MCN 212

Topic: Home Care of

Pregnant Client

Shielamae P. Rubio
2021373
 Objectives:
By the end of this session you should be able to:

• Describe what constitutes a healthy community and the usual

nursing and client concerns when home care is required during
pregnancy or childhood.
• Assess a pregnant woman or child and their community for likely
success with home care.
• Counsel and communicate effectively with women on self-care
in the home during pregnancy.
• Consider cultural and religious beliefs in the community
affecting the care a pregnant woman receives in the home and
the support she receives from her partner and family.
• Assess how to involve partners and other key family members in
counseling.
 Home Care for Pregnant Client
*  
Home care, is care of persons in their homes, provided
or supervised by a certified home health care or community
health care agency.
It is well documented that women who receive prenatal
care have better pregnancy outcomes than those who don’t
(Bernstein & VanBuren, 2013). Because home care can be a
means of increasing personalized prenatal surveillance and
initiating specific health teaching, pregnant women who need
these added measures are also good home care candidates
(Olander, Atkinson, Edmunds et al., 2012).
Assessing and orienting families to home care, making
home visits, supervising and coordinating home health
personnel, providing health teaching, and evaluating whether
home care remains appropriate are all important nursing
responsibilities.
Box 4.1 shows 2020 National Health Goals that speak to home care.
 Home care is possible today because specialized therapies
such as fetal monitoring, or laboratory analysis are available in portable
versions for home care. Home care visits vary in frequency depending
on a client’s condition and the ability of the client or family to learn.
In some settings, telephone, email, and chat room contacts are set up
to link health care providers with families so questions can be answered
immediately even when the health care provider isn’t physically present
in the home.

Care at home may include:

• Direct care, in which a nurse remains in continual attendance or
visits frequently and actually administers care
• Indirect care, in which a nurse plans and supervises care given
by others, such as home care assistants.
Frequency of visits varies with individual factors.
For example:
• Those clients whose conditions are categorized as low
risk probably need only weekly visits; a home health care
aide may make the majority of visits.
• Those at intermediate risk need one to three visits per
week; a nurse is necessary for the level of care needed.
• Those at high risk may need as many as seven visits per
week; a nurse combined with other team members such as
a nursing assistant, physical therapist, or a respiratory
therapist will be needed for this complex level of care.

Determining family roles, such as who is the wage earner,

the decision maker, the nurturer, or the problem solver, is
an important part of planning.
 Home care is most successful when these family roles are not
disrupted, but strengthened, to support whatever new activities or
concerns need to be addressed (Box 4.2).
 Home care works best when a family is strongly committed to home care
and well prepared to cooperate with health care providers. Pregnant
women with complications such as preterm labor that has been halted,
hyperemesis gravidarum (excessive nausea and vomiting of pregnancy), and
gestational hypertension are examples of conditions that can be managed at
home with supervision and periodic visits by a community or home care
nurse. Although it is not well documented that bed rest prolongs such
pregnancies, women with multiple pregnancies may be another example
(Bigelow & Stone,2011).
Low birth weight occurs in newborns when preterm labor begins and cannot
be halted. In other instances, labor can be halted, but the woman needs
careful monitoring for the rest of her pregnancy to be certain her fetus is
continuing to grow and labor is not beginning again. Nurses can be
instrumental in ensuring women who are candidates for monitoring at home
receive enough orientation and support to feel comfortable with their at-
home arrangements so low birth weight can be prevented. Nurses can also
be instrumental in making sure the time spent during home care is not
wasted but is used as a time of preparation for birth and childrearing.
Factors that have contributed to the success of the home as a health
care setting include:

• It is less costly for the health care delivery system. It is less costly to care for
pregnant women or children at home rather than in a hospital setting largely
because the number of health care personnel needed is reduced. Home care can
also reduce the cost of care when monitoring is the main type of care needed.
• It presents the opportunity to focus not only on a specific health problem but
also on promoting healthy behaviors for the entire family.

For example, to prevent a child or woman from being exposed to secondary

smoke, family members should agree to establish a “smoke-free” home, allowing
a family illness to improve the lifestyle of a whole family (Ashford & Westneat,
2012).
• It can increase a woman’s or child’s self-confidence and self-efficacy because
it allows for more self-care and often more control of circumstances.
• Families can be better assessed in their own environment than in an agency
environment because family interactions, values, and priorities are more obvious
at home than in a health care setting.
• Home visits provide a private, one-on-one opportunity for health teaching.
Disadvantages of home care include:
• Cost containment has to be weighed against the safety and quality of
care. Not all home settings are safe for care and not all families have
the commitment necessary, so it is not an alternative for all families.
In addition, although home care is cost-effective for health care
agencies, it may not be cost-effective for the family. Costs that health
insurance would have paid for had the client been hospitalized, such
as dressings and medications, may no longer be covered once the
person is transferred to home care. This means it can actually increase
the cost for an individual family if the family’s insurance does not
cover the cost of nursing visits or necessary supplies.
• The physical care required (e.g., tracheal suctioning or a
complicated medication regimen) can be overwhelming for family
caregivers.
• A financial strain can arise if at least one parent or a spouse has to
quit work and, therefore, cannot earn an income.
• Bed rest at home can cause social isolation and a disruption of
normal family life.
 ASSESSING A FAMILY FOR HOME CARE
Assessment begins with an interview to determine present structure and function of the
family and then identifies ways family members think the illness and care at home will
change their lives.
This could include a wide range of changes such as:
oincreased expenses,
othe need for a parent or spouse to take a leave from work,
othe need for family members to help with frequent ambulatory health care visits,
oand the need to arrange for child care for other children.
Because these needs change as the course of an illness changes, assessment must be
ongoing.
A first home visit usually includes a thorough health history and physical examination to
document a woman’s or child’s current status, as well as an environmental, community,
and social assessment. Other assessments focus on likely adherence to medical,
preventive, or medication regimens; whether the family will be able to safely monitor
the client’s health at home; and what other services or resources the family will need,
such as the services of a home health care assistant or further nursing visits to ensure
home care is optimal.
Future visits focus on continuing the assessment and evaluation of patient progress and
readiness to help the woman or child move to another level of health care.
Typically, women receiving home care are taught how to self-assess various health
parameters such as blood pressure, temperature, pulse, protein in the urine, serum
glucose (with the use of a glucometer), fundal height, fetal movement, fetal heart rate,
and uterine contractions.
 WHO RECOMMENDATIONS FOR SELF-CARE DURING PREGNANCY

