Siamanga H.

Nursing School, Athens, Greece

SUMMARY. The purpose of this study is to provide information about the development of house nursing care (HNC) in Greece and its contribution during the post-burn period. In 1979 the Metaxas Hospital in Piraeus developed a pilot HNC programme aimed at local cancer patients. In 1986 a similar pilot programme was pursued by the Saints Anargiri Hospital of Oncology. In 1990 the Greek Red Cross organized an HNC unit for the entire population. According to Greek Red Cross data concerning HNC, 2,721 patients were given such nursing care within seven years, with 32,113 visits. It is clear that the cost of hospital nursing care is higher. It is concluded that most burns can be treated successfully with HNC. Patients suffering from burns can be discharged from hospital sooner. The number of malformations caused by scars is reduced, and the cost of HNC is much lower.

Introduction

House nursing care (HNC) is as old as the existence of people on earth. As we read in the Old Testament, the Jewish people used to visit patients and help them to alleviate their pain.1 A form of HNC was offered by the church in 58 ad.2

Organized HNC started in Liverpool, England, in 1859. Later, in 1874, a national organization was established that employed trained nurses to provide nursing care for the poor in London and wherever such need existed.3-5 HNC soon became an institution and it gradually acquired its present form.

In 1979 the Metaxas Hospital in Piraeus developed a pilot HNC programme aimed at local cancer patients. In 1986 a similar pilot programme was pursued by the Saints Anargiri Hospital of Oncology. In 1990 the Greek Red Cross organized an HNC unit for the entire population.6

Definition

HNC requires the development of suitable conditions and potentialities so that integrated nursing care can be provided in the patient’s home when he or she needs it.7

HNC constitutes an integral part of primary health care. It is available to all members of the family, from infants to the elderly.

HNC comprises a series of services that can be pro-vided at home in order to help people, irrespective of their age, to face the problems arising from a sudden illness, the recurrence of a chronic ailment, or prolonged disability and incapacity, preserving the highest possible level of health, physical activity, and personal freedom, depending on each specific case.8,9

Aims

The aims of nursing care are based on the principle of the preservation, promotion, and restoration of health, no matter who provides the nursing care in the home.

Nursing care may take the form of education and practical demonstration or of an attempt to connect the patient with local community services, with the aim of helping the patient to remain at home. The complications of chronic illness are countless, but they can be prevented with the aid of proper nursing care in the patient’s home. The patient’s pain can also be alleviated in the home.

Essential services are designed on the basis of the patient’s needs as well as those of the family. These services are provided by specialized personnel or through appropriate nursing methods and services.10,11

Nurses participating in HNC programmes have to deal with patients recovering from serious pathological diseases or after surgery, following discharge from hospital, and especially with patients suffering from chronic illnesses and elderly people with a variety of problems.6 These nurses have to perform all sorts of nursing practice not requiring special hospital equipment.

The aim of nurses is to teach the patient’s family and help them to take upon themselves the safe care of the patient.

The reasons why HNC is essential

The most important reasons why HNC is essential are the following:7,12

• the number of elderly people is increasing, with the result that there are ever more people with various chronic problems and needs;
• patients remain in hospital less time, owing to a lack of hospital beds;
• HNC decreases nursing costs per patient, because of the reduction in the number of days they remain in hospital;
• the possibility of applying chemotherapy, haemodialysis, and other nursing practices in the patient’s home enables him or her to remain in, or return to, the domestic environment and to continue therapy among the family, which has a positive impact on the patient’s mental state;
• rehabilitation of the patient in his or her social and work environment is more rapid.

The benefits of the development of HNC are therefore financial, social, and psychological.

The running of the Greek Red Cross HNC programme

The Greek Red Cross HNC programme went into action in September 1990. Nursing care is provided to persons of all ages and involves two particular categories: those suffering from chronic ailments and those who have recently had a serious illness or accident. The unit offers its services free of charge. It uses three cars for its transfers.

The scientific team is comprised of:

1. A head nurse
2. A full-time general practitioner
3. Five nurses
4. Two physiotherapists
5. Volunteer nurses

Each nurse works in a specific area. The nurse is responsible for a specific number of patients whom he or she visits in relation to their needs. The nurse assesses and ranks the patients, sets objectives, and finally applies individual nursing care.

These nurses have to acquire a good scientific education and a sound knowledge of modern developments in science and health field infrastructures, as well as the skills and experience necessary to deal with the wide variety of needs that they will be called upon to face.

The HNC contribution on the part of the Greek Red Cross is illustrated below (Table I).

The highest percentage, namely 73.2%, was that of chronic patients.13

If we compare the cost of hospital nursing care with that of HNC, we find that HNC is more economical. The cost of a patient who accepts HNC is one-fifth to one-sixth that of hospital nursing care (Tables III, IV).6,14

It is obvious that the daily cost of hospital nursing care is much higher than the cost of each Greek Red Cross visit.

