Home Visit

Introduction:
For each minor symptoms it may not possible to go to hospital

Again hospitals are loaded with patients who come with major problems

There are many people who are suffering with disease, stay home

without paying much attention to their health.

Community health nurses knock at the doors of the people to render

care whereas hospital nurses deliver care to only those people who go

to hospital.
Purposes:
Usual purposes:
1. To fulfil planned visits
2. Family seeks help from nurse to from nurse to visit one member who is sick/injured/has
any other problems
3. To visit antenatal/ high risk mothers who needed continuous support
4. To assess postnatal mother & new born
5. To alert on immunization
6. To assess nutritional status & conduct PE
7. As a follow up care
Other purposes:
1. To check treatment compliance of patients with communicable diseases & non
communicable disease
2. To screen contacts for communicable diaseases
3. To provide health education
4. Supervise other health workers
Principles:
1. Learn your community by collecting relevant information, that would help in
diagnosing community
2. Identify resources, use them efficiently.
3. Be one among the community by establishing a good rapport
4. Learn policies & procedures of your institution that would allow you to
perform duties freely & protect you legally
5. Conduct need analysis tat provides platform for home visit.
6. Prioritize identified needs and plan further.
7. Prior to home visit know about family by collecting information from family
folder or information system
8. Empathize and be patient in listening
9. Respect individual culture and family
Conti
10. Your procedures & health messages must have scientific rationale.
11. Nevertry to present in a way that you are the only one who know
everything. Now a days people have many opportunity to come across
various sources.
12. Involve family in planning & executing care
13. Thoughyou may go with a need based plan, if you happen to identify
any problem at home that may take up priority
14. Observe all the family members
15. Need based care concentrate on vulnerable groups( women, children,
elderly)
16. Problem based plan concentrate on morbidities
17. Write a note on your diary or individual record
18. Evaluate work to assure quality for further improvement.
Advantages of home visit:
It helps in prevention of disease, promotion of health & maintenance of health, early
detection of disease, surveillance & follow up.
It is possible to meet all members of family at a time in their natural setting.
Family tends to develop confidence in the subsequent visits.
Helpful in assessing individual & family in action
Helps in assessing existing relationship between family members
Family members get relaxed & at ease in their home
Older people of family can be contacted & their influence on the family
Family members attitude & practice can be observed
Helps in referring people who are in need for higher level care
Governmental agencies do not charge for service
Patient can get health messages at their home
Help nurse to learn culture of family & provide care accordingly
Can assess progress or growth of family
It identifies new problems and plan needed care accordingly
Disadvantages:

Travel time is costly

It is less efficient for nurse than working with groups or seeing many clients in

an ambulatory site.
 Steps involved in home
visit
1. Planning for a home visit
2. Locating house
3. Establishing rapport with family
4. Observation
5. Interviewing-phases
6. Nurse in action at home
7. Closing the visit
8. Documentation
9. Evaluation of home visit
1. Planning for a home visit
Before proceeding to plan get to know days issues (political issues, very hot day,
heavy rain or road blocks or fairs /festivals) in the area to be visited.
Stick on institution policy in scheduling home visits
Elicit due visits from institute information system/ family folders
Plan to visit group of houses in same located in same area
Plan approximate date, duration of time to be spent for each family based on
care
Planning of care include activities related to health promotion,
maintenance,.
Fill community bag with adequate supplies
Plan and arrange transportation
CHN with teaching responsibilities for students, should schedule time for it
Carrying umbrella & water bottle protects health
Wear footwear suitable for area
2. Locating house
Once you reach area locate house/ family

Identify & address from family folder/ from the information system list from

institution & note landmarks

If you are new to the area, can ask people by respectfully presenting name of

the head of the family.

3. Establishing rapport with family
When you reached house to be visited & if the door is opened & family members are

standing out you do not have the job of knocking door, but make sure people are

from the same house.

