Chapter 11: Home Visit - Opening the Doors for Family Health

a. All nurses try to help people stay well, but I can also help you assess your home for any dangers to the baby. Although all nurses try to keep clients safe and healthy, the community/public health nurse is most qualified to assess the home environment and wider community for dangers as well as resources.

A new mother asked the community/public health nurse what a nurse visiting her at home would do differently from what the nurses in the hospital had already done. Which of the following would be the best response from the nurse? a. All nurses try to help people stay well, but I can also help you assess your home for any dangers to the baby. b. Hospital nurses and I all try to be helpful, but I can also tell you how to obtain excellent child care. c. In the hospital, you had a nurse focus on your baby and another nurse focus on your care. Ill be focusing on both you and your baby. d. The other nurses in the hospital focus on helping you and the baby get off to a great start. Im going to repeat everything to be sure you really know it.

a. To geriatric clients and the local senior citizen centers A nurse can be assigned a specific neighborhood or a specific aggregate. As a clinical specialist in gerontology, the nurse would probably be assigned to work where there is a need for such expertise. The nurse could also be assigned a specific neighborhood, but not on the basis of risk, the nurses own residence, or the nurses choice.

A clinical specialist in gerontology accepted a position with the local health department as a community/public health nurse. For whom can the nurse expect to provide care? a. To geriatric clients and the local senior citizen centers b. To the neighborhood at highest risk in the city c. To the neighborhood where the nurse lives d. To wherever the nurse selects

d. Confirming the information obtained with the client Having heard from only the wife, the nurse must attempt to validate the information with the husband or recognize that all information was from only one perspective.

A home health nurse was making an initial visit to an elderly man. As the nurse began the assessment, the wife gave all the information requested. Which of the following actions would the nurse take next? a. Agreeing upon appropriate interventions with the family b. Creating appropriate nursing diagnoses c. Assessing the environment of the wider community d. Confirming the information obtained with the client

c. Stress how to get in touch with the public health agency if the mother ever has questions or needs assistance and then wish her the very best. After discussing the options and choices that the family has if it declines further visits, the nurse has provided information so the family can engage in informed decision making. The nurse has no further obligation.

A new mother seemed hesitant to let the community/public health nurse into her apartment. However, the visit seemed to go well, with the nurse sharing information, resources, and positive support to the new mother. At the end of the visit, the mother thanked the nurse profusely but said she thought she was all right now so there was no need for the nurse to return. Which of the following actions would be most appropriate for the nurse to take? a. Chart that the mother was noncompliant and would not let the nurse return. b. Plan on returning in 1 week to answer any new questions the mother might have about her baby, how to care for him, or how infants grow and develop. c. Stress how to get in touch with the public health agency if the mother ever has questions or needs assistance and then wish her the very best. d. Try to find free formula, baby cereal, infant clothes, and other goodies to give the new mother so she will let the nurse back into the apartment.

b. By confirming the nursing inferences that have been developed Nurses are in the position to share assessment information, determine what it means to the family, and discuss nursing inferences that have been made. Consultation and collaboration with other professionals within the agency are important to make sure that the nurse is seeing the complete situation of the patient and that an appropriate plan of care has been developed for the client.

A nurse briefly summarized a home visit with the agency supervisor. How can discussing clients with a colleague help the nurse? a. By ensuring that the agencys policies and procedures are correct b. By confirming the nursing inferences that have been developed c. By ensuring that appropriate referrals are made for the client d. By confirming that the client understands the obligations of the agency

d. The only person the nurse can change is the nurse. The only person the nurse can change is the nurse. Trying to change another person may make that person feel dominated and thus feel more strongly that change must be resisted.

A nurse is often frustrated when clients do not comply with the nurses suggestions that would improve their health. What might be helpful to remember in such situations? a. It takes a long time and much effort to change peoples behavior. b. The clients may not change today, but they may change tomorrow. c. The nurse may have to change the clients values in order for the client to want to change behaviors. d. The only person the nurse can change is the nurse.

a. Apologizing and saying that the visit will be rescheduled when the client is feeling better When a client has a gun and has become agitated and the nurse is feeling uncomfortable, the number one priority is the safety of the nurse. Therefore, the nurse should leave the immediate environment.

