Domiciliary nursing : a community service aimed at helping older persons age in place

Abstract

The political pressures towards cost-containment and the social perspective from a policy of segregation to one of integration demanded a re-orientation in the healthcare delivery system for older adults. The Malta Memorial District Nursing Association is the main provider of home-based nursing service in Malta. The utilisation of domiciliary nursing and thus the fusion of informal and formal care may enable an older person remain living in the community with minimal efforts of care for as long as possible. Identification of patient needs is very complex. A healthcare system, in which nursing tasks are delegated and prescribed by others, restricts the possibility to respond to individual needs. AIM: To investigate the provision and utilisation of domiciliary nursing care to meet the needs of older adults living in the community. METHOD: The study adopted a qualitative research method to investigate the provision and utilisation of domiciliary nursing services for elderly persons living in the community. The descriptive - exploratory design with a reflective approach intended to yield data on the realities and viewpoints of domiciliary nursing care providers and receivers. The study was designed to consist of two stages. The first stage consisted of semi-structured interview of seven domiciliary nurses employed with Malta Memorial Domiciliary Nursing Association with the aim to explore the extent of nursing care provided to elderly persons in their home. The second stage also consisted of semi-structured interview of ten older adults receiving nursing care with the aim to assess their satisfaction with service in meeting their needs of care. All interviews were tape recorded and fully transcribed. RESULTS: In a bureaucratic healthcare system like Malta, where forms of intervention and outcome are prescribed and specified, may not be conducive of empowering the receiver to retain independence and autonomy. Such system, where eligibility and criteria for receiving care is more service-led rather than needs-led and where older persons are directed to services in terms of what is available, does not leave much room for self-realisation and self-development. This rigid, inflexible approach may be creating unnecessary dependencies. A reorientation of service delivery and nurses' role are needed. The model that focuses exclusively on treating ill health needs to be replaced by one that encompasses health promotion and disease prevention CONCLUSION: Training in geriatric domiciliary nursing care should be introduced as a post-graduate course for nurses who work with elderly persons in the community. This initiative must be supported by the introduction of a standardised geriatric assessment tool to be used in home visits to identify elderly persons in need of care and upon which holistic care can be planned. Finally, MMDN A as the main provider for domiciliary nursing care in Malta, needs to engage in client health education programmes accompanied by the creation of elderly-friendly information booklets and materials.