2. 6.1.1. Introduction
Home Visiting :
Home visiting means visiting the family at their place to assess the
health needs, to provide services such as preventive,promotive,curative or
rehabilitative services at their door Step by community health nurse or health workers
before commencing home visits, a base line survey should be completed.The data
analysed and a map of area prepared showing the situation of the subcentre. Villages
& hamlets.
In each family at least 3 monthly visits should made by health worker and in intensive
area, it should be every month.
Home visiting is the backbone Of community health nursing Visits at home should be
made by A.N.M., public health nurse i.e. community health nurse It provides an
opportunity to the community health nurse to observe the environmental and
conditions at home and provides an opportunity to provide services based on
inindividual need of family and its member.
3. Definition
Home visiting : is defined as providing the service to family at their door step to maintain the
health and to reduce the mortality and morbidity in family.
Home visit provides an opportunity to Community health nurse to make direct observation of
home environment, life style, cultural practices and to make family health assessment.
Home visits also provide an opportunity to maintain continuity Of Care.
Home visit is the nurses key activity in meeting the needs of family and community,in general
nursing services & health counselling.
Home visits refers to meeting the health needs of people at their doorstep, while provision of
health services at home needs technical skills, resourcefulness, judgement, teaching abilities
& a full understanding Of human relations.
Home visiting is one of the most important responsibilities of the community health nurse.
The health worker should study the health data and map Of area.
The community health nurse should have the knowledge of name & addresses of Dais, UHG &
medical practitioners and should know about transport facilities.
4. 6.1.2. Purposes of Home visits
To observe the family structure, familial rules & relationship. life style and
cultural practices
To establish working relationship with family members.
To find out health problems and to investigate associated causes of problem.
TO plan and implement nursing per need of the family.
To teach the family about the cause & type of health problems which can occur
due to poor environment in family.
To guide & counsel the family related to various health problems.
To do the follow up & evaluate the health care given to family.
To refer the complicated cases for hospitalisation or institutional care.
To maintain continuity in care.
5. 6.1.3. Principles of Home Visits
1. Based on needs of people : Home visits should be made according to needs of the people of family.
2. Before visiting family, collect information pertaining to family : Collect background information regarding family in particular and
community in general. i.e. information regarding family size. occupation, income, religion, resources, etc.
3. Use safe technical skills : Make use of safe technical skills while providing care & services to family.
4. Use kind & courteous approach : The approach used towards family should be kind & courteous in order to gain confidence.
5. Planned & purposeful : The home visit should be planned before visiting and should have a definite aim of visit such as provision of MCH
services etc.
6. Regularity : Home visits should be conducted at regular intervals, so that maximum co operation of the selected units or family can be
acquired.
7. Flexibility : There should be flexibility in home visits. There is always a possibility that owing to the prevailing circumstances at home, the
aim of home visit has to be changed or cancelled.
8. Voluntary & convenient : Home visits should be voluntary & convenient for the family members. During home visits people should be
motivated to accept the health aspects voluntarily instead of forcefully Imposing one's concepts on them.
9. Interpersonal relationship : Health assessment of family members can be done, if interperssoanl relationships are good With family. Even
the planned procedures can be implemented effectively with good interpersonal relationship. So, the community health nurse should
establish interpersonal relationship with family members.
10. Educative : Community health nurse should ensure that the family members should get education regarding the health problems, care &
referral services.
11. Evaluative : Home visits should be followed & should be in continuity. The care provided or education given should be evaluated in regular
visits.
7. Frequency of Home Visits :
Frequency of home visits depend upon following factors :
Extend of health needs
Extend of health problems
Needs felt by family
Family's ability to deal or cope with health problem.
Family's regularity in home visit.
8. Selecton Of Family for visit :
Families for visits are selected on basis of :-
Priority
Needs related to health felt by family.
Available time.
Work load on community health nurse.
Policies of health agency.
Available facilities.
9. Establishing Priorities:
Priorities are established on the following guidelines as given by K.K. Guiani
Visit in response to needs felt by family.
Visits to premature infants & infants with defect.
Regular visits to postnatal mothers and antenatal mothers.
Visits to chronically ill patients.
Supervising visits to infants, toddlers, eligible couples.
Collection of family information & investigations.
Information, education, counselling and guidance purposes
10. 6.1-4. Components of Home Visiting OR
Phases of Home Visits
Home visiting provides an excellent opportunity to observe the real family condilion, assess
the health status of its members and implement nursing process.
