The health care services delivery environment is a dynamic one in the late 1980s. Increasing costs, evolving societal values, advances in treatment therapies, changing demographics, and other factors are affecting both the how and the where of the delivery of health care services (Mentkowski, & Doherty, 1984). The introduction of technological innovations into health care is not only enhancing the quality of the services delivered, it is making possible the effective treatment and care of patients in home and community environments who would have previously required institutionalization (Thomas, 1988).
The restructuring of the health care delivery environment adds new dimensions to the ethical issues involved in the practice of nursing. These issues are particularly relevant to the delivery of health care services in the home home health care. Professional nurses must become cognizant of these issues, and they must integrate their knowledge of nursing practice with the requirements of home health care so that these issues are addressed effectively. As a profession, nursing must develop and promote licensing and accreditation criteria which assure quality health care delivery in the home.
Some of the more significant of the ethical issues which are associated with home health care are discussed in the remainder of this paper. Their relevance to nursing practice, and associated licensing and accreditation implications are also considered.
In spite of the widely accepted public perception, the home health care concept is nothing new (Caring, 1988). Physicians who make house calls are providing home health care, as are midwives who assist women in giving birth at home. Both physician house calls and midwifery were standard forms of medical practice in the United States until around 1941 (Murphy, 1982). Further, prior to the end of the Second World War, the usual locus of treatment for chronically ill patient...