HOME VISITING

INTRODUCTION

Nurses work with a families in a variety of setting, including clinics, school, support groups
offices. However, an important aspect of the nurse’s role in reducing health risks and
promoting of populations has been the tradition of providing services to families in their
homes.

Home visits give a more accurate assessment of the family structure and behaviour in the
natural environment. It also provides opportunities to observe the home environment and to
identify barriers support for reaching family health promotions goods.

DEFINITIONS

HOME

Home visit is autonomous, and the knowledge, skills and experience of the nurses are
employed Home is the place of service where nursing practice (Basvanthapa.2008)

HOME VISIT

1. Home visit is the process of providing care to patients at their doorstep

(Bsavanthapa.2008)
2. A home visit is “ a formal call by a nurse on a client at the client’s residence to
provide nursing care” Mary Clark (1999:187)
3. Home visiting refers to the care given to the family in their own homes by health
workers or volunteer community workers (ideally supported by health workers).
(ITG 2002).
4. Home visiting is a comprehensive and on-going care involving all family members
adopted to meet their special needs within the environment of their homes”, (Bradly
Mary 1987). Home visiting is a visit made by health care personnel to an individual’s
home in order to assess the ability of an individual to function independently following
discharge from hospital or other health care setting home(Churchill, 2003).

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AIMS OF HOME VISITING
1. To care for the sick, and rehabilitate the disabled.
2. To have the knowledge about the community’s resources and cultural beliefs
which might be helpful when patients are discharged from hospital.
3. To offer continuity of care.
4. To preserve and promote health.
5. To prevent and control diseases.

PURPOSE OF HOME VISIT

 Home visits give a more accurate assessment of family structure, the natural or home
environment and behaviour in the environment.
 Provide opportunities to identify both barriers and support for reaching family health
promotion goals.
 The nurse can work with the client directly to adapt interventions to match resources.
 Visiting the client in their home may also contribute to the family’s sense of control
and active participation in meeting their health needs.

 To give follow up care, for example a postnatal visit to a woman just delivered and
discharged from hospital to see how she’s coping with the baby at home especially the
prim Para.
 To give information, education and communication on the problems identified
 To do demonstrations related to heath needs.
 To review and refer serious conditions to the appropriate authorities for continuous
and further management of the identified problem e.g. social worker
 To recruit new clients who need help from the health facility, but do not come to the
clinic.
 To investigate the source of an infectious disease e.g. TB, cholera, e.t.c.

OBJECTIVES OF HOME VISITING

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 To teach and convince the community and the client about the importance of home
visiting.
 To create an understanding between community members and health care providers so as
to enhance good working relationship.
 To reassure the clients that they are equally important as other members of the
community in order to help them develop a sense of being cared for.
 To eliminate the fears and anxiety about home visiting.
 To give health education and appropriate demonstrations in the client’s own environment
by using the available resources.
 To check if problems that were identified and treated at the health centre or hospital have
subsided or have resolved, e.g. high blood pressure, diabetes mellitus, oedema e.t.c

PRINCIPLES OF HOME VISITNG

The goal of home visiting is to provide appropriate nursing care leading to wellness of the
patient. When carrying out home visiting, the community health nurse should follow certain
basic principle given below.

 Home visiting should be planned with purpose and should be beneficial to the
patient.
 The purpose of home visiting be should clear and must meet the needs of the
patient. It should include surveys and statistics, MCH services, home nursing in
cases of illness, including, health teaching.
 Home visiting should be regular and flexible according the needs of the patient.
 Home visits should be educative, i.e. it gives excellent opportunities for health
education.
 Home visiting should be convenient, acceptable and educative to the patients.
 Have a full understanding of your agency’s policies e.g. schedule visits only during
daylight hours.
 Home visit should be acceptable, and convenient to the client and family.
 The nurse must be flexible and should respect the culture, tradition, and taboos of the
families.
 The nurse should have good scientific knowledge on the subject to be discussed and
should explain it in simple terms and be able to answer questions that may be raised.

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  Identify community leaders and resources you can utilize in the course of your visits
e.g. church leaders.

SAFETY PRECAUTIONS IN HOME VISITING

1. Know the phone number of the agency, police, and emergency services.
2. Let the agency know your daily schedules and the phone of your client so that you can
be located in case you don’t return when expected.
3. Never walk into the client’s home uninvited.
Know where the client lives before leaving to make a visit and carry a map with you
where necessary for quick referral

RISK GROUPS FOR HOME VISITING

1. Pregnant mothers.
2. Post natal women
3. Nursing mothers
4. Single parent families.
5. Motherless babies
6. Mothers with pre term babies or twins.
7. Families with special problems such as chronic diseases, mental illnesses,
malnutrition, and discharged patients.

