PUBLIC HEALTH NURSIN

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• WHO IS A PUBLIC HEALTH NURSE?

DEFINITION OF PUBLIC HEALTH NURSE

• PUBLIC HEALTH NURSE (PHN): Is a Registered nurse with certificate in midwifery and who in addition, has undergone one year training in Public Health Nursing.
• The PHN is a medico-social worker, a health teacher and a family counselor with the expert knowledge of interpreting the health service that are available in the community to the people who may need it.

SCOPE OF THE PUBLIC HEALTH NURSE

1. Administration
1. Allocation of resources
2. Data collection
3. Planning
4. Report writing
5. Evaluation of programme
2. Reproductive and Child Health Services including Family Planning, education on Sexually Transmitted Infection(STI, HIV and AIDS)
3. Home Visiting
4. School Health Services

5. Prevention and Control of Communicable Diseases
6. Immunization
7. Health Education
8. Training of Health Personnel

9. Occupational Health Services
10. Adolescent Reproductive Health
11. Disease surveillance
12. Weekly, monthly, quarterly and yearly case-based reporting on diseases of priority

HOME VISITING

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• WHAT IS HOME VISITING?

Explanation of Home Visiting

• Simply put, home visiting is extending health services to various people in their homes.
• Home visiting is a visit undertaken by a health worker to individuals and families in their own homes to render health services.

• Home visiting is a visit made to clients in their homes to prevent illness or disability, to promote and maintain health, encourage individuals and families to live healthy lives and improve their health standards

Types of Home Visiting

1. Routine
2. Special or Selective

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• HOW DOES THE NURSE PREPARE FOR HOME VISITING?

Preparation Towards Home Visiting

1. Conduct a community study of the area
2. Draw map of the area
3. Identify the area to visit
4. Determine the type of visit – Routine / Special

5. Determine the time for the visit that will suit your clients
6. Set objectives for the visit (that is what you want to achieve at the end of the visit)
7. Get the needed items for the visit

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8. Wash the home visiting bag and the content orderly and neatly
9. If special visit, inform the client on time and get needed information from the health facility

10. Read through your previous reports to assess your previous performance to make plans to improve on the next visit
11. Arrange for means of transport on time

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12. Plan where to start the visit and where to end
13. Plan your visit for the month, and quarterly, paste a copy on the notice board of the house, and give a copy of your itenery to your in charge or your supervisor.
14. Determine the number of houses to be visited

Advantages or Importance of Home Visit

1. It gives the nurse the opportunity to examine clients e. g. infants, toddlers, nursing mothers, the aged and pregnant women and advice according to findings. (e . g. counsel on child care, personal hygiene, diet and prevention of home accidents)

2. It enables the nurse trace contacts of infectious diseases and refer them to the hospital for investigation and treatment
3. Patients discharged from hospitals such as patients suffering from infectious diseases are followed –up to their homes for supervision of consumption of drugs, diet and rest

4. It enables the nurse to offer the needed services to families with special problems e. g. the physically challenged children, such as mentally retarded, deaf and dumb; able to refer such clients to welfare agencies.

5. It enables the nurse to give individualized or family care using the family’s own resources.
6. Home visiting is cost effective since most clients can be seen on a single visit.
7. It is convenient; many clients prefer to be nursed in their own environment.

8. It enables the nurse to mobilize clients to access health services.
9. It enables the nurse to obtain first hand information about a situation or condition.
10. It establishes good nurse client relationship

11. It helps in proper evaluation of health care given to a client.
12. The nurse is able to teach in the actual home environment using the client’s own tools.
13. It helps to trace infectious diseases and defaulters at child welfare clinic.

Clients may gain more confidence in the nurse who visits them in the home and thus express themselves better.

14. Home visiting helps involve the people in their care.

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16. It helps to identify positive and negative forces in the home. (e. g. feeling of family towards a teenage pregnancy or the aged)
17. With the nurses visiting, it enables her assist individuals and family as a whole to achieve high level of wellness. (e. g. 3 year old child at Enchi)
18. It helps to discuss other actions that perhaps were not considered so urgent at the time of clinic visit to be discussed in the home.
19. It makes it possible for the nurse to find out if referrals to health facilities have been carried out.

