Home Visiting Assignment

Running head: HOME VISIT 1

Home Visit Assignment: Maternal Child Client

Student Name

School of Nursing, Minnesota State University, Mankato

NURS 482

Dr. XXX (faculty name)

Date

DISCLAIMER: This sample paper is intended to be a resource to better understand how key

content may be addressed in a paper for this assignment. The sample paper is not intended to be

used as a guide for formatting, as the assignment grading criteria and/or APA format

requirements may differ from current requirements; or used to obtain content for your individual

paper. This sample paper may not reflect a paper that received a 100% grade.

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Home Visit Assignment: Maternal Child Client

Each year, it is estimated that over three million children are born (Centers for Disease

Control and Prevention, 2020). With each child born, there is a mother who will begin her

postpartum journey. Although this time is very exciting and there is an abundance of attention

given to the newly born child, mothers also need continuous attention as many complications can

occur postpartum. Some risks associated with postpartum pregnancy include stress, depression,

and anxiety (Pacific Post-Partum Support Society, 2020).

The purpose of this paper is to evaluate the process of performing nurse visits in a home

setting. Through home visits, a nurse is able to implement preventative interventions to promote

healthy behaviors and lifestyle habits. Three home visits were conducted with the nurse and a

postpartum mother and her husband. An evaluation of each home visit will be discussed.

Implemented interventions that were determined through assessing the mother’s needs and

identified health risks will also be elaborated upon and discussed. For the purpose of this paper

and the privacy of the individuals interviewed, initials will be used throughout the paper in place

of names.

To prepare for this assignment, the mother was contacted by the nurse through email and

the mother agreed to participate in the virtual home visits and acknowledged that her privacy will

be protected. The nurse explained the purpose of the home visits to the mother and her husband

and explained any additional information that the family was seeking.

Home Visit One

Due to the current social distancing regulations in place and the for the safety of the

mother (P.E.), father (B.E.), and infant, the first home visit was conducted through a Facetime

video call that was in each individual’s home. P.E. and B.E. are both white, Christian, 26-year

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old’s, and they recently had a baby girl who was born at the end of August. They live together in

a newly built home in the community where they both grew up. Through the Facetime call, the

nurse was able to obtain a virtual tour of the couple’s home, in which it appeared to be very

clean, organized, and spacious. The nurse was very familiar with the area in which the couple

resides. The house is built in a new development and many of the neighbors are young couples

with children. The area appears to be safe and accommodating for families of all ages.

P.E. was sent the authorization form through email prior to conducting the interviews, in

which she printed the form, signed and initialed in the appropriate spaces, and emailed the form

back to the nurse the day before the first virtual home visit. P.E. was once again reminded that

the interviews are completely confidential, and the purpose of the home visits was explained

again by the nurse. The first home visit interview was conducted only with P.E. because B.E.

was at work. Through the virtual interview, P.E. was asked about what topics of postpartum

motherhood she would like to know more about and what concerns she presently has while being

a first-time mother. The nurse then began to build a trusting relationship with the mother and

gain insight into what topics may be explored for future home visits. As the conversation began

to build, the nurse utilized the Friedman Family Assessment Model to guide interview questions

that would allow the nurse to understand the mother’s background, along with current concerns

and health risks. The purpose of this interview tool is to understand the family’s background,

family structure, environmental characteristics, and stress and coping abilities (Kaakinen,

Coehlo, Steele, & Robinson, 2018).

Both P.E. and B.E. work full-time in their local community. Prior to giving birth, P.E.

worked at a bank and maintained Monday through Friday hours that were consistent each week.

B.E. works at a manufacturing company in which he works long hours that vary week to week.

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P.E. explained that this adds extra stress because she feels he will not be around if she needs him,

and with the current COVID-19 pandemic, she does not want extra people in her home to assist

her with her daughter because she does not want to risk her health. When B.E. is not working,

P.E. tries to take care of herself while he watches their daughter. She also works as an online

health and fitness coach, so healthy behaviors like exercising are very important to her but

challenging at this time. She is trying to develop a routine in which she can focus on her health

while knowing that the baby is taken care of, but with B.E.’s unpredictable schedule, it makes it

difficult. P.E. expressed her gratitude for the willingness of her parents and her in-laws to take

care of the baby, but she is simply worried about her daughter’s health, so she rarely asks them

for help.

The family prefers to spend as much time together as possible, so when B.E. is not

working, they enjoy going on walks, participating in virtual bible study groups, exercising, and

watching movies together. P.E. stated that she is confident in her and B.E.’s communication

because each day they talk about their highs and lows of the day, and this facilitates

communication between the two. However, P.E. struggles with anxiety, and she becomes very

emotional when hardships occur, so she stated that she shuts down and will not talk with B.E.

This may hinder effective communication because if P.E. chooses not to talk through her feelings

with B.E., this could lead to miscommunication and possible conflict (Psych Alive, 2020). The

nurse observed P.E. becoming emotional talking about this struggle she had, and she was the

comforted by the nurse through effective listening and reassurance.

Neither P.E. or B.E. have any present medical conditions or illnesses, but they both have

a family history of depression, anxiety, hypertension, and osteoarthritis. When asking P.E. if she

has any current concerns that she would like to discuss, she mentioned her increasing anxiety and

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stress. She brought up that she grew up in a Catholic household, so it was frowned upon to talk

about these emotions as she was growing up. Bottling these feelings up have only led her to

believe her anxiety and stress will increase. With her anxiety comes worry about the future and

the safety of her daughter. She expressed that she continually thinks about situations that would

put her daughter in danger, specifically sudden infant death syndrome (SIDS) and these thoughts

consume her emotions and actions. After discussing these concerns, the nurse proceeded to ask

the mother if she would like to continue discussing her increasing anxiety, stress, and fear of

SIDS into the next home visit and the mother agreed.

Follow-Up and Evaluation of First Visit

After reflecting upon the first virtual home visit, the nurse deemed it was a successful

visit. Through open communication and building a trusting relationship, the nurse was able to

form meaningful conversation with P.E. and gain background information about the family and

P.E. Even though B.E. was not able to participate in the first visit, he reached out to the nurse

several days after the first visit and thanked her for taking the time to listen to his wife’s concerns

and worries. He stated that having their first child in the middle of a global pandemic has been a

very real and challenging struggle for the two of them, but P.E. has been beginning to become

more distant and emotional. Through active listening and asking questions, the nurse was able to

communicate with B.E. to avoid misunderstandings and take time to think about meaningful

responses (Concorde Career College, 2019). The nurse was able to commend the mother at the

end of the visit for her openness during the visit, which was comforting for the mother. This visit

allowed the nurse to gain an insight into the life of a first-time mother who is not only dealing

with the struggles of postpartum life and caring for a new infant, but also the worry of illness and

the feeling of isolation due to the current virus outbreak. The nurse is not a mother herself, but

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she was able to empathize and connect with P.E. through her story. She then realized that nursing

is more than assessments and treatments, but instead about making connections and being a

source of hope for those who are in times of uncertainty,

Home Visit Two

Since P.E. agreed to meet for another virtual home visit, the nurse examined her notes

from the first meeting and identified the areas of concern or health risks that the mother had. In

preparation for the second visit, the nurse spent time researching screening questionnaires that

would be beneficial for the mother to fill out to identify her risk for anxiety and depression, and

also the risk of SIDS in her daughter.

The first form that the nurse found was the Edinburgh Postnatal Depression Scale

(EPDS) found from The American College of Obstetricians and Gynecologists (ACOG). The

ACOG (2018) identify this 10-question rating scale to be very effective in determining the

mother’s risk for depression and anxiety (p. 210). This self-rating questionnaire examines the

mother’s feelings, emotions, and behaviors in the last seven days. According the ACOG (2018),

“The EPDS includes anxiety symptoms, which are a prominent feature of perinatal mood

disorders…” (p. 210). The second questionnaire was found from the Journal of Pediatric

Nursing. The tool used was a 14-question Newborn Safe Sleep Survey that rated each question

through yes, no, or maybe type questions (Whiteside-Mansell et al., 2017, p. 4).

The second virtual home visit was held over Facetime and B.E. was able to participate

this time. The nurse re-introduced the purpose of these visits and reassured the mother and father

that confidentiality still remains. The nurse then began to ask the couple how they were doing

since the last visit. The couple explained that they have been getting more sleep as B.E. is off of

work for the next two weeks, so they are starting to develop a routine with sleep schedules. P.E.

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was still feeling very anxious and stressed over the thoughts that consume her mind about her

daughter’s safety and well-being. The nurse noticed that P.E. teared up when talking about this

topic, so she comforted the mother by telling her that she is there to help her overcome this

anxiety and fear. B.E. interjected into the conversation and expressed his concerns for his wife

because she has not been herself lately. He held her hand and talked about how she does not

seem to be as energetic as she once was and stated that she prefers to be with their daughter most

hours of the day, which he feels is not helping her anxiety and stress. P.E. responded to this

statement from her husband and said she feels that if she is not with the baby, she is afraid that

something terrible will happen to her.

After discussing the new and ongoing concerns that the family has had since the last visit,

the nurse showed P.E. the two questionnaire forms. The nurse educated the mother about the

purpose of filling out these forms and how they can help the nurse identify interventions that can

help the mother. P.E. scored a number 20 on the EPDS, which indicates that she is at a high risk

for depression and/or anxiety. After the mother filled out the form, the nurse went over each

question and answer with P.E. to identify what areas where of most concern to her. The mother

identified anxious thoughts, blaming herself for most things, feeling scared or panicky, and not

finding enjoyment in things she used to as her major areas of concern. The nurse then asked the

mother why she thinks she feels this way and the mother replied by stating that she is unsure why

she feels so anxious and down, but she knows she wants to feel better because she is very excited

to be a new mother. P.E. thinks that her slight anxiety before pregnancy might be contributing to

the abundance of anxiety she is experiencing now being postpartum.

The mother then filled out the Newborn Safe Sleep Survey, which is scored on a four-

point scale, in which the mother scored in the highest percentile, which indicated there was little

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to no risk of SIDS occurring. The nurse then went over the completed form with P.E. and asked

her why she has concerns over SIDS. The mother replied by explaining that she is afraid she will

accidentality leave a blanket in the crib or that the mattress is not safe. The nurse then identified

areas of concern that were shown from the survey answers.

As the second virtual home visit was concluding, the nurse went over the main topics

discussed during the visit with the mother and together they determined that the main areas of

concern for the mother were anxiety, stress, and possible depression she is experiencing

currently, and also the fear of SIDS. The nurse then asked the mother if she would agree to meet

for one last virtual visit to be able to go over educational resources and tools that would be

helpful in overcoming and managing the mother’s concerns. P.E. agreed to meet for another visit

and a time and date was then scheduled.

Follow-Up and Evaluation of Second Visit

Following the second virtual home visit, the nurse was able to reflect upon many ideas

and thoughts regarding the conversations that were held. It was nice to have B.E. attend this

second visit as he is P.E.’s emotional support person, so he was able to give insight into what he

notices about P.E.’s behaviors and emotions. It was nice to hear that B.E. is going to have some

time off to help P.E. with the baby and any other household duties. It was even better to hear that

they are trying to develop an effective schedule that fits both of their needs and allows them both

free time during the day to focus on themselves. Since P.E. is struggling with anxiety, stress, and

fear of SIDS, the nurse was able to withhold any judgements and show empathy to the mother

and her husband as this is a very difficult subject to talk about (Nurse & Midwife Support, 2020).

Even though P.E. has a history of anxiety, she is not taking any medications and explained she

has not tried any interventions to try and help her manage it. This was helpful information for the

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nurse because there were many options to research for interventions for the next visit. The nurse

witnessed B.E.’s support for P.E. during the second visit, which also revealed the need for

management of her emotional dilemmas as B.E. is noticing P.E. becoming more distant, less

energetic, and more anxious in her everyday life. Through the use of the screening questionnaires

and open communication, the nurse was able to determine that P.E. was very aware of her

concerns and health risks, but she was not aware of how to control them. She comes from a

family of health professionals, but she explained that she was too embarrassed to ask any of them

for help through this time.

Home Visit Three

After a date and time was decided upon for the final virtual home visit, the nurse began

preparing information and resources that would be useful and effective in the health teaching

portion of the visit. The purpose of the health teaching, as explained by Schoon et al. (2019) “…

is to motivate clients to learn about ways to promote their own health and then act on that

knowledge” (p. 188). The nurse constructed a PEEK Learner Readiness Assessment after

gathering information from the previous two virtual visits. Once this information was obtained,

the nurse was able to identify areas that would be beneficial for a teaching plan for the mother.

The nurse and mother agreed upon two behavioral health outcomes that she would like to

achieve during their time together, which included stress and anxiety management and

identifying signs and risks of SIDS to prevent occurrence.

B.E. was able to attend this visit as he still had time off from work, so it was appreciated

that he could be there for the support of P.E. during this visit. Again, the nurse addressed the

purpose of the home visits and assured the family that their privacy is protected during the course

of the visits and after. The nurse then began to go over the main interest points she gathered from

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the previous two visits, which she discussed and verified with the mother. After the areas of

concern were then mentioned, the health teaching began. First, the nurse wanted to address P.E.’s

ongoing anxiety and stress. Since the nurse gathered from the previous visits that the mother is a

visual and auditory learner, she utilized the use of handouts, which were emailed to the mother,

videos, and talking. The nurse began with management of stress and anxiety. She referred to a

handout that she emailed to the couple from the Florida State University’s College of Medicine

(2016) that went over various treatment ideas for managing stress and anxiety, such as mood

journaling, yoga, bright light therapy, exercise, and meditation. The nurse went over the various

techniques and explanations for how these interventions can reduce stress and anxiety, and she

also asked the mother which ones she would be most interested in learning more about. The

mother explained that she would like to know more about different postpartum exercises and

mood journaling. The nurse explained that mood journaling is used to track thoughts, emotions,

behavior responses, and outcomes of daily events in order to identify what things may trigger the

mother to feel stress or anxiety (Florida State University, 2016). The mother was then showed an

example of the journal sheet that was downloaded off of the Florida State’s website. The nurse

stressed the importance of monitoring behaviors from certain events each day because this can

assist in identifying triggering events.

The nurse also showed a video from The ACOG (2020) of various exercises that are

deemed safe for postpartum mothers. The mother was reminded that benefits from postpartum

exercises include promoting better sleep, relieving stress, and decreasing the risk of depression.

The nurse went over the various types of exercises that were appropriate for the postpartum

mother, some of which included walking, yoga, and light strength-building activities for 20 to 30

minutes a day (ACOG, 2020). Kegel exercises were also stressed as a health intervention

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because this assists in building strength back in the pelvic floor, which supports the bladder to

prevent incontinence and bladder leakage (ACOG, 2020). The nurse encouraged the mother to

slowly integrate exercises into her daily routine when the infant naps and the husband is home.

This would then allow for the mother to take time focusing on herself and exercising while

knowing that the infant is safe. The couple was emailed a list of postpartum appropriate exercises

from the ACOG (2020) that the mother could follow to assist her in developing a safe exercise

plan. The nurse also suggested the mother utilize her Beachbody on Demand membership for

using their postnatal exercise programs. Lastly, the mother was referred to the CDC’s website

(2020b) that shared physical activities for postpartum women while social distancing during

COVID-19. The pandemic was a concern for the mother and infant’s health, so this information

was emailed to the mother to retrieve on her own time.

It was clear that a lot of the mother’s anxiety and stress was closely related to the fear of

something terrible happening to her daughter, so the nurse addressed the mother’s fear of SIDS.

The couple was emailed several information documents and videos that went over what SIDS is,

how it can occur, the risks, what to look for, and how to prevent it from occurring. Both B.E. and

P.E. were already taking proper precautions to ensure the safety of their daughter while she

sleeps, so the nurse suggested that they go over the information emailed to them from Allina

Health (2015) that examined specific recommendations for reducing their daughter’s risk of

SIDS. The nurse then showed example pictures from the Allina Health website (2015) that

demonstrated how the baby should be lying in the crib and what the crib should look like. P.E.

was reminded that these are all proper precautions that she has already been taking, so it is

suggested that they continue doing these steps to ensure their daughter’s safety. The nurse

suggested that the couple watch the SIDS information video (Children’s National, 2020) to

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enhance their learning, as they are both visual and auditory learners. Lastly, the nurse reminded

the couple that even though they are not smokers, they should not allow smoke around the infant

as this may increase the risk of SIDS (CDC, 2020c).

Follow-Up and Evaluation of Third Visit

After the final virtual home visit was conducted, the couple was thanked for their

openness and willingness to participate in this assignment. They were reminded that their privacy

is protected, and no information would be included in the paper that they did not deem

appropriate. The PEEK Learner Readiness Assessment served as a visual representation of the

information gathered from the interviews that gave the nurse insight into the couple’s personal

lives. This assisted the nurse when developing a teaching plan because she was then able to

adjust the teaching to the learning needs of the couple, which resulted in positive outcomes.

While conducting the virtual visits, the nurse repeated P.E.’s words in conversations to eliminate

any miscommunication, and also to show that the nurse was listening closely (Schoon et al.,

2019, p. 190). Simple graphics were utilized to enhance the mother’s learning, as she is a visual

learner (Schoon et al., 2019, p. 190). Since P.E. struggles with stress and anxiety, in order to

promote a positive experience, the mother’s feelings and concerns were acknowledged and

positive language was used (Minnesota Department of Health, 2019, p. 135).

During the final virtual visit, P.E. was able to learn a variety of information that related to

her anxiety, stress, and fear of SIDS. During the end conversations, she expressed her

gratefulness for the resources given to her and the information that was demonstrated and taught

by the nurse. P.E. explained that she is very willing to try all the different forms of exercise, such

as yoga, solo walks, Beachbody postnatal workouts, and core strengthening moderate intensity

exercises. She was commended for her willingness to begin these interventions and she was also

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educated on the importance of taking time for herself while doing this. The nurse encouraged the

use of the mood journaling and P.E. expressed great interest, as she had never heard of this

technique before. She stated she was going to order a new journal so she could get started. Both

of these interventions deemed to be effective as P.E. was engaged in learning through asking

questions, seeking additional information, and putting these practices into action. The

information presented on SIDS was very reassuring for the mother as she was able to

demonstrate the correct safety measures when her daughter is sleeping in her crib, such as lying

her flat on her back, not having blankets or pillows in the crib, and having a firm mattress with a

tight cover sheet. The mother felt reassured from the resources given to her and the nurse’s

assurance. As the visit concluded, P.E. and B.E. expressed their gratitude for the information

presented to them and they explained how they are hopeful this will not only positively impact

P.E.’s life, but also their family’s life. However, the initial visit without P.E.’s husband was

challenging as P.E. was very anxious during this initial interview and the emotional support from

her husband would have been helpful in calming her.

Overall, the student nurse felt this assignment was very beneficial as she had no prior

experience with postpartum mothers, and she also was very unfamiliar with how to properly

conduct home visits through the use of assessments, forming teaching plans, and carrying out

interventions through identified health risks. The experience was very humbling as the current

pandemic made the virtual home visits feel less personable. The nurse had to make extra efforts

to assure the mother that she was being listened to and cared for, which was done through

reassuring, kind, and encouraging words. The nurse felt these visits were beneficial to P.E.

because she was able to learn and implement new health teachings into practice to promote

positive health behaviors and identify ways she can continue to improve her current health risks.

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References

Allina Health. (2015, December 2). Reducing the risk of sudden infant death syndrome (SIDS).

Retrieved from https://www.allinahealth.org/health-conditions-and-treatments/health

library/patient education/beginnings/your-newborn/health-care/reducing-the-risk-of-sids

Centers for Disease Control and Prevention. (2020a). Births and natality. Retrieved from

https://www.cdc.gov/nchs/fastats/births.htm

Centers for Disease Control and Prevention. (2020b). How to be physically active while social

distancing. Retrieved from https://www.cdc.gov/physicalactivity/how-to-be-physically

active-while-social-distancing.html

Centers for Disease Control and Prevention. (2020c). Sudden unexpected infant death and

sudden infant death syndrome. Retrieved from https://www.cdc.gov/sids/Parents

Caregivers.htm

Children’s National. (2020). SIDS: What every parent should know. Retrieved from

https://childrensnational.org/news-and-events/video-gallery/sids-what-every-parent

should-know

Concorde Career College. (2019, July 12). Active listening matters in healthcare. Retrieved from

https://www.concorde.edu/about-us/blog/career-tips-advice/active-listening

Florida State University College of Medicine. (2016). Treatment guidelines. Mother’s Mental

Health. https://mothersmentalhealth.org/treatment-guidelines/

Kaakinen, J. R., Padgett Coehlo, D., Steele, R., & Robinson, M. (2018). Family health care

nursing: Theory, practice, and research. (6th ed.). Philadelphia, PA: F.A. Davis Company.

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Minnesota Department of Health. (2019). Public health interventions: Applications for public

health nursing practice (2nd ed.). Retrieved from

https://www.health.state.mn.us/communities/practice/research/phncouncil/docs/PHInter

entions.pdf

Nurse & Midwife Support. (2020, August 17). Communication skills. Retrieved from

https://www.nmsupport.org.au/students-and-graduates/communication-skills

Pacific Post-Partum Support Society. (2020). The postpartum journey. Retrieved from

http://postpartum.org/the-journey/is-this-depression-anxiety/

Psych Alive. (2020). Communication between couples: How to communicate in a relationship.

Retrieved from https://www.psychalive.org/communication-between-couples/

Schoon, P. A., Porta, C. M., & Schaffer, M. A. (2019). Population-based public health clinical

manual: The Henry Street Model for nurses (3rd ed.). Indianapolis, IN: Sigma Theta Tau

International.

The American College of Obstetricians and Gynecologists. (2020). Exercise after pregnancy.

Retrieved from https://www.acog.org/patient-resources/faqs/labor-delivery-and

postpartum-care/exercise-after-pregnancy

The American College of Obstetricians and Gynecologists. (2018, November). Screening for

perinatal depression. Obstetrics and Gynecology, 132(5), 208-212. Retrieved October 2,

2020, from https://www.acog.org/-/media/project/acog/acogorg/clinical/files/committee

opinion/articles/2018/11/screening-for-perinatal-depression.pdf