Conducting a Home Visit
Whenever a nurse makes a
home visit, the agency should know the nurse’s schedule and the locations of
the visits. The nurse should learn about the neighborhood and obtain directions
for reaching the expected destination. A plan of action should always be
established in case of emergencies.Nurses are not expected to disregard their
personal safety in an effort to make or complete home visits. If nurses
encounter dangerous situations during visits, they should return to their
agencies and contact their supervisors or law enforcement offi-cials, or both.
Suggested precautions to take when making a home visit are presented in Chart
2-1.
The first visit sets the
tone for subsequent visits and is a crucial step in establishing the
nurse–patient relationship. The situations encountered can vary depending on
numerous factors. Patients may be in pain and unable to care for themselves.
Families may be overwhelmed and doubt their ability to care for their loved one.
They may not understand why the patient was sent home from the hospital before
being totally rehabilitated. They may not comprehend what home care is or why
they cannot have 24-hour nursing services. It is critical that the nurse try to
convey an un-derstanding of what the patient and family are experiencing and
how the illness is affecting their lives.
During the initial home
visit, which usually lasts less than an hour, the patient is evaluated and a
plan of care is established to be followed or modified on subsequent visits.
The nurse informs the patient of the agency’s practices, policies, and hours of
oper-ation. If the agency is to be reimbursed for the visit, the nurse asks for
insurance information, such as a Medicare or Medicaid card.
Safety Precautions in Home Health Care
·
Learn, or
preprogram a cellular phone with the telephone numbers of the agency, police,
and emergency services.
·
Let the
agency know your daily schedule and the telephone numbers of your patients so
that you can be located if you do not return when expected.
·
Know
where the patient lives before leaving to make the visit and carry a map for
quick referral.
·
Keep your
car in good working order and have sufficient gas in the tank.
·
Park the
car near the patient’s home and lock it during the visit.
·
Do not
drive an expensive car or wear expensive jewelry when making visits.
·
Know the
regular bus schedule and know the routes when using public transportation or
walking to the patient’s house.
·
Carry
agency identification and have enough change to make telephone calls in case
you get lost or have problems. Most agencies provide cellular phones for their
nurses so that the agency can contact the nurse, and so that the nurse can
contact the agency in case of an emergency or unexpected situation.
·
When
making visits in high-crime areas, visit with another per-son rather than
alone.
·
Schedule
visits only during daylight hours.
·
Never
walk into a patient’s home uninvited.
·
If you do
not feel safe entering a patient’s home, leave the area.
·
Become
familiar with the layout of the house, including exits from the house.
·
If a
patient or family member is intoxicated, hostile, or obnox-ious, reschedule the
visit and leave.
·
If a
family is having a serious argument or abusing the patient or anyone else in
the household, reschedule the visit, contact your supervisor, and report the
abuse to the appropriate authorities.
The initial assessment
includes evaluating the patient, the home environment, the patient’s self-care
abilities or the family’s ability to provide care, and the patient’s need for
additional re-sources. Identifying possible hazards, such as cluttered walk
areas, potential fire risks, air or water pollution, or inadequate sanita-tion
facilities, is also part of the initial assessment.
Documentation
considerations for home visits follow fairly specific regulations. The
patient’s needs and the nursing care given are documented accurately to ensure
that the agency will qualify for payment for the visit. Medicare, Medicaid, and
third-party payers require documentation of the patient’s homebound status and
the need for skilled professional nursing care. The medical diagnosis and
specific detailed information on the func-tional limitations of the patient are
usually part of the documen-tation. The goals and the actions appropriate for
attaining them need to be identified. Expected outcomes of the nursing
inter-ventions must be stated in terms of patient behaviors and must be
realistic and measurable. They must reflect the nursing diag-nosis or the patient’s
problems and must specify those actions that are expected to solve the
patient’s problems. If the docu-mentation is not done correctly, the agency may
not be paid for the visit.
While conducting an
assessment of the patient’s situation, the nurse evaluates the need for future
visits and the frequency with which those visits may need to be made. To make
these judg-ments, the nurse may find it helpful to consider the following
factors:
· Current health status: How well is the patient progressing?How
serious are the present signs and symptoms? Has the patient shown signs of
progressing as expected, or does it seem that recovery will be delayed?
· Home environment: Are worrisome safety factors apparent?Are
family or friends available to provide care, or is the pa-tient alone?
· Level of self-care abilities: Is the patient capable
of self-care?What is the patient’s level of independence? Is the patient
ambulatory or bedridden? Does the patient have sufficient energy or is he or
she frail and easily fatigued?
· Level of nursing care needed: What level of nursing
care doesthe patient require? Does the care require basic skills or more
complex interventions?
· Prognosis: What is the expectation for recovery in this
par-ticular instance? What are the chances that complications may develop if
nursing care is not provided?
· Patient education needs: How well has the patient
or familygrasped the teaching points made? Is there a need for fur-ther
follow-up and retraining? What level of proficiency does the patient or family
show in carrying out the neces-sary care?
· Mental status: How alert is the patient? Are there signs
ofconfusion or thinking difficulties? Does the patient tend to be forgetful or
have a limited attention span?
· Level of adherence: Is the patient following the instruc-tions
provided? Does the patient seem capable of doing so? Are the family members helpful in this regard, or
are they unwilling or unable to assist in caring for the patient as expected?
With each subsequent
visit, these same factors are evaluated to determine the continuing health
needs of the patient. As progress is made and the patient, with or without the
help of significant others, becomes more capable of self-care and more
independent, the need for home visits may decline.
As the visit comes to a
close, it is important to summarize the main points of the visit for the
patient and family and to identify expectations for future visits or patient
achievements. The fol-lowing points should be considered at the end of each
visit:
·
What are the main points the patient or family
should re-member from the visit?
·
What positive attributes have been noted about the
patient and the family that will give them a sense of accomplishment?
·
What were the main points of the teaching plan or
the treat-ments needed to ensure that the patient and family under-stand what
they must do? A written set of instructions should be left with the patient or
family, provided they can read and see (alternative formats include video or
audio recordings). Printed material should be in the patient’s pri-mary
language and in large print when indicated.
·
Whom should the patient or family call in case they
need to contact someone immediately? Are current emergency tele-phone numbers
readily available? Is telephone service avail-able or can an emergency cell
phone service be provided?
·
What signs of complications should be reported
immediately?
·
What is the day and time of the next visit? Will a
different nurse make the visit? How frequently will visits be made, and for how
long (if determinable at this time)?
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