1. Section Editor(s): MARRELLI, TINA MSN, MA, RN, FAAN

Article Content

As I write, the 2012 election battle is heating up-known candidates, long-time candidates, and some newer names are emerging-but I sometimes worry when people say to me, "what does the candidate I choose (or not choose) have to do with me? If I just keep my head down and keep working it will all work out." Sadly, this ostrich view of the world does not work, especially if you are employed in any aspect of healthcare or use any healthcare services-which is all of us! We must embrace advocacy for the things in which we believe and support, which are values directly tied to the patient for whom care is being provided at home.

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My enthusiasm for the political world started early: I was lucky enough to win a Soroptomist writing award while in high school about "Why 18-21 olds should be allowed to vote." There were two winners from each state and the "prize" was to be able to go to Washington, DC, and work with one of your state's two senators-in my case, Connecticut. This meant there were 100 "winners" (two from each state) who were housed in what was then the Congressional Hotel on Capitol Hill. We got to view government at work firsthand, an education and experience that stayed with me and propels me to tell you to get as involved as you can. Nothing gets done without the "want to" get things done, and that enthusiasm for your job or your beliefs is the fire that makes all the difference. There are so many government initiatives and other ways you can get involved; this is a just snapshot:


* You may have heard or read about the "Independence at Home Demonstration" program, which, briefly put, is a Centers for Medicare and Medicaid (CMS) initiative announced in late December to encourage better coordination of care through home-based primary care. To see the press release, visit


* The Role of Human Factors in Home Healthcare: Workshop Summary is a 308-page collection of papers providing an overview of a workshop that discussed the "migration of medical devices, technology, and care practices into the home" (Olson et al., 2011). There is also a 189-page book entitled Healthcare Comes Home:The Human Factors, which includes the Committee on the Role of Human Factors in Home Healthcare's conclusion and recommendations. Visit for more information.


* In keeping with nurses practicing to the full extent of their education and training, as recommended by the Institute of Medicine (IOM) report, addressed later in this editorial, there was a brief recently published by the Agency for Healthcare Research and Quality about Primary Care Medical Homes (PCMHs), titled "Improving Evaluations of the Medical Home." This offers decision makers a concise description of why and how to commission effective evaluations of medical home demonstrations. Visit to read the brief and see more information about PCMHs. Many believe that these PCMHs will be the model for the future of healthcare, so it is imperative that home care organizations, leaders, and clinicians identify where they fit into this scenario.



At the end of this lengthy editorial are 10 tips for thinking about all these ideas.


There has been a plethora of press and other information about the IOM and Robert Wood Johnson Foundation's release of the study The Future of Nursing: Leading Change, Advancing Health produced by a distinguished committee, chaired by Donna Shalala and other healthcare leaders. This document has the potential, I believe, to change healthcare and nursing as we know them now. The IOM report is a very interesting read, and you can visit their Web site to view the report or order the book, which is 671 pages long and comes with a CD of the complete report:


I was in an audience last summer when Susan Hassmiller, the study's director, gave a great presentation about the IOM report and its findings. There are key messages that will resonate across the entire healthcare industry. Because nursing represents the largest group of the healthcare professions (more than 3 million), the implications in sheer numbers are significant. In this issue of Home Healthcare Nurse, Elizabeth Madigan provides some important findings about the report and its implication for home healthcare nurses. In addition, Kathy Duckett provides her perspectives about what the report may mean for us.


The IOM held nine forums to obtain feedback, one of those being the "Forum on the Future of Nursing: Care in the Community," with home care and other community-based care settings represented. This report and its findings could possibly unleash a battle over turf. I recently accompanied a family member to the doctor and, because he knows I am an editor and read everything, the first thing the doctor said to me after hello was "nurses and nurse practitioners will be putting me out of business." Although I think there is room for all of us and that not all patients need specialist care to the extent that is the norm in the U.S. healthcare system, it is interesting that a new study entitled "Advanced Practice Nurse Outcomes 1999-2008: A Systematic Review" found advanced practice nursing care comparable to physician care (Newhouse et al., 2011). Whatever the future holds, collaboration and true interprofessional care (as opposed to parallel care and care planning) will become the norm to meet quality, cost, and safety initiatives. And like the IOM report clearly identifies, nurses must practice to the full extent of their education and training (IOM, 2011). Nurses must also serve as leaders in the movement to improve our dysfunctional healthcare system, and to do this they must be knowledgeable and competent in quality improvement, the critical framework the IOM developed long before the The Future of Nursing report was published.


