Patient care is an integral part of the treatment process, which largely influences recovery terms and quality. At the same time, the nature of the assistance provided by medical personnel is regulated by the relevant legislative provisions and policies that determine the course of work. Some practices are valuable and effective and are used as useful mechanisms for helping patients. Nevertheless, there are policies that do not always affect the quality of care positively because of certain gaps in their preparation and implementation. In nursing practice, home-based care is the common practice of helping those patients who are forced to be on treatment at home. Despite some advantages of this approach, for instance, an opportunity to spend enough time with each patient, gaps may arise. In order to rule out potential negative manifestations of this policy, it is essential to consider the factors that are manifested during nursing work and their causes. The analysis of home-based healthcare service as one of the ways to care for patients can help to consider this approach in detail and identify potential gaps with the goal of eliminating and avoiding them.
Public Policy Description and Its Effect
Throughout the world, the proportion of patients requiring constant professional medical care is constantly increasing after discharge from the medical facility, which leads to the actualization of nursing. Professional home-based services include a wide range of care and support for those who recover from hospitalization, who are disabled, have chronic or incurable diseases, and need medical, social, or therapeutic care or self-care assistance. This practice includes a set of measures aimed at restoring the health status of patients and implemented by junior medical personnel. At the same time, the role of this work carried out in recent years has significantly increased. According to Wysocki et al. (2015), the costs for this type of care incurred in accordance with the state Medicaid program “rose from 19% in 1995 to 43% in 2009” (p. 256). It, in turn, proves the relevance of this approach in modern medicine.
The effect of home-based care on nursing practice is determined by the principles that guide medical professionals resorting to this type of patient assistance. In case junior medical staff performs immediate duties responsibly and provides people with the necessary support, the process of recovery is faster in comparison with self-drive. Wysocki et al. (2015) note the specific importance of this practice for older adults since, as a rule, this particular group of the population needs nurses’ attention and timely assistance. However, different categories of patients sometimes cannot live without the help of clinics’ and nursing communities’ employees who visit their homes and provide all the necessary assistance. Therefore, the effect of home-based service interventions is significant, and this policy is in demand and relevant.
The Gap Existing Between the Organization and the Policy
The institution under discussion is a nursing home where palliative care is a frequent and common practice. The staff working in this healthcare institution regularly works with patients who experience problems and cannot help themselves. Special assistance measures aimed at educating such people and helping them in the implementation of daily procedures are the conditions of this institution’s work. That is why the policy of home-based service is relevant here and requires responsibility from each employee involved in these activities.
Despite the joint work aimed at the successful implementation of the tasks, some gaps still arise, which negatively affects the quality of care. In particular, one of the main shortcomings is the lack of sufficient nursing training to help patients at home. Junior medical employees are not always able to define the range of their duties clearly and implement all necessary procedures comprehensively. Certainly, the level of nurses’ qualification should be appropriate in order to work with the population. Nevertheless, it is the task of the clinic’s management to ensure that subordinates have sufficient professional training and are able to carry out the assigned tasks responsibly.
Such parameters as quality indicators may be used to identify gaps in the practice of medical personnel working in this institution and following provisions of the policy under consideration. In order to do it, special means, or tools are used. “The tools are practical and designed to meet the needs of hospital leadership and quality improvement teams” (“Toolkit for using the AHRQ quality indicators,” 2017). One of the essential parameters is the readiness to change, which means that quality care is possible if employees are ready to recognize and correct mistakes made (“Toolkit for using the AHRQ quality indicators,” 2017). Another indicator is the priorities for quality improvement when the management and other responsible boards distribute tasks correctly in accordance with the degree of their importance. These and some other tools are valuable mechanisms for overcoming the gap and changing the current situation for the better to support the policy of home-based care.
Patient Care and Organizational Consequences of the Existing Gap
In case home-based care does not meet the established quality standards, negative consequences for both patients and the healthcare organization can manifest themselves. As Shippee, Henning-Smith, Gaugler, Held, and Kane (2017) note, family dissatisfaction with the quality of nursing assistance may be one of the outcomes. A patient who cannot independently perform daily procedures is forced to wait for help from the relevant healthcare authorities. The policy of home-based service is the program that provides this assistance. If work is performed poorly, the management will receive complaints, which will inevitably lead to the violation of the clinic’s reputation and negative feedback from disgruntled patients.
