Tools (means) of community health nursing. The nurse reaches individuals, families, and communities through several means:

• Direct care contacts: home visits, clinic visits, group conferences, school and workplace visits
• Health education
• Community organizing (Topic 10)
• Epidemiologic methods — studying distribution and causes of health problems to guide action
• Case management, referral, and coordination with other services
• Records and reports (e.g., FHSIS) and surveys

Home visit. A professional, purposeful interaction in the client's home between the nurse and the family, aimed at promoting, maintaining, or restoring health. It lets the nurse see the real living conditions, involve the whole family, and teach care using the family's own resources.

Purposes of the home visit

• Assess the family's health, home environment, and resources in their real setting
• Give or demonstrate nursing care and let the family practice it
• Provide health teaching adapted to the home situation
• Follow up clients (e.g., postpartum mothers and newborns, TB patients, defaulters, hypertensive or diabetic clients, discharged patients)
• Detect cases and contacts and refer as needed
• Build rapport and encourage use of health services

Bag technique. A tool by which the nurse, during a home visit, uses the public health bag to perform nursing procedures with ease and efficiency while preventing the spread of infection. The public health bag is essential equipment that contains basic medicines and articles the nurse needs for care during home visits.

Case management. A collaborative process in which the nurse assesses a client's needs, plans, links to and coordinates services, monitors, and evaluates, so that care is continuous, client-centered, and cost-effective. Steps: case finding/screening → comprehensive assessment → planning with the client → linking and coordinating resources → monitoring → evaluation and closure.

Principles of a home visit

• It must have a purpose or objective.
• It is planned using available information (records, referral notes, previous visits), yet flexible enough to adapt to what is found.
• It uses the nursing process and involves the family actively in planning and care.
• It respects the family's culture, time, beliefs, and privacy.
• It uses the family's own resources where possible and teaches simple, safe methods.
• It is documented, and the nurse follows through with referrals.

Phases of a home visit

Setting priorities among home visits (commonly taught)

• By need and urgency: acute or emergency needs before stable chronic follow-up; new cases and first visits (e.g., newly delivered mothers and newborns, newly diagnosed TB) receive early visits.
• By number affected: a problem affecting many people or the community ranks above one affecting a single person.
• By infection risk within the day's route: visit the most susceptible clients (newborns, infants, postpartum mothers) and non-infectious clients first, and clients with communicable diseases last, to avoid carrying microorganisms to vulnerable clients.

Principles of bag technique

1. Minimize or prevent the spread of infection from individuals to families and the community.
2. Save time and effort in performing nursing procedures.
3. Keep the client's welfare foremost while performing the technique.
4. Adapt to agency policies and to the home situation while keeping infection-prevention principles.

Steps in bag technique

1. On arrival, choose a clean, flat, safe work area (e.g., a table) out of reach of children; spread a paper or plastic lining and place the bag on it with the handles folded under — never on the floor or bed.
2. Ask for water and a basin or container for hand washing if there is no running water.
3. Open the bag; take out the lining for the work area, the hand towel, soap, and apron, placing them on one corner of the clean work area.
4. Wash hands thoroughly and dry them; put on the apron.
5. Take out only the articles needed and place them on the clean area within easy reach.
6. Place a waste receptacle (paper bag) outside the clean area.
7. Close the bag before starting care; do not reopen it with contaminated hands.
8. Perform the nursing care or procedure.
9. Clean and disinfect used articles before returning them to the bag.
10. Wash hands again.
11. Return articles to their proper places in the bag.
12. Remove the apron, folding the soiled side in.
13. Fold the lining and place it back in the bag (between the bag flaps); close the bag. Dispose of waste properly; leave no contaminated material in the home unless safely disposed of.

Documentation. Record observations, care given, the client's response, teaching and evaluation (e.g., return demonstration), referrals, and the plan for the next visit — accurately, objectively, and promptly. Records are legal documents and ensure continuity of care.

Planning a day's route. A public health nurse must visit:

• A. A 3-day-old newborn and mother (first postpartum visit)
• B. A diabetic client for routine monitoring
• C. A client on TB treatment who missed two doses
• D. A family with a child recovering from measles

Sequence for infection control: A → B → D → C. The newborn and mother (most susceptible) come first and the non-infectious diabetic client next. The order of C and D depends on current infectiousness: a child recovering from measles is usually no longer infectious once more than 4 days have passed since the rash appeared, whereas a client with pulmonary TB who has missed doses may be infectious, so the TB client is visited last, with the nurse wearing a respirator or mask according to protocol. Urgency matters too: if any client is in an emergency, that client is attended to at once and the plan adjusted.

