FAMILY NURSE CONTACT

ROSECHELLE S. ELARCO, RMT,RN,MAN

 FAMILY AS THE UNIT OF CARE IN COMMUNITY
HEALTH NURSING

A family is an aggregate of persons of different ages,

their family development, dynamics, interaction and
the health of the family as a whole.
FAMILY as a UNIT of CARE in CHN
❑Family is considered as the natural and fundamental unit
of society.

❑Family as a group generates, prevents, tolerates and

corrects health problems within its membership.
✓Health problems may be caused by family behavior or
relationship

❑Health problems of family members are interlocking

 FAMILY as a UNIT of CARE in CHN

❑Family is the most frequent locus of health decisions and actions

in personal care.

❑Family is an effective and available channel for much of the

community health nursing effort.

❑Family provides a crucial environmental force.

❑Family through its interaction with the larger social system

validates and influences health efforts
CHARACTERITICS OF FAMILY AS A PATIENT
*FREEMAN
▪ Family is a product of time and place

▪ Family develops its own lifestyle

▪ Family operates as a whole/group

▪ Family accommodates to the needs of the individual

▪ Family relates to the community

 FAMILY NURSE CONTACT

The enhancement of the health and well being of the entire

family unit became the primary objective for community
health nursing visits through Family Nurse Contact.
 FAMILY NURSE CONTACT
• Is an activity with or on behalf of a particular
family or individual

• Crucial approach in delivering community

health nursing service for the family through
home visit, clinic visit, group conference,
telephone contact or written communication.
Objectives of Family Nurse Contact
• To assess the health needs and problems of
the family utilizing a multidisciplinary
approach
• To ensure family's understanding and
acceptance of their problems
• To provide the needed support and assistance
to the family
Objectives of Family Nurse Contact
• To develop the individuals and or families
competence to cope with their health
problems

• To contribute to the personal and social

development of the family through varied
health activities
 METHODS OF
FAMILY- NURSE CONTACT
CLINIC VISIT

❑The nurse is able to help the family meet their

needs, ease their anxieties and help them
decide on what to do to promote and
maintain their health.
CLINIC VISIT
- The patient visits the Health Center/OPD to avail of
the services thereto offered by the facility primarily
for consultation on matters that ailed them physically.
• NURSES plays a very important role in building a closer
ties with the patient to gain their trust and confidence and
particularly in the implementation and promotion of health
care.

➢ PRE CONSUTATION CONFERENCE

pre clinic lecture is usually conducted prior to the admission of
patients and one way of providing health education.
 STANDARD PROCEDURE PERFORMED DURING CLINIC
VISIT

1. REGISTRATION/ ADMISSION
- Establish rapport
- Family records/ retrieve records of old clients.
- Recording of chief complaint and clinical history
- Performs physical examination on the client and record it
accordingly
 STANDARD PROCEDURE PERFORMED DURING CLINIC
VISIT

2. WAITING TIME
- Give priority number
❖Health education

3. TRIAGING
- Manage program based cases
❖IMCI
❖Control of Diarrheal Diseases (CDD)
- Refer all non program based cases to the physician
- First aid treatment to emergency cases and refer
necessary to the next level of care.
 STANDARD PROCEDURE PERFORMED DURING CLINIC
VISIT

4. CLINICAL EVALUATION
- Validate clinic history and physical examination
- nurse arrives at evidence based diagnosis and provides rational
treatment based on DOH programs
❖ identify patient’s problem
❖Formulate nursing diagnosis and validate
❖Perform the nursing intervention
❖Evaluate the intervention if it is enabled the patient to achieve the
desired outcome.
❖Inform the patient on the nature of the illness, appropriate treatment
and prevention and control measures
 STANDARD PROCEDURE PERFORMED DURING CLINIC
VISIT
5. LABORATORY and other EXMINATIONS
- Identify a designated referral laboratory when needed.

6. REFERRAL SYSTEM
❑ Refer patient if he needs further management
❑ 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 and counselling messages
- Give or schedule appointments for the next visit
GROUP CONFERENCE

❑The nurse can obtain the essential

information to enhance the community health
nursing service for the people in the
community
TELEPHONE CONTACT

❑This will facilitate an easy access to

communicate with the family
WRITTEN COMMUNICATION

❑This is the least individualized. The teaching

materials sent with a covering personal note
commonly sent to a school child.
Methods of Family Nurse Contact

HOME VISIT
❑It is a professional contact made by the nurse to or in
behalf of a patient or family to further a special activity of
the agency
 HOME VISIT
- A family- nurse contact which allows the health worker
to assess the home and family situations in order to
provide the necessary nursing care and health related
activities.
HOME VISIT
➢ defined as the delivery of specialized nursing care services in
the home health care setting

➢Process of providing nursing care to patient or family at their

DOORSTEP

➢The services provided as an extension of the Health Service

Agency ( Health Center)

