19. Home Visiting

HOME VISITING

• Home Visiting Health Care started around 1800s in United States firstly.
• Public Health Nursing also started first in United States. The Public Health Nurses were funded by philanthropic organizations in New York in 1877, they used to visit the patient and give care to them.
• According to Warhol (1980), Home Visiting Health Care includes an arrangement of health related services to people in their place of residence.
• Stanhope. M (1992) “Home Visiting Health Care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining or restoring health, or maximizing the level of independences, while minimizing illness.”
• According to American Medical Association (1979) “The provision of nursing care, social work, therapies (diet, occupational, physical, psychological), vocational and social services and homemaker home health aide services may be included as basic components of home health care. The provision of these needed services to the patient at home”.

Principles of home visiting

• Before starting home visiting, you should do the planning for transport, availability of drugs, where, who, when and for what are visiting.
• Home visits should be done on priority basis; this priority may be made on base of prevalence of problems in the area etc.
• Should respect the social norms, values and beliefs of community, where you are going to visit for health care.
• Should develop positive interpersonal relationship & not argue with client.
• Should listen the client, whatever he/she is talking about.
• Should accept the rights of client for accepting or rejecting your health care delivery.
• Should be flexible, not tie your talks.
• Should knock the door of home & take consent for entrance after telling purpose of visit.
• Speak simple and lay language with clients in community, preferably, communicates in their mother-tongue, this will increase the rapport intimacy between & client and Nurse.
• Should maintain the log diary during home visits. Write all issues, problems; facts and findings from start of visit to end of visit.

Advantages of home visiting:

• To observe and assess the real physical, social, psychological, spiritual, economical, sanitary problems of individual, family and community.
• To collect data about all type of problems for interventions or for informing to policy makers.
• Provides the primary health care at door step of public, which decreases the financial load of community to buy health care because preventive health care is very cheap than curative. Someone said “Prevention is better than cure”. Primary Health Care provides the Family planning, Immunization, Food, Health Education, Treatment of minor illness, Control of Epidemic diseases, Sanitation, Safe water and Maternal and child health care.
• For surveillance of diseases.
• For evaluation of any health programs.
• To change un-healthy practices and lifestyle of families and community.
• To provide antenatal & postnatal care to mothers.
• Home visits provide the platform to discuss all family and community matters with nurse. And nurse gives the suggestions accordingly.
• By home visits, nurse identifies the cases of epidemic diseases and suggests and assists for proper secondary or tertiary care.
• In home visits, nurse also helps in census and collection of vital statistical data.

Purpose of home visiting

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  • All advantages are the purposes of home visits.

Steps in Home Visiting:

I already mentioned that home visiting is a process, which starts from fact finding (Data collection) to Evaluation of services. The steps of this process are as under:

• Fact finding
  • There are two types’ facts (Data): Primary or Subjective and Secondary or Objective facts (data).
• Primary data or Subjective data

Data which is reported by family and community members and recorded by nurse on log diary is as under:

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  • These are intangible facts and based on other’s reports.
  • Inquire about immunization and family planning.
  • Inquire about illnesses-previous and present.
  • Inquire about history of major disease in any member of family.
  • Inquire about usage of long term medication, e.g. for anti-hypertensive, antipsychotic, hypoglycemic for diabetes.
  • Inquire about methods of disposal of waste.
  • Inquire about ways of cooking, they are use to cook.
  • Take diet history of week.
  • Ask about physical and mental symptoms.
  • Inquire about heating or cooling system in house.
• Secondary Data or Objective Data

Facts (data) which CHN can see, observe, feel and measure evidently. These are as under:

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  • To observe the sanitary conditions of home and community.
  • To observe the sanitary conditions of kitchen.
  • To observes the methods of cooking in home.
  • To observe the food stuffs condition physically, this is being consumed. Whether it is fresh or not? It is balanced or not?
  • To check the water for quantity and quality.
  • To observe the personal hygiene of members of family.
  • To observe the constructions of houses, whether these are ventilated and according to principles of health or not?
  • To observe the life style of family.
  • To observe the ritual practices, are related with health.
  • To observe the cultural practices are related with health.
  • To see the diseased members of family or community.
  • To observe the signs of diseases or illnesses, if is reported.
  • Observes physically the drugs, which are being taken by the members of family.
  • Check Immunization cards physically.
  • See the scar of vaccine injected on arm.
• Data analysis
  • Separate all data category wise e.g. sanitary problems in on column and Nutritional problems in another column of table).
  • Analyze the data or facts by keeping into tables, frequencies, percentage and mean.
  • Through analysis, we can know the causes of problems, prevalence of problems.
  • Priorities the problems on base of need and danger.
• Planning action with family
  • Plan the day, time, and topic or type of interventions.
  • Arrange material resources for interventions.
  • Intimate the family about your visit and interventions (E.g. Health Education etc).
  • Before interventions, tell the advantages of the interventions.
• Action and health education
  • After prioritizing the problems and select one problem for health education or for other action at one time.
  • If you give the health education, than should:
    • Use simple language.
    • Avoid usage of terms in speaking.
    • Speak short sentences.
    • Use demonstration method of teaching. (E.g. Demonstration of healthy cooking).
    • Use Pictorial Posters, Use Video aids rather than audiotapes.
  • Actions:
    • Physical actions are depending upon the type of problem. But some points given bellow should be kept in mind for actions, formulated for any type of problem:
    • Actions should be culturally accepted.
    • Cost of actions should be affordable by the family and community.
• Evaluation of services
  • It is a final step of any process or action which measures the success or failure or any action or program, is launched in community.
  • It is divided into two type of evaluation, one is formative evaluation measure the results during process of action or program and another is summative evaluation-measures the results at the end or after the action or program is done.
  • Evaluation may be taken by asking verbal interviews or by semi-structured or structured tools.
• Write daily log book
  • It is a diary or note book, in which each and every action or activity or observation and incidences are recorded.
  • The format of log is given as bellow:

Name of Community or family: _______________________

Location of community: _____________________________

• Write Observation visit reports
  • During home visits, whatever you observe in home, in streets, in community which may healthy or un-healthy, you have to write that observation in following format.
  • After Analysis of that observation, CHN can conclude the problems and plans and formulates actions.

Name of Community: ______________________________

Location of Community: ____________________________