Home visiting

Introduction

Home visits are an indispensable component of community health services, particularly vital in regions such as Nepal where over 90-95% of the population resides in rural areas with inadequate access to fundamental healthcare services. Regarded as the cornerstone of community health nursing, home visits address the needs of individuals, families, and communities by offering nursing services and health counseling. They present a unique opportunity and challenge for nurses to collaborate with families within their own environment, fostering a sense of teamwork. Additionally, home visits allow for the observation of household dynamics and the identification of barriers to, as well as sources of support for, achieving optimal family health. A home visit constitutes a direct interaction between a nurse and a family, enabling the healthcare provider to evaluate the home environment and family dynamics, thereby facilitating the delivery of essential nursing care and health interventions.

Definition of home visiting

Home visiting refers to meeting the health needs of people at their doorsteps. It requires different skills as technical skills, resourcefulness, judgment, teaching abilities, knowledge of prevention, simple therapeutic measure, decision making skills and full understanding of human relationships. Each home visit should benefit the individual, family and community to fulfill the objectives of visit.

Purposes of home visiting

1. To assess the health, socio-economic, and cultural needs of individuals, families, and communities.
2. To deliver domiciliary midwifery care to pregnant women, during delivery, and in the postpartum period for both mother and infant.
3. To provide care to the sick, including postpartum mothers and newborns, while educating responsible family members to continue care.
4. To evaluate the living conditions and health practices of patients and their families, enabling tailored health education.
5. To offer basic health services for minor ailments such as injuries, boils, and abrasions.
6. To provide counseling on family planning, immunization, and nutrition.
7. To offer health education on disease prevention and control.
8. To establish strong nurse-public relationships to promote health.
9. To facilitate inter-referrals system and promote the utilization of community services.
10. To investigate potential sources of infections or diseases.
11. To supervise and mentor other healthcare workers.

Principles of home visiting

When carrying out the home visit, the community health nurse should follow certain basic principles which are as follow:

1. Every home visit should be guided by a clear purpose and specific objectives.
2. Home visits should be planned based on priority, addressing the most pressing needs first.
3. The purpose of each visit should be transparent, consistent, and adaptable to the evolving needs of the family.
4. Begin by introducing yourself, your organization, and the purpose of the visit, while gathering pertinent information about the individual and family environment.
5. Foster a positive interpersonal relationship with the family by being courteous, compassionate, and approachable.
6. Actively listen to the family members and respect their perspectives.
7. Ensure that health education and nursing care provided are evidence-based and scientifically sound.
8. Employ safe technical skills and adhere to established nursing procedures.
9. Engage all family members in the nursing care process whenever possible.
10. Cultivate a constructive interpersonal relationship between the nurse and family members to facilitate goal achievement.
11. Periodically evaluate the effectiveness of your interventions and adjust as necessary.
12. Maintain detailed records of each home visit in your dairy.
13. Express gratitude to the family and individuals for their cooperation and participation during the visit.

Advantages of home visiting

1. Community health nurses can observe and assess individuals and families in their own environment, which often fosters a more relaxed atmosphere and facilitates easier communication compared to hospital or clinic settings.
2. One visit allows for the assessment of all family members by a single healthcare provider.
3. Home visits provide an opportunity to observe the background, attitudes, interpersonal dynamics, and family relationships of individuals and families.
4. This observation aids in understanding the basic physical and emotional needs of individuals and guides them in meeting those needs.
5. Prompt and appropriate home visits contribute to a positive relationship between the nurse and the family, enhancing the image of nurses in the community.
6. Home visits offer a platform to address any concerns or questions raised by family members.
7. Individuals gain more knowledge and adopt a realistic approach to healthcare as they are more relaxed in their familiar surroundings.
8. Nurses can observe family practices and the actual care provided by family members.
9. Home visits provide an opportunity to meet other family members and influential individuals within the family.
10. They enable the identification of new health problems that may not have been apparent during clinic visits.
11. Home visits are particularly beneficial for patients who are unwilling or unable to travel to healthcare facilities.
12. High-risk families can be identified and prioritized for targeted interventions through home visits.

