Home Visits
The purpose of home visits is to give a more detailed assessment of the family structure, the natural or home environment, and behavior in the home environment” (Stanhope & Lancaster, 2017, p. 323). It is possible for the nurse to work closely with the client to modify interventions accordingly. Compared to a hospital or other inpatient care, home visits have positive long-term effects and can be cost-effective for society. An invaluable aspect of a home visit is the fact that it extends beyond simply providing care in a different environment. Rather, it is an effective method of intervention.
There are many advantages to using this service, including convenience for clients, especially those who have mobility issues or are unable or unwilling to travel; control over the setting and comfort of the clients; the ability to customize services; and the ability to discuss concerns and needs in a natural, relaxed environment. In contrast, costs are a significant disadvantage. Preparation for the pre-visit, travel time and expenses to and from the client’s home, and post-visit follow-up contribute to the high cost.
Phases of Visit
The visit is a five-phase process. The first phase, initiation, involves the initial interaction of the family and the nurse. The initiation phase “provides the foundation for an effective therapeutic relationship” (Stanhope & Lancaster, 2017, p. 323). The second stage, previsit, requires the nurse to assess the referral or the family record for any risks associated with the visit. The third stage, in-home, is spent chiefly developing the relationship and carrying out the nursing procedure. Assessment, intervention, and evaluation are all continuing processes. What happens during the home visit is determined by the cause of the visit. The fourth stage, termination, occurs when the goal of the visit has been achieved and planning for future visits is possible. The final step, postvisit, involves careful documentation of the visit, services provided, diagnoses, etc.
Contracting with Families
The literature defines contracting as “a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional” (Stanhope & Lancaster, 2017, p. 327). The nursing contract is a renegotiable working agreement that is not necessarily recorded. In fact, the contract must and will be renegotiated in the in the nursing process in most cases. It might be a contingent or noncontingent contract. “A contingency contract states a specific reward for the client after completion of the client’s portion of the contract” (Stanhope & Lancaster, 2017, p. 327). A noncontingency contract, on the other hand, does not stipulate any direct rewards but rather benefits the contractor with positive outcomes of the nursing process. The agreement must be made with the family’s most responsible and fitting member.
Contracting (phases and challenges)
The nursing contract is a three-stage process, which includes the beginning, working, and termination phases (Stanhope & Lancaster, 2017). In the first stage, data collection occurs. The parties establish needs and goals and develop a treatment plan. In the second stage, the family and the nurse divide responsibilities and determine the time frame in which the contract will stay in power. Then, they implement the plan, evaluate its effects, and renegotiate if necessary. In the final stage, the contract is terminated as the goals are either achieved or not.
Contracting entails multiple advantages and disadvantages. On the one hand, it promotes the clients’ agency in care and stimulates learning through implementation. On the other hand, this approach requires a lot of effort from both parties to be successful. According to Stanhope & Lancaster (2017), “some nurses may have difficulty relinquishing the role of the controlling expert professional; contracts are not always successful, and contracting is neither appropriate nor possible in every case” (p. 328).
Empowering Families
According to literature, “the goal of an empowering approach is to create a partnership between the nurse and the family characterized by cooperation and shared responsibility” (Stanhope & Lancaster, 2017, p. 328). Empowering is aimed at enabling families to be active and responsible for their health care. As help-giving sometimes entails harmful consequences for the family and the practitioner, empowerment might be an effective strategy for preventing health risks. For instance, help-giving might lead to resentment and depreciation if the quality of service is subpar or if treatment goals are not fulfilled. Researchers note that “for families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action” (Stanhope & Lancaster, 2017, p. 328). Families must be recognized as competent units capable of providing care for themselves to prevent frustration and devaluation.
Empowering Families (LGBTQ+)
Empowering approach is especially important for vulnerable groups such as LGBTQ+. As noted by Stanhope and Lancaster (2017), nurses ought to “provide culturally competent care” for such communities (p. 329). Historically, the medical system has challenged LGBTQ+ couples with unique obstacles. For instance, same-sex couples may struggle with visiting partners at hospitals or adopting children (Stanhope & Lancaster, 2017). In addition to that, same-sex couple still struggle with legal medical recognition in numerous states. Those barriers seriously impair trust and appreciation for medical professionals, thus directly and indirectly increasing health risks in LGBTQ+ families. Although it might be discomforting for a nurse to discuss such private issues as the intimate life of LGBTQ+ couples, those conversations offer a great deal of empowerment for marginalized people. As Stanhope and Lancaster (2017) state, nurses can facilitate the recognition of such families in the medical system.
Reference
Stanhope, M., & Lancaster, J. (2017). Family health risks. In Foundations for Population Health in Community/Public Health Nursing-E-Book (pp. 310-332). Elsevier.