A nurse visited a middle-aged client at home after his hospital discharge. The client was cleaning a gun. When the nurse asked the client to put the gun away, the client became agitated. What is the nurses best action at this time? a. Apologizing and saying that the visit will be rescheduled when the client is feeling better b. Focusing on client assessment and staying calm because filling out the necessary forms will not take long c. Hurrying through the visit and finishing the documentation inside the safety of the nurses car d. Using a low voice and slow, calm movements, and asking whether there is a problem

b. I cant help with those items, but I can share with you some other resources that may help you adapt to having this new little person in your lives. Families may test what the nurse is willing to do, or they may be so overwhelmed that they make inappropriate or unrealistic demands. The nurse must state limits immediately to maintain trust. However, referrals are appropriate for emergency food, clothing, and shelter, including formula for newborns.

A nurse visited a new family to help them adapt to the needs of their newborn. The family asked the nurse to help them obtain diapers, formula, and transportation to the clinic. How should the nurse respond? a. I cant believe you even asked me that. I dont have any money! b. I cant help with those items, but I can share with you some other resources that may help you adapt to having this new little person in your lives. c. Ill ask at the home office and see if someone knows a resource for you. d. My sister has some cloth diapers she isnt using anymore; I can bring those over, but I dont have any formula. Have you tried asking the hospital for free samples?

a. Home visits allow you to focus on the entire family and see threats to health and safety. Home visits allow the nurse to see threats to the family health and safety in the home or immediate environment. Home visits also encourage a family focus, although they do not guarantee it. It is common for new nurses who have little experience in home visiting to feel uncertain and ambivalent about the experience.

A senior student nurse asked the instructor, Why do we have to make home visits? The client learned self-care in the hospital. Which of the following statements would be the best response from the instructor? a. Home visits allow you to focus on the entire family and see threats to health and safety. b. Making home visits will increase your marketability after you graduate. c. Our State Board of Nursing requires home visits as part of community/public health education. d. The national accreditation policies require that students make home visits before they graduate.

c. Complete the documentation and discuss questions beyond the nurses expertise with a consultant. After the visit, the nurse should make sure that documentation is complete, make any necessary referrals, and consult with colleagues or an expert in a particular clinical area about unresolved issues. Legal documentation is always required after a home visit.

After a completing a home visit, which of the following would be the priority action for the nurse? a. Submit the insurance and other third-party payer forms correctly. b. Call the family and determine their satisfaction with the visit. c. Complete the documentation and discuss questions beyond the nurses expertise with a consultant. d. Order the necessary supplies and equipment for the return visit.

a. Indicating that he or she will return at another time and then leaving the home In some households, members may be intoxicated from consuming alcohol or may be using illicit drugs during the visit. Such individuals are likely to be cognitively impaired and will not benefit from your visit. You should indicate that you will return at another time, and then leave the home.

After being invited into the apartment of some elderly clients, the nurse was shocked to realize the elderly husband was smoking marijuana. Which of the following actions should the nurse take? a. Indicating that he or she will return at another time and then leaving the home b. Asking the man to stop and stress that the nurse cannot return if they are going to engage in illegal behavior while the nurse is there c. Calling the police, reporting the illegal behavior, and agreeing to serve as a witness if the case goes to trial d. Leaving and refusing to come back until all illegal drugs are out of the apartment

c. We have to assume that the new mother will be able to manage without us. The purpose of care in the community is to enable the family to remain at home and manage without the constant presence of health care providers.

After leaving the home of a new mother and her newborn, the student nurse asked the instructor, What will the new mother do when we arent there to help? Which of the following statements would be the best reply from the nursing instructor? a. I am going to ask you to come back tomorrow to help the new mother further. b. Why would the new mother experience any problems? c. We have to assume that the new mother will be able to manage without us. d. Well have another nurse stop by tomorrow to help the new mother.

c. Would you like to introduce me to your cats? The appropriate response to animals in the house is to first assess for safety. If safety is not an issue, then ask for an introduction. Pets are often considered members of the family.

