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
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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, costeffectiveness, 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
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Biophysical considerations
Psychological considerations
Physical environmental considerations
Sociocultural considerations
Behavioral considerations
Health system considerations
Planning the Home Visit
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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
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Client health status
Goals and objectives for care
Nursing interventions
Effects of interventions
Subsequent plans for care