Blending the Roles of Home Care Nursing and Cardiovascular Specialties: A Model for Nursing Practice in the Community

Abstract

Changes in reimbursement and advances in technology have resulted in a decreased hospital stay for patients undergoing cardiac surgery. These patients are being discharged into the community setting earlier, resulting in an increased demand for transitional specialty home care. This article relates the experience of a Midwest home care agency charged with the development of specialty home care for these complex patients. It offers a new practice model for professional nursing staff delivering this level of care. This model challenges traditional beliefs that cardiac specialty home care can best be provided by nurses with critical care or acute care cardiology background. This agency was successfully able to use the specialty roles of generalist home care as a foundation for advanced cardiovascular practice in the home care setting due to the agency’s commitment to support this process with an on-site advanced practice nurse skilled in both cardiovascular nursing and home health care.

Substantive Areas of Clinical Nurse Specialist Practice

“…375 Clinical nurse specialists have been instrumental in practice change at the organizational level by introducing innovative models of nursing practice and patient care. 283,320, Clinical nurse specialist practice models 283,379,[384][385][386]392,395 and those directed toward changing healthcare delivery to patients and families in a variety of settings 320,[376][377][378][380][381][382][383][387][388][389][390][391]393,394,[396][397][398] have been developed and/or implemented. Examples of the latter include a community nursing health promotion model for chronic childhood illness, 378 adaptation of the synergy model for the care of the critically ill patient, 388,397 and a model of healthcare delivery to incarcerated populations.…”