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Nurse home visiting with pregnant women and new mothers in the early decades of the twentieth century was designed to improve birth and newborn outcomes, hasten Americanization of immigrant mothers, and improve their parenting skills. Today the Nurse Family Partnership home visitation program improves newborn and child outcomes by positively influencing maternal role attainment and significantly decreasing maternal smoking and other substance abuse, child abuse and neglect, and children's emergency room visits. It also improves life possibilities for vulnerable young women by decreasing the interval and frequency of subsequent pregnancies and reduces dependence on welfare by increasing workforce participation. This article reviews the history of home visits by nurses to pregnant women and demonstrates the benefits achieved by these programs today.

This article describes home nursing in the Netherlands between 1950 and 2004. The developments in this period are described form the theoretical perspective on professions of Andrew Abbott: 'professions are exclusive occupational groups applying somewhat abstract knowledge to particular cases'. In 1950, home nursing was an all-round profession providing home nursing care and preventive care to all categories of patients, mainly in their own homes. It was - and still is - a profession situated in the 'periphery' of the health care system, where care and support to patients with pain, suffering and disabilities because of age or chronic illness are considered as belonging to a separate task domain, relatively independent of the mainly curative activities that are performed in the 'medical centre' of health care, especially in the academic hospitals. Typical compared to other countries is that an extensive network of private initiatives, in the form of Cross Organisations of different denominational signatures, existed in the Netherlands until 1990, covering the whole country with home nursing services. In that year, the provision of home nursing and home help were integrated and most home nursing organisations merged into large, regional home care organisations. In this article, six main social developments are described, that influenced the development of home nursing and resulted in the profession as it is now: a differentiated profession divided into different levels of care, working in an organisational, largely bureaucratic setting of home care organisations, where managers and external regional assessment organisations (RIO's) decide on the care to be provided. They now find themselves in a transmural setting, where boundaries between different forms of care no longer exist, and co-operation with other professionals, such as home helps, specialist nurses, GPs, and hospital physicians, is frequent. Currently, their professional autonomy and independent decision-making regarding diagnosis and therapy is affected, and elements of bureaucratisation and managementism (for example aspects such as time-writing) affect their daily work. However, home nursing can still be characterised as a relatively exclusive and independent profession, solving particular cases in the homes of patients by performing activities that are based on abstract, methodical knowledge.

Since the early 1990s home care increasingly has emerged as a favoured policy response to the growing costs which an aging population poses for our health care system. This paper explores the early history of home care for the elderly in Ontario during the first three decades after World War II. It demonstrates that policy debates over the merits of home versus institutional care for the elderly, and community-based over hospital-based approaches to home care are not recent phenomenon but have been on going since the 1940s within the public health and social services sector. The paper examines why home care failed for so long to develop beyond the margins of Ontario's highly institutionalized health care system. It also explores how earlier visions of community-based home care, designed to help the elderly age in place, increasingly were obscured by an exclusive preoccupation with home care's "cost effectiveness" as an alternative to hospital or residential care, a rationale which discounted home care's costs to unpaid and principally female care givers. The paper concludes that the Ontario health ministry's systematic devaluing of caregiving and home maker skills, the fear of undermining the family's willingness to provide care, as well as the failure to develop effective mechanisms for integrated regional health care planning, also impeded the progress of home care's development before the 1980s.

Providing the right care, in the right place, to dying persons is hampered by a lack of understanding of where death and dying normally take place and ignorance about what influences location of death. This paper reports the findings of a multidisciplinary historical investigation of 20th-century influences on location of death in Canada. It builds on a study that found a hospitalization-of-death trend in Canada over much of the 20th century but a reduction in hospital deaths beginning in 1994. This study found 2 key influences on location of death: (1) health-care and health-system developments that consolidated care in hospitals while also raising and sustaining public expectations of beneficial if not curative hospital care--the rising hospital-death rate throughout the 20th century can thus be considered an outcome of the shift of illness care from the home to the hospital; and (2) reduced availability of home-based caregivers. A number of developments limited the availability of home care for chronically ill and terminally ill persons, including the increased participation of women in the workforce and the shift in nursing from private home duty to hospitals. Although some health and social support for home care has developed recently, this support clearly does not match that for hospital care. These findings indicate that location of death is an important focal point for studying and planning improvements in end-of-life care.

