Nurses are in charge of helping patients make a smooth transition to their homes after being discharged from hospitals and various care settings. Home care nursing services have developed as a speciality in the healthcare industry, where industry leaders have established best practices for patient care post-discharge.
Nurses play a vital role in the clinical decisions made during the transition process and function as educational guides for patients and their caregivers. They have access to various information, tools and resources to ensure a smooth transition from hospital to home and that patients and their caregivers have the knowledge, skills and support needed for optimal recovery.
It is vital for healthcare companies to develop and maintain the optimal level of collaboration and partnership with patients, their families, and nursing staff to achieve the desired transition outcomes.
This article examines the necessary components of a shared transition vision, including a clear understanding of both patient and family/caregivers’ roles and responsibilities, to develop a pathway for planning for post-discharge healthcare transitions.
The role of nursing staff in the transition
Home care nurses play two critical roles in ensuring patients transition seamlessly from the hospital or other health care facility to their homes. The first is the nurse’s ability to quickly reconcile a patient’s medication regimen and ensure that they implement it safely in the home care setting.
For example, the nurse is responsible for establishing the patient’s medication schedule, prefilling pill boxes with the correct dosages, ensuring the patient’s understanding of their medications, the number of refills prescribed by the doctor and coordinating with the prescribing physician.
The second role of nursing staff in this setting is to ensure that the patient schedules and keeps their follow-up appointment with their healthcare provider within the prescribed time of being discharged from the healthcare facility. This time frame is commonly a two-week period where the nursing staff must manage the patient’s medication profile and document details like medication side effects. The patient will take this medication profile with them on their follow-up visit.
The role of family and other caregivers
An individual’s family, partner, friends and significant others play a crucial role in their well-being, especially when they are discharged and must return to their home setting. Registered nurses and social care support staff working in home care environments have played a crucial role in collaborating with a patient’s support group and making their transition as easy as possible.
Often, this support group helps the patient by communicating with professionals to ensure their individual needs are met. Discharged patients often feel overwhelmed and disoriented in their home environment – social support from family, friends and a community network can assist with easing this transition back into a home setting.
Despite the need for collaboration, nursing staff and healthcare providers may fail to recognise the importance of family members’ contributions. Problems can occur if services and support are not integrated, resulting in delayed transfers of care, readmissions and poor care. On the other hand, incorporating patient support groups into the transition can ease the burden on nursing staff and allow them time to deliver better care.
Facilitating a collaborative transition
Coordinating a patient’s move from the hospital or home into long-term care requires skill and experience and can bring out the best (or worst) in patients and their family members, friends and caregivers. Healthcare providers and nursing staff can benefit if care moves seamlessly from one setting to another and patients experience a smooth transition.
Using best practices supported by evidence is required of nurses, patient support groups and healthcare providers to help standardise care, reduce patient care variability, improve patient outcomes and minimise the number of readmissions.
Healthcare providers can assist with the process by developing some nursing practice guidelines focusing on family-centred care and the relationship between nursing staff and the people they serve.
Hiring the best home care nurses
Nursing professionals providing home care must be able to meet the patients where they are most comfortable – in their own homes. The first priority is to establish strong relationships with the family members, who need to feel comfortable that these nurses can provide the necessary care for their loved ones.
This form of care needs nurses with a higher level of sensitivity, interpersonal skills, and most importantly – experience with working in the home care environment. Hiring the right nurses and caretakers is critical to establishing a flexible care plan to provide patients with medical support, comfort and dignity. The ultimate ideal is to promote the patient’s quality of life after discharge.
Healthcare providers looking to effectively facilitate the transition of patients from hospitals to homes and deliver the most optimal nursing services possible should invest in hiring the best home care nursing talent available. They should prioritise working with full-time nursing professionals who can provide consistent and adequate support for patients in their homes throughout the care lifecycle.
The Greys Solution
How can your healthcare company access the specific quality of nurses required for successful home care nursing services? By partnering with reputable healthcare staffing providers and building care teams driven by the most qualified and skilled nursing practitioners. This is where Greys Nursing Services can bring immense value.
Our recruitment team has over 40 years of experience in the healthcare industry, cultivating long-term relationships with clients and staff in the care continuum. We focus on obtaining the highest level of care and service with every placement by leveraging a database of nursing professionals who we can match to your staffing needs.
Our rigorous screening and vetting process can help ensure that healthcare nursing candidates understand your patient’s medical needs, lifestyle, culture and home environment. A qualified nurse who has been screened and vetted for the home care setting can lessen the likelihood of complications during the patient’s transition and deliver care on par with your standards.