Subscribe
Share
Share
Embed
A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.
Morgan: Do you want to know
how nurses can support complex
and frail patients at home?
Yeah, me too.
We know that patients with more
complex care needs, in particular,
benefit from primary care teams.
Even smaller teams with just an MOA,
a nurse, and a family doctor or nurse
practitioner better support patients
with higher complexity care needs.
In this team bit, I want to highlight
two activities that a nurse can do
to support a patient who's living at
home and is frail or who might have
just returned home from hospital.
The first is home visits, and the
second are more virtual touch points.
At the end, I'm going to loop
back on why I think both these
are good for nurses to lead.
Let's start with the idea
of nurses doing home visits.
For patients who have been having
trouble getting to the clinic,
home visits can be a blessing.
They can also allow you to assess a
person in their, in their natural habitat.
You can glean a lot more by doing
a home visit, obviously, than
seeing somebody in the office.
It can be a really good snapshot
of the quality of home life and
their relative safety at home.
Now, this kind of visit that a nurse
can do at home is different than home
care because you're going to be focusing
on primary care needs of the person.
And the primary care team's scope
is different than home care scope.
And then as part of the team
in primary care, the feedback
and follow up are different.
A nurse in a primary care team working
more closely with a primary care
provider has a different connection
and a different way of describing
things, so you understand better.
What's going on compared to,
a home care nurse who might,
you might not know as well.
Now, the visit can also be similar to
home care in that a nurse can assess
the home and home life and do that
differently than you would with a clinic.
You can provide some services
at home, like blood pressure
checks and sorts of other things,
vaccinations, wound care, et cetera.
If you wanted to start with home visits,
you might want to start with patients
who actually aren't receiving home care,
perhaps those who are on the wait list.
So there's not, a confusion as to what one
nurse is doing compared to another nurse.
you're providing more access
to services and particularly
for those who are waiting.
So I, I would start with, uh,
home visits with patients that
are not yet receiving home care.
Okay.
If you're going to start this
in your team, I do think a good
place to start would be to have
a common checklist or template.
That way you can start to figure out
what the approach is going to be.
And there's a consistency
amongst the team.
And in a checklist, you can have things
like safety, what equipment you need.
there's actually an older
article from way back Canadian.
1999, and they suggest this mnemonic
called in homeness, for all the things you
might need to think about, for, people who
are frail or immobile at home from safety
to all the services you can think about.
I'll put the links in
the show notes for that.
A new nurse in practice can actually
take this and develop a custom checklist
as part of the preparation, the team.
So if, home visits are one option,
the second one was the virtual touch
And I like this idea as well, Casey,
who's an RN at the ISU, really values
connecting more frequently with
patients, and this is what she said.
Kacey: I think one of the
biggest areas with frailty care
is More frequent touch points.
So, again, when we look at how much
doctors are working, how long hours
are those pieces, is there's not
necessarily a lot of time left for more
frequent touch points, more frequent
opportunities to connect with people.
And when people are living at home
with frailty, there's A nurse can
be that person that just picks up
the phone maybe once a week and
touches base to say, Hey, Mrs.
Robinson, how are you feeling today?
Morgan: So, this can be by phone.
It can be by video if that's possible.
It depends what you and
your patient are used to.
I wouldn't start by changing
the process if a person is
not used to doing video calls.
But if they are, like to
do video touch points.
And that's if the patient is
comfortable or the caregiver
is comfortable doing that.
And I think that can be really helpful
if you haven't done a home visit before.
And if you haven't done a home visit
and you're doing video, If the person's
willing, ask for a virtual tour.
It's a great way for them to show
things off, and it's a great way for
you to see how their environment is.
And that can be an incredibly
valuable point of a touchpoint.
So why are touchpoints great for
nurses to do instead of family
doctors or nurse practitioners?
And why are nurses perhaps well
suited for home visits as well?
I think first and, well, at least
initially, nurse capacity is
likely greater than an established
primary care provider like a nurse
practitioner or a family doctor.
Also, I think nurses can frame the
quick check ins better than family docs.
They can be more focused while
building the relationship.
And I think for Family docs, it can
be a little harder to do that, because
there might be other things that
are sort of on the back burner that
a patient might want to ask about.
So sometimes it can be a
little hard to have that quick
visit without feeling short.
And a newish nurse can engage in a
way that sort of starts off with a
focused conversation and then some
time to build that relationship.
So I think those are lots of reasons
why nurses are great to start these kind
of touch points and home visits early.
I think the nurse's perspective on
functional care is the main reason for me.
I mean, capacity is going to run out
at some point as, a nurse gets busy, as
people get used to working together, both
you and the patients in your practice
get used to working with a nurse, their
capacity is going to be maxed out.
But it's this functional perspective
that I think is incredibly important,
particularly for people who are frail.
nurse can bring their clinical
judgment into this and think about
ways to help with that functional
assessment and management.
It is different than how, physicians
and nurse practitioners might focus in.
this is important and helpful both at
single points in time and over time.
So that longitudinal relationship that
gets built over time can be really helpful
to have the nurse in there early, getting
to know people, as they are at home.
And then the last, reason why I think
these are both excellent, approaches
for nurses to take is that nurses are
very good at the coordination component
in that wider clinical neighborhood.
I won't call it case management, but
that, clinical coordination of services.
A nurse is a great person to, think
about what additional supports might
be needed from mobility aids to home
care to other kinds of supports.
and they're good at coordinating and
following through on that kind of need
in a way that I think, We tend to do a
little bit less as primary care providers.
I know from firsthand experience, and
I was just talking with Hannah earlier
today, how much better Hannah is at
following through in this way than I am,
and it's so important if they've had the
firsthand experience with the person,
they have so much more context to provide
to the next member in the neighborhood
that it's so much more valuable.
So if any of this sounds
appealing, talk about it as a team.
If it's something you want to do, if
it's a good fit for your practice,
if you have patients who are perhaps
a little bit frail in community,
perhaps waiting for home care, or
recently come out of hospital, then
work out what the scope is going to be.
Is it going to be home visits?
Those virtual touch points,
or is it going to be both?
Think of a timeline for how
long you're going to do this.
Figure out what you think
your success criteria are and
run quality improvement cycle.
I'd start with a list of five or so
patients and then reach out to one or two
and see if you've got two patients that
say yes, work with those two and then
loop back and figure out what worked,
what can be done better and decide if you
want to continue this in your practice.
That seems like a good place
to wrap up this Team Bit.
I'll see you next time.
Thanks for listening to Team Up.
If you've got any questions
or topic suggestions, please
email us at isu at familymed.
ubc.
ca.
Sarah: The Innovation Support Unit is
a distributed multidisciplinary team.
We work mostly remotely from communities
across the Lower Mainland and
Vancouver Island in British Columbia.
Morgan: Sarah and I are both recording
from our offices in the territories
of the Lekwungen speaking peoples, the
Songhees and Esquimalt First Nations.
Sarah: And recognizing the colonial
history and the ongoing impacts of
colonization and healthcare systems
and in Indigenous communities in
Canada and around the world, as we
move through the season, we'll work
to bring an equity lens to this work.
And we really encourage you, our
listener, to reflect on your past,
present, and future participation.
On the indigenous lands
where you are situated.
Morgan: we'll see you in
the next episode of team up.