No place like home: exploring the potential of community nursing

Could community nursing be the solution to the ever-growing hospital bed shortage?

Many hospitals across Australia regularly struggle to cope with the number of patients versus the number of beds available.

Beds are in high demand, and doctors and nurses are often overworked, under-resourced and underappreciated as they strive to keep up with the flow of patients that come through the doors each day.

But could the solution be as simple as early discharge to community nursing organisations for non-critical patients?

Community nursing is not a new concept. However, in recent times there has been a rise in the number of referrals to companies that offer such services.

Although there is a misconception that community nursing is just for the aged, it can help anyone who doesn’t require ongoing critical care in hospital and who can benefit from regular home visits.

It’s clear to see why there has been a rise in referrals, as community nursing offers many benefits to hospitals and patients. The main benefits for hospitals include freeing up beds and resources, and redirecting health carers to more urgent patients requiring more complex care.

There are huge benefits for not only aged patients, but also patients of all ages receiving care within their own home. They are in a familiar environment, which can make them more comfortable and relaxed while receiving treatment, and a relaxed patient generally recovers quicker than a stressed patient. Often, patients find it easier to rest at home in their own bed with familiar surroundings; and when a patient is well rested, their body is likely to heal faster, allowing them to be back up on their feet and enjoying their independence sooner rather than later.

Many patients will also feel like they have greater control over their care as well, and they are often more involved in their treatment and ongoing care, as they feel like they are maintaining a sense of independence by staying within their own home for treatment.

With community nursing, a patient will, in most cases, see the same nurse regularly. This can make it easier for the nurse to build a rapport with the patient and to notice subtle changes in the patient’s condition.

Community nurses vary between RNs, ENs and AINs, and which one a patient will see depends on the type of care and services required. This is similar to how patients are treated in hospital: if they require more than one type of care classification, or if their condition changes, then they may have a few different nurses seeing them regularly.

When assessing a patient for community nursing, the RN doing the assessment will also take into consideration other factors, often doing assessments around the home, checking for things such as trip hazards, unsafe stairs, lack of adequate lighting and access points. The nurse will also assess the patient’s ability to perform daily tasks, as well as review other needs such as that for OT, ACAT or even counselling services.

Each patient is assessed based on their situation and needs, and the nurse will make the appropriate referrals so the patient receives the best care possible whether it be ongoing or temporary.

Community nurses also liaise with the patient’s family and other healthcare providers, such as GPs and specialists, to ensure everyone is on the same page with regard to the patient’s care.

There are various providers of in-home nursing care, and most offer the same services. These include things like nursing assessments, psychogeriatric assessment scales (PAS) and dementia assessments, continence care assessments, wound care management, drains management (including removal), vac dressings, general hygiene and personal care within the home, and continuous hospital care (post discharge/early discharge from hospital, for example, after a total knee or hip replacement).

Other services might include administration of medication: oral, subcutaneous IM and IVI medications, cannulation, supra pubic catheter management, urethral indwelling catheter management (including insertion and removal).

Often any service that can be provided by a nurse within a hospital setting can be done in a community setting.

The main difference between these service providers is that they will usually either accept only public patients or private patients, though some will take on both.

A public patient will be just a general Medicare patient with no insurance, whereas private patients include coverage by the Department of Veterans’ Affairs, private health insurance, WorkCover, third party insurances, or cover under certain charities such as Baptist Care.

Most services accept referrals direct from nursing unit managers, CNCs, discharge planners and so on within the hospital, or through organisations such as the Triple I Hub or other healthcare providers like GPs and specialists.

Community nurses and other staff within their organisations are bound by the same privacy and record keeping laws/requirements found in the hospital setting. So, the patient’s information, privacy and confidentiality are protected in the same way they would be if the patient was being treated in a hospital.

The system could work similarly to that of the antenatal GP shared care service, whereby an expectant mother can do the majority of her antenatal appointments with an approved GP and only attend antenatal appointments within the hospital’s antenatal clinic when necessary.

This model of care has eased some of the strain on the antenatal clinics within hospitals sharing the care of its expectant mothers with approved GPs, while also lowering the wait times for the mothers so they can spend more time preparing for their babies and less time sitting in waiting rooms.

With this many benefits to receiving care in a community setting, could this be the solution to the chronic shortage of beds?

Shifting to a shared care approach, where hospitals share the care of their patients with community nursing services, and allowing the patient to be discharged early but still receive the same level of care post-hospital has the potential to make way for more critical patients, who require more complex care within a hospital setting. This may also reduce surgical wait times in cases where the wait time is based on the availability of beds.

Rebecca Singh is the client liaison manager at NBS Health Services.

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