As the nurse entered the house of an elderly couple and was invited to sit, three cats rubbed against the nurses legs. Which of the following would be the most appropriate comment for the nurse to make? a. Are these cats hungry? Or do they want something else? b. Cats can really cause health problems. Would you like me to call the animal shelter for you? c. Would you like to introduce me to your cats? d. Would you please lock up your cats until were done?

c. It was a successful short-term achievement toward the long-term goal of environmental safety. Short-term objectives are often helpful toward slowly achievable long-term goals. It is also wise to be aware of and verbalize small, subtle changes or achievements.

During the second visit, a nurse noticed that although an elderly gentleman had not been able to clean up the apartment, he had been able to clean up the kitchen. Why would the nurse praise him for his cleaning efforts when only one room had changed? a. It demonstrated that the home-bound man was trying to be compliant with the nurses suggestion. b. It made the apartment so much nicer for both the client and the nurse. c. It was a successful short-term achievement toward the long-term goal of environmental safety. d. The elderly gentleman obviously expected considerable praise for doing such a female task.

a. Research has shown home visits save far more than their cost in decreasing child abuse, drug-resistant infections, and even emergency department visits. Research has demonstrated that home visits result in fewer instances of child abuse and neglect and fewer emergency department visits, accidents, and poisonings during the childs first 2 years of life. These effects were still apparent 15 years later.

It was suggested a public health departments funding for home visits be cut because so much time and money were spent in travel and such expenses seemed inappropriate in a time of fiscal restraint. Which of the following would be the nurses best response to this suggestion? a. Research has shown home visits save far more than their cost in decreasing child abuse, drug-resistant infections, and even emergency department visits. b. The public health department staff members are the most knowledgeable concerning funding needed and how best to spend the funds. c. The voters agreed on the tax levy funding the department. It would not be politically wise to act against voters obvious desires. d. With all the fear about bioterrorism, it is an inappropriate time to cut funds to the public health department.

b. A client with acquired immune deficiency syndrome (AIDS) who is waiting for a hospice opening Because an AIDS client is immunosuppressed, the nurse should visit that client before visiting clients who have, or may have, an infection.

Of the five clients listed below, whom should a nurse visit first? a. A married couple who have been having problems with independent living since the husband developed a staphylococcal infection b. A client with acquired immune deficiency syndrome (AIDS) who is waiting for a hospice opening c. A new admission who was discharged from the hospital with a diagnosis of pneumonia d. A man with a draining chest abscess who is receiving intravenous antibiotics

c. The elderly couple themselves The clients are the experts in their own health, their health history, their experience in various stages of health and illness, and their health and illness concerns.

On the first home visit, a nurse explained to an elderly couple how the nurse could help them. Who would be the most knowledgeable concerning the couples health needs? a. The nurse who had analyzed all of the background data b. The hospital case manager who had coordinated the couples care c. The elderly couple themselves d. The nurse who had been the primary care provider in the hospital before discharge

a. Ambivalence because the nurse could be helpful but also judgmental of their situation Although all the options are possibly true, if the clients are home for the nursing visit they are at worst feeling ambivalent about the meeting. They are willing to consider what the nurse may have to offer.

The nurse is to visit newly referred clients for the first time after their discharge from the nursing home back to their apartment. Which of the following is the most likely feeling the clients will have regarding the nurses visit to them? a. Ambivalence because the nurse could be helpful but also judgmental of their situation b. Glad because the nurse can be of immediate help c. Fearful because the nurse is someone who has the authority to intervene in their lives d. Angry because the nurse is essentially an intruder into their lives

d. It clarifies who will do what, when, where, and why. A contract clarifies and documents mutual understandings. The agreement usually entails one or more family members continuing to meet with the nurse for a specific number of visits or weeks. Initially, specific goals and the nurses role regarding health promotion and illness prevention may be unclear.

The supervisor suggested that a nurse use a contract to confirm goals and plans with an elderly man who had recently moved into a self-care halfway house. Which of the following is an advantage of such a contract? a. It documents the cost of each nursing service. b. It protects the nurse if the nurse is ever sued for malpractice. c. It is legally binding for both parties. d. It clarifies who will do what, when, where, and why.

d. Establishing trust for a productive relationship Although all the options listed are important, the relationship is the most important because without it, the other tasks cannot be completed. Without at least earning trust, the nurse will not be able to visit the family again. Also, building and preserving relationships is a central focus of home visiting.

