Home Health Nursing
Have you ever considered home health nursing? Like any other nursing specialty, it’s not for everyone, but it can be a challenging and rewarding career option for the right candidate.
Not to be confused with private duty assignments in the home, home health nursing involves making several visits each work day to a variety of (at least temporarily) homebound patients.
These visits entail a complete head-to-toe assessment which can be brief or complex depending on the patient, the findings, or the physician’s orders. The visit will also include patent and caregiver teaching. Again the extent and complexity depends on the specifics of the situation. Each visit should build on the previous teachings and may involve some sort of return demonstration or pop quiz, if you will.
There may be a task to perform such as assessment and wound care, incision care, IV administration and/or site change, Foley catheter change, G-tube change, etc. The patient and/or caregivers may need specific instruction in the care of these as well.
Or the patient and caregiver may need in-depth instruction for a new diagnosis such as diabetes which would include such things as blood glucose monitoring, insulin or other medication administration, and how to identify and treat the signs and symptoms of hypo or hyperglycemia.
Patients and caregivers may also need instruction in medications including dose, administration, possible side effects, purpose and desired results. Other areas of common patient/caregiver education include specific dietary and nutritional needs or restrictions, and home safety issues.
Teaching caregivers how to safely assist patients with hygiene care (bathing, showering or a bed bath), transfers and ambulation may require the assistance of a PT or OT, but the home health nurse also needs to know how to perform and instruct in these as well.
Home health care is most often ordered by the physician following discharge from the hospital, or it may be ordered in lieu of hospitalization. In most instances it is not expected to be long term, but rather to help the patient and/or caregivers become independent in the necessary care.
For reimbursement purposes, Medicare and insurance companies have specific guidelines and criteria that patients must meet to be eligible for home health care. The home health nurse is responsible for reviewing this and documenting accurately. One of the worst parts of home health nursing is the paperwork! Much of it can now be done using a laptop or hand held computer, but there is still a lot of documentation to be done.
The nurse is the eyes and ears of the physician in the home. Many times home health referrals are made because the physician suspects that the patient needs more assistance or instruction in order to improve his/her outcomes. Or perhaps a higher level of care is needed.
The home health nurse learns to assess a home situation and to make recommendations for durable medical equipment (DME) and other disciplines to participate in the care such as a PT, OT or ST. A home health aide may be added to assist with hygiene care and to teach the patient and/or caregivers how to safely bathe and groom the patient.
If necessary, a medical social worker (MSW) may be called in to assist the patient and family in making more complex short term or long term plans for care, or help them to cope with life changing circumstances.
The beauty of home health care is being able to spend quality time with patients and caregivers one-on-one. But home health care is a team approach and the nurse is not expected to do it all.
It can be scary at times because there isn’t another nurse just down the hall to call for assistance or consultation. But there is backup a phone call away, and with cameras in cell phones, it can be even easier to get that consultation.
The autonomy and the ability to utilize skills that sometimes seem wasted in the fast pace of a hospital setting often draw nurses into the home health arena. Call a home health agency and ask to make a ride-along visit with a home health nurse to consider if this might be something you’d like to explore further.
By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of TheNursingSite.com
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