The idea of home health/hospice originated from the 11 century, went through the religious impact of and nowadays have a strong public and governmental support. Home care and hospice services mainly provided through nursery play a very important role in the community with strong ethical implications and crucial cultural issues.
In the 11th century the hospice meant a place where weary or ill travelers could have a shelter. During the “Crusades movement” between 1095 and 1291, all over the Western Europe the incurably ill travellers were permitted to stay in places of medical treatment. (Connor, 1998). The first hospice was opened in Rhodes in the 14th century by the order of the Knights Hospitaller and afterwards hospices operated within time of the religious orders’ existence. The 17th century can be considered the time of hospices’ renovation. The hospices of the Daughters of Charity of Saint Vincent de Paul in France, Our Lady’s Hospice in Ireland, the Friedenheim in London, the Home for Incurables in Adelaide and the Anglican House for the Dying in Sydney, and St. Rose’s Hospice in New York City were opened in by the beginning of the 18th century. (Lewis, 2007). The modern hospice care is associated with the English physical Dame Cicely Mary Saunders, who from 1948 started to promote compassionate and palliative care for the terminally ill patients and since 1963 delivered lectures at Yale University in the United States. The first modern St. Christopher’s Hospice was established in a suburb of London in 1967. In 1969, the best-seller “On Death and Dying” written by Swiss psychiatrists Elisabeth Kubler-Ross was published. It is based on the interviews with the incurable patients and outlines the five stages thought which they progress. Starting from 1974 the hospice movement in the United States has been given the governmental and public support through its institutions, commissions, laws, reports and programs.
Community offers home hospice services delivered by a caregiver, nurse, doctors, hospital social workers and other professional staf through the local home health agencies. Their goal is making life of their patients as painless and comfortable as possible thought optimizing pain and symptoms management, medical interventions and therapy, and psychological relief. Along with services, hospice care also includes community settings where such services are delivered, either medical centers, hospitals, nursing and assisted living facilities, or homes. Medical centers and hospitals mainly provide quick aid, surgery and post-surgery treatment, whereas home care is a community-based treatment. More than 90% of hospice services provided in the United States are based in patients’ homes, thus caregivers must create an appropriate environment for the ill persons to make them feel a part of the community (Hospice Care, 2011)
According to the National Association for Home Care and Hospice, 12 million US citizens require home health care that can be served by 33 000 home health care agencies. 63.8% of the patients are women and 69.1% of all the patients are older than 65 years. Thus, in 2009, Medicare spending equaled to 41% of the total home and hospice care expenditures that were approximately 75.2 billion US dollars. The most frequent home care cases include heart failure, diabetes, and ulcer of the skin, hypertension and osteoarthritis that are typical for the elders (Home Health Care Statistics, 2013)
The Code of Ethics for Nurses issued by the International Council of Nurses, stipulates that a nurse should hold the patients’ personal information in confidence and use judgment in revealing it. Thus, a nurse must know the ways of dealing with the information to ensure that the patient will benefit from it. Moreover, a nurse is responsible for maintaining high standards of personal conduct promoting ethical behavior that would reflect well on the profession in general. For example, it is not allowed to use benefits of the family members like participation in the family events or accept expensive presents. In addition, a nurse should develop and sustain the professional values, maintaining a status of professional by avoiding household work or running errands. Finally, a nurse must have resppectful relations with co-workers in nursing and other areas to promote ethical conduct. (The ICN Code of Ethics for Nurses, 2012).
Public health nurses deal with refugees and immigrants. Thus, nurses need high cultural competence to be capable to deliver services for them. It is possible trough raising awareness of cultural diversity in values, believes and behaviors of their patients. The culturally competent homecare nurse can identify and resolve any misunderstandings between the various cultural systems. However, the nurses should have a desire to understand the cultural values of each individual to avoid generalization and inappropriate communication. The model of Giger and Davidhizar, Kim-Godwin, Clarke and Barton, the nursing theory of Madeline Leinenger, and the cultural competence theory of Campinha-Bacote can be used for the assessments in the nursery practices. (Deena, 2013). In addition, nurses must know the law regulating their activities and the standards of the U.S. Department of Health and Human Services to deliver the appropriate health care cultural and language services (Health Care Language Services Implementation Guide, 2013).
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A nurse is responsible for promoting health, preventing illness, restoring health and alleviating suffering. Thus, the nurse’s role refers to humans’ rights and dignity. A nurse must be a highly moral person to be able to treat people disrespectful to their age, culture, nationality, gender, sexual orientation, race, social status and disability or illness. A nurse creates the environment, in which the human values, rights, customs and spiritual beliefs are respected. Consequently, a nurse makes valuable contribution into the community development, since the level of humans’ right respect for the vulnerable groups of population indicates the social status of the community.
To sum up, the idea of home health and hospice services has been developed from the ancient times and nowadays is one of the most important health care aspects. It has become a part of community philosophy with strong ethical and cultural impact mainly implemented through high moral and professional nursery.