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Home Visits

Many nurses are uncomfortable with the notion of home visits, feeling that they are intruding on the family’s privacy. Remember, parenting is personal and many mothers and fathers feel that professionals are "peering over their shoulders" as they interact with the child with disabilities. As time goes on, families of children with special needs generally get used to having professionals in their home; however, there are certain tips that nurses can employ to make home visits more successful and comfortable for everyone (based on information in Turnbull and Turnbull):

Make an appointment for the home visit and explain its purpose. Children with disabilities often have very busy schedules, between school, medical appointments, therapy sessions, and recreational options. When the nurse visits, there should be a defined purpose and something of value for the family.
Arrive and leave on time, cancelling only when it’s unavoidable. Nurses who cannot keep to the schedule send a message that the family’s time is of little value, and demonstrate a marked lack of respect. While delays happen from time to time, there’s no excuse for a series of cancellations or late arrivals

Instant Feedback:

Since the child and parents are in their own home environment, there is no great harm done if the nurse shows up without an appointment, or pops in a half hour early.

Dress comfortably and appropriately; expect to get messy or spend some time on the floor with the child. Parents are acutely aware of the body language of the professionals working with their child. When working with infants, it’s normal to hold the baby and even participate in feeding or other care activities. Older children who become comfortable with the nurse often climb up, hug, or want to play on the floor. Wear loose clothing that can be easily washed; avoid scratchy fabrics like wool that may be irritating for the child. Think carefully about jewelry (necklaces, earrings, pins) that can be dangerous to the child.
Be sensitive when food or drink is offered. Some families equate hospitality with a drink and snack and would be quite offended if the nurse declines. In other cases, the child’s parent is already busy enough and preparing food may be an imposition. It can be helpful to bring your own bottled water to the home, sending a subtle message that you have taken care of the issue.

Instant Feedback:

When the nurse makes a home visit, the parents have a social obligation to act as hosts.

Expect distractions, but bring activities for the children to minimize interruptions. Small, safe, age-appropriate toys for the child with disabilities and/or siblings can distract the child and allow uninterrupted conversation with the parent. They’re also invaluable when the nurse is waiting with the family in a crowded clinic waiting room. Dollar stores, fast food restaurants, and therapy catalogs are great resources for toys or craft materials.
Be aware of your surroundings and leave if safety issues arrive. Most parents have great respect for the nurse working with their child, and will ensure that the environment is safe and comfortable. Follow your instincts, however, if there are signs of impending violence, substance abuse, or environmental dangers. A cell phone is invaluable for calling ahead to the home (watchdogs can be an issue!) or explaining an abrupt departure.
Do not be judgmental about parents’ participation in your work with the child. It’s easy to say, "The child would do so much better if the parents would just do an hour of speech in the evenings," before heading home to your own quiet environment. For the mother and father of four active children, that hour just might not exist. One mother of an infant with Down syndrome and severe congenital heart disease had this to say about her daughter’s first year of life, "She was a year old before I was able to wash my hair and shave both legs in the same day. Can you imagine that–shaving one leg a day because that’s all the free time you had?" Life with a special needs child is NOT always life as we know it.

Instant Feedback:

Home visits are costly in terms of nursing time, so it’s important for the family to eliminate all distractions and focus on the parent/professional relationship.