What is the Role of Home Nursing Care?
A Holistic Approach
We advocate a holistic nursing approach to support our patients and their families. This means that as a home nurse, you not only perform care tasks but also offer a listening ear. Care tasks include hygiene assistance (such as showering), symptom monitoring, and providing calm palliative care during the terminal phase. In addition, you are expected to provide psychological, emotional, social, and mental support.
You visit your patient regularly. Whether this is once a week, three times a week, monthly, or every six weeks depends on the individual patient’s needs. By visiting regularly, you build an essential bond between the patient and the medical team, closely monitor disease progression, respond quickly to new needs, and can adjust the care service to ever-changing circumstances. At the same time, you remain mindful of future needs.
A Multidisciplinary Team for Personalized Care
Flexibility is key — you should be able to adapt the length of each visit as needed. Often, unexpected visits require changes to your schedule. A large part of your role involves informing the patient, providing feedback, and strengthening coordinated care delivery.
Home nurses are often the main point of contact for other therapeutic or specialized services. Home nursing is most effective when delivered through a collaborative approach. By gathering all relevant information from everyone involved in care, you can tailor a care plan so interventions occur at the right time, address patient needs, and support symptom management.
Open communication and multidisciplinary teamwork are essential for the success of any home nursing plan.
Psychological and Emotional Support
A holistic approach addresses the psychological, social, mental, and emotional needs of every patient. Since ALS is progressive and increases patient dependence, emotional and psychological challenges such as fear and grief inevitably arise. Some fears can be alleviated, others can only be shared — but sharing alone often reduces anxiety for both caregiver and patient.
Home nursing, alongside other professional caregivers, provides emotional and mental support. Our home nursing service can also offer access to additional professionals such as social workers, music therapists, or pastoral care workers. Nurses within the multidisciplinary team empathize deeply with patients and families, attend to physical comfort and emotional well-being, and sometimes face unique and difficult experiences. Finding peace of mind and meaning is vital.
Practical Advice
You will frequently encounter patients with bladder and bowel issues, especially constipation. Causes include changes in diet, mobility, fluid intake, medication, or muscle weakness. It is best to anticipate and treat these problems proactively rather than wait for them to occur. Always approach these issues with understanding, discretion, and professionalism.
Skin changes often result from prolonged pressure due to immobility or reduced hygiene. These problems are usually easy to prevent or resolve with good care. Start with proper hygiene.
Sorbolene or bath oil-based products like Hamilton’s are commonly used. Avoid soap, which dries out the skin and causes itching. To prevent further dryness, apply Sorbolene after showering or several times daily if the skin is dry.
Fungal infections tend to develop in warm, moist areas. Make sure to thoroughly dry all folds and crevices, including between toes and in the groin. Cornstarch can be used to absorb sweat and reduce infections or skin scaling. Antifungal creams and powders are available for treatment and prevention. Also, consider the patient’s clothing: cotton is recommended as it promotes airflow, reduces sweating, and helps avoid warm, moist environments where problems arise.
Regularly check skin in vulnerable areas such as ankles, hips, heels, the sacrum, and ears. Alert family and other caregivers to these spots, and refer to an occupational therapist if pressure relief interventions are needed.
Panic attacks are more common during breathlessness, general anxiety, pain, and mental strain. The home nurse’s role is to reduce stress and anxiety and manage environmental factors. This may involve an extra visit, a phone call, or referral to another healthcare professional such as the GP. Hospital admission may be necessary if requested by the patient and family.
It is essential to teach the patient comfortable positioning to ease breathing. Medication may sometimes be given, such as low doses of benzodiazepines like Clonazepam drops under the tongue to reduce panic attacks. Small doses of morphine slow breathing and stop panic attacks. With the GP’s permission, small amounts of these medications can be kept at home for such use. Family members can be taught to administer these medications.
Palliative Care
Consider palliative care as active, comprehensive care for patients with incurable illnesses, aiming to maintain the best possible health and quality of life while preserving as much independence as possible.
Home nurses can optimally organize care for those who choose to stay at home until the end, surrounded by their family. This involves good palliative care, effective symptom management, open communication, and family support tailored to the wishes of the patient and their loved ones.