9/20/2015najwa subuh community health nursing 1. 9/20/2015najwa subuh community health nursing 2 a...

04/21/23 Najwa Subuh Community Health Nursing

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• A home visitA home visit is a purposeful interaction in a home (or residence) directed at promoting and maintaining the health of individuals and the family (or significant others).

• A major distinction of a home visit is that tile health professional goes to the client rather than the client coming to the health professional


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• Home visiting involves a process of initiating relationships with family members, negotiating & implementing a family-focused plan of care, & evaluating health outcomes & family satisfaction

• Each home visit involves several phases or steps: preplanning the visit, traveling to the home and initiating the visit, accomplishing the interventions, evaluating and summarizing the visit with the family, ending the visit and leaving the home, and conducting positive activities.

• Efficiency is increased when community & public health nurses wisely manage their time and equipment.

• A home visit is a purposeful interaction in a home directed at promoting and maintaining the health of individuals and the family.

• Home visit is the process of providing nursing care to the client’s own setting. The setting may be in a single or multiple unit structure and may be located in a rural or urban setting.

• A comprehensive range of community nursing services is provided by Community Health. The main focus of this service is to enable people to be cared for in their own homes rather than as patients in hospitals.

• Therefore Community Nurses do a considerable amount of wound management and palliative care, antenatal and post natal care, and also stomal nursing care is offered.

• They also carry out assessments in the home and liaise with other agencies and service providers. They provide assessment, care and support for individuals and families of all ages,


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PURPOSEPURPOSEBasic goals of home visit:Basic goals of home visit: Promoting support systems that are adequate and

effective & encouraging use of health-related resources.

Promoting adequate, effective care of a family member who has a specific problem related to illness or disability.

Encouraging normal growth and development of family members and the family and educating the family about health promotion and illness prevention

Strengthens family functioning and relatedness

Promoting a healthful environment


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AdvantagesAdvantages1)Home setting provides more opportunities

for individualized care

2)most people prefer to be cared for at home

3)environmental factors impinging on health, such as housing condition & finances, may be observed and considered more readily

4) Information collection and understanding lifestyle values are easier in families' own environment


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5)Participation of family members is facilitated

6) Individuals and family members may be more receptive to learning because they are less anxious in their own environment and because the immediacy of needing to know a particular fact or skill becomes more apparent

7)Care to ill members in the home can reduce overall costs by preventing hospitalizations & shortening the length of time spent in hospitals or other institutions

8)A family focus is facilitated


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DisadvantagesDisadvantages1. Travel time is costly2. Less efficient for nurse than

working with groups or seeing many clients in an ambulatory site

3. Distraction such as TV and noisy children may be more difficult to control

4. Clients may be resistance or fearful of the intimacy of home visits

5. Nurses safety can be an issue


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Phases of RelationshipsPhases of Relationships

1.A pre-initiation or preplanning phase

2.an initiation or introductory phase

3.A working phase4.An ending phase

What does the Public Health Nurse do?

1. Get needed medical appointments2. Have a healthy pregnancy 3. Breastfeed successfully 4. Raise healthy children 5. Keep children safe 6. Plan the size of the family 7. Make healthy food choices 8. Evaluate children’s health & development9. Get accurate immunization information 10. Get treatment for/prevent lead poisoning 11. Obtain Medical & community resources 12. Deal with loss 13. Develop a crisis plan of action


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Families Retain much Control The family can control the nurse's entry into the

home by explicitly refusing assistance, establishing the time of the visit, or deciding whether to answer the door.

The nurse if there to offer services & engage the family in a dialogue about health concerns, barriers & goals.

As with all nurse-client relationships, the nurse's commitment, authenticity, and caring constitute the art of nursing practice that can make a difference in the lives of families


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Nursing Care Is More Nursing Care Is More Interdependent with FamiliesInterdependent with Families

•Because families have more control over their health in their own homes, & because change is usually gradual, greater emphasis must be placed on mutual goals if the nurse & family are to achieve long-term success.

•Except in emergency situations, the client determines the priority of issues with which to be dealt

•Families are sometimes unaware of what they do not know. The nurse must suggest health related topics that are appropriate for the family situations


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Increasing nurse- Family Increasing nurse- Family Relatedness- Fostering a Caring Relatedness- Fostering a Caring

PresencePresenceNursing efforts are not always successful. However, by being concerned about the impact of home visits on the family & by asking questions regarding her\his own motivations, the nurse automatically increases the likelihood that home visits will be of benefit to the family.

