By ROBYN KNAPP
It has been predicted that the baby boomer generation will be the most effected by the changes health care system with regard to nursing care. The current health care system is in a state of flux. With insurance companies constantly raising rates and premiums, and the hospital stays becoming less frequent, the end result is that health care must extend to the home. The impact of this new era of home care will have various effects on the population that is served. Although it is true that home care has been in existence for almost as many years as the profession of nursing itself, the amount of clients that home care now serves is quite a bit larger than the past as well as more medically demanding. What this situation implies for the nursing profession is a larger responsibility in ensuring that clients who are discharged within one to two days receive the necessary teaching and follow up nursing care to ensure progressive healing and a maximum return to wellness.
In order to help ensure the goal for the client after discharge, the hospital nurse must be acutely aware of what the clients teaching needs will be from the time of admission.
For instance, those clients that have chronic respiratory disorders will need to be taught how to assess themselves for the danger signs and symptoms of circulatory overload. The patient needs to be taught that a weight gain more than one to two pounds per day may indicate circulatory overload and lead to respiratory distress. While this teaching plan may seem simplistic, the fact remains that many of these respiratory compromised clients are released from the hospital prior to their blood work and medical condition stabilizing.
The problems arise when the client is not functioning at a cognitive level to utilize the teaching from the nurse. Even more crucial is the need for family to be involved and their desire and willingness to participate in home care. When all falls through, which happens more frequently than not, the client is the one who suffers the consequences. As it happens, family cannot always coordinate with the nurse's schedule, follow through teaching may not be completed by the nurse on that particular shift. Sometimes by no ones fault, the system fails the patient just from lack of time. The solutions to this dilemma cannot be elucidated in one or two sentences. As the old saying goes, "it takes a village to raise a child", "similarly it takes a village to promote the wellness of an individual". With this said, one can infer the difficulties in promoting the physical and emotional wellness of a client recently discharged from the hospital.
To at least begin to offer some solution's, would be to hire more nurses. Since this is not logical in keeping with the hospitals policy to save monies, there has to be other possible solutions. One solution would entail a network that extends from the hospital to the home. The homecare nurse begins working with the patient and nurse before discharge. Facilitation of communication, along with the care of genuinely concerned individuals involved in the health care system will make a positive difference in the quality of the client's life.
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