Discussion on Community Portfolio

This portfolio will discuss about the service provided by Western Health, Hospital In The Home (HITH) and also explore the roles and responsibilities of nurses in HITH setting. Hospital in the Home (HITH) in Western Health Hospital offers home care, which is otherwise necessary during a hospital stay. HITH often offers an option to hospital admission, or a chance to move home sooner than would otherwise be feasible. Each patient will be evaluated to determine whether HITH can fulfill its medical requirements. In consultation with the team, HITH is appropriate for a care plan. Western Health HITH covers four sites: Footscray Hospital, Sunshine Hospital, Williamstown Hospital and Sunbury Day Hospital. (Artefact1) The hospital in the home program in Western Health Hospital aims to provide permanent care from healthcare institutions to the home, coordinating the care from hospital to home and monitoring the development in consultation with treating medical term (Western Health, N.D). HITH therapy is free of cost. The HITH employees are available for daily or evening contacts at any moment (24 hours, seven days a week). Common admissions conditions and treatments at Hospital in the home are of anticoagulation therapies for pulmonary embolus, deep vein thrombosis and atrial fibrillations, short term intravenous antibiotics, long term intravenous antibiotics, negative pressure wound therapy, post-operative care, VACC dressing, wound management. (Artefact 2) HITH Liaison nurse will discuss the medical treatment and assess the needs of the patient in the hospital prior to the care delivery in home environment

Hospital in the Home (HITH) is a sensitive care service providing care in-house, which would or else have to be hospitalized. HITH often offers an option than would otherwise be feasible to hospital admission or to previously moving home. Major changes of the last half-century had shifted the healthcare systems and delivery away from the foundations. Statements about home benefits and social care have taken the status of conservative knowledge. Reshifting has moved many types of healthcare, for every age group patient into a home. There may be many reasons for this restructuring. First, it is supposed that people want greater responsibility for healthcare delivered at home. They want care rather than long term hospital care. Second, it is supposed that some hospitals permit a safe shift of efficient care to the home. Finally, it is assumed that equal and better care at a lower cost from shifting healthcare to home. With many benefits, shifting also has some serious concerns. The burden of care is shifted to families and communities from healthcare institutions.

Anyone believed to be medically stable can receive HITH. Nurses during HITH ensure the availability of patients at home and keep all equipment safe and away from children provided by the hospital. (Artefact 10). If HITH is planned a HITH Liaison Nurse will visit the patient in the hospital to assess the need and for discussing the medical needs. The employees of HITH are on call 24 hours a day, seven days a week so that patients can contact anyone at any time in regard to their care with problems. Defined by individual requirements, the frequency and duration of the visits the patients receive. This is discussed before the patient goes back by the HITH nurse. The goal of community nurse is to encourage, defend and conserve the health of society. It includes basic concepts such as, promoting a healthy lifestyle, prevention of health problems, providing express care, educating society about managing chronic situations, evaluating a communal delivery of patient care and wellness, implementing fitness and wellbeing plans and conducting research to improve health conditions (Shepperd et al., 2016) 
Clinicians and health professionals operate tirelessly to care for their patients in an increasingly complicated, inefficient and stressful setting. The design, incentive and culture, however, of the systems in which they operate are often, maybe often, poorly aligned to help them meet the requirements of patients. A learning healthcare system recognizing the imperative to focus on the person is one where patients and their relatives are the main drivers of the learning process ' design and operation. If patients, their relatives, other careers and the population are fully involved, there can be a considerable improvement of the active care, health, care experience and financial results. Patients and clinicians both need to be engaged in these complicated circumstances for ideal care. Clinicians provide data and guidance based on their science knowledge and possible results in the treatment and intervention choices. Patients for choosing the correct care choice, information from both sources is required. In the context of primary care patients and families participated in decision-making, pain and discomfort was decreased, physical health was recovered quicker, and emotional health improved. Communication instruments, in particular, health literacy, need to be adapted to the patient's conditions. Health literacy relates to the capacity of an individual for proper health choices to gain, comprehend and apply health information. Family-centered care is a way to care for patients and their families through health facilities that ensure care is being planned for the entire family, not only individuals (Chen, Mullins, Novak and Thomas, 2016). The quality of general results and patient care was also linked favorably to the empowerment of infants. Discussing that high-quality care relies on a competent nursing staff that implements professional nursing norms. It is the consequence of empowerment to have the capacity and confidence to continue to offer high-quality care in stressful healthcare settings.
    The community nurse is believed to be a role model and resource person to new staff nurses and nursing students. They have proved their efficiency in hospital in the home care. The reliance of nurses on family involvement in the provision of services indicates that family-centered care practices on the leadership of workload rather than the empowerment of the customer. Over-reliance on parents is likely to adversely affect the mental wellness of parents and children and long-term harm to the work of the family. Family-centered care that occurs from necessity rather than the choice is in straight divergence with the overarching viewpoint. Preceptor nurses support new nurses in their continued professional development, who complete the training program and operate effectively in the position of a community nurse. They identify methods to acknowledge the dedication of nurses to welcome and develop fresh health care professionals to guarantee the quality, secure treatment for patients and optimal results. 

