What does a Home Health Care Nurse Do? Home Health Care Nurses provide a valuable service to patients that are homebound. Home health care nurses care for the chronically ill, terminally ill, and disabled patients within their home setting. Patients may suffer from cognitive impairments, or physical disabilities. Many home bound patients need physical assistance with personal care needs, and often have a direct support professional to help them with their non medical needs. A health care nurse will provide medications, monitor vital signs, and educate patients' needs. Most are registered nurses, however, some agencies hire licensed practical nurses to work for in home patients. Observation, Assessment and Treatment Home care nurses observe and assess the health of their clients. They monitor vitals and reactions to medications and look for changes in behavior and condition. Home care nurses report directly to the client’s physician and family, especially regarding concerns for new medical conditions or worsening health. Some nurses have specialties that allow them to administer treatments, such as therapeutic rehabilitation. Companionship The purpose of in-home nursing care is to provide an individual with independence while still remaining under supervised care. Elderly and disabled individuals are able to remain in the comfort and security of their own homes under the care of an in-home nurse. The nurse is responsible for the medical and emotional well-being of his or her patients. According to the Joint Commission, homebound patients are prone to depression and feelings of isolation, but home care nurses counteract these emotional pitfalls by providing companionship. They carry on conversations and get to know their patients and connect with them on a more personal level. Medication Administration Home care nurses are licensed and certified; therefore, they can administer medication to patients, including intravenous medications. Nurses are not able to prescribe medications to their patients, though they can alter a patient’s dosage with a physician’s approval. In-Home Assistance Home care nurses provide assistance with simple tasks such as bathing, grooming and eating. Some agencies require home care nurses to provide light housekeeping, do laundry and prepare meals for their clients, as well as
provide emotional, medical and physical support. Home care nurses are often required to assist patients with toileting, getting in and out of bed and transporting them to and from the house. Related: What to Expect as a Nurse Anesthetist Education and Requirements Home care nurses go through one of three different accredited programs to be licensed and certified: a diploma program, an associate’s degree or bachelor’s degree. After completing school, a home care nurse needs to pass a state nursing board exam to receive his or her license. Most states require licensed nurses to complete their continuing education and training to maintain their license on an annual or bi-annual basis. After passing the nursing licensure exam, home care nurses need to pass the Home Health Care Nurse certification through an American Nurses Credentialing. What is home care? Many definitions of home care exist, and home care can “look like” many different things. You might think of it as a service in which visiting nurses make home visits to provide wound care or other skilled or hands-on care, or may visit at-risk teenage mothers and their infants. Some home care nurses will visit while aides or companions who are staying with frail elders and provide meals, light housekeeping, and assistance with activities of daily living. All of these activities may fall under the umbrella of home care. However, as government reimbursement decreases and pay-forperformance and other outcome- and quality-driven initiatives take effect, the definition of home care must incorporate prevention and community. To that end, the U.S. Public Health Service defines home care as services “provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health or for maximizing the level of independence while minimizing the effects of disability and illness, including terminal illness.” Home health care refers to any health care given in the patient’s home. Such care may be provided by Medicare-certified or Medicaid-certified home health agencies, visiting nurse associations, hospice nurses who make home visits, community health nurses who provide well-child care to at-risk mothers, and many other types of home care. Also, some organizations provide what generally termed non medical home care is provided by aides or companions to help frail elders remain safely in their homes. These services might include personal care (such as assistance with hair washing),
light housekeeping, shopping, meal preparation and cleanup, and other types of care that can help patients stay in the home. Home health care team members The home health care team may consist of: •
Medical director
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Registered nurses
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Licensed practical nurse
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Occupational therapist
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Physical therapist
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Physical therapy assistant
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Speech therapist
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Speech-language pathologist
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Dietitian or nutritionist
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Medical social worker
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Pharmacist
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wound, ostomy, and continence nurse.
In some cases, certain home care services must be provided under the supervision of a licensed provider. Related: Happy Nurses Lead To Happy Patients Being all things to the patient Imagine knocking on a stranger’s door and introducing yourself to a patient you’ve never met in a setting that’s personal and private. You are a stranger—a guest in the patient’s home. The home setting imparts a certain intimacy that makes the visit seem very personal: All parties must establish a comfort level with one another. As the visitor, you must acknowledge that you’re in the patient’s and family’s space and convey respect for that space. What’s more, you will become all things to the patient, playing multiple roles beyond the nurse clinician. In effect, you’ll serve as the admitting nurse, the clinical decision maker, the person who knows and follows the rules regarding home care, the provider of hands-on care, and the instructor who teaches the patient and family—all while working to meet the plan-of-care
goals, coordinating other services the patient needs, and collaborating with the physician. Examples of patients who may need home care •
An older adult new to diabetes or insulin treatment
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A child going home with a tracheotomy and learning problems
• A patient discharged with a urinary catheter for long-term use that will be homebound • A patient with a wound who needs further assessment, care, and management • A patient who needs skilled care and education or training after discharge •
A patient with a complex chronic illness who needs ongoing management, such as medication management and assessed for changes in the plan of care
In a home care setting, RNs teach patients and their families how to manage their illnesses or injuries, explain post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication. Home nursing care is often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing facility. When caring for patients, RNs establish a care plan or contribute to an existing plan that is developed by the physician. Plans may include numerous activities, such as teaching self-monitoring techniques, administering medication, including careful checking of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treatments; observing the patient and recording those observations; and consulting with physicians and other healthcare clinicians. Related: Esteemed Nurse Kathryn Joanne Stull, LPN, will be Honorably Mentioned in the Worldwide Leaders in Healthcare Please follow us on Facebook, Linkedin, Pinterest and Twitter