During the last ten years, poor patient outcomes and unnecessary patient deaths have generated major concern regarding the quality and safety of the American health care system. Compounding this concern is a critical shortage of registered nurses. As a results of these problems, there is increasing interest in establishing the relationship between professional nursing care and patient outcomes in all care settings. However, while evidence mounts linking nursing care to patient outcomes in hospitals, little is known about the relationship between nursing care and patient outcomes in home health care. The home environment is unpredictable and uncontrolled, and often presents barriers to the delivery of care. Therefore, the purpose of this study was to develop an understanding of barriers that interfere with the delivery of nursing care in Medicare-certified home care agencies. Using a descriptive pheonemological approach, nine expert home care nurses were interviewed, and the narrative accounts were analyzed using Giorgi’s method. Analysis fo the narrative data revealed that the livid experience of encountering barriers when delivering nursing care in the home is a complex, multi-dimensional phenomenon involving the patient, the caregiver, the nurse, the physician, the clinical agency, the insurance company, and the health care system itself.
