N3000 Class 10
Key points to remember:
Clients and/or families allow healthcare professionals into their homes during vulnerable moments.
Always empathize; put yourself in the clients' or families' shoes and consider their feelings.
Objectives of home visits:
To enter a client's home and understand their health needs from their perspective.
Develop a relationship with the client and possibly their family.
The nurse acts as a guest, working collaboratively to identify and meet health care needs.
Consider the necessity of the home visit for the client.
Understand the advantages (personalized care, direct observation) and disadvantages (client privacy, safety concerns) of home visiting.
Essential steps before a visit:
Call and introduce yourself.
Schedule a convenient place and time for the visit.
Discuss the referral and the visit's initial reason.
Obtain detailed directions to the client's home.
Prepare for potential refusal of meeting by hypothesizing possible outcomes.
Prior preparations include:
Pack necessary items based on the type of visit (e.g., for a new mom or an elderly adult with complex care needs).
Have a reliable GPS system available.
Carry a cell phone for emergencies.
Check the weather to dress appropriately.
Ensure your vehicle is in good condition with a full tank of gas.
Bring hand sanitizer and prioritize personal safety.
Assessment of potential risks before visiting:
Determine if the neighborhood poses a high risk.
Assess for pets, history of violence, and substance misuse.
Evaluate client or family receptiveness and awareness of surroundings.
Safety practices include backing the car into the driveway and locking doors.
Be prepared to cancel the visit if personal safety is compromised.
Engagement
Assessment
Intervention
Termination and Evaluation
Post-Visit Documentation
Reference: Chapter 12, Pages 291-295
Key activities for engagement:
Introduce yourself and your professional identity.
Clarify the source of referral and the purpose of the visit.
Establish a shared understanding of the visit's purpose with the family.
Build the nurse-client relationship.
Steps in the assessment phase:
Conduct assessments of the client or family.
Engage in the "seeing phase" to understand their needs.
Apply the Calgary Family Assessment Model (CFAM) to pinpoint family health concerns.
Set mutually acceptable goals and solutions.
Assess the home environment, understanding what to look for.
Consider risk factors based on the environment:
Differences in risks between seniors and children/infants.
Specific hazards in the kitchen, bedroom, living room, bathroom, and stairs/entrances.
Intervention phase entails:
Implementing interventions with the CFIM framework.
Planning and prioritizing care in collaboration with the client/family.
Continuing to strengthen the nurse-client relationship.
Finalizing the visit:
Review the visit with the family.
Assess whether the established goals were met.
Provide referrals to other community resources as necessary.
Plan for future visits based on ongoing needs.
Follow agency policy when documenting the visit.
Objectives of effective debriefing:
Recognize and release emotions experienced during visits.
Reinforce the objectives of care delivered.
Clarify information and enhance critical thinking and problem-solving skills.
Foster reflective thinking and link practical events with theory.
Relieve stress associated with home visits.
Contracting strategy involves:
Formally involving family in the nursing process.
Jointly defining roles of family members and the nurse.
Recognizing the advantages and disadvantages of this approach.
Expected outcomes from home visiting in various contexts:
Public Health Nursing:
Increased rapport, parenting skills, health knowledge.
Decreased child abuse/neglect, maternal depression, hospital visits.
Better-adjusted children and enhanced social supports.
Continuing Care Nursing:
Improved rapport, understanding of illnesses, coping capacities.
Reduced unnecessary medical visits, length of stay in hospitals.
Enhanced client health and knowledge of available resources.
Strategies for enhancing home visiting skills:
Observe and learn from experienced nurses during joint visits.
Review and reflect upon communication and assessment skills.
Evaluate past home visits for accomplishments and areas of improvement.
Self-reflect on personal values and approaches.
Accept realities, seek common ground, and respect families' capabilities.