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7/27/2019 Challenges of Home Care Nursing in Nigeria ; A case of hemiplegia
1/22
CHALLENGES OF HOME CARE NURSING IN
NIGERIA:
A CASE OF HEMIPLEGIABy
Omolola Adams Olatayo RN
INTRODUCTION
A Nursing Home, Convalescent Home, Skilled NursingFacility (SNF), Care Home, Rest Home or Intermediate Care
provides a type of residential care. They are a place of
residence for people who require continual nursing care and
have significant deficiencies with activities of daily living.
(http://en.wikipedia.org/wiki/nursing_home, retrieved
30thmay, 2013). Home care nursing is for individuals who
need direct nursing care, but who do not wish to live in a
nursing facility. A nurse can visit the home and provide carein that setting. A home health care patient is referred to as a
client, and home care can last for a short period of time or
an indefinite amount of time, according to medicare.gov.
(Annie, 2010).
Jose 2009 , explained Hemiplegic is a common
outcome of stroke, and setting goals for its rehabilitation is
extremely important. Because hemiplegia affects muscles of
the face, arm and leg on one side, it prevents patients fromdoing a variety of activities which range from walking to
feeding themselves. Therefore, the goals of the rehabilitation
plan are very specific to each patient, and they must be
agreed upon before the rehabilitation program is initiated.
Even the side of the body affected by hemiplegia can
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influence the rehabilitation plan, as people with right-sided
hemiplegia may also have difficulty with speech and
language (aphasia). When this is the case, they also require
a comprehensive plan of aphasia rehabilitation.
Blood supplies nutrients and oxygen to the body. The
brain, which coordinate every action of the body makes from
walking and talking to moving your arm and breathing,
receives about 20% of the blood that flows through the
entire body. A stroke, also called brain attack occurs when
the vessels supplying blood to the brain is blocked. This
results in the death of the brain cells. Depending on the area
of the brain involved and the extent of brain cells death, the
specific body functions such as speech, movement, or
memory may be affected.
(http://www.healthplus24.com/diseases/stroke.aspx
retrieved 30thmay, 2013).
Hemiplegia is a difficult condition to treat. Basically, the
results depend upon the extent of regression of the
pathology within the brain. Good nursing plays a very
important part in the physical and mental care of the patientuntil he reaches the stage where, with sufficient restoration
of motor function, he again considers himself a relatively
normal member of society. Whether he then leads a more or
less vegetative type of existence in his effort to prolong his
life, or whether he re-enters into his previously energetic
activities even though he realizes that such conduct may
hasten another apoplectic stroke which may be fatal,
depends on his own philosophic concepts of life.(http://www.jstor.org/discover/10.2307/... Retrieved
30thmay, 2013).
Home health care is a burgeoning issue that will
continue to grow. Looking at it from a narrow lens, it needs a
broad, multi-disciplinary approach. Yet, home health care
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involved use of technology, including telemedicine, robotic
aids, virtual coaches, respiratory equipment, and other to
think about the diversity of the people dealt with their
language, literacy, and support both technical
characteristics of home health populations care receiversand providers are essential for developing equipment.
(http://www.ahqr.gov... Retrieved 31may, 2013)
According to Marcia (2010), As a home health care
nurse you will be expected to work with patients of different
ages and with different medical conditions. This may include
working with post-operative patients, pediatrics cases,
mothers and newborns, adults with a variety of medical
conditions and even terminally ill patients. At times you may
also be called upon the help in health screening clinics, flu
clinics blood drives, etc., but basically your work will be in
the patients home.
LITERATURE REVIEW
INTRODUCTION
Hemiplegia is not a progressive disorder, except in
progressive conditions like a growing brain tumor. Once the
injury has occurred, the symptoms should not worsen.However, because of lack mobility, other complications can
occur. Complications may include muscle and joint stiffness,
loss of aerobic fitness, muscle spasms, bed sores, pressure
ulcers and blood clots.
(http://en.wikipedia.org/wiki/hemiplegia retrieved 30thmay,
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2013). The elderly people are increasingly moving out of
institutions and into clients homes. To cope with the
challenges, nursing staff have to recognize the specific
nursing problems involved in home care, as well as the most
appropriate nursing interventions. The focus of home careproblems forms the basis for planning, implementing and
evaluating interventions. (Soini & Valimaki 2002).
