This article was downloaded by: [JAMES COOK UNIVERSITY] On: 17 March 2015, At: 12:03 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Community Health Nursing Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hchn20
Evaluation of Home Visits Using a Nursing Process Approach M. Gay Dolan , Karen A. Pachis & Joyce M. Skelton Published online: 07 Jun 2010.
To cite this article: M. Gay Dolan , Karen A. Pachis & Joyce M. Skelton (1990) Evaluation of Home Visits Using a Nursing Process Approach, Journal of Community Health Nursing, 7:2, 69-75, DOI: 10.1207/ s15327655jchn0702_3 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0702_3
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF COMMUNITY HEALTH NURSING, 1990, 7(2), 69-75 Copyright O 1990, Lawrence Erlbaum Associates, Inc.
Evaluation of Home Visits Using a Nursing Process Approach
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
M. Gay Dolan, RN, MS, Karen A. Pachis, RN, MSN, and Joyce M. Skelton, RN, MS Mennonite College of Nursing
Few tools for home visit evaluation of students exist in current nursing literature. Therefore, a tool was developed that utilizes a nursing process framework to measure essential nursing behaviors in the home. Incorporated into the tool are unique facets of community-oriented nursing practice, such as home environment assessment, familyoriented nursing diagnoses, bag technique, and contracting. The tool is a two-page form designed to evaluate pre-visit, onsite, and post-visit nursing activities. The tool has been refined using empirical data from clinical experiences with over 200 students in community health nursing. The clinical evaluation of students is a major challenge for all of us in nursing education. Literature on the topic repeatedly cites the need for the evaluator to reduce subjectivity in the process of clinical evaluation. The identification of specific performance criteria is suggested as the primary means for reducing teacher bias. The challenge is compounded when the area of clinical instruction to be evaluated is the community setting. Community health nursing roles are initially perplexing to the student who has become accustomed to the structure of an institutional setting. Students are apt to be dispersed throughout the community, creating distance and time barriers that do not exist when the client is institutionalized. With these concerns in mind, the goal of the community health nursing faculty of Mennonite College of Nursing was to develop an evaluation method which controls for subjectivity and clarifies role expectations, yet is practical to use. A review of the literature reveals a paucity of information on the evaluation of students in the community health setting. Methods that have been utilized include instructor observation, audiotapes, written process recordings, student logs, and post-visit conferences. Gustafson (1980) also described student peer evaluation as an alternative to instructor observation because student/instructor home visits tend to be anxiety-provoking for the student. A combination of evaluative methods has been used. Support for this approach is documented by Clark and Bozian (1983). According to Suchman (1967), evaluation involves a combination of basic assumptions underlying the activity being evaluated and of personal values on the Requests for reprints should be sent to M. Gay Dolan, RN, MS, Instructor, Community Health Nursing, Mennonite College of Nursing, 804 North East Street, Bloomington, IL 61701.
70
Dolan, Pachis, and Skelton
part of those doing the evaluating. Identification of these assumptions and values helped to define and direct our work. Our task began with the assumption that the selection of evaluative methods is dependent on institutional philosophy, the structure of the course, and the professional philosophy of the clinical instructors. The second assumption made was that the role of the community health nurse (CHN) could be formulated into measurable performance criteria.
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
INSTITUTIONAL PHILOSOPHY
The philosophy of our institution supports a formative evaluation. Evaluation is viewed as a growth-promoting process whereby both students and faculty collaborate to identify strengths and weaknesses of student performance. The student has the right to know what behaviors must be demonstrated. Faculty are responsible to inform the student of progress in the course. A tool for this purpose, the College Clinical Evaluation Tool, is utilized throughout the program. The tool, adapted from the work of Cronin-Stubbs and Mathews (1982), lists behaviors that are congruent with the American Nurses Association (1973) Standards of Nursing Practice. Within courses, faculty identify specific ways in which the student demonstrates satisfactory achievement on the College Clinical Evaluation Tool.
