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Paper Topic:

Homecare/visiting Registered Nurses procedures/services provided (example: wound care) and responsibilities



Home health care is offered by visiting nurse associations (VNAs ) and other public health agencies to patients who cannot afford to pay for the services they need . A nurse and a social worker are the ones coordinating the care given in the hospital with home health care , but before anything else the physician must first determine that a patient needs a follow-up care at home . Patients with or without insurance and Medicare , should be able to experience the services of Home Health Care

available in their specific location or country . Several agencies do limit the services to citizens above sixty years of age . Often , the services are directly related to Diagnostic-Related Groups . A major goal of the VNA involvement is to keep the patient in the hospital no longer than absolutely necessary and to make sure that there is a follow-up care at home if needed . Advantages of Home Health Care include the ability of the patient to become independent on taking care of oneself and the shortened period of him or her staying at the hospital (Allen 1991

Importance of

Health care consumers have become increasingly aware of health care through health education programs and the mass media . There has been an increase in the use of existing health care facilities . Consumers have become better informed and much more critical of health services . No longer are consumers content merely to have access to what is provided they demand what services are to be provided and how the services should be distributed . The influence of the consumer has led to the development of new health services facilities which more effectively meet the needs of the public . As a result , more health care personnel are being employed in nonhospital health facilities (Ashley , 1984

Definition of concepts and services

Diagnosis-Related Groups (DRGs ) - Since 1983 , the rate of increases in overall medical expenses began to decline according to the Bureau of Labor Statistics (BLS . Organizations such as the American Association of Retired Persons (AARP ) have fought to reduce health care costs especially for the elderly . Many procedures formerly performed in hospitals are now being done on an outpatient basis or outside the hospital . Hospital costs continue to rise . However , the overall rate increase trend in health care costs has slowed significantly . The Medicare reimbursement system utilizing diagnosis-related groups (DRGs has apparently been instrumental in slowing this trend . Patients are being discharged earlier and hospitals have an incentive to cut costs (Kent Hanley

A service offered by home care registered nurses is wound care Drainage of pus from an infected wound should be carried out , generally after some general and specific measures have been instituted and only when it is clear that there is an abscess associated with the site of initial infection . An area of cellulites should not be incised because the infection may spread by attempted draining when pus is not present (Kent Hanley

Intravenous drug therapy --- once believed to be a symbol of a confined patient usually hooked up to a bag or bottle and tubing in the traditional hospital setting ---

This however is no longer a typical scene . intravenous fluids and other kinds of drugs are now governed in other surroundings such as the home or place of employment . In other situations the patient is being instructed by the nurse to be the one administering the IV medication to oneself . The intravenous solutions would be prepared by the pharmacist and be given to the nurse for further instructions to the patient . Recurrently , the administered drug is an antibiotic . The therapy sessions are to be explained and supervised well to prevent complications of intravenous therapy and drug side-effects . Almost half the price (50 ) may be cut off compared to hospital cost . A problem exists in collecting payment from insurance companies for example , both Medicare and Medicaid have been reluctant to reimburse for IV antibiotic therapy at home . Some insurance companies will pay for 80 percent of the home intravenous treatment but would have paid 100 percent if it had been given in the hospital (Kent Hanley

The Diagnostic-Related Groups (DRG ) classification system has created an unprecedented growth in home health care . Patients are being discharged after shorter hospital stays but frequently are in need of more intensive home health care . The nurse does procedures in patients homes that were formerly performed only in hospitals . The home health care industry is the fastest-growing industry in the health field since the DRG preset payment system began in late 1983 (Betz , 1982

Many nurses enjoy the more personal one-to-one relationship with patients in the home setting compared to the more impersonal , fast-paced hospital setting which includes a heavier patient load . Hospital nursing tends to be more fragmented . Home care can be Patients adapt better psychosocially in their own environment

At the ANA convention in 1984 , some discussion occurred pertaining to direct reimbursement for nurses as primary providers of home care . It was resolved that the development of the nursing diagnosis would be a basis for home health care payment . It was felt the RN should be authorized to propose the plan for home care . In the late 1990 , a provision was included in the Federal Employees Health Benefits Plan that will provide for direct reimbursement to certain nurses . The law enables insurance providers to make direct payment to nurse practitioners , certified nurse midwives , and clinical nurse specialists


The tremendous advances in science , medicine and technology after World War II necessitated the trend of specialization . Specialization in nursing led to the development of new curricula in basic nursing education and the establishment of new programs in graduate education and the establishment of new programs necessary for adequate preparation of nurse specialists

Nurses provide primary , secondary and tertiary nursing care in the prevention of illness and promotion of health . Nurses perform these functions in episodic and distributive health care settings . The term primary nursing refers to the type of nursing that permits a one-to-one relationship between the nurse and the patient . Home care services help a lot in reducing the soaring costs of health care


Allen , L (1991 . The care crisis : Hospitals need new leadership Management Review , Mosby . V . 80 ,

. 46-49

Ashley , J (1984 . From team nursing to individual care . Nursing Mirror pp . 20-21

Betz , N (1982 , December ) Primary nursing : Two faces with little acquaintance . Nursing and Health Care 3 (10 , 543-546

Kent , V Hanley , B . Home health care . Nursing and Health Care . 11 (5 235-240 ...

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