Some executive home health nursing positions such as those in administration or nursing management could require master's level education. Some organizations, like the American Nurses Credentialing Center offer certifications in home health care. Scope and standards of practice The scope of home health nursing is directly related to the nursing process. This includes assessment, diagnosis, planning, implementation, and evaluation. The standards of home health nursing integrate research, education, proper use of resources, the quality of care provided, team collaboration, and ethical principles. Pediatric Home Health Nursing To help reduce cost and improve quality of care for increasing numbers of children with chronic conditions, pediatric medicine is transitioning many patients from hospitalized care to home health management. Home Health Care is often a less expensive and more convenient option for pediatric patients, and discharge to home with home health care has been shown to reduce hospital readmission rates and length of hospital stays, ultimately reducing costs for the patient. There are 2 types of pediatric home health nursing: 1) Skilled Nursing Visits (SNV): intermittent, short visits by nurses to a patients home with the goal of helping the patient and caregivers reach total independence at home. Nurses typically visit the patient to provide monitoring, perform lab work, and administer medications. 2) Private Duty Nursing (PDN): extended, 24-hour care services to patients at home to satisfy long-term care needs of patients who cannot safely live at home with their caregivers without medical care supervision. In a recent study of 2783 hospitalized pediatric patients who were discharged home with home health nursing, 92% of the patients received PDN services, while 8% received SNV, suggesting that PDN is more common in the pediatric population. Barriers in home health nursing Home health nursing is a unique field considering the obstacles faced by healthcare professionals. When out visiting clients, the nurse is alone and cannot rely on others most of the time. Nurses in home health care must learn to be autonomous. The variety of home conditions that a nurse will step into can also present problems. Cleanliness and safety play large roles in client care. Not all homes are equipped to provide a clean environment for the client. Environmental issues in the home include unsanitary conditions that allow for bacterial growth and conditions that may increase the risk of falling for the client, such as poor lighting and area rugs. Education regarding this is important