Using teach-back after teaching glucose self-monitoring. The nurse asks the client to demonstrate the glucose meter steps and explain what to do if the reading is high. Errors are corrected immediately. This is the best way to confirm understanding.

Case management example. An older woman living alone after a stroke is discharged home. The nurse reviews the discharge summary before the first visit (diagnoses, current medicines, precautions, follow-up plan), assesses function, home safety, nutrition, and social support, and then plans with the client: rehabilitation referral, fall-proofing the home, medicine supply through the health center, and linkage with the barangay and social welfare for support. The nurse monitors progress and closes the case when goals are met.

• Care provider — performs procedures safely using bag technique
• Health educator — teaches in the family's language and home setting; uses return demonstration and teach-back
• Case finder and surveillance reporter — detects new cases and contacts and reports notifiable diseases
• Coordinator and case manager — links families with services (RHU, hospital, social welfare, community groups) and ensures follow-through
• Advocate — speaks for vulnerable clients (e.g., older persons living alone) to obtain services
• Supervisor — guides midwives and barangay health workers who make home visits
• Record keeper — maintains accurate home-visit records and reports

• Consent and respect for the home: the nurse is a guest; explain purpose and obtain consent before assessment or care.
• Scope of practice: under the Philippine Nursing Act of 2002 (RA 9173), nurses provide nursing care, health education, and linkages, and administer treatments and medicines on written prescription — they do not prescribe independently (e.g., antibiotics). Oxygen is given only on a prescription, a standing order, or an emergency protocol of the agency.
• Confidentiality: what is seen and heard in the home is confidential; records are sensitive personal information under RA 10173.
• Duty to report: notifiable diseases must be reported under RA 11332; suspected abuse or neglect requires ensuring the client's safety and referral through proper channels.
• Nurse safety: assess risks before and during visits; leave if unsafe and inform the supervisor; some agencies require visits in pairs in high-risk areas.
• Documentation is a legal record and must be accurate and timely.

Case 1 — Where to put the bag. In a small house, the only free surfaces are the floor and the client's bed.

• Correct action: ask for a chair or small table, line it, and place the bag on it; if none is available, use the cleanest raised surface available on a clean lining, never the floor or bed.
• Why: prevents contamination of the bag and its contents.

Case 2 — Order of visits. The nurse has a postpartum mother with a newborn and a client with suspected pulmonary TB to visit.

• Correct order: postpartum mother and newborn first, suspected TB client last.
• Why: reduces risk of carrying infection to a highly susceptible newborn.

Case 3 — Evaluating teaching. After teaching a family how to prepare oral rehydration solution, what is the best evaluation?

• Correct action: ask a family member to prepare it in front of the nurse (return demonstration).
• Why: performance shows understanding better than asking "Do you understand?"

• Placing the bag on the floor, bed, or a soiled surface.
• Opening the bag with contaminated hands or taking out items not needed.
• Returning used articles to the bag without cleaning and disinfecting them.
• Placing the waste bag inside the clean work area.
• Visiting communicable-disease clients before newborns or other susceptible clients.
• Making unplanned "social" visits without objectives.
• Prescribing medicines such as antibiotics, or starting treatments like oxygen without a prescription, standing order, or emergency protocol — beyond nursing scope.
• Asking "Do you understand?" instead of using teach-back or return demonstration.
• Delaying documentation until the end of the week.

• Home visit = purposeful, planned, flexible family–nurse contact using the nursing process.
• Phases: pre-visit, initiation, in-home, termination, post-visit (documentation and referral).
• Daily visit order: susceptible and non-infectious clients first; communicable cases last; emergencies at once.
• Bag technique purpose: prevent spread of infection while saving time and effort; client welfare first.
• Bag on a clean, lined, raised surface; hand washing before and after care; close the bag before care.
• Waste receptacle outside the clean area; clean and disinfect articles before returning them.
• Apron removed and folded with the soiled side in; lining folded and returned to the bag.
• Evaluate teaching by return demonstration or teach-back.
• Case management: assess → plan → link/coordinate → monitor → evaluate; client-centered.
• Nurses administer treatments on written prescription (RA 9173); report notifiable diseases (RA 11332).