In addition to discontent, more severe consequences may manifest. In case of complaints to higher authorities, fines may be imposed on the healthcare institution that does not fulfill its immediate duties. The leaders of the clinic will have to report on the work of the staff and take emergency measures to correct the current situation. According to Shippee et al. (2017), patient feedback is a direct criterion for assessing the quality of nurses’ work, and if dissatisfaction is constantly reported, explanations will be required on the reasons for inadequate care.
Finally, the health consequences of patients are the most dangerous. Not being able to take care of themselves independently, patients with limited mobility may experience severe suffering caused by inadequate medical assistance. Despite periodic nurses’ visits, their care may be inadequate or unqualified, which, in turn, inevitably increases the risk of patient deterioration. In order to avoid it, the interest of both the clinic’s leaders and employees themselves is an indispensable condition for the safety of the population.
Measures to Close the Existing Gap
In order to avoid dangerous consequences, certain measures are to be taken. Specific solutions can include a set of procedures aimed at improving nurses’ professionalism and strengthening managers’ control over the work of subordinates. As effective ways to solve the problem, some quality indicators can be used. Timely intervention can allow preventing risk outcomes and obtaining positive feedback on the work of medical specialists who adhere to the policy of home-based service.
Toolkit as a Guideline for Success
One of the tools, in this case, may be “monitoring progress and sustainability of improvements” (“Toolkit for using the AHRQ quality indicators,” 2017, para. 6). This mechanism helps to monitor nursing activities successfully and, if necessary, make the necessary adjustments. This indicator is useful primarily for the management of the clinic. Another quality indicator is “implementing evidence-based strategies to improve clinical care” (“Toolkit for using the AHRQ quality indicators,” 2017, para. 6). Well-grounded nursing interventions and work based on theoretical approaches can allow excluding any manifestations of discontent from patients and achieving positive outcomes. This measure is valuable both for the management and the personnel of the clinic.
Timeline for Completion
In order to implement the whole range of innovations comprehensively and make the policy of home-based service more sustainable, it may take at least three months. During this period, both the staff of the clinic and the representatives of the administration can receive appropriate training and all the necessary knowledge regarding the new working strategy. In case it takes more time, the new mode of work can be implemented gradually, and the results of activities should be monitored. If the dynamics of treatment and patients’ feedback are positive and there are no complaints, it will mean that the new course is effective and useful.
Responsible Personnel
As employees who will monitor that the gap is closed senior nurses can be appointed. They are well aware of the activities of their immediate subordinates, know all the weaknesses, and can ensure the comprehensive implementation of the updated home-based service policy. Moreover, this staff is responsible for the work of the entire clinic’s nursing staff, and in case of violations, they will be accountable to the senior management. Consequently, they are also interested in not allowing complaints from patients and fines, therefore, they can be entrusted with direct control over assessing the success of nursing activities.
Existing Barriers to a Successful Implementation
Some barriers may arise in the way of introducing new working conditions. According to Aldridge et al. (2016), it may be the “lack of adequate education/training,” “inadequate size of palliative medicine-trained workforce,” and the “need for greater funding for research” (p. 224). Nevertheless, if the management ensures that all the innovations meet the conditions of the new program, and the staff of the clinic will strive to hone their skills, these challenges will not cause severe outcomes.
Conclusion
Care based on home-based service can be improved by following appropriate strategies and introducing quality indicators as tools to improve the professionalism of nurses and the quality of supervision by the management. The existing gap can have dangerous consequences for both employees and patients. Nevertheless, adherence to specific provisions may help to avoid violations, complaints, and fines. About three months may be needed to implement the new working strategy comprehensively. Despite some barriers that may arise, the responsible attitude of stakeholders towards this issue can help to maintain the high quality of care.
References
Aldridge, M. D., Hasselaar, J., Garralda, E., van der Eerden, M., Stevenson, D., McKendrick, K.,… Meier, D. E. (2016). Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine, 30(3), 224-239. Web.
Shippee, T. P., Henning-Smith, C., Gaugler, J. E., Held, R., & Kane, R. L. (2017). Family satisfaction with nursing home care: The role of facility characteristics and resident quality-of-life scores. Research on Aging, 39(3), 418-442. Web.
Toolkit for using the AHRQ quality indicators. (2017). Web.
Wysocki, A., Butler, M., Kane, R. L., Kane, R. A., Shippee, T., & Sainfort, F. (2015). Long-term services and supports for older adults: A review of home and community-based services versus institutional care. Journal of Aging & Social Policy, 27(3), 255-279. Web.