Home HealthcareNurse welcomes your letters to the editor on this important topic and your response to Elizabeth Madigan's and Kathleen Duckett's articles about the IOM report entitled "The Future of Nursing and the Future of Home Care Nursing: Two Views on the Future."


This March 2012 issue of Home Healthcare Nurse offers three Continuing Education (CEs) articles: (1) "Adults With Sickle Cell Disease: An Interdisciplinary Approach to Home Care and Self-Care Management With a Case Study," an interdisciplinary article authored by Lishia Lee and colleagues; (2) "An Interdisciplinary Wound Team in Home Health: The Role of the Physical Therapist in Wound Care" by Michelle Abeln and Anna Pitassi; and (3) "The Management of Respiratory Insufficiency in Patients With ALS at or Near the End of Life" by Andrea Torres.


Infection control continues to be an important component of quality care, and the article "Hand Hygiene Practices of Home Visiting Community Nurses: Perceptions, Compliance, Techniques, and Contextual Factors of Practice Using the World Health Organization's 'Five Moments for Hand Hygiene,'" by Ohood Felembam, addresses the World Health Organization's innovative practice method related to hand hygiene using an observational study.


As we examined some of the IOM report's findings, it is particularly timely that we have one article related to nurse practitioners and their scope of practice. "The Effect of Nurse Practitioner Practice in Home Care on Emergency Department Visits for Homebound Older Adult Patients: An Exploratory Pilot Study" highlights one model from Canada and explores the scope and differences with the U.S. model.


This issue also has two articles to highlight the importance of therapy in home care and hospice. Andy Carter skillfully writes about an important and difficult topic in the VNAA's Voice column, titled "Reimbursement for Therapy in Medicare Home Health: Balancing Patient Need and Program Integrity." Finally, Tracey Collins, a physical therapist, writes about her important experiences with hospice patients at home in "Reflections of a Hospice Physical Therapist."


The variety of information and articles in this issue reflects the diversity in home care, hospice at home, and other community-based programs.


Prescription to Help: A Ten-Point Plan!


1. Retain your best team members: nurses, therapists, and aides. Clinical competence will be more important than ever! (The demographics are likely to increase demand for nurses and aides.)


2. Be supportive of education and team members expanding their "framework" or knowledge and support them to practice at the full extent of their education and training.


3. Recognize home care as one piece of the continuum-one very important piece.


4. Be able to articulate at the table with hospital managers and other components of the continuum about what home care and other home-based programs can offer to them, including improved safety, quality, outcomes, and cost impact.


5. Strive to be in the first group of home care industry leaders and clients who meet the learning curve of the new emerging system.


6. Learn and integrate the new "glossary" into your thinking and planning across your organization (think accountable care organizations, home-based primary care, evidence-based practice, PCMHs, etc.).


7. Read the literature so you have peer-reviewed data to bring to a discussion and information to support evidence-based practice and changes and apply evidence-based management.


8. Be active and advocate for what you believe!


9. Encourage and mentor others to come along as how we "have known" home care changes significantly.


10. Take a leap and consider running for an office!


As always, we look forward to hearing from you. E-mail me at!



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Tina Marrelli, Editor




Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press. [Context Link]


Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., . . ., Weiner, J. (2011). Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economic$, 29(5), 1-21. Retrieved from[Context Link]


Olson, S., Committee on the Role of Human Factors in Home Health Care, & National Research Council. (2011). The role of human factors in home healthcare: Workshop summary. Retrieved from[Context Link]