THE HOME VISIT

Introduction
Home visiting is very essential to the community health services, because majority of the patient are found in the home The home is utilized for many reasons in the relation to the health of the family. The home is also utilized frequently to provide nursing services. The services in the home requires technical skills, knowledge of preventive and therapeutic measures, Teaching ability, judgment & full understanding of human relations. Home is the place where ther nursing practice is autonomous & the knowledge, skill, & experience of nurses are employed. Home visits give a more accurate assessment of the family structure & behavior in the nature environment. Home visit also provide opportunities to observe the home environment and to identify barriers & supports for reaching family health promotion goods. Meeting the family on its home ground also may contribute to the family sense of control & active participation in meeting the health needs. The nurse works with the patients first hand to adopt the intervention to meet realistic resource.

PRINCIPAL OF WORK
1. Plan the work so that visits are made on the basis of need, divide your intensive area into units of 800-1000 population each, and plan for regular visit to the home in selected units at a time. 2. Be sensitive to the persons feelings and needs at the time of the visit 3. Understanding the others persons point of view 4. Be sure of the scientific soundness of the subjects you discuss 5. Use safe technical skills, including hand washing, inspection etc. 6. Have a full understanding of your agencys policies. 7. Attain a working knowledge of the community resources and use them wisely. 8. Collect facts about the home, the patient and the environment and make an objective analysis of the facts as an initial step in visiting the home. 9. Work with the person & family-Plan jointly 10. Evaluate your own work-quality is more important than quality; one or two home visits that accomplished are of greater value than 8 or 10 casual visit. 11. Make a note of important facts in your diary 12. On return, record facts in the family folder or individual health cards.

TECHNIQUE OF HOME VISIT

A) Fact finding: The first step during a home visit is to study the clinical records for understanding the present need of the family so nurse will be able to build on what has been done. Introduction yourself. Establish a friendly relationship through, courtesy, graciousness and genuine interest. Observe inside and outside of the home of discern good and bad factors that may influence the situation. Talk with the person or persons concerned to find out what they know & understand about situation. Use simple language. Discuss what has been done & what the person wants to do about the problem how & what plans he may have for the future. Specific observation & question in specific areas will provide basic data for planning & giving appropriate nursing care. Conditions pertaining to the environment. Type of house? What are hazards? Availability of storage of food & water How is rubbish disposed? Availability of sanitary latrine

Maternal & child health

Marital status of individual Eligible couple Is anyone pregnant? Has she registered? Has she had tetanus told? She know family welfare services? Has there been any recent birth dates & sex, Death- date & place. Recent marriage, if any Children under five and their health status, details of immunization.

Any illness in the family If fever is it with rigor, or cough or with rash. Duration of rash & illness. Any skin diseases like itching patch & rash. The attitude of the nurse-her friendly, courteous & understanding manner, will determine her ability to meet the health needs of the family & together facts

B)

C)

D)

E)

objectively. These facts are obtained by studying records of individual & his home with concerned. EXAMINATION AND ANALYSIS OF THE FACTS. When facts have been collected the process & analysis begins. It is important to remember that true, honest analysis is based on the facts and not on opinion. The personal, environmental & economic factors, the emotional involvement and the Spiritual aspects taken together constitute the usual health problem. It is when the persons talks about any one or all aspects of the situation that he is (aware) in varying degree of a problem. This awareness create question like what is it? How did it develop? And what can I do? It state that individual is searching for an answer to his problem During home visit listen the point of view of the individual & find out what he knows about the subjects and it may takes 2-3 homes visits to reach this point. Record exactly what individual wants to say & symptoms, attitude and relationship to identify need & problem & act on it. Assess the coping ability of family & help them to use outside resources when the family resources exhausted. PLANNING ACTION WITH THE INDIVIDUAL OR FAMILY. Planning action with the person and family is of the greatest important in all your work & relationship Fulfill their basic need, then only they listen you I.e. hungry women cannot able to listen the health education topic. Explain about the family resources & outside resources to attain their needs. ACTION What you do depends on the first steps in the visit. Even though you have decided plan for family. You must be prepared to alter the plan to meet the needs that exist in the family at the time of visit. Ex. You planed to give health education to antenatal mother for institutional delivery but during visit you found that her child has high fever & mother is anxious. help at a time when a person is anxious & feels the need, create confidence & co Operation in other matters FOLLOW- THROUGH It is important step & involves assistance with hospital clearance. Another visit is before the admission to the hospital to explain hospital living & his role. A visit in hospital to tell her about the children & home; periodic visit to children & contact to other agencies for help to these children.

Follow-up of persons undergoing domiciliary treatment in chronic illness is important eg. TB, Leprosy. F) USE OF EXPERT TECHNICAL SKILLS Every professional worker needs tools & specials skills. Your nursing knowledge & specials are essentials to successful work in the home. Hand washing is necessary before & after the procedure so soap & towel as part of your equipment Thermometer, a baby scale, a urine analysis kit and when possible a pocket size blood pressure apparatus, blood specimen tubes and needles; records should be their in nursing bag. You are able to be a Doer rather than a caller or visiter. You render services than lip services. When you teach by demonstration you dignify work & the patient &/or family gains & respects for the task. G) EVALUATION OF SERVICE Review each family records periodically & answer the questions What is the immediate problem need? What is the total problem? List the difficulties & unhelpful factors in the situation List the helpful factors e.g. Coping abilities of family What has been done about the immediate problem? What plans are being made and what action is being taken to deal with the underlying cause of the problem? How did the person respond use of men & material measures? Value of referral services? Do you need guidance & counseling & discussion with your supervisor? Community health result are not always immediate obvious. It takes months & sometimes years is wisely spent with those people that are able to use your services as well as with those that are dependent. STEPS IN HOME VISITING A) Planning for a visit Community health nurse should assess or consider many factors while making a visit to the family such as: Physical and environment status Familys cultural background. This helps the community health nurse to understand their attitudes, beliefs, practices regarding medical practice and diet. Occupations and income of family to determine and assist in budgetary problems Age Psychological factors- this includes family relationships

 Educational level B) Activities during visit Providing nursing care- e.g., taking temperature, for giving a bath Demonstrating and teaching- e.g., giving insulin injection Making nursing diagnosis and tentative nursing care plan Establishing priorities C) Approach to family ( how to make a home visit) Locate the right house. Knocking at the door and call out Introducing yourself, your agency and the purposes of your visit. Establish good rapport being courteous, polite, warm & friendly. Good observer of verbal and non-verbal response from family. Use (words) how, what, when, why, while questioning. Be a good listener. Keep in mind agencys policies during visit regarding fees and care. 1. Do not force information. 2. Observe local customs, e.g. removing shoes or chappals before entering the house is necessary in Indian communities.

9. Record & report

1. Introduce yourself 2. Talk informally for while 3. Encourage the individual to

8. Review the important point HOME VISIT TECHNIQUE 7. Use simple language

Talk about problem 4. Be prepare to postpone the original purpose 5. Complement the mother

6. Sensitive to Belief, culture

NRUPUR INSTITUTE OF NURSING SCIENCE AND RESEARCH

ASSIGNMENT ON

PRINCIPLES AND TECHNIQUES OF HOME VISITING

SUBJECT: COMMUNITY HEALTH NURSING

SUBMITTED TO, SAJITHA MADAM NINSAR

SUBMITTED BY, MR. RAVINDRA PATEL ROLL NO. 25 S.Y. P.B. BSc(N)

ON DATED: 2/11/2011