Home care and the older adult: illness care versus wellness care.
If older citizens are to maximize their potential for optimal functioning and independence, there will surely be a greater need for holistic nursing care. How can nurses fulfill this need in view of existing barriers? What can they do to ensure that home- and community-based holistic nursing care will be available to elderly citizens for whom the quality of life is at risk? Although there are no easy answers, there are several strategies that nurses might find useful in this current predicament. These strategies fall into four categories: Documentation. When restrictions are imposed, nurses must be prepared to challenge fiscal intermediaries. To do this, they must have strong documentation of the rationale for service. Every effort must be made to document those services that are reasonable and necessary for the treatment of a client's illness or injury. Client advocacy. Because of the restrictions on service that are imposed by the principal sources of public funding, nurses must seek wide support from other community sources. Gaining such support requires a knowledge of community structure, the display of activism and leadership, and a willingness to engage in the political process. Lobbying. As an extension of client advocacy, nurses must create an effective lobbying force to educate public policy makers and legislators. Nurses must persuade elected representatives that there is a need to develop a broader interpretation of what constitutes a "skilled nursing service." Research. Nursing research, sweeping but creative, must become part of every professional nurse's responsibility. Ways to measure the outcomes of holistic nursing must be found.(ABSTRACT TRUNCATED AT 250 WORDS)