COURSE STRUCTURE
The community health nursing course of our college focuses on family-centered nursing care in the home. Emphasis is placed on direct care versus observation. The student's primary clinical placement is in a community health agency where the student is assigned a caseload of families to visit in the home setting. A clinical focus on home visiting is beneficial in many respects. First and foremost, students are exposed to the most fundamental of all community nursing roles: the home visitor. An ongoing relationship with a client in the home setting allows students to develop confidence and nursing skill. Continuity of care for the client also helps to insure quality of care. In addition, students are able to give support to one another through the commonality of experience.
FACULTY PHILOSOPHY
As faculty, our beliefs about evaluation support the need for methods that place emphasis on direct observations of students. The instructor is accountable for students' clinical performance and must be present periodically to confirm the accuracy of techniques and findings. Besides being evaluators, faculty should be available to students as clinical experts, resource persons, and role models. When
Home Visit Evaluation
71
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
accompanying the student on a home visit, the instructor can appraise the interpersonal and technical skills of the student. Verbal cues and a guiding hand can enhance student performance. Concurrently, the instructor can make judgements about the client's status, validate the student's decisions, and give immediate feedback to improve nursing effectiveness. The instructor should assume an active role through role modeling. Modeling allows for learning of more complex technical, interpersonal, and social skills that are frequently needed when working with families in the home setting. HOME VISITING PROCESS
In the home, as in other care settings, the nurse employs the stages of the nursing process in the provision of care. These stages include assessment, formulation of a nursing diagnosis, care planning, and implementation and evaluation of care. Leman (1984) viewed the home visit itself as a process which includes the following components: referral, pre-visit activities, entry into the home, promoting the nurseclient relationship, evaluation, concluding the visit, post-visit activities, and termination. Conceptualization of home visiting as a process broadens the scope beyond contact time between the client and the nurse in the home. When nursing care is provided in the home, the nurse engages in activities that lend a unique flavor to the nursing process. Development of skill in the following areas helps to ensure a successful home visit: Neighborhood assessment. Home environment assessment. Family-oriented data collection. Interview and physical assessment of the client in the home. Role-modeling positive health behaviors. Bag technique. Contracting. Teaching to enhance self care ability. 9. Telephone nursing. 10. Utilization of community resources. 1. 2. 3. 4. 5. 6. 7. 8.
TOOL DEVELOPMENT
As clinical instructors in community health nursing we identified a need for an objective tool to be utilized in the evaluation of instructor-supervised home visits. A primary goal in tool development was to describe a set of behaviors that would guide the student through the phases of the home visiting process. Content for the tool was compiled from personal experience and community health nursing textbooks (Burgess, 1983; Schoolcraft, 1984). Refining content was a process that evolved over several years using empirical data from home visits with students.
72
Dolan, Pachis, and Skelton
The format for the tool was an easy decision. The use of a nursing process framework is supported by professional standards, college policies, and faculty philosophy. From a practical standpoint, the tool needed to be concise and easy to complete while traveling to and from the home. Making a home visit is an anxious moment for students, thus the behaviors stated on the tool are explicit and simple (see Table I).
