"We are all functioning at a small fraction of our capacity to live fully in its total meaning of loving, caring, creating and adventuring. Therefore, the actualizing of our [full] potential can become the most exciting adventure of our lifetime." - Herbert Otto, 1972

In this new millennium we have come full circle in our love for and use of technology in healthcare and nursing. It's past time for home care professionals to reaffirm and carry out our commitment to caring on an interpersonal level.

Over the past 20 years, editors and authors contributing to Home Healthcare Nurse have striven to include the characteristics of love, caring, creating, and adventuring, as well as technological and scientific excellence into each article presented to its readers.

I have chosen to speculate upon the caring and caregiving syndromes for this 20th anniversary issue of HHN for several reasons:

* The importance of caring has grown exponentially as the rapidity of change and technology has intensified since the journal first began publication in 1982.

* Home healthcare is a practice field in which nurses have the most need and opportunity to express these characteristics in their daily encounters with clients and families in a broad community setting.

* The demographics of the populations in the United States and throughout the world demand we increase our interpersonal skills in the recognition, coping, and managing of caregiver burden.

* Our society has become convinced of the individual's responsibility for self-care and the economic need for increased reliance upon family caregivers or their surrogates for the care and supervision of aging parents, spouses, and disabled children.

The Scope of Caregiving

"Caring" is a word not related to well by others because, unlike "love," caring implies more than physical interaction-it implies commitment and involvement; both caring for and caring about. It means that others can lay claim to your time, your interests, and resources (Stevenson & Tripp, 1989).

When you care, you cannot remain unrelated. You are compelled to listen and to a form of knowing that transcends curiosity or the facts. A caring culture determines what matters, what is stressful, what is considered coping, what being related means, and what counts as giving and receiving help.

Home healthcare nurses work at the cutting edge of caregiving that occurs in the home and in community settings. We cope and help others to cope under a healthcare financing system that often fails to value the difference a home care stay, even brief, can contribute to the recovery from an acute illness; and the prevention of disability with an outcome that mitigates in favor of the maintenance of independent functioning at home. Our focus has always been upon the quality of life.

We continue to reach for an individual's return to functioning and their continued contributions to their family and community life. At the same time, we are in the enviable position of having the skills and being at the site where individuals need the most assistance with adjusting to, managing and making choices about their future life and death situations.

In the Beginning

Home Healthcare Nurse was launched with high hopes and much foresight about how this specialty practice could positively affect the quality of life and the longevity of persons who experienced an acute or chronic illness.

I am reminded of one nurse who wrote an article about her treatment of a leg wound on a client with diabetes who would not permit her to enter his home. She succeeded treating the client in this rural setting, even though it meant performing wound care through an open window of the patient's home.

Nurses often submitted vignettes about adjusting to care for the family pets, and poetry describing the strength of their caring for clients and family members. There were glimpses of a humor born of loving the work and the clients with whom they interacted. Of course there were the frustrations of not being considered an integral part of the healthcare team, of being an observer rather then a decision maker!

Today

Today the nurse makes judgments based upon assessments, scientific knowledge, and experience about the patient's abilities and response to therapies. The nurse must care for the growing numbers of caregivers, both home health aides and family members who are providing the bulk of care in the home.

In a 1998 study conducted by the United Hospital Fund of New York, researchers found that there are more than 25 million family caregivers practicing in the United States-individuals who provide ongoing care to seriously ill or disabled family members (Levine, 2000).

These caregivers complement medical technology with human caring that allows clients to remain at home longer, rather than having to be routinely institutionalized. Home care nurses must advise, inform, and teach them how to give care and to navigate health, social, and reimbursement systems.

Healthcare costs are being contained through reduced length of hospital stays, increased out-patient care, and reductions in home care benefits through managed care organizations and public financing programs. Thus, society's reliance upon unpaid, untrained, family members has increased.

These family members:

* are 60% female, 51.3% of whom also hold full-time jobs;

* provide, an average of 20.5 hours of labor-intensive caregiving per week;

* work alone 82% of the time, without assistance from the formal in-home care system, (75% of the caregivers who had hired help expressed worry about neglect or mistreatment of their family member at the hands of paid caregivers);

* reported (60%) that they had received no instruction in performing activities of daily living (USDHHS, 2000);

* reported that professional nurses and physicians were most effective in providing instructions about medications;

* need more options for respite services that will extend the life span of their caregiving (Levine, 2000).

The Future Role for Home Care Nurses

What began as an altruistic calling in the late 1890s and early 1900s and grew into a cottage industry in mid-century with the passage of the Medicare system has now become a mature business, an adult system of care, recognized for its contribution to the health and wellness of the American community.

Now in its adulthood, home care nursing must take a greater role as family educator and healthcare counselor/advocate for caregivers who struggle with the everyday emotions and challenges of caregiving.

The Challenge

During my 10 years as editor of Home Healthcare Nurse, I witnessed many changes in technology, scientific knowledge, therapies, and care modalities. However, I believe that nothing has as much positive impact upon treatment outcomes as the interpersonal relationships established among home care nurses, their clients, and family caregivers.

The challenge for the future will be to maximize and build upon those relationships, despite the obstacles of shortened turn-around time between admission and discharge from service and the financial hurdles that are continually placed in our path. As we accept this challenge, I envision that we will come full circle in our roles as community home healthcare nurse caregivers, family educators, and advocates.

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