SAN FRANCISCO--For both nurses and their patients, home care is
becoming an increasingly cost-effective and satisfactory alternative
to longer hospital stays. At the Oncology Nursing Society Annual
Congress, several speakers discussed methods used at their
institutions to improve home health services.
Mills-Peninsula Hospitals, Burlingame, California, started a program
in 1994 to increase home care and community support for cancer
patients who need intensive case management. "It became apparent
to us that we were getting to patients too late. Many admissions
could have been avoided, or discharges made more timely, if oncology
nursing were available in the community," said study co-author
Marie Rinaldi, RN, MS, OCN, cancer care clinical nurse specialist
with Mills-Peninsula Health Services.
Ms. Rinaldi along with Jennifer Vickerman, RN, MS, OCN, took on an
expanded role, following 15 high-risk cancer patients each, as well
as performing their other duties. High-risk cancer patients were
defined as those with complex symptom management or educational
needs, concurrent treatment with radiation and chemotherapy, poor
caregiver support, three or more emergency department visits each
month, and frequent or lengthy acute admissions. A comprehensive plan
for each patient was drawn up, and each patient was followed at
Results revealed that patients symptoms decreased--they
experienced less pain, nausea and vomiting, and weight loss--and in
the first year of the program, the nurses were able to save the
hospital at least $35,000.
Another innovative plan was created at the University of Kentucky
Hospital to help ease problems caused by lack of communication in
outpatient care. The hospital formed joint nurse/physician/clerk
response teams that met before each clinic to go over each
patients record and plan of care. Each member of the team
entered information into "The Book," which contained
records of each patients history, treatment, and other vital
As a result, communication was enhanced, and both patients and health
care professionals experienced increased satisfaction with their
roles and the care provided. "It really enhanced trusting
relationships," said study author Mary Ryles, clinical nurse
manager, University of Kentucky, Lexington.
In an era of shorter hospital stays, nurses also face another
challenge: to meet patient and family expectations of care in a much
shorter time. Breast cancer patients undergoing segmental or modified
radical mastectomy with axillary dissection, for example, are
typically released the same day as the operation or one day after.
This can lead to fewer educational opportunities, less psychosocial
support, added caregiver burden, and undetected complications.
To help avoid these problems without increasing the hospital stay,
Methodist Hospital, HealthSystem Minnesota, is providing home care
nurse visits for these patients 24 to 48 hours preoperatively and 24
After being surveyed, 15 (94%) of 16 patients undergoing treatment
felt that the education and emotional support received at home was
helpful, and 88% were "satisfied or very satisfied" with
their care, said study author Karen Swenson, RN, MS, OCN, oncology
research manager with HealthSystem Minnesota.
Six surgical nurses who were surveyed reported that patients who
received preoperative home visits were more prepared for surgery and
easier to educate.
However, even with the program, one-half of the patients were
uncomfortable about going home after the first day. Thus, while home
care may be helpful for many patients, it is not a solution for
everyone, Ms. Swenson said. "Some patients may need
hospitalization for symptom control and emotional support," she commented.
A study at the University of Western Ontario, London, Ontario,
explored the use of a take-home book about chemotherapy as a
replacement for a 45-minute education session with a nurse in the
hospital. The take-home book, written by one of the hospitals
oncologists, was presented to 103 patients in a 15-minute session
with a nurse educator. The control group of 102 patients received the
45-minute hospital session.
Three months later, there was little difference between the two
groups in the patients knowledge of chemotherapy or their
satisfaction with treatment. The group that had received the book
found the side effects they experienced more upsetting--probably
because these patients tended to have more aggressive cancers than
the control group, said study author Heather Porter, RN, PhD, a
consultant for H.B. Porter & Associates, Kitchener, Ontario.
The group with the self-care book tended to ask for more home care
visits and, probably as a consequence, experienced fewer hospital
stays, Dr. Porter said. "Many patients took their books with
them everywhere," she noted.