Conclusions

It is well known that patients suffering from burns need close observation, high-quality nursing care, and continuous interventions in order for them to recover.

Integrated nursing care for burn patients involves the presence and co-operation of a team of specialists to face effectively the various problems that invariably arise.15

As far as minor burns are concerned, patients are dealt with as out-patients. Patients with burns of average gravity are dealt with in hospital, and special therapeutic units are not necessary.16-18

When HNC is well organized, it can handle the above burns as well as burns that were previously dealt with in Intensive Care Units. HNC can offer much as regards burns, because:

• most burns (85.20%) cover less than 20% of the body and can be dealt with in the home;
• with nursing supervision and appropriate treatment, the possibility of contamination, especially of the transplant, can be reduced;
• the patient’s psychological state can be attended to, bearing in mind that this can easily be influenced in the short post-operative period by a psychotic syndrome;
• physiotherapy and work therapy become more intensive, provided that a physiotherapist is present in the HNC scientific team;
• the patient has a better return to society. In general, the patient is strengthened physically and psychologically when he or she returns to the family environment after such a traumatic experience;
• the cost is much lower.

RESUME. L’Auteur, dans cette étude, fournit des informations sur le développement du système des soins infirmiers domestiques (SID) en Grèce et sur la contribution de ce système pendant la période successive à une brûlure. En 1979 l’Hôpital Metaxas au Pirée a développé un programme-pilote destiné aux patients du lieu atteints de cancer. En 1986 un programme-pilote semblable à été poursuivi par l’Hôpital d’Oncologie Saints Anargiri. En 1990 la Croix Rouge Grecque a organisé une unité SID pour l’entière population. Selon les données de la Croix Rouge Grecque pour ce qui concerne les SID, 2,721 patients ont reçu ces soins dans une période de sept ans, avec 32,113 visites. Il est évident que le coût des soins hospitaliers est supérieur. L’Auteur conclut que la majorité des brûlures peuvent être traitées avec succès avec le système SID. Les patients atteints de brûlures peuvent être renvoyés de l’hôpital plus précocement. Le numéro des malformations causées par les cicatrices est réduit, et le coût du système SID est notamment inférieur.

Bibliography

1. stopoulou I.: Home nursing: Historical evolution, aim and content. General Family Medicine, 183-8: Oct.-Dec., 1993.
2. Mastora M., Siamanga H., Konstandou H., Theodosiou K., Kritikou D., Lianou E., Tsiouri E.: Nursing at home. Alternative form of care. Historical background in Greece. 20th Annual Panhellenic Medical Conference, Athens 1994.
3. Davis C.: “Rewriting Nursing History”. New Jersey, Green Helm Books, 1980.
4. Papamikrouli S.: Nursing in Greece - Perspectives. IA Panhellenic Nursing Conference, Alexandroupoli: 13-36, 1984.
5. Lanara B.: “Heroism and Nursing”, Athens, 1977.
6. Tsiouri E.: Program functioning - nursing at home. Greek Red Cross General Family Medicine, 178-82: Oct.-Dec., 1993.
7. Papanastasiou-Alexoglou A.: “Community Nursing”, Athens, 1991.
8. Warhola C.: “Planning For Home Health Services: A Resource Handbook”. Public Health Service, Washington, 1980.
9. Kyriakidou E.: “Community Nursing”, Athens, 1995.
10. American Medical Association: “Physician’s Guide to Home Health Care”, Monroe, 1979.
11. American Nurses Association: “Standards of Community Health Nursing Practice”, Kansas City, 1973.
12. Kyriakidou E.: “Factors That Affect the Formation of the Nurse’s Position Towards the Institution of ‘Nursing at Home’”, Athens, 1990.
13. Mastora M., Konstandou H., Lianou E., Theodosiou K., Kritikou D., Siamanga H., Tsiouri E.: Nursing at home. Contemporary health care for the elderly. 5th Panhellenic Gerontology Conference (Geriatrics), Athens, 1993.
14. Christopoulou I.: Financial evaluation of home nursing for those suffering from cancer. Health Inspection, 108-112: Mar.-Apr., 1992.
15. Harharidou M.: Nursing treatment of burn suffering in ER (Intensive Care). Problems and perspectives in the Intensive Care Unit, Athens, 1993.
16. Siamanga H.: “Burns in Greece. Organization of Nursing in Burn Patient Units”. Athens, 1993.
17. Ioannovitch I.: “Plastic Surgery”. Athens, 1990.
18. Dyer C., Roberts D.: Thermal trauma. Nursing Clinics of North America, 25: 85-117, 1990.