Nursing Process in Home Care AKA: The Process of Home Visitation

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Nursing Process in Home CareAKA The Process of
Home Visitation
NURS 312 Home Health Nursing
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(No Transcript)
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Rice Model of Dynamic Self-Determination for
Self-Care
Patient motivational factors for self-care
Patient indicators of optimal health
Caring
Home care nurse as facilitator
Patient education
Case management
Aesthetic Spiritual Communion
Patient advocacy
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Phases of Nurse-Patient Relationship

• Preplanning
• Initiation/Introduction
• Working
• Ending

• Dependence
• Interdependence
• Independence

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Phases of each home visit

• Preplanning
• Initiation
• Implementation
• Termination
• Post home visit

Pre
Direct Care
Post
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Preplanning Phase

• Clarify purpose of referral with referral source
• Review any specific protocols, training needed or
  already initiated
• Hospital, SNF, Rehab unit visit

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Initiation Phase

• Initial contact with patient/family
• May be hospital visit, by phone, or initial home
  visit
• Begin relationship building
• Clarify reasons for visit
• Mutual goal setting

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Visit Phase

• Home entry issues
• Minimize environmental distractions
• Noise, clutter, interruptions,
• Minimize behavioral distractions
• avoidance, denial, complaints, abuse
• Address nurse related distractions???
• Fears, anxiety, insecurity

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Termination Phase

• Recap what you did, focus
• What to expect
• Set time for next visit
• Review what to do before next visit
• Who and when to call for help if needed

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Post Home Visit

• Charting
• Case Management- referrals, calls
• Case conferences
• Review any orders, progress toward goals

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A home visit is a purposeful interaction in a
home environment directed at promoting and
maintaining the health of individuals and the
family.
Five goals of home visits
1. Promote support systems. 2. Adequate,
effective care of family member with a
problem. 3. Encourage normal growth and
development 4. Strengthen family functioning and
relatedness. 5. Promote a healthful environment.
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Requirements for a healthy nurse-patient
relationship in home settings

• A caring presence
• positive regard, empathy, genuineness
• Create agreement for relationship
• Communication
• Functional sender receiver

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Family assessment
Individual assessment
Identification of all health problems
Plan of care
Implement plan
Evaluate care
Begin with the end in mind what outcome are you
wanting? What outcome is family wanting? What
is physician wanting? How will you know youve
arrived?
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Care of the whole

• Individual health issues
• Family health issues
• Physical
• mental
• environment
• lifestyle
• health promotion
• disease prevention
• illness care

• Individual stages
• Family stages
• Anticipatory guidance

Seek first to understand, then to be understood.
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Integrity

• Maslows hierarchy
• Putting 1st things 1st
• Crisis Intervention
• Support systems

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Supporting Family Functioning

• Communication
• Decision Making
• Parenting
• Limit setting
• Negotiation of roles
• Power
• Coping
• Strengths
• Weaknesses
• Resources
• Demands

Assisting decision-making ENUFF - Empathetic,
nonjudgmental, unconditional, feeling focus
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The W Approach to Case Management in Home Care

• Where are we headed?
• How will we know weve arrived?
• When do we need to get there?
• Why are we doing this?
• What do we have to do to get there?
• What do we have to work with?
• Who are the players involved?