Phases of Home visiting are :
Initiation phase : Community health nurse informs the family about the purpose of visiting after
giving introduction oi herself and also obtain Information about family members.
Before visiting family, nurse must obtain information regarding the location of home, its distance
from health centre, address. This information can be Obtained from records such as map. nurses
records or family folder. Once nurse is aware about the family to be visited. she plans the visit to
home and later on planned date, visit the family.
Maintenance phase : Community health nurse maintain the interpersonal relationship for which
she uses her talent for making herself acceptable to family members by providing services,
solving their health problems and helping them in crisis.
Termination phase : Community health nurse after providing care, services to family during
visits, terminate the visit. Always record the visit with planned objectives and activities and also
evaluate whether planned objectives were achieved or not.
11. Advantages of Home visits :
1. Home visit provide an opportunity to provide health services to farnily members at their own
place of living.
2. It provides an opportunity to study or observe the environmental, social & family situation.
3. Home visit create a good understanding between family members and the nurse.
4. It helps the nurse to modify her way of care based on the resources available at home.
5. It provides an excellent opportunity to community health nurse to implement nursing
process.
6. It is an option for those families which are unable to visit health centre due to some reasons.
7. Home visit provide natural environment for discussion related to health issues.
8. It is convenient for family members as they have not to travel and go out of home for getting
health services.
9. It provides an opportunity to contact and interact with family members & establish rapport.
10. It provides an opportunity to make continuity of family health care.
12. Disadvantages :
Consumes lot of time & energy.
Sometimes have to face unforseen events.
Non acceptance by family members.
13. Planning for Home Visits :
Planning involves deciding about visit to family before hand (Figure 6.2).
1. Divide the intensive area into units of population each and plan regular visits
to home in one unit at a time, The plan may have to be changed in case oi
emergency.
2. Make sure that priority needs are not neglected.
3. Visit the septic or communicable cases after clean cases only
4. Try to Visit more distant homes first and work your way back to the subcentre.
5. Refer family folders or individual health records for information before visiting.
6. Be aware of the procedures or health education which need to be given to
family.
7. Keep all the articles in bag which are required for providing needed care to
family members.
8. Have knowledge of all available services related to health nearby the family
which is to be visited.
6.1.5. Planning and Evaluation Of Home
Visits :
14. Priorities for Home Visits
a) Mothers :-
Pregnant women who live far away from an Ante-natal clinic.
Those who are unable to visit health centre due to poverty. ignorance, fear.
Those who have abnormal signs/symptoms on examination at ante-natal
clinic.
Those with an illness likely to complicate the pregnancy.
Mothers who had more than 3 previous pregnancies.
Primiparas.
Those who have delivered without help of a trained dai.
15. b)Child:-
Low birth weight babies.
Twins
Birth defect, difficult delivery.
Child not gaining weight.
Breast feeding not established or stopped before 6 months.
Follow up after illness
Not attending MCH Clinic.
16. c) Chronic ill patients :
Making decision regarding frequency of visits depend upon
extent of health problems, health needs, needs felt by family, family's ability to
deal with their health needs. health problems & family's regularity in clinic.
Families for visit selected on basis of priorities, available time, work load, health
agency's pohcies & facili. ties available.
18. Evaluation :
Evaluation is the process of comparing nursing actions and outcomes criteria of hotne
visit. This can be cleared from the following example :-
A community health nurse has done the survey, prepared a map and have identified
the families which need to visited. And she plans :-
•TO visit no……….. in....... . area on dated………... at approximate ……….. time.
To prepare the articles in bag as per need of procedure to be carried out.
To carry health education material with the purpose of teaching to family
members.
To initiat interpersonal relationship with family members.
To assess health needs of family.
To provide services based on need of family by modifying the planned services if
required.
19. After home visit. community health nurse compares with the set planned objectives
whether met or not such as
Visit the family on planned date, time, area with house no.
All articles were in bag required for providing care to family.
Health educaton material was with nurse by which she was able to deliver education to
family members.
Initiated interpersonal relationship & recieve co-operation & participation of family
members in carrytng out nursing procedures.
Provided the services to family members based on need.
By comparing these with planned objective. it can be seen that criteria which was
set is being met. It means evaluation is being done by finding out how far the visit has
been useful and what have been the difficulties and what else need to be done to
meet the planned objective.
