A conceptual framework for home nursing

Abstract

Home nursing is typically dismissed as a series of tasks, limited in range and basic in nature. The present article describes research which repudiates this view while presenting a conceptual framework of home nursing which captures the dynamics and impact of this form of nursing upon the patient. Through using the approach of 'grounded theory' (Glaser & Strauss 1967) the present stereotype was found to be deficient. Home nursing was observed to be far more complex and challenging than generally acknowledged. Whilst the development of a conceptual framework was the primary aim of the research, the author has compared the home nursing studied in Australia to the observations of Kratz (1976, 1978) upon district nursing in England. It was found that the home nurse plays a central role in the patient's response to chronic illness. Lawrence & Lawrence (1979) have described how nursing intervention can produce, through adaption to the stress of long-term illness, a higher form of human functioning than that existing before the onset of the disorder. Surprisingly, this process has never been examined in relation to home nursing which, more than ever, is caring for increasing numbers of patients experiencing chronic illness and disability. The present study found that different variables and parameters which exist in home nursing but not in acute facilities affect the nursing intervention. If a body of nursing knowledge is to be developed and maintained from which nursing education can be co-ordinated, understanding of different nursing situations and the variables active in each is essential.(ABSTRACT TRUNCATED AT 250 WORDS)

Dissatisfaction and insecurity of patients in domiciliary care

“…relahonship could come to an end, which fiirther mcreases dissahsfachon English & Morse (1988) -who stated that the greater the madences of informahon withheld by the nurses, the greater the madences of difficult behaviour exhibited by the patient -demonstrated that meetmg the pahent's needs is the pnmary method of avoidmg difficult patients Primary nursê " domialiary nursmg care, it is necessary that the patient '^°*^^ ^^° '^ responsible for takmg care of him The pn-"^^^ ""''5^''^ she has learned to know the patient well and has the skills to devise a nursmg care plan which responds tô^^ patient's total needs, is likely to have opportunities tô^^" 8^^^" his self-esteem and self-care abilities When, httlê ^^ ^ P^^ent begins to trust her, he will start to h the nurse and the viaous circle can be viaous circle can be ''^ ^he nurse focuses her attention on the mtemal or *^'^^" problems of the patient and not only on the extemal°' ' '"^•^^st problems Accordmg to Coombs (1984), the domiciliary care nurses' concem extended beyond the perfonnance of procedure to the total state of the pahent and carer The visits were also educational, where diet, hygiene, ^ safety were discussed The pnmary multiteam (e g Chnstman 1983) has good opporto help the insecure patient and mcrease hiŝ^'^f action by safeguardmg the contmuity of comprehenive care and improving the patient's quality of lifê^^ findmgs of this study confinn the theoretical model presented earlier Relationships between factors associated with dissatisfaction and feelmg of^"^ ^° ^ quj^ complex Analysis of this therefore, demands fiirther, more profound studies…”

“…Satisfaction and secunty can be regarded as outcome cntena when the quality of domiciliary care is evaluated PatiKit satisfaction has been considered from different viewpoints in several studies Forgan Morle (1984), who has cianfaed how satisfied elderly patients were with dififerent aspects of their hospitai care, showed that patients were satisfied on the whole but were dissatisfied with communi-catKMi Accordmg to Owtwynd's (1988) study, whidi concemed patient sahsbchon, there were no deferences between public and pnvate ho^tals The most common complamts were that the staff was overworked Shields et al (1988) collected mformation in a psychiatnc uiut ihout how comfortable the patients felt in the hospitai Several people felt msufiiaently mfonned about their own treatment and progress Hansson (1989) concluded that psychiatnc patients were very satis6ed with the care generally The quality of information and co-<^>erahon assessed by patients was linked with care satisfaction and outccnnes Richards & Lambert (1987) showed that the quality of interaction which gave pabents an opportunity to partiapate in their care increased the satisfaction of elderly patients Rakel (1977) states that the quality of the interrelationship influences the degree of patient satisfaction which then directly affects the level of patient compliance Accordmg to Pendletcm et al (1984), tlwre is evidence linkmg ccm^liance with patient satisfaction, with patients' memory for, ami uiuierstanding of, tibe advice given in the patient-care piov^ba uiterachon, and with intentions to follow the advice Greenfield et al (1985) stated that by giving the pahent an opportunity to ask questions and discuss decisions conceming care, it was possible to increase the achve involvement of the pahent in the care and to maintain the safasfachon of the pahent with his/her care Speedling & Rose (1985) argued that pahent sahsfachon IS an insufhaent measure of the quality of the pahent-care provider relationship The interaction should also encourage pahenfs to take an active role in their care Coombs (1984) observed that the philosophy and policies of domialiary nursing, with its emphasis on pnmary nursing care, provided the foundation of sahsfaction It was not a queshon of task-onented nursing, but the nurses paid attention to the emotional and social state of the pahent English & Morse (1988) demonstrated, when they analysed the charactenstics of the 'difftcult patient', that the pahent's dissatisfachon with bhe care relationship, expenenced independence, communicahon and coUaborahon in their own care, lead to mental disturbance and difificult behaviour…”

Generating grounded theory of/for educational practice: the journey of three epistemorphs

“…Atwood, 1977;Wolanin, 1977;Combs, 1984;Hinds, 1984;Hutchinson, 1986;Phillips & Rempusheski, 1986;Morse & Johnson, 1991;Rempusheski, 1999). Typically, these articles are aimed at audiences that would be more interested in the substance of the theory than in the research procedures.…”

The Albrecht Nursing Model for Home Health Care: Implications for Research, Practice, and Education

“…Such a model must incorporate concepts of health service delivery, home care, and nursing on which to focus practice, research, and education. The approaches used to develop and select variables for this model were (1) review of literature on home health care (Auerbach, 1985;De Crosta, 1980;Mundinger, 1983;Shaw, 1985;Spiegel, 1983;Stuart-Siddall, 1986); (2) experience as a site visitor for the NLN Community Health Home Care Accreditation Program (NLN, 1987); (3) professional experience in an official agency providing home health care and a hospital-based home health care agency; (4) graduate experience in a veterans administration hospital-based home health care agency, a voluntary home care agency, and a proprietary home care agency; (5) experience teaching undergraduate nursing students community health nursing; and (6) critique and synthesis of four models related to home health care (Coombs, 1984;Dreher, 1984;Landau, 1981;Shortell et al, 1977).…”

“…First, Dreher's (1984) is the only one found to deliver public health nursing service of which home care is a component. Coombs's (1984) is the only one derived from a review of the literature that specifically identified itself as a conceptual framework for home nursing. Landau (1981) provided a method for analyzing a health care delivery system.…”