Validating and Refining The Neal Theory of Home Health Nursing Practice

The home health care industry has recently undergone tremendous change. How providers of care are adapting to the changes in their environment and the effect this has on nurses’ job satisfaction has not been explored. Nurses’ job satisfaction provides an indicator of a change in the system’s ability to deliver quality patient care and to attract and retain staff. The purpose of this study is to describe the level of job satisfaction of home health care nurses in three regions of the country. Neal’s theory of becoming a home health nurse was used as a framework for understanding the findings. Nurses in this study were satisfied with aspects of their job related to professional autonomy, relationships with patients and peers, and a sense that their work is worthwhile and important. They are less satisfied with their relationship to administration and their ability to effect changes in the system.

Section: Discussionmentioning

confidence: 99%

Home Health Care Nurses’ Job Satisfaction: A System Indicator

Ellenbecker

2001

“…Issues that influence the nurse's progression are logistical and clinical. Neal's model hypothesizes that the home health nurse reverts to the stage of dependence when faced with factors that may be temporary impediments such as patient entity or unfamiliar clinical situations that can be overcome, then returns to the stage of autonomy (Neal, 2000b). Specifically, patient entity is "everyone and everything that affects or potentially affects the clients care within the home environment" (Neal, 1998, p. 274).…”

Section: Disaster Planning Education For Home Care Nurses Patients mentioning

confidence: 99%

“…In addition to obtaining personal expertise (Benner, 1984), the home health nurse must assess the client's and caregivers willingness to learn, ability to learn, and the ability to manage self-care to prepare them to manage and adapt in the event of a disaster. The Neal Theory of Home Health Nursing Practice (Neal, 1998(Neal, , 1999a(Neal, , 1999b(Neal, , 2000a(Neal, , 2000b provides a model to provide education for the orientation, in-service, mentorship, and preceptor programs needed for nurses to obtain the qualities and characteristics to function effectively in a disaster environment and provide the requisite training for their clients. The Neal model (see Figure 1) describes a three-stage process by which nurses attain and reattain autonomy through their ability to adapt.…”

mentioning

confidence: 99%

Disaster Planning Education for Home Care Nurses, Patients, and Caregivers

Mailey

2002

Home health nurses are at the forefront of protecting noninstitutionalized nursing patients and their caregivers from disasters. The September 11 terrorist attack on our nation magnifies the uncertainty of our lives and the need to be prepared through disaster planning education. Disasters-large or small, natural or man-madecan strike anywhere and anytime. The Neal Theory of Home Health Nursing posits that home health nurses progress through three stages (dependence, moderate dependence, and autonomy) as they spend time in home health nursing, adapting, gaining experience, and confidence. Neal's Theory can be applied to preparation for disasters that could confront home health nurses, providing the framework for planning, training, and oversight that the home health agency can use to ensure that the home health nurse is prepared. The role of collaborator is a cumulative result of the progression through Neal's three stages and positions the home health nurse to influence strategic disaster planning and education within the agency, community, state, and federal policy levels.

“…18,19 There have been many studies regarding the autonomy of nurses, specifically in home care. 20,21 Overall, NPs in the US perceive and show a high level of autonomy, even though there are variations among states. Autonomy is most often measured using qualitative methods such as interviews.…”

Section: Introductionmentioning

confidence: 99%

Nurse Practitioners in Swiss Family Practices as Potentially Autonomous Providers of Home Visits: An Exploratory Study of Two Cases

Gysin

Bischofberger

Meier

et al. 2020

In Swiss primary care, general practitioner (GP) home visits have decreased due to impending GP shortages particularly in rural areas. Nurse practitioners (NP) are newly introduced in family practices and could potentially offer home visits to the increasing number of multimorbid elderly. We analysed consultation data from two pilot projects (Practice A and Practice B) with the goal to measure the frequency and patient characteristics of NP consultations both in the practice and on home visits, and to determine the NPs’ autonomy based on the required GP supervision. In Practice A, 17% of all NP consultations were home visits, in Practice B 51%. In both practices, the NPs saw older patients and reported higher autonomy on home visits compared to consultations in the practice. In Practice A, the NP encountered a higher share of multimorbid patients on home visits than in the practice, and the NP’s proportion of autonomously conducted consultations increased from 0% in the first month to 19% after 13 months of GP supervision. In Practice B, the NP was autonomous in about three-quarters of consultations after 2 years on the job. These first cases provide some evidence that NPs could reach a relatively high degree of autonomy and might pose a potential solution for the decreasing numbers of GP home visits to multimorbid elderly in Swiss primary care.