ADVANTAGES OF THE HOME VISITS

1. Home visit provides an excellent opportunity to implement nursing procedures.

2. Home visits provide an opportunity to study the home and family situation.
3. Home visits provide an opportunity to render services to the family member at their
own surrounding.
4. Prompt and proper home visits creates a good understanding and between nurse and
family and builds good image of nurses.
5. Home visiting clarify the doubts raised by the family members.
6. Home visits help the nurses and family members to modify the ways of their care.
7. Home visits help to observe family practices and progress of care given by nurses and
others.

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 8. Home visits are convenient for the patient.
9. Home visits are the best option for patients unwilling or unable to travel.
10. Home visits provides natural environment for the discussions of concerns and needs.
11. Home visits provide the opportunity to individualized services.

COMPONATES OF HOME VISIT

Home visit itself can be viewed in a process in which the nursing activity may be initiation
phase, pre-visit phase, activities during home visit phase, post visit phase activities and
termination phase of visit or transfer phase visit. Building a trusting relationship with the
family and client is the cornerstone of successful home visits.

Five skills are fundamental to effective home visits: observing, listening, probing and
prompting. The need of these skills is evident in all phases of the home visit process.

Before making a home visit the community health nurse (CHN) has to do the following;

 Has to prepare for the visit

 Introduce herself/himself to the family of the client
 Make contract with family
 Make an assessment
 Draw a plan with interventions
 Implement plan
 Conduct an evaluation
These functions may be carried out on every visit, but depth of purpose and emphasis
changes as movement toward an agreed upon goal becomes evident

1. INITIATING PHASE
In this phase the community health nurse clarifies the sources of referral for visit and
purpose of visit and can also share information on the reason and purposes for home
visit with family. Usually, home visit is initiated as a result of referral from a health or
social agency. However a family may request service or a nurse may initiate the home
visit as result of case finding activities.

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 The initiation phase is the 1 st contact between the nurse and the family. It provides the
foundation for an effective therapeutic relationship.

2. PRE-VISIT
When the nurses are assigned to home visit, they must know prior information
regarding the house and the family which includes location of the house and its
distance, address and some information on need for visit. Pre visit is part of
assessment phase in which the nurse gather information about the patient, investigates
community resources assembles supplies and plans for the first patient contact.
This information can be obtained from family-folder or other nurses or family
members regarding age, sex, family culture and values, problems, care given and etc.
This helps the nurses to take appropriate steps during the visit to meet the needs of the
patients and also helps to make initial planning.
The family should be informed of how they come to the attention of the nurse for
example as a result of a referral. If a referral has been received, it is important and
useful to ascertain whether the family is aware of the referral. If possible, the visit
should be arranged when as many family members will be available for the entire
visit. Determine family’s willingness for home visit and schedule the subsequent
home visits.
The possibility exists that the family may refuse a home visit. Less experienced nurse
may mistakenly interpret this as a personal rejection. The nurse need to explain the
reasons for refusal, there may be a misunderstanding about the reasons for a visit , or
there may be lack of information about services. However, the nurse should open the
possibility of future contact. There are instances when the nurse will be mandated to
persist in requesting a home visit because of legal obligations, such as follow up of
certain communicable diseases.

3. IN HOME PHASE / ACIVITIES DURING HOME VISIT

The community health nurse have to use their talents to make a family to be receptive
to their visit for which they have to begin to develop trust and rapport, which are the
basis for positive inter-personal relationship. Here the nurse introduces herself to the
family shows professional identity, establish nurse client relationship
The next step is a description by the nurse of her/his role, responsibilities and
limitations. Another component of home visit is to determine the client’s

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 expectations. The major portion of home visit is concerned with establishing the
relationship and implementing.
During the visit, the nurse assesses the family needs and plans the nursing care
according to the needs and implements it accordingly. During home visits, nurses
practise a variety of role when intervening in patient care. She has to take the role as
collaborate, consultant health educator and an epidemiologist and takes steps to
implement nursing process. The frequency and intensity of home visits vary not only
with the needs of the family but also with the eligibility of the family for service.

THE NURSING PROCESS

The nursing process is a highly flexible, convenient, and effective method of problem solving
that adapts well to the multiple problems that need to be untangled in home care situations.
Because the nursing process is a deliberate and systematic approach to client care, it helps to
organize care that is specifically related to the client’s needs.