20. It helps to give the nursing mother support and encouragement and to encourage family members to support the client.
21. It helps to discuss calmly, with the mother, the agreement made at the clinic, e. g. Family Planning

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• WHAT ARE SOME OF THE CHALLENGES OF HOME VISITING?++++

Challenges /Disadvantages of Home Visiting

1. Time consuming
2. It is tiring
3. Divided attention in the home
4. Sometimes there are distractions in the home may make teaching difficult
5. Individual families cannot share experience with other families

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Challenges /Disadvantages of Home Visiting cont’d

6. Occasionally, patients may be uncooperative (e. g. HIV/AIDS clients)
7. Sometimes, it is difficult to identify homes of special visits
8. Health worker is exposed to infections
9. Transport and logistics problems

Challenges /Disadvantages of Home Visiting cont’d

10. Unfavorable weather conditions
11. Long distances
12. Hazards: Physical attach, sexual harassment, injuries from snakes bites, dog bites, and falls etc.

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• WHICH PRINCIPLES GUIDE HOME VISITING?

Principles of Home Visiting

1. Should be participatory
2. Should foster client progress
3. Should address multiple goals
4. Should permit flexibility
5. Must be sensitive to client’s needs

Principles of Home Visiting cont’d

6. Requires a well - trained staff
7. Its expected outcome should be realistic
8. Its evaluation should focus on client’s responses, cost effectiveness, and processes used in intervention

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Skills Needed During Home Visits

1. Expert nursing skills
2. Expert interviewing skills
3. Observation skills
4. Probing skills

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Skills Needed During Home Visits cont’d

5. Assessment skills: Assessment of home environment condition of households, family members body language and non – verbal cues.

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• HOW DO WE CARRY OUT HOME VISITING?

Techniques in Home Visiting

1. Good manners and behaviours are essential
2. Ensure confidentiality
3. Much of the nurse’s work can be achieved through good observation
4. Nurse should not frown on any awkward situation seen but instead advice tactfully.

Techniques in Home Visiting cont’d

5. The success of a visit will depend partly on the conduct of the nurse during the initial visit.
6. Create relaxing atmosphere
7. Use simple clear language
8. Ask relevant questions
9. Appreciate and congratulate efforts

Planning and Carrying out Routine Home Visit

• Introduction: To conduct an effective home visit, plan and set objectives for the visit, decide on the area and number of homes to be visited, date and time to be visited. In addition, stock the visiting bag with the necessary items

Picture of CHN Going for Home Visit

Steps for Carrying out Routine Home Visit

1. Set off on time to meet the people at home.
2. Before entering a house, the nurse should observe the outside conditions of the house
3. Knock and wait for a response before you en
4. Greet every one in the house, introduce yourself and tell them the purpose of the visit. Accept a seat when you are offered or ask for one
5. Enquire about their welfare, at the same time make general observations to assess the home condition
6. Ask about every individual member of the family especially: vulnerable groups - children, pregnant women, and aged. Identify needs and concerns of the family
7. Enquire about peculiar health problems and set objectives with the client.

8. Discuss and help provide solutions to family needs if possible.
9. Counsel them on your findings and help find solutions to problems

10. Assess the information collected, analyze and plan with the family members or the individuals, set objectives and prioritize them
11. Counsel and advise according to the set objectives

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• Supervise implementation of set objectives (short or long-term ) using the family’s own resources. Refer to the appropriate agency when necessary.
• Use the home visiting bag to perform needed activity(e. g. wound dressing, B/P, or examination of pregnant woman / new born baby)

Evaluate care given with family members at next visit or appropriate time.

14. Thank them for their cooperation and tell them of their next visit
15. Record findings
16. Write report

How to Establish Rapport

1. Greet client in an open respectful manner
2. Introduce yourself
3. Ascertain the condition of client and other family members

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How to Establish Rapport cont’d

4. Pay full attention
5. Talk in a private place
6. Assure client of confidentiality

Things to Observe on a Visit to a Home

• NOTE: The first visit to a house whether Routine /Special is called PRIMARY VISIT.
• Observe the environment: are people in the house clean? Does the family look poor? Are there too many people in the home?
• Where does the family get water? How is water kept in the home?

Things to Observe on a Visit to a Home cont’d

• Is there a toilet in the house or they use public toilet?
• Do they have a covered container for rubbish?
• Does the family keep animals e. g. goats, chicken or sheep? Are these animals housed or not?
• Where does the family cook? Open space or enclosed kitchen? What do they use, electricity, gas, etc?

Observe whether there is good interpersonal relationship among family members – tensed or relaxed?

• Observe the type of housing, the windows, materials used for the building, lighting system, type of roofing, cemented floor or uncemented? Home cont’d

4. Tactfully observe the kind of food they eat: observe the feeding of the children and look out for the following:- if the child breastfeeds or eats while you are in the house, observe how it is done; (for attachment and duration of breastfeeding )

• If the toddler feeds himself/herself, does anybody supervise the feeding?
• Does the toddler or pre –school child eat from the same plate with older children or adults?
• Does the mother wash child’s hands with soap and water before he/she eats?