*Visit your health center at least four times during your pregnancy, even if you do not
have any problems.
*If you have any concerns about your health or your baby's health, go to the health
center.
*Bring your home-based maternal record to every visit.
*Eat healthier foods including more fruits and vegetables, beans, meat, fish, eggs,
cheese, milk.
*Take iron tablets and any other supplements or medicines you have been given every
day as explained by your health worker.
*Rest when you can. Avoid lifting heavy objects.
*Sleep under a bed net treated with insecticide.
*Do not take any medication unless prescribed by the health center.
*Do not drink alcohol or smoke.
*Practice safe sex, including use of a condom correctly in every sex act to prevent STIs
or HIV/AIDS, if you or your partner is at risk of infection.
*Know the signs of labour – painful contractions every 20 minutes or less; bag of
waters break; bloody sticky discharge.
*Know the danger signs and when to seek care .
DANGER SIGNS DURING PREGNANCY
If any of the following signs occur, the woman should be taken
immediately to the hospital or health center.
* vaginal bleeding
* convulsions/fits
* severe headaches with blurred vision
* fever and too weak to get out of bed
* severe abdominal pain
* fast or difficult breathing.
If she has any of these signs she should go to the health center as soon
as possible:
* Fever
* Abdominal pain
* Feels ill
* Swelling of fingers, face and legs
 Nursing Process Overview
For the Pregnant Woman or Child on Home Care

Assessment
Being able to assess communities as well as families is important. Assessing
the total family is important to be certain home care will match a family’s
usual self-care or childrearing practices.
Nursing Diagnosis
Nursing diagnoses for home care may address the physiologic reason for
supervised home care or the effect of the experience on the family, such as:
• Deficient knowledge related to complication of pregnancy and necessary
procedures and treatments needed
• Interrupted family processes related to need for home care
• Ineffective role performance related to bed rest at home
• Social isolation related to the need for home care
• Anxiety related to complication of pregnancy, which has required home
care
Outcome Identification and Planning
Both outcome identification and planning for home care require close collaboration
between the health care providers supervising care at home and the family
experiencing home care. A major portion of this involves reviewing with a family
exactly what their needs are, what will be expected of them, what they can expect of
the nurse, and developing outcomes that address these needs and expectations.
 
Implementation
Women receiving home care have the advantage over those hospitalized of being in
their own environment with their families and not confined in a distant place. Because
home care providers may only visit intermittently, however, there is the disadvantage
of patients not being constantly supervised. Both women and children may need
assurance that if changes do occur, introducing new interventions, evaluating their
effectiveness, and suggesting changes will be necessary.
Interventions performed for a client at home, ranging from teaching and counseling to
hands-on care, are little different from those performed in an acute care facility. In
order to do all these tasks, home care nurses need to have the same background and
level of expertise as acute care nurses. In addition, they need to be extremely flexible
because each home visit may be very different from the one just before or after.
Nursing interventions for home care often involve not only giving care but also
teaching family members how to give care. This may include encouraging members to
voice the frustration they feel at being constantly confined at home or what they
perceive to be a lack of progress in their child’s or partner’s condition.
Outcome Evaluation
Because a home setting is less structured than a health care facility, an evaluation will
show some goals for care, such as bed rest, are more difficult to accomplish in the
home; at the same time, because there is more individual care and room for innovation
at home, goals involving patient teaching can be more easily accomplished.
The evaluation may reveal circumstances, such as the client requires more monitoring
than originally believed, demands are greater than the family is able to undertake, or a
family’s composition has changed, making a responsible caregiver no longer available.
The outcome evaluation for the pregnant woman receiving home care includes
determining whether the woman and her fetus are remaining well at home and whether
the woman feels comfortable and secure with the arrangement. For many women,
successful home care will mean the difference between too early a birth and a
successful term pregnancy.
Examples of outcome criteria for pregnant women could include:
• Client demonstrates adequate skill at performing home monitoring procedures.
• Client verbalizes changes in condition she will need to report to her health care
provider.
• Client participates as a member of the family within limitations imposed by
pregnancy complication.
• Family members state they have adjusted to home care of mother.
• Client states she is able to maintain contact with friends and family despite
complete bed rest at home.
Thank You!!!
God Bless