Chapter 4

Home Care and the Childbearing

and Childrearing Family
Defining the Community and Home Care

Community: a limited geographic area in which

residents relate to and interact among themselves
Home care: care of persons in their homes, which
is provided or supervised by a certified home
healthcare or community healthcare agency

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2020 National Health Goals Related to
Home Care During Pregnancy or Childhood

Increase to at least 77% the proportion of all

pregnant women who receive early and adequate
prenatal care, from a baseline of 70.5%.
Reduce the rate of preterm births, from a baseline of
12.7% to a target of 11.4%.
Reduce or eliminate vaccine-preventable diseases
such as measles (from 115 to 30 cases per year),
pertussis (from 2,777 to 2,500 cases per year),
varicella (chickenpox)(from 482,535 to 100,000
cases per year), and keep poliomyelitis at zero cases
per year.

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Incorporating Procedures into Family
Routine

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Safety Tips for Home Healthcare Travel
and Visits

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Areas of Nursing Assessment Relevant to
Performing a General Home Assessment
#1

Safety
Space
Patient support
Electricity
Environment
Nutrition
Oxygen use (if applicable)

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ursing Assessment Relevant to Performing
Home Assessment #2

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Areas of Assessment Relevant to
Performing a Home Assessment for Home
Care of a Child by Age Group

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Examples of Nursing Diagnoses Related to
Home Care of . . .

. . . a Pregnant Woman
 Social isolation related to the need for home care
 Ineffective role performance related to bed rest at home
. . . a Child
 Risk for delayed growth and development related to lack
of usual childhood activities
 Interrupted family processes related to changes in family
routine

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Interventions Related to Home Care
of a Pregnant Woman or a Child
Nursing Diagnosis
Social isolation related to the
need for home care
Ineffective role performance
related to bed rest at home
Risk for delayed growth and
development related to lack of
usual childhood activities
Interrupted family processes
related to changes in family
routine
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Possible Nursing and
Therapeutic Interventions
• Discuss possible alternative
methods of communication with
social and work contacts (e.g.,
Is Internet available?).
• Assist woman in identifying
what roles she has within the
family and explore who might
assist in fulfilling these.
• Teach family about age-
appropriate activities that child
can perform.
• Assist family in identifying
important family processes that
will be interrupted while the
child is cared for at home.
Examples of Nursing Diagnoses and
Outcomes Related to Home Care of a
Pregnant Woman or a Child

Nursing Diagnosis Outcome

Social isolation related to the need
for home care
Ineffective role performance
related to bed rest at home
Risk for delayed growth and
development related to lack of
usual childhood activities
Interrupted family processes
related to changes in family routine satisfactory family processes that
Pregnant woman will be able to
continue to communicate with
social and/or work contacts.
Family will be able to cope with
temporary changes in pregnant
woman’s role status in the home.
Alternative age-appropriate
activities will be offered to the
child.
Family will be able to find
meet the needs of all family
members.

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Evaluating Outcomes Related to Home
Care of a Pregnant Woman or a Child

Nursing Diagnosis Outcome Evaluation

Social isolation related to the need • Pregnant woman expresses that
for home care she is able to maintain
satisfactory social and work
contacts despite complete bed
rest at home.
Ineffective role performance
related to bed rest at home ?
Risk for delayed growth and
development related to lack of ?
usual childhood activities
Interrupted family processes
related to changes in family routine ?

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Quality & Safety Education for Nurses
(QSEN)

 Patient-Centered Care
 Teamwork & Collaboration
 Evidence-Based Practice
 Quality Improvement
 Safety
 Informatics

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Interventions Related to Home Care of a
Pregnant Woman or a Child: Direct Versus
Indirect Nursing Care

 Direct care: home care situation in which a nurse

remains in continual attendance or visits frequently
and actually administers care
 Indirect care: home care situation in which a nurse
plans and supervises care given by others (such as
home care assistants)

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Question #1

Which question would be most appropriate to ask in

assessing the community in relation to initiating home
care for a pregnant woman who needs to be on bed
rest?
A.Does the caregiver know what steps to take if the
pregnant woman’s condition suddenly becomes
worse?
B.Is there adequate electrical wiring in the home?
C.Is an emergency response mechanism (e.g., 911)
available?
D.Are there working smoke detectors in the home?

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Answer #1

C. Is an emergency response mechanism (e.g., 911)

available?
Rationale: Although all of the questions are related
to assessing the adequacy of being able to provide
home care, the other questions are related to the
adequacy of resources available in the individual
home rather than in the community. Availability of
an emergency response is a community resource.

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Question #2

Which of the following is not a nursing responsibility

related to care being provided to pregnant women and
children in the home?
A. Making home visits for assessment and reevaluation
purposes
B. Supervising home health personnel
C. Driving the pregnant woman to her follow-up
medical visits
D. Providing health teaching to the patient and family

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Answer #2

C. Driving the pregnant woman to her follow-up

medical visits
Rationale: Although nurses may assist in arranging for
patient transportation, transporting home care patients
to their primary care providers is not a nursing
responsibility. All other activities listed are considered
appropriate nursing actions.

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Question #3

Select the assessment finding that would most likely

result in a decision that home care is not an option for
a child.
A. Smoke detectors with outdated batteries
B. The family is unfamiliar with administering total
parenteral nutrition needed by the child.
C. Three ants were found crawling on a kitchen
counter.
D. The need for the primary wage earner to become
unemployed to become the primary caretaker

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Answer #3

D. The need for the primary wage earner to become

unemployed to become the primary caretaker
Rationale: Loss of family income affects the entire
family as well as the child needing home care. Smoke
batteries can be replaced, and the family can be
educated about the importance of working smoke
detectors. Administering total parenteral nutrition is a
skill that can be taught to the primary care provider
and evaluated. The presence of ants would need to be
explored further, but education related to kitchen
sanitation would probably remediate the situation.

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