Home Visiting

Dr. 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.

continued
Four 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-thanexcellent 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.

Follow-up And Preventive-3

:(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

Convenience.1

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.

Access.2
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

Information.3
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
clients health status

Relationship.4
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.

Cost.5
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 healthrelated 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 regardthis 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 feedbackthe 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
Choose suitable place. 1
Quite
Clean
Good ventilation
Patient bed and linings. 2
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