Optimization of home care nurses in Canada: A scoping review

Abstract

Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra‐professional and Inter‐professional and Inter‐sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter‐related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra‐ and inter‐professional and inter‐organisational contexts.

Home health aides’ experiences of their occupational health: a qualitative meta-synthesis

“…Stress at work created mental strain and lead to multitasking, a lack of focus, rushing, moving too fast and an increased risk and fear of falling and injuries [28,31]. These findings have also been mentioned by other researchers [11,13,15]. Excessive sick leave was reported as a problem in home care [39].…”

“…Those studies reported that low wages and minimal benefits are typical features of home care work and are often a source of job dissatisfaction [11,13,15]. Time pressure during hectic workdays [26,27,33,37,39,52,53] and increased indirect work task are sources of negative emotions such as frustration, stress, workload and overtime hours [34,47,51,53].…”

The Complexity of Living with Diabetes and Urinary Incontinence for Older Adults with Multiple Chronic Conditions Receiving Home Care Services: An Interpretive Description Study

“…These findings highlight that, despite examples of excellence, at the system level there are ongoing and significant barriers to patient- and family-centred home-care provision for this population in Ontario. This is an international trend in countries with similar home-care provision to Canada due to many factors, including: demands for services greater than existing funding mechanisms; human resource challenges, including recruitment and retention in the home-care sector; lack of system integration ( Farmanova et al, 2019 ; Ganann et al, 2019 ; Markle-Reid et al, 2017 ; Province of British Columbia, 2014 ).…”

Systematic review of the characteristics of brief team interventions to clarify roles and improve functioning in healthcare teams

“…According to Hudson et al [22], role understanding is an integral part of teamwork because it generates trust and mutual respect. Greater understanding of others' roles in the team promotes role clarity to foster optimal utilization of all professional roles and improve patient outcomes and health system cost-effectiveness [23]. Hence, role clarity is key to effective team training interventions.…”