Authors' objectives:

The objective of this assessment is to assess the effectiveness, cost effectiveness and safety of home care nursing for follow-up, chronic and rehabilitative care.

The scope of assessment is home care nursing in the community, provided by nurse or home care team and that involving volunteers, non-governmental organisations (NGO), excluding care provided by nursing homes and home nursing by private practitioners as well as home visiting.

Authors' recommendations: In this assessment there is positive evidence for home care nursing for neonates, elderly, respiratory, orthopedic, palliative, cardiac, stroke, psychiatric and physical as areas of care that require home care follow-up. However, evidence on the aspects of day care, follow-up care for elective surgery, follow-up care for children, stoma care and wound care were inconclusive due to insufficient evidence. There is a favourable outcomes for the patients and families and patients have a better quality of life. The most common nursing care activities identified are patient education regarding bedsore prevention, patient and family education on treatment and physio exercises, dressing, changing of nasogastric tubes, changing of urethral catheters, administration of insulin, testing of blood sugar and taking of blood pressure and provision of emotional support. It has also resulted in shorter duration of hospitalization, reduced readmission to the hospital, reduced risk of nosocomial infection. Patients and families reported satisfaction with the home care provided. Home care nursing has to involve a multidisciplinary team. There is also a need to have protocols and clinical pathways as references and guide in the provision of home care. The availability of telenursing has also contributed in enhancing and enlightening the home care nurses in the delivery of quality care. Home care nursing provides nurses autonomy, independence, direct patient contact and the high technology care which they find challenging and rewarding. It is recommended that home care nursing should be provided by a multidisciplinary team comprising of a doctor, nurse, physiotherapist, occupational therapist, speech therapist, social worker dietitian and pharmacist. A case manager should manage the care. Home care nursing should provide follow-up care for neonates, especially low birth weight babies facing feeding problems requiring enteral feeding, jaundice requiring phototherapy, respiratory problems requiring home oxygen therapy, chronic conditions in the elderly, palliative care for the terminally ill, home rehabilitative care for cardiac conditions, orthopedic conditions, stroke patients, mentally ill patients, physically disabled as well as provision of respite care for carers. There is a need to develop protocols and clinical pathways for reference by the home care team members in the delivery of care. Specialised training is needed in the respective disciplines for nurses providing specialised care such as neonatal care, cardiac care, stoma care, palliative care, care for the elderly and psychiatric care. It is also recommended that telenursing facilities to be made available to the home care nurses in areas where telehealth and telemedicine services are being provided. There is also a need for further assessments to be carried out for follow-up care, care for chronic conditions and rehabilitative care in order to identify the actual criteria, types of conditions requiring the care and categories of staff to provide the care.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.moh.gov.my/

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment Unit

Contact Address: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, Level 21, PERKIM Building, Jalan Ipoh, 51200 Kuala Lumpur, Malaysia. Tel: 603 4045 7781, Fax: 603 4045 77 40

Copyright: Malaysian Health Technology Assessment Unit (MHTAU)