Making home visits and delivering home-based nursing gives the nurse an excellent opportunity to observe and interact with families in an environment that is familiar to them. Further, by visiting the home, the nurse is able to assess safety, hygiene, support systems, and play stimulation within the environment that is closest and most familiar to the family.
Making Home Visits
In making home visits, it is essential that the nurse recognize his or her status as a visitor in the home with services that the family can accept or reject. The relationship is a negotiated one, and the nurse must recognize that successful negotiation entails gaining support and acceptance from the family.
To gain and maintain access to the home, the nurse needs to demonstrate flexibility, an understanding of the diversity present in homes, and an awareness of social rules that will affect the relationship between the family and nurse. In establishing initial contact with a family, some guidelines assist in ensuring that the contact is successful:
▪ With the first telephone call, identify affiliation, source of referral, purpose of referral, knowledge of situation, and how families can further contact the nurse.
▪ Demonstrate willingness to negotiate times for the visit.
▪ Ask for clear directions to the home. If the area is unfamiliar, check with a supervisor for more detailed directions and ensure that safety equipment, including a telephone, is included.
▪ Alert the family about when the visit will occur.
▪ Establish where to park and how to access the home.
When making the initial visit, family-centered actions will facilitate development of trust and rapport. The nurse must also be aware of variables that will affect assessment and the safety of the nurse:
▪ Maintain a respectful distance. Do not enter the family’s space prematurely. Enter the home and less public areas within the home when verbally and nonverbally invited to do so.
▪ Respect customs. Place shoes and coat in areas comfortable to the family. Observe for and avoid special areas that certain family members claim for sitting.
▪ Suspend values. What works for a family might differ from the nurse’s perception of what is acceptable.
▪ Be prepared to accept hospitality; professional boundaries are less secure in home settings, and the relationship might be less formal.
▪ Be prepared for the unpredictable. Homes can be more distracting than clinical settings; they have no common baseline, and variables are less controlled. Distractions and variations provide useful information for ongoing care and the relationship.
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