The nursing process includes;

 ASSESSMENT
This is a process of obtaining data. Therefore a CHN is required to have the skills of
how to obtain data. The client is the primary and most important source, though
interviews, observations, and a systematic physical examination provide the most
valuable data. Observation of nonverbal communication and interactions is
important. A thorough and systematic physical examination is performed, and
notations are made. Vital signs are always monitored. Patterns of data are noted. The
information is organized, and analysis of data begins in the nurse’s mind.

 ASSESSING THE HOME

The home environment has to be assessed since it has the effects on physical and
emotional health as well as social development of the family. It’s important to
assess the home properly to avoid misinterpretation of the needs and problems of
that family.

Demographic information such as age, ethnic and marital status, ages of children,
locations, education, and primary caregivers’ data is gathered.

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 The nurse collects relevant information on housing condition, surroundings, family
composition, social economic status, dietary pattern and means of communication
health status of each individual in the family that is including mother and child, vital
statistics, immunization status, family planning status e.t.c. in short data on family
histories and past histories are important. All these variables are important when
conducting an assessment because they do have an impact on the client’s perception
of their health and current problems.

 PLANNING
The second step of the nursing process is planning. This involves development of
the care plan to meet the identified problems. This is done together with the family
before the nurse leaves the home. The nurse plans future visits with the family. The
number and spacing of visits vary depending on the situation. The nurse should
record the observations made during that visit and the plan of care based on the
needs and goals agreed upon.

Plan of care should be clearly understood by the family. The goals must be realistic,
compatible with the developmental stage and be acceptable to family members. The
frequencies of visitations vary according to the prevailing situation. Usually frequent
short visits may be more meaningful to the family.

 IMPLEMENTATION
The third step in the nursing process is intervention or implementation of the care
plan. These are interventions in action that addresses the causes or factors related or
contributing to the problem; the goal is to achieve the expected outcomes for the
client. The nurse should involve the client in decisions regarding changes in the plan
of care so that both comprehend the focus of each nursing visit.

Apart from the services rendered at home of the client, the CHN plays a strategic role
of maintaining communication with the referring health facility or agency.

 EVALUATION

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 Expected outcomes are evaluated on the regular basis as set in the planning step. The
nurse should evaluate the care plan in light have the update knowledge of the situation
after each visit.

When expected outcomes are not met, or only partially met, the plan must carefully be
evaluated to determine the reason and then modified accordingly until the goals are met.

4. TERMINATION PHASE
When the purpose of the visit has been accomplished, the nurse reviews with the
family what has occurred and what has been established. Termination of the visits and
ultimately termination of the services begin at the first contact with the establishment
of a goal or purpose.*** (Below are the following that suggest termination)***
 Nurse-patient goals reached, health restored and the patient can function
without nursing actions.
 A patient changes his residence or leaves the home to go to another home
 The nurse transfers the patient to another nurse or other members to provide
health care.

In addition, nurse has to review visits with family and plan for future visits.

5. POST-VISIT PHASE/ ACTIVITIES

Even though the nurse has concluded the home visits and left client’s home ,
responsibility for the visit is not complete until the interaction has been recorded. The
major task for the post-visit phase is documenting the visit and the services provided.
The nurse records the important events in the family and reports the necessary
***materials*** to the higher authorities and discusses the problems of the family
with the colleagues and other members of the health team. And makes plans to meet
the needs of the family. The records are kept where only authorised persons can read
them. The nurse analyses community resources and prepares for the next visit.

PROBLEMS OF HOME VISITS AND POSSIBLE SOLUTIONS

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 1. Consumes a lot of time and energy: Community health nurses have to make trips from
their places to the patient’s home which consumes more time than required to serve
actual purpose of visit or providing care.
To overcome this problem, the nurse has to plan properly, proper street maps or
knowledge of location.
2. Non acceptance: The family might not accept the nurse due to various factors. The
causes might be cultural differences between the nurse and the family.
To prevent such, the nurse must be careful while communicating with the patient and
should behave in a friendly and professional manner.
3. Problems of local language: The nurse may not be fully acquainted with the local
community language.
Solution to this, the nurse must try by all means to learn the local language.
4. Role confusion: Confusions may prevail vis-a-vis the role a nurse in the community
where due to lack of knowledge individuals or families may fail to understand the role
of a nurse.

BAG TECHNIQUE

The major aim of health care services in the home is to help people with their problems and
work with them towards keeping the family health. When performing home visits, the
community health nurse should carry a community health bag, a general nursing kit and a
separate kit kept for deliveries and another kit for immunization.