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
USE OF THE TOOL
Each student is expected to make a minimum of two instructor-supervised home visits during a 10-week clinical course. Additional visits are planned as deemed necessary by either the instructor or student. Arranging for shared home visits requires careful planning. Scheduling home visits is the student's responsibility and requires an appointment with both the client and instructor. This very first step gives evidence of a student's organization and time management skills. Being able to select the subject, date, and time of the home visit allows ample time for students to prepare. Pre-visit client contact via the telephone gives the instructor an opportunity to evaluate the student's communication and assessment skills. Prior to the home visit, a conference is held between student and instructor to review the student's accomplishment of pre-visit activities identified on the tool. The student is expected to articulate knowledge of the family unit, individual client needs, and environmental factors that impact on care giving. Nursing diagnoses, goals, and interventions for the home visit are reviewed jointly. Resources for client education and referral are examined. While conferencing, the instructor gives positive feedback for preparedness. When warranted, the instructor directs the student to do further research to correct deficiencies. On-site activities begin with gaining entry into the home. This requires knowledge of the environment in order to ensure personal safety as well as effective communication skills. During the home visit, the student is expected to direct nursing care, utilizing the instructor as a resource. The student follows through on the plan which was previously reviewed. In the event that the client's needs have changed, the care plan is revised with the guidance of the instructor. Bag technique and other procedural skills are evaluated at this time. Following the home visit, the tool directs the student to engage in the following activities: documentation, reporting, referral, care-plan revision, and selfevaluation. Documentation is reviewed by the instructor for accuracy and completeness. Reports are given as necessary to physicians and agency personnel to ensure continuity of care. Referrals are made based on information collected by the student in a Community Resource File. Reporting and referral provide another opportunity for evaluating telephone communication skill. When the home visiting process has been completed, criteria on the Home Visit Evaluation Tool are judged satisfactory or unsatisfactory by the clinical instructor. Unsatisfactory ratings are indicative of areas of clinical performance that need im-
TABLE 1 Home Visit Evaluation Tool Student Name Date Instructor Home Visit Evaluation Tool
Competency:
S = Satisfactory U = Unsatisfactory
Pre-Visit Activities Assessment
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
--
1. Collect pre-visit assessment data related to: a. culture b. significant others c. physical status d. mental status -- e. developmental level f. socioeconomic status -- 2. Identify environmental factors of clinical significance including: -- a. pertinent observations of the neighborhood in which the family lives b. pertinent observations of the home -- 3. Inxstigate potential community resources for family benefit. -- 4. Utilize effective telephone communication skills. Nursing Diagnosis ----
-----
1. 2. 3. 4.
---
Identify actual or potential family health problems. Identify relationship between the family's bio-psycho-social status and casual factors. Formulate appropriate individual and family nursing diagnoses based on assessment data. Prioritize nursing diagnoses utilizing: a. input from family b. theory base
Planning -
1. Research information related to the clients pathophysiology and therapeutic regimen. 2. Formulate family goals that are: a. derived from assessment data - b. family-centered -- c. measurable -- d. realistic for time frame -3. List specific nursing interventions for home visit. -4. Contract with the family to achieve desired goals. 5. Organize for home visit by: -- a. maintaining necessary bag inventory -- b. collecting appropriate resource materials c. scheduling time and place of visit On-Site Activities Implementation
--
-
1. Utilize effective communication skills which include: -- a. introducing self and instructor -- b. identifying individuals present in the home -- c. explaining the purpose of the visit -- d. conducting self as a guest in the home -- e. noting verbal and nonverbal responses to the visit -- f. showing respect and interest in the family g. facilitating client sharing 2. Collect adequate individual/family data by using appropriate: --a. interview skills --b. physical assessment techniques 3. Serve as a role model for positive health behaviors. 4. Adapt procedure to the home setting.
