Aldona Droseikiene

Organisation of home care.

Current demographic developments in Europe have resulted in increased interest in home care. Several European countries aim to stimulate community living and care, including home care, a concept which is not only regarded as just a potentially cost effective way of maintaining people's independence, but is also the mode of care preferred by clients.

"Home is a place of emotional and physical associations, memories and comfort", as reported by the World Health Organisation. Health and social services provided at home are becoming increasingly important. There is a need for information on home care in Europe.

Home care was defined for this review as 'professional care provided at home to adult people with formally assessed needs', which includes rehabilitative, supportive and technical nursing care, domestic aid and personal care, as well as respite care provided to informal caregivers. Home care  range from care for persons with complex needs (for instance 24 hours support) to care for those who only need help occasionally with relatively simple tasks, e.g. domestic aid for frail elderly people and adults with a handicap.

The effective care of the sick requires deep and singular knowledge of the patient, competence and commitment of the healthcare professional, and a sturdy bond of trust between the two. Despite the many sociocultural and professional factors that may divide healthcare professionals and patients, and the impact of political and economic pressures on health care as a whole, effective medical practice needs to replace hurried and impersonal care with careful listening, empathic attention, and personal fidelity.

Narrative Medicine is one cost-effective and evidence-based method to equip health care professionals with the skills needed to respond to the challenge. By fortifying clinical practice with the ability to recognize, absorb, interpret, and be moved by stories of illness, narrative training enables practitioners to comprehend patients’ experiences and to understand what they themselves undergo as clinicians and providers. Professionalism, cultural competence, bioethical competence, interpersonal communication skills, self-reflective practice, and ability to work with health care teams can be strengthened by increasing narrative competence. Narratives of illness, until recently, were conceptualized as textual—illness memoirs, hospital charts, doctors’ stories, and patients’ verbal accounts of sickness. The fields of narrative medicine and arts and medicine are now attuned to the power of visual art—paintings, photography, sculpture, movies, graphic novels—to convey that which even language cannot convey about suffering and healing.

Nurses have a strong tradition of providing patient-centered care. In all types of programs health care providers are introduced to the importance of patient-centered care right from the start , and this emphasis continues across levels, specialty courses and clinical experiences. Yet, how do we know if the care providers provide is patient-centered? With the delineation of the QSEN competencies and knowledge, skills and attitude statements, our traditional understanding of patient-centered care has been articulated, extended and, in many cases, challenged. This module provides the opportunity to consider ways to build upon our current teaching strategies to explicitly foster trainers' inquiry into and provision of patient-centered care using narrative and reflective pedagogies.

This module aims to introduce nurses to the field of narrative in medicine and health care, with particular application to its use in clinical work with patients and families, and in wider professional contexts including supervision, training, management and teamwork