Tensions and constraints for nurses in hospital‐in‐the‐home programmes

Abstract

Economic necessity constrains health-care expenditure and waiting lists for hospital treatments remain high. As a result, more care is delivered via alternative means, such as same-day surgery initiatives and home-care programmes. Acute care delivered in the home to patients who would otherwise require hospitalization is becoming an increasingly acceptable means of treatment. These Hospital-in-the-Home programmes offer increased comfort while delivering comparable outcomes to many patient groups. The purpose of this paper is to generate discussion concerning the tensions that exist for nurses who practice in the home under the auspices of acute-care institutions. Data drawn from field work that formed part of a critical ethnography is used to generate the discussion. The larger research project explored the constructions of the role of the nurse in four Hospital-in-the-Home programmes in Victoria, Australia. It will be argued that there is significant pressure exerted upon nurses to support the imperative to reduce bed days in acute hospitals by transferring people to their home. At times, this agenda clashes with the nurses' professional commitment to provide holistic patient care, yet the dilemmas are largely unacknowledged and/or unrecognized by the nurses despite the tension they generate.

The experiences and needs of frail older people receiving home health care: A qualitative study

“…Nurses providing home health care usually work without medical supervision. Their work therefore consists of independent decision‐making and depends on their education and experience (Duke & Street, 2005 ; Williamson, 2007 ). Holmerová et al ( 2018 ) assert that qualified and trained staff are one of the basic preconditions ensuring quality care.…”

Atuação do enfermeiro na atenção domiciliar: uma revisão integrativa da literatura

“…However, some of these challenges can be overcome by strengthening initiatives for professional training, for example, through adapting the curricula of nursing colleges and schools with the goal of training students in environments more adequate for home care (49) . In the home environment, it was possible to find various types of required skills employed by nurses (13,23,30,35) . An HC-expert nurse is capable of interacting with patients and families using technical and scientific, sociocultural, ethical and aesthetic knowledge, and also intuitive knowledge in a unique way, being capable of feeling and perceiving situations peculiar to home care and employing them for the common good (35) .…”

“…Skills for perceiving issues and interpreting situations in the home can be influenced by prior knowledge, experience, education, cognitive strategies, care philosophies, and individual perceptions (13) . For this assessment, it is necessary to be professional (23) , and to have practical experience (13,23) , knowledge (13) , personal intuition (13) , and decision-making abilities (23) . Knowledge for nursing practice in HC can be obtained by peer experience, experience learning (28)(29) , evidence-based practice, and intuition (30) .…”

La urgencia bajo la lupa: una revisión de la producción científica sobre servicios de emergencia en hospitales desde la etnografía

“…Ethnographies in hospital institutions date to the Chicago school, with the study by Goffman, "Asylums" 15 , and much of the revealing work has been performed in psychiatric institutions 16,17,18,19 . In general hospitals, we can cite numerous studies around the globe 20,21,22,23,24,25,26,27,28,29,30,31,32,33 . In Latin America 34,35,36,37,38,39,40,41,42,43 , although there have been studies in Argentina and México, most of the research has been done in Brazil.…”