Steps in home visiting

Community health nurse has to follow certain steps of home visiting.

1. Fact finding
2. Data collection and analysis
3. Planning action with family
4. Action and health education
5. Follow through
6. Evaluation of service

1. Fact finding

• Begin by preparing a comprehensive map of the area to be visited, including key landmarks such as roads, ward offices, schools, clubs, temples, churches, and government offices. Additionally, organize family folders and survey materials for efficient data collection.
• Collect background information on the family and community, utilizing surveys and family folders. This includes details such as family size, occupation, education, date of birth, income, religious beliefs, customs, cultural values, available local resources, past health history, current health status, utilization of family planning methods, immunization status, and practices related to safe motherhood.
• Establish a friendly and positive interpersonal relationship with the family members, demonstrating courtesy, politeness, and genuine interest in their well-being.
• Employ technical skills and nursing procedures as necessary during the visit.
• Identify the specific needs of both individuals and the family as a whole. This may include requirements for antenatal, intranatal, and postnatal care, as well as care for infants, toddlers, children under five, and those suffering from acute or chronic illnesses, including individuals unable to access healthcare facilities.
• Observe the home environment thoroughly, noting any factors that may impact the health of the family members.
• Engage in discussions with family members to identify the root causes of any issues and explore potential solutions collaboratively.

Fact-finding can be achieved through observation, assessment, review of health records, discussions with neighbors or local leaders, and analysis of gathered data. These facts serve as a guideline for planning, educating, and addressing problems effectively.

2. Data collection and analysis

Following the collection of data and facts, the analytical process begins. Analysis should be objective, transparent, and grounded in factual evidence rather than personal opinion. It should encompass various dimensions including personal, environmental, economic, emotional, and spiritual factors, which collectively contribute to common health issues. Each problem and corresponding facts should precisely illustrate the issue and outline expected actions. A systematic discussion of each point should be undertaken, critically examining the matters at hand. Conclusions should only be drawn after careful consideration of all relevant information.

The information gathered represents raw data that requires processing to yield meaningful insights. Data should exhibit uniformity, consistency, accuracy, and completeness, with extraneous information being omitted. Various analytical techniques such as tabulation, population pyramids, graphs, and pie charts can be utilized to present findings effectively.

3. Planning action with family

Planning action with the family is a pivotal aspect of our work and relationships. It involves setting realistic objectives and devising strategies to achieve them effectively. Beginning with identifying small achievements and acknowledging them fosters motivation and confidence within the family. Encouraging discussions around available resources and potential solutions helps identify feasible courses of action. Priority should be given to addressing essential basic needs such as hunger, followed by considerations for personal hygiene, safe water, and sanitation. Effective planning necessitates consideration of the family’s circumstances, home environment, and available local resources to ensure practicality.

 Additionally, planning should align with both short-term and long-term objectives of the family. Exploring alternative plans or suggestions can offer valuable insights. It’s essential to respect the ideas, suggestions, and solutions proposed by individuals within the family. Ultimately, effective planning lays the groundwork for successful actions and the achievement of objectives.

4. Action and health education

After planning, a formal home visit should be conducted to address the identified problems. During the initial visit, the community health nurse should introduce herself and clarify the purpose of her visit. The conversation should be informal, allowing ample opportunity for questions and discussion. Action and health education should be tailored to fit the family’s schedule. It’s important to determine the best time for teaching based on their daily activities. For instance, if the family is engaged in food drying in the yard, this presents an opportune moment to educate them on proper food storage techniques. Explain the objectives, benefits, and methods of storage while assisting them in the process, fostering effective teaching and building strong interpersonal relationships. Practical demonstrations should be emphasized over theoretical explanations. At times, families may lack information about accessing hospital care. In such cases, it’s important for the community health nurse to facilitate access to healthcare services by arranging transportation for ill individuals to the hospital, assisting eligible couples with sterilization procedures, and ensuring children receive necessary immunizations. This proactive assistance positively influences the community’s perception of the community health nurse.

