BY:scm

INTRODUCTION
 Nurses work with families in a variety
of settings, such as; clinics, schools,
support groups and offices.
 However, an important aspect of the

nurse’s role in reducing health risks

and promoting of populations has
been the tradition of providing
services to families in their homes.
 Home visits give a more accurate
assessment of the family structure
and behaviour in the natural
environment.
 It also provides opportunities to

observe the home environment and

to identify barriers for reaching
family health promotions.
 HOME
A home is a place where one lives
or a place of residence
(Basavanthappa, 2008).
 HOME VISIT
 Home visit is the process of

providing care to patients at their

doorstep (Bsavanthapa,2008)
A home visit is “a formal call by a
nurse/midwife on a client at the
client’s residence to provide nursing
care”( Mary Clark, 1999:187).
 Home visiting refers to the care given

to the family in their own homes by

health workers or volunteer
community workers (ideally
supported by health workers). (ITG,
2002).
 To care for the sick, and
rehabilitate the disabled.
 To have the knowledge about the
community’s resources and
cultural beliefs that might be
helpful when patients are
discharged from hospital.
 To offer continuity of care.
 To preserve and promote health.
 To prevent and control diseases
 Home visits give a more accurate
assessment of family structure,
the natural or home environment
and behaviour in the environment.
 Provide opportunities to identify
both barriers and support for
reaching family health promotion
goals.
 The nurse/midwife can work with
the client directly to adopt
interventions to match resources.
 To give follow up care, for
example a postnatal visit to a
woman just delivered and
discharged from hospital to see
how she’s coping with the baby at
home especially the prim Para.
 To give information, education

and communication on the

problems identified.
 To do demonstrations related to
 To teach and convince the
community and the client about
the importance of home visiting.
 To create an understanding
between community members and
health care providers so as to
enhance good working
relationship.
 Toreassure the clients that they
are equally important as other
members of the community in
order to help them develop a
sense of wellbeing.
 Home visiting should be planned
with purpose and should be
beneficial to the patient.
 The purpose of home visiting be

should clear and must meet the

needs of the patient. It should
include surveys and statistics, MCH
services, home nursing in cases of
illness, including, health teaching.
 Home visiting should be regular
and flexible according the needs
of the patient
 Home visits should be educative, i.e.
it gives excellent opportunities for
health education.
 Home visiting should be convenient,
acceptable and educative to the
patients.
 Have a full understanding of your
agency’s policies e.g. schedule visits
only during daylight hours.
 Know the phone number of the
agency, police, and emergency
services.
 Let the agency know your daily
schedules and the phone of your
client so that you can be located
in case you don’t return when
expected.
 Never walk into the client’s home
uninvited.
 Pregnant mothers.
 Post natal women.
 Nursing mothers.
 Single parent families.
 Motherless babies.
 Mothers with pre term babies or

twins.
 Families with special problems
such as chronic diseases, mental
illnesses, Malnutrition, and
discharged patients.
 Home visits provide an excellent
opportunity to implement nursing
procedures.
 Home visits provide an opportunity
to study the home and family
situation.
 Home visits provide an opportunity
to render services to the family
member at their own surrounding.
 Prompt and proper home visits
create a good understanding
between the nurse and the family
and builds good image of the nurse.
 Home visiting clarify the doubts

raised by the family members.

 Home visits help the nurses and

family members to modify the ways

of their care.
 Home visits help to observe family
practices and progress of care
given by nurses and others.
 Home visits are convenient for the

patient.
 Home visits are the best option for
patients unwilling or unable to travel.
 Home visits provides natural
environment for the discussions of
concerns and needs.
 Home visits provide the opportunity

to individualized services.
 Home visiting itself can be viewed
as a process by which the nursing
activities are carried out in phases
such as; initiation phase, pre-visit
phase, activities during home visit
phase, post visit phase activities
and termination phase of visit or
transfer phase visit.
 Four skills are fundamental to
effective home visits: observing,
listening, probing and prompting.
 The need of these skills is
evident in all phases of the home
visit process
 Before making a home visit the
community/public health nurse
(CHN) has to do the following;
 Has to prepare for the visit
 Introduce herself/himself to the

family of the client

 Make contract with family
 Make an assessment
 Draw a plan with interventions
 Implement plan
 Conduct an evaluation
 These functions may be carried
out on every visit, but depth of
purpose and emphasis changes as
movement towards an agreed
upon goal becomes evident
 In this phase the
community/public health nurse
clarifies the sources of referral for
visit and purpose of visit and can
also share information on the
reason and purposes for home
visit with the family.
 The initiation phase is the 1st

contact between the nurse and

the family.
 It provides the foundation for an
effective therapeutic relationship.

