Home VisitingHome Visiting

Dr. Friyal AlQahtaniDr. Friyal AlQahtani

Learning Objectives

• Define home visit.• State goal/ Purpose of home visiting.• List the importance of home visiting.• Classify the types Of home visiting.• Discuss the advantages and disadvantages of home

visit.• List priority in home visiting.• Enumerate the basic principles of home visiting.• Explain the techniques of conducting home visits.• Apply the role of the nurse during Home Visits.

Definition of home visit

• The process of providing nursing care to the client own residence. The sitting may be in a single or multiple unit structure and may be located in a rural or urban setting.

Home Health Care Defined as the Following :

Four Different Perspectives include:1. Official:• Services are provided to individuals and their

families in their place of residence for the purpose of promoting, maintaining, or restoring health or of minimizing the effects of illness and disability.

2. Patient:• Skilled and compassionate care is provided

on a one-to-one basis in the comforting and familiar surroundings of the home.

continuedFour Different Perspectives

3. Family:• It is a means to keep the family together

as a functioning, integrated unit.

4. Provider:• All disciplines involved are challenged

to provide excellent care in often less-than-excellent conditions and surroundings.

The goal / purpose

• When visiting clients in the homes is to:

Community resources Which providing health care to families

in their homein KSA

• King Fahd Specialist hospital – AlDaman ,

• Central AlDamam Hospital ,

• King Faisal Hospital- Alriyadh ,

• Al madinah ,Makah Hospitals,

• King Abd Alaziz University Hospital –Jadah

Importance Of Home Visiting

1.Bring health services within reach of all members of the community into their home or those who do not whatever reasons attend clinics.

2. Improve the health of the community with particular emphasis on mothers and children.

3.Demonstrate understanding of the families visited to realize their problems.

4. Serve a linkage between the community agency and families

Types Of home Visiting

• One useful concept is to classify visits according to nurses objectives which are based upon responses to the needs of the families.

1-Systematic Routine Visits:• These are made to families in the district to

get acquainted, estimate competencies of family members, determine if there are health problems and teach healthful family living.

• e.g: Antenatal, postnatal, give medication ……etc.

2-Selective Visits:• Those visits are made in response to

specific problems such as infectious diseases, chronic illness, epidemiological surveys,TB, case finding….

3-Follow-up And Preventive (Visits For Nursing Activities):

• Visit cases after discharge from hospital to continue care of the patient at home ( To reduce Long stay of Hospital)

• Visit to families with new born babies, given necessary care and health teaching.

• Checking on newly discharge premature babies.• Helping a mother with a child weaning problems.• Follow up care of recently hospitalized and

discharge child with servere malnourshment,kashiokor..

• Discuss hazards facing the family.e.g:Safety.

Principles involved in preparing for a home visit

1.A home visit must have a objectives.

2.Planning for a home visit should make use of all available information about

family through family records. we should consider and give priority to the

essential needs if the individual and his family.

3.The family unit is significant: Health needs of one family member may

become initiated during the visit, yet each person in the family contributes to family

functioning and the level of family.

4.The nurse is a guest in the client home and make only those nursing

interventions the client agrees to. she must be flexible and respect clients

rights and participate in goal setting and goal achievement.

5.The nurse must always remember that sympathy and empathy are necessary.

6.Nusre should give praise and ensure the family they are trying to do well.

Advantages of Home Visits

1.Convenience

2.Access

3.Information

4.Relationship

5.Cost

6.Outcomes

1.Convenience

• Clients often prefer to be seen in their homes• Reduced transportation costs• No waiting for services• Clients have greater control over their health

and lives.• The nurse can observe family and

environment factors that influence health.• Allow for primary intervention, to prevent

disease or injury from occurring.• -facilitate family participation and promote

family focus.

2.Access

• Clients may be immobile or lack transportation

• The community health nurse gains access to families to provide health education and other prevention strategies. Also she has access to clients that may not necessarily present themselves for services in other settings

• A home visit permits the nurse to identify clients in need of services

3.Information

• The home visit permits the nurse to obtain information not readily available in other settings

• Valuable information is obtained about family dynamics, physical environment, psychological and sociocultural factors present that may have a bearing on the client’s health status

4.Relationship

• In the home setting, the client exerts autonomy and control

• The nurse may foster a sense of empowerment

• Permits a sense of privacy • Clients may offer more information

especially about sensitive issues• The home visit fosters a sense of continuity

in the nurse-client relationship, especially if there are repeated visits, or a long-term purpose for the visits.

5.Cost

• Home visits and home care are less expensive than hospital care or long-term facility placement with better outcomes, especially when chronic health issues are involved.

6.Outcomes• Home visitation programs have been

documented to achieve a variety of health-related outcomes for many different populations

Disadvantages of home visits:

Distractions • 1.Environmental Distractions include:• Background noise• Crowded surroundings• Interruptions• 2.Behavioral Distractions include:

– Client behaviors:– Explore reasons for behaviors– Work to establish trust– 3. Nurse-initiated include:– Fears– Bodily harm– Client rejection– Lack of control– Personal reactions to different lifestyles

Other obstacles -Resistance:• -Some family members may resist having a nurse visit in the

home. They may feel not easy about the nurses values or attitudes.

• The resistance may also be caused by cultural difference between the nurse and the family. Also, some people do not wish to have any one in their homes other than friends or a family members.

