CARE OF CLIENTS IN THE

HOME SETTING
Home Visit

 A formal call by a nurse on a client

at the client's residence to provide
nursing care
Advantages of Home Visits
 Convenience
 Access
 Information
 Relationship
 Cost
 Outcomes
Challenges of Home Visits
 Client diversity

 Multiplicity of problems
 Maintaining balance
Areas of Balance
 Intimacy vs. distance
 Assisting vs. devaluing
 Dependence vs. independence
 Altruism vs. realism
 Creativity vs. inadequacy
 Risk vs. safety
 Cost containment vs. quality
 Restoration vs.and health promotion
Figure 21–1 Maintaining Balance in Home Visiting
Successful Home Visiting
Programs
 Address multiple goals
 Use professional staff
 Incorporate a series of visits
 Are targeted to high-risk
populations
Principles for Home Visiting
Programs - 1
 Voluntary participation and collaborative
relationships.
 Promote personal and program goals.
 Address multiple goals, long-term as well
as short-term gains in health status.
 Permit flexibility in the intensity and
duration of services provided.
Principles for Home Visiting
Programs - 2
 Include sensitivity to client diversity.

 Employ well-educated staff.

 Address realistic expected outcomes.
 Evaluation focuses on outcomes, cost-
effectiveness, and processes used.
Purposes of Home Visit
Programs
 Case finding and referral
 Health promotion and illness
prevention
 Care of the sick
 Care of the dying
Types of Home Health Agencies
 Governmental agencies
 Voluntary agencies
 Proprietary agencies
 Institution-based agencies
 Hospice agencies
 Medicare-certified agencies
Initiating the Home Visit
 Source of request for a home visit
 Preliminary health assessment
 Review of referral information
 Review of prior agency records
Preliminary Assessment Data
Categories
 Biophysical considerations
 Psychological considerations
 Physical environmental considerations
 Sociocultural considerations
 Behavioral considerations
 Health system considerations
Planning the Home Visit
 Reviewing previous interventions
 Prioritizing client needs
 Developing goals and objectives
 Considering acceptance and timing
 Delineating nursing activities
 Obtaining materials
 Planning evaluation
Implementing the Visit

 Validating assessments and diagnoses

 Identifying additional needs
 Modifying the plan of care
 Performing nursing interventions
 Dealing with distractions
Evaluating the Home Visit
 Response to interventions
 Short-term outcomes
 Long-term outcomes
 The home visit process
 Outcomes-based quality improvement
Documenting the Visit
 Client health status
 Goals and objectives for care
 Nursing interventions
 Effects of interventions
 Subsequent plans for care