(Continued)
73
74
Dolan, Pachis, and Skelton TABLE 1 (Continued) -
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On-Site Activities Implementation -5. Demonstrate proper procedure in accordance with: -a. prescribed standards -b. agency policy -6. Utilize correct bag technique. -7. Perform nursing interventions efficiently. -8. %ke appropriate precautions for maintenance of: -a. personal safety -b. client safety -9. Implement formal and informal teaching when appropriate. -10. Focus nursing care on appropriate family members. -11. Terminate the visit by: -a. collaborating with appropriate agency personnel -b. making referrals -c. utilizing Community Resource File -d. reporting to agency personnel when appropriate -4. Appraise self-performance by identifying: -a. factors that facilitated g o d achievement -b. factors that hindered goal achievement -c. alternative behaviors for next home visit Comments Student -
Instructor -
provement. Students are encouraged to participate in the evaluative process by appraising self-performance. Opportunities for improvement exist as students make subsequent home visits. The Home Visit Evaluation Tool benefits both students and instructors. The presentation of behaviors in a step-by-step fashion helps students to be more independent in their functioning. Knowing role expectations helps to reduce anxiety. The behavioral competencies stated on the tool provide such direction. This guided independence is an important feature for the student adapting to the more autonomous role of a home visitor. From an instructor's perspective, the behaviors listed on the tool have served as a practical guide for the objective evaluation of students' actions. Travel time can be utilized for pre-visit/post-visit evaluation conferences as well as completion of most segments of the tool. Students express appreciation for the guidance and emotional
Home Visit Evaluation
75
support provided when the instructor is present. When used in conjunction with instructor observation, the tool is meeting our needs for an objective, specific, practical method of evaluation.
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
REFERENCES American Nurses' Association. (1973). Standards of nursing practice. Kansas City: Author. Burgess, W. Fd.). (1983). The home visit. In Community health nursing (pp. 307-323). Norwalk, CT: Appleton-Century-Crofts. Clark, H. M., & Bozian, M. (1983). A cookbook approach to evaluation of clinical experience in community health nursing. Journal of Nursing Education, 22(6), 249-254. Cronin-Stubbs, D., & Mathews, J. (1982, July/August). A clinical performance evaluation tool for a process-oriented nursing curriculum. Nurse Educator, pp. 24-29. Gustafson, D. D. (1980) Student peer evaluation: A successful adaptation for observed home visits. Journal of Nursing Education, 19(2), 4-7. Leman, C. (1984). Visiting clients in the home. In V. Schoolcraft, (Ed.), Nursing in the community (pp. 344-367). New York: Wiley. Schoolcraft, V. (Ed.). (1984). Nursing in the community. New York: Wiley. Suchman, E. (1967). Evaluative research. New York: Sage.
Journal of Community Health Nursing Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hchn20
Evaluation of Home Visits Using a Nursing Process Approach M. Gay Dolan , Karen A. Pachis & Joyce M. Skelton Published online: 07 Jun 2010.
To cite this article: M. Gay Dolan , Karen A. Pachis & Joyce M. Skelton (1990) Evaluation of Home Visits Using a Nursing Process Approach, Journal of Community Health Nursing, 7:2, 69-75, DOI: 10.1207/ s15327655jchn0702_3 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0702_3
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
JOURNAL OF COMMUNITY HEALTH NURSING, 1990, 7(2), 69-75 Copyright O 1990, Lawrence Erlbaum Associates, Inc.
Evaluation of Home Visits Using a Nursing Process Approach
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
M. Gay Dolan, RN, MS, Karen A. Pachis, RN, MSN, and Joyce M. Skelton, RN, MS Mennonite College of Nursing
Few tools for home visit evaluation of students exist in current nursing literature. Therefore, a tool was developed that utilizes a nursing process framework to measure essential nursing behaviors in the home. Incorporated into the tool are unique facets of community-oriented nursing practice, such as home environment assessment, familyoriented nursing diagnoses, bag technique, and contracting. The tool is a two-page form designed to evaluate pre-visit, onsite, and post-visit nursing activities. The tool has been refined using empirical data from clinical experiences with over 200 students in community health nursing. The clinical evaluation of students is a major challenge for all of us in nursing education. Literature on the topic repeatedly cites the need for the evaluator to reduce subjectivity in the process of clinical evaluation. The identification of specific performance criteria is suggested as the primary means for reducing teacher bias. The challenge is compounded when the area of clinical instruction to be evaluated is the community setting. Community health nursing roles are initially perplexing to the student who has become accustomed to the structure of an institutional setting. Students are apt to be dispersed throughout the community, creating distance and time barriers that do not exist when the client is institutionalized. With these concerns in mind, the goal of the community health nursing faculty of Mennonite College of Nursing was to develop an evaluation method which controls for subjectivity and clarifies role expectations, yet is practical to use. A review of the literature reveals a paucity of information on the evaluation of students in the community health setting. Methods that have been utilized include instructor observation, audiotapes, written process recordings, student logs, and post-visit conferences. Gustafson (1980) also described student peer evaluation as an alternative to instructor observation because student/instructor home visits tend to be anxiety-provoking for the student. A combination of evaluative methods has been used. Support for this approach is documented by Clark and Bozian (1983). According to Suchman (1967), evaluation involves a combination of basic assumptions underlying the activity being evaluated and of personal values on the Requests for reprints should be sent to M. Gay Dolan, RN, MS, Instructor, Community Health Nursing, Mennonite College of Nursing, 804 North East Street, Bloomington, IL 61701.
