Advanced home care : nurses' everyday practice

Aim: The overall aim of this thesis was to explore nursing care within Advanced home care (AHC) through nursing documentation and nurses’ perceptions of nursing care, in order to delineate the required nursing competencies

Background: Home health care has increased significantly, in Europe, North America and other parts of the world. Many care recipients prefer to be treated at home and technical developments makes it possible to treat even severe sickness in the home environment. However, this also affects nursing care, and setting high demands on nurses.

Methods: In study 1 nurses from four different AHC units were interviewed. In study 2 nursing records were collected from two different AHC units and nursing interventions were detected and described. Content analysis was used in both studies. A synthesis of both studies was conducted for this thesis.

Findings: Study 1 comprises 2 domains; planned care and acute care. In study 2 three teams emerged; no ordinary day, daily joys and challenges and providing safe and secure care Synthesis of the 2 studies were sorted into four themes; contents of nursing care within AHC, nurse’s perception of nursing care, nursing documentation within AHC and nursing competencies needed within AHC. Nursing care Within AHC was either planned or acute. Contents of nursing care was e.g. interventions, including intravenous infusions, blood transfusions and high technology utilization Other common nursing interventions were sampling, dressing and bandaging, administration of nutritional products and administration of pharmaceuticals. Contents of nursing care also included information and education. Nurses' perceived nursing care within AHC was that this was joyful, free, rewarding and challenging; they respected patients' autonomy and appreciated patients' families. Nurses found team work essential. However, work was performed mostly alone and they encountered situations where they felt insecure. Nurses’ documentation was perceived as essential for patient safety. However, documentation was often fragmented, frequently lacked evaluation and information was hard to find. Most of the nurses interviewed lacked a specialist education but had long experience from nursing. Apart from personal qualities and maturity, nurses expressed competencies needed as high technology, pathophysiology, acute care, documentation and retrieving evidence based practice.

Conclusions: There are no ordinary days within AHC and nurses perceive nursing care within AHC as joyful but challenging. To provide safe and secure care nurses need advanced knowledge and skills in advanced nursing comprising pathophysiology, high technology, medical techniques, pain and pain relief, psychology and communication. Furthermore, nurses need to appreciate PCC and FPCC. Documentation of nursing care In AHC was often fragmented and information hard to find. This could be a threat to patient safety and accurate nursing records have to be a priority. Least but not last nurses need to develop their knowledge in information techniques in order to retrieve information about best practice.

List of scientific papers

I. Öhlén, A. Forsberg, C. Jirwe, M. and Broberger, E. Nurses' perceptions of nursing care within AHC. [Submitted]

II. Öhlén, A. Forsberg, C. Broberger, E. (2013). Documentation of nursing care in advanced home care. Home Health Care Manage Pract. 25(4):169-75.
https://doi.org/10.1177/1084822313490729