Name:________________________________ Date:_______________

Course/Year:___________________________

Home Visit

Purpose:

 To educate the family about measures of health promotion, disease

prevention and control of health problems.
 To provide supplemental interventions for the sick, disabled or dependent
family member.
 To provide family with greater access to health resources in the
community.

Material:

 Questionnaire
 PHN Bag

Rating:
1- Needs Improvement 4- Very Good
2- Good 5- Excellent
3- Better

Procedure:

Pre-Visit Phase 1 2 3 4 5 Remarks

1. Contact the family, determines
the family willingness for a home
visit.
2. Set an appointment.
3. Plan for the home visit, set
purpose:
a. To have
more accurate
assessment of the family
condition
b. Educate the family
c. Prevent
spread of infection
d. Provide
supplemental
intervention
e. Provide
greater access to health
 resources
4. Use information about the
family
5. Set plan focus on identified
family needs, needs
recognized by the family
6. Check and gather the needed
materials.
7. Comply with practices and
policies for personnel safety.
In Home Phase
1. Greet client or household
member and introduce
yourself.
2. Explain purpose of home visit.
3. Inquire about health and
welfare of client/ patient and
other family members. Ask
about any health and health-
related problems. (Health
Assessment Form)
4. Place the PHN bag in a
convenient place before doing
bag technique.
5. Wash hands and wear apron
and put out needed articles
and/or medicines, dressings
from bag.
6. Perform physical assessment
and nursing care needed. If
more than one member of the
family is for health supervision
and care, start with the well
member to avoid transfer of
infection.
7. Give the necessary health
teaching and advice based on
client’s patient’s need and
condition.
8. Evaluate with the family
9. Make appointment either for
clinic or home visit.
10. Wash hands and close bag.
Post-Visit Phase
1. Record findings and nursing
care given.
2. On succeeding home visit and
 when nurse has gained the
family’s trust and confidence,
she/he may look into more
detailed aspects of the
household and surroundings
and other health
problems/concerns.

Total Score
Equivalent Grade

Signature of the Clinical

Instructor
Signature of the Student

Comment/Remarks:
____________________________________________________________________
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