❑In performing home visits, it is essential to prepare a plan of

visit to meet the needs of the client and achieve the best
results of desired outcomes.
CONCEPTS OF HOME VISITING
✓Home visiting provides opportunity to make direct observation
on home environment, family structure, familial roles and
relationships, life style, cultural practices, group dynamics, etc.
and make family health assessment.
✓In home visiting the members are relaxed, have more time and
privacy and feel free to raise questions, seek clarifications and
sort out their problems
✓It provides opportunities to make direct observation of care
given by family members in planning and implementing family
health care services
✓It provides opportunities to contact and interact with most of the
family members and establish report with the family as a whole
✓It also make possible to have active participation of family
members in planning and implementing family health care
✓It makes feasible to plan and provide comprehensive family
health care with major emphasis on promotive and preventive
care
PURPOSE of HOME VISIT
1. To give nursing care to the sick, post partum mother
and her new born with the view to teach a responsible
family member to give the subsequent care.
2. To assess the living condition of the patient and his
family and their health practices in order to provide
appropriate health teaching.
3. To give health teaching regarding the prevention and
control of diseases.
4. To establish close relationship between the health
agencies and public for the promotion of health
5. To make use of the inter- referral system and to
promote the utilization of community services.
 PRINCIPLES OF HOME VISIT
• A home visit should be planned and must have a purpose or
objective.
• The purpose of home visits should be clear and must meet the
needs of the patients.
• Planning for a home visit should make use of all available
information about the patient and his family through family
records.
• In planning for a home visit, we should consider and give priority
to the essential needs if the individual and his family.
• Planning and delivery of care should involve the individual and
family.
• Home visit should give excellent opportunities for nurse to
demonstrate hygienic principles
• Home visit should be convenient, acceptable and educative to
the patients.
• The plan should be flexible and regular
PRINCIPLES OF HOME VISIT
• The nurse should make an attempt to include each family
member while using nursing process
• The nurse and the family must develop positive
interpersonal relationship in their work to achieve the goal
• The nurse must respect the patient’s rights.
• Home visit should be recorder in the diary and family
folder.
ADVANTAGES OF HOME VISIT
• Home visit provides an excellent opportunity to implement
the nursing process.
• Home visits provide an opportunity to study to the home
and family situation.
• Home visits provide an opportunity to render service to
the family members at their own surroundings.
• Prompt and proper home visit create a good
understanding between nurse and family and build good
image of nurses.
• Home visits clarify the doubts raised by the family
members.
ADVANTAGES OF HOME VISIT
• Home visits help to observe family practices and progress
of care given by nurse and others.
• Home visits help to prevent and handling the problems
• Home visits help the nurse and family members to modify
the ways of their care.
• Home visits facilitate patient control of the setting.
• Home visits are the best opinion for patients unwilling or
unable to travel
• Home visits provide natural, environment for the
discussion of concerns and needs
ROLES of CHN in home visits
• Records the history of family to ascertain the cause and
duration of illness
• Providing treatment and related care
• Demonstrating the nursing procedure to educate the
family members
• Giving medicines as per the standing orders and
providing essential nursing care
• Supervising the nursing procedure provided by family
members
• Including the patient himself in taking care of chronic
illness and giving them mental support.
 GUIDELINES TO CONSIDER REGARDING THE
FREQUENCY OF HOME VISIT
• NO definite rule to be followed on the frequency of home visits
a. The physical needs, psychological needs and educational
needs of the individual and family
b. The acceptance of the family for the services to be rendered
c. The policy of a specific agency and the emphasis given
towards their health programs
d. Take into account other health agencies and the number of
health personnel already involved in the care of a specific
family
e. Careful evaluation of past services given to a family and how
the family avail of the nursing services
f. The ability of the patient and his family to recognize their own
needs, their knowledge of available resources and their
ability to make use of their resources for their benefits
COMPOMENTS OF HOME VISIT
1. INITIAL PHASE (Planning)
Activity: collect information from clinical and other records before planning for a
visit
During home visit, she has to assess or observe and make a note in
initial visit

2. ACTION PHASE
a. SOCIALIZATION PHASE- establish rapport with the client and family
b. WORKING/ PROFFESIONAL PHASE- apply problem solving techniques
to situation found in the home, plan with the family to resolve health
problem situations, provides nursing care
c. SUMMARY PHASE- documentation of significant findings

3. TERMINATION PHASE- nurse-patient goals are reached, health is restored

and the patient can function without actions. The nurse records the important
events in the family and reports the problems of the family.
For Ret Demo: Steps in Conducting Home Visit
1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine the health needs
4. Look for a place to put your PHN bag, in the table or
chair six feet away from bedside, or any convenient place
as long as proper procedure can be done in that area.
5. Put the bag in a convenient place then proceed to
perform the bag technique.
6. Perform physical assessment and nursing care needed. If
more than one member of the family is for health
supervision and care, start with the well member to avoid
transfer of infection.
and give health teaching
For Ret Demo: Steps in Conducting
Home Visit
7. Give the necessary health teaching and advice based on
the clients need and condition. If the client is weak or too
indisposed condition, you may teach the family member
since they are with client most of the time
8. Clean all the articles used. Wash hands, remove apron
and fold place in the bag( you may put in a plastic bag or
above the bag flaps)
9.Record all important data, observation and care
rendered
7. Make an appointment for a follow up home visit or clinic
visit. Leave specific instructions if necessary on how to
ensure nursing care to the sick family member.
THE BAG TECHNIQUE
The bag technique is a tool by which the nurse, during her
visit will enable her to perform a nursing procedure with :
• ease and deftness
• save times and effort
• the end view of rendering effective nursing care to clients.

