Hastings Report and Implications of Home Care

Critical Care Practice in Home Care

This Hastings Center Report is a treatise on the ethical dilemmas and social implications of high-tech home care (Arras, 1994). The Report describes the impact of such care on patients, families, health care providers and health care delivery systems. The authors contend that high-tech home care is the hypermedicalization of the home. The invasion of the home by high-tech hypermedicalization challenges the very notion of home and family. High-tech care creates a complex social phenomenon that benefits some while burdening others. Alternative settings, made to be more "homelike" should be considered instead of turning homes into high tech settings. Family members and significant others are burdened with the responsibility of taking on the role of nurse or doctor and providing care that leads to "technical isolation at home. Patients and families should be informed of the benefits and burdens of such care and factors that should be considered. Acknowledge that for some patients, high-tech home care may not be a viable option or is should be done on a trial bases. Studies that will provide data on the quality and delivery of high-tech home care and the needs of patients and families are needed. State health departments need to become active in the regulation of such care.

Historically, home health settings have been a domain where advanced practice nurses were relied on and had the opportunity to demonstrate autonomy, authority, and accountability. This same description is true of advanced practice that critical care staff nurses have conducted for decades (Smith, 1979). Critical care nurses already respected professionals in the delivery of complex health services, are crucial to the ongoing expansion of home care services. Nursing research can promote the development of specialized home health services such as treating chronic congestive heart failure or preventing the severe cardiovascular sequeale of sleep apnea (Smith, Metzger, Mayer, Volker, Baldwin, & Pingleton, 1994) contribute to the formation of ethically sound home health care policies based on the experiences with patients' advanced directives and rights to die are needed.

Attention needs to be directed at the creation of standards, evaluation processes, financing guidelines, outcome measurements, and alternative care environments. Advanced practice nurses are vital to ensuring that the ideals sought through the high-tech home care are actualized.

Arras, J. and Dubler, N. (1994). The hospital ethical and implications of home care. Hastings Report, 19-20.

Home Care Technology References

Arras, J.D. (1994). The technologic tether: An introduction to ethical and social issues in high-tech home care [Special supplement]. Hastings Center Report, 24(5), 51-52.

Barkauskas, V. (1990). Home health care. In J.V. Fitzpatrick, R.L. Taunton, & J.Q. Benoliel (Eds.), Annual review of nursing research (Vol. 8, pp. 103-132). NY: Springer Publishing.

Brooten, D., Brown, L.P., Hazard-Munro, B., York, R., Cohen, S.M., Roncoli, M., & Hollingsworth, A. (1988). Early discharge and specialist transitional care. IMAGE: The Journal of Nursing Scholarship, 20, 64-68.

National Academy of Science. (1995, February). Workshop on human factors and home medical equipment. Report of National Research Council and National Academy of Science Committee on Human Factors.

Smith, C.E. (1994). A model of caregiving effectiveness for technologically dependent adults residing at home. Advances in Nursing Science, 17(2), 27-40.

Smith, C.E. (1995). Technology and home care. Annual Review of Nursing Research, 13. New York: Springer, Cor.

Smith, C.E. (1996). Quality of life and caregiving in technological home care. In S. Fitzpatrick & A. Jacox (Eds.), Annual Review of Nursing Research (Vol. 14, pp. 95-118). NY: Springer Publishing Co.

Smith, C.E., & Kleinbeck, S.V.M. (1996). Nutrition and quality of life measurement. In B. Spilker (Ed.), Quality of Life & Pharmacoeconomics in Clinical Trials (2nd ed., pp. 1063-1075). Philadelphia: Raven Press.

U.S. Congress, Office of Technology Assessment, Health Program (May 1987b). Technology-dependent children: Hospital vs. home care--a technical memorandum. OTA-TM-H-38, Washington, D. C.: U. S. Government Printing Office.

Williams, A.R., & Williams, P.D. (1990). Home caregivers and children on apnea monitors. Family Systems Medicine, 8(2), 151-158.

Williams, P.D., Williams, A.R., & Griggs, C. (1990). Children at home on mechanical assistive devices and their families: A retrospective study. Maternal-Child Nursing Journal, 19(4), 297-311.