CONCEPTUAL LITERATURE
DEFINITION OF HEMIPLEGIA
Hemiplegia is the total paralysis of the arm, leg, and
trunk on the same side of the body. Hemiplegia is more
severe than hemiparesis, wherein on half of the body has
less marked weakness. Hemiplegia and hemiparesis may be
congenital, or they might be acquired conditions resulting
from an illness, an injury, or a stroke.
(http://en.wikipedia.org/wiki/hemiplegia retrieved 30thmay,
2013)
CAUSES OF HEMIPLEGIA
Many conditions give to rise to hemiplegia. Generally,
an injury to the right part of the brain will cause a left-sided
hemiplegia while an injury to the left side brain will cause a
right-sided hemiplegia.
Stroke: is the commonest cause of the hemiplegia.
Insufficient blood supply the brain leads to loss of brain
functions. The stroke may be caused by the following;
A clot formed within the blood vessel blocking the
blood supply- thrombus
A thrombus breaks away from its site of origin and forms a bolus
elsewhere in the circulation an emboli
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A bleed from a blood vessel supplying the brain - a hemorrhage.
Head injury
Diabetes
Brain tumour
Infections meningitis, encephalitis
Migraine syndrome recurrent headaches of severe intensity
occasionally accompanied by sensations of numbness and
tingling in one half of head.
Diseases affecting the nerves multiple sclerosis, acute
necrotizing myelitis
Inflammation of the blood vessels vasculitis
Conditions presenting from birth cerebral palsy. Lack of
blood supply damages nerve cells in the brain. Birth trauma,
difficult labour, perinatal strokes in infants within 3 days of
birth can also cause cerebral palsy
Hereditary diseases leukodystrophies. This is a raredisorder affecting myelin sheath which covers and protects
nerve cells in the brain. The condition usually appears in
infancy or childhood. (http://www.askdrshah.com/app...
Retrieved 30thmay, 2013).
RISK FACTORS
The risk factors may be controllable or uncontrollable
Uncontrollable risk factors are:
*age
*a family history of stroke
*diabetes
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Controllable risk factors may include:
*high blood pressure
*heart disease
*coronary heart disease and high cholesterol
Lifestyle risk factor that increase stroke risk may include;
smoking, excessive alcohol intake and obesity.
(http://www.healthplus24.com/ retrieved 30thmay, 2013).
SYMPTOMS OF HEMIPLEGIA
Injury or insults to the brain cells that control movements in
one half of the body cause hemiplegia. Hence, symptomslargely depend upon the part of the brain affected. The same
can be said about the severity of individual symptoms.
Difficulty in walking.
Problems in balance, losses balance when trying to walk
Difficulty in swallowing
Trouble with vision. Blurred vision or weakness of the eyes.
Speech becomes difficult.
Numbness, tingling or loss of sensations on one half of the body.
Loss of control over bladder and bowel movements leading to an
inability to hold on to stool or urine.
Unable to perform tasks like holding objects, tying laces, dressing
oneself, buttoning, etc.
Feeling depressed.
Heightened emotional sensitivity with inability to handle stressful
situations
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Memory seems poor, unable to recall recent or past events concerning
people, places and activities. (http://www.askdrshah.com/app...
Retrieved 30thmay, 2013).
PATHOGENESIS
The exact cause of hemiplegia is not known in all cases, but
it appears that the brain is deprived of oxygen and this
result in the death of neurons. When the corticospinal tract is
damaged, the injury is usually manifested on the opposite
side of the body. For example if one has an injury to the rightside of the brain, the hemiplegia will be on the left side of
the body. This happens because the motor fibres of
corticospinal tract (also called pyramidal fibers), which take
origin from the motor cortex in the brain, cross to the
opposite side in the lower part of medulla oblongata and
then descend down in spinal cord to supply their respective
muscles. Depending on the site of lesion in brain, the
severity of hemiplegia varies. A lesion in internal capsulewhere all the motor fibers are condensed in a small area, will
cause dense hemiplegia i.e. complete loss of power of all
muscles of one half of body while a lesion at cortical or
subcortical level will cause varied amount of weakness of
one half of the body. (http://en.wikipedia.org/wiki/hemiplegia
retrieved 30thmay, 2013).
DIAGNOSIS
Complete blood count.
