CHN Clinichome Visits

CLINIC & HOME VISITS
 CLINIC VISIT
 STANDARD PROCEDURES:
1. Registration/Admission
 Greet the client upon entry & establish rapport
 Prepare the family record of new patients or retrieve records of old clients
 Elicit & record the client’s chief complaint & clinical history
 Perform physical examination on the client & record it accordingly
2. Waiting Time
 Give priority numbers to clients
 Implement the “first come, first serve” policy except for emergency/urgent
cases
3. Triaging
 Manage program-based cases (ex: IMCI)
 Refer all non-program based cases to physician. For all other cases which
has no potential danger, treatment/management is initiated by the nurse &
she decides to do her own nursing diagnosis & then refer to physician for
medical management
 Provide first-aid treatment to emergency cases & refer when necessary to
the next level of care
4. Clinical Evaluation
 Validate clinical history & physical examination
 The nurse arrives at evidence-based diagnosis & provides rational treatment
based on DOH programs
 Identify the patient’s problem
 Formulate/Write the nursing diagnosis & validate
 Give/Perform the nursing intervention
 Evaluate the intervention if it has enabled the patient to achieve the
desired outcome
 Inform the client on the nature of the illness, the appropriate treatment &
prevention & control measures
5. Laboratory & Other Diagnostic Examinations

 Identify a designated referral laboratory when needed
6. Referral System
 Refer the patient if he needs further management following a two-way
referral system (BHS to RHU, RHU to RHU, RHU to Hospital)
 Accompany the patient when an emergency referral is needed
7. Prescription/Dispensing
 Give proper instructions on drug intake
8. Health Education
 Conduct one-on-one counseling with the patient
 Reinforce health education & counseling messages
 Give appointments for the next visit
 HOME VISIT
 Is a family-nurse contact which allows the health worker to assess the home &
family situations in order to provide the necessary nursing care & health-related
activities
 It is essential to prepare a plan of visit to meet the needs of the client & achieve the
best results of the desired outcomes
 When planning for a home visit, it is necessary to assemble the records of the
patients & list the names to be visited, study the case & have a written nursing care
plan
 PURPOSE OF HOME VISIT

 To give nursing care to the sick, to a post partum mother & her newborn
with the view to teach a responsible family member to give the subsequent care
 To assess the living condition of the patient & his family & their health
practices in order to provide the appropriate health teaching
 To give health teachings regarding the prevention & control of diseases
 To establish close relationship between the health agencies & the public for the
promotion of health
 To make use of the inter-referral system & to promote the utilization of
community services
 PRINCIPLES INVOLVED IN PREPARING FOR A HOME VISIT

 A home visit must have a purpose or objective
 Planning for a home visit should make use of all available information about the
patient & his family through family records
 In planning for a visit, we should consider & give priority to the essential needs
of the individual & his family
 Planning & delivery of care should involve the individual & family
 The plan should be flexible
 GUIDELINES TO CONSIDER REGARDING THE FREQUENCY OF HOME

VISITS
 There is no definite rule to be followed on the frequency of home visits. The
schedule of the visit may vary according to the need of the patient or family
for nursing care, but one has to consider the ff factors:
 The physical needs, psychological needs & educational needs of the
individual & family
 The acceptance of the family for the services to be rendered, their interest &
willingness to cooperate
 The policy of a specific agency & the emphasis given towards their health
programs
 Take into account other health agencies & the number of health personnel
already involved in the care of a specific family
 Careful evaluation of past services given to a family & how the family avail
of the nursing services
 The ability of the patient & his family to recognize their own needs, their
knowledge of available resources & their ability to make use of their
resources for their benefits
 STEPS IN CONDUCTING HOME VISITS

 Greet the patient & introduce yourself
 State the purpose of the visit
 Observe the patient & determine the health needs
 Put the bag in a convenient place then proceed to perform the bag technique
 Perform the nursing care needed & give health teachings
 Record all important data, observation & care rendered
 Make appointment for a return visit
 THE BAG TECHNIQUE

 Is a tool by which the nurse, during her visit will enable her to perform a
nursing procedure with ease & deftness, to save time & effort, with the end
view of rendering effective nursing care to clients
 An essential & indispensable equipment of a public health nurse which she has
to carry along during her home visits
 Principles of Bag Technique

