Home Visiting- presenter Mrs. L.

Tikoimaleya

4/14/12

What is home visiting?

A home visit is a purposeful interaction in a home/residence directed at promoting and maintaining the health of individuals and the family(Maurer & Smith 2005) A home visit is conducted to visit client where they live in order to assist them in their efforts to achieve as high a level of wellness as possible( Allender & Spradely 2004) 4/14/12

history
Home Visiting was established in 1885 Buffalo, New York to care of the poor sick at home who were economically affected. The main functions of the visiting nurses were as follows:

to provide nursing care for religious instruction

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To reduce the incidence of acute communicable diseases in 1910, community oriented nursing intervention concentrated on:

Improved sanitation Economic improvements visiting Better nutrition

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home nursing

Preventative education to

objectives
At the end of these unit, the student is able to: 1. Explain

i) the aims of home visiting ii) the advantage and the limitation of home visiting

2. Describe activities to be carried out with:

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i) preparation for the visit

Cont objective

3.Demonstrate skills in: i) planning a visit ii) establishing, maintaining & terminating a relationship with the clients and family iii) assessing the individual/family in self-care iv) assisting the individual/family develop self reliance 4/14/12

cont

v) referring the individual/family to the appropriate stakeholders as and when required vi) recording the visit vii) updating of data as required

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Working in the community and being able to visit families in their home is a privilege A home is a: unique setting most intimate of spaces own creation private spaces

i) ii) iii) iv)

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cont

Work with the family where they live street, with homeless shelter, with relatives, next of kin, or significant others or boat house in order to assist them. CHN have historically sought to promote well being of families in the home setting CHN seeks to prevent specific 4/14/12 illnesses, injuries, & premature death

cont

CHN provide opportunities for families to become aware of potential problems, to receive anticipatory education and to learn to mobilize resources for health promotion and primary prevention. In clients 'homes, care can be personalized to a familys coping strategies, problem solving skills, and environmental resources 4/14/12

cont

CHN can uncover threats to health that are not evident when the family members visit a physicians/health clinic or emergency room. All levels of prevention can be addressed during home visiting
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aim
To improve health and the quality of life through:

Initiate and maintain relationship with the family/Gibbs Trust Model More accurate assessment of the:

i) family structure ii) the natural or home environment iii) behavior in that environment
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cont aim
iv)Provide opportunities to identify both barriers and supports for reaching family health promotion goal

Source of data Follow- up care Implementation of the nursing process in the home
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advantages of home visiting

Client convenient remains at home but continue ongoing treatment /care Client control of the setting greater control of the interaction Providing for an option for the clients who are unable/unwilling to travel Ability to individualize services
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cont advantages

Relaxed environment for the discussion for concerns and needs Able to observe factors that influence family health Able to observe family interaction Allows for early intervention
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Able to identify environmental hazards and resources Allows for assessment of family over longer period of time Facilitates family participation in health care Facilitate family focus and individualized care 4/14/12

disadvantages of home visiting

Costly - cost of pre-visit preparation is high - travel to and from the home Less coverage: time spent with one client/ family Change in value system and style of practice not very compatible in providing services at home
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No easy access to emergency

cont

Personal safety concerns Work individually (no group consultation) Distraction difficult to control Family resents intrusion into home and/or prefers the health care setting Can be exhausting for the care giver
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Planning a visit

Factors to be considered in planning a home visit: geographic layout of the area number of house/homes to be visited Distance (further from the home- less no to be visited) Transport Time sent in a home- full assessment

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Walk from Here !

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suitability

Acceptance Working time of the family Special functions in the family Safety of the nurses

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cont

Building a trusting relationship with the client/family is the cornerstone of successful home visits Five(5) skills are fundamental to effective home visit: Observation Listening prompting Questioning * probing *

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Process of home visiting

The process of home visiting is summarized into phases and its activities Phase 1 Initiation Phase Phase 2 Pre-visit phase Phase 3 In Home Phase
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Initiation Phase

Initiated by; referral by the health or social agency the family/individual Nurse initiated for case finding activities Clarify source or referral for visit Clarify purpose for home visit
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Pre-visit Phase

Initiate contact with the family Establish shared perception of purpose with family Determine familys willingness for home visit Schedule home visit
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In- Home Phase

Introduce self and professional identity Interact socially to establish rapport Establish nurse-client relationship Implement nursing process4/14/12

A joke folks the current A/H1N1 swine flu strain has yet to be isolated from pigs! Transmission is strictly from human to human! 4/14/12

JICA Immunizationr

Vaccine Carrier

Safety Box Syringe 4/14/12 Immunization Child

Termination Phase

Review visit with family- the objective of the visit is achieved Plan for future visits planned together with the family Thank the family for their time

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Post-visit Phase

Record/document visit and the services provided - major task Plan for the next visit Clean up utensils/equipment Thank you for listening

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Thank you

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Home Based Care

Objectives: At the end f the study students are able to :

1. Explain the goals of home based care 2. Describe activities that are carried out in home based care
2.1 preparation for the visit 2.2 4/14/12 During the visit

cont

3. Discuss the importance of assessment in home based care 4. Identify strategies in helping the client/ family to develop self reliance 5. Demonstrate skills in
5.1 Assessing the health status of client /family
5.2 Identify potentials in self care for client and family 5.3 Assisting client and family to develop self 4/14/12 reliance

What is home based care?