Blood biochemistry test.
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Cranial CT a highly detailed, non-invasive, imaging procedure that
combines x-ray with computer technology and allows the study of the
brain from many angles.
Cranial MRI a non-invasive, highly sensitive procedure that uses
electromagnetic properties of tissues providing detailed studies of
their structures.
An EEG (electroencephalogram) can measure the nerve activity
within the brain. (http://www.askdrshah.com/app... Retrieved
30thmay, 2013).
TREATMENT
Treatment should be based on assessment by the relevant
health professionals, including physiotherapists, doctors and
occupational therapists. Muscles with severe motor
impairment including weakness need these therapists to
assist them with specific exercise, and are likely to require
help to do this. Pharmacological: drugs can be used to treat
issues related to the upper motor neuron syndrome. Librium
or valium could be used as relaxant. Surgery: it may be used
if the individual develops a secondary issue of contracture
from a severe imbalance of muscle activity. Rehabilitation:this is the main treatment of individuals with hemiplegia. In
all cases the major aim of rehabilitation is to regain
maximum function and quality of life. Both physical and
occupational therapy can significantly improve the quality of
life.
EMPIRICAL LITERATURE REVIEW
Patients with hemiplegia constitute one of the largest groupsof persons suffering from chronic neurologic defects. It has
been estimated that there are more than 1,000,000 at any
one time in the United States. (Donald 2010). Nursing care
in hemiplegia, as in other conditions where destructive
processes have been arrested, should aim toward
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restoration of function. The amount of improvement will
depend largely on the extent of the initial injury. It may be
limited to the patients being able to walk only from his bed
to the bathroom or may consist of complete rehabilitation.
No matter how small the improvement, the gratitude of thepatient and his family warrants the attempt. (Anne 2009).
There are three main types of nursing facilities;
1. Intermediate care facility (ICF): an intermediate care
facility is a health care facility for individuals who are
disabled, elderly, or no-acutely ill, usually providing less
intense care than that offered at a hospital or skilled
nursing facility. Typically, an ICF is privately paid by theindividual or by the individuals family. An individuals
private health insurance and/or a third party service
like a hospice company may cover the cost.
2. Assisted living facility (ALF): Assisted living residences or assisted
living facilities (ALF) are housing facilities for people with
disabilities. These facilities provide supervision or assistance with
activities of daily living (ADLs); ALFs are an eldercare alternative on
the continuum of care for people, for whom independent living is notappropriate but who do not need the 24-hour medical care provided by
a nursing home and are too young to live in a retirement home.
Assisted living is a philosophy of care and services promoting
independence and dignity.
3. Skilled nursing facility (SNF): a skilled nursing home certified to
participate in, and be reimbursed by Medicare. Medicare is the federal
program primarily for the aged (65+) who contributed to social
security and Medicare while they were employed. Medicaid is the
federal program implemented with each state to provide health careand related services to those who are below poverty line. Each state
defines poverty and, therefore, Medicaid eligibility. Those eligible for
Medicaid may be low-income parents, children, including state
childrens health insurance programs (SCHIPs) and maternal-child
wellness and food programs. Seniors and people with disabilities.
(http://en.wikipedia.org/wiki/nursing_home, retrieved 30thmay,2013)
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REASONS FOR HOME CARE
There are basically 4 reasons for home care settings;
1. For living longer since most patients want to age in
place with dignity.
2. Patients have more chronic, complex conditions.
3. They leave the hospital earlier and thus need more intensive care.
4. Sophisticated medical devices have been moved into homes. Devices
that were only used in homes and bedrooms. (Agency for healthcare
research and quality, 2011).
TYPICAL NURSING HOME STAFF
Administration; once a patient has moved into the nursing
home, their relatives may not have significant contact with
the administration team, unless there are specific concerns
that arise. Depending on the size of the nursing home, the
administration staff may be very small, consisting of only a
handful of people.
Support personnel; some staff members focus solely oncaring for the buildings and grounds. Custodians,
maintenance staff and groundkeepers. Nursing home may
have an activities director who is responsible for planning
and implementing holiday events, daily and weekly
educational and social activities, coordinating special visitors
and religious services.
