HOME VISIT

HOME VISIT

Dosen : Nurul Hidayah

Tanggal : 15 Mei 2013

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A.  Definition

A home visit is a purposeful interaction in a home (or residence)directed at promoting and maintaining the health of individuals and the family (or significant others).(Smith &Maurer, 2008)

B.  Purpose

1.    Promoting support systems that are adequate and effective and encouraging use of health-related resources.

2.    Promoting adequate, effective care of a family member who has a specific problem related to illness or disability.

3.    Encouraging normal growth and development of family members and the family, and educating the family about health promotion and prevention

4.    Strengthening family functioning and relatedness

5.    Promoting a healthful environment

C.  Advantages Of Home Visiting

1.    Home setting provides more opportunity for individualized care

2.    Most people prefer to be cared at home

3.    Environmental factors impinging on health, such us housing condition and finances, may be observed and considered more readily

4.    Information collection and understanding lifestyle values are easier in families own environment

5.    Participation of family member is facilitated

6.    Individuals and family members may be more receptive to learning because they are less anxious in their own environment and because the immediacy of “needing to know” a particular fact or skill becomes more apparent

7.    Care to ill family members in the home can reduce overall costs by preventing hospitalizations and shortening the length of time spent in hospitals or other institutions

8.    A family focus is facilitated

D.  Disadvantages Of Home Visiting

1.    Travel time is costly

2.    Less efficient for nurse than working with groups or seeing many clients in an ambulatory site

3.    Distractions such as television and noisy children may be more difficult to control

4.    Clients may be resistant or fearful of the intimacy of home visits

5.    Nurse safety can be an issue

E.  Family Health-Related Problems and Goals

Problem	Goals
Lifestyle and resources	Promote support systems and use of health related resources
Health status deviations	Promote adequate, effective family care of an ill or disabled member
Patterns and knowledge of health maintenance	Encourage growth and development of family members : health promotion and prevention Promote healthful environment
Family dynamics and structure	Strengthen family functioning and relatedness

F.   Principles of nurse-client relationship with family

1.    By definition, the nurse focuses on the family

2.    The health focus can be on the entire spectrum of health needs and all three levels of prevention

3.    The family retains autonomy in health-related decisions

4.    The nurse is a guest in the family’s home.

G.  Characteristics of relationships with families

1.    Families retain much control

2.    Goals of nursing care are more long term

3.    Nursing care is more interdependent with families

H.  Phases of relationship

1.    Pre initiation or pre planning phase

2.    An initiation or introductory phase

3.    A working phase

4.    An ending

I.     Planning before home visit

1.        Have name, address, and telephone number of family with directions and a map

2.        Have telephone number of agency where supervisor of faculty can be reached

3.        Have emergency telephone numbers for police, fire and rescue personnel.

4.        Clarify who has referred family to you and why

5.        Consider what is usually expected of a nurse in working with a family who has been referred for these health concerns (e.g. postpartum visit) and clarify the purposes of this home visit.

6.        Consider whether any special safety precautions are required.

7.        Have a plan of activities for the home visit time.

8.        Have equipment needed for hand washing, physical assessment, and direct care interventions or verify that clients has the equipment in the home.

9.        Take any data assessment or permission forms that are needed

10.    Have information and teaching aids for health teaching as appropriate.

11.    Have information about community resources as appropriate.

12.    Have gas in your automobile or money for public transportation.

13.    Leave an itinerary with the agency personnel or faculty.

14.    Approach the visit with self-confidence and caring

Nursing activities during three phases of a home visit

J.    Initiation phase of home visit

1.        Knock the door and stand where you be observed if peephole or windows exist.

2.        Identify self as  (name), the nurse from )name of agency)

3.        Ask for the person to whom you were referred or the person with whom the appointment wasmade.

4.        Observe environment as regards your own safety.

5.        Introduce yourself to those present and acknowledge them.

6.        Sit where family directs you to.

7.        Discuss purpose of visit. On initial visits discuss services to be provided by agency.

8.        Have permission forms signed to initiate services. This may be done later in the home visit if more explanation of services is needed for the family to understand what is being offered.

K.  Implementation phase of home visit

1.        Complete health assessment database for the individual client.

2.        On return visits assess for changes since the last encounter. Explore degree that family was able to follow up on plans from previous visit. Explore barriers if follow up did not occur.

3.        Wash hands before and after conducting any physical assessment and direct physical care.

4.        Conduct physical assessment as appropriate and perform direct physical care.

5.        Identify household members and their health needs, use of community resources, and environmental hazards.

6.        Explore values, preferences, and clients’ perceptions of needs and concern.

7.        Conduct health teaching as appropriate and provide written instructions. Include any safety recommendations.

8.        Discuss any referral, collaboration, or consultation that you recommend

9.        Provide comfort and counseling as needed.

L.  Termination phase of home visit

1.        Summarize accomplishment of visit

2.        Clarify family’s plan of care related to potential health emergency appropriate to health problems.

3.        Discuss plan for the next home visit and activities to be accomplished in the interim by the community health nurse, individual client, and family members.

4.        Leave written identification of your self and agency, with telephone numbers.

M.     Fostering goal accomplishment with families

1.        Share goals explicitly with family

2.        Divide goals into manageable steps

3.        Teach family to do for themselves

4.        Do not expect family to do something all of the time perfectly

5.        Be satisfied with small, subtle changes

6.        Be flexible.

Main Resources

Smith, C, M. ,& Maurer, F, A. (2008). Community/Public health nursing practice: Health for families and populations.

Philadelphia : Saunders.