A Theoretical Framework of Home-Based Professional Nursing Practice

Abstract

The purpose of this article is to introduce a descriptive middle-range theoretical framework unique to professional nursing practice provided in the patient's home. The variety of care models provided in the home, ranging from nonskilled home maintenance service to hospital-at-home programs, reinforces the need to clearly define and describe home-based professional nursing practice. This framework includes six concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy), and four relational statements of the concepts that describe the experience of patients in their homes and home-based providers. The four theoretical statements are: (1) The patient's beliefs, habits, and self-management actions in the home are shaped by the meaning of home and the physical home environment. (2) The patient has ultimate decision-making control and authority over his/her own health-related behaviors in the home. (3) Home-based care includes interprofessional teams to provide holistic care and maximize self-management ability. (4) The home-based nurse is autonomous when working in the home with the patient/caregiver and has primary responsibility for holistic assessment and intervention. Knowledge of this theoretical framework can help nurses maintain the integrity and purpose of the professional nurse's role in home-based care as well as provide guidance for nursing education and organizational structures. Recommendations for research to test and validate the framework are provided.

A Clinical Nurse Specialist in Home Healthcare

“…Clinical actions to promote self-management include teaching and coaching the patient and caregiver to administer medication, complete activities of daily living such as bathing, and safely work with medical equipment in the home. The Hinck Theoretical Framework for Home-Based Professional Nursing Practice 7 identifies 6 concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy) that are building blocks in 4 relational statements to describe the experience of patients in their homes and interactions with providers.…”

Management of the decompensating patient receiving home health

“…As a result, home health continues to evolve greatly in response to the growing demand 2. However, incorporating new technologies and innovating practices in the home health setting can be especially challenging due to its field-based delivery of care model 3. Patients with acute medical conditions are being discharged earlier from inpatient facilities at an accelerating rate.…”

“…Patients with acute medical conditions are being discharged earlier from inpatient facilities at an accelerating rate. This healthcare approach allows patients who are stable enough to receive treatment at home in a more comfortable setting 2,3…”

“…2 However, incorporating new technologies and innovating practices in the home health setting can be especially challenging due to its field-based delivery of care model. 3 Patients with acute medical conditions are being discharged earlier from inpatient facilities at an accelerating rate. This healthcare approach allows patients who are stable enough to receive treatment at home in a more comfortable setting.…”

“…This healthcare approach allows patients who are stable enough to receive treatment at home in a more comfortable setting. 2,3 It may be difficult for nurses to navigate priority care for patients in the home health setting because they're dealing with complex conditions and using unfamiliar equipment. In addition to adjusting methods of care provided in this setting, there's been a growing trend of novice nurses entering the home health subspecialty.…”