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Commentary: Caregiver Competence to Prevent Home Injury to the Care Recipient with Dementia
Rehabilitation Nursing Editorial Board Member
Patient safety is of paramount concern to healthcare professionals and consumers, given the Institute of Medicine (2000) report To Err Is Human and other recent publications that reveal unsafe practices and life-threatening errors in acute care environments. Nurses are cognizant that safety and error prevention extend beyond acute care environments to the entire continuum of care, but safety issues in home care of individuals receives little attention in the healthcare literature. As more care is given in the home setting, it is essential that healthcare professionals support family caregivers in providing safe, quality care.
National Long Term Care Survey data indicate that family caregivers provide care to approximately 4.2 million older adults with disabilities and enable them to stay in their homes or familiar communities in the least restrictive care environments. Families may experience a variety of stressors associated with balancing caregiving responsibilities with the responsibilities of work and family. Particular stress may be associated with providing a safe environment for individuals experiencing some form of dementia. Educational interventions by healthcare providers have empowered caregivers to solve problems more effectively, to develop competence in providing care, and to reduce stress. Nurses are challenged to further develop the science associated with caregiver education to support families as effective managers of safe home care environments.
The authors of this article present a home safety model for the care of individuals with dementia that identifies salient characteristics that support the development of caregiver competence. The “safety platform” represents a reframing of concepts that creates a unique way of viewing home safety issues. Further testing of the model is essential to build the evidence base and demonstrate effective outcomes.
Self-efficacy and practical ability are identified as two essential elements of competence. They also are elements that must be learned to effectively and efficiently build the safest environment within a larger context of often-complicated care environments that have limited resources. It is interesting to speculate how technology might be used to facilitate the caregiver’s development of self-efficacy and practical ability as essential components in the “safety platform,” build caregiver confidence, and create safer environments. Is the infrastructure for creating safer home environments at an affordable cost on the horizon? Imagine wireless sensors to document the movement of people and objects and help to prevent falls or limit wandering. Consider computers that analyze data and generate behavioral cues and prompts, such as activities of daily living that could promote self-care and ease caregiver burden. Monitors and electronic devices that send reminders to take medications are now common, and there is the potential of expanding this technology. Other technological advances might help to build family caregiver and healthcare provider teams through instant communication, problem solving, and immediate resolution of issues. The family caregiver receives in-time support and education, and safe home care environments are established.
The current article presents a home safety model that builds the knowledge base for caregiver competence for patient safety. It also provokes thoughts on how the “safety platform” might evolve as the rapid advances in technology become integral to safe home care environments.
Committee on Quality of Health Care in America [CQHCA], Institute of Medicine. (2000). To err is human: Building a safer health system (L.T. Kohn, J.M. Corrigan, & M.S. Donaldson, Eds.). Washington, DC: National Academies Press.