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 When the nurses are assigned to
home visiting, they must know
prior information regarding the
house and the family which
includes location of the house and
its distance, address and some
information needed for the visit.
 Pre visit is part of assessment phase
in which the nurse gather
information about the patient,
investigates community resources
assembles supplies and plans for the
first patient contact.
 This information can be obtained
from family-folder or other nurses or
family members regarding age, sex,
family culture and values, problems,
care given etc
 The community health nurse have to
use their talents to make a family to
be receptive to their visit for which
they have to begin to develop trust
and rapport, which are the basis for
positive inter-personal relationship.
 During the visit, the nurse assesses

the family needs and plans the

nursing care according to the needs
and implements it accordingly.
 The nursing process is a highly
flexible, convenient, and effective
method of problem solving that
adapts well to the multiple problems
that need to be untangled in home
care situations.
 Because the nursing process is a

deliberate and systematic approach

to client care, it helps to organize
care that is specifically related to the
client’s needs.
The nursing process includes;
 ASSESSMENT
 ASSESSING THE HOME
 PLANNING
 IMPLEMENTATION
 EVALUATION
 When the purpose of the visit has
been accomplished, the nurse
reviews with the family what has
occurred and what has been
established.
The following suggests termination of
the visits;
 Nurse-patient goals reached, health
restored and the patient can function
without nursing actions.
A patient changes his residence or
leaves the home to go to another
home
 The nurse transfers the patient to
another nurse or other members to
provide health care.
 In addition, nurse has to review
visits with family and plan for future
visits.
 Even though the nurse has concluded
the home visits and left client’s home,
responsibility for the visit is not
complete until the interaction has
been recorded.
 The major task for the post-visit
phase is documenting the visit and the
services provided.
 The records are kept where only
authorised persons can read them.
 The nurse analyses community
resources and prepares for the next
visit.
 Consumes a lot of time and
energy
 Non acceptance
 Problems of local language
 Role confusion.
 Expensive in terms of transport

and allowances.
 When performing home visits, the
community health nurse should carry
a community health bag, a general
nursing kit and a separate kit kept
for deliveries and another kit for
immunization.
 The purpose of the bag is to carry
out nursing procedures in houses
which include; weighing the children,
performing minor dressings and to
conduct delivery in emergency
situations.
 OUT SIDE POCKET
 soap in a soap holder
 brush
 news paper or plastic material to
put the bag on
 hand towel
 admission forms and referral
forms
 INSIDE CONTENTS
 These include:
 2 Receivers
 2 thermometers
 4 gallipots
 adhesive tape
 baby weighing scale
 cord clamps which are sterile
 cotton wool balls and maternity
pads
 gauze bandages
 gloves (sterile and clean gloves)
 haemoglobin scale book
 plastic sheet or newspaper
 spatula
 tape measure
 incontinent sheets
 Jik 1:6 concentration
 methylated spirit
 multistix
 plastic apron
 Fetostethoscope
 Torch
 Water in a container
 Sphygmomanometer
 Binaural stethoscope
 syringes and needles different

sizes( 2mls, 5mls , 21G & 23G

Sterile packs
 Cord care pack
 Delivery pack
 Dressing pack
 Vaginal examination pack
Orals
 Fansidar tablets
 Folic acid tablets and Ferrous
sulphate tablets
 Oral rehydration salts
 Panadols
 Aldomet tablets
 Valium tablets

Injectables
 50% Dextrose
 Diazepam 5mg, 10mg
 Ergometrine
 Hydrocortisone 100mg
 Vitamin k 10mg
 The bag should be kept clean at
all times. Never PUT the bag on
the floor or use material that can
transmit infections so easily.
 Wash hands thoroughly with soap

and water before touching the

inside of the bag.
 Always carry a paper where to put
the bag.
 When in a home, the bag
should be kept away from
children.
 When the CHN arrives at the
home, she should ensure that the
bag is put on a clean surface.
 A plastic sheet should be spread

on the floor or table and place the

bag on it before use.
 Remove soap, nail brush, and

towel from the side pocket in

readiness for use.
 Hands should be washed with soap
and water thoroughly before opening
the inside of the bag to remove the
required tools to use during visit.
 After procedure, all disposable items

such as cotton swabs should be

wrapped in a news paper and
disposed off into the pit latrine.
 The CHN folds the plastic sheet with
exposed side innermost and puts
it in the outside pocket of the
bag.
 Wash hands with soap and water
after procedure.
 Write brief notes of the procedure
done, observations made, and the
instructions given to the client on the
client’s card.
 Finally thank the client and family
members for their cooperation and
hospitality.
 In order to keep the nursing home
visit bag read for use at all times, the
nurse should empty the contents and
clean the bag at least once a week or
more often depending on how much
it is used.

 Wash the bag with soap and water
and dry it in the sun
 While empting the contents, check
the expendable items e.g. gloves,
catheters thermometer or glass
article for being broken or
spoiled.
 After drying, the bag should be re
equipped with articles, drugs or
sterile dressings/ packs and linen.
 Home visiting is essential in meeting
the health needs of the client in the
community.
 It is a very important vehicle in

promoting, preserving and

maintaining health of the individual,
family and the community as well as
preventing diseases.
 These services are under utilised
in Zambia, may be due to low
staff levels in the health facilities
as well as lack of community
awareness on the availability of
the services.
 If well utilised, it is a very effective
method of taking the health
services as close to the individual
and family as possible.
REFERENCES
Allender J.A., (1998) Community and Home Health
Nursing, Lippincott, Philadelphia.
Basavanthappa.B.T., (2003) Community Health Nursing,
Jaypee,New Delhi, India.
Central Board of Health, (2002) Integrated Technical
Guidelines for Frontline Health Workers, Lusaka.
Dickerson. E.J. and Schult M.O., (1979) Maternal and
Infant Care, R.R.and Sons Company, New York.
Leahy.K.M., Coob.M.M. and Jones.M.C., (1982)
Community Health Nursing, 4th Edition, McGraw Hill,
New York.