The history of nursing in the home: revealing the significance of place in the expression of moral agency The relationship between place and moral agency in home care nursing is explored in this paper. The notion of place is argued to have relevance to moral agency beyond moral context. This argument is theoretically located in feminist ethics and human geography and is supported through an examination of historical documents (1900-33) that describe the experiences and insights of American home care/private duty nurses or that are related to nursing ethics. Specifically, the role of place in inhibiting and enhancing care, justice, good relationships, and power in the practice of private duty nurses is explored. Several implications for current nursing ethics come out of this analysis. (i) The moral agency of nurses is highly nuanced. It is not only structured by nurses' relationships to patients and health professionals, i.e. moral context, it is also structured by the place of nursing care. (ii) Place has the potential to limit and enhance the power of nurses. (iii) Some aspects of nursing's conception of the good, such as what constitutes a good nurse-patient relationship, are historically and geographically relative.

A hospice pioneer and veteran of 23 years reflects on the early days of the hospice movement in the United States. The political, social and economic forces, which shaped the industry, are addressed from a local state and national perspective. Current challenges are briefly referenced with a call for hospice leaders to recognize the need for and identify where hospice fits into the broad end of life discussions.

This article highlights the striking parallels in the history of birthing and dying as they moved from home to hospital in Canada in the twentieth century. It shows that deaths, like birth, has been hidden in hospitals only since mid-century. It demonstrates that the availability of paid and unpaid female caregivers was a key factor affecting the shifts in location of death, much as it was for birth. Thus, women have been the major consumers and caregivers of health services at both ends of the life cycle.

The National Hospice Organization grew out of efforts by the founders of the earliest hospice programs in the United States to protect their emotional investments in hospice care, to advocate for hospice interests in Congress and other public policy forums, to define standards for the fledgling movement, and to provide education on the nuts and bolts of running hospice programs for others who were interested in starting hospices in communities from coast to coast. Unlike the model of St. Christopher's Hospice in England, which began as a free-standing in-patient facility and later added home care services, most U.S. hospices started as home care-based programs, often largely manned by volunteers. Among the crucial issues that have dominated the work of NHO during its first 21 years were passage and maintenance of the Medicare hospice benefit, ideological battles over the hospice philosophy, and efforts to extend hospice care to other populations, such as people with AIDS.

Midwives today trace their professional identity back to the period following the midwifery regulation of 1902, when provisions were made for the training and registration of all midwives, and for the gradual elimination of the untrained practitioner. Some historians have argued that this represented a definite break and signalled the willingness of midwives to move towards a professional status. A comparison of midwifery in Sheffield pre- and post-regulation demonstrates no significant change in the practice and profiles of those in the occupation; all midwives remained primarily married or widowed part-time workers. Training for midwives was instituted early in Sheffield. Those trained had fairly high caseloads for the period, but their social and economic status was no different from non-trained midwives in the area. Regulation had a significant impact on the attitude of doctors towards midwives, who were increasingly viewed as part of a medical structure of care. Some midwives attempted to pursue collective action in order to improve their prospects, but they were in the minority. The limits to their professional development were demonstrated by their lack of control over supervision, their subordinate relationship to doctors, and their inability to work in unison.

Medicare legislation stimulated the development of home care services but also resulted in fragmentation of service components. In the 1980s, prospective pricing and diagnosis-related groups, and resulting pressures to reduce inpatient length of stay, prompted additional growth of the industry. Even so, in 1995 home care represented only 3% of total national expenditures on health care. The annual growth rate of the home infusion industry dropped from 64% in 1982-86 to 24% in 1986-93. While revenue per patient for home infusion is expected to decrease under managed care, an increasing number of patients will support continued market growth. The home infusion market is highly competitive, with only a few large national providers and many small local providers. In 1996, 29% of acute care hospitals provided or were developing a home care program. Community pharmacists' options in the home infusion area include independent services, partnerships, joint ventures, contracts with hospitals, and franchises. The home infusion market is being integrated into alternative sites, such as ambulatory infusion centers (AICs), as providers attempt to diversify to maintain managed care contracts. AICs provide infusion therapy and nursing to noninstitutionalized, nonhome-bound patients. Untapped sources for future growth of the infusion market include long-term-care facilities. More consistent studies of the home care market are needed. Despite slowed growth in recent years, home care has a strong market in the United States.

