The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 and March 1991. Data collection was twice, just prior to discharge and a
minimum of
three months post discharge. thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions for these patients were analyzed in this
study.
@ES The results of the study are summarized as follows :
@EN 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven functional categories and ti was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in
the
categories of sexuality, 79.3%, health perception, 68.2% self concept, 62.5%, and sleep and rest 62.5%. Looking at the nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently
given
;
alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 63.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%.
2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was found that of the 11 functional categories, the need level for health perception, nutrition, activity
and
self
concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other
hand,
role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement in digestion and decrease in pain.
No statistically significant changes were found in ability related to ADL, the total ADL score at discharge was 19.78±8.23, and after 3 months 19.01±8.12. Considering that a majority of the patients were over 60 years of age and that many had
brain or
spinal cord injuries, the fact that their ADL ability did not deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slignt but not statistically significant decrease
in
the
quality of life scores between the two test times (147.83 at discharge and 143.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be
interpreted
as a
positive impact by the home health care nurses.
3. One of the home care nursing activities was diagnosis. For this activitiy it was found that for nine functional health categories (sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance,
alteration
in skin integrity both actual and potential, and impaired physical moblity in that order.
4. Delivery of home health care by the home halth nurses included the following nursing activities ; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included
changing
dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheosotmy suctioning and tracheostomy
care,
care of dentures, applications of heat and other similar nursing activities.
5. In conclusion almost 50% of the sample indicated a need for continues nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had
chronic and
debilitation problems there was no decrease in ADL abilities or in quality of life.
Further study needs to be done to increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommendend that study by done using a randomized sampling with a control group to compare patients
who
receive home care with those who do not.
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