Diploma of Nursing
HLTEN608B PRACTISE IN THE DOMICILIARY
HEALTH CARE ENVIRONMENT
Impact of Health Problems on Domiciliary Client Care
Assessment
Introduction
As for all nurses, Domiciliary Nurses are entrusted with:
• Client and family information enabling them to
• Recognise and respond to
- Condition changes
- Care needs
- Coping abilities
• Family involvement is encouraged – however should be:
- Co-ordinated as per the care plan
- Timely and responsive
- And incorporate the philosophy and aims of Domiciliary Care
Case Management
Case management is a system of care provision
• commonly used in the domiciliary health care environment.
• That provides cost effective
• client assessment,
• care planning,
• implementation and
• evaluation of provided care,
• ensuring appropriate care
• An EN plays integral role in facilitating the care management process
Case Management
Working with a case manager
e.g. RN, Allied Health Professional ensuring that the care includes:
• Assessment and evaluation
• Client goal directed care planning
• Education for client and family
• Knowledge of available services
• Co-ordination and appropriate referrals
• Accurate documentation (Video 11 minutes) to ensure timely care plan
and goal revision
• Appropriate goal oriented discharge planning
Funnel et al 2009 p80-81
EN: desired qualities and awareness
To provide effective domiciliary health nursing care a nurse must:
• Adapt to different home environments and
• Adapt to client/family responses and perceptions of support and
care.
• Be aware of
• client history and life experiences,
• immediate environment and
• cultural and religious beliefs.
Domiciliary health care environment EN role
Enrolled nurse role in domiciliary care: ‘Job description’
• Work ethically and professionally within scope of practice
• Independently under indirect S/V but seek guidance
• Recognise, respond to clinical manifestations of client health problems
• Communicate effectively with clients/families and allied health team
• Strong organisational and time management skills - self-motivation
• Client and family advocate; Non-judgmental approach
• Adapt care based on client and family needs
• Maintain safety: own and client; adhere to infection control
• Current driver’s license – no restrictions
Confidentiality, Privacy and Trust
Confidentiality and privacy of client information in all situations
• An ethical, professional and legal obligation in domiciliary health
care environment
• Mandatory reporting obligations challenging but essential
Therapeutic relationship:
• open and honest approach to gain and maintain mutual trust
Patient education:
• Explain to client how information is gathered, documented and
• Used in line with service policies and protocols encompassing
• The need to share information with other health professionals such
as the case manager
8
Recognising impact of Health Problem
Initial assessment involves:
• Initial phone call – establishing initial nurse, client, caregiver
therapeutic relationship
• Assessment data collecting interview re client’s health and
medications
• Historic database including
• the socio-environmental and family assessment
• The nursing health history:
• feelings about previous health care and expectations
• Past health-illness patterns
• Risk factors and resources available
Clinical Manifestations of Health Problems
Clinical manifestations of health problems in domiciliary environment
• Medical Status
• Neglecting to eat: weight loss or gain; constipation and / or
dehydration; incontinence
• Mobility, personal hygiene; loss of muscle or bone strength; transfers
• Home environment safety: potential for harmful interactions
• Family coping? Social interactions including the lack of them
• Behaviour: emotional responses and attitudes to care – client and self
• Finances; resources use and needed
• Adverse drug reactions
• Chronic wounds
Stayles & Flanagan 2002, P 11 & 45
Discuss assessments with RN/allied health
Discuss information gained from assessments
• with RN appropriate members of the health care team for
- care planning
- problem solving and
- evaluation.
• Evaluate care and outcomes for both physical and psychological
impact for the client and family.
Assessment of client requiring domiciliary health care includes
• Health status and care needs
• Identification of actual or potential problems
• Socio-economic and cultural factors impact related to care provision
• A problem solving approach to assess health problem impact on
• Activities of Daily Living and
• The care and outcomes of physical and psychological impact on
client and family
Client consent to discuss client information to
• enable family and allied health contribution to care planning, problem
solving and evaluation
Element 2.2 Discuss assessments with RN/allied health
Element 2.3 Holistic assessment of Impact on ADLs
Gaining Consent to Discuss Issues
Client and family more active role in domiciliary health care setting
• Referral and permission for home care based on informed consent
• Client consent to discuss care with family
• Then family involvement in decision making and care
• Encouraging client /family care plan and intervention
• Acknowledgment of client’s home as the care setting
• Recognition of the multiple needs of the client
• Client self-care decision making strategies encouraged throughout
http://www.entirafamilyclinics.com/
Gaining Consent to Discuss Issues
Client and family more active role in domiciliary health care setting
• In homecare the EN must be holistically client and family focused.
• As care is provided through home visits, client and family more involved
• Consent given by client for open communication with families so that:
•Family education and problem solving strategies can be incorporated
into client’s care plans.
•In turn, families, along with the client, can contribute to planning,
implementing and evaluation of care
Communicating client assessment
Discuss with RN and allied health, client assessment of:
• Actual or potential client problems.
• Impact of socio-economic / cultural factors related to care provision
• Impact of health problems on client and family
• With client consent discuss the with the client or family:
• Physical, psychological and social impacts of a health problem on
client activities of daily living
• Enabling their contribution to care planning and problem solving.
http://ltcsbooks.com/assessing-pain http://oscr.umich.edu/
Problem Solving Approach
Critical thinking and a Problem Solving Approach essential
• In homecare EN must be holistically client and family focused.
• Care provided through home visits, client and family more involved
• Client care plans: more detailed teaching/problem solving strategies
Video: Nursing Process Overview: ADPIE
(Assessment, Diagnosis, Planning,
Implementation and Evaluation) 9 minutes 20 seconds
Reflective Questioning
The process of Reflective questioning leads to continuous improvement
• What care would you like if you were being cared for by yourself!?
• What are you doing now?
• What can we do better?
• What differences do we need to make to our care to do it better?
• How can we make that happen?
Video Reflective Practice 4 minutes
Activity: Patient Safety in Home Care
• Explain your EN role in ensuring patient safety and quality care in
the home care environment:
• Medication Management
• Falls prevention
• Unplanned hospital admission
• Nurse work environment
• Functional outcomes and quality of life
• Wound and pressure ulcer management
Patient Safety and Quality: An Evidence-Based Handbook
for Nurses. Carol Hall Ellenbecker; Linda Samia; Margaret J. Cushman; Kristine Alster.
http://www.ncbi.nlm.nih.gov/books/NBK2631/