70
Dolan, Pachis, and Skelton
part of those doing the evaluating. Identification of these assumptions and values helped to define and direct our work. Our task began with the assumption that the selection of evaluative methods is dependent on institutional philosophy, the structure of the course, and the professional philosophy of the clinical instructors. The second assumption made was that the role of the community health nurse (CHN) could be formulated into measurable performance criteria.
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
INSTITUTIONAL PHILOSOPHY
The philosophy of our institution supports a formative evaluation. Evaluation is viewed as a growth-promoting process whereby both students and faculty collaborate to identify strengths and weaknesses of student performance. The student has the right to know what behaviors must be demonstrated. Faculty are responsible to inform the student of progress in the course. A tool for this purpose, the College Clinical Evaluation Tool, is utilized throughout the program. The tool, adapted from the work of Cronin-Stubbs and Mathews (1982), lists behaviors that are congruent with the American Nurses Association (1973) Standards of Nursing Practice. Within courses, faculty identify specific ways in which the student demonstrates satisfactory achievement on the College Clinical Evaluation Tool.
COURSE STRUCTURE
The community health nursing course of our college focuses on family-centered nursing care in the home. Emphasis is placed on direct care versus observation. The student's primary clinical placement is in a community health agency where the student is assigned a caseload of families to visit in the home setting. A clinical focus on home visiting is beneficial in many respects. First and foremost, students are exposed to the most fundamental of all community nursing roles: the home visitor. An ongoing relationship with a client in the home setting allows students to develop confidence and nursing skill. Continuity of care for the client also helps to insure quality of care. In addition, students are able to give support to one another through the commonality of experience.
FACULTY PHILOSOPHY
As faculty, our beliefs about evaluation support the need for methods that place emphasis on direct observations of students. The instructor is accountable for students' clinical performance and must be present periodically to confirm the accuracy of techniques and findings. Besides being evaluators, faculty should be available to students as clinical experts, resource persons, and role models. When
Home Visit Evaluation
71
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
accompanying the student on a home visit, the instructor can appraise the interpersonal and technical skills of the student. Verbal cues and a guiding hand can enhance student performance. Concurrently, the instructor can make judgements about the client's status, validate the student's decisions, and give immediate feedback to improve nursing effectiveness. The instructor should assume an active role through role modeling. Modeling allows for learning of more complex technical, interpersonal, and social skills that are frequently needed when working with families in the home setting. HOME VISITING PROCESS
In the home, as in other care settings, the nurse employs the stages of the nursing process in the provision of care. These stages include assessment, formulation of a nursing diagnosis, care planning, and implementation and evaluation of care. Leman (1984) viewed the home visit itself as a process which includes the following components: referral, pre-visit activities, entry into the home, promoting the nurseclient relationship, evaluation, concluding the visit, post-visit activities, and termination. Conceptualization of home visiting as a process broadens the scope beyond contact time between the client and the nurse in the home. When nursing care is provided in the home, the nurse engages in activities that lend a unique flavor to the nursing process. Development of skill in the following areas helps to ensure a successful home visit: Neighborhood assessment. Home environment assessment. Family-oriented data collection. Interview and physical assessment of the client in the home. Role-modeling positive health behaviors. Bag technique. Contracting. Teaching to enhance self care ability. 9. Telephone nursing. 10. Utilization of community resources. 1. 2. 3. 4. 5. 6. 7. 8.
