Home Visits as a Population Health Nursing Strategy Study Guide

Home Visits as a Population Health Nursing Strategy Study Guide

1) The population health nurse visits a new mother and infant at home. During the visit, the nurse and mother discuss how the postpartal course is going and how the infant is doing with feeding and sleeping. The nurse provides information and answers any questions the mother may have and performs teaching as needed. In what role is the nurse functioning?

Case finding and referral.
Care of the sick.
Health promotion and illness prevention.
Home health nursing.

Answer: 3

Explanation: 3. Promoting maternal and child health is health promotion. The nurse visits the postpartal mother to answer questions, assess how the mother is recuperating, and how the infant is progressing. The nurse performs teaching as needed, which is health promotion and illness prevention. It is not case finding and referral, or care of the sick. Home health nursing is a specific type of home nursing that addresses an illness event.

Nursing/Int.Conc: Nursing Process: Evaluation

Client Need: Health Promotion and Maintenance

Cognitive Level: Analysis

Learning Outcome: 13-5

2) The nurse receives a referral to visit a client who neighbors fear is being abused by a spouse. The client allows the nurse inside but is obviously reluctant to have the nurse in the home. The nurse could best address the client’s concerns by: (Select all that apply.)

Tactfully communicating the reason for the visit.
Establishing appropriate expectations for the visit for the client and nurse.
Starting to establish a rapport with the client.
Stating that the neighbors made the referral.
Informing the client that her name has been given to a local women’s shelter.

Answer: 1, 2, 3

Explanation: 1. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women’s shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.

Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women’s shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.
Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women’s shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Safe and Effective Care Environment

Cognitive Level: Application

Learning Outcome: 13-2

3) The population health care is planning to make a visit to the home of a new community member who is recovering from major surgery. What observations should the nurse identify as advantages to making this home visit? (Select all that apply.)

Client’s home is neat, clean, and cheerful.
Client and spouse sit together in the living room.
Client ambulates safely with the use of a walker.
Client requests no further visits because the neighbors will know.
Client states that no care is needed because insurance won’t cover it.

Answer: 1, 2, 3

Explanation: 1. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.

Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.
Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.

Nursing/Int.Conc: Nursing Process: Assessment

Client Need: Health Promotion and Maintenance

Cognitive Level: Analysis

Learning Outcome: 13-1

4) The community has a large number of immigrants. The nurse organizes a home visiting program to this community area to address family health concerns and provide health information. This is considered:

Care of the sick.
Case finding and referral.
Health promotion and illness prevention.
Health protection.

Answer: 3

Explanation: 3. Visiting the homes of this population to address health concerns is an aspect of health promotion and illness prevention. The client is in a familiar environment and is more comfortable, which makes teaching easier for the nurse. The population is not indicated as sick. Case finding and referral would apply if the nurse was seeking something specific among this population. Health protection is part of health promotion, but is more of a broad-scale activity done to maintain health.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Health Promotion and Maintenance

Cognitive Level: Analysis

Learning Outcome: 13-3

5) The population nurse is planning to make a home visit. What should the nurse take into consideration for this visit? (Select all that apply.)

Reason for the visit and age of the client.
Surrounding neighborhood.
Support systems employed by the client.
Client’s ability to pay for services.
Preliminary client treatment goals.

Answer: 1, 2, 3, 5

Explanation: 1. The reason for the visit, age of the client, neighborhood, and client’s support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.

The reason for the visit, age of the client, neighborhood, and client’s support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
The reason for the visit, age of the client, neighborhood, and client’s support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
The reason for the visit, age of the client, neighborhood, and client’s support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.

Nursing/Int.Conc: Nursing Process: Planning

Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Outcome: 13-4

6) A client receiving telephonic care visits with a population health nurse asks why a home visit is needed after hospitalization. What should the population health nurse explain to the client?

Home care is a subspecialty of population health care.
The home care nurse reports to the population health nurse.
A home visit is the only way that the population health nurse will be paid.
The client is extremely ill and the population health nurse needs someone to make an assessment.

Answer: 1

Explanation: 1. Home health is actually a subspecialty within population health nursing in which the primary, but not sole, focus is on resolution of existing health problems and health restoration. Effective home health nurses, who provide holistic nursing care, employ principles of population health nursing within the segment of the population that is ill. The home care nurse does not report to the population health nurse. A home visit is not being done so that the population health nurse can be paid. There is no evidence to support that the client is extremely ill or that the population nurse needs someone to assess the patient at home.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Outcome: 13-8

7) After several home visits, the nurse and the client have agreed to improve the client’s overall nutritional status. In order to achieve this outcome, the nurse should:

Assess the client’s food preferences and methods of food preparation.
Plan menus for the client to prepare.
Accompany the client when food shopping.
Refer the client to a Meals-on-Wheels program.

