Home care nurses’ decisions about the need for and amount of service at the end of life

Abstract

Findings highlight the role of considerations of family caregiver capacity, the influence of relationships and the importance of the context of practice, as part of a complete understanding of the complexity of access to care at the end of life.

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

“…Nursing practice in HC is influenced both by patient profile and by the logic peculiar to homes. In HC, nurses offer care to a diverse profile, with a predominance of patients under palliative care (12)(13)22,27,33,50,52,55) and the elderly (16,(28)(29)35) being noticed in this review, although analyzed articles have also reported care actions for children (11,19,25) and young individuals (28) with complex needs, as well as mentally challenged persons (14,27) . Review of the articles revealed that nurses conduct various actions in HC, such as: interpersonal support; health education for patients, family members; and caregivers; performance of technical procedures; and clinical and administrative supervision, as demonstrated in Chart 1.…”

“…Analysis of the articles shows that nurses have a central role in HC (13,25,27,33,40,46) . The relevance of their practice is in the fact that they are considered clinical specialists (11,27,34,56) , coordinators of care (12,15,27,34,40,43) , and case managers (15,40,43) , responsible for offering various care practices to patients (40) and also for performing important leadership roles (27,40) .…”

“…The relevance of their practice is in the fact that they are considered clinical specialists (11,27,34,56) , coordinators of care (12,15,27,34,40,43) , and case managers (15,40,43) , responsible for offering various care practices to patients (40) and also for performing important leadership roles (27,40) . In this regard, nurses have been portrayed in the literature as crucial professionals in the construction of this type of care (13) . Nursing practice in HC is influenced both by patient profile and by the logic peculiar to homes.…”

“…Home visits were mentioned as important aspects of this professionals practice (14,37,41,50) , requiring planning (37) and organization (41) , for example, when making decisions on the ideal moment for the next visit to patients and families, a process that is difficult for both novice and veteran nurses (50) . Care planning in the home context is defined as a complex practice with various goals, including the relationship and assessment of demands and capacities of patient and family, workload, and resources for home care (13) . As managers of care, home nurses assess patient demands in all aspects of health (physical, mental, social) and build care plans.…”

Family Caregiver Satisfaction With Home-Based Palliative Care Services in North Rhine-Westphalia, Germany

“…Side effects appear to be an important issue, making family members feel fearful and helpless (Hinds, 1992;Hanson, Danis, Garrett, 1997;Lau et al, 2010). Dissemination of information and psychological support, especially for such negative events such as side effects, are of great importance to families (Hileman, Lackey, Hassanein, 1992;Hinds, 1992;Addington-Hall, McCarthy, 1995;Gelfman, Meier, Morrison, 2008;Stajduhar et al, 2011), given the fact that family members evaluate symptoms as significantly worse than professionals (Higginson, Wade, McCarthy, 1990). Therefore, it is crucial for palliative services to offer individual practical training and educational consultations for family members, and to adjust the content of these resources continuously to suit the unique needs of families (Hudson, 2009).…”