NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Family Functioning
* Safety Behavior: Home Physical Environment
* Social Support
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Home Maintenance Assistance
* Sustenance Support
* Discharge Planning
NANDA Definition: Inability to independently maintain a safe growth-promoting immediate environment
Individuals within a home establish a normative pattern of operation. A vast number of factors can negatively impact on that operational baseline. When this happens, an individual or an entire family may experience a disruption that is significant enough to impair the management of the home environment. Health or safety may be threatened and there may be a threat to relationships or to the physical well-being of the people living in the home. An inability to perform the activities necessary to maintain a home may be the result of the development of chronic mental or physical disabilities, or acute conditions or circumstances that severely affect the vulnerable members of the household. As a result of early hospital discharges, nurses are coordinating complicated recovery regimens in the homes of patients. The patient’s home must be safe and suited to the recovery needs of the individual. Patients must have the resources needed to provide for themselves and their families during recovery or following a debilitating illness. Because there is considerable room for cultural and intrafamilial variations in the maintenance of a home, the nurse should be guided by principles of safety when evaluating a home environment.
* Defining Characteristics: Patient or family expresses difficulty or lack of knowledge in maintaining home environment
* Lack of preventative care such as immunizations
* Poor personal habits:
o Soiled clothing
o Frequent illness
o Weight loss
o Body odor
o Substance abuse
o Depressed affect
* Poor fiscal management
* Risk-taking behaviors
* Vulnerable individuals (e.g., infants, children, elderly, infirm) in the home are neglected or often ill.
* Home visits reveal unsafe home environment or lack of basic hygiene measures (e.g., presence of vermin in home, accumulation of waste, home in poor repair, improper temperature regulation)
* Related Factors: Poor planning and organization
* Low income
* Inadequate or absent support systems
* Lack of knowledge
* Illness or injury of the client or a family member
* Death of a significant other
* Prolonged recuperation following illness
* Substance abuse
* Cognitive, perceptual, or emotional disturbance
* Expected Outcomes Patient maintains a safe home environment.
* Patient identifies available resources.
* Patient uses available resources.
Ongoing Assessment
* Assess whether lack of money is a cause for not maintaining the home environment. Grants or special monies can sometimes be found to modify the home to suit the need of the physically challenged patient. Other supports and services are available to reduce financial stress.
* Assess history of substance abuse and determine its impact on ability to maintain home. The financial support of a substance abuse problem can siphon money from every available resource.
* Perform a home assessment. Evaluate for accessibility and physical barriers. Assess bathing facilities, temperature regulation, whether windows close and doors lock, presence of screens, trash disposal. These are basic necessities for a safe environment. Beyond this, evaluate the home to determine if the special needs of the patient can be accommodated.
* Evaluate each member of family to determine whether basic physical and emotional needs are being met. A distinction must be made between optimal living conditions and a safe home environment.
* Assess patient’s knowledge of the rationale for personal and environmental hygiene and safety. Realize, however, that knowledge deficit is unlikely to be responsible for poor home maintenance in all cases. The patient’s personal priorities, culture, and age may play a role in determining individual preferences.
* Assess patient’s physical ability to perform home maintenance. For example, patients may not do laundry because they are unable to carry large boxes of detergent from the store, or may be unable to carry rubbish to the collection site because sidewalks are icy.
* Assess whether patient has all assistive devices necessary to perform home maintenance. If unavailable, other options may need to be explored (e.g., a homemaker, family assistance).
* Assess impact of death of relative who may have been a significant provider of care. Aspects of home maintenance may have been performed by the deceased, and a new plan to meet these needs may need to be developed.
* Assess patient’s emotional and intellectual preparedness to maintain a home. Some patients who are mentally challenged are quite capable of living alone if provided with the appropriate supports, whereas the patient with a disease such as Alzheimer’s may be unable to care for self.
* Enlist assistance from social worker or community resources that may be helpful to family or patient. Patients may be unaware of the services to which they are entitled.
Therapeutic Interventions
* Begin discharge planning immediately after hospital admission. Shortened hospital stays and early discharges require an organized approach to meet individual needs of family. Patients and their families may be managing more complicated recoveries in the home than were previously encountered.
* Integrate family and patient into the discharge planning process. This will ensure patient-centered objectives and promote compliance.
* Plan a home visit to test the efficacy of discharge plans. The nurse may visit the home to determine its readiness to accommodate the patient, or the patient may go home briefly to help in identifying potential problems.
* Arrange for ongoing home therapy. Arrange for physical therapy, dietitian, occupational therapy consultations in home as needed. Complicated recovery necessitates that services be brought to the patient.
* Assist family in arranging for redistribution of workload. Build in relief for caretakers. This prevents fatigue during performance of physically or emotionally exhausting tasks.
Education/Continuity of Care
* Ensure that family, patient, or caregiver has been instructed in the use of all assistive devices.
* Begin care instruction or demonstrations early in hospital stay. This enables patient to learn tasks.
* Teach care measures to as many family members as possible. This provides multiple competent providers and intrafamilial support.
* Arrange for alternate placement when family is unable to provide care. The need for placement may be temporary or extended; the patient’s status will determine needs.
* Provide telephone support or support in the form of home visits. This monitors status of patient and the well-being of others in the home.
* Refer to social services for financial and homemaking concerns. Inform of community resources as appropriate (e.g., drug abuse clinic).
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