21 CHAPTER

Home Visit A nursing care visit in a client’s residence

Advantages of Home Visits Convenience Access Information Relationship Cost Outcomes

Convenience Clients often prefer to be seen in their homes Reduced transportation costs No waiting for services

Access Clients may be immobile or lack transportation Community health nurse has access to clients that may not necessarily present themselves for services in other settings A home visit permits the nurse to identify clients in need of services

Information The home visit permits the nurse to obtain information not readily available in other settings Valuable information is obtained about family dynamics, physical environment, psychological and sociocultural factors present that may have a bearing on the client’s health status

Relationship In the home setting, the client exerts autonomy and control The nurse may foster a sense of empowerment Permits a sense of privacy Clients may offer more information especially about sensitive issues The home visit fosters a sense of continuity in the nurse-client relationship, especially if there are repeated visits, or a long-term purpose for the visits.

Cost Home visits and home care are less expensive than hospital care or long-term facility placement

Outcomes Home visitation programs have been documented to achieve a variety of health-related outcomes for many different populations

Challenges of Home Visiting Programs Client diversity Multiplicity of client problems

Need for Balance between Opposing Agendas Intimacy and professional distance Dependence and independence Risk and safety Cost containment and quality Health restoration and health promotion services Task orientation and meeting client needs

Need for Balance between Opposing Agendas FIGURE 21-1 Maintaining Balance in Home Visiting.

Purpose of Home Visiting Programs Four categories Case finding and referral Health promotion and illness prevention Care of the sick Care of the dying

Case Finding and Referral Identify clients needing additional services Provide referrals to appropriate sources of services

Health Promotion and Illness Prevention Focuses on specific populations Examples: New mothers Children needing child developmental interventions

Care of the Sick Providing direct services Examples: Elderly Populations with chronic conditions Recent hospital discharges

Care of the Dying Specialized services to people with terminal illnesses Palliative care Education and information for family members Caregiver respite services Physical therapy Counseling and spiritual care Assistance with specialized equipment needs

Planning a Home Visit Review previous interventions Prioritize client needs Develop goals and objectives Consider acceptance and timing Delineate nursing activities Obtain necessary materials Plan for evaluation

Review Previous Interventions Determine the efficacy of the interventions Identify successful and unsuccessful interventions

Prioritize Client Needs Potential threat to their health Degree to which the health threat concerns the client The ability to resolve the health issue

Develop Goals and Objectives Stated general expectations Example: Develop effective parenting skills Objectives Specific/tangible outcomes desired Example: client will display effective communication skills in relating to their children

Consider Acceptance and Timing Client’s readiness to accept intervention Build rapport and trust Timing of the visit Client must be open to the visit Introduction of the interventions

Delineate Nursing Activities Nursing diagnosis utilizes: Practice guidelines Agency procedures/protocols Clinical pathways Examples: health promotion, referral, education, technical procedures

Obtain Necessary Materials Supplies and materials for home visit Educational materials Health care equipment Wound care supplies Physical assessment equipment

Evaluation Planning Evaluation criteria obtained from outcome objectives Long-term evaluation criteria Client’s receptiveness or response to nursing interventions Short-term evaluation criteria Actual accomplishment of objective

Implementation of the Home Visit Validate assessment and diagnosis Identify additional needs Modify the plan of care as needed Perform nursing interventions Deal with distractions

Distractions Environmental Behavioral Nurse-initiated

Environmental Distractions Background noise Crowded surroundings Interruptions

Behavioral Client behaviors Explore reasons for behaviors Work to establish trust

Nurse-initiated Fears Personal reactions to different lifestyles Bodily harm Client rejection Lack of control Personal reactions to different lifestyles

Evaluative Criteria Intervention outcomes not immediately apparent Need to determine if subsequent visits are needed Need to evaluate if appropriate level of prevention was implemented

Resources Nurse-Family Partnership is an evidence-based nurse home visitation program the improves the health, well-being and self-sufficiency of low-income, first-time parents and their children following the David Olds model, Registered Nurses visit the home from the time the woman is pregnant until the baby is two years of age. Outcomes have been measured for over 25 years.

Resources The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end of life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America.

Resources Home Health Agency Center, a section of Health & Human Services. This site links to current home health policies and regulations as well as home health prospective payment system rate updates. Links to payment systems, legislation, manuals, research, publications.

Resources HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care and claims processing. HEDIS is sponsored, supported and maintained by the National Committee for Quality Assurance (NCQA).