References:
- Community and Public Health Nursing, 2nd Philippine Edition, ISBN 978-981-48-6503-6, by Earl Francis R. Sumile (pp. 87–91)
- A home visit allows firsthand assessment of the home situation: family dynamics, environmental factors affecting health, and resources within the home.
- The nurse is able to seek out previously unidentified needs.
- It gives the nurse an opportunity to adapt interventions according to family resources.
- It promotes family participation and focuses on the family as a unit.
- Teaching family members in the home is made easier by the familiar environment and the recognition of the need to learn as they are faced by the actual home situation.
- The personalized nature of a home visit gives the family a sense of confidence in themselves and in the agency.
- Difficulty may be met in cases of safety of the nurse, efficiency, and inability to control the environment/distractions.
Because of the nature of this visit, multiple ethical issues may arise:
- Maintaining a client focus: goals must be clear and distractions must be avoided.
- Client independence: the nurse may be able to gain and provide confidence for the family if goals are being met.
- Honesty: telling the truth about how the family performs its responsibility is important. Suggestions are more important than advice. The nurse must be able to identify what the family knows about themselves.
- Privacy and confidentiality: both the family and the nurse share their own experiences during care. Anything that transpires during this period should not be shared to anyone. The nurse limits care to common areas of the household so as not to compromise privacy of the family.
- Limits of intervention: the nurse has to recognize the knowledge and skills of the family to care for themselves. The nurse needs to assess what the family knows about a certain problem. For example, the nurse may have a mother explain and demonstrate how they care for their child. If lacking or inappropriate, the nurse steps in to teach the client.
- Termination: ideally, termination is included in the objectives of care, where continuation of care is moved to the health center. The nurse has to be grateful to the family for allowing for their care.
Phases of a Home Visit
- Pre-visit Phase: the nurse contacts the family, determines their willingness for a home visit, and sets an appointment with them. A plan for the home visit is formulated during this phase. Planning occurs similarly to the nursing process, and follow specific principles:
- The home visit should have a purpose. Some purposes include assessment; education; infection control; supplemental intervention; or the provision of greater access to community health resources through rapport, information, and referrals.
- Use information about the family collected from all possible sources. All available information is used to determine and analyze the family situation.
- Focus on identified family needs, particularly those recognized by the family as requiring urgent attention (salient).
- The client and family should actively participate in planning for continuing care.
- The plan should be practical and adaptable. Flexibility is important in working with families because the nurse will not know the family’s priority needs until the home visit.
- In-home Phase: this begins as the nurse seeks permission to enter and lasts until departure. This phase consists of initiation, implementation, and termination.
- Initiation: knock or ring the doorbell and declare yourself in a non-threatening voice. Upon entering, introduction is done for the nurse and the agency they represent. Observation of the environment and general safety is appraised. To establish rapport, the nurse initiates a short social conversation, then states the purpose of the visit and sources of information the prompted the visit.
- Implementation: the application of the nursing process; assessment (interview, physical examination, observation), intervention (care, teaching, counseling, referral), and evaluation.
- Termination: summarizing with the family the events during the home visit and setting a subsequent home visit or another form of family-nurse contact such as a clinic visit. Recording of findings may also be done at this time if necessary.
- Post-visit Phase: after returning to the health facility, documentation occurs, recording events that transpired during the visit, personal observations, and feelings of the nurse about the visit. A referral may be made. Planning may be done at this time if a subsequent visit has been set.