What happens during a home visit?

Want to use home care nurses? Be sure the nurse is able to carry out many tasks and has the right personality for the job, say managers of women’s health programs.

Here’s a run-down of what home care nurses do on a first visit to a new mother, according to Susan D. Emanuele, RN, BSN, manager and founder of an early discharge/home care program called Lifestarts at HIP (Health Insurance Plan) of New Jersey, an HMO in New Brunswick.

• Let the mother ask all the questions she has. This usually takes 45 minutes.

• Conduct a complete physical assessment on the mother, including checking her episiotomy, teaching her how to palpate her fundus, explaining engorgement, and answering questions like, ‘When will these hemorrhoids go away?’ and ‘When can I have sex?’

• Conduct a complete newborn assessment. For example, show the mother the baby’s fontanelle and tell her what is normal and abnormal, explain when she should and should not call the pediatrician, show her how to determine if the baby has urinated (rip the disposable diaper the baby was wearing).

• Observe a feeding, whether from a bottle or the breast. Often the nurse will catch the mother microwaving bottles to heat them, Emanuele says. Heating bottles in the microwave is dangerous because it can cause the milk to get too hot even though the bottle feels only warm.

• Get the mother some juice so you can look in the refrigerator to see if the family is eating well.

• Conduct a compete safety assessment. Check for plug covers, cabinet locks, functioning smoke detectors, and a gate on the stairs. If parents don’t have these, encourage them to install the devices immediately. Emanuele says her nurses will buy a smoke detector for a family rather than leave it to chance. They are then reimbursed by HIP for the cost.

Some of these may sound like tasks similar to what hospital nurses carry out, but Carol Dabek, MS, RNC, IBCLC, director of home care at Women and Infants Hospital in Providence, RI, warns that home care nursing is different from what many nurses are used to. "The problem is, you can’t necessarily take somebody who is a fabulous postpartum newborn nurse and make them a home care nurse," she says.

A home care nurse must:

• Be able to work solo. The main reason people drop out of the program is because they didn’t anticipate the isolation, Dabek says.

• Have good decision-making skills, so they must have had a lot of experience in the subspecialty of maternal and infant care

• Be flexible. "We go into fancy homes and destitute homes, with all sorts of people," explains Dabek. "You have to decide if it’s safe or unsafe and not impose your own standards."

Due to the staff dropout rate, Dabek says if there was one thing she’d do differently, it would be to expose the hospital nurses who wanted to provide home care to that environment early in the training process rather than at the end. Once they understand what home visits will be like, and they decide to pursue it, then you can spend money and effort in training them, she says.