Although being related is necessary, it is inadequate in itself for high quality nursing. A CHN must also be competent.

CHN also depends on assessment skills, judgment, teacher skills, safe technical skills, and the ability to provide accurate information.


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The three characteristics of a helping relationship "positive regard, empathy, "positive regard, empathy, & genuineness“& genuineness“

Presence; being related interpersonally in ways that reveals positive regard, empathy, genuineness, and caring concern.

Positive regard; involves recognizing the value of persons because they are human beings. Accept the family, not necessarily the family's behavior. All behavior is purposeful; & without further information, you can't determine the meaning of a particular family behavior.


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Empathy is the ability to put you in someone else's shoes, to be able to walk in her\his footsteps so as to understand his\her journey.

• Empathy requires sensitivity to another's experience including sensing, understanding, & sharing the feelings & needs of the other person, seems- things from the other's perspective's


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Genuineness- means that what you say and do is consistent with your understanding of the situation

• The nurse can promote genuine self-expression in others by creating an atmosphere of trust accepting that each person has right to self-expression, 'actively seeking to understand'.


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Creating Agreements for Creating Agreements for RelatednessRelatedness

Nurses are expert in caring for the ill; in knowing about ways to cope with illness, to promote health, and to protect against specific diseases; & in teaching & supporting family members.

Family members are experts in their own health. They know the family health history, they experience their health states, & they are aware of their health-related concerns.


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Contract is legally binding agreements. This is not true of nurse-client contracts.

Nurses are legally & ethically bound to keep their word in relation to nursing care; clients aren’t legally bound to keep their agreements.

However, establishing a mutual agreement for relating increases the clarity of who will do what, when, where, for what purposes, and under what conditions.

Because of some people's negative response to the word contract agreement may be better.


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Increasing Understanding Increasing Understanding through Communication Skillsthrough Communication Skills• The nurse's ability to be with

family members determines the success of the nurse-family relationship.

• A nurse can employ techniques of speaking & listening appropriately & still not have a working relationship because caring is not there.


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Promoting Nurse SafetyPromoting Nurse Safety

Promote safety of CHN is critical. The purpose of the home visit is to offer or provide nursing services that make contribution to the family's health and to do so while maintaining the nurse's safety. The purpose of a home visit is to provide care at all costs.

Assertiveness, not abandonment of one's own needs, is required, which is especially true when you are learning to be a CHN and the boundaries of your professional role.


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Promoting Safe TravelPromoting Safe Travel• All CHN can benefit from basic

crime prevention courses that local or state police provide regarding safety on the street and in automobiles.

• Knowing that she\he is incorporating basic self-protection behaviors is especially helpful for a CHN.


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Promoting the Safety of Family Promoting the Safety of Family MembersMembers

•lf you believe that someone is in imminent physical danger or is being injured you need to call the policing authority that responds to domestic violence.

•If someone has been injured you should call for both police and rescue workers, If you believe that dependent children or adults are being neglected or abused you need to contact your faculty or supervisor & follow your school or agency's policies & procedures. Short of these priorities the CHN is not legally bound to respond.


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Managing Time & Managing Time & EquipmentEquipment The community health nurse's effectiveness

depends on the planning the day for the efficient use of time and other resources.

Physical resources are often limited to equipment carried by the nurse, or provided by the family at the home, or both.

Consequently, making do with what is at hand and doing this consistent with basic principles of safety and infection control are the hallmarks of a skilled CHN, although more specialized equipment is being used in the home to care for sicker individuals


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What can I expect during a What can I expect during a home visit?home visit?

1. Parenting education and support

2. Information regarding their child’s health.

3. Safety information. 4. Developmental information. 5. Nutrition education. 6. Community resources. 7. Assistance with appropriate

referrals as needed


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What kind of help can if get with my What kind of help can if get with my childrenchildren??

The Public Health Nurse provides The Public Health Nurse provides appropriate interventions & uses a appropriate interventions & uses a

strengths-based approach to:strengths-based approach to:

Help promote healthy attachment and bonding between parents and their babies. Provide parents with information needed to promote healthy brain, physical & social/ emotional development in their babies. Teach parents the importance & life long impact of responsive care giving.


