A future as a home care nurse

Usha Prabhakar, Senior Director-Nursing and Clinical quality, Healthcare at Home India, says how home-based healthcare, initially an unorganised sector, is catching the eye of investor brands and following certain protocols

India’s evolving economy is seeing several new services that are being conceived to convenience a modern society. Among them is home-based healthcare, a service that is gaining traction among recipients of medical facilities wishing to recover in the comfort of their home. What used to be an unorganised sector once is now an attractive area for investor brands as it follows certain protocols, besides being quite technology intensive. This is why seeking out a career as a home care nurse is a lucrative alternative to traditional hospital nurses. To qualify, an aspirant must have the following qualifications:

• GNM or B Sc Nursing
• Registered with State Council
• Training on life saving technique and infection control

By and large all home care nurses in India, and globally, are registered general nurses. Their role involves providing care to the patient by working in collaboration with other healthcare providers such as the primary doctor, members of staff at the hospital where the patient may have been cared for, as well as members of the patient’s family. Many homecare nurses are in fact specialists in providing palliative care or end-of-life care to patients. By providing expert management on pain and other symptoms combined with compassionate listening and counselling skills, home and palliative care nurses promote the highest quality of life for the patient and family. Some nurses do like to specialise in areas like oncology care, critical care, paediatrics or geriatric care. Diabetes management, Chemo port flush, PICC line dressing, VAC dressing, bed sore or wound management and dressing, post cardiac surgery care, post organ-transplant care, stoma-care and dialysis at home, are some of the other health cases that require specific knowhow and for such cases, nurses with both experience and technical training are preferred.

There is a distinct body of knowledge with direct application to the practice of home and palliative care nursing. This includes pain and symptom management; end-stage disease processes; psychosocial, spiritual, and culturally sensitive care of patients and their families; interdisciplinary collaborative practice; outcome evaluation skills; loss and grief issues; patient education and advocacy; bereavement care; ethical and legal considerations and communication skills. Besides being good at decision making and clinical governance, independent nurse practitioners at home are more confident, accountable and updated with thorough knowledge and competent clinical skills.

Broadly speaking, the popular areas of specialisation, and associated responsibilities, are as follows:

• Home oncology: Caring for a cancer patient in their home is both rewarding and demanding. This job requires the nurse to take on a team approach since doctors, nurses, social workers, physiotherapists and family members must work in collaboration to make the patient most comfortable.
• Mother and child care programme: As more and more expectant mothers have the demands of a job looming on the horizon shortly after having their baby, this journey has become incredibly stressful. The paucity of correct information, guidance and education has made the role on a home care nurse very important, especially as families go nuclear and the guiding hand of an elder is conspicuous by its absence. More and more small families are recognising the difference a home care nurse can make to the mental health of women and children.
• Maternity services: Not just after but before delivery, more young women bereft of parental guidance are likely to fall back upon these services. Here trained nurses deal with aspects like changes during pregnancy, diet, exercise, preparing for a new arrival and, finally, postpartum care and caring for the infant both of which is an equally important aspect. HCAH deputes its nurses for one-to-one sessions, clinical sessions over the phone and doorstep, anti-natal and post natal exercises, counselling and stress management.
• Home dialysis: Nearly ten to 15 per cent of India’s 1.25 billion people suffer from kidney ailments –a direct consequence of the rising incidence of diabetes. Of these, a large number of patients progress to end-stage renal disease and require organ transplant and renal replacement therapies to survive. The renal replacement therapy market is segregated into haemodialysis and peritoneal dialysis (PD). Renal replacement services are provided by hospitals, stand-alone clinics, nursing homes, dialysis care providers and home healthcare providers. Renal nurses provide such services at home safely and educate both patient and family.
• Autonomous working and decision making: There is a freedom to work alone and independently when nurses work with homecare service providers. This not only hones their decision-making skills, but also clinical skills. As nurses have to make independent visits to patients’ places, the accountability on them is high. This gives the nurse complete control over the situation, thereby making them more confident and independent.
• ICU services at home: This includes setting up of ICU at home with all relevant necessary equipment, handling critical care patient round the clock in shifts, and administering noninvasive ventilation- BiPAP and CPAP to Asthma, COPD and respiratory disease patients, as well as monitoring invasive ventilator at home.

After gaining practical experience a nurse may opt for a bigger role such as nurse counsellor, nurse educator, manager, human resource recruiter, and clinical quality control manager, industrial or corporate nurse. With palliative care, hospice care and home-based healthcare also being in demand abroad, many can hope to find suitable employment in another country. Since India is a hospital tourism hub, Indian healthcare providers are respected globally, and this includes the nursing community as well. The India International Healthcare Recruiters website, for example, counts countries like Abu Dhabi, Australia, Ireland, New Zealand, South Africa and the UK as the top recruiters for nurses, including home-based healthcare.

Nurses, consistent with their individual educational preparation, experience and roles, also promote the highest standards of end-of-life care through community and professional education, participation in demonstration grants, and in end-of-life research. As society’s needs change and awareness regarding issues surrounding end-of-life needs increases, nurses are called to advocate for the terminally ill and their families through public policy forums, including the legislative process. In light of the recent debate on euthanasia, and the Indian medical community’s emphasis that palliative care deserves attention instead, such legislative and policy initiatives by the homecare nursing community takes their role beyond the ambit of caring for a patient by the bedside.