Home and Community Care Nursing Handbook

Home & Community Care Nursing Practice

Introduction

Nursing practice is defined in each province and territory through its own consistent Standards of Nursing Practice. These standards provide parameters through which competencies are developed and which practising Home Care nurses are expected to possess.

Competencies identify the extent to which the Home and Community Care nurse can practice and limitations to his/her practice.

The following section discusses:

• Delegation
• Nursing Standards and Competencies
• Program Standards, Policies and Procedures
• The Nurse/Client relationship
• Confidentiality
• Record keeping
• Incident reports

Delegation

Regulated Worker Delegation

Registered Nurses are regulated and thereby accountable to their respective employers, regulatory body and clients. When a nurse decides to delegate a component of care to another regulated worker, he/she is accountable for the decision to delegate and for determining that the provider of care has the necessary knowledge and skills to perform the care safely and competently. The professional receiving the delegation is accountable for determining that he/she has the necessary knowledge and skills to perform the care safely and competently.

Unregulated Worker Delegation

A nurse may delegate a specific task or procedure to an unregulated worker only in specific client situations and if employer policy permits.

In order to ensure client safety, the nurse must determine that:

• the client's health status is stable;
• the client's response to the procedure can be predicted;
• the worker has the ability to perform the task safely; and
• support and supervision would be available to that worker at all times.

Nursing Standards & Competencies

Each nursing regulatory body has Standards of Practice, the majority are based on the Canadian Nurses Association (CNA) Code of Ethics. In addition to the Standards of Practice, nursing bodies have a list of competencies that each new nurse is required to meet in order to be registered. Competencies determine the level of knowledge, skill and judgement required to enter the practice of nursing.

Program Standards, Policies & Procedures

Standards, policies and procedures are valuable tools for program staff, communities and individual clients and their families. They provide clear direction on program tasks and activities. A full description of the benefits and value of standards and policies can be found in the standards and policies manuals. First Nations and Inuit Communities will also need to develop procedures that are associated with each of the policies. Procedures are simply a description of how policies are carried out.

Nurse - Client Relationship

The nurse-client relationship is considered a therapeutic relationship in which the behaviour of the nurse has the primary benefit of improving nursing care to patients, clients, families and communities. This is a relationship built on mutual respect, which is essential to providing safe, competent and ethical nursing care.

Confidentiality

Confidentiality is one of the eight primary values considered central to ethical nursing practice, as outlined in the Nurses Code of Ethics. Nurses have an ethical, legal and moral responsibility to protect information that is obtained in the context of the nurse-client relationship. They are obligated to ensure that the sharing of such information outside of the health care team is done only with the informed consent of the client or as required by statutory law, such as in the case of reporting child abuse.

Client Record Keeping

Client records are confidential legal documents. Documentation of client care is a very important component of providing nursing care. Nurses document the care they give and the services they provide to clients for a variety of reasons including the following:

1. Documentation of care is a method of communicating information about the client to other members of the health care delivery team to ensure continuity of care.
2. The client record provides a mechanism for ensuring the accountability of nurses to the client for the care they provide and in turn provides the nurse with protection against liability.
3. Client records are necessary in order to monitor and evaluate the quality of care and assist in improving quality of care delivery.
4. Client records and documentation are a valuable source of health data that can be used to evaluate client outcomes and subsequently improve nursing practice and client care. This data is used in summary totals without client identifiers, patient confidentiality will be maintained at all times.

Limitations to Nursing Practice

As regulated health professionals, nurses must practice within a defined scope of practice as set out by their regulatory body. The scope of practice of a nurse refers to the role, functions, responsibilities and activities that he/she is able to carry out. Nursing Colleges and Associations establish the scope of practice for their membership and define broad limits of practice.

The individual Home Care nurse may have a more limited scope of practice than that defined by the nursing regulatory body. This is dependent upon the:

• type of care needs of the clients;
• policies and requirements of the employer; and
• area or type of setting in which nurses are practicing.

For example, procedures that may be deemed safe in a home setting in an urban area with access to 911 and physician back-up may not be deemed within the scope of practice of a home care nurse working for a Tribal Health Authority in a remote community.

A more specific example of this may be the client requiring chemotherapy. The urban home care program offers a home chemotherapy service that is linked with a local hospital. The chemotherapy is prepared by the hospital pharmacy and administered by the Home Care nurse to the client in his/her home setting. The protocol stipulates what monitoring is to occur and that if any complications arise from the administration of the chemotherapy, the Home Care nurse calls 911 and the client is transported to the hospital.

In a remote/isolated location, the administration of Home Chemotherapy will not be in the Home Care nurse's scope of practice for several reasons. There is no local hospital and/or pharmacist to mix and/or prepare the chemotherapy, no 911 system that can immediately transport the client to a hospital if complications occur and the nurse is not available at all times.

Home Care Nursing Practice is defined in each province/territory by the respective nursing regulatory body. In addition, the practice is further defined and limited by the employer and the setting in which the nurse is employed.