Home Visiting

The most significant and essential component of the health service in community health is the nursing home visit. The majority of individuals (90–95%) reside in the neighborhood. It emphasizes preventive rather than therapeutic techniques. The capacity to teach, have good judgment, make sound decisions, and have a thorough understanding of human relations are all necessary for providing health services.

Purpose of home visit:

• To determine or pinpoint the family's true issue.
• To look into the origin of any illnesses or infections.
• To encourage a couple to employ family planning techniques.
• To provide health education on topics such as diet, vaccines, latrines, environmental sanitation, and personal cleanliness.
• To recommend situations to suitable organizations.
• To monitor past actions to determine whether the desired outcomes were achieved.

Principles of home visiting:

Nursing care is given to patients at their homes during home visits. The purpose of a home visit is to offer patients the proper nursing care necessary for their well-being. The following fundamental guidelines should be followed by the community health nurse when performing home visits:

• Be understanding of the person's wants and feelings.
• Home visits should be tailored to the requirements of the people who will be receiving them at the time of the visit. Recognize the person's issues and sociocultural background.
• Use safe technical expertise and nursing technique, and make sure the topic you explain is scientifically solid.
• Understand the policies of your organization inside and out
• As a first step in the home, gather information about the house, the patient, and the surrounding area. Then, objectively analyze the information.
• Determine the family's health issues.
• Home visits should serve as an educational opportunity, providing great chances for health education.
• Work with the individual or family to develop a shared plan.
• Consider your own work; quality is more important than quantity. One or two successful home visits are worth more than eight or more unproductive ones.
• Home visits should be noted in the family folder and diary.

Advantages of home visit:

• The individual and family are seen and studied by the community health nurse in their own setting, which is more informal and facilitates dialogue than in a hospital or clinic. One person can examine and evaluate the entire family during a single visit.
• Since the socioeconomic background is made obvious during the house visit, more realistic instruction can be given in the actual circumstance.
• A foundation for teaching can be formed by observing family practice and the progression of care.
• Home visits that are timely and appropriate foster good communication between the nurse and the family and enhance nurses' reputations.
• Home visits provide answers to the family members' questions.
• The nurse has the chance to witness actual care being provided by family members.
• A home visit offers the chance to prevent and handle health issues.
• It aids in the modification of the nurses' and families' methods of care. 10 high-risk families can be found and visited right away.
• The nurse can be welcomed as a friend, and other families will gather around to listen to the advise given and benefit as well. A lot can be assessed at once (for example, personal hygiene, water supply sanitation, refuse disposal, kitchen cleanliness, food storage, and personal & emotional health).
• Health education can be offered "on the spot" and will be pertinent. The nurse can demonstrate how to do things properly using the household's standard tools. The benefits will be explained, the advice will be applicable and tailored to the family's needs.

Steps in home visiting:

In order to conduct a home visit, a community health nurse must take the following actions:

Fact finding:

In order to understand what needs to be done, which is listed below, this is the first step during the home visit, which aids in studying the clinical & other records:

• Prepare:
  • Family folders & survey folders.
  • Map of the area to be visited including Vocation, road, ward office, school, markclub, temple, church, government office, tea shop etc.
• Collect background information of the family & community in general according to survey & family folders. ie:
  • Information about family size (no. of family members)
  • Date of birth (age), sex
  • Education
  • Occupation
  • Custom
  • Culture
  • Values
  • Religion
  • Family planning
  • Immunization
  • Local resources
  • Safe motherhood etc.
  • Health status (past & present)
• Create a nice, positive interpersonal relationship by being respectful, polite, and genuinely interested.
• Using technical expertise and nursing practice e. Identify the needs of individuals and families, including those who require prenatal, intranatal, and postnatal care, newborn and toddler care, care for children under the age of 5, acute and chronic illness, and those who are unable to travel to a health center for treatment.
• Be aware of your surroundings at home and any potential influences on your family's health.
• Find out the issues' causes and potential solutions by talking to family members.
• Facts can be discovered by observation, assessment, examination of medical records, dialogue with neighbors or local leaders, analysis, etc. These kinds of information offer guidelines for problem-solving, lesson planning, and teaching.

Data collection and analysis

After gathering the information, analytical procedure starts. Analysis must be accurate, truthful, and fact-based rather than subjective. Step-by-step discussion and careful examination of the issues are required. After that, only draw a conclusion. The data that we gather is unprocessed. For meaningful usage, unprocessed data must be processed. Data must be uniform, reliable, accurate, and comprehensive. Information that is not necessary should be removed. Data can be examined and prepared using:

• Population pyramid
• Table
• Graph
• Pie charts etc.

