Dating way back in history, almost all health care was done at home.
In the early, 19th century, the doctor made house calls with everything he
needed in his black bag. Other than the doctor's occasional visits,
usually female family members cared for the patient. In the early 20th
century, not only did the nation grow in technology, but the medical field
also grew with new inventions, developments, technology, and ways to
provide improved care for the sick. Many of these different ideas were put
to the test as hospitals began to become more accessible. Many of the
procedures like x-rays and aseptic surgeries could no longer be provided at
the home. As the wide range of services available in the medical field
expanded, the need for more hospitals increased. With the increased demand
for hospitals, also came the increased demand for more hospital health care
workers. Now as we are in the 21st century, the trend is again changing.
Caring for the patient in their home is growing at a very rapid rate. In
the following pages, I hope to familiarize individuals with home health
care nursing.
First, I will explain the increasing need for home health care
nursing. Next, I will talk about DRG's and how this type of insurance
guideline determines what type of care a patient will receive. Then I will
proceed to explain about what type of experience and qualifications needed
for home health care nursing. Next, I will talk about how home health
nursing is an independent career and explain safety issues and rules for
playing it safe while in the field. Then I will talk about the importance
of documentation. It is the key to getting paid. Finally, I will talk
about the pros and cons of salary and benefits of home health care nursing.

Home health care is growing at a very rapid rate. As our older
population continues to age, the hospital stays continue to shorten, and
individuals prefer home over institutional health care, the need for home
health specialist will continue to be in great demand (Stulginsky,1993).
According to the U.S. Department of Health and Human Services, 1991,
predictions for the year 2000 indicated that home health will need 8,000
more registered nurses than employed in 1990 to keep pace with the need
(cited in Stulginsky, 1993).
The need for home health nursing has increased mainly because of
diagnosis-related groups (DRGs). The DRG's dictate how long a patient may
stay in the hospital according to their medical diagnosis. Many patients
are going home much sooner than many years ago, and often before they feel
ready.
The characteristics experienced by the patient influences the need
for home health care. Such characteristics may include but are not limited
to patients who cannot care for themselves, patients who have wounds and
need dressing changes, patients with complex or new medication orders,
patients with ostomies, patients with newly diagnosed diseases (example:
diabetes), patients who are terminally ill, patients requiring intravenous
therapy (IVs), patients with tubes (example: foley, nasogastric, and
tracheostomy), and patients receiving therapy (example: occupational or
physical) (Gonzalez 1994).
Many nursing opportunities are available in home health care. But
the question many registered nurses ask themselves ' Is home health care
really for me?' The requirements are at least one year's experience,
preferably in medical/surgical nursing, critical care or another speciality,
but you do not have to be skilled in high-tech care to enter the field
(Gonzalez 1994). When one decides that he or she is ready to give home
health care a try, their past experiences comes in very useful. Patient
assessment skills are very important skills to have well developed prior to
selecting a career in home health care. When going to a patient's
residence, the nurse must be aware of what he or she should be assessing
for pertaining to the patient's diagnosis. For example, if a patient was
discharged three days after his coronary artery bypass graft (CABG), a home
health nurse would need to know how to assess for actual or potential
complications (Sebolewski, 1996)
Another important skill needed for home health care nursing is
teaching. Nurses in home health care teach both the patients and their
family members on a routine basis. Encouraging patients, explaining the
procedures for a technique, or giving information to keep the patient safe
until your next visit are very important teaching skills a nurse must be
prepared for. With the nurse's prior experience, this information will be
easier to explain and teach (Stulginsky, 1993).
Another important reason why registered nurses should have prior
acute care experience is because of the independence he or she will have
with this career. When the nurse goes on a home visit, he or she is
usually by him or herself. The nurse must make on-the-spot decisions
without asking a co-worker his or her, opinion. At first even with prior
experience, this may be a very difficult task, but it allowes the nurse to
be creative and make his or her own decisions. As you gain experience in
home health care, you will gain confidence (Benefield, 1993).
As I mentioned before, home health care nursing is an independent
career. On most if not all of your home visits, you will be alone. This
brings to mind the safety issues involved with home health care nursing.
Many articles that I have read, have pointed out several occasions that the
home health care nurse felt uncomfortable or unsafe. (Brown - Morrison
1995), (Brady, 1995) (Smith 1997). While caring for the patient at the
hospital can be uncomfortable, at least you are in an environment where you
feel safe and secure. This article I read explained how a nurse's first
home health visit went. She arrived to the patient's home, which was in a
bad section of town. The window had no glass except jagged pieces around
the edges, and a loud mean bark of what she envisioned was a bit bull.
Another time her visit was in a parking lot of a local supermarket. She
drove through the parking lot and soon noticed a small brown beat up truck
and cab. She studied it for several minutes before getting out of her car
(Brady, 1995).
Another article I read had another nurse in a very frightening
situation. The nurse had tried phoning her patient several times before
the visit, but the phone had been busy. Finally, she decided to go ahead
and make the visit. When she arrived to the weather-beaten house, she was
walking carefully on the crumbling sidewalks. She knocked on the door
several times and never got a response. She feared the worst and tried the
door, which was unlocked. After walking in calling the patients name and
identifying herself, the patient bolted upright. The patient feared she
was trying to steal something and would not let her leave. The nurse
continued to explain why ...