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Turkish Nurses' Concerns About Home Health Care in Turkey

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Turkish Nurses' Concerns About Home Health Care in Turkey RESEARCH PAPER Turkish nurses’ concerns about home health care in Turkey AUTHOR ABSTRACT Sezer Kisa Objective MSc. PhD, Gazi University, School of Nursing, Besevler, The purpose of this study was to explore nurses’ Ankara, Turkey concerns regarding the introduction of home health care in Turkey. [email protected] Design The study was a descriptive research design using a Acknowledgement self administered questionnaire. The author would like to express her gratitude to Adnan Kisa, PhD, Professor and Dean of School of Setting Communication and Journalism, Baskent University, The setting was a 400 bed general public hospital in for his assistance with the collection of data. Ankara, Turkey. Subjects 243 staff nurses were invited to participate in the KEY words study with 187 nurses returning the self administered questionnaire (response rate 76.95%). Home health care, nurses, Turkish health system Main outcome measure: The main outcome measure was the level of support by participating nurses for the delivery of home care in the Turkish health system as a way of cost effective health service provision. Results The results show that about 60% of the participating nurses supported the introduction of home health services in Turkey. Conclusions The results of the study can be used to support the introduction by health policy makers and health professionals of home care as an alternative delivery system in the Turkish health sector. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 97 RESEARCH PAPER INTRODUCTION health care where health services are provided to individuals and families in their places of residence During the last two decades, health care systems for the purpose of promoting, maintaining, or around the world have undergone profound change, restoring health (Kisa and Ersoy 2005; Ellenbecker driven by a complexity of economic and political 2004). Home health care nursing presents a factors. One of the outcomes of these changes has challenge to nurses who must incorporate new been the shift of consumers from traditional inpatient technology, increasing patient acuity, and complex, facilities to a range of community‑based treatment multidimensional patient needs into their practice. options (Kim et al 2006; Kisa and Ersoy 2005; Celik et al 2001). Individuals with chronic and acute illnesses Patient‑oriented care models are increasingly seen are receiving treatment in these alternative settings as effective in improving the quality of nurses’ work which may include outpatient surgery facilities, local (Kim et al 2006; Cho 2005; Kisa and Ersoy 2005; nursing programs, home health care programs and Ellenbecker 2004). Patient oriented care is defined other facilities that are being developed to meet the as care that takes the individual patient as the focus health care needs of people in cost‑effective ways by means of systematic and comprehensive nursing (Pare et al 2006; Jester and Hicks 2003). care, coordinated by a continuously responsible nursing caregiver. Four trends have been reported as influencing factors for health care provision in general and home health In the last few years health policymakers in many care in particular. These trends are (a) the driving countries, including Turkey, have passed a number force of economics and the resultant pressure to of health care reform plans which aim to increase reduce the enormous cost of health care systems, efficiency, effectiveness, transparency and quality in (b) the movement of health care delivery away health care services in order to reduce the costs of from acute care into the community, (c) the rapid health care provision (Teke et al 2004; Tengilimoglu growth of ‘managed care’ systems that manage the et al 2004; Kisa et al 2002; Kisa 2001). The general provision of health care with the aim of controlling strategy includes a shift of focus from hospital to costs, and (d) the increasing share of older people home. Studies indicate that home care can benefit in populations (Kim et al 2006; Hartung 2005; from developments in health care (Boling 2005; Berkhout et al 2004; Huston and Fox 1998; Cochran Bradley 2003; Estaugh 2001; Congdon and Magilvy and Brennan 1998;). 1998; Freeman and Chambers 1997; Dahlberg and Koloroutis 1994). Moreover, home care can take a Home health care is a labour intensive industry that central role in the process of change in health care relies on nursing personnel as a major resource in the systems, particularly in the area of coordination and provision of services. Assuring access to quality home cooperation within multidisciplinary teams (Branick health care services depends on an organisation’s et al 2002). Home health care is a labour intensive ability to retain qualified nursing staff. Predicted industry that relies on nursing personnel as a major severe nursing shortages and an increasing demand resource in the production of services. Thus, in for home health care have made the retention of countries like Turkey, it is important to understand experienced, qualified