❑The public health bag is an essential and indispensable

equipment of a public health nurse which she has to carry
along during her home visits. It contains basic
medications and articles which are necessary for giving
care.
Principles of Bag Technique
1. Performing the bag technique will minimize, if not
prevent the spread of any infection.

2. It saves time and effort in the performance of nursing

procedures.

3. The bag technique should show the effectiveness of total

care given to an individual or family.

4. 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.
PRINCIPLES TO CONSIDER AND PROCEDURE IN THE USE
OF THE PHN BAG
1. The bag should contain all necessary articles, supplies and
equipment which may be used to answer emergency needs.
2. The bag and its contents should be cleaned as often as
possible, supplies replaced and ready for use at any time.
3. The bag and its contents should be well protected from
contact with any articles in the home of patient.
4. The arrangement of the contents of the bag should be the
one most convenient to the user to facilitate efficiency and
avoid confusion.
5. Hand washing is done as frequently as the situation calls for,
minimizing or avoiding contamination of the bag and its
contents
6. The bag when used for a communicable case should be
thoroughly cleansed and disinfected before keeping and re-
using
Content and arrangement of the
PHN BAG
 Contents and arrangement of the PHN BAG

Front of the Bag LEFT TO RIGHT

▪Thermometer (oral and rectal)
▪Tape measure
▪Adhesive plaster
▪Cotton applicator

On RIGHT REAR of the BAG On LEFT REAR of BAG

▪ 2 test tubes and 1 holder ▪ Medicine glass
▪ Medicine dropper ▪ Baby scale
▪ Alcohol lamp ▪ Bandage scissors
▪ Rubber suction
Contents and arrangement of the PHN BAG
BACK of the Bag LEFT TO RIGHT

▪ 70% Alcohol
▪ Betadine Solution
▪ Hydrogen peroxide
▪ Terramycin ophthalmic ointment
▪ Zephiran solution
▪ Spirit of ammonia
▪ Acetic acid
▪ Benedicts solution
▪ Liquid soap
▪ Cotton in sterile water
Contents and arrangement of the PHN BAG
IN THE CENTER OF THE BAG

▪ 2 pairs of forceps ( curved and straight)

▪ 1 surgical scissor
▪ Sterile dressing ( OS and cotton balls)
▪ Roller bandage
▪ Syringes ( 5ml and 2 ml)
▪ Hypodermic needles g19, 22, 23, 25
▪ Sterile cord clamp
▪ Kidney basin
Contents and arrangement of the PHN BAG
On the TOP PILE CENTER OF THE BAG

▪ Hand towel
▪ Soap in soap dish
▪ apron
▪ Plastic /linen lining

POCKET OF BAG

▪ Surgical gloves
▪ Waste receptacle

❖ Folded paper lining inserted between the flaps and cover of the bag
❖ BP apparatus and stethoscope are carried separately
 Steps in Performing the Bag Technique Actions Rationale
1. Upon arrival at the patient’s home, place the bag on the table lined with a To protect the bag from getting contaminated.
clean paper. The clean side must be out and the folded part, touching the
table.

2. Ask for a basin of water or a glass of drinking water if tap water is not To be used for handwashing
available.
3. Open the bag, take the linen /plastic and spread over the work field area.
The paper lining clean side out. ( Folded part out)

4. Open the bag and take out the towel and soap ( soap dish) To prepare for handwashing
5.Do hand washing To prevent infection from the care provider to the client
Wash hands using soap and water. Wipe to dry with towel.
6. Take out the apron from the bag and put it on with the right side out To protect the nurse’s uniform

7. Put out all the necessary articles needed for specific care. To have them readily accessible.

8. Place paper receptacle outside the working area.

9. Close the bag and put it in one corner of the working area. To prevent contamination.

10. Proceed in performing the necessary nursing care and treatment. To give comfort and security and hasten recovery.

11. After the giving the treatment, clean all things that were used and To protect the caregiver and prevent infection.
perform handwashing.
12. Open the bag and return all things that were used in their proper places
after cleaning them.
13. Remove apron, folding it away from the person, the soiled side in and
the clean side out. Place it in the bag.

14. Clean and fold the paper /plastic lining, place it inside the bag and
Close the bag.
15. Take the record and have a talk with the Mother. Write down all For reference in the next visit.
necessary data that were gathered, observations, nursing care and
treatment rendered. Give instructions for care of patients in the absence of
the nurse.

16. Make appointment for the next visit (either home or clinic) taking note For follow-up care.