The purpose of the bag is to carry out nursing procedures in houses which include weighing
the children, performing minor dressing and to conduct delivery in emergency situations. The
bag is used for carrying the materials and equipment needed during home visit to attend to
family health care needs.

DEFINITION

Bag technique is a procedure or a skill used in home visiting by use of a bag to carry
necessary tools by the CHN. It involves observing certain principles and steps closely
when handling, packaging, and when using the bag. This is a last thing done to gather the
bag and necessary equipment to take along.

CONTENTS OF THE BAG

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TABLE: 1 EQUIPMENT

OUT SIDE POCKET INSIDE CONTENTS

 soap in a soap holder These include:  incontinent sheets
 brush  2 Receivers  Jik 1:6 concentration
 news paper or plastic  2 thermometers  methylated spirit
material to put the  4 gallipots  multistix
bag on  adhesive tape  plastic apron
 hand towel  baby weighing scale  Foetal scope
 admission forms and  cord clamps which are  Torch
referral forms sterile  Water in a container
 cotton wool balls and  Sphygmomanometer
maternity pads  Disposable bags
 gauze bandages  Binaural stethoscope
 gloves (sterile and clean  syringes and needles
gloves) different sizes( 2mls,
 haemoglobin scale book 5mls , 21G & 23G )
 plastic sheet or Sterile packs
newspaper Cord care pack
 spatula Delivery pack
 tape measure Dressing pack
Vaginal examination pack

TABLE 2: DRUGS

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Orals Injectables

Fansidar tablets 50% Dextrose

Folic acid tablets Ferrous sulphate tablets Diazepam 5mg, 10mg
Oral rehydration salts Ergometrine
Panadols Hydrocortisone 100mg
Aldomet tablets Vitamin k 10mg

Valium tablets


PRINCIPLES OF THE BAG TECHNIC

 The bag should be kept clean at all times. Never PUT the bag on the floor or use
material that can transmit infections so easily.
 Wash hands thorough with soap and water before touching the inside of the bag.
 . Always carry a paper where to put the bag.
 When in a home, the bag should be kept away from children.
 Aseptic technique should be used when handling sterile contents from the bag
 After the visit, make sure all the equipments and tools used are cleaned and
packed back in the bag and recorded in the inventory book.
 Fold the newspaper inside out and put it back in the side pocket.

PROCEDURE FOR THE BAG TECHNIC

 When the CHN arrives at the home, she should ensure that bag is put on the clean
surface.
 A plastic sheet should be spread on the floor or table and place the bag on it before
use.
 Remove soap, nail brush, and towel from the side pocket in readiness for use.
 Hands should be washed with soap and water thorough before opening the inside of
the bag to remove the required tools to use during visit.

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  After procedure, all disposable items such as cotton swabs should be wrapped in a
news paper and disposed off into the pit latrine.
 The CHN folds the plastic sheet with exposed side innermost and puts it in the
outside pocket of the bag.
 Wash hands with soap and water after procedure.
 Write brief notes of the procedure done, observations made, and the instructions
given to the client on the client’s card.
 Finally thank the client and family members for their cooperation and hospitality.
In order to keep the nursing home visit bag read for use at all times, the nurse should empty
the contents and clean the bag at least once a week or more often depending on how much it
is used. Wash the bag with soap and water and dry it in the sun. While empting the contents,
check the expendable items e.g. gloves, catheters thermometer or glass article for being
broken or spoiled. After drying, the bag should be reequipped with articles, drugs or sterile
dressings/ packs and linen.

CONCLUSION
Home visiting is essential in meeting the health needs of the client in the community. It is
very important vehicle in promoting, preserving and maintaining health of the individual,
family and the community as well as preventing diseases. These services are under utilised in
Zambia may be due low staff levels in the health facilities as well as lack of community

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awareness on the availability of the services. Well utilised it is a very effective method of
taking the health services as close the individual and family as possible.

REFERENCES

Allender J.A., (1998) Community and Home Health Nursing, Lippincott, Philadelphia.

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Basavanthappa.B.T., (2003) Community Health Nursing, Jaypee,New Delhi

Central Board of Health, (2002) Integrated Technical Guidelines for Frontline Health
Workers, Lusaka.

Dickerson. E.J. and Schult M.O., (1979) Maternal and Infant Care, R.R.and Sons Company,
New York.

Leahy.K.M., Coob.M.M. and Jones.M.C., (1982) Community Health Nursing, 4th Edition,
McGraw Hill, New York.

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