Situation: The public health nurse makes a home visit to a family. The father, 58, a driver, has hypertension and smokes daily. The mother, 34, is 7 months pregnant with their third child. Their eldest child, who will start school next month, missed a scheduled vaccine dose and is underweight on growth monitoring. The household stores its water in uncovered drums near the kitchen. After the family lets the nurse into the home, which should the nurