The provision of healthcare to patients in their homes has become increasingly common and popular for several reasons. The average length of hospital stay has decreased dramatically since the 1980s when the United States came to the realization that something had to be done about out-of-control healthcare spending. Home care emerged as a cost-efficient alternative to expensive hospital care. Improvements in technology, driven in part by the need to decrease length of hospital stay, have allowed patients with complex healthcare needs to remain in their homes for care formerly only offered in hospitals. Finally, there is a trend away from institutional care for older adults, with most preferring to age in place.
As you know, home care has changed drastically over time. A 1928 Visiting Nurse Service booklet by the Henry Street Settlement in New York City described the function of the "visiting nurse" as follows:
It is the function of the Visiting Nurse Service to give skilled nursing care in the homes and instruction in personal hygiene, sanitation and the prevention of disease; also as far as possible, to solve the related social and economic problems that are met in the families under its care either by using the resources of the organization or referring the problems to the proper cooperative agencies.
The booklet goes on to describe nursing care that revolved around basic human needs of food, clothing, and shelter. So much has changed in 94 years! In this issue, author Dr. Susan Hinck introduces readers to a midrange theoretical framework of home-based professional nursing practice in a much different world. One might ask why it is important to develop a theoretical framework of home care nursing. A theoretical framework is needed to guide practice, education, and administration. It can elucidate and clarify the role of the home care nurse in a way that places home care nursing on par with other areas of specialty nursing practice.
Dr. Hinck asks for your feedback and critique, as this will help to continue to define home-based nursing practice as the important specialty, we know it is.
Best wishes,