TOOL DEVELOPMENT
As clinical instructors in community health nursing we identified a need for an objective tool to be utilized in the evaluation of instructor-supervised home visits. A primary goal in tool development was to describe a set of behaviors that would guide the student through the phases of the home visiting process. Content for the tool was compiled from personal experience and community health nursing textbooks (Burgess, 1983; Schoolcraft, 1984). Refining content was a process that evolved over several years using empirical data from home visits with students.
72
Dolan, Pachis, and Skelton
The format for the tool was an easy decision. The use of a nursing process framework is supported by professional standards, college policies, and faculty philosophy. From a practical standpoint, the tool needed to be concise and easy to complete while traveling to and from the home. Making a home visit is an anxious moment for students, thus the behaviors stated on the tool are explicit and simple (see Table I).
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
USE OF THE TOOL
Each student is expected to make a minimum of two instructor-supervised home visits during a 10-week clinical course. Additional visits are planned as deemed necessary by either the instructor or student. Arranging for shared home visits requires careful planning. Scheduling home visits is the student's responsibility and requires an appointment with both the client and instructor. This very first step gives evidence of a student's organization and time management skills. Being able to select the subject, date, and time of the home visit allows ample time for students to prepare. Pre-visit client contact via the telephone gives the instructor an opportunity to evaluate the student's communication and assessment skills. Prior to the home visit, a conference is held between student and instructor to review the student's accomplishment of pre-visit activities identified on the tool. The student is expected to articulate knowledge of the family unit, individual client needs, and environmental factors that impact on care giving. Nursing diagnoses, goals, and interventions for the home visit are reviewed jointly. Resources for client education and referral are examined. While conferencing, the instructor gives positive feedback for preparedness. When warranted, the instructor directs the student to do further research to correct deficiencies. On-site activities begin with gaining entry into the home. This requires knowledge of the environment in order to ensure personal safety as well as effective communication skills. During the home visit, the student is expected to direct nursing care, utilizing the instructor as a resource. The student follows through on the plan which was previously reviewed. In the event that the client's needs have changed, the care plan is revised with the guidance of the instructor. Bag technique and other procedural skills are evaluated at this time. Following the home visit, the tool directs the student to engage in the following activities: documentation, reporting, referral, care-plan revision, and selfevaluation. Documentation is reviewed by the instructor for accuracy and completeness. Reports are given as necessary to physicians and agency personnel to ensure continuity of care. Referrals are made based on information collected by the student in a Community Resource File. Reporting and referral provide another opportunity for evaluating telephone communication skill. When the home visiting process has been completed, criteria on the Home Visit Evaluation Tool are judged satisfactory or unsatisfactory by the clinical instructor. Unsatisfactory ratings are indicative of areas of clinical performance that need im-
TABLE 1 Home Visit Evaluation Tool Student Name Date Instructor Home Visit Evaluation Tool
Competency:
S = Satisfactory U = Unsatisfactory
Pre-Visit Activities Assessment
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
--
1. Collect pre-visit assessment data related to: a. culture b. significant others c. physical status d. mental status -- e. developmental level f. socioeconomic status -- 2. Identify environmental factors of clinical significance including: -- a. pertinent observations of the neighborhood in which the family lives b. pertinent observations of the home -- 3. Inxstigate potential community resources for family benefit. -- 4. Utilize effective telephone communication skills. Nursing Diagnosis ----
-----
1. 2. 3. 4.