Answer: 1

Explanation: 1. In implementing a home visit, goals are agreed upon for the overall health of the client. In this instance, the improvement of the client’s overall nutritional status cannot be achieved unless the nurse assesses the client’s food preferences and methods of food preparation. Otherwise, if the nurse plans meals without these considerations, the outcome will not be achieved. Accompanying the client when food shopping will not necessarily guarantee this outcome, nor will a referral to a Meals-on-Wheels program.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Outcome: 13-5

8) The population nurse is conducting a home visit. Which action should the nurse take during this visit?

Continue to validate the accuracy of the assessment and resulting diagnosis.
Focus on the plan of care as it is written.
Concentrate on the already-identified needs.
Plan to write an evaluation.

Answer: 1

Explanation: 1. The validity and accuracy of the assessment and resulting diagnosis should always be a factor in the home visit implementation. Additional needs can be added to modify the plan of care, so focusing solely on the plan of care as it is written may not meet the client’s needs. Concentrating only on the identified needs may ignore other issues that arise in subsequent home visits. The evaluation is part of every visit and is not something that is done at another time.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Outcome: 13-5

9) The nurse is making a home visit to a new client. The client is very friendly and welcomes the nurse into the home; however, the nurse sees that the client has a gun on the coffee table. The nurse hurriedly goes through the visit and leaves. What should the nurse do prior to the next visit?

Call the police prior to making the visit.
Call the client prior to the visit and state that there cannot be a visible firearm present during the visit.
Cancel future visits to this client.
Refer the client to another agency for visitation.

Answer: 2

Explanation: 2. The distraction the nurse encountered was both environmental and behavioral. Presence of a firearm is an environmental concern, and the nurse’s reaction of hurrying through the visit indicates a level of discomfort with the presence of the firearm. Notifying the client prior to the next visit about the presence of the firearm addresses the nurse’s concern and lets the client know that this is not acceptable. There is nothing to indicate that the client is creating a distraction. Calling the police is not a necessary step prior to the next visit. Canceling future visits could impair the client’s overall health. Referring the client to another agency is not solving this concern.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Safe and Effective Care Environment

Cognitive Level: Application

Learning Outcome: 13-6

10) During a visit to the home of a client newly diagnosed with diabetes the nurse notes that the client constantly answers the cell phone and has conversations with those callers, which interrupts teaching. The client apologizes after each call. What action should the nurse take?

Request that the client not answer the cell phone.
Leave some pamphlets for the client to read.
Have the client repeat back the information the nurse has given.
Ask the client if another time would be better to complete this teaching.

Answer: 4

Explanation: 4. Asking the client if there is a better time to do this teaching subtly conveys to the client that the calls are distracting and also gives the client control over the timing of the teaching. Distractions such as continuous calls can be frustrating to the nurse and can impede teaching. Requesting the client not to answer the cell phone is appropriate but may anger the client, which will impede any learning. Leaving pamphlets for the client to read may not impart the necessary information the client needs to understand diabetes. Having the client repeat back the information the nurse has given would provide an understanding to the nurse of what has been taught but may also give the impression to the client that the nurse feels the client has not understood the teaching.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Health Promotion and Maintenance

Cognitive Level: Application

Learning Outcome: 13-6

11) The population health nurse is reviewing the long- and short-term criteria for a home visit to a client. The nurse completes this evaluation because it:

Indicates whether reimbursement will be provided to the agency.
Allows for tracking utilization of supplies for home visits.
Determines the effectiveness and appropriateness of the interventions and the client’s response.
Determines whether the interventions are at the primary, secondary, or tertiary level.

Answer: 3

Explanation: 3. Unless there are evaluative criteria, the client’s response cannot be determined nor whether the interventions were effective and appropriate. Evaluative criteria can be used for reimbursement and supplies can be tracked with such criteria, but effectiveness of the visit cannot be determined without evaluative criteria. Evaluative criteria can be at any level of prevention.

Nursing/Int.Conc: Nursing Process: Evaluation

Client Need: Health Promotion and Maintenance

Cognitive Level: Analysis

Learning Outcome: 13-7

12) The home care nurse is using OASIS information to evaluate outcome measurements for client care. Which data should the nurse use for this evaluation?

Client’s Braden Skin Assessment score is 12.
Client has a stage 2 pressure ulcer on the sacrum.
Client admission paperwork completed within 24 hours.
Client self-administers insulin and changes foot wound dressing independently.

