Objectives
As a home health nurse, we think it is important for you understand the rationales for why and how home health nurses function today. Much of it is based on our history which has its roots in social, economic and political factors.1. Compare and contrast Community Health, Public Health and Home Health Nursing.4
2. Discuss the social, economic and political factors that have defined today's home health nursing practice.
Background
So why is the history important?
Today's home health nursing roots date back to Western Civilization and Hygiea, the Greek Goddess of Health and Panacea, the Restorer of Health. During the early Christian times Paul's letters to the Romans records the visits of Phoebe to homes of the sick. In the late 19th century England, William Rathbone employed nurses to care for his wife in their home and established the first visiting nurses association. This module will concentrate on the evolution of home health nursing as it relates to American History. Some of the most influential and significant figures or events are as follows.
The history of home health nursing is important because it defines the rich heritage and culture of the professional nurse. Throughout history the social, economic and political issues have influenced the practice of nursing. Understanding the background of these movements helps to explain why things are like they are and gives us an appreciation for what our predecessors have worked for.
Content (Milestones in Home Health Nursing History)1. Home Health Nurse
There are several terms that describe nursing care in the home. A public health nurse is one who works for a governmental agency such as a health department. A community health nurse works in an agency which receives some community funding such as the Visiting Nurse Association. A home health nurse works for a private or hospital based home health agency. These definitions today have some overlap are many times used interchangeably. Depending on the type of agency, nurses in the home may or may not give direct nursing care.
2. Major Milestones
Significant events that have impacted home health nursing practice are:
A. In 1885, the oldest nonprofit nursing home care agency was established to provide nursing care to patients in their home. The term District Nurses was coined by Florence Nightingale for these nurses who provided home health care and thus began the first Visiting Nurses Association. http://www.vnaa.org/home.htm
B. In 1893, in New York City, Lillian Wald and Mary Brewster became the founders of American Community Nursing. Lillian Wald went on to establish the Henry Street Settlement in New York and began using the term Public Health Nursing. http://www.vnsny.org/mh_about_wald.htmlC. In 192, in Wendover, Kentucky, a midwife by the name of Mary Breckenridge established the Frontier Nursing Services in response to her concern for the high maternal and infant mortality rates. Although the focus began on mother and baby care, the nurses soon became family nurses. http://www.frontiernursing.org/history_of_fsn.htm
D. In 1966, In response to public demand for universal access to health care for the elderly, poor and mentally ill, government legislation was passed called Medicare and Medicaid. This significant legislation triggered the transition from a nursing based home care model to a medical model. http://www.nahc.org/Consumer/hcstats.html
E. During the 1980s Diagnosis Related Groupsb(DRG's were developed and implemented in response to a federal administration initiative to contain costs as the U.S. economic system was threatened by inflation. High technology and shortened hospital stays brought the acute care patient into the home. For more information check:
http://www.umanitoba.ca/centres/mchp/concept/dict/drg.define.htmF. Out of the Balanced Budget Act of 1997, the Prospective Payment System (PPS) was implemented for Home Health Services. PPS is a cost based model which uses the cost of care data to calculate the amount of reimbursement Home Health agencies can expect to receive. Reimbursement is based on an episode of care. In order to use this system home health agencies are using the Outcomes Assessment and Information Set(OASIS) .
http://cms.hhs.gov/providers/hhapps/default.asp