---
Identify actual or potential family health problems. Identify relationship between the family's bio-psycho-social status and casual factors. Formulate appropriate individual and family nursing diagnoses based on assessment data. Prioritize nursing diagnoses utilizing: a. input from family b. theory base
Planning -
1. Research information related to the clients pathophysiology and therapeutic regimen. 2. Formulate family goals that are: a. derived from assessment data - b. family-centered -- c. measurable -- d. realistic for time frame -3. List specific nursing interventions for home visit. -4. Contract with the family to achieve desired goals. 5. Organize for home visit by: -- a. maintaining necessary bag inventory -- b. collecting appropriate resource materials c. scheduling time and place of visit On-Site Activities Implementation
--
-
1. Utilize effective communication skills which include: -- a. introducing self and instructor -- b. identifying individuals present in the home -- c. explaining the purpose of the visit -- d. conducting self as a guest in the home -- e. noting verbal and nonverbal responses to the visit -- f. showing respect and interest in the family g. facilitating client sharing 2. Collect adequate individual/family data by using appropriate: --a. interview skills --b. physical assessment techniques 3. Serve as a role model for positive health behaviors. 4. Adapt procedure to the home setting.
(Continued)
73
74
Dolan, Pachis, and Skelton TABLE 1 (Continued) -
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
On-Site Activities Implementation -5. Demonstrate proper procedure in accordance with: -a. prescribed standards -b. agency policy -6. Utilize correct bag technique. -7. Perform nursing interventions efficiently. -8. %ke appropriate precautions for maintenance of: -a. personal safety -b. client safety -9. Implement formal and informal teaching when appropriate. -10. Focus nursing care on appropriate family members. -11. Terminate the visit by: -a. collaborating with appropriate agency personnel -b. making referrals -c. utilizing Community Resource File -d. reporting to agency personnel when appropriate -4. Appraise self-performance by identifying: -a. factors that facilitated g o d achievement -b. factors that hindered goal achievement -c. alternative behaviors for next home visit Comments Student -
Instructor -
provement. Students are encouraged to participate in the evaluative process by appraising self-performance. Opportunities for improvement exist as students make subsequent home visits. The Home Visit Evaluation Tool benefits both students and instructors. The presentation of behaviors in a step-by-step fashion helps students to be more independent in their functioning. Knowing role expectations helps to reduce anxiety. The behavioral competencies stated on the tool provide such direction. This guided independence is an important feature for the student adapting to the more autonomous role of a home visitor. From an instructor's perspective, the behaviors listed on the tool have served as a practical guide for the objective evaluation of students' actions. Travel time can be utilized for pre-visit/post-visit evaluation conferences as well as completion of most segments of the tool. Students express appreciation for the guidance and emotional
Home Visit Evaluation
75
support provided when the instructor is present. When used in conjunction with instructor observation, the tool is meeting our needs for an objective, specific, practical method of evaluation.
Downloaded by [JAMES COOK UNIVERSITY] at 12:03 17 March 2015
REFERENCES American Nurses' Association. (1973). Standards of nursing practice. Kansas City: Author. Burgess, W. Fd.). (1983). The home visit. In Community health nursing (pp. 307-323). Norwalk, CT: Appleton-Century-Crofts. Clark, H. M., & Bozian, M. (1983). A cookbook approach to evaluation of clinical experience in community health nursing. Journal of Nursing Education, 22(6), 249-254. Cronin-Stubbs, D., & Mathews, J. (1982, July/August). A clinical performance evaluation tool for a process-oriented nursing curriculum. Nurse Educator, pp. 24-29. Gustafson, D. D. (1980) Student peer evaluation: A successful adaptation for observed home visits. Journal of Nursing Education, 19(2), 4-7. Leman, C. (1984). Visiting clients in the home. In V. Schoolcraft, (Ed.), Nursing in the community (pp. 344-367). New York: Wiley. Schoolcraft, V. (Ed.). (1984). Nursing in the community. New York: Wiley. Suchman, E. (1967). Evaluative research. New York: Sage.