Answer: 4

Explanation: 4. Outcome measures include end-result outcomes that reflect the client’s status as a result of care. The client being able to self-administer insulin and change a foot wound dressing independently is data for this type of evaluation. Process measures evaluate the performance of the home care agency with respect to specific evidence-based processes of care, such as timeliness of admission, and pressure ulcer assessment. The client’s Braden Skin Assessment score and completion of paperwork within 24 hours of admission would be information for a process evaluation. Potentially avoidable events measures address negative outcomes such as pressure ulcer development. The client’s stage 2 pressure ulcer on the sacrum would be this type of evaluation.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Safe and Effective Care Environment

Cognitive Level: Analysis

Learning Outcome: 13-11

13) The population health nurse is working with a client who is receiving hospice care. In which areas should the nurse collaborate with other health care team members in the care of this client?

(Select all that apply.)

Management of pain control.
Assisting the family in adjusting to the eventual death of the client.
Ensuring that all services provided are able to be reimbursed.
Obtaining additional services for identified client needs.
Ensuring the client has arrangements made for burial.

Answer: 1, 2, 4

Explanation: 1. Collaboration among health care team members in hospice care addresses effective pain management control, assisting the family as needed in adjusting to the eventual outcome of the client, and obtaining additional services for identified client needs. Hospice care is reimbursable, but not all services provided in hospice care may be reimbursed. Ensuring the client has arrangements made for burial is a consideration but does not necessarily entail collaboration among the health care team members.

Collaboration among health care team members in hospice care addresses effective pain management control, assisting the family as needed in adjusting to the eventual outcome of the client, and obtaining additional services for identified client needs. Hospice care is reimbursable, but not all services provided in hospice care may be reimbursed. Ensuring the client has arrangements made for burial is a consideration but does not necessarily entail collaboration among the health care team members.
Collaboration among health care team members in hospice care addresses effective pain management control, assisting the family as needed in adjusting to the eventual outcome of the client, and obtaining additional services for identified client needs. Hospice care is reimbursable, but not all services provided in hospice care may be reimbursed. Ensuring the client has arrangements made for burial is a consideration but does not necessarily entail collaboration among the health care team members.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Psychosocial Integrity

Cognitive Level: Analysis

Learning Outcome: 13-9

14) The home health nurse is making the initial assessment visit to a new client. After doing the assessment for treatment, the nurse completes an OASIS assessment form. How will this form be utilized?

To ensure that the appropriate diagnosis-related group (DRG) is used for payment.
By home health agencies who have certification.
For reimbursement purposes in home health agencies with Medicare clients.
As a requirement for all home health and hospice agencies.

Answer: 3

Explanation: 3. The OASIS assessment form is used when the home health agency is seeing clients who can have their services reimbursed by Medicare. DRGs are not utilized in the OASIS form. Certified home health agencies will be able to receive Medicare and third party reimbursement, but third party reimbursement does not require use of the OASIS. OASIS is not a requirement for all home health and hospice agencies.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Safe and Effective Care Environment

Cognitive Level: Analysis

Learning Outcome: 13-10

15) The population health nurse is planning to terminate continuing home visits with a community member. Which actions should the nurse take to prepare the client for this termination?

(Select all that apply.)

Review goals accomplished with the client.
Make referrals for continuing care if needed.
Plan for termination beginning with the first visit.
Explain to the client the length of time visits that will be provided.
Establish mutual goals with the client to meet identified needs.

Answer: 1, 2, 3, 4

Explanation: 1. When terminating a client from home visits the nurse should plan for termination from the first visit, inform the client of the time-limited nature of services and their probable duration, review goal accomplishment with the client, and make referrals for continuing care, if needed. Engaging in mutual goal setting with client to meet identified needs is an action completed during the implementation of home visits.

When terminating a client from home visits the nurse should plan for termination from the first visit, inform the client of the time-limited nature of services and their probable duration, review goal accomplishment with the client, and make referrals for continuing care, if needed. Engaging in mutual goal setting with client to meet identified needs is an action completed during the implementation of home visits.
When terminating a client from home visits the nurse should plan for termination from the first visit, inform the client of the time-limited nature of services and their probable duration, review goal accomplishment with the client, and make referrals for continuing care, if needed. Engaging in mutual goal setting with client to meet identified needs is an action completed during the implementation of home visits.
When terminating a client from home visits the nurse should plan for termination from the first visit, inform the client of the time-limited nature of services and their probable duration, review goal accomplishment with the client, and make referrals for continuing care, if needed. Engaging in mutual goal setting with client to meet identified needs is an action completed during the implementation of home visits.

Nursing/Int.Conc: Nursing Process: Implementation

Client Need: Safe and Effective Care Environment

Cognitive Level: Application

Learning Outcome: 13-5