Home visiting / home health service is that component of a continuum of comprehensive health care in which health services are provided to individuals and families in their place of residence to promote, maintain or restore health
Assessment is the first step in the process of family health care, but when do you carry out this assessment?
You could assess family members when they visit your health facility. However, to get a comprehensive picture of a family’s health, you need to visit them at home. Home visits are an important part of your work as a community health nurse, as they allow you to see families and their needs in their own homes.
Objectives of Home Visiting
- To create close relationships with communities and families.
- To discover the conditions in which the family lives & to identify how these conditions affect their health.
- To promote family health by providing family members with health education adapted to their levels of growth and development.
- To monitor the use of skills learned in health education
- To demonstrate to the family how to administer health care needed by other family members.
- To refer to appropriate specialized services.
Purpose of home visiting.
- Afford the opportunity to gain a more accurate assessment of the family structure and behaviour in their natural environment.
- Provide the opportunity to make observations of the home environment and to identify both barriers and supports for reaching family health promotion work.
- Meeting the family on their home ground may also contribute to the family’s sense of control and active participation in meeting their health needs.
- It keeps you aware of what is going on in your catchment area.
Principles of home visiting
- Family members should be included in all phases of the care process.
- The health workers (teams) are guests in the client's home therefore only make these
interventions that the clients agree with. - Mutual health team: client goals and interventions may require long periods to achieve; therefore, patience is necessary.
- The health team functions autonomously in the family health care provision. The family and the team develop a positive interpersonal relationship as they work to achieve their goals.
- The health team is a visitor to a client; therefore, the team must not wait to be motivated.
- Should be to demonstrate the principles of health
Skills of a community health nurse
- Good technical skills and knowledge of preventive and therapeutic measures.
- Good communication skills and teaching abilities.
- Good leadership skills and rational thinking to make sound judgments.
- Good counselling skills and an understanding of human relations.
- Good understanding of community culture and environment.
Areas to be assessed during home visits
- General cleanliness
- Solid waste disposal
- Latrines
- personal hygiene
- vaccination of < 1-year-old infants
- vaccination of women
- Antenatal care
- Feeding of children <2 yrs
- Family planning
- Presence of insects or rodents in the house
- Presence of a sick person in the house and action taken.
The Process of Home Visiting
The process of home visits is carried out in five phases:
Entry or Initiation Phase
The community health nurse shares information with the patient on the reasons and purposes for home visits. This interaction may occur in a hospital ward or at a clinic.
Pre-visit Activities
Before the home visit, you must look for information regarding the patient and the family. You also need to gather information regarding the house's location, distance from your health facility, and physical address. It also assesses patients' willingness, reviews records, and schedules the visit.
Activities during Home visits
This is the working phase during which you put into action your planned health activities. During this phase, you must establish trust and rapport with the patient and the family so that there can be an appositive interpersonal relationship (a professional nurse-patient relationship). This relationship will enhance the achievement of the mutually determined health-oriented goals.
Termination Phase of Visit
This occurs when the health-oriented goals have been met. Termination of home visits can occur due to any of the following reasons:
- The patient’s health has been restored, and the patient can function without the nurse.
- The patient has changed their residence.
- The community health nurse has transferred the patients’ care to another nurse or agency.
Post-visit Activities
- Post-visit activities include recording and reporting important events of the home visits and sharing the reports with the appropriate authorities and individuals about the patient's family
Advantages of Home Visiting
- Home visits give a more accurate assessment of the family structure and behaviour in their natural environment.
- Home visits provide an opportunity to observe the physical environment of the home and identify barriers to, and resources for achieving family health.
- At home, the nurse works with the patient first-hand to implement health action using realistic resources.
- By meeting the family on its home ground the nurse will be enhancing the family’s sense of control and active participation in meeting its health needs.
- It provides an excellent opportunity to implement planned health care.
- It provides an opportunity to learn about the home and family situation.
- It provides an opportunity to render health care services to the family members in their surroundings.
- It creates a good understanding between the nurse and the patient and builds a good image of nurses.
- It provides an opportunity to clarify the doubts and misconceptions raised by family members.
- It provides an opportunity to observe and appreciate family practices and the progress of care given by the nurse and others.
Disadvantages of Home Visiting
- Home visits consume a lot of the nurse's time and energy, as well as transport costs.
- Unforeseen events may occur during home visits, which will interfere with planned activities.
- The patient’s family may not accept the nurse due to various factors such as cultural or religious differences, personal characteristics of the nurse and the patient, or, to some extent, the socio-economic status of the nurse and the patient.
- There is confusion about the nurse’s role in a community where there may be a lack of knowledge and understanding of the role of the community health nurse.
- Certain homes may be geographically unreachable.
