Le financement des soins infirmiers à domicile en Belgique - KCE

114 Financing of Home Nursing KCE reports 122
Topic 16: Labour differentiation
On the one hand, there will be less GPs in the future, and nurses will have to take over
tasks which are currently carried out by GPs. On the other hand, there are many
nursing interventions which are carried out routinely by home nurses and which might
be rather easily delegated to care assistants. These evolutions will require adaptations in
horizontal and vertical labour differentiation of home nurses.
Adequate mix of general and specialist home nurses
Several participants from home nurses, self-employed as well as employee nurses,
agreed that chronic nursing care delivery including nursing interventions with regard to
personal hygiene, should not be underestimated. These basic nursing tasks are often
thought upon as routine nursing tasks that can be substituted by lower qualified
employees, e.g. care assistants or family aids.
However, participants argued that e.g. in frail older people, an adequate assessment of
the patient’s status and situation is required.
• “Carrying out ‘routine nursing interventions’ in vulnerable older patients
allows nurses to observe and to assess the patient’s status”. (participant 22;
session 2)
In this context it was also mentioned that currently, home nurses too often have to
hurry and run, while they actually need more time to think.
• “A ‘thinking’ general home nurse could save time and money”. (participant 1;
session 2)
Although it was not thoroughly discussed, several participants emphasized the specific
knowledge/expertise of a general home nurse in the long term follow-up of chronically
ill (older) persons, including a close personal relationship and psychological approach.
• “We need both, general home nurses and specialist nurses”. (participant 15;
session 1)
• “Home nursing is characterized by its own knowledge/experience: long term
follow up and accompaniment by the same general home nurse in a personal
relationship”. (participant 1; session 2)
The relation between family doctor and nurse: doctor’s prescription
/ lack of autonomy for nurses
Some participants suggested that doctors’ prescription of nursing care delivery was
suboptimal. Home nurses often have to ask the doctor to prescribe nursing care, but a
doctor often does not agree with the home nurse on the appropriateness of a nursing
intervention. Another complaint was that doctors often do not (correctly) prescribe
the type of nursing care that a patient should require according to the home nurse. In
this context, it was mentioned that doctors insufficiently know the nomenclature of
home nursing.
For many participants there seems to be a contradiction between the Royal Decree nr.
78 which allows nurses to perform some nursing interventions without a doctor’s
prescription and the financing system of home nursing which requires a doctor’s
prescription for most nursing interventions, except for hygienic nursing care delivery
(specific interventions which confronted home nurses with this contradiction were not
mentioned in the stakeholder dialogues.)
Several stakeholders from both health authorities and home nurses suggested that
prescription of wound care materials and interventions should be done by home nurses.