Decision Making Tool: Determining Next Home Care Visit

Access decisions are a key aspect of clinical decision making in home care practice, but are rarely acknowledged as such. Substantial individual variation in decision-making processes also exists in this regard. Such variability leads to creative problem solving, but decision-making can be challenging without a common frame of reference. Study findings validate concepts contained in the Home Care Nursing Frequency of Visiting Decision Making Tool that was implemented in Fraser South in 2003, and suggest ways to refine and further develop the tool. Despite the potential for tools to be useful in making decisions about HCN visiting and scheduling, no tools were identified that support the processes used in home care offices to make HCN assignments or scheduling of nursing visits. Development of such tools should take into account the client/family ‘story’ and be balanced with resources available in individual home care offices. As well, documentation and communication (continuity of information) was identified as a key influence on HCNs’ abilities to build and maintain relationships (and therefore make good decisions), particularly in the absence of staff continuity. Having access to client/family information contributes greatly to ‘knowing’ the client and family. Thorough, accurate, yet condensed documentation is required to increase efficiencies, particularly for home care offices that have fewer resources (e.g., in rural settings). Finally, making decisions about eligibility for palliative services was an area that HCNs said created considerable tension when there was a lack of clarity about when a client should receive palliative service and at what level, such as for those clients with advancing non-malignant diseases. Study findings suggest that clients with chronic illness not designated as palliative have less access to home care nursing services than those who are as palliative. The needs of palliative home care clients tend to be prioritized above the needs of non-palliative clients because it is perceived that those who are palliative have greater needs.  

A Fraser Health (FH) Shared Work Team has modified the FH 2003 Home Care Nursing Frequency of Visiting Decision Making Tool as an outcome of the published research findings in the Final Report, January 2010 entitled, Access to care at the end of life: Encounters between home care nurses and family caregivers.  

The FH Newton Home Health Office is piloting and evaluating Draft #5 of this modified tool entitled, FH 2011 Palliative Care: Determining Next Home Care Nurse Visit for three months, November 2011 to January 2012.  

This decision making tool is a clinical practice support tool to support home care nurses to make decisions about their next visit for patients and families at end of life.  

Decision-making Recommendations Include:

  1. Acknowledge that access decisions are a key aspect of clinical decision making in home care, requiring a clear description of the skills and abilities involved in access decisions. Support is needed for the development of this competency with decision making tools, processes and education.
  2. To strengthen access decision making, use the research findings to modify the Decision making Tool for Home Care Nursing Visiting (2003); implement the revised 2003 decision making tool across home health offices and then evaluate its utility for informing clinical decision making about access.  

Publications: 

Roberts, D., McLeod, B., Stajduhar, K., Webber, T., Milne, K. (2014). Applying Research Into Practice: A Guide to Determine the Next Palliative Home Care Nurse Visit. Home Healthcare Nurse. 32(2), 88-95.

Stajduhar, K.I., Funk, L., Roberts, D., McLeod, B., Cloutier-Fisher, D., Wilkinson, C., and Purkis, M.E. (2011). Home care nurses’ decisions about the need for and amount of service at the end of life. Journal of Advanced Nursing, 67(2), 276-286.

Stajduhar, K.I., Funk, L.M., Roberts, D., Cloutier-Fisher, D., McLeod, B., Wilkinson, C., & Purkis, M.E. (2011). Articulating the role of relationships in access to home care nursing at the end of life. Qualitative Health Research, 21(1), 117-131.

Shared Work Team Members:
Barbara McLeod
Della Roberts
Kya Milne
Pat Loitz
Terry Webber
Jenny Wright
Sally Sprecher
Sue Mole

Project Contact:
Barbara McLeod  This email address is being protected from spambots. You need JavaScript enabled to view it.

Funding:
Internally Funded by the Fraser Health Authority

Status: While this initial work is completed - we are looking into other phases of this decision-making tool. 

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