20. Techniques of Home Visiting
1. Always plan the visit.
2. Always carry out the nursing community bag for home visit.
3. Introduce yourself during visit.
4. Be polite & friendly in approach.
5. Talk informally for a while & assess whether visit is convenient or not.
6. Encourage the individual member of a family to talk about her own or family problems.
7. Do not ask intimate questions in front of others, maintain privacy.
8. Be prepared to postpone original purpose of your visit if there is some urgent health problem
which need to be dealt in home. If that is ignored, confidence is lost.
9. Complement the mother on any improvement since your last visit and so encourage her for
further efforts.
10. Be sensitive to the habits & culture of family.
11. Never critcize the family members.
21. 12 . Teach in a language. which family can understand.
13 . Make use of aids for demonstraung to family members.
14 . Always record the visit in diary.
15 . Plan With family about next Visit after reviewing important points with
family.
16 . Visit the family at time when it is convenient to them.
17 . After finishing all home visits. return to subcentre. record in family folder or
individual health record.
18 . Identify cases which need to be discussed with supervisor.
22. 6.1.6. BAG Technique
Community Nursing Bag : It is a bag which contain medicines and equipments required for providing care to family.
Characteristics of Bag :
It should be made of light material, canvas, leather.
It should have washable lining.
It should have handle to hold the bag with hand or strap for carrying on the shoulder.
It should have two outside pockets:-
1. One for diary & disposable paper bags (newspaper).
2. One for soap. towel, nail brush.
Its main section should have cover or a zip which can be closed to cover the equipments kept in bag. It should contain:-
1. Solutions medicines.
2. Simple instruments
3. Other equipments as required to provide care.
The main section should have two parts:-
1. One for sterile equipments.
2. One for clean equipments.
23. Technique of Using Home Visiting Bag
As the same bag is used for several homes in a day, efforts should be made
to keep it as dean as possible and to avoid spread of infection.
1. Take out larger piece of newspaper from outer pocket and spread it on the
surface where bag is to be kept or keep the bag on a clean surface.
2. Prepare a clean surface or an area on newspaper near to bag.
3. Remove soap, towel & nail brush and take it to area near the place where
water is available.
4. Wash hands well.
5. Open the bag and take out needed articles and keep on newspaper, near bag.
6. Carry out the procedure. placing soiled swabs inside a newspaper bag for
disposal by burning.
24. 7. Wash and boil used utensils if possible. collect them in a seperate wrapping to
take it to Wash tre for disinfection .
8. Wash hands.
9. Open the bag.
10. Replace the clean articles.
11. Close the bag.
12. Return soap. towel & nail brush to outer pocket.
13. Check the bag daily. wash hands before opening it & make necessary
replacements. a week. thoroughly clean & disinfect the contents & bag itself.
replacing the liningwith a clean one.
Equipment : Two seperate kits - one for deliveries and other for general nursing and
prenatal & postnatal visits.
25. Equipments of Bag
Solution and medicines :
For external use : Spirit,antiseptic such as Dettol, gentian violet, eye drops and eye ointment.
For Internal use : Aspirin,rehydration powder & other medicines according to standing orders
Instruments : Oral & rectal thermometer, scissors, artery forceps, dressing for ceps.
Other equipments : Plastic apron,solution bowl,small gallipot,kidney tray, towel and plastic
sheet. sprtng balance. measunng glass, 5 ml teaspoon, tape measure, urinalysrs kit. 2 urinary
catheters. adhestve plaster. swabsticks, guaze dressings. cotton bandages (one tnangular, one
roller). health education material.
Syringes,needles,ampuJe file and drugs for injuction. Microscope slides and Hagedorn
needles in a spirit bottle for taking blood slides.
Razor blade & cord ties for emergency delivery. Wooden spatuals and a torch,for throat
examination or treatment. Arm circumference scale. To help detect malnutrition in small
children.
26. Points to Remember :
Not to keep paper, cartoons,notebooks etc. which can not be disinfected.
Not to keep personal items such as handkerchief or money in bag.
Always wash hands before handling the bag and follow correct procedure for
opening & clossing the bag.
keep the requrred articles in bag and do not remove from the bag more than
what is rquared for particular nursang care to be implemented.
Always replace the articles after thoroughly cleaning them.
Keep the bag clean area or newspaper but not directly on the ground.
