• Nurses in the home health care environment face more challenges than their counterparts in health care facilities.nursing duties image by Pix by Marti from Fotolia.com
  
  With an aging population, the home health care industry has continued to grow, with more than a million people delivering care as of 2009. In 2009, a Columbia University research study "The Prevalence and Risk Factors for Percutaneous Injuries in Registered Nurses in the Home Health Care Sector " found that home health care work can be both physically and emotionally demanding and dangerous.
  
  

Unhealthy Environments

• Because clientele are often aged or disabled, sanitary conditions within the home can be subpar. In hospitals and nursing homes there are established health codes that must be followed to ensure a clean environment, but this is not the case in the private homes of those that require home health care. These unclean conditions can be the result of housekeeping neglect, exposure to cigarette smoke, spoiled food and vermin, contributing to infection, disease and emotional stress. Needle sticks injuries in these type of conditions (an average of 7.6 per 100 according to the study) increase the risk of hepatitis and HIV.
  
  

Exposure to Violence

• Home health care nurses are quite often alone with their patients during their work time. There is no back-up support should a patient become argumentative, uncooperative or violent. Particularly, patients suffering from dementia may strike out at those trying to assist them. Often suspicious of strangers, aged clients can be accusatory and threatening. Family members may also be threatening. The home may be in a less than desirable neighborhood where crime is high. Aggressive pets have also been found to pose a danger and risk to health care workers.
  
  

Ethical Issues

• Home health care nurses are often faced with disturbing ethical issues; among them, illegal activities going on in the homes. Nurses may be confronted with illegal drug dealing or consumption. Nursing staff are conflicted as to whether to report this to the police for fear of retaliation or, if unable to return to the home and the patient, the patient's health may be endangered or compromised.
  
  

Gender and Race Issues

• Sexual harassment has been reported by both sexes while on the job. Young female nurses report being particularly vulnerable, be it by male patients or family members. Men also reported being harassed by patients.
  
  Racial issues, where staff of a particular race went into neighborhoods or a home of a different race, increased staff fears and perceptions of risk.