Comm. Health - Family Nursing: The Home Visit
Terms
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- Deciding where to meet the family
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- before contacting family, should 1st decide where to meet
1. meeting in family home
2. meeting in the clinic - Advantages of meeting in the family home:
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1. can view EVERYDAY family environment
2. RELAXED setting & therefore demonstrate TYPICAL interactions
3. emphasizes that family health is the RESPONSIBILITY of the whole family
4. increased possibility of having MORE family members present - Disadvantages of meeting in the family home:
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1. perception of invasion of PRIVACY
2. CHN must be highly skilled to SET LIMITS & guide interactions
3. SAFETY issue for CHN
4. LIMITED access to resources - Advantages of meeting in the clinic
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1. easier access to other health care providers for CONSULTATION
2. family interactions may be so INTENSE that an UNFAMILIAR environment may diffuse emotionally charged discussion - Disadvantages of meeting in the clinic
- 1. CHN cannot see family members in everyday environment (may reinforce possible culture gap)
- After deciding where to meet, CHN contacts the family
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- tells family how they came to CHN's attention (why?)
- CHN gives a brief summary of the CHN's knowledge of the family situation
- schedules meeting ASAP when as many family members as possible can attend
- recap time, place and purpose
- notify client how to contact CHN - What if client refuses to meet?
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- explore reasons for refusal
- nurse may need to persist because of legal obligations (ex. follow up of certain communicable diseases) - Engagement stage of home visit
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- beginning of interview process
- professional identification & tells the location of the agency
- engage in brief social conversation to establish relationship
- describe role, responsibilities, & limitations
- determine client expectations - Family Assessment Stage of home visit
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- CORNERSTONE for family nursing interventions
- SYSTEMATIC assessment process
- IDENTIFIES health CONCERNS & STRENGTHS (building blocks for interventions)
- many assessment models (may need to modify to fit situation)
- after analyzing data, develop prioritized list of concerns & strengths then plan for intervention - Contracting Stage of home visit
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- contracting is making an agreement between 2 or more parties
- involves shift in responsibility & control toward shared effort by client & CHN
***- the premise (assumption) of contracting is FAMILY CONTROL
- there are 2 types of contracting: contingency & non-contingency - Contingency Contract
- states a specific reward for the client after completion of the client's portion of the contract
- Non-contingnecy
- does not specify rewards, but IMPLIED rewards are the positive consequences of reaching the goals specified in the contract
- 3 phases of contracting with families during home visit
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8 Sets of activities:
1. Beginning Phase -
i. mutual DATA COLLECTION & exploration of needs & PROBLEMS
ii. mutual establishment of GOALS
iii. mutual development of PLAN
2. Working Phase
iv. mutual division of RESPONSIBILITIES
v. mutual setting of TIME LIMITS
vi. mutual IMPLEMENTATION of plan
vii. mutual EVALUATION & renegotiation
3. Termination Phase
viii. mutual termination of contract - Family Intervention stage
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- after assessment, implement interventions using a family intervention model
- should be done in partnership with family - Termination & Evaluation stage
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- when purpose has been accomplished
- review with family what has occurred been accomplished
- provides basis for determining if further visits are required or if referrals to community resources are needed - Post visit documentation stage
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- visit must be recorded for legal & clinical purposes
- must be CURRENT, DATED, & SIGNED
- recording may consist of narratives, flow sheets, problem oriented medical records, subjective & objective assessment plans, or combination of these