Associate professor in gerontological care, Docent in clinical nursing science
Åbo Akademi University, Health Sciences, Strandgatan 2, 65100 Vasa, Finland
ROLE OF NURSING IN AN INTER-PROFESSIONAL PRAXIS – home care as an example
The focus of patient care is rapidly shifting away from hospitals to outpatient care and to domiciliary care, such as home health care and hospital-at-home care. This often occurs with the objective of reducing healthcare costs while simultaneously improving the quality of care.
Home care, an umbrella term, can be defined as the care services provided by health professionals in patients’ homes. Home care services facilitate flexibility in patients’ schedules and time management, for example, reducing the need for travelling to or from the hospital or waiting for appointments. Moreover, care at home helps with hospital admission avoidance. For the chronically ill, care at home constitutes a lifeline to the self‐management of medical treatment or interventions for acute exacerbations of chronic conditions.
Home health care encompasses a range of nursing activities, from preventive health work to palliative care, all with the goal of enhancing patients’ functional capavity, health status and quality of life. It consists of interventions such as taking blood samples and other measurements and the monitoring of medicine compliance and patients’ clinical condition. Hospital‐at‐home (HAH), then, support individuals with acute health problems who require temporary special health and nursing care such as infusions or respiratory treatments yet do not need continuous observation. The aim of HAH care is the provision of elements of healthcare normally provided to hospital inpatients, yet realised in a home setting. HAH care is comprised of medical and nursing care.
While patient´s clinical symptoms primarily guide the decision‐making process connected to place of care, the whole psychosocial and existential human being must be taken into consideration during the planning, realisation and evaluation of care at home (Lou et al., 2017), both together with the patient him/herself and his/her family caregivers. The entire interprofessional team must engage in personcentredness, collegial communication and respect for the other (Larsen, Broberger, & Petersson, 2017). Inter-professionality means that professionals from different disciplines work together in order to reach the common goal, which is alwys the best of the patient. Every professional brings to the collaboration his/her specific professional know-how, which is respected by others, and the decisions are made together. There is no leader in that interprofessional collaboration, for the responsibilities and the goal are shared in every sense of the word, and the patient is in centrum, not a single profession/al. (Dijkstra et al., 2022.)
In a scoping review with an HAH context (Vaartio‐Rajalin & Fagerström, 2019), researchers found that patient‐centredness was perceived as respect for a patient’s autonomy, self‐determination capacity and social relationships and made concrete by nurses through a continuous, trustful relationship established during the planning and evaluation of care together with the patient and his/her near‐ones. In that review, nurses were considered an instrumental factor in the facilitation of patient‐centredness. Without nursing, the care is focused only in diagnoses, clinical symptoms, medication and its´ effectivity, and despite the clinical care outcomes (such as normalized hypertonia) may be positive, the patient´s quality of life is not considered (look a film from https://euroqol.org/eq-5d-instruments/).
There is also evidence that the care organization gains from inter-professionality, for existing service structures and processes are used effectively, employees perceive less work-related stress and more working satisfaction, all professional in inter-professional team learn new competencies, and the quality of care as well as safety of care are rising (Al Sabei et al., 2022; Dijkstra et al., 2022; De Luca et al., 2021; Zidek & Medland, 2020).
Al Sabei, S. D., Labrague, L. J., Al‐Rawajfah, O., AbuAlRub, R., Burney, I. A., & Jayapal, S. K. (2022). Relationship between interprofessional teamwork and nurses’ intent to leave work: The mediating role of job satisfaction and burnout. Nursing forum (Hillsdale), 57(4), 568-576. https://doi.org/10.1111/nuf.12706
De Luca, E., Sena, B., Cataldi, S., & Fusillo, F. (2021). A Delphi survey of health education system and interprofessional nurse’ role. Nurse education today, 99, 104779. https://doi.org/10.1016/j.nedt.2021.104779
Dijkstra, N. E., Sino, C. G., Schoonhoven, L., Verdoorn, S., Bouvy, M. L., Heerdink, E. R., . . . Pharmacology, P. a. C. (2022). Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews. Journal of interprofessional education & practice, 28, 1.
Larsen, A., Broberger, E., & Petersson, P. (2017). Complex caring needs without simple solutions: The experience of interprofessional collaboration among staff caring for older persons with multimorbidity at home care settings. Scandinavian Journal of Caring Sciences, 31(2),
Lou, S., Carsten, K., Moldrup, M., Shahla, S., Zakharia, E., & Nielsen, C. P. (2017). Early supported discharge following mild stroke: A qualitative study of patients’ and their partners’ experiences of rehabilitation at home. Scandinavian Journal of Caring Sciences, 31(2), 302–311.
Vaartio‐Rajalin, H., & Fagerström, L. (2019). Professional care at home: Patient‐centeredness, interprofessionality and effectivity? A scoping review. Health and Social Care in the Community, 27(4), 1–9. https ://doi.org/10.1111/hsc.12731
Zidek, S., & Medland, J. (2020). Interprofessional Collaboration: A Model for Nurse Executives to Follow to Support Magnet® Designation. The Journal of nursing administration, 50(10), E8-E11. https://doi.org/10.1097/NNA.0000000000000933
Jūratė Macijauskienė, project coordinator
Živilė Kepežinskienė, project manager
Dinara Kozhakhmetova, responsible for WP4 Dissemination
Baituganova Aizhan, responsible for WP4 Dissemination