Direct care staff; the direct care staff have direct, daily
contact with the patient. The following are types of directcare staff included in all nursing homes;
Registered nurse (RN)
Licensed practical nurse (LPN) or licensed vocational nurse (LVN)
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Certified nursing assistance (CAN)
Services; nursing homes offer the most extensive care a
person can get outside hospital. Nursing homes offer help
with custodial care like bathing, getting dressed, andeating as well as skilled care given by a registered nurse
and includes medical monitoring and treatments. Skilled
care also includes services provided by specially trained
professionals, such as physical, occupational, and respiratory
therapists. The services nursing homes offer vary from
facility to facility, services include;
Room and board
Monitoring of medication
Personal care (including dressing, bathing, and toilet assistance)
24-hour emergency care
4. Social and recreational activities.
(http://en.wikipedia.org/wiki/nursing_home, retrieved 30thmay,2013)
Resident oriented care; with resident oriented care,residents are able to make more choices and decisions about
their lifestyle. Their families are more involved in the
residents care, and employees have greater degree
participation with the residents. Resident oriented care
combines the clinical models of care with a flexible social
model. (http://en.wikipedia.org/wiki/nursing_home, retrieved
30thmay, 2013)
Qualities of home healthcare nurse
Clinical skills; due to a need for a cost containment,
hospitals are discharging patients home much earlier. These
patients still have acute care needs. Their needs will require
knowledgeable, skilled nursing care. As a home healthcare
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nurse there is a need to be more than just a compassionate,
friendly disposition. A strong clinical skills and good problem
solving abilities is needed. The nurse must also have an
excellent ability for ongoing assessment and evaluation of
patient and be able to devise and work within a care planthat is tailored to patients needs. Home healthcare nursing
require to be independent and confident in many technical
areas of nursing skill, including drawing blood work, starting
and maintaining IVs, providing wound assessment and
dressing changes, working with wound vacs, oxygen and
managing other medical equipment.
Critical thinking skills; when you work in home
healthcare, you are working alone for the most part. Your
supervisor at the agency is assessable by phone but for the
most part you have to be an independent decision maker.
You must be able to recognize and handle emergency
situations and have sound nursing judgments.
Supervisory skills; the registered nurse is a case manager
in home healthcare. You will be responsible for overseeing
the case as a whole. This includes supervising the work ofhome health aide and the LPN or LVN. Good supervisory
skills are imperative to assure the case runs as smoothly as
possible.
Organizational skills; a home healthcare nurse has to be
organized. It will be your responsibility to make your own
daily schedule. Each day you will be making visits, phone
calls, providing patient care, interacting with other agency
staff members, contacting physicians and working with thepatients family. You may need to adjust your schedule
often. For example, if one patient cancels his visit or if your
supervisor unexpectedly needs you to accept a new case,
you have to organize your day to accommodate this.
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Good communication skills; you will interact with a lot of
people in your role as a home healthcare nurse. You must
have effective verbal and written communication skills for
this. (Marcia 2010).
Nursing care during the acute stage of hemiplegia
After the first stroke there is always danger of second stroke.
The nursing responsibility in preventing this is the provision
of complete rest for the patient. The equipment necessary
for rest is quite, orderly room, and a firm spring and
mattress on a single bed, placed so that it is accessible from
both sides. If the bed sags, a ply board of the same size as
the spring may be placed between it and the mattress.Blocks may be put under each leg of the bed to elevate it to
a desired height. The next consideration is the bed posture
of the patient; the paralyzed side, which the patient is not
able to move to ease a strain, needs special consideration.
The leg is usually rolled out at the hip, the knee is bent, and
the foot is dropped, with pressure on the outer aspect of the
ankle bone. The arm is held closely to the body; the forearm
lies across the chest with the hand usually clenched. Thepillows under the head may push it forward and flatten the
chest. If this kind of posture is permitted, contractures and
deformities will surely develop. The foot will assume drop-
foot position because of shortening of the heel tendon and it
will be difficult to straighten the knee and the hip. Moving
the arm away from the body will become painful because of
the tight muscles in the axilla. Pneumonia, pressure sores,
contracture and urinary retention are common complicationsin hemiplegia. All the complications suggest maintenance of
one position for too long a time, and may be prevented by
changing the position frequently. (Anne 2009).
JOB DUTIES OF HOME CARE NURSE
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Job duties for a home health nurse vary based on an
individual clients needs. Medical tasks completed by the
nurse can include administering medication, tube feeding,
ventilator monitoring and suction of the airway. Some clients
may require some light housekeeping duties and assistancewith activities of daily living as well.