The authors introduce the Yale Intensive In-Home Child and Adolescent Psychiatric Service, a model of home-based care for children with severe psychiatric disturbances. This model synthesizes the principles and method of the wrap-around paradigm and in-patient child psychiatric practice within the reality of the managed care system. A clinical team, under the direct supervision of a child psychiatrist, works directly within the family to understand and address the multilevel transactions that have affected the child's ability to function in various domains and resulted in recommendations for intensive intervention, including psychiatric hospitalization. This article suggests that if the psychiatrist is to provide the highest level of care, cognizance of and involvement in the child's ecology are as essential for the child and adolescent psychiatrist as other aspects of the child's world and life. In the days of ever shortening patient lengths of stay, this model of care offers promise for both clinical and fiscal effectiveness.

The London Bible and Domestic Female Mission was founded in 1857 by Ellen Ranyard. A nursing mission was added in 1868. The structure and work of the mission can be used to exemplify three strategies utilized in Victorian philanthropy. First, the use of working class women in the maintenance of social order, secondly the utilization of the middle class household to exemplify relations between the social classes, and thirdly the creation of districts in an attempt to recreate a 'golden age' of rural communities. Ranyard created a women's mission to women. As such it did not display the gender division of labour apparent in much health and caring work, but a hierarchical division of labour based on social class is evident.

Twenty-five years ago the computer was introduced to assist the dosage calculation in the Dutch anticoagulation services. Many of the laboratory findings in patients treated by anticoagulants can be quantitated and may be used to construct a computer dosage algorithm.

The purpose of this study is to identify Miss Florence Nightingale's concept of home nursing in the 19th century. The texts of her 27 writings were analyzed in terms of home nursing. In her writings of 1850's, she discussed patients' own homes as well as hospitals as the settings where nursing care should be provided. "Hospitals are an intermediate stage of civilization" was the recognition which formed the core of her philosophy. Miss Nightingale envisaged "nursing care provided to individuals in their own homes" was more desirable and could replace hospitalization. If in their own homes, patients could be helped to feel the everydayness and independency of their life. Miss Nightingale thought, a concept very similar to the concept of normalization of today. In her later years she expressed that she expected home nursing could become and everyday fact. Miss Nightingale used the term "home nursing" as early as 1900 in the same sense as it is today, the concept of home combined to that of nursing. It is one of the findings that should be noted in the history of home nursing.

Psychiatric home care is gaining recognition and acceptance in the home care industry, but there is still a long way to go before it becomes a service that both providers and payors no longer question. A retrospective look will help determine how smooth the journey into the future will be.

This article describes the history of Medicare-based home care and the changing requirements of the home care industry as the reimbursement models continue to evolve. Medicare-based home care was once seen as an ancillary service of the hospitals. Now, with the advent of managed care, home care provides new options and opportunities and is facing new challenges at both the local and the national levels. Current proposals in Washington, such as bundling, co-pays, and a Prospective Payment System, will have farreaching effects on the industry. This article discusses the various reimbursement models, including Medicaid, Medicare HMOs, managed care, and capitation, and identifies key areas and opportunities for home care in the future.

Before the current array of prepackaged disposable supplies and durable medical equipment, many "clinical pearls" were devised by home healthcare nurses to facilitate self-care and family caregiving in the home. Analysis of the oral history of a home healthcare nurse practicing between 1965 and 1980 identified the practical clinical pearls she created and targeted ingenuity, resourcefulness, and caring as essential attributes of past, present, and future home healthcare nurses.

Before World War II, it was not uncommon for a person with influenza caused by streptococcus to develop empyema. Retired surgeon Harry Morton recalls two well-known patients who had empyema-related operations outside the hospital.

Throughout the history of community health nursing, home visiting has been and remains a central nursing intervention. Yet little conceptual clarification has dealt with this intuitively very valuable nursing intervention. Here, the concept of home visiting was investigated through a concept analysis. The nature of home visiting as it emerged over time was gleaned from historical and current literature. A working definition, capturing the essence of home visiting and implying new measurement possibilities, was formulated. Home visiting emerged as a specific nursing intervention, preceded by an antecedent event, unfolding as a process, with phases labeled as "contacting," "going to see," "gaining entry," "seeing," "terminating," and "telling." Nurse sub-outcomes, nursing strategies, contextual factors influencing the process, and potential consequences of home visiting were uncovered.