Salazar Colleges of Science and Institute of Technology

211 N. Bacalso Avenue, Cebu City

COLLEGE OF NURSING
Email: scsitcollegeofnursing@gmail.com

HOME VISIT
Description

A nursing home visit is a family-nurse contact which allows the health worker to assess
the home and family situations in order to provide the necessary nursing care and health
related activities. In performing home visits, it is essential to prepare a plan of visit to
meet the needs of the client and achieve the best results of desired outcomes.

Purposes
To give care to the sick, to a postpartum mother and her newborn with the view to
teach a responsible family member to give the subsequent care.
To assess the living condition of the patient and his family and their health
practices in order to provide the appropriate health teaching.
To give health teachings regarding the prevention and control of diseases.
To establish a close relationship between the health agencies and the public for
the promotion of health.
To make use of the inter-referral system and to promote the utilization of
community services.

Principles
The following principles are involved when performing a home visit:
A home visit must have a purpose or objective.
Planning for a home visit should make use of all available information about the
patient and his family through family records.
In planning for a home visit, we should consider and give priority to the essential
needs of the individual and his family.
Planning and delivery of care should involve the individual and family.
The plan should be flexible.

Guidelines
The following guidelines are to be considered regarding the frequency of home visits:
The physical needs, psychological needs and educational needs of the individual
and family.
The acceptance of the family for the services to be rendered, their interest and
the willingness to cooperate.
The policy of a specific agency and the emphasis given towards their health
programs.
Take into account other health agencies and the number of health personnel
already involved in the care of a specific family.
Careful evaluation of past services given to the family and how the family avails
of the nursing services.
The ability of the patient and his family to recognize their own needs, their
knowledge of available resources and their ability to make use of their resources
for their benefits.

Steps
1. Greet the patient and introduce yourself.
2. State the purpose of the visit
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place and then proceed to perform the bag
technique.
5. Perform the nursing care needed and give health teachings.
6. Record all important data, observation and care rendered.
7. Make an appointment for a return visit.
 Salazar Colleges of Science and Institute of Technology
211 N. Bacalso Avenue, Cebu City
COLLEGE OF NURSING
Email: scsitcollegeofnursing@gmail.com

FAMILY ASSESSMENT GUIDE

Family Name: ___________________________________________________________

Address: _______________________________________________________________

I. Demographic Data

Household No. _________ Barangay House No. __________

II. Family Data

Length of residency: ________________________

Place of origin: ____________________________
___________________________
Family size: ______________________________
Religion: Husband- _________________
Wife- _____________________

Family Member’s Chart

FAMILY AGE SEX CIVIL POSITION RELATIONSHIP EDUCATIONAL OCCUPATION

STATUS IN THE TO FAMILY ATTAINMENT
MEMBERS
FAMILY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

III. Family Characteristics

Type of Family Structure

A. Extended ___________ D. Nuclear ___________

B. Matriarchal __________ E. Patriarchal _________
C. Dominant Family Member ___________________________

General Family Relationship/Dynamics

CRITERIA STATUS ADDITIONAL INFORMATION

Observable conflicts between family

members
Characteristics of communication
Interaction patterns among members

Family Dietary Habits

What did you eat yesterday? (24 hours dietary recall)
Breakfast: ______________________________________________________________
Lunch: ________________________________________________________________
Supper: _______________________________________________________________

Monthly Family Income Source

Husband: __________________________
Wife: __________________________
Others: __________________________

Family Health Status/Health History

Father: __________________________________________________________
Mother: __________________________________________________________
Children: __________________________________________________________

Monthly Family Income Source

Total (Check bracket)

below 500 _____ above P20,000- P30,000 _____
above P5,000-P10,000 _____ above P30,000-P40,000 _____
above P10,000-P15,000 _____ above P40,000-P50,000 _____
above P15,000-P20,000 _____ more than P50,000 _____

Felt Family Needs (Identify & rank according to priority)

FAMILY NEEDS RANK FAMILY NEEDS RANK

IV. Home and Environment

A. Is your lot owned? _____ Yes _____ No

B. Is your house owned? _____ Yes _____ No

C. Type of housing materials

_____ wood _____ makeshift
_____ concrete _____ others, specify
_____ mixed

D. Is the living space adequate? _____ Yes _____ No

E. What are the appliances owned by the family?

F. Type of garbage disposal

_____ collected _____ burning
_____ waste segregation _____ burying
_____ feeding to animals _____ throw in the river/sewer
_____ open dumping _____ others, specify _________________

G. Type of waste disposal

_____ flush _____ water-sealed
_____ wrap & throw _____ pit privy
_____ others, specify ____________________

H. Type of drainage system _____ Open _____ Closed

 I. Source of water supply
_____ owned _____ shared
_____ bought _____ others, specify _________________

J. Drinking water source

_____ refrigerated _____ covered
_____ uncovered

K. Containers used
_____ plastic pitchers _____ jars, clay pots
_____ bottles _____ others, specify _________________

L. Food storage/cooking facilities

_____ covered _____uncovered _____ stove
_____ refrigerator _____ cabinet _____ pots/pans, etc.

M. Common household pests found at home

N. Are there breeding sites of insects, rodents, etc. present

_____ Yes _____ No

O. Pets/animals kept in the yard/home

P. Are there accident hazards present? _____ Yes _____ No

V. Health and Health Practices

A. Common illnesses encountered for the last 6 months and the treatment
applied.

B. Whom do you consult for health-related problems?

_____ manghihilot _____ albularyo
_____ midwife _____ nurse
_____ doctor _____ health center
_____ barangay health worker _____ others, specify ___________

C. For problems other than health, whom do you consult?

_____ family members _____ relatives
_____ friends _____ barangay officials
_____ priest _____ others, specify ___________

D. Immunization status of family members

E. Have you had adequate

1. rest and sleep? ____ Yes _____ No
2. exercise? ____ Yes _____ No
3. relaxation activities? ____ Yes _____ No
4. stress management activities ____ Yes _____ No

VI. Environment

1. Kind of neighborhood
2. Social and health facilities available
3. Communication and transportation facilities

VI. Awareness of community organization

A. Are you aware of existing organizations in the community?

_____ Yes _____ No

B. Name all the organizations you know.

 C. Are you a member of any of these organizations?
_____ Yes _____ No

D. Are you aware of its activities and projects?

_____ Yes _____ No

E. How are you involved in its activities?

_____ attend meetings _____ give donations
_____ planning _____ evaluation
_____ implementation _____ others, specify _____

F. Name 5 formal and non-formal leaders of the community whom you think
can lead the people.
1.
2.
3.
4.
5.

Name of Interviewer: _____________________________ Date: ____________

Name of Clinical Instructor: __________________________________________

______________________________________________________________________
* Adapted from the Family Health Management Manual for Nursing Students Community Exposure Book 1 By Lydia C.
Viet, RN, MAN