CHALLENGES IN HOME CARE NURSING
In an emergency situation ,no other nurses or
physicians are present to help in the home setting
The nurse is the sole provider for all medical care
No one is there to relieve the nurse for breaks or launches, which
mean the nurse, can work up to 12hours straight with no breaks.
(Annie 2010).
Capabilities of patients and caregivers this range in literacy and
health, as well as cultural traits.
Tasks and medical therapies undertaken, the devices and technologies
used tasks range from simple feeding and bathing to managing
home dialysis and complex intravenous drips.
Physical as well as community environment environments range
from those with low lighting or stairs that block wheel users, to home
with no internet access for data transfer or remote monitoring. (AHRQ
2011).
Lots of paperwork; the home healthcare agency you work for has to
adhere to government regulations and requirements to maintain
licensure. Paperwork has to be completed for each skilled visit that
complies with these regulations.
Environmental factors; remember, you are providing care in a
persons private home. You must respect that this is their house and
accept the way they live. Although not always the case, you might
find yourself working in home environment that are not very clean.
You still must remember your duty and take care of the patient
regardless of their standard of living.
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Personal attachment; working one on one with your patients can form
attachments that are not usually formed in a hospital or clinic setting.
You tend to become quite involved in their lives since you may visit
their homes for weeks or more. You must know where your
professional boundaries are and adhere to them. Always stay withinthe scope of what you were hired to do. ( Marcia 2010).
CONCEPTUAL FRAMEWORK
Jean Watsons philosophy of nursing stated ten primary
carative factors
1. The formation of a humanistic altruistic system of values.
2. The installation of faith hope.
3. The cultivation of sensitivity to ones self and to others.
4. The development of a helping trust relationship.
5. The promotion and acceptance of the expression of positive and
negative feelings.
6. The systematic use of the scientific problem solving method for
decision making.
7. The promotion of interpersonal teaching learning.
8. The provision for a supportive, protective and/ or corrective
mental, physical, socio cultural and spiritual environment.
9. Assistance with the gratification of human needs.
10.The allowance for existential phenomenological forces.
APPLICATION OF THE FRAMEWOK
As earlier discussed by jean Watson, care of hemiplegic
patient at home setting, its a holistic care in which all
aspect of patients wellbeing is taken into consideration. The
care begins from the formation of humanistic - altruistic
system that begins developmentally at an early age with
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spiritual care, supportive care, protective care, family care to
achieve fullest health status in which the patient has a good
rehabilitation care.
CONCLUSIONThe considerable practical application to the home care
sector is between the clients needs and assigned tasks. This
issue gets to the heart of the loop-hole that currently exists
in our policies provision of home supports. Client needs in
quantity, breadth and scope greatly outstrip the ability of
homecare setting to make clients unhappy and frustrated
health personnel, who want to do more but are restricted by
the limitations of the system. Also of practical application,but even more challenging than the lack of fiscal and human
resources, is the difficulty to meet the needs and
preferences.
Sudden recovery from hemiplegia is very rare. Many of the
individuals will have limited recovery, but the majority will
improve from intensive, specialized rehabilitation, and
homecare. Potential to progress may differ in cerebral palsy,
compared to adult acquired brain injury. It is vital to
integrate the hemiplegic child into society and encourage
them in their daily living activities by homecare nurse. With
time, some individual may make remarkable progress.
IMPLICATION TO NURSING PRACTICE
Care of patient with hemiplegia may be quiet challenging; it
requires all human effort most especially when there is no
adequate manpower or technological gadgets that can
minimize energy to be expended. Its amazing to belief that
in Nigeria setting where a nurse will have to care for an
hemiplegic patient within 1o hours without break nor relieve,
this also make home care nursing to be tasking such that
patient lifting is dangerous to the nurse health as the career.
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Its therefore imperative to understand the specific care an
hemiplegic patient require before embarking on the work
while other parameters are structured such that it facilitates
the care.
Health education about the causes, courses, prognosis of
hemiplegia should well elaborated for society to digest so as
to minimize the illness in the society, also ways of
prevention should be well instituted most especially among
the risk individual and non risk individual. Prevention of the
unaffected among them should be well highlighted and
continual monitoring of the state of the health.
