Kristel De Vliegher

Health Care Assistants in Home Nursing The Holy Grail or the Emperor’s New Clothes? A Qualitative Study

What are the experiences of home health care workers with regard to the delegation of nursing activities, the supervision of health care assistants (HCAs), and the impact of these changes on the work of home nurses (HNs). In-depth interviews were performed with 12 HNs, 12 HCAs, and eight managers in home nursing. HCAs take care of a less care dependent patient population, allowing the HNs to spend more time on more complex, technical nursing care. However, the analysis revealed some barriers, such as a knowledge gap and insecurity felt by HCAs leading to unnecessary patient visits by HNs, unfamiliarity of HNs with the role of delegating activities and supervising HCAs, and poor face-to-face communication between HNs and HCAs.

Caring for homecare: A mixed methods analysis of the current and future role of home nurses

The financial constraints and the shift of care from the hospital to the homecare setting challenges home nursing to provide care to sicker patients than in the past, to perform more intensive and technically complex nursing activities at home, and to think about a more efficient and effective use of the current home nursing staff. A mixed-method analysis was performed to understand the impact of these evolutions in home nursing in general and on the current and future role of home nurses.

The Activity Profile of Home Nurses A Systematic Review

The role of home nurses as providers of health care has changed and will continue to change. To guide appropriate decision making and future policy planning, it is important to have a clear picture of the activity profile of home nurses. A systematic literature review was conducted in the databases Cinahl, Cochrane, Embase, and Medline for the literature published between January 1990 and November 2013. Nine reports were identified: six quantitative studies and three literature reviews. Home nurses provide multidimensional care. However, a glaring omission in these reports was a consideration of the physiological aspects of home care. This is probably due to the questionable validity of existing nursing intervention classification schemes and the lack of scientific evidence on technical and complex interventions in home nursing care.

Perspectives on the delegation of hygienic care in the context of home nursing: a qualitative study

BACKGROUND In light of current trends and healthcare evolutions, delegation of patient care from home nurses to health care assistants (HCAs) is increasingly important. Hygienic care is an essential component of nursing education and practice, yet it has rarely been the subject of scientific literature. AIM To understand the opinions and experiences of home nurses and policy makers with regard to the meaning of hygienic care and the delegation of these acts in the context of home nursing. METHODS A descriptive qualitative study (six focus groups with home nurses and two with policy makers from the Belgian home nursing sector). Content analysis of the data and the use of NVivo 11.0 software. FINDINGS Hygienic care is a cyclical care process of continuously investing in a trusting relationship with a patient, assessing their care needs and ability for self-care and taking action and evaluating care as situations change. All of this must be mutally agreed with the patient and should consider their environment and lifestyle. The decision to delegate hygienic care is based on patient assessments and the patients specific care needs using nursing diagnoses and indicators. Finally, barriers and facilitating factors for both delegating and providing hygienic care were addressed. CONCLUSION Hygienic care is a crucial component of nursing care, that can be delegated to HCAs with the necessary supervision.

Inter-rater agreement of an alternative guideline for the assessment of the activities of daily living in home nursing.

Method A quantitative comparative field study in a stratified random sample of 612 patients receiving home nursing for ADL deficiencies. A proportional stratification according to mutuality membership, region (Flanders, Brussels and the Walloon region) and the patient’s level of ADLdependency in 5 categories: minor dependency (T2 en T7), level A, level B, level C (which is the highest level) was performed. Home care nurses were invited by the ‘National College of Advising Physicians (NCAPh) and the Belgian sickness funds, to participate in the study and to perform ADL assessments according to two guidelines: the current guideline of the Belgian Evaluation Scale (BES) and an alternative guideline which was written by a workgroup of the Agreement Commission for home care nursing of the National Institute for Health and Disability Insurance. The weighted kappa statistic (κ) (and its 95% confidence interval) and the proportion agreement were the main outcome measures.