nursing staff a priority for how nurses view home health care. The purpose of health care organisations (Ellenbecker 2004). this study was to explore nurses’ concerns regarding Home health care and community health nursing the introduction and suitability of home health care are rapidly developing career alternatives for nurses in Turkey. who are moving out of hospital‑based roles which Home health care have a traditional focus on acute, episodic care Home care is an important player in the health care (Berkhout et al 2004). As a specialty, home care arena because of its potential for cost savings. Home nursing is defined as a component of comprehensive care is a combination of several different kinds of AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 98 RESEARCH PAPER services (for example, catheter care, administration medical, nursing and rehabilitation services. of injections, medication reminders, oxygen therapy, These can include infusion therapy, monitored nutritional evaluation and other health and lifestyle chemotherapy, physical therapy, occupational information, advice and support) that can be vital to therapy, social work and counselling. Home support patients (Cho 2005; Hoye et al 1997; Freeman and services are designed to complement health services Chambers 1997). Since the 1990s, home based and include personal care, meal preparation, health care has been one of the most rapidly growing housekeeping, transportation, and other assistance areas in the health care sector in the United States with activities of daily living (Kisa and Ersoy 2005; of America and other western countries (Kisa and Bradley 2003). Ersoy 2005; Madigan 1997). Market forces and Health services delivery in Turkey the development of government policies to control The Turkish health care system is financed by taxes, cost increases in the health sector have driven this insurance premiums and out‑of‑pocket payments development. which are a combination of national health insurance In Turkey, home health care services cover a broad and private health insurance. The health insurance range and can include pharmacy services, skilled cover provided by social security is comprehensive. professional and paraprofessional services, custodial The private sector is small but growing rapidly and care, and medical equipment delivered to and complements rather than competes with the state maintained in the home (Kisa and Ersoy 2005). system. The country has three main social security In order to be covered by health insurance, most organisations which are public institutions: the services must be ordered by a physician and must Government Employees Retirement Fund (GERF) be medically necessary to maintain or improve the which provides pensions for civil servants, the Social person’s health. Insurance Organisation (SIO) for blue‑collar workers and Bag‑Kur for people who are self‑employed. These Home care serves a number of functions for acute, are also the public providers of the health care system continuing, preventive and palliative care; each of (Kisa and Ersoy 2005). these functions necessitates a different provider mix, level of care and need for health management Health services in Turkey are for the most part in the home (Kisa and Ersoy 2005; Bradley 2003; nationally funded and are delivered mainly at public Congdon and Magilvy 1998). For example: facilities. These include hospitals and clinics run by • Acute care: facilitates early discharge or prevents the Ministry of Health (MoH), by other government admission to hospital or other costly facilities. agencies, or by the universities. There are also private hospitals and clinics, but as these are expensive, • Continuing care or long term care: allows only people who are wealthy generally access them. individuals to remain in their current environment The present fragmented landscape of providers is in the community as long as possible. a difficult setting in which to coordinate and deliver • Preventive care: prevents occurrence of injuries, health services (Kisa et al 2002; Kisa 2001). illnesses, chronic conditions and their resulting disabilities. The nationalised health care system in Turkey does not provide extensive care for older people or people • Palliative care: offers total care to a person and who have a disability or who are terminally ill. Family supports caregiver(s) to improve the person’s caregivers usually meet these needs. Home care quality of life. services are provided by private companies, but are Home care services are generally defined in terms limited in terms of quantity, are expensive, and are of two broad categories: health services and home not covered by government health insurance. The support services. Health services are those ordered government health care system has no home health on the patient’s behalf by a physician and comprise care program or hospice program. For example, AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 99 RESEARCH PAPER many of the pain‑relieving drugs used for terminally RESULTS ill patients require special prescriptions and this As can be seen in table 1, over half the respondents limits their use in home care.
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