Revamping a tried and true concept
Home Care Program Nursing Care Delivery Model focuses on relationships to build health
With over 400 visiting home care nurses and thousands of people needing the service, the question - and challenge - is how do we deliver that service? How do we assign nurses providing home care services?
Forums were held with staff to get their input. The answer to those questions is why the Region's home care program has picked up a familiar model, dusted it off and updated it.
"We asked about where we are today and where we need to head," says Kathleen Klaasen, CNS with the Region's Home Care Program, noting the new care delivery model echoes the concept started with the Victoria Order of Nurses. "This model was in place 30 years ago. This is the new and improved version of it - where a group of three to six nurses will work together as a care team to provide service to those clients living within a defined neighbourhood."
"Visiting home care nurses provide nursing service but also focus on health prevention/promotion, help people connect to health services and work collaboratively with the health care team," explains Klaasen. "The new nursing care delivery model aims to maximize the scope of practice for nurses enabling them to meet and exceed provincial and national standards of practice and core competencies of home care nursing."
It's a timely shift, according to Klaasen.
"Nursing services had become too task focused - injecting insulin, changing a wound dressing - that in some ways, we had lost sight of the comprehensive assessment and service coordination piece, which we began to see resulted in a lack of continuity of care. It became clear there was a need to increase communication among the home care team and our partnerships with other health care providers," says Klaasen.
In the new model, regular care reviews - when the nursing care team meets to discuss the people on their caseload, their care needs and what needs to be followed up on - happen every week or two. This in and of itself is a shift from the annual care reviews that were previously part of the routine.
"The care reviews are more frequent and more collaborative, engaging other members of the health care team such as home care case coordinators," notes Klaasen.
This helps given acuity is increasing. Just as other areas of health care have found, people requiring home care have greater health care needs than in years past.
"Nurses would say the home care clients we're caring for are much more complex. They have multiple co-morbidities and a higher level of acuity," says Klaasen.
Donna Sale, Director of Operations for Home Care, agrees. "The complexities of client care have significantly gone up when compared to even five years ago. People who we used to see in long term care or hospital, are now being successfully cared for at home," she says.
This creates the need for strong clinical nursing expertise. In this new model of care, the opportunity exists for nurses to brainstorm as a group and learn from each other, as well as to have access to clinical nurse specialists and nurse educators. It also allows for a consistent, evidence informed approach to practice and opens the door for mentorship.
"We're looking at how we can best support nurses in building their clinical expertise - clinical education in person, webinars, online education . . . and we're looking at helping them develop Collaborative Care competencies that will help them work more effectively as a care team," says Klaasen.
With consistency in nurse-client assignments comes the opportunity to build relationships with the people receiving care. It also allows for a greater degree of familiarity, which can strengthen a nurse's assessment on issues like mental health, risk of falls, a person's mobility or what causes a wound. The model empowers nurses to return to a holistic, health promotion approach to service delivery. It also puts a home care nurse in a stronger position to realize what other health care providers may need to be called in to support a person's health.
"How are they presenting that day? Are there reasons they are not doing well that particular day?" says Sale, who notes that a visiting home care nurse has a greater focus than just one task like wound care, for example. "With that comprehensive overview of clients, the nurses are in a position to prevent admission/readmission to hospital with early intervention and promotion. Ultimately, that impacts patient flow."
The new care delivery model will be officially launched this fall in three areas: Point Douglas, St James and Assiniboine South. Launching with these sites first offers the chance to enhance what's working, and tweak what's not. The goal is full implementation in these areas by the end of 2014 and rollout beginning in other areas in the spring of 2015.
The model is being evaluated, which invites further opportunity to discover what works well in terms of client and staff outcomes. It also allows the chance to improve on things.
"As we implement the model, we revise and change how we do things. These lessons help us understand the big question - how do we implement this city and program wide?" Klaasen says.
The nurses - who were involved in the planning - are excited about these changes. "The change really speaks to the heart of being a nurse. Nurses going into community did so to provide holistic care, health promotion and prevention, and chronic disease management," says Klaasen. "Nurses are so engaged, so excited by what is basically the essence of why they became a nurse in home care. They are driving this change."