1. 21
CHAPTER

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

3. Advantages of Home Visits
Convenience
Access
Information
Relationship
Cost
Outcomes

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

5. 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

6. 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

7. 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.

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

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

10. Challenges of Home Visiting Programs
Client diversity
Multiplicity of client problems

11. 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

12. Need for Balance between Opposing Agendas
FIGURE Maintaining Balance in Home Visiting.

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

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

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

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

17. 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

18. 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

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

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

21. 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

22. 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

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

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

25. 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

26. 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

27. Distractions
Environmental
Behavioral
Nurse-initiated

28. Environmental Distractions
Background noise
Crowded surroundings
Interruptions

29. Behavioral Client behaviors Explore reasons for behaviors
Work to establish trust

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

31. 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

32. 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.

33. 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.

34. 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.

35. 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).