Page 272 - Encyclopedia of Nursing Research

HOMeleSS HeAlTH n 239

other management applications, such as As more nurses have moved into home
scheduling, patient census, visit tracking, care settings, they are often finding themselves
cost statistics, utilization reports, accounting overwhelmed, especially if they have previ- H
statements, and discharge summaries. ously worked only in inpatient settings. Home
Newer technological systems have care is unstructured, and the nurse is often
emerged that are designed to focus on the called on to make autonomous decisions. A
patient encounter and visit during an episode research-based theory of home health nursing
of care. They include clinical applications (Neal, 1999; Neal-Boylan, 2009) was developed
used to assess and document the care process, to help nurses and administrators understand
to generate care plans, and to prepare critical the characteristics needed to be a successful
pathways or protocols that outline the criti- home health nurse and to help guide nurses
cal events. These newer systems are using the new to home care as they transition.
electronic information superhighway to com- Home health has increasingly become
municate patient information for continuity of the focus of myriad research studies as
care from hospital to the home, to the commu- researchers strive to discover how to retain
nity, and back to the hospital. The systems also home health nurses given an environment of
offer other applications that focus on decision increased demand and complicated expecta-
support, evaluation of care, and measurement tions regarding documentation. researchers
of outcomes across settings, time, and geo- are also evaluating home health nursing
graphic locations. The systems are considered practices to determine whether they are evi-
part of the lifelong longitudinal record con- dence-based and protect the patient and the
taining patient-specific health-related data. nurse in the home environment.
Tele-health home monitoring systems
are being used with increasing frequency to Leslie Neal-Boylan
monitor the status of patients who reside in
remote locations or who need frequent super-
vision. These systems vary and include their
own manufacturer guidelines. However, cri- HoMeless HealtH
teria for patient enrollment are fairly con-
sistent, such as the ability of the patient to
physically and cognitively participate in the The global economic recession and the contin-
program, a safe home environment, a pre- uing ongoing declared and undeclared wars
dicted extended stay on service, a useable have caused a marked increase in the number
phone system, and a willing caregiver. Staff, of homeless people worldwide. Homelessness
patients, and caregivers must receive train- is a complex phenomenon that has many
ing in the use of the equipment (Visiting intersecting causes: historical, social, eco-
Nurse Associations of America, 2008–2009). nomic, political, and educational; but regard-
The Outcomes Assessment and Set emerged less of the cause, the loss of “your” home and
in an attempt to accurately assess the home its connections with your life is a major stress-
health patient’s status on admission to home ful assault on the personal identity of individ-
care and at various intervals throughout the uals, families, and population subgroups.
home care stay. The data gleaned are used by The impact of this disruption in
Medicare, Medicaid, and private insurances health increases dramatically when a per-
to determine reimbursement for home visits. son becomes homeless. These detrimen-
The Outcomes Assessment and Set includes tal effects include diminished mental and
several versions of forms that include ques- physical health (Savage, lindsell, Gillespie,
tions ranging from functional ability to lee, & corbin, 2008), lack of access to both
wound status and more. preventive (Bonin, Fournier, Blais, perreault,