• -They may feel ashamed about their homes. • -In order to avoid resistance, the nurse should give accurate and

complete description of the purpose and nature of the home visit. She should be careful about communicating a negative feeling. She should always behave in friendly and professional manner.

-Role Confusion:• - It may be difficult for the nurse especially students or new

practitioner to distinguish between helping relationship and friendship when visiting a client in the home.

Priority In Home Visiting:

• it is probably better to visit a limited number who are at high risk than visiting a large number on a superficial basis.

• Worksheet

Special At Risk Family /Group:

• Family with special problems (e.g: Lack of support, any handicapped condition or elderly..etc).

• Child under 5 years of age.• Elderly who is living alone.• Family with mental health problems.• Non clinic attendants (i.e. those who do not use the under

family clinic) (children clinic).• Malnourished children.• Family with a poor health history (e.g: Recurrent hospital

admission).• Family with infectious illness (e.g: The visit at the end of the

day).• Follow-up visits following discharge from the hospital to

ensure that treatment is being carried out.

Techniques Of Home Visits:• Phase I:Pre-visit activities:• Collection of data, other activities.• Phase II:Introduction to the family:• Entering the house.• Explaining the purpose of visit.• Acknowledge each family member.• Beginning relationship with family.• Phase III:• Actions to be accomplished during the home visit.• Observations made.• Barriers to change.• Phase IV:Closing the visit.• Phase V:• Post visit activities.• Recording the visit.• Evaluation.• Pahse VI:Termination of the visit.

The nurses Behavior should Include:

1-Creativity:• The nurse should use creative approaches to nursing care in

the home in response to unique situations that differentiate the home environment from other setting.e.g:Absence of familiar hospital equipment should encourage the nurse to think of using other convenient home facility.

2-Flexibility:• Since the nurse is a guest in client home,she should then

respect client preference for the timing of carrying out the various activities.

3-Follow Through:• In order to enhance the establishment of trust,the nurse must

follow through with commitments.

4-Respect:Mutual nurse client respect will help to form the basis

for trust.5-Communication: -The nurse communicates with family members during

all stages of the nursing process. - Effective communication will assist the nurse in

information gathering technique and providing support. Productive nurse client relationship called therapeutic communication or “positive interpersonal relationship:. During the assessment phase, the nurse should assess her own communication and that of the client and other health team members. Honestly, value clarifications, goal setting, self awareness of own feelings, sensitivity and listening will enhance communication.

Establish a therapeutic effective relationship

During the implementation phase, the nurse help in implementation of communication techniques:

• Empathy.• Sympathy• Positive regard→this requires a willingness to accept people as they are.• Setting model →t he helper can be a model by setting an example of certain

behaviors.• Providing feedback→the helper acts as reinforcing by providing feedback, both

verbally and nonverbally.Utilize listening skills by:• -Giving the client full undivided attention.• -Accepting the client as a person without letting personal values • interfere.• -Resist distractions.• -Waiting for response this gives the nurse the opportunity to • understand what has been said.• -Summarize client thoughts or feelings.

General Rules To Be Followed During Home Visit:

Barrirs To change

• Some barriers which may be faced by the nurse in attempting to change clients or families are:

• 1.Faulty perception regarding the client or families readiness to change.

• 2.The language used by the nurse may be unfamiliar to the client or family.

• 3.The emotional content of the messages between the nurse and the client or family and the nurse may be missed, avoided or inaccurately interpreted as being irrelevant to the issue under discussion.

• 4.Too many suggestions for change may be offered by the nurse, resulting in inconvenient or incompatible messages for the client.

• 5.The client or family may misinterpret the messages of the nurse and vice versa. To avoid misinterpretation of messages, it is a good practice to request the client to give feedback on what she or he heard from the nurse.

• 6.The client or family may arbitrarily desire the right to refuse, regardless of the ideas, because of the elements of power. The nurse can engage the situation in such a way that the client retain control.

Nursing activities of the home visit:

• Assessment

• Nursing care

• Treatment

• Health education and counseling

• Referral and follow up care.

The three most common intervention in home health care

include:

• Helping families deal with stress created by health problems.

• Making referrals for community services.

• Teaching and educating clients, with the focus on strengths rather than weakness.

Role of CHN working in home agency toward the patient

–1 .Choose suitable place–Quite–Clean

–Good ventilation–2 .Patient bed and linings

–Clean–Change linings regularly

–Use draw sheet when appropriate

– Patient residue– Should be disposed in the bathroom to

prevent the spread of infection– Daily monitoring– Face color– Temp– Pulse rate– Urine color– Stool color– Vomiting– Edema– Dehydration signs

– Nutritional status– According to health status– Balanced small frequent meals– Comfort– Decrease visits– Short visits– Movement– Encourage active movement– Passive movement and positioning to

prevent bed sore if pt is bedridden

– Prevent bed sore– Frequent cleaning and positioning– Support with pillows– Personal hygiene– Administering medication– Orally– I.V– Rectally– Inhalants– Ointments– I.M

– Care of the client with communicable disease

– Isolate pt in private room– Use gown when providing care to pt– Clean hands with antiseptic solution

before and after care provided– Use special dishes for the pt food used

by him only– Observe family members who contacted

pt before isolation for signs of disease

• Follow dr. instruction and consult him about any changes

• Apply dressing

• Insert NG tubes

• Suction secretion from respiratory system

• Health education for pt and family

• Care for children and infants