Challenges for home care nurses in providing quality care

Abstract

The purpose of this article is to explore the processes that enable home care nursing services to provide good quality care. The focus is on how quality care is defined by nurses, patients and carers, and palliative care provision is used as an exemplar. The international policy scene is one of escalating costs and shortage of qualified nurses, which has resulted in a variety of forms of skill mix. In addition there has been an emphasis on partnership working with patients and carers, who are encouraged to participate in care giving. The article draws upon data generated in studies conducted by the author and colleagues over a 10-year period. The main conclusions of the article are that nurses, patients and carers were able to articulate the essential components of high quality care and that these elements fitted the structure, process and outcome framework first described by Donabedian (1969). In addition, forming a good relationship and rapport with the patient and family is viewed as a critical pre-requisite to quality care. It is noteworthy that the awareness contexts first described by Glaser and Strauss (1965) are still a relevant framework for analysing nurse patient and carer interactions. Finally it is suggested that the quality indicators identified in this article could be used as a useful starting point to develop criteria for judging quality of provision in palliative and supportive care services.