Chapter 30: Nurse in Public, Home, Palliative & Hospice

Nurse in Public, Home, Palliative & Hospice emphasizes the paradigm shift toward the Triple Aim model, which seeks to boost population health outcomes, improve the individual patient experience, and lower per capita costs through strategic health promotion and chronic disease management. A significant distinction is made between the patient as a passive recipient in institutional settings and the client as an active partner in home-based care, where the nurse functions as a guest in the residence and collaborates closely with family caregivers. The historical evolution of these fields is explored, from the 19th-century roots of visiting nursing to the transformative impact of 1965 Medicare legislation and the pioneering work of figures like Florence Wald in the hospice movement. Key specialized models such as the Nurse-Family Partnership, which supports maternal and child health, and transitional care, which ensures safety during patient transfers between settings, are highlighted as essential to modern practice. Professional standards are upheld through the use of the nursing process and standardized terminologies like the Omaha System, which facilitates the documentation of clinical problems, interventions, and outcomes in a way that is computer-compatible and quantifiable. For home health agencies, the Outcome and Assessment Information Set (OASIS) serves as a critical, mandated tool for measuring client outcomes and securing reimbursement from the Centers for Medicare and Medicaid Services (CMS). Clinical priorities discussed include rigorous medication reconciliation to prevent adverse drug events, strict infection prevention protocols for wound care and invasive devices, and the management of opioid safety. Furthermore, the text details the importance of interprofessional collaboration, where nurses lead teams comprising therapists, social workers, and physicians to deliver holistic care. Emerging trends such as nursing informatics, the use of electronic health records (EHRs), and telehealth technologies like biometric telemonitoring are presented as vital tools that enable older adults to age in place while maintaining high-quality surveillance. Quality is maintained through Outcome-Based Quality Improvement (OBQI), benchmarking against national standards, and voluntary accreditation from organizations such as the Joint Commission. Finally, the text aligns these nursing roles with the national Healthy People 2030 objectives, underscoring the vital contribution of community-based nurses in reducing mortality and promoting long-term wellness across the lifespan.