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Why does Community Health Why does Community Health District want to help families?District want to help families?

Decrease the stress on families.

Increase a family’s stability & self-sufficiency.

Provide timely, individualized parent education.

Provide community resources and referrals as needed.


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Need AssessmentNeed Assessment•Despite the utility of the home visit intervention, health department/agency retrenchment has reduced home visit funding and utilization.

•Absolute reductions in resources and the dilemmas of resource distribution have played a part. Less visible is the enduring policy legacy of nineteenth-century social welfare opposition to non-institutional service delivery


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Assessing Your Home-Care Assessing Your Home-Care NeedsNeeds

•A number of options are available for finding help at home. It is often best to start by assessing both your It is also important to evaluate the values and preferences of the person receiving care.

•He or she may be more comfortable with a home care worker who shares his or her cultural background and/or language.


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Assessing Your Home-Care Assessing Your Home-Care NeedsNeeds

• The care recipient may also have a preference between male and female caregivers, particularly if the worker will be helping with personal care.

• This assessment may also enable you to include alternative (and possibly less expensive) approaches to care such as adult day care, friendly visiting services, home grocery delivery, pharmacy delivery services and meals-on-wheels programs


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•The purpose of needs assessment is to gather the information required to bring about change beneficial to the health of the population.

• "Health gain" can therefore be achieved by reallocating resources as a result of identifying four factors:

1.Non-recipients of beneficial healthcare interventions (that is, unmet need);

2.Recipients of ineffective health care (and releasing the resources for unmet need);

3.Recipients of inefficient health care (and releasing resources for unmet need); and

4.Recipients of inappropriate health care (for whom the outcomes could be improved).


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• There are a variety of checklists to help you evaluate what types of help are needed. In general, consider the following areas:

1. Personal Care: bathing, eating, dressing, toileting2. Household Care: cooking, cleaning, laundry,

shopping 3. Health Care: medication management, physician's

appointments, physical therapy 4. Emotional Care: companionship, meaningful

activities, conversation

• Once a family member has moved to a nursing home, it is important to visit as often as time allows. Residents of nursing facilities need to be reassured on a regular basis that they are still an important


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List of ideas help to provide care & List of ideas help to provide care & support to loved one during your visits. support to loved one during your visits.

•When you visit, be supportive & affectionate. Personal contact with others is extremely important and many times the only touch older adults living in a facility experience is when they are dressed or bathed.

•Residents in nursing homes need to know they are loved and not forgotten. If they are receptive, hold their hand, give them hugs when you arrive and leave, and give them eye contact when they are talking to you. It is important to try to ignore any distracting smells or noises so as not to upset your loved one.


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List of ideas help to provide care List of ideas help to provide care & support to loved one during & support to loved one during

your visits. your visits.

Ask permission to visit and then plan your visits in advance. First, it is important to enable your family member to retain as much control in his or her life as possible.

By asking their permission to visit, you are enabling your loved one to have control over at least one aspect of their schedule.


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• Because there are two parts to a visit (looking forward to the visit, and the visit itself), plan your visits ahead of time rather than just dropping by. Planning ahead allows a resident the enjoyment of anticipating your visit.

• When you visit, share news about your life and your family and don’t forget the photo album!

• Do not spend the entire visit asking them questions about how they feel or if they have eaten. Instead, share funny stories or talk about a big decision you have made. Make sure to tell your loved one


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• Make sure the nursing home staff know about your visit ahead of time, will have the time to meet with you, and have the opportunity to gather all relevant data (e.g., lab results) and any ancillary staff you wish to see, in advance of the visit.

• Ask them to be sure that the medical record is complete & will be available. Ask them to let the family know about your visit, so that they can be present if they wish.

• The initial assessment visit is very important. The history and physical examination, which lead to the formulation of the patient’s care plan


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•Home health care, broadly denied, refers to all of the services and products provided to clients in their homes to maintain, restore, or promote their physical, mental, and emotional health.

•Its purpose is to maximize the client’s level of independence and to minimize the effects of existing disabilities through non-institutional services.

•Its primary goal is to use these supportive services to decrease rehospitalization and prevent or delay institutionalization


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9/20/2015najwa subuh community health nursing 1. 9/20/2015najwa subuh community health nursing 2 a...

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