 Performing the bag technique will minimize, if not prevent the spread of any
infection
 It saves time & effort in the performance of nursing procedures
 The bag technique should show effectiveness of total care given to an
individual or family
 The bag technique can be performed in a variety of ways depending on the
agency’s policy, the home situation, or as long as principles of avoiding
transfer of infection is always observed
 Contents of the Public Health Bag

Paper Lining Extra paper for making waste bag
Plastic/Linen lining Apron
Hand Towel Soap in a soap dish
Thermometers (oral & rectal) 2 Scissors (surgical & bandage)
2 Forceps (curved & straight) Sterile dressing
Disposable syringes w/ needles (g. 23 & 25) Cord clamp
Hypodermic needles (g. 19,22,23,25) Micropore plaster
Cotton balls (dry & w/ alcohol) Tape measure
Sterile gloves Baby’s scale
Alcohol lamp 2 Test tubes & holders
Solutions of: Betadine, Zephiran Solution, Spirit of Ammonia, Acetic Acid -
albumin, 70% Alcohol, Hydrogen peroxide, Ophthalmic ointment, Benedict’s
Solution glucose
*Sphygmomanometer & Stethoscope are carried separately
 Important Points To Consider In the Use of the Bag

 The bag should contain all the necessary articles, supplies & equipments
that will be used to answer emergency needs
 The bag & its contents should be cleansed very often, the supplies replaced,
& ready for use anytime
 The bag & its contents should be well protected from contact with any
articles in the patient’s home; consider the bag & its contents clean &
sterile, while articles that belong to the patients as dirty & contaminated
 The arrangement of the contents of the bag should be the one most
convenient to the user, to facilitate efficiency & avoid confusion
 Steps In Performing the Bag Technique Actions
STEPS RATIONALE
1. Upon arrival at the patient’s home, place the bag To protect the bag from being
on the table lined with clean paper. The clean contaminated
side must be out & the folded part touching the
table.
2. Ask for a basin of water or a glass of drinking To be used for handwashing
water if tap water is not available.
3. Open the bag & take out the towel & soap To prepare for handwashing
4. Wash hands using soap & water, wipe to dry To prevent infection from the care
provider to the client
5. Take out the apron from the bag & put it on To protect the nurse’s uniform
with the right side out
6. Put out all the necessary articles needed for the To have them readily accessible
specific care
7. Close the bag & put it in one corner of the To prevent contamination
working area
8. Proceed in performing the necessary nursing To give comfort & security & hasten
care & treatment recovery
9. After giving the treatment, clean all things that To protect the caregiver & prevent
were used & perform handwashing infection
10. Open the bag & return all things that were used
in their proper places after cleaning them
11. Remove apron, folding it away from the person
the soiled side in & the clean side out. Place it
in the bag
12. Fold the lining & place it inside the bag; close
the bag
13. Take the record & have a talk with the mother. For reference in the next visit
Write down all the necessary data that were
gathered, observations, nursing care &
treatment rendered. Give instructions for care
of patients in the absence of the nurse
14. Make appointment for the next visit (either For follow-up care
home or clinic) taking note of the date & time
 ISOLATION TECHNIQUE IN THE HOME

 All articles used by the patient should not be mixed with the articles used by the
rest of the members of the household
 Frequent washing & airing of beddings & other articles & disinfection of room
are imperative. Abundant use of soap, water, sunlight & some chemical
disinfectants is necessary
 The one caring for the sick member should be provided with a protected gown
that should be used only within the room of the sick
 All discharges, especially from the nose & throat of a communicable disease
patient should be carefully discarded
 Articles soiled with discharges should first be boiled in water 30 minutes before
laundering. Those that could be burned should be burned
SWA – 3X SOAP ; 3X WATER; 1X ALCOHOL – cleaning the thermometer

after use

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CLINIC & HOME VISITS

5. Laboratory & Other Diagnostic Examinations

 PURPOSE OF HOME VISIT

 PRINCIPLES INVOLVED IN PREPARING FOR A HOME VISIT

 GUIDELINES TO CONSIDER REGARDING THE FREQUENCY OF HOME

 STEPS IN CONDUCTING HOME VISITS

 THE BAG TECHNIQUE

 Principles of Bag Technique

 Contents of the Public Health Bag

 Important Points To Consider In the Use of the Bag

 Steps In Performing the Bag Technique Actions

 ISOLATION TECHNIQUE IN THE HOME

SWA – 3X SOAP ; 3X WATER; 1X ALCOHOL – cleaning the thermometer

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