Healthcare and nursing are ever-changing fields. Policy-makers and management continually refine health practices to provide better and more efficient care with limited resources (Underwood, 2010). A general healthcare trend is the move towards keeping people out of our overloaded hospitals and facilities, with the idea that “Home is Best” (Vancouver Coastal Health, 2013, para.1). As a Community Health Nurse, my role is to support people to stay at home by helping them manage chronic conditions, coordinate home supports and providing care for wounds and catheters. Paradoxically, in my field, I have noticed a trend towards fewer home visits, rather than the increase one might expect. Instead, there is a push to care for people through telephone contacts or clinic appointments.
From a government and upper management point of view, reducing home visits makes sense. As people are expected to stay at home, there are more people needing care from a limited number of community nurses. A study by VanDeVelde-Coke (2004)found that nurses seeing clients in the home takes 46.6% more time than in a clinic if one includes travel time and charting, thus making home visits inefficient. The same study found that clients were equally or even more satisfied with their care at a clinic. At my health unit, nurses can see 11 clients per day in the clinic or over the phone, compared to visiting three to six clients in the home. On occasions, clients tell me that a clinic visit is way more convenient as they do not need to wait at home for a nurse. Often my clients say they prefer telephone visits over home visits as it takes less time and is less disruptive to their schedule.
In practice, however, patient care can suffer when fewer home visits occur. A local news article (Lus, 2011, October 25) raised concerns that reducing nurse home visits to new mothers means that serious illness of both the mother and baby can be missed. This story also highlights that without home visits the opportunity for people to open up about health problems to someone they trust may be missed. Though the media has not picked up on it yet, in my own practice as a community health nurse for the elderly and general adult population, I am seeing a similar phenomenon occur with fewer home visits. When people are seen in the clinic or assessed on the telephone, it is difficult to see if they are coping well at home. The nurse cannot tell if the client has a home that never gets cleaned, medications strewn all over the kitchen or throw rugs that could be trip hazards scattered about. During a phone call, a nurse cannot visually assess whether a client has increasingly swollen legs. Clinic visits are often shorter than home visits, allowing for less thorough assessments in general. Though in theory clients are asked to come to the clinic only if it will not negatively affect their health, I have seen clients fall simply walking into the treatment room. In my opinion, having more actual nurses see clients in both the home and through clinic/phone visits would be ideal.
In theory, the initiative to keep people at home and out of hospitals or facilities seems to be aided by the trend of community health nurses seeing more clients in the clinic or over the phone, allowing nurses to see more clients in general. Unfortunately, in practice it is more difficult to provide thorough and safe care to patients when fewer home visits occur. Perhaps a solution may be found in a balance between hiring more community health nurses to do home visits when needed and continuing with the attempt to seeing clients in other ways when it is deemed appropriate.
Lus, Steve. (2011, October 25). BC cuts back nursing visits to new moms. CBC News. Retrieved from http://www.cbc.ca/news/canada/british-columbia/b-c-cuts-back-nurse-visits-to-new-moms-1.1100144
Underwood, Jane, (2010). Maximizing community health nursing capacity in canada: a research summary for decision makers.Canadian Health Services Research Foundation. Retrieved from http://www.cfhifcass.ca/Migrated/PDF/ResearchReports/11510_Reiss_report_en_FINAL.pdf
Vancouver Coastal Health. (February, 2013). Home is Best News. Retrieved from http://vchnews.vch.ca/wp-content/uploads/2013/02/HiB-Newsletter-Feb-2013.pdf
VanDeVelde-Coke, Susan. (2004). The effectiveness and efficiency of providing homecare visits in nursing clinics versus the traditional home setting. Canadian Health Services Research Foundation. Retrieved from http://www.cfhifcass.ca/Migrated/PDF/ResearchReports/OGC/coke_final.pdf