What is the most crucial aspect of the first visit to a new client? a. Confirming that all needed assessment data are obtained b. Creating an accurate and appropriate list of nursing diagnoses c. Establishing a systematic evaluation plan d. Establishing trust for a productive relationship

b. Liquid soap, paper towels, educational materials, and assessment equipment Not knowing what he or she will see or need, the nurse should bring safety supplies (soap, paper towels) and basic assessment tools. The nurse can return to the car for additional supplies or equipment if it is needed.

What should a nurse bring to the home visit when first going to the apartment of a newly admitted patient whose referral sheet was essentially blank? a. Everything that might possibly be needed b. Liquid soap, paper towels, educational materials, and assessment equipment c. Nothing; the nurse should assess the situation and then get supplies d. Agency forms and a pen

b. Home visits reflect a situation under the clients control and in the clients environment. All of these factors can lead a nurse, especially an inexperienced one, to feel uncomfortable. However, the major difference is that the setting and the control are clearly the clients, not the nurses.

Which of the following reasons explains why new community/public health nurses are very uncomfortable with home visiting, even in nice neighborhoods? a. Home visits are a new skill to be mastered, and learning is uncomfortable. b. Home visits reflect a situation under the clients control and in the clients environment. c. Home visits require lots of supervision, backup, and extra resources. d. Home visits take much more time and effort than does giving care in the hospital.

a. Before leaving his or her car, he or she should check the immediate surroundings for anyone or any situation that makes the nurse uncomfortable. Any of these behaviors could cause the nurse to be physically injured except checking ones surroundings before exiting the car, which is an effective precaution the nurse should always take.

Which of the following would be appropriate to help ensure a nurses safety? a. Before leaving his or her car, he or she should check the immediate surroundings for anyone or any situation that makes the nurse uncomfortable. b. The nurse should intervene immediately with a family whose fighting is starting to become physical, before it escalates further. c. The nurse should visit a family over the weekend, when no one is expecting an outsider to drop by. d. When approached on the street by an unknown person, the nurse should stop and tell them how to reach the agency to be formally accepted as a client.

d. Positive regard, empathy, and genuineness Carl Rogers wrote that the three characteristics of a helping relationship are positive regard, empathy, and genuineness, which are relevant in all nurseclient relationships.

Which of the following would be essential characteristics of a professional helping relationship? a. Acceptance and sympathy b. Enthusiasm and energy c. Positive intent, supportiveness, and trust d. Positive regard, empathy, and genuineness

c. Unless a medical emergency, whatever the client believes is most important Because the client is the ultimate decision maker, the clients priorities must be addressed first.

Which of the following would be the first priority when a nurse is completing a home visit? a. Consistency with agency rules and procedures b. Legally, whatever the medical referral requires c. Unless a medical emergency, whatever the client believes is most important d. What the nurses professional judgment determines to be the major threat to health

c. To establish rapport with the clients and work with them to define mutually agreeable goals Although all the steps are important, establishing rapport, defining problems, and agreeing on goals must be done before it is possible to begin the other steps. These events occur during the initiation phase, which starts during the first visit and may take several visits.

Which of the following would be the nurses primary goal during the first visit to home-bound clients? a. To assess the health of all family members and the immediate environment b. To discuss the time and financial limits to the care the nurse can give c. To establish rapport with the clients and work with them to define mutually agreeable goals d. To implement the nursing care plan established before hospital discharge

b. The nurse may be unable to care for as many clients because of the time lost in transportation. e. The nurse may sometimes be concerned for personal safety. f. It may be difficult to control distractions, such as noisy children. Travel time is costly, and it is less efficient for the nurse than working with groups or seeing many clients in an ambulatory site. Distractions, such as television and noisy children, may be more difficult to control. In addition, nurse safety can be an issue.

Which of the following would most likely be a problem for the nurse making home visits? (Select all that apply.) a. Assessing the client may be more complex when family and environmental factors are considered in the assessment. b. The nurse may be unable to care for as many clients because of the time lost in transportation. c. Clients will be unable to receive individualized care. d. Teaching may be more time-consuming when both the client and the family are involved. e. The nurse may sometimes be concerned for personal safety. f. It may be difficult to control distractions, such as noisy children.