Definition: Broadly define and refers to all of the services and products provided to clients in their homes to maintain, restore, or promote their physical, mental and emotional health Purpose: To maximize the clients level of independence and to minimize the effects of existing disabilities through non-institutional services Primary Goal: to use these supportive services to decrease hospitalization and to prevent or delay institutionalization Goal: To assist the client to return to an optimum 4/14/12 level of health and independence.

cont

To enable the client to reach optimum level of health and independence it is essential to work with family in the provision of care Family in this context is : individual, caregiver, or any significant person who assist the client in need of care at home Care at home nurse provide care for procedures and treatments and for those who wish to live out the final days of their lives in their homes rather than institution.

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Home Health Care System

Developed countrys privilege Locally, only to some extent Individual with extremely complex needs may need the service of an agency with a direct link to a medical equipment company
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Caregivers

Clients cared for in their home environment are looked after by two (2) types of carer: Formal: Formal caregivers are professional/ trained nurses, paraprofessionals who are compensated for the in-home care they provide or services provided Informal: Family members, friends, 4/14/12 significant others who provide care in

Nurses Role & Functions

Distribution of power at home differs from institution Establish trust and rapport with client and family Individual family empowerment family function independently Nurse continually assess the clients response to intervention, report their findings and collaborate to modify 4/14/12 treatment plan as needed

cont

Today caregivers provide care in the home that was historically provided only in the hospital Caregiver also provide maintenance care between the visits of the professional provider Informal caregivers are the focus of the nurses consideration because they are not skilled many skills will 4/14/12 taught by the nurse. be

cont

Clients goal: health promotion, maintenance, and restoration Services can be tailored to any clients need or problem Intimate home setting Cultural belief and practices are more visible Lessen the burden of the nations

Advantages:

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Disadvantages:

Physiologic, psychosocial problems due to long term care Complex responsibilities due to health care costs Inadequate living condition and support system will compromise client care
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Nursing Specific Roles

Advocator Caregiver/Clinician Educator Case Manager

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advocator

The nurse advocate for the client by: Assistance to community resources Make inform decision Coping mechanism to changes in the life style Negotiation for legal issues Collaborate with other health care professionals
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caregiver

Assess and diagnose the clients actual potential health problem Plan care and evaluate clients 'outcome Direct actual care e.g. bathing , feeding etc Carry out and direct specific procedures and treatment e.g. IV, ostomy care, wound care

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Educator
Educative role focuses on:

Illness care training of caregiver Prevention of problem Promotion of wellbeing. Education is ongoing and is considered the crux of home based care Responsible for the secondary client 4/14/12 who are the care givers

cont

CHN can teach caregivers how to manage clients successfully at home by using these approach Keep safety at the forefront of all interventions Include all family members and care givers in the plan To help keep caregivers frustration low choose to chose an area that the 4/14/12 client is motivated to learn

cont

Provide tips on energy conservation for caregiver and client Include how to clean and manage equipment Help the family how to develop a home emergency escape plan

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Case manager/coordinator

The CHN coordinates the activity o0f all other health professionals involve in the health care Physician, Dietitian, Physiotherapy, CRA, and nurse practioner Report any changes in the client condition Bring about and inform changes in the care plan

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cont

Documentation of care coordinated must be recorded Clients progress towards goal Achievement at each visit Client should be ready for self care and discharge from your care

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Clients safety

Hazards in the home are major causes of falls, fire, poisoning ect. Improper use of house hold equipment Improper storage of medicine, chemicals/ poison, ect. Loose floorboards Family member/caregiver should be instructed to make sure the 4/14/12

cont

All household items/furniture should be kept safe and out of the way Assessment of the home environment- very important to inspect the home thoroughly Post a list of emergency telephone numbers e.g. police, ambulance, fire or physician beside the phone

For clients who live alone:

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cont

Post list of clients medication and potential side effect in a central location e.g refrigerator door Help the client and family to apply for medical alert system such as bracelet or necklace Enroll your client in an emergency response system especially if your client lives alone.
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continuity of care at home

To allow continuity of care at home the nurse should identify (care giver is trained to) and appoint a family member who will be tasked as caregiver Meet the physical needs e.g. -bathing infectious condition e.g. HIV Wound dressings & administration medication

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cont

Meet the emotional, spiritual, psychological needs of clients Give some comfort when necessary Reassure when required Support when needed Strengthening of family support through: Health education
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