Observe whether there is bath room in the house, observe the drainage system

5. Observe the source of water supply
6. Observe the general cleanliness of the house, number of rooms and the number of people in the house, any likelihood of overcrowding?

Tactfully observe the health of the family members

8. Observe and test their knowledge on health (how will you do this?)
9. Observe the composition of the family, whether its nuclear or extended family?

Observe whether the husband is interested or not, helpful or not, on health issues of the family.

11. Observe where the children sleep, family size and spacing of the houses.
12. Observe anything, which brings danger to the health of the family.

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Clients Commonly Nursed at Home

Clients Commonly Nursed at Home cont’d

CHN MEASURING B. P.

CHN EDUCATING PREGNANT WOMAN AFTER EXAMINATION

CHN EXAMINING A BA

How to Conduct Special Home Visit

1. Collect data and identify client (s) from health facility or from your previous visit records when possible.
2. Decide on the number of clients to visit, what you intend to do in these homes

How to Conduct Special Home Visit cont’d

3. Set objectives for each of the clients
4. Stock the visiting bag with the needed items
5. Set off on time to meet clients and their caretakers if appointment had been booked.
6. Knock and wait for response before you enter

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How to Conduct Special Home Visit cont’d

7. Greet and introduce yourself if that is your first visit and tell them the purpose of your visit. (If that is not your primary visit, what will you do, instead of point 7?)
8. Ask of other members of the family and their health.

How to Conduct Special Home Visit cont’d

9. If it is a follow up visit, evaluate the care previously given and identify the current needs together with the caretaker.
10. Re-plan, set objectives and prioritise them.
11. Assess client’s health status.

How to Conduct Special Home Visit cont’d

12. Assist and counsel the caretaker on client’s needs, using family’s resources. (e. g. personal cleanliness, feeding of the elderly, introduction of family foods to a growing child etc. )
13. Encourage family members to give the needed support.

How to Conduct Special Home Visit cont’d

14. Thank caretaker/family members of their cooperation, and inform them of your next visit.
15. Record activities done and refer If no improvement or client’s condition is retrogressing.

How to Conduct Special Home Visit cont’d

16. Write a report
17. Visit regularly to assess progress.

How to Supervise Special Clients

• HYPERTENSIVE PATIENTS: Ask about the patient's general health, diet, drugs, rest and sleeping conditions, coping strategies to avoid stress. Find out about exercise, personal hygiene and environmental hygiene, regular check ups, family support. Counsel on your findings

How to Supervise Special Clients cont’d

• DIABETES MELLITUS: Counsel client on the following:
• Proper vulva care, sleep, rest, moderate exercise, diabetic association, family support, regular check-ups, prevention of infections, care of hands and feet,.
• Advice them to take their card wherever they go (why?)

How to Supervise Special Clients cont’d

• Tuberculosis Patient: Counsel client on the following:
• Bowel movement, sleep pattern, recreation, care of sputum mug, and disposal of sputum.
• The patient’s general health, diet, personal hygiene,
• Any special problem, identify contacts and refer

How to Supervise Special Clients cont’d

• Tuberculosis Patient cont’d:
• Educate on importance of compliance and continuation of treatment
• Relationship with family members and prevention of spread
• Occupation, if a child (discuss schooling with parent/ caretaker)
• Date for review

How to Supervise Special Clients cont’d

• TWINS:
• Establish rapport, find out about their general health, examine from head to toe and check their weight
• Check previous weight and immunization from record booklet
• Discuss findings with mother and advice where necessary

How to Supervise Special Clients cont’d

• TWINS CONT’D:
• Educate on techniques of breast feeding both babies, rest, diet and personal hygiene
• Counsel on exclusive breast feeding if possible
• Encourage family members to help, if possible house help
• Emphasis on regular attendance of CWC

How to Supervise Special Clients cont’d

• PR EGNANT MOTHER:
• Establish rapport
• Examine from head to toe and counsel according to findings
• Check ANC card and comment about your findings
• Record your findings

How to Supervise Special Clients cont’d

• PREGNANT MOTHER CONT’D:
• Interview and counsel client on the following:
• General health, diet, bowel movement, exercise, rest, sleep, personal hygiene, danger signs in pregnancy (e. g. severe headache, oedema of feet and vaginal bleeding)

How to Supervise Special Clients cont’d

• PREGNANT MOTHER CONT’D:
• Counseling cont’d: regular attendance to ANC, taking of routine drugs, Tetanol immunization, Family Planning, breastfeeding and hospital supervised delivery
• Inform client about next visit
• Refer when necessary
• Record findings and thank patient

How to Supervise Special Clients cont’d

• PRETERM/NEW BORN BABY:
• Establish rapport, explain purpose of visit to mother, find out child’s health, breast feeding, provision of warmth, prevention of infection/ personal cleanliness, sleep pattern of the child.
• Examine baby from head to toe

How to Supervise Special Clients cont’d

• PRETEM/NEW BORN BABY CONT’D:
• Inspect and dress cord if necessary, explain findings to mother and give necessary education

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• Encourage attendance at CWC. Congratulate client and family members.

