care of clients in the home setting copyright ©2008 by pearson education, inc. upper saddle river,...

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Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health Nursing, 5/e Mary Jo Clark 21 CHAPTER

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Page 1: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Care of Clients in the Home Setting

Copyright ©2008 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.Community Health Nursing, 5/eMary Jo Clark

21CHAPTER

Page 2: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Home Visit

• A nursing care visit in a client’s residence

Page 3: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Advantages of Home Visits

• Convenience

• Access

• Information

• Relationship

• Cost

• Outcomes

Page 4: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Convenience

• Clients often prefer to be seen in their homes

• Reduced transportation costs

• No waiting for services

Page 5: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Access

• Clients may be immobile or lack transportation

• Community health nurse has access to clients that may not necessarily present themselves for services in other settings

• A home visit permits the nurse to identify clients in need of services

Page 6: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Information

• The home visit permits the nurse to obtain information not readily available in other settings

• Valuable information is obtained about family dynamics, physical environment, psychological and sociocultural factors present that may have a bearing on the client’s health status

Page 7: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Relationship

• In the home setting, the client exerts autonomy and control

• The nurse may foster a sense of empowerment• Permits a sense of privacy • Clients may offer more information especially

about sensitive issues• The home visit fosters a sense of continuity in

the nurse-client relationship, especially if there are repeated visits, or a long-term purpose for the visits.

Page 8: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Cost

• Home visits and home care are less expensive than hospital care or long-term facility placement

Page 9: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Outcomes

• Home visitation programs have been documented to achieve a variety of health-related outcomes for many different populations

Page 10: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Challenges of Home Visiting Programs

• Client diversity– Multiplicity of client problems

Page 11: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Need for Balance between Opposing Agendas

• Intimacy and professional distance

• Dependence and independence

• Risk and safety

• Cost containment and quality

• Health restoration and health promotion services

• Task orientation and meeting client needs

Page 12: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Need for Balance between Opposing Agendas

Page 13: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Purpose of Home Visiting Programs

• Four categories– Case finding and referral– Health promotion and illness prevention– Care of the sick– Care of the dying

Page 14: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Case Finding and Referral

• Identify clients needing additional services

• Provide referrals to appropriate sources of services

Page 15: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Health Promotion and Illness Prevention

• Focuses on specific populations– Examples:

• New mothers• Children needing child developmental interventions

Page 16: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Care of the Sick

• Providing direct services

• Examples:– Elderly – Populations with chronic conditions– Recent hospital discharges

Page 17: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Care of the Dying

• Specialized services to people with terminal illnesses– Palliative care– Education and information for family members– Caregiver respite services– Physical therapy– Counseling and spiritual care– Assistance with specialized equipment needs

Page 18: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Planning a Home Visit

• Review previous interventions

• Prioritize client needs

• Develop goals and objectives

• Consider acceptance and timing

• Delineate nursing activities

• Obtain necessary materials

• Plan for evaluation

Page 19: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Review Previous Interventions

• Determine the efficacy of the interventions

• Identify successful and unsuccessful interventions

Page 20: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Prioritize Client Needs

• Potential threat to their health

• Degree to which the health threat concerns the client

• The ability to resolve the health issue

Page 21: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Develop Goals and Objectives

• Goals– Stated general expectations

• Example: Develop effective parenting skills

• Objectives– Specific/tangible outcomes desired

• Example: client will display effective communication skills in relating to their children

Page 22: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Consider Acceptance and Timing

• Client’s readiness to accept intervention– Build rapport and trust

• Timing of the visit– Client must be open to the visit

• Introduction of the interventions

Page 23: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Delineate Nursing Activities

• Nursing diagnosis utilizes:– Practice guidelines– Agency procedures/protocols– Clinical pathways

• Examples: health promotion, referral, education, technical procedures

Page 24: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Obtain Necessary Materials

• Supplies and materials for home visit– Educational materials– Health care equipment– Wound care supplies– Physical assessment equipment

Page 25: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Evaluation Planning

• Evaluation criteria obtained from outcome objectives– Long-term evaluation criteria

• Client’s receptiveness or response to nursing interventions

– Short-term evaluation criteria• Actual accomplishment of objective

Page 26: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Implementation of the Home Visit

• Validate assessment and diagnosis

• Identify additional needs

• Modify the plan of care as needed

• Perform nursing interventions

• Deal with distractions

Page 27: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Distractions

• Environmental

• Behavioral

• Nurse-initiated

Page 28: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Environmental Distractions

• Background noise

• Crowded surroundings

• Interruptions

Page 29: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Behavioral

• Client behaviors – Explore reasons for behaviors– Work to establish trust

Page 30: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Nurse-initiated

• Fears– Bodily harm– Client rejection– Lack of control

• Personal reactions to different lifestyles

Page 31: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Evaluative Criteria

• Intervention outcomes not immediately apparent

• Need to determine if subsequent visits are needed

• Need to evaluate if appropriate level of prevention was implemented

Page 32: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Resources

• Nurse-Family Partnership is an evidence-based nurse home visitation program the improves the health, well-being and self-sufficiency of low-income, first-time parents and their children following the David Olds model, Registered Nurses visit the home from the time the woman is pregnant until the baby is two years of age. Outcomes have been measured for over 25 years.

Page 33: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Resources

• The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end of life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America.

Page 34: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Resources

• Home Health Agency Center, a section of Health & Human Services. This site links to current home health policies and regulations as well as home health prospective payment system rate updates. Links to payment systems, legislation, manuals, research, publications.

Page 35: Care of Clients in the Home Setting Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Community Health

Community Health Nursing, 5/eMary Jo Clark

Copyright ©2008 by Pearson Education, Inc.

Resources

• HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The performance measures in HEDIS are related to many significant public health issues such as cancer, heart disease, smoking, asthma and diabetes. HEDIS also includes a standardized survey of consumers' experiences that evaluates plan performance in areas such as customer service, access to care and claims processing. HEDIS is sponsored, supported and maintained by the National Committee for Quality Assurance (NCQA).