RECOMMENDATION
All through my findings and personal encounter during work
as homecare nurse, its been discovered that certain areas
need to be well harmonized so to meet the standard of
acceptable international practice. In fact home setting in
Nigeria system is quite different from what is practice in
most part of developed world. Basically, home nursing in
Nigeria setting is exactly what is known as resident
oriented care in USA. Therefore below are my
recommendations;
1. There should be a policy and law that will regulate and
guide the activities of the practice.
2. The mode of recruitment exercise should be adequately
looked into so as to distinguish a registered nurse from an
auxiliary nurse in Nigeria context.
3. Nursing and Midwifery Council of Nigeria should work with
different agencies that specialize in homecare nursing to
collaborate with each power in homecare experience for
nursing students so as to prepare them for future work.
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4. Nursing and Midwifery Council of Nigeria should take up
the task of developing a curriculum that will guide activities
of auxiliary been used by these agency to possess a few
months training before been qualified for such work, this will
further reduce or minimize patronizing quake nurse in thesociety, also will reduce level of damage that patient may be
exposed to.
5. Training and retraining of homecare nurse should be
instituted so as to refreshing their knowledge and widen
their horizon on the latest type of care in vogue and skilled.
6. Nursing and Midwifery Council of Nigeria should find a way
of making homecare nursing a post basic course so as tomeet up with the developed world.
7. Health hazard allowance should be paid to homecare
nurse due to hazard been exposed to such as breaking of
backbone while lifting patient.
8. Federal Government should also set up Intermediate Care
Facility (ICF), Assisted Living Facility (ALF) or Skilled Nursing
Facility (SNF) that will contain essential equipment at variouslevel of government, at least one at each senatorial district,
also allow participation of both State and Local government
participation as well as private participation, with reference
to USA model.
9. The agency should encourage research work so as to
know modern happenings in homecare setting that will assist
in quality type of care and disseminated the result findings
to every aspect of nursing and those in the field.
10. Homecare nursing should be introduced into the basic,
post-basic and university curriculum and be exposed to
practice in the course of training.
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11. Contract agreement between the patient and the agent
should not be secrecy such that the nurse will know the
exact things to do which may stand as case in the court of
law in any eventuality.
12. Professionalism and ethic as well as etiquette of nursing
should be hold in the course of training and practice because
too much familiarism disregards code of practice.
13. Federal government of Nigeria should enforce pension
and insurance scheme unto the agencies so that the job will
be secured and provide funds when quiting or retiring.
REFERENCES
Agency for Healthcare Research and Quality (2011). Human
factors challenges in home health care. Research Activities,
376. http://www.ahrq.gov/news/newsletters/research-
activities/dec11/12... Retrieved 31-05-2013
Anne Prochazka (2009).Nursing care in Hemiplegia, The
American Journal of Nursing, 46:2, 118-120,
http://www.jostor.org/stable/3456848 retrieved 30-05-2013.
Annie McElfresh (2010). What is home care nursing?
http://www.livinstrong.com/article/132398-what-is-home-
care-nursing/ retrieved 30-05-2013.
Cathy Hecimovich (2008). Home cares unique challenges,
Healthcare quarterly 11:4, 76-77
http://www.longwoods.com/content/20074 retrieved 31-05-
2013
Donald A.Covalt (2010). Rehabilitation of the patient with
hemiplegia. Annals of medicine 37: 5
http://www.ahrq.gov/news/newsletters/research-activities/dec11/12http://www.ahrq.gov/news/newsletters/research-activities/dec11/12http://www.jostor.org/stable/3456848%20retrieved%2030-05-2013http://www.livinstrong.com/article/132398-what-is-home-care-nursing/http://www.livinstrong.com/article/132398-what-is-home-care-nursing/http://www.longwoods.com/content/20074%20retrieved%2031-05-2013http://www.longwoods.com/content/20074%20retrieved%2031-05-2013http://www.ahrq.gov/news/newsletters/research-activities/dec11/12http://www.ahrq.gov/news/newsletters/research-activities/dec11/12http://www.jostor.org/stable/3456848%20retrieved%2030-05-2013http://www.livinstrong.com/article/132398-what-is-home-care-nursing/http://www.livinstrong.com/article/132398-what-is-home-care-nursing/http://www.longwoods.com/content/20074%20retrieved%2031-05-2013http://www.longwoods.com/content/20074%20retrieved%2031-05-20137/27/2019 Challenges of Home Care Nursing in Nigeria ; A case of hemiplegia
21/22
http://annals.org/article.asp?articleid=675130 retrieved 30-
05-2013.
