Makati Medical Center College of Nursing

144 Legaspi Corner V.A. Rufino St., Libran House, Legazpi Village, Makati City

Home Visit Plan

Family name: Acua

Name of the Student: Villa, Kristoffer

Address: 7157 M. Ocampo

Year/section: 2nd year/ A

Date and Time: 7/15/15 1:00

Phase of relationship: Working Phase

General objective: To implement all interventions to

Rotation Area: 1st / Pio Del Pilar

the patient and their family.

Specific Objectives
At the end of the 1st hour of the nursefamily interaction, the family would be
able to:

The family has to acknowledge

the student and to understand
the purpose and objectives of
the visit.
The patient and family needs to
agree with the health objectives
and cooperate with the student
nurse he/she carries out the
planned nursing intervention.

Activities of the Nurse

Introduce yourself to the family

and state the purpose of the
visit.
State the interventions that
should be done. These would
include the health teaching of
the following issues:
- The importance of adequate
living space, cleanliness /
hygiene, and pest control.
Work with the family on the
steps and how they can do it
themselves by guiding them in

Evaluation
1) The family understood the
purpose of the visit
2) The family was able to
understand how to have a clean
environment and pest control
3) The family also understood the
need for an adequate
environment
4) The family learned how to have
a proper environment for the
newborn baby
5) The family learned how to have
proper hygiene

The patient and family needs to

state their understanding of the
health teaching.
To make sure that they can carry
out the intervention in a proper
way.

planning.
Discuss the health problems that
were identified by you to the
family regarding the following:
- Inadequate living space and
ventilation
- Presence of vectors (lice,
cockroaches)
Carry of the health teaching plan
to the family and patient which is
the following:
- Teaching them open a
window or door to facilitate
air circulation in their home
- Teaching them the
importance of having
adequate living space and
cleanliness
Ask the family to state the health
tasks that they have learned and
understood from the health
teaching plan
End the home visit by asking for
permission to have another visit
on July 22nd at 1 pm.

Makati Medical Center College of Nursing

144 Legaspi Corner V.A. Rufino St., Libran House, Legazpi Village, Makati City

Home Visit Progress Report

Family name: Acua

Name of the Student: Villa, Kristoffer

Address: 7157 M. Ocampo

Year/section: 2nd year/ A

Date and Time: 7/27/15 1:00 pm

Phase of relationship: Termination Phase

General objective: At the end of the visit, the student nurse will

Rotation Area: 1st / Pio Del Pilar

Implement the intervention for the identified problems.

1st Level Assessment

Activities of the Nurse

1) Living space dirty causing irritant to

newborn baby

2) Risk for Sickness due to unsanitary

living space

Taught the family about proper

home ventilation and also about
having proper home living space
for a newborn baby.
Teach family the proper way of
pest control
Teach the family about proper pet
management

Recommendation for Future Nurses

Monitor familys progress on a

implementing proper home
ventilation
Monitors familys progress on
proper home environment
Monitors familys animals to see if
they are clean
Monitors familys surrounding

3) Vectors running rampant around the

living space

4) Animals in household has fleas & or

lice

5) The lighting in the household is dim.

environment

Makati Medical Center College of Nursing

144 Legaspi Corner V.A. Rufino St., Libran House, Legazpi Village, Makati City

Home Visit Plan

Family name: Acua

Name of the Student: Villa, Kristoffer

Address: 7157 M. Ocampo

Year/section: 2nd year/ A

Date and Time: 7/15/15 1:00

Phase of relationship: Orientation Phase

Rotation Area: 1st / Pio Del Pilar

General objective: To orientate all interventions to the patient and their family.

Specific Objectives
At the end of the 1st hour of the nursefamily interaction, the family would be
able to:

The family has to acknowledge

the student and to understand
the purpose and objectives of

Activities of the Nurse

Introduce yourself to the family

and state the purpose of the
visit.
State the interventions that
should be done. These would
include the health teaching of
the following issues:

Evaluation

the visit.
The patient and family needs to
agree with the health objectives
and cooperate with the student
nurse he/she carries out the
planned nursing intervention.
The patient and family needs to
state their understanding of the
health teaching.
To make sure that they can carry
out the intervention in a proper
way.

The importance of adequate

living space, cleanliness /
hygiene, and pest control.
Work with the family on the
steps and how they can do it
themselves by guiding them in
planning.
Discuss the health problems that
were identified by you to the
family regarding the following:
- Inadequate living space and
ventilation
- Presence of vectors (lice,
cockroaches)
Carry of the health teaching plan
to the family and patient which is
the following:
- Teaching them open a
window or door to facilitate
air circulation in their home
- Teaching them the
importance of having
adequate living space and
cleanliness
Ask the family to state the health
tasks that they have learned and
understood from the health
teaching plan
End the home visit by asking for
permission to have another visit
on July 15th at 1 pm.