[Catfish RN]

Hello all you HHN's out there. I am a RN working on my BSN and I need to interview a Home Health Nurse.
My assignment is: What types of clients, coordination, roles of otherteam players and client education. Compare differences in documentation, environment, work place issues and nursing care in acute care versus home health setting.

Does anyone want to assist me, volunteer info, help?
Thanks,
Cathi

[jnette]

Hello Catfish !

Welcome to Allnurses !

I've only bee doing HH for nearly two years now, but still maintain it is Nursing's best kept secret!

Don't know exactly what you need, but I'll try to help you out if I can.. one question at a time, please.

There are several others here who may well be better qualified than I to answer your questions.. those who have been doing HH longer than I. I hope they pop in to help as well.

I'll try to help you if I can until then...

[Catfish RN]

Thank you so much.
1) What types of patients do you get?

[jnette]

Mostly elderly medicare patients... although we do get several younger or middle-aged pts. on private insurance as well. And several medicaid.

A lot of CHF, AFIB, CAD, PVD, COPD, Diabetes with other comorbidities. Also numerous TKRs, THRs, Rotator Cuff tears with repair, LE fxs., wrist fxs. with external fixators requiring BID dressing changes.

Every now and then we might get something out of the "ordinary" but the above are the most frequent.

[Catfish RN]

Not sure if this went through so I am resending...
How is the care coordinated? What are the roles of the other team members?
Thanks,
Cathi

[jnette]

Originally Posted by Catfish RN

Not sure if this went through so I am resending...
How is the care coordinated? What are the roles of the other team members?
Thanks,
Cathi

Other team members? Not quite sure I understand what you mean by that, but at the HH Agency itself we have Office Nurses who do a lot of the paperwork (computerised), intake for referrals, take and write new MD orders, careplans, etc.

Then we have regular office staff for charting, filing, and other admisinstrative duties. We have a fulltime Social Worker, perhaps 2 dozen HH aides, a HH aide supervisor (RN), a couple Wound Care specialists (nurses) and about 5 Physical Therapists. One RT, and a dietician.

As for coordination of care, not sure how you mean that, either. Not even sure I could even answer that as I don't hang out in the office much and don't really know all the ins and outs of that aspect.

[Catfish RN]

Documentation, how is different from the Acute care setting?
I also have seen "OASIS" a lot when I have read some of the posts. What is that?

[jnette]

Originally Posted by Catfish RN

Documentation, how is different from the Acute care setting?
I also have seen "OASIS" a lot when I have read some of the posts. What is that?

Most agencies have preprinted "visit notes" sheets. These incorporate all the major system assessments just as you would do in a hospital setting. There is a block for each system (VS, Neuro, GU, GI, Musculoskeletal, etc., etc.)

These are checked off or noted according to pt. responses. There is a separate block for wound care needed and provided.

The bottom and back of the sheet has a place for the nurse to summarize her findings of the home visit, add any comments and what teaching she has provided.

As for the OASIS.. LOL !!! The dreaded OASIS.

I'm going to copy and past what Nrs. Karen recently gave to another inquiry on the OASIS... hope she doesn't mind :


"Outcome & Assessment Information Set (OASIS) is an asessment information tool /form required to be utilized by Medicare and Medicaid certified homecare agencies to document clinical outcomes of each patient.

It also determines payment for care for Medicare patient sbased on patients functional, diagnosis and clinical status.

How well one completes this multipage form (ours is 15 pgs) on admission, resumption of care post hospitalization, and discharge documents progress in getter better or lack thereof between admission and discharge from homecare services using a score.; also affects how much $$$ agency receives for care.

This OASISdocument is transmitted to the state+ Medicare and compared to other patients with same diagnosis across the US. The total Outcomes by agency are publically reported measures quarterly posted on CMS (Medicare) website.

Within the next 2 years, agencies will be payed more $ dependent on improvment in scores for patinets so a very big deal.

Takes minimum of 45 min to 1hr15 min to complete this document."

Hope that helps.

[Catfish RN]

Your answers are very helpful. Thank you again. We are not done though...
What is the Environment like in Home health? How about work place issues?
I know it's two questions but I think they are kinda related.

[jnette]

Environment? Well... I'm biased, since I dearly love HH.

And fortuanately for me, I work in a rural setting.. country roads, lovely scenery, meadows, cows, rail fences, hills and valleys, babbling brooks. Yep.. you get the visual.

So it's very liberating and refreshing not to be confined to a unit floor.. and instead of hearing intercoms, pages, loudspeakers, etc., we can listen to our choice of music while drinking coffee in the morning as we toodle down the road in our vehicles.

It would depend on the geographical area, I suppose. Personally, I'm not a city person, so I wouldn't care too much for HH in a city setting.

I can say that regardless of the setting, HH patients are always more than pleased to see us arrive at their front door. Thye welcome the visits warmly and I have yet to meet a patient who does not. It is also a unique setting in that you are in THEIR home, on THEIR turf, and it is something we respect at all times.

Not sure if this is what you meant by "environment", but for what it's worth.

As for workplace "issues"... I suppose these are common in ANY nursing environment, but since I am one who arrives at the office before the rest, and thus gets OUT before the rest arrive, (most of the time), I'm not really exposed to these "issues". If I hear things that don't concern me, I just go on my merry way and ignore it.

I feel that our agency is pretty good at teamwork and being helpful not only amongst the roadwarriors, but between the office staff and the road nurses as well. I'm sure every agency is different, some may have more issues than others. I can only speak of what I know and have experienced with MINE.

We do have bi-monthly nurses meetings during which issues are aired, changes made, insevices held.