Hemiplegia, http://en.wikipedia.org/wiki/hemiplegia retrieved
30-05-2013.Hemiplegia Treatment, Causes, Symptoms, Homeopathic
Treatment- http://www.askdrshah.com/app/hemiplegia.asp
retrieved 30-05-2013.
Jose Vega (2009). What are the goals of hemiplegia
rehabilitation?
http://stroke.about.com/od/unwantedeffectsofstroke/f/goalso
fHPRx.htm retrieved 30-05-2013.
Marcia pope (2010). The joys (and challenges) of Being a
Home Healthcare Nurse. http://voices.yahoo.com/the-joys-
challenges-being-home-healthcare-... Retrieved 31-05-2013.
Nursing home, http://en.wikipedia.org/wiki/Nursing_home
retrieved 30-05-2013
Soini H, Valimaki M (2002). Challenges faced by employees
in the home care of elderly people. Br J Nursing 11(2):100-10. http://www.ncbi.nlm.nih.gov/pubmed/11823737
retrieved31-05-2013.
Stroke, http://www.healthplus24.com/diseases/stroke.aspx
retrieved 30-05-2013.
http://annals.org/article.asp?articleid=675130http://en.wikipedia.org/wiki/hemiplegia%20retrieved%2030-05-2013http://en.wikipedia.org/wiki/hemiplegia%20retrieved%2030-05-2013http://www.askdrshah.com/app/hemiplegia.asp%20retrieved%2030-05-2013http://www.askdrshah.com/app/hemiplegia.asp%20retrieved%2030-05-2013http://stroke.about.com/od/unwantedeffectsofstroke/f/goalsofHPRx.htm%20retrieved%2030-05-2013http://stroke.about.com/od/unwantedeffectsofstroke/f/goalsofHPRx.htm%20retrieved%2030-05-2013http://voices.yahoo.com/the-joys-challenges-being-home-healthcare-http://voices.yahoo.com/the-joys-challenges-being-home-healthcare-http://en.wikipedia.org/wiki/Nursing_home%20retrieved%2030-05-2013http://en.wikipedia.org/wiki/Nursing_home%20retrieved%2030-05-2013http://www.ncbi.nlm.nih.gov/pubmed/11823737%20retrieved31-05-2013http://www.ncbi.nlm.nih.gov/pubmed/11823737%20retrieved31-05-2013http://www.healthplus24.com/diseases/stroke.aspx%20retrieved%2030-05-2013http://www.healthplus24.com/diseases/stroke.aspx%20retrieved%2030-05-2013http://annals.org/article.asp?articleid=675130http://en.wikipedia.org/wiki/hemiplegia%20retrieved%2030-05-2013http://en.wikipedia.org/wiki/hemiplegia%20retrieved%2030-05-2013http://www.askdrshah.com/app/hemiplegia.asp%20retrieved%2030-05-2013http://www.askdrshah.com/app/hemiplegia.asp%20retrieved%2030-05-2013http://stroke.about.com/od/unwantedeffectsofstroke/f/goalsofHPRx.htm%20retrieved%2030-05-2013http://stroke.about.com/od/unwantedeffectsofstroke/f/goalsofHPRx.htm%20retrieved%2030-05-2013http://voices.yahoo.com/the-joys-challenges-being-home-healthcare-http://voices.yahoo.com/the-joys-challenges-being-home-healthcare-http://en.wikipedia.org/wiki/Nursing_home%20retrieved%2030-05-2013http://en.wikipedia.org/wiki/Nursing_home%20retrieved%2030-05-2013http://www.ncbi.nlm.nih.gov/pubmed/11823737%20retrieved31-05-2013http://www.ncbi.nlm.nih.gov/pubmed/11823737%20retrieved31-05-2013http://www.healthplus24.com/diseases/stroke.aspx%20retrieved%2030-05-2013http://www.healthplus24.com/diseases/stroke.aspx%20retrieved%2030-05-20137/27/2019 Challenges of Home Care Nursing in Nigeria ; A case of hemiplegia
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