5. Follow through/Follow up

It is one of the most important steps of home visit. Follow up for those works which were already planned & implemented to find out how far the objectives are fulfilled. It also helps to find out how far the instruction, suggestion & actions were followed. Appreciate if they have done well & if not find out the cause. It gives clear ideas for the planning for next visit.

6. Evaluation of service

For this, review each family record periodically & answer the following questions.

• What is the immediate problem/need?
• What is the total problem?
• List the difficulties and hindering factors in the situation.
• List the helpful and supporting factors e.g. coping ability of family, availability of local resources
• What has been done about the immediate problem?
• What plans is being made & what actions are being taken to deal with the underlying cause of    problem?
• How did the person respond to your visit?
• What change took place?
• Have you made effective use of man, material and measures?
• How far the visit has been useful?
• What is the attitude of individual, family and community?
• Do you need guidance, counseling and discussion with your superior?

The result of community health service is not always seen immediately, it takes time. Knowledge is changed but attitude, habit and behavior change is difficult, but once changed, it has permanent effect. It may take various times depending upon individual’s attitude and thinking.

There are some failure parts on health workers and families so they should analyze properly, acknowledge them and re plan accordingly with proper and wise time. When you are providing services to the community, you should have enough patience to see the result of your action.

Bag technique

 Home visiting bag

A community health nurse relies on essential tools to provide effective nursing care during home visits. The community health nursing bag is a fundamental component of her daily practice, containing necessary equipment, supplies, and medications. It serves as a means to transport materials and equipment required for delivering family health care. The bag is typically crafted from khaki material, featuring outer and inner pockets for organization. The outer covering boasts two compartments: one for a soap dish with soap and a hand towel, and the other for newspapers or plastic sheets. Additionally, both sides possess pockets for storing bottles of solutions such as spirit, antiseptic lotion (e.g., Dettol), calamine lotion, and gentian violet. The inner lining is equipped with pockets to house medicines, small bags, and other medical equipment and supplies. Proper arrangement of items within the pockets ensures easy accessibility.

Purposes of the home visiting bag

1. Facilitating basic health measurements for students.
2. Providing basic first aid and simple treatments.
3. Demonstrating the promotive aspect of healthcare.
4. Performing nursing procedures in a home setting.

Principles of using the bag

Cleanliness

• The bag and its contents are maintained for efficient service, requiring regular cleaning and readiness for use at all times.
• Hands should be washed with soap and water before handling the bag to prevent contamination.
• Soiled or contaminated instruments and articles must be washed and disinfected before being returned to the bag.
• The bag should be protected from contamination by children and dust, ensuring it remains on a clean surface during use.
• Personal items should not be stored in the nursing bag.

Usage and care

• The bag is essential for each home visit, particularly for maintaining cleanliness and demonstrating nursing care.
• Proper hand hygiene is crucial, and soap and water should be readily available.
• Careful handling of instruments and disposal of soiled materials should be practiced.
• After use, the bag should be cleaned and reequipped with fresh supplies.

Equipment and materials in the home visiting bag

• Newspaper
• BP instrument and stethoscope
• Foetuscope
• Scissors
• Small bowl
• Betadine solution/ointment
• Cotton
• Hand towel with a towel bag
• Paper bag
• Apron
• Bandage
• Thumb forceps and artery forceps
• Thermometer
• Gauze pieces
• Measuring tape
• Soap dish with soap
• Essential medicines (e.g., paracetamol, antacids, vitamins)

Regular maintenance of the nursing bag, including cleaning and restocking, ensures its readiness for effective service provision during home visits.

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