Home Health Care Management & Practice

Asthma is a common chronic disease of childhood. Despite advances in treatment, the morbidity and mortality from childhood asthma continue to increase. Asthma is a frequent cause for school absences and visits to health care providers. The home health care nurse can play a vital role in helping children and parents learn to manage asthma, rather than allowing the asthma to manage them. Assessment and education are the keys to prevention of acute exacerbations of asthma.

This article describes the evolution of a home health care program's development, focusing on the Visiting Nurse Association of Central Jersey's Cocaine-Abused Babies Program (CAB). The various components of the planning process are enumerated, including needs assessment, determination of appropriate objectives and outcomes, identification of stakeholders, and staffing needs. Examples from the agency's 5-year-old program are used to illustrate each part of the process. The CAB Project is an intensive home visiting program. Its primary objective is to enhance parenting abilities of mothers who used cocaine prenatally and to enhance and support the nurses providing intervention visits.

The decade of the nineties has already exhibited a dramatic growth in the home health care industry. Ongoing health care reform in this country provides home health care professionals an exciting opportunity to broaden their scope of practice as they care for the prenatal client who presents with complex home health care needs. The purpose of this article is to provide the nurse with an overview of those conditions that are now frequently seen in the home care environment. These informational guidelines provide a framework in which the home health nurse can work while allowing flexibility for the individual differences of providers, institutions, and clients.

The toll of adolescent pregnancy on the adolescent as well as society is immense. This population presents unique challenges to the nurse. Adolescent pregnancy within a developmental context, assessment of health status, health education, parenting, and life choices for pregnant adolescents are described in this article. Resources and suggested interventions are also included. The goal of a healthy outcome for both mother and baby is achieved by collaboration between the nurse and the adolescent.

The management and care of the child with diabetes is ever changing and increasingly complex. The past 20 years have seen a burst in technologic advances, diabetes research, and new information to facilitate optimal diabetes control. Application of those advances is necessary for home health care professionals involved in the care of children with diabetes and their families. Common issues of management for the child with diabetes need to be addressed, and practical information for home health care interventions needs to be developed for those who assist children with diabetes and their families. In light of managed care programs and limited hospital stays, home health care offers an opportunity to ensure appropriate and adequate diabetes education to care for the child with diabetes at home safely and effectively. Home health care professionals ideally should be a part of the diabetes management team but can also act as a bridge between the inpatient and outpatient settings.

Through changes in technology and medicine, the population of the intensive care nursery (ICN) has become more acute, along with new challenges for the home care provider. The follow-up care of these infants is multifaceted. They have medical, technical, developmental, financial, and psychosocial issues that affect them as well as their families and community. These issues may become evident in the form of a crisis, postdischarge, or may remain chronic and long term. The home health care nurse is in a unique position to facilitate, report, educate, and provide compassionate care for these infants and their families as well as connect them to their community. This article discusses some of the issues facing the ICN infant and family postdischarge and suggests home care interventions. It is followed by a three-part tool that may be used to assess an infant's ICN course, home assessment, and infant assessment.

Five assessment tools appropriate for families with young children are discussed. The tools chosen are valid and reliable and adaptable to use within the home setting. The tools identified are: The Brazelton Neonatal Assessment Scale, The Denver II, The HOME Scale, The Family APGAR, and The McMaster Family Assessment Device. With the shift in health care delivery into the community, nurses need to be prepared to complete assessments efficiently and effectively. The tools presented are widely used. None is diagnostic but each serves as a basis for further evaluation when combined with other available data. Each is best used when combined with a comprehensive, primary health care approach that is fundamental to health promotion and early intervention.

The resurgence of "natural " remedies and holistic drugs warrants special noting by health care professionals, especially within the context of their use in pregnant and nursing mothers. As home health care takes a more visible stance in prenatal and postpartum care, health care providers will be called upon to be resources of information regarding these therapies. Popular holistic therapies for insomnia, weight loss, and fatigue will be discussed as well as their implications on the fetus and nursing infant.