Episode 13 is a teamBIT that focuses on how nurses can support frail patients with complex needs through home visits and virtual touchpoints.

Morgan emphasizes the benefits of nurses assessing primary care needs in an environment that patients feel most comfortable in: their home. Morgan suggests a good starting place is with patients that are not yet currently receiving home care. Another approach nurses can use is virtual touch points for more frequent communication, offering a more accessible and personalized approach to help support patients who need more care. The episode concludes with our host exploring the advantages of involving nurses in coordinating care, leveraging their functional assessment capabilities, and integrating their work with broader clinical teams.

Special Thanks

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Throughout this season you’ll hear from several amazing nurses:

Angela Wignall is a Registered Nurse who has worked in perinatal health and public health. Since recording this episode Angela has been promoted to the CEO of the Nurses and Nurse Practitioners of BC from her position as Senior Executive Director. Angela is also a board member at the Canadian Nurses Association.
Diana Boateng is a Registered Nurse and is working on her dual master’s degree in nursing and health informatics. In her Masters, she is a co-op student working with the Innovation Support Unit. Her background is mostly in acute care but she has been interested in exploring what it means to be a nurse in primary care.
Hannah Roy works as a Registered Nurse in primary care and urgent primary care. She has certified practice in STI management and is completing her Masters degree to be a nurse practitioner.
Jamie Duteil is a Registered Nurse and the Health System Improvement Director at Health Quality BC. She has managed urgent primary care centres and acute care centres.
Kacey Wall is a Registered Nurse and a diabetes educator, she has worked in primary care networks and is a team member of the Innovation Support Unit.
Nikki Kafal is a Registered Nurse and has spent her career working in emergency and critical care settings. She is completing a dual master degree in nursing and health informatics and joins the Innovation Support Unit as a co-op student.

Links and Resources
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**https://www.aafp.org/pubs/afp/issues/1999/1001/p1481.html**

This article, published in 1999, introduces the acronym “INHOMESSS” as a mnemonic that provides framework for the evaluation of a patient’s functional status and home environment.

**Nurse Home Visit Guidelines: Australian Medicare Local Alliance**

A guideline written for primary care nurses working in home care. This guideline provides information on the potential risks associated with entering an unknown setting and how to minimize these risks to nurses.

S07 E13 teamBIT: Nurses Supporting People w Frailty. 09:11 Share

Team Up! Team-based primary and community care in action

Shownotes Transcript

S07 E13 teamBIT: Nurses Supporting People w Frailty.