Planning action with family

It is among the most crucial aspects of our work and relationships. Some remarks might elicit inquiries regarding the circumstances and a debate of "what can I do about this?" When a family's finances are a little tight, we can't expect them to buy a lot of goods. For example, if you ask them to "filter water" for drinking, they might not do it since they don't have enough money to buy a filter. Therefore, determine the family's actual needs first and then plan accordingly using alternative options. Priority should be placed on meeting fundamental needs like hunger before moving on to personal cleanliness, access to potable water, or sanitation. Planning is therefore crucial, and in order to be useful, it should be based on the state of the family, the environment at home, and the local resources that are available to the family. The family's short- or long-term goals should also be taken into consideration when planning.

Additionally, some alternative ideas or strategies are beneficial. Respect the person's opinions, advice, and suggestions. A smart plan will always result in taking positive action and achieving goals.

Action and health education:

To remedy the issue, a formal home visit should be conducted after planning. The community health nurse should introduce herself and go over her objectives on the initial visit. The presentation should be casual, providing plenty of opportunities for questions and a forum for debate. Health promotion activities should be scheduled around family time. Find out when would be the best to teach them. Include family, a local leader, TBA, MCHW, FCHV, and other staff members in health-related action and health education. Show them respect and communicate ideas, advice, information, etc.

Follow through/up:

It is one of the most crucial house visit steps. Follow up on previously planned and completed projects to determine how well the goals have been attained. It provides precise planning guidance for the upcoming visit.

Evaluation of service:

Review each family record on a regular basis and respond to the following questions to evaluate the services.

• What urgent issue or requirement exists? What exactly is the issue?
• List the challenges and obstacles that the scenario presents.
• List the supportive and assisting elements, such as family members' ability to cope and the presence of nearby services.
• What has been done to address the current issue?
• What preparations are being made and what steps are being done to address the root of the issue?
• How did the individual react to your presence? What modification occurred?
• Have you used people, resources, and measures effectively?
• How useful was the visit so far?
• What attitude do the person, the family, and the community have?
• Do you require direction, counseling, and a conversation with your superior?

Although it might be challenging to change habits, attitudes, and behaviors, once altered they have a lasting impact. The length of time depends on the attitude and way of thinking of the individual. There are some areas where health workers and families have failed, therefore they should appropriately analyze, admit these areas, and replan in an appropriate and time-conscious manner.

Bag technique

A community health nurse must bring along a few essential instruments when performing house visits in order to provide quality nursing care. Her regular nursing practice requires a community nursing bag, which holds the necessary supplies and equipment, including medications. Khaki cloth can be used to create a bag for community health nurses. Both the interior and the outside contain pockets. Two pockets are on the outside covering. The soap dish with soap and a hand towel goes in one pocket. The newspaper or plastic sheet goes in the opposite pocket. For storing bottles of solutions like spirit, antiseptic lotions like Dettol, calamine lotion, gentian violet, etc., both sides have two pockets.

Other medications, tiny bags, and other medical supplies and equipment can be stored in the pockets on the interior lining. For simple access, they ought to be placed in the pockets properly.

Use and care:

When and where the bag is used:

• The bag is needed during each home visit.
• Soap and water needed to protect from diseases and to prevent the carrying of infection from one place to another.
• Demonstration of nursing care requires essential materials ready for use, which are carried in the bag. Inspection of the person including taking of TPR is an essential activity of almost every home visit where there is an ill person.
• Cleanliness is one of the main lessons to teach and learn. The use of the bag is the excellent demonstration of cleanliness.

Care of home visit bag:

The bag needs to be used in multiple different homes, so it needs to be kept as clean as possible.

• Choose a spot that is clean where the bag can be put up.
• Place the bag on a level surface that has been covered with newspaper or a plastic square.
• Create a newsprint bag to hold cotton and sole dressing.
• Take the watch off.
• Open the bag by unbuttoning the exterior liner.
• Remove the soap and towel.
• Each time you care for a patient, wash your hands with soap and water.
• Take out the tools required for the specific procedure, then shut the bag.
• Follow the nursing procedure, putting contaminated swabs in a newspaper bag for burning or other acceptable disposal.
• Following the procedure, all the instruments should be cleaned and dried.
• Close the bag after washing your hands and replacing them after opening it.
• Put the used dressing or dirty paper bag in the appropriate spot for dumping and burning.
• Rewash your hands.
• Move the sack. Keep the used newspaper or plastic sheet folded with the exposed side on the inside and place it in the bag's exterior pocket.
• Report what you saw, what you did, any instructions you were given, and your plans for the following visit.

Equipments or materials in home visiting bag

The equipment commonly kept in the bag are:

• BP instruments with stethoscope
• Soap disc with soap
• Apron
• Foetuscope
• Thermometer
• Paper bag
• News papers
• Hand towel with a towel bag
• Scissors
• Measuring Tape
• Instruments- a thumb forceps, an artery forceps,
• Small bowl
• Bandage
• Some gauze pieces
• Cotton
• Spirit in a small bottle
• Betadine solution or ointment
• Some essential medicines:
  • Paracetamol
  • Ibuprofen
  • Diegene
  • Jeevan Jal Ops,
  • Vit. B complex