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Delivering person-centred care at home

Negotiating patients' needs and adapting to their lifestyles can often be a challenge when you have to attend to a patient at home, where you can find yourself a guest. 

Negotiating patients' needs and adapting to their lifestyles can often be a challenge when you have to attend to a patient at home, where you can find yourself a guest. 


Understanding at-home patient care delivery can make a real difference in person-centred care
Picture: iStock

There is much information in the literature, in presentations and in government-related initiatives about moving to patient- or person-centred care. In the various settings for healthcare, including hospitals and rehabilitation centres, it is sometimes hard to apply the concepts of such care.

Patients ‘come’ to us in inpatient settings and there are processes and economies relating to the scale of the settings in place to achieve the work of the organisation while meeting patients’ needs.

Respecting patients' homes

By comparison, although home-care nurses and managers sometimes meet their patients before they are discharged, they usually do so when they visit them for the first time at home.

When care is provided in a person’s home environment, we are guests there and this construct changes the dynamic. Think about who visits your home, who you ‘let in’ and why. Those we allow into our homes are usually people we know.

As more and more patients view home as the preferred setting for healthcare, let’s examine three of the reasons why.

  1. We are a guest in someone’s home and space. In home care, visiting nurses must conform, be flexible and adapt to the patient’s lifestyle and space. This of course changes the patient-nurse dynamic. There are usually family members or caregivers the nurses must also engage with too, teach and otherwise work with to successfully implement plans of care. This understanding about being on the patient’s ‘turf’ is difficult for some, and nurses must conduct themselves in a way that is seemingly therapeutic and personal. They must also assess the home itself to establish, for example, whether home support care is effective or the fridge used to store medications is working properly.
     
  2. We are equal partners in care and care planning. Because we are guests in someone’s home, we sometimes must negotiate what needs to happen to meet patient goals. This can be as fundamental as, for example, working to obtain scales in the home for a patient with heart failure and diabetes who has a long history of emergency department visits after weekends, when family frequently bring in ‘favourite’ snacks of chips and other high-salt, high-fat foods. Observation, assessment, teaching, training and other skills are the role of the home-care nurse while working to manage patients and their families successfully in their homes.
     
  3. Patient ‘rights’ require nurses to think differently. The patient ‘rights and responsibilities’ can take on a different meaning. This includes the freedom from some hospital traditions or restrictions, such as having set visiting hours and meal times. There are also often pets, though I use this term liberally as I have seen squirrels that are pets and other rodents that certainly are not. These beloved pets often do not want a ‘stranger’, such as a visiting nurse, touching ‘their’ family member.

Many aspects of the environment of care make home-care practice different from acute care. These nuances, and the different patient-centred dynamics, help ensure that home-care patients have input into all aspects of care, care delivery and related decisions so that person-centred care is truly delivered in only one healthcare setting: the person’s home.

References

Marrelli TM (2017) Home Care Nursing: Surviving in an Ever-changing Care Environment. Sigma Theta Tau, Indianapolis IN.


About the author

 Tina Marrelli is currently president of healthcare publishing and consulting specialists Marrelli and Associates Inc in Venice, Florida. 

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