class 10 Flashcards by Rebecca Penney

home visit

provision of CHN care where the individual/family reside

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home visit referral process

-referral from social or health agency (may be mandatory)
-request from family members/self referral

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3 types of home visits

initial routine visit
subsequent routine visit(if needed)
-emergency crisis intervention visit

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contacting phase of home visit coordination

-liason nurse(hospital) make referral during discharge planning
-intake coordinator take info
-nurse contacts client
-preparing for the visit (supplies, nursing bag, house/client details, resource info)

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entry phase of home visit

-going-to-see phase to seeing phase
-assessment, planning, and intervention
-removing shoes & applying “indoor” shoes
-work as a resource to client/family

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2 forms of termination phase of home visit

-ending of home visit or cessation of services
-referral and documentation
-evaluate/document interventions
-give contact info
-discuss next visit/cessation of visits

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advantages of home visit

-dignity for client
-environmental/SDOH visible
-family visible
-accessibility/no travel costs for client

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disadvantages of a home visit

-safety of the nurse
-adequate equipment/supplies
-no extra staff/second opinion
-may be more time consuming (travel, set-up/down etc)
-client may not be home/may not allow nurse in
-fear of pets

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stages of a home visit - #1 planning

-deciding best place to meet(home or clinic)
-review agencies policy on meetings
-contact family
-inform how they were referred to cHN
-arrange a time that is most convenient for most family members
-confirm date/time/place/ or directions

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advantages of meeting at clinic

-can see more clients in shorter time
-more cost-effective than home visits
-access to other HCPs
-avoid intense/unsafe family interactions

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disadvantages of meeting at clinic

-not able to assess home/neighborhood/community
-may not access family members/natural interactions
-limited access to cultural/religious traditions
-may be a burden to client

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eastern health responsibilities of client for home visits

-no smoking 1h before/during visit
-animals must be controlled
-firearms placed in a locked cabinet
-staff will be required to wear footwear
-walkway free of ice/snow

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what if the client refuses the visit?

-review the referral info
-explore reasons for referral
-offer to meet elsewhere
-inform case manager/physician

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what if a client refuses a visit that ISNT mandatory?

-accept clients right
-inform Dr
-inform cline you will contact them in a few days to reassess need for home visits
-document

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what if the client refuses a visit that IS mandatory?

-inform client it is mandatory
-if refusal continues, inform client supervisor will need to be involved
-follow agency policy regarding follow up

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4 safety features for nurse during home visits

-can refuse unsafe visits/bring a 2nd nurse
-staff safety risk assessment tool
-safety line: can check-in/check-out of visit

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stages of home visit - #2 engagement stage

-provides professional identification & tells the client the location fo the agency
-engages in a brief social conversation to help establish rapport
-describes his/her role, responsibilities, and limitations
-determines the clinet’s expectations

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stages of home visit - #3 assessment phase

family assessment: a systematic assessment process by which the CHN identifies family health concerns and strengths using CFAM, friedman, McGill

stages of home visit - #4 intervention stage

-calgary family intervention model(CFIM)
-mutual goal setting and care planning with a family’s approach
-if interventions are needed post-assess CHN will use CFIM
- can only OFFER interventions, do with that what they will (no instruction, direct, demand, insist)

family nursing interventions

-direct care
-teaching
-anticipatory guidance
-coordinator of care
-advocacy
-therapeutic conversation
-commendation of strengths
-child protection
-normalizing situations
-crisis intervention
-caregiver support
-referrals

the calgary family intervention model (CFIM)

-the first nursing family intervention model, accompanies CFAM.
-CFIM focuses on promoting, involving, and sustaining effective family function in 1-3 areas: cognitive, affective, and behavioural
-interventions need to be tailored to each family & chosen area

cognitive domain of CFIM

-offer commendations, information, our opinion

affective domain of CFIM

-validating or normalizing emotional responses
-encouraging illness narratives

behavioural domain of CHN

-encouraging family supports
-supporting family caregivers
-encouraging respite

contracting with families

continuously negotiable agreement between 2+ parties -can be written, signed, revised -involves a shift in responsibility towards control/shared effort by client and CHN -involves family in nursing process -made with all responsible and appropriate members of the family

contracting with families - beginning phase

1.mutual data collection and exploration of needs and problems 2.mutual establishment of goals 3.mutual development of a plan

contracting with families - working phase

4.mutual division of responsibilities 5.mutal setting of time limits 6.mutual implementation of plan 7.mutual evaluation and renegotiation

contracting with families - termination phase

8.mutual termination of contract -provides a smooth transition and closure to family and CHN

advantages of contracting with families

-gives direction and structure when working with families -reinforces the commitment on both parties

disadvantages of contracting with families

-requires time and effort -requires willingness for increased responsibility on the part of the family -nurse may be reluctant to relinquish control -is not appropriate in all situations

mutual goal setting and care planning with families

-involves shift in responsibility toward a shared client and CHN effort -family control to increase healthful choices -formally involves family in care plan

Beginning phase of goal setting with families

-mutual data collection and exploration of needs and problems -mutual establishment of goals -mutual development of a plan

working phase of goal setting with families

-mutual division of responsibilities -mutual setting of time limits -mutual implementation of plan -mutual evaluation and renegotitation

stages of a home visit - #5 termination & evaluation

mutual termination of working relationship -purpose of visit has been accomplished, CHN reviews whats has occured/been accomplished -phase provides basis for evaluating if further home visits are needs or referrals to community resources are required

stages of a home visit - #6 post-visit documentation at the office

-debrief emotions and stress -reinforce objectives of care/care provided -review knowledge/information -enhance critical thinking and problem solving -foster reflective thinking

post-visit documentation may consist of:

-narratives -flow sheets -problem orientated medical records -subjective and objective assessment plans -combination

health risk

the factors that determine or influence whether disease or other unhealthy results occur

social risk

risky social situations that can contribute to the stressors experienced by families

health risk reduction

assumption that decreasing # of risks or magnitude of risk will result in lower probability of the event occuring

family crisis

occurs when family is not able to cope with an event and becomes disorganized -attempt to gather their resources to deal with demands created

family empowerment

-used to promote and protect the health of families, encourage autonomy, provide families w info to actively involve them so they can make informed choices

empowered family seeking help

-access and control over needed resources -deicison-making and problem solving abilities -abilities to communicate and obtain needed resources

empowerment requirements for intervention

-directed towards the building of nurse/family relationships -emphasizes health risk reduction and health promotion

family resiliency

-the ability to cope with expected and unexpected stressors resilient families will: -recognize and draw on their strengths to cope -choose adaptive responses to restore equilibrium -maintain positive outlook -work together to find solutions -have flexible roles to deal with stressors -maintain routines; functions are achieved -reach out for support as needed