Shifts in Homecare Nursing Practices and Their Implications for Families and Clients Receiving Palliative Care at Home

Home care nurses provide critical health services to individuals living at home. Early patient discharges from hospital have shifted home care nursing practice from an emphasis on prevention to a focus on acute care management. As a result, older frail individuals and those requiring preventative or palliative care services are less likely to have timely access to home care nursing services. This, in turn, affects peoples’ ability to be cared for and to die at home.

IALH Research Fellow Kelli Stajduhar (Nursing) and colleagues at the University of Victoria, Trinity Western University, the University of Manitoba, McGill University and Island Health recently published findings from a study that examined how changes in home care nursing practices affect families and individuals receiving palliative care services at home. The study addressed two questions:
a) In what ways have home care nursing practice changed?
b) What are the implications of these changes for clients in need of palliative care and their family caregivers?

Qualitative data were collected through focus groups and in-depth interviews with a total of 38 participants who worked in home care (29 home care nurses and 9 home care managers/clinical practice leaders).

Participants identified three impacts as a result of changing home care practices: a) the erosion of relationship-focused care; b) reduced opportunities for upstream interventions; and c) shifts in health care system priorities.

For example, participants noted fewer opportunities for “continuity in care or for the relationship and trust building required to create a safe environment for sensitive conversations.” They also noted that individuals in need of palliative care services are often referred to home care late in their disease trajectory. However, when referrals for home care are made early enough, nurses “have more capacity to prevent crises at home, thereby reducing the likelihood of unnecessary human suffering.”

In addition, participants commented on a number of systems issues that impact their work. These include increased workloads without increased resources, a reduction in the amount of time spent with clients, and pressure to teach clients and families to care for themselves. The researchers stated that “health system changes may be constraining home care nurses’ abilities to enact care that is consistent with palliative care principles and philosophies”. They also noted that “As the demand on nurses’ time has increased…it has been the client, family and the nurses themselves who have paid the price.”

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