How to Supervise Special Clients cont’d

• PRETERM /NEW BORN BABY:
• Record findings and write report
• Report findings when necessary

How to Supervise Special Clients cont’d

• MALNOURISHED CHILD:
• Establish rapport, and find out the health of the child
• Request for card and check attendance at CWC.
• Check and record weight and compare to previous record.

How to Supervise Special Clients cont’d

• MALNOURISHED CHILD CONT’D:
• Examine from hair to toe, compare findings with previous one. Counsel and advise on findings.
• Ask for child’s food and inspect, find out if child is eating well

How to Supervise Special Clients cont’d

• MALNOURISHED CHILD CONT’D:
• Advise on regular attendance to clinic, reassure the mother
• Check immunization status from the card.
• Congratulate mother and book appointment for next visit

How to Supervise Special Clients cont’d

• MOTHERLESS: Find out about Care taker, health of the child, counsel on Replacement or Complementary feeding, provision of warmth, prevention of infections, care of feeding utensils and sleep pattern. Examine from head to toe. Explain findings and counsel on regular attendance of CWC.

How to Supervise Special Clients cont’d

• MENTAL DISORDER: Counsel on Health of client and relatives, drugs, existing problems, schooling or occupation. Explain disease condition to family members; counsel on hygiene, diet, and regular check ups. Refer problem to appropriate place if necessary. Thank care taker and family members. Record and report findings

How to Supervise Special Clients cont’d

• ELEPHANTIASIS: Counsel the client and family on nutritious diet, bowel movement, sleep pattern, and continuation of treatment, relationship with family members, any special concerns, prevention of mosquito bites, counseling on environmental health.

How to Supervise Special Clients cont’d

• ELEPHANTIASIS CONT’D: Care of the leg- Put leg in warm salty water, dry and dress the wound if any.

How to Supervise Special Clients cont’d

• CVA: Locate the Care taker , enquire general health from care taker. Undress client with Care taker and examine from head to toe. Counsel Care taker on findings. Emphasis on frequent change of position and exercise, diet, medication and regular check ups.

How to Supervise Special Clients cont’d

• CVA CONT’D: Any other concerns and counsel. Inform client about next visit. Thank client, Care taker and relatives. Record findings.

How to Supervise Special Clients cont’d

• LEPROSY : Establish rapport and greet family members. Test for muscle sensitivity, dress wound if any. Counsel on personal cleanliness, diet, sleep pattern, recreational activities, drugs and continuation of treatment.

How to Supervise Special Clients cont’d

• LEPROSY CONT’D: Discuss prevention of home accident, care of hands , feet, and eyes. Counsel on relation with family. Other concerns and counsel. Remind client of date for review with the Doctor. Book appointment for your next visit.

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

1. Establish rapport and good interpersonal relationship with family members and patient.
2. Counsel the family on the causes, signs and symptoms, mode of spread, treatment and preventive measures of the disease.

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

3. Trace those who have close contacts with the patient, that is family members and friends, and put them under surveillance, or refer.
4. The patient should have his own feeding utensils.

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

5. Isolate the patient if possible.
6. Counsel the patient and family members about disposal of patient’s feaces, sputum and disinfection of clothing.
7. Counsel on environmental hygiene

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

8. Reassure family and the patient
9. Counsel patient on medication and continuity of treatment
10. Counsel patient and family members on output of patient’s urine

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

11. Counsel patient and family members on drinking of copious fluid
12. Counsel family members to give patient nourishing diet.
13. Educate family members on personal hygiene, especially oral hygiene and proper disposal of discharges

SUPERVISION OF FAMILY WITH COMMUNICABLE DISEASES

14. Ensure that the patient is comfortable
15. Counsel family members to report any occurrence of the disease among them.
16. Record findings, thank patient and family members.
17. Refer when necessary. Book appointment for next visit

Things to Record in Home Visit Book

1. Date and time
2. Activity carried out
3. Location
4. Purpose
5. Outcome observed

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Things to Record in Home Visit Book

6. Objective
7. Nursing care plan
8. Special problems encountered

NOTE: Make carbon copy or photocopy of any referral made for the patient