Community nurses plays a vital role in health promotion, follow-up, patient education and empowering patients and families in the community. Community nurses work with families and individuals to empower and change their unhealthy lifestyles by providing appropriate care and education. Health promotion leads to positive patient outcomes, quality of life, and self-management techniques and information about the illness. (Kemppaien, Tossavainen& Turunen 2013). Community nurses provide care to the patients as well as support and empower families. According to Muntean, Tomita& Ungureanu 2013 community nurses are pillared to develop the community and aids in individual and community wellbeing. They provide support and optimal care to the patients in community and involve families in the care delivery process. This involvement directly and indirectly supports and empowers families to take care of their loved ones within their surroundings. This process acts as providing emotional support to the patient, which might act as healing effect and aid in fast recovery of the patient.
Context of the situation.
While I was on the placement, an incident occurred during the visit to the patients home. The patient had Autism and lived with the parents. We were supposed to change his VAC dressing for his amputated toe. While we took the dressing off, the wound was badly macerated. We could not do the dressing in that wound. We enquired the patient and family about any malfunction or leakage in the machine that they might have noticed. But the patient’s family screamed and abused us that it was our fault. They accused us for not doing our job properly and that led to the wound maceration. The patient was agitated and aggressive towards family members and us. We tried to calm the patient and provided assurance to the family members. We were advised by the doctor to take the VAC dressing off but the patient and family insisted leaving on the VAC dressing as it was. It was really hard for the preceptor nurse and myself to convince the patient and family. We attempted to provide some evidence and education for what we were doing and why it was important.
My thoughts, feelings and concerns
The situation was really tense and frustrating to witness. I felt a sense of unhealthy environment for the patient to leave with family who was not supportive and cooperative. I felt sad for preceptor nurse and myself being accused for not doing the dressing right. At the same time, I admired my preceptor nurse for her counselling and communication skills to calm down the patient and reassuring the family. I gained some good communicating and counselling skills from my preceptor nurse which would help me in being a good nurse in the future.

Identified areas for professional development:
The areas for professional development that I seek to improve were the ways for conflict resolution and improve communication skills. According to Lemone et al., 2014 one of the important skills to deal with patient and families or even work mates is conflict resolution. Another area for professional development that I need to improve was professional communication skills. Communication and conflict resolution plays a vital role in nursing profession and is linked with each other. I would like to improve those skills to be more competent in caring for patients and ways to manage difficult situations. Koutoukidis, Stainton, & Hughson, 2012 mentioned that professional communication is an important skill to be acquired by any health practitioners for their professional development.

Impact on my future career:
Professional skills such as communication, conflict resolution, critical thinking is some of the experiences that I acquired from this placement that will help me in my nursing career. These skills will help me in minimizing errors and developing relationship with patients, family and other health professionals that lead to better patient outcome. Similarly, patient safety and time management are some other issues that I learned from this placement.

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