If doors is closed knock/ press call bell

When people are out greet them, tell purpose of visit by introducing yourself & your

institution

Leave foot wear outside & enter house.

Show your respect & cheerful face to all members of family

When family members offers seat accept cheerfully

Be friendly & show respect.

4. Observation
Make a note of familys response, need to observe verbal & nonverbal cues of
family to initiate further action.

Observing house & surrounding will help you to know strong & weak factors
promote or demote health

Initiate conversation with members to know about each individual. Get to

know about their concern about health.

During conversation, observe any person with acute/ chronic illness, pregnant
women, children, etc.

Encourage a discussion regarding water stagnation, mosquito breeding, etc.

Observe attitude & practices.

5. Interviewing, its phases:
Interview is a conversation where questions are delivered with a purpose to a

person who willingly answers to the same.

It will reveal more information about family, health

Understand health care values of various cultures.

Principles of interviewing:
Develop trust with client/ family
Choose appropriate environment, free of distractions
Provide privacy
Be confidential
Make client as comfort as possible
Maintain personal distance level
Maintain good eye contact & interact at eye level
Community health nurse should be a good listener
No preconceived ideas about the client or family
Time & duration should be planned
Recording the interview
Evaluation of interview
Setting essential follow up goals
Phases of interview:
There are 3 phases of interview:

1. Introduction/ initial phase

2. Focus / Working phase

3. Termination/ Recapitulation & transition phase

1)Introduction/ initial phase
Introduce yourself

Respect client & family

Make client comfortable

Watch for signs of client discomfort; do not overtire client or family

Use polite & professional tone through the interview

Thoroughly explain interview procedure

Always initiate interview with general concerns, then move on to

specific ones.
2)Focus / Working phase:
Take notes only needed. Do not write throughout

Use effective communication technique

Control process of interview, but do not monopolize

Be flexible

Treat individual & family with respect

Do not contradict the views or beliefs of individual and family

Never try to impose your own moral standards upon individual

Be compassionate & empathetic

Create conducive environment

3)Termination/ Recapitulation &
transition phase
Recap interview results

Set further goals & discuss about follow up plans or care

At the end find out from individual if anything else he/she

wishes to discuss
6. Nurse in action at home

Assessment of individual & family for health problems

Assessing knowledge attitude, belief

Involve family members in goal setting

Reinforce previous health education

Provide planned care

Conduct health teaching

Demonstration of home remedies

7. Closing the visit

Here CH Nurse concludes her visit

Conveys her plan for next visit

Confirms their availability

Completes visit by thanking the family.

8. Documentation

It is for appropriate follow up activities

All care provided, procedure performed, health education session must be

recorded.

It should clearly convey about problem identified, care provided, outcome &

follow up
9. Evaluation of home visit

Community health nurse can evaluate effectiveness of visit by using,

1. Was able to identify problems & needs of family?

2. Was there good relationship between family & CHN ?

3. Was family cooperative ?

4. Did the family show interest & involved in specific home remedy measures ?

5. Whether health message has reached individual & family ?

Phases of home visit:

1. Pre initiation/ preplanning phase-(Planning for a home visit,

Locating house)

2. Initiation/ introductory phase: (Establishing rapport with family,

Observation, Interviewing-phases)

3. Working phase: (Nurse in action at home)

4. Ending /termination phase: (Closing the visit, Documentation,

Evaluation of home visit)

Promoting nurses safety;
Include the following:
If possible obtain familys permission to work with them by phone before home visit
Ask for direction to their road, or home
Consider time of day is safe for visit
Do not carry purse or jewelers
Wear appropriate dress
Carry ID card
Avoid secluded area- basement, empty building
If feel unsafe, do not visit family
Sit between client & exit
Consider asking pets to be removed from room
Consider whether an escort is needed to visit if required
Avoid a home in which fight, drug use are in progress
Always report agency after end of the day
Visit only during scheduled work hours.
THANK YOU