Date of Paper/Work

5-2014

Type of Paper/Work

Scholarly project

Degree Name

Master of Science in Nursing

Department

Nursing

Advisor(s)

Kathleen Kalb

Abstract

Homecare is provided to an estimated 12 million patients annually (National Association for Home Care & Hospice, 2010). The homecare nurse provides continuity of care as the patient transitions from hospital to home. Providing safe, quality care in the home is a priority for the homecare nurse. The variety of nursing care provided in the home demands a variety of skills, and excellent critical thinking skills.

The types of care needed in the home include post-surgical care, wound care from simple to complex wound vac therapy, chronic disease management such as diabetes, post-transplant care, infusion therapy, and central line care. Homecare has specialty areas such as hospice care, pediatric home services, general medical homecare, and infusion therapy. Some general medical homecare agencies also provide infusion therapy and central line care. The homecare nurse has extensive, yearly skills training and is supported by a nurse educator. Despite the supportive, knowledgeable environment, there is such a wide variety of skills needed in the home that some skills are rarely used by the homecare nurse. Infusion therapy with central line care is one area in which the nurse employed by a general medical homecare agency may have some previous experience, but does not use this skill on a regular basis.

The Medicare and Medicaid population must be cared for by a Medicare certified agency to ensure reimbursement for nursing services provided in the home. The number of Medicare clients with a central line is a small percentage of the general homecare agency clients. The nurse may not care for a client with a central line for months after the annual education session. This infrequency presents the problem that whenever a skill is not practiced on a regular basis, the homecare nurse’s knowledge and confidence may be diminished (Bowden, Rowlands, Buckwell, & Abbott, 2012). Because the homecare nurse is providing care in the home independently, this situation is more stressful and resources for consultation related to how to provide a specific skill are more limited.

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