While nurses in general share a number of skills and attributes, there are additional qualities and

characteristics you need to be effective as a home nurse. In addition to the independence you’ll

experience when you work directly with patients in their homes, you will encounter situations

and personal challenges you won’t necessarily see on a regular basis in a clinical setting.

Respectful

When a nurse sees a patient in the hospital or a doctor’s office, she is usually expected to repeat

doctor’s orders and carry out those orders regardless of the patients’ desires. In a home setting,

however, you must respect the patients’ wishes and honor requests you might not get in a clinical

setting. As a home nurse, you might encounter more resistance to taking medication or doing

physical therapy at the proper times, so it's important to tap into your skills of persuasion to

gently urge your patients to comply.

Tactful

In the hospital you can restrict visits and monitor the way friends and family interact with your

patients. At the patients’ homes, however, you have much less control over what other caregivers

decide to do. A home health nurse must therefore be adept at educating other caregivers on what

constitutes the best choices for patient meals and activities. You need to know how to tactfully

correct and guide visitors and family members to ensure your patients’ safety and well-being.
Flexible

As a home health care nurse, you’ll find yourself in a wide range of settings on a regular basis. If

you’re the type who prefers to go to the same place of employment and follow a set of consistent

guidelines at work, then home nursing care is not for you. You must enjoy and welcome a

diverse group of clients who vary widely in their needs and expectations. Your schedule might

be interrupted repeatedly by visitors and unexpected changes in your patients' daily habits.

Additionally, each home environment is different, requiring you to be flexible in how you

address issues such as house cleaning, meal preparation and medication storage.

Skillful

As a home nurse, you will usually work with little direction and oversight, so you must be able to

quickly adapt to each new situation. You need the ability and willingness to make decisions on

your own based on your training and understanding of health care procedures. You also must be

able to effectively assess patients and their health, review and administer doctors’ orders, and

provide the needed care. Common duties include wound care, injections, catheterizations and

taking patient vital signs. Additionally, you must be detail-oriented to complete the amount of

paperwork that goes with the job of a home health nurse.

convenient medium before 22/03/2020 6.00 p.m.

1. Mention five steps in nursing process. (5 marks)

2. State two common ways of collecting data about client (2 marks)

3. Briefly explain five qualities of a home nurse. (5 marks

4. Explain the importance of home nursing. (10 marks)