Community Nursing and Home Care Services

Community nursing mainly denotes community nurses visiting communities as well as the homes of the affected patients in order to provide home care services to the patients according to the needs of the patients. Such nurses mainly try to assess the risks that are associated with the patients when they live alone in their houses and to take care whether the caregivers of the patients are providing good care or not according to the education imparted on them (Hudson et al., 2015). According to the needs identified by the nursing professionals after visiting the homes of the patients, they can also help the patient connect with the appropriate community services for different types of support (Oliver et al., 2014). This assignment would be mainly based on discussing the various risks that remain associated with the lives of the nurses who provide this form of services. Various literatures would be reviewed in order to gather more evidences of the risks faced by the nurses and would be discussed in the assignment.

Studies have clarified that such community visiting services mainly begin at the hospital or other healthcare facilities. Professionals are seen to work closely with the patients in order to ensure that smooth transition is done for the patients who are returning home. All the different aspects of the care are coordinated and addressed among the families and accordingly modifications are done in the home and individuals are educated for better care (Hafskjold et al., 2016). Therefore, under the direction of the physician, the registered nurse will visit the patient and provide a thorough assessment. She will mainly work as a case manager to help the patients and the family members meet the care needs and teach them, support and identify others services they need (Dmytryshyn et al., 2015).

These services mainly recruit nurses who need to have expertise in different domains of nursing. These domains may contain disease management, diabetic care, medication management, and cardiac care, wound care, and post surgical care, geriatrics, maternal and childcare as well as pediatrics (Sundler et al., 2016). Therefore, they can visit patients with wide variety of disorders and management issues and identify their need and accordingly suggests services and interventions.

Studies have reported that although they have several benefits, yet many of the nurses have complained of severe safety issues. This aspect had rises an concern about the security and safety of this form of services and that effective policies need to be developed by government and organizations had to take responsibilities of the safety of nurses trough protocols and guidelines (Jukic et al., 2017). The nursing professionals disclosed a scary experience in one of the qualitative studies based on open-ended questionnaires by the interviewers. The nurse had stated that she as locked in the family home and she was not allowed to leave. She had received no call from the office to determine her safety. Even after the occurrence of the incident, the organization had not conducted any follow-up with the family and no additional safety plan was developed. In fact, the organization gain allocated the same nurse to attend the same patient (Nakken et al., 2015).

Benefits and Risks of Community Visiting Nurses

Literature review conducted had shown that community-visiting services were specifically more risky for the nursing professionals when they had to visit patients for mental health patients. Many of the patients suffering from the mental health disorders, which are psychotic in nature, can be specifically dangerous cases for professionals to handle.  Such situations can expose the nurses to unpredictable events in the house of the patients like that of aggression and violence on the professionals (Vander et al., 2016). They can be subjected to physical, mental, emotional as well as verbal violence that might create a concern for the safety issues of the nurses.

Many of the papers had compared the risk faced by mental health professionals who provide acute care services to patients in hospitals with that of the community visiting nurses who visit mental healthcare patients in their homes. Although, both of the nurses were seen to project being sufferers of violence and aggression form mental health patients, the risks of safety issues and harm to their health were higher in case of the latter nurses (Wishart et al., 2016) . Some of the points being opinionated by the researchers for the increased safety issues of the latter cohort of professionals is the absence of immediate help from the other healthcare professionals of the team and from the organization providing the services. In the hospitals, nurses tend to get immediate help from their colleagues and mental support after facing the incidences. This attribute reduces their anxiety and support their mental condition after facing the aggression. Any physical harm faced by the professionals is immediately treated. However, such is not the case of the professionals who are visiting communities or homes for assessing the unmet needs of the mental health patients and accordingly develop interventions. They also remain highly vulnerable to violence and aggression but their safety issues remain a huge concern (Pink et al., 2015). They cannot get any immediate help from other professionals or organization when the mental health patient attacks the nurse or behaves in an unethical manner. Such nurses mostly report physical, sexual and verbal assaults and emotional or mental violence are less. These aspects might harm the professionals physically and mentally affecting their ability to work and carry on their profession. Such professionals who have faced physical violence at homes of the patient have reported fractures, backaches, migraines, headaches, metabolic disorders, indigestions and many others. Moreover, depression, anxiety, nervousness, panic attacks and similar such mental turmoil have also reflected in the studies conducted on community visiting nurses caring for mental patients at homes or in communities.

Safety Issues Faced by Community Nurses Visiting Mental Health Patients

Another area of concern that the nurses working in community visiting services have reported is the geriatric care provided to the old patients. Older cohort of patients who require home visits by the nurses of this form of services often suffer from  co-morbid disorders as well as different form of disabilities. They either ask for such services, as they cannot tolerate the stress of travelling and getting care from different hospitals. Often they might also need rehabilitation services out of which a proportion is completed in the rehabilitation ward of the care centers and the later part in their residences (Park et al., 2016). Therefore, often community visiting services  appoint nurses who are expected to travel to the residences of the old patients in order to assess the kind of care being taken about the patients and to check whether they are maintaining the lifestyle modification that is advised to them and to check their medication compliance and condition of their health. Studies have reported that community visiting nurses care for older adults with disabilities with different interventions. These interventions include multiple visits, geriatric training and experiences, interdisciplinary collaborations, multi-dimensional assessments and many others. Nurses also face often-different types of issues while caring for them that also possess various risks for them (Scheepmans et al., 2014).

Patients who are old often lose the ability to conduct many normal activities in life like that of mobility, dressing, cleaning eating and many others. A nurse caring for such patients need to not only ensure effective interventions like medication and care plans but also have to conduct different risk analysis which are not required in other patients suffering from chronic issues. Therefore, they often feel burdened with more work when they care for geriatric patients that drain their physical energy and mental stability. Another issue that they also face is the dilemma and the confusions that the family members face regarding the palliative care of the patients in end stages (Moir et al., 2015). There are conflicts among the family members about the palliative care strategies that need to be taken for their old patient and even between the autonomy and dignity of the old patient and that of the family members. Therefore, nurses need to intervene and participate in the situation to help them to come to a conclusion and involve strenuous arguments and decision making sessions. Therefore, this additional work pressures that the professionals need to handle while caring for the geriatric patients burn them out. They cannot handle the physical and the mental stress of the work-burden making them to withdraw from the job. This affects the quality of their life and interrupts their mental stability. Such risk might affect them in a way by which they leave their jobs, becomes depressed, lose the work-life balance and lose their confidence (Rest & Hirsch, 2015).

Geriatric Care and Its Risks for Community Visiting Nurses

Three other challenges that community visiting nurses also face while caring for the older people are handling dementia patients, ensuring self-care by the patients and the abuse and neglect faced by them. People suffering from dementia have memory ailments and therefore, frequent repetitive instructions need to be given. Extreme patience and calmness are important to tackle such patients and this attributes make it very difficult for the professionals to handle the situations as they become frustrated (Wills et al., 2016). In addition to this, care and support also need to be ensured for the caregivers at the house who care for the patient. Caregivers suffer from depression, physical ailments like back pains, headaches, fatigues, stress and many others. Therefore, these firm of caring create huge work pressure on the nurses. This might make them burn out resulting them in providing low quality care, irritation, error prone actions and many others affecting patient dissatisfaction.

One of the most concerning dilemma that often provides the nurses a hard time is the reporting of abuse and neglect. Abuse and neglect are common in the aging population. Different types of causes might be associated with neglect and abuse. Inability to care for the patient due to health literacy issues, inability to develop the physical strength to carry on with the care, easily getting burnt out and others are the cause of abuse by the caregivers. However, poor financial conditions, lack of employment, stress at workplace and drinking disorders of the caregiver also cause abuse of the old patients. Therefore, it becomes important for the nursing professionals to identify whether the patient is abused and neglected and accordingly take interventions. However, there arises high number of risks to the safety of the patient. The abusers of the old patients might attack the nurse verbally as well as physically to prevent her from reporting the cases. One of the nurses was seen to state, “Personally I have been verbally abused, shouted at in the street, and harassed by residents who have been upset by my actions”. Therefore, it exposes them to the risk of physical harm and mental instability. They might also suffer from ethical dilemmas where the old patients themselves request the nurses to not report or complain about their family caregivers (Klein et al., 2016). All these not only create a mental and emotional pressure on the nurses but also expose them to threatening situations in their lives comprising their safety and security. Therefore, all such risk factors remain associated with this form off nursing domain. Policies and organizational protocols need to be developed by the healthcare organizations so that they can maintain the safety and care of the patients.

Challenges Faced by Community Visiting Nurses Caring for Older Adults

Conclusion:

From the above discussion, it becomes clear that community-visiting services provided by the nurses have many benefits for the patients. However, several other risk factors also impose safety concerns for the patients who visit communities and houses to care for the patient. While caring for mental health patients, nurses might be exposed to aggression, violence and assaults. This might result in physical harm as well as emotional instability and mental health issues in the nurses. Moreover, caring for old patients single-handedly results in huge work-burden on the nurses. This makes them burned out affecting their job satisfaction, work-life balance and severe fatigue. Moreover, recognizing domestic violence incidents become easier in these services by the nurses but they can receive threats and violence from the perpetrators to not report about the issues. All these affect the safety concerns of the nurses and make them expose to various physical, emotional and mental turmoil. Therefore, it becomes important for the healthcare organizations to take actions and develop policies and safety protocols for nurses who visit homes and communities and save their lives from various negative outcomes.

References:

Dmytryshyn, A. L., Jack, S. M., Ballantyne, M., Wahoush, O., & MacMillan, H. L. (2015). Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses. BMC nursing, 14(1), 12. https://doi.org/10.1186/s12912-015-0061-2

Hafskjold, L., Eide, T., Holmström, I. K., Sundling, V., van Dulmen, S., & Eide, H. (2016). Older persons’ worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences. Patient education and counseling, 99(12), 1955-1963. https://doi.org/10.1016/j.pec.2016.07.015

Hudson, P., Trauer, T., Kelly, B., O’connor, M., Thomas, K., Zordan, R., & Summers, M. (2015). Reducing the psychological distress of family caregivers of home based palliative care patients: longer term effects from a randomised controlled trial. Psycho?Oncology, 24(1), 19-24. https://doi.org/10.1002/pon.3610

Jukic, N., Gagliardi, C., Fagnani, D., Venturini, C., & Orlandoni, P. (2017). Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients. Clinical Nutrition, 36(4), 1062-1067. https://doi.org/10.1016/j.clnu.2016.06.021

Klein, S., Hostetter, M., & McCarthy, D. (2016). The Hospital at Home Model: Bringing Hospital-Level Care to the Patient. Retrieved October, 5, 2016. https://www.commonwealthfund.org/sites/default/files/2018-09/1895_Klein_hospital_at_home_case_study_v2b.pdf

Moir, C., Roberts, R., Martz, K., Perry, J., & Tivis, L. (2015). Communicating with patients and their families about palliative and end-of-life care: comfort and educational needs of nurses. International journal of palliative nursing, 21(3), 109-112. https://doi.org/10.12968/ijpn.2015.21.3.109

Nakken, N., Janssen, D. J., van den Bogaart, E. H., Wouters, E. F., Franssen, F. M., Vercoulen, J. H., & Spruit, M. A. (2015). Informal caregivers of patients with COPD: Home Sweet Home?. European Respiratory Review, 24(137), 498-504. DOI: 10.1183/16000617.00010114

Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447. https://doi.org/10.1016/j.outlook.2014.07.004

Park, H. R., Park, E., & Park, J. W. (2016). Barriers to chronic pain management in community-dwelling low-income older adults: Home-visiting nurses’ perspectives. Collegian, 23(3), 257-264. https://doi.org/10.1016/j.colegn.2015.05.002

Pink, S., Morgan, J., & Dainty, A. (2015). Other people’s homes as sites of uncertainty: ways of knowing and being safe. Environment and Planning A, 47(2), 450-464. https://doi.org/10.1068/a140074p

Rest, K. D., & Hirsch, P. (2015). Supporting urban home health care in daily business and times of disasters. IFAC-PapersOnLine, 48(3), 686-691. https://doi.org/10.1016/j.ifacol.2015.06.162

Scheepmans, K., de Casterlé, B. D., Paquay, L., Van Gansbeke, H., Boonen, S., & Milisen, K. (2014). Restraint use in home care: a qualitative study from a nursing perspective. BMC geriatrics, 14(1), 17. 
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Sundler, A. J., Eide, H., van Dulmen, S., & Holmström, I. K. (2016). Communicative challenges in the home care of older persons–a qualitative exploration. Journal of advanced nursing, 72(10), 2435-2444. https://doi.org/10.1111/jan.12996

Vander Elst, T., Cavents, C., Daneels, K., Johannik, K., Baillien, E., Van den Broeck, A., & Godderis, L. (2016). Job demands–resources predicting burnout and work engagement among Belgian home health care nurses: a cross-sectional study. Nursing outlook, 64(6), 542-556. https://doi.org/10.1016/j.outlook.2016.06.004

Wills, C. E., Polivka, B. J., Darragh, A., Lavender, S., Sommerich, C., & Stredney, D. (2016). “Making Do” decisions: How home healthcare personnel manage their exposure to home hazards. Western journal of nursing research, 38(4), 411-426. https://doi.org/10.1177/0193945915618950

Wishart, L., Macerollo, J., Loney, P., King, A., Beaumont, L., Browne, G., & Roberts, J. (2016). ‘Special Steps’: An Effective Visiting/Walking Program for Persons with Cognitive Impairment. Canadian Journal of Nursing Research Archive, 31(4). https://cjnr.archive.mcgill.ca/article/view/1551

Risks associated with caring for mental health patients: