FAMILY HEALTH CARE SETTINGS

In the next unit, we studied the types of family in family health nursing care, the characteristics of the family, the factors affecting the health of the family. And the nursing process used to provide nursing services in the community, in which we can provide effective nursing care through assessment of family health nursing, nursing processes, planning, implementation and evolution, etc.

Also, to provide all these health care services including maternal and child health services, family welfare services which include family planning etc., we have to go to the community where the family lives i.e. go to their homes to provide community nursing health services. What should be the setting for home visit? What should be considered before home visit? Also, what should be taken along during a home visit? We will see about that etc. in detail within this unit.

There are many varieties of providing health care services in the family, not all of our objectives can be fulfilled in one setting, and these settings have many advantages and disadvantages in fulfilling their objectives in the community.

Home visit

Home Nursing

Clinic

Occupational health services include health centers etc

Define Home Visit

SETTING

(A) Home Visit

(B) Clinic

(A) Home Visit

Home Visit = Alome Fome Visit is an important aspect of community health nurse, which is a type of nursing service that can be delivered to everyone living in the community. Especially P.H.C. Nursing and total family care is provided to the people through home visits to the small villages below.

In small villages, people live in more superstition and ignorance. And do not go to the nearest health center or hospital during illness. Such people can be improved with the aim of getting better treatment as well as their belief. Home visit is done for that. Thus, the person doing the home visit should have complete knowledge about the home visit.

Points to be remembered by nurse before going to Home Visit ::-

(1) The nurse should be familiar with the family as if visiting them.

(2) To maintain sufficient respect and manners in all respects.

(3) While talking, talk sympathetically and cooperatively, do not lecture.

(4) To take anything positively and think accordingly and give a positive answer.

Principles of Home Visit :: –

(1) Planning should be done according to the needs of the people. E.g. There is some kind of health problem in Amook area. Accordingly, it should be according to the health need.

(2) Accurately collecting all the information of the family as well as general information of the community. In which to ask about family size, income, religion, customs etc.

(3) Being sensitive to the person’s feelings and needs during the visit.

(4) Always use nursing procedures safely and with technical skill.

(5) Giving more importance to quality than quantity of work.

(6) Approach to family should always be polite and trusting

Advantages of Home Visit :-

(1) The nurse can understand the actual situation of the home and family.

(2) As family members have enough faith in us, they are more interested in our program at home and more relaxed at home.

(3) The social, economic background of the family home can be known. So that actual measure can be given good teaching.

(4) New health problems of the family can be known.

(5) Visiting the family members to find out whether they are availing of the health services available to them or not (provides an opportunity to see whether the services of other health agencies are available to the family or not).

Purposes of Home Visit :-

(1) To maintain the health of the people.

(2) To provide total family care e.g. Antenatal Care, Postnatal | Care, Family Planning etc…

(3) To remove the superstition, ignorance of the people and explain the scientific point of view.

(4) To impart health education, e.g. On Personal Hygiene and other topics

(5) To detect, treat and prevent Communicalbe Disease.

(6) To make successful every program run by public health eg family planning, immunization etc.

(7) To improve health by giving nutritional advice to people.

(8) To improve hygiene in people’s homes.

(9) To obtain marketing information

(10) To explain health hazards to people.

(11) For Rehabilitation & Follow-Up

Planning of Home Visit ::-

If we ever have to go on a home visit, it is necessary to plan for it. Planning includes both art and science. By planning, a specific objective can be achieved within a specific time frame. Points to keep in mind while planning.

(1) Area :: –

First survey the area and prepare a map with detailed information including village location, population, road etc. Collecting all kinds of background information of the community, preparing family folder and individual card.

(2) Population :: –

Find out about the population of the area you are going to. And according to its number, to know whether home visit can be done in our fixed time

(3) Occupation ::-

Keep in mind the business hours of the people where THT is going to visit. Whether they are present at home when you go? It should be known in advance when he has free time etc.

(4) Climate ::-

Always plan according to season. Visit in the morning in summer, afternoon in winter, and before rain in monsoon.

(5) Distance :: –

Know in advance how far the area to be visited is from the center, so that enough time can be allotted to reach on time and be served.

(6) Transport ::-

If the area is far away, is there any transport facility to go there? Also know the timings of buses or rickshaws in advance. If there is a nearby area, you can also go on foot etc., know every aspect.

(7) Health Need ::-

Knowing the health needs of the people in the area to be visited. Know the health needs of the family in advance. Such as Antenatal, Postnatal Care Infant, Seek and also include those who are unable to come to the center.

(8) Time Table :-

Making a time table according to each of the above points. Keeping a proper bag for the visit and then going for the visit.

• Steps of Home Visit ::-

(1) Approach ::-

While visiting any family, taking permission from respect while entering the house, getting a place while talking to sit. Knowing the names and occupations of the household members while conversing. All this is an art. Communicate intimately with each member.

(2) Observation; –

After going to the family, during the conversation, look at the house and observe the situation of the house, including the hygienic condition of the house, ventilation, health condition of the family, how many children there are. Income of the head of the household, whether any member is ill? Collecting all kinds of information about immunization of children,

(3) Health Talk ::-

After home visit, plan health education according to the health needs of the family. This health education can be provided through planning as well as incidentally.

(4) Records ::-

After completing the visit, keep a note of everything. For example: how many houses visited throughout the day and what advice was given and if any health-related medicines or equipment were distributed to any house, it should be recorded in a separate register, if it is recorded, it will be very useful in future. Also planning for another visit can be done from it.

Evaluation of Home Visit :: –

By evaluating the home visits we have done, we get an idea of ​​what we are doing wrong and what to do to bring improvement. Evaluation can be done as follows.

(1) Check the record of each visit.

(2) To know the benefits to the people from the visit.

(3) to observe hygienic improvements in the family since the visit,

(4) Seeing the impact of your work on the family.

(5) Seeing the respect you get from people,

(6) To try to find out the reasons for the difficulties encountered during the visit and what kind of behavior can increase the cooperation of the people.

(7) Whether people’s accommodation, superstitions have been removed? see that

Home visits can be made more effective if all the above considerations are evaluated. Every community health nurse should carry out evaluation of their home visits regularly.

Home Visit Bag :: –

A nurse working in the field of Public Health Nursing often carries a home visit bag with her throughout her field, as it contains most of her essentials. E.g. Procedure equipment, medicine etc. This bag is very useful for the health worker. It has different compartments. The nurse has an idea of ​​which item is kept in which compartment. So it is very important to carry a home visit bag in the field,

Bags are made of canvas, leather or even light metal. It can be carried in hand or shoulder. The bag has an exterior pocket. Contains notebook, major tape, newspaper or plastic seat, soap, soap dish, nail brush etc.

Principles of bag technique,

A single bag is used for multiple family visits. So the principles of technique on how to handle it are as follows

(1) Spread the plastic seat or news paper on a flat and clean surface and place the bag on them. So that it is not contained, hang it up if it cannot be put down and there is a place to hang it up. Place the bag in a place where children cannot touch, (2) Wash hands with soap and water before opening the bag.

(3) Take out only the necessary items from the bag.

(4) Perform nursing procedures as required.

(5) Wash, boil, hand wash everything after the procedure and then put it in its place in the instrument bag, when this is not possible, keep everything separately.

(6) Keep everything inside in small packets separately. should

(7) Medicine to be labeled on every bottle

(8) Burn contaminated dressing.

(9) Used news paper, folded so that the used item is inside and placed in the outer pocket of the bag.

Equipment :: –

Do not visit home even if you say without Home Visit Bag or Kit. have different kits. One is a delivery kit that is used for delivery, and the other is a kit for general nursing and postnatal as well as prenatal visits.

(1) Delivery Kit ::-

UNICEF Ki is widely used for delivery. It is very suitable. The necessary Instrument & Articles are in aluminum box. Currently, the modern trend is now for disposable delivery kits supplied by UNICEF and WHO, in which everything is to be used and disposed of for a single delivery by the mother.

Nursing Bag :: –

Nursing Bag If a separate bag is not supplied, the nurse should amend it by keeping an air tight plastic bag or container.

If equipment is to be carried over a long distance, it can be easily lifted in the hand. This box or plastic bag should be light in weight and should contain the necessary articles. It should have a separate cotton lining, which the nurse should carry separately, a pen or pencil notebook or diary in which to record what she observes. And one has to write one’s record in it before leaving home. She should keep her Begum some clean news paper, used for dressing,

Care of Equipment :: –

Regular care is taken of every equipment of Bag. It is very important.

(1) Carrying contaminated articles from house to house can prevent the possibility of cross infection.

(2) The instrument can be kept usable for a long time.

(3) To use every instrument well.

It should be remembered that to keep the contents of the kit clean and in good condition, different equipments should be taken care of as mentioned below.

(1) Bag :: –

If it is a metal bag, it should be cleaned with soapy water and boiled, but if it is a canvas bag, it should be heated in sunlight without washing. If the bag has a cotton lining, it should be changed from time to time. The outside pocket of the bag is made for soap, towel, or napkin, news paper etc.

(2) Rubber Articles :: –

Wash all rubber articles in the bag thoroughly with soapy water, hang the tube and catheter to dry thoroughly. Dry in plastic apron and cent shade, rubber gloves should be dried inside and outside with a clean cloth, thoroughly exposed to air before storing in cotton bags. After applying the powder and paring it, boil the rubber thing in boiling water for 10 minutes to sterilize it.

(3) Thermometer; –

The thermometer and its cover should be kept after washing in an antiseptic solution with soapy water.

(4) Bottle ;:-

Empty the bottles kept in Home Visit Bag once a month. Its lid should be opened and boiled properly. Then it should be well labeled. In which to write the dose and then fill the medicine in it.

(5) Enamel & Steel Articles ::-

Boil these types of articles for 20 minutes. To dry with a clean tile, if the articles are hot, allow them to cool slightly, in an emergency, enamel and stainless steel tools can be flamed and used. To jab the flame, pour some spirit into the articles or vessel and let it spread. Then light it with a match. Be very careful before doing this. Do this procedure only in a place where there is no damage due to fire.

(6) Cord Ligatures ::-

This is kept in a glass bottle. This bottle should be boiled by opening the lid and the thread should be boiled for 20 minutes and then placed in the bottle. Put some spirit in the bottle. Always use a sterile form to remove the thread. or close sterile well. A rubber pad can be used for that. The thread should always be strong when using a weed. Its knot should not break by bending it.

(7) Eye Antiseptic :: –

If silver nitrate proportion is to be used for eye cleaning, it should be changed every week. Also the bottle should be properly closed. Should be labeled. Currently, these types of antiseptics are not commonly used. But only drops available in the ready-made market are used.

(8) Instruments :: –

Wash each instrument thoroughly with cold water after use. Boil for 20 minutes and dry before putting in the kit. Never boil scissors. Wash it with soapy water and flame or keep it in an antiseptic solution before use. Wash and dry after use. Then apply some oil on its blade and joint so that it does not rust.

(9) Dry Dressing & Swabs :: –

(1) There are many different methods of sterilizing dressings and swabs. PHC to sterilize the dressing at regular intervals. And there should be arrangements in the hospital. If there is such convenience, the swab and dressing should be kept in a small cotton bag or paper packet and placed in a small sweal or should be autoclaved by keeping two layers of cotton in the packet.

(r) Put the dressing or swab back into the packet or tin and place in the oven. But it requires linen in the oven. The tin in which the dressing is placed should have holes in the bottom and the lid. And keep the lid open while boiling. In this way, the mother should prepare the dressing at home. So that the midwife can sterilize herself as needed during delivery.

(3) Burning and destruction of dressings, old linen and cotton material. Of which the linen should be thoroughly washed and boiled or autoclaved. Ironing should also be done. It should be kept in a small bag. Sterilization can be done at home in emergencies.

(10) B.P. Instrument or Sphygmomanometer ::-

Cotton arm bandage should be kept separate from B.P, instrument or sphygmomanometer rubber bag and should be washed and cleaned frequently. Rubber tubing and rubber bags should never be soaked and should not be hung to dry. Always wash cloth bags. For which shop solution should be used.

11) Stethoscope ::

Soak the chest pieces in plain water. Clean the tube with antiseptic solution and immerse in the solution. Boiling and cleaning a metal phytoscope.

If the correct technique is used, the nursing bag does not become a site of infection. Full disinfection of nursing bag is not necessary daily, if the kit is used in an infected home, the kit should be cleaned daily and towels, swabs, dressings and all necessary medicine, antiseptic etc. should be changed. The bag and its articles should be cleaned once a week. Feet should always be kept on Safe & Clean space. Never keep it locked. It should be kept accessible to everyone at all times. Disinfect the delivery bag completely after use. If the bag is to be used again for nursing care, keep it prepared.

Method of Disinfecting the Bag :-

Empty the bag completely and boil the boilable articles. Immerse other articles in antiseptic or soapy water. After washing the bag, wash your hands properly after everything is disinfected. Spread a clean towel or clean cloth on the table and prepare the bag again, the items in the bag are not sterile but have an infection fee. Its antiseptic method aims for our work bag technique to close it once it is complete and keep the clean news paper inside. So that it can be taken for use again.

If the instrument is used for an infected person, the nurse who gave the treatment should not be a source of infection herself. He should take a bath, wash his hair, wear clean clothes before handling disinfected articles and bathe himself after boiling each article.

Points to be remembered for bag technique ::-

(1) Items that cannot be disinfected should not be carried in bags. Do not keep things like paper, notebook, pencil, measuring tape etc., money or handkerchief in the bag.

(2) Do not touch anything in the bag without first washing your hands. The procedure requires opening the bag and handwashing. Then remove the articles as required and close the bag. Do not take out extra items other than items needed for nursing care, the less handling required to pick up and put things in the bag, the less infection there will be.

(3) Do not put used articles in bags unless they have been cleaned. If there is nothing boiled or washed in it, it is best to keep it outside the bag.

(4) Always keep the bag on the table, bed or box. Place the bag on it only after placing the clean paper. But never place the bag directly on the ground.

Canvas Bag :: –

Canvas bag has green color cover. It has an iron frame. The bottom groove in the frame is small. And the upper chamber is large. A cotton cloth is wrapped over it. which has a cord. From which Khana remains separate. This frame has to be placed in the green cover. It has three compartments, in which the outer compartment is smaller, called outer compartment, or unsterile compartment. It contains unstrile items.

The middle compartment is also called inner pocket or inner compartment. Which contains clein and styrol.

The lower compartment is called Lower Compartment. Which contains clean things. In which tablets and equipment for handwashing are placed.

Outer Pocket or Outer Compartment:-

(1) Contains urine test equipment like spirit lamp, test tube holder, two test tubes, two droppers, bottle of acetic acid, matchstick, bottle of banentic solution. Each of these items should be placed in a cotton or plastic bag.

(2) Height, Weight, Measuring Articles including measuring tape, spring balance, square or square, etc., are also packed in a cotton bag and labeled.

(3) Equipment for antenatal care including phytoscope, needle, spirit, telequest book, plastic apron, plastic sheet, chiddal forestep. Extra Napkin, Condom, Oral Pills, Ors. Packet, kidney tray, scabies treatment equipment including small cup, paint brush, BB lotion (Benzyc benzoate lotion) bottle in a cotton bag.

Inner Pocket Or Inner Compartment :: –

Inner Compartment contains Sterile & Glass Articles, to be placed in Cotton Bag, for Emergency Delivery, Artery Forceps for Mother – 2, Scissors – 1, Small Bowl – 2, in which – one for placing styling articles and other for making lotion Female Catheter , kidney trays, for perineum care, cotton swabs, bandages etc…

Lover Comartnment::–

including bottles of oral tablets like tablets, iron, anti-calcium, aspirin, B-complex, multi vitamins, sulfa tablets, diarrhea tablets, boring powder etc., spoons and medicine, glasses, hand washing equipment including napkins, shop with shop dishes and nail brushes etc. are kept.

Solder or Subnum Bag :

Items that are kept in solder bangs or subnam bags. It includes family, mother and child cases, plain continuous sheet, old news paper, separate paper for taking height, separate paper for urine testing, plastic or cotton bag which can be used to keep contaminated articles. Red, blue pencil and scale, home visit book, planning book etc. should be kept in Sildar or sarbanum bag and go to home visit.

CLINICS

INTRODUCTION ::-

Every PHC running in rural area. Clinics are organized on different days at or in dispensaries or nursing homes. People already know about this clinic. Clinics are planned in advance. On which day and at what time what type of patient is examined is determined by systematic planning, the clinic should be in a certain place, good and accessible to the people where all kinds of facilities are available.

Definition ::-

A clinic is a place where sick persons are treated through health person observation and practical check. It is called clinic. In short it can be said that a clinic is a place where preventive and curative care can be given.

Objectives of clinics ::-

(1) To reduce Mortality & Morbality

(2) To detect and treat any health problem in the community or individual.

(3) To provide psychological support by discussing his problems with the patient.

(4) To remove any superstitions or doubts among people regarding health problems

(5) To provide health teaching,

(6) To make community programs a success by gaining public trust and cooperation.

(7) To provide abnormal case finding referral services,

(8) To provide maternal and child health services and to explain well about family planning services,

(9) To explain how different diseases are spread and how they can be prevented from spreading,

(10) for planning and research activities of public health work, “

Types of Clinic :: –

Clinics are of different types as follows….

(1) M.C.H. Clinic.

(2) Well Baby Clinic

(3) Family Planning Clinic,

(4) Antenatal Clinic

(5) Postnatal Clinic

(6) T.B. Clinic.

(7) Leprosy Clinic

(8) Cancer Clinic.

(9) Diabetes Clinic.

(10) Dental Clinic

(11) Psychiatric Clinic

(12) Skin & V.D. Clinic.

Planning of Clinic :: –

Deciding what type of clinic to arrange Deciding where to arrange the clinic To fix date and time convenient for people. To determine the setting of the clinic by conducting a survey to find out the need of the people for this clinic. Eg: How to plan once or twice every week

Physical Setup & Organization of Clinic –

(1) Place :: –

Clinic should be away from congested area, slum area as well as market and school.

The clinic should be located in an easily accessible location, with transportation facilities or within walking distance.

The building of the clinic should be good and convenient and at a well-known location.

There should be separate seating arrangements for men and women.

Clinics should have exam rooms and tables to maintain patient privacy.

There should be facility of investigation room and drinking water.

Doctor’s room, laboratory, office should be separate.

(2) Building :: –

The building of the clinic should be well constructed. Also the barrier of the floor should be made of cement or tiles.

The roof of the clinic should be cement, crocrete slabs or cement sheets.

Floor should not be slippery. So that the beneficiary does not slip and get injured.

The building should be well ventilated and 24 hours electricity supply should be available and the beneficiary should get all kinds of treatment.

(3) Rooms :: –

There should be enough rooms. There should be a waiting room. There should be a system for central registration and arrangement of cards as well as folders, number wise.

There should be doctor exam and consulting room, conference room, nurses room, lab for blood and urine exam.

There should be facilities for nurses teaching and conference rooms in which immunization or health teaching can be given,

Recreation room in which. There should be TV, Newspaper, Magazine, etc. Drinking water, toilet, latrine, wash basin etc. should be arranged.

The clinic should have separate doors or facilities for Entress & Exit. So that the crowd of people does not accumulate at one place.

(4) Furniture :: –

The furniture in the clinic should be in working condition as required. There should be benches or chairs for sitting in the waiting room. There should be 3 to 4 chairs and 2 to 3 tables and 1 cupboard in the registration room.

Nurses room should have table, 3 to 4 chairs, registers for keeping records, cupboard, examination table etc. There should be a table, chair, examination table and privacy for doctor consulting and examination.

(5) Equipments Required for Clinic :: ‘

BP Tonrch, Tongue Semula Common, Hammer, Thermometer etc for Physical Exam. Height, Weight Machine, Vaginal Speculum for Gynec Exam, Vaginal Rectator Dilatal, Valsellum etc.

Sufficient linens like sheets, mattresses, 4 (curtains) towels, napkins etc. should be provided. Necessary stationery like, register, paper pad, file, O.P.D. There should be paper, etc. Audio visual aids like flip book, roller board, overhead projector, computer, laptop etc., so that health education can be imparted well. Necessary medicine like tablets, Iron, A, Calcium etc. and antiseptic lotions like Spirit, Dettol, Avalon, etc. should be there. Necessary dressing materials like gauze, bandages etc. should also be available

Ways to disseminate Cllnic information to the public

(1) To inform the people in advance about which clinic is there and which subject is the clinic. Giving information about which specialist will come to the clinic and what kind of care will be provided.

(2) To explain to the people what the purpose of the clinic is.

(3) Clinics can be advertised through microphone, Mahila Mandal, Sarpanch and also through schools.

Requirement of Good Clinic ::-

For the clinic to run well, the clinic should have all kinds of facilities first. People’s cooperation is very important for the clinic. The cooperation of social organizations, women’s organizations, youth organizations, voluntary organizations etc. is very important for the clinic. According to the Social Economical Condition of the village where the clinic is to be run, there should be arrangements for compositions, paper shows, film shows for health, and light refreshments so that people can easily come to the clinic.

Functions of Health Person in Clinic :: –

6. Any health person can run a clinic and it should have many responsibilities. Good adjustment and co-operation with people is especially necessary. Every clinic program needs to be planned and well thought out to be successful. A person arranging a clinic should strive to fulfill the goal of meeting the health needs of the people. The person running the clinic should pay special attention to the following points and take appropriate action.

(1) Advertisement :: –

Before starting the clinic, make an announcement about it so that everyone living in the village knows about it. The advertisement should cover the date, time, time and topic etc. Taking help of well-known persons for advertising. E.g. Village Sarpanch, Talati, Panchayat Staff, Social Worker, School, Teachers etc. Apart from this, it can also be given through advertisement, publicity and poster. Advertisement should be effective enough, knowledgeable enough and attractive enough to be known to everyone.

(2) Planning & Arrangement ::-

Make all the preparations for the clinic before the date and time as well as the time you have fixed for the clinic. Eg: Medicine, stationery, necessary equipment, drinking water system, seating system etc. The clinic should always be opened at the appointed time. There should be no defect in any system. Also, no problem should arise in the ongoing clinic.

(3) Approach & Positive Attitude ::-

Welcoming everyone who comes to the clinic. Also do not show negative attitude. To keep everyone informed of every activity of the clinic. If any question is asked, give a positive answer, when any family comes to the clinic, get their complete identification & information and make a family folder and then give the family their Identity Card and ask them to bring the card with them when they come back to the clinic.

(4) Special Attention and Priority ::–

If any emergency case comes in the clinic, then give priority to it. Also, if there is any old age person or handicapped person, give special attention to him.

(5) Satisfactory Services ::-

To give a satisfactory answer to every person who comes to the Clinic, and to provide all available services without discrimination against anyone. Not to wrongly seat the people coming to the clinic, to inform all the same information of any kind. Hearing everyone’s complaints and providing Comprehensive Cure as far as possible in the clinic. Follow up if necessary.

(6) Health Education :: –

We should not miss the opportunity to impart health education whenever we get a chance. Because this is a chance to provide health education to more people of the community. Health education can be given as per the requirement of the group, and health education can be given regardless of any topic.

(7) Record Report :: –

A note of the necessary action should also be kept after completion of the clinic. Every type of record should be noted in the register. So that the necessary information about it can be useful in future. Record report becomes very useful if any statistical information or research activity is to be done in future.

(8) Evaluation :-

This is important, because evaluation can tell you how many people you are serving and which services are most needed. People’s problems, impact of health services etc. should be evaluated.