Buurtzorg is a nurse-led, nurse-run organization of self-managed teams that provide home care to patients in their neighborhoods. Championing humanity over bureaucracy, autonomous teams work with primary care providers, community supports, and family resources to bring patients to optimal functioning as quickly as possible. The award-winning organization grew out of a common sense approach based on principles of trust, autonomy, creativity, simplicity, and collaboration. These organizational principles translate into highly effective and efficient care, satisfied patients, and enthusiastic nurses. The model is being replicated worldwide, with teams starting in Minnesota, Sweden, Japan, and other countries.

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Purpose To investigate the prevalence of potential age‐related eye conditions in elderly who are assisted by home healthcare nurses. The number of referrals to the general practitioner ( GP ), feasibility of screening and associations between vision loss and health outcomes were also studied. Methods Cross‐sectional study in which trained home healthcare nurses screened the eyes of 151 patients [mean age 80 (50–96 years)] using their available correction, with VISION 2020 Netherlands screeners (e.g. acuity/field loss). Health outcomes were assessed with questionnaires. Results Distance decimal visual acuity was ≤0.3 in 20.5% (unilateral) and 19.9% (bilateral) of patients, and near visual acuity was ≤0.4 in 17.7% (unilateral) and 33.3% (bilateral). Macular dysfunction was present in 21.5% (unilateral) and 8.3% (bilateral) and peripheral field problems in 11.4% (unilateral) and 7.9% (bilateral). GP referrals were proposed in 21.5%; in 40%, the GP or ophthalmologist was already aware of eye problems. Although health problems were prominent in participants (8.6% fractures, 22% depression and 18% anxiety), no significant associations were found between vision loss and self‐reported outcomes. Conclusion Sixty per cent of frail elderly home healthcare patients had an ophthalmologic condition. Although a large number was already known in eye health care, >20% was referred with an unrecognized ophthalmologic problem. Basic ophthalmologic screening by home healthcare nurses might be a potentially relevant tool to reduce the burden of age‐related vision loss, contributing to the joint World Health Organization – VISION 2020 initiative to eliminate avoidable blindness. Relevant health outcomes do not seem to be clearly related to having visual impairment, but rather to having general health problems.

When I started to work as a community health nurse in 1986 in a small village in the Netherlands, I thought I had found the most perfect job I could have. I had my own responsibilities, decided autonomously what patients needed, made the schedules together with my colleagues, and worked closely together with general practitioners (GPs), social workers, midwives, social care, occupational therapists (OTs), physical therapists (PTs) and volunteers. The team included priests and policemen when necessary. I had 'my own' neighbourhood, providing preventive programmes and care from the cradle to the grave. And, very importantly, we didn't have separate management. We had a local voluntary board that recruited new nurses and determined budgets. Every year we held an evaluation at the local Chinese restaurant and discussed the problems we had to deal with, if there were any.For eight years I worked this way and I'm sure it was the most effective and productive way of community health nursing I could and can imagine. During this time, we developed standards for different patient groups, we had high professional standards and the educational level throughout the country was the same; only with a post-registration higher level education could you become a community health nurse. In the 'hierarchy' of nursing, the community health nurse had a high status, if not the highest. Patients were happy, GPs were happy and nurses were happy. So, why didn't we keep it this way?The management paradigmIn 1993 there was growing pressure from politicians and policy makers to create 'professional' organizations. Regional reorganisation meant that community health organisations had to merge with social care, nursing homes and residential care facilities, and sometimes even hospitals. Every year a new management layer emerged and patient needs were redefined as 'products'. We had 10 different products: nursing care, nursing care special, nursing care extra, personal care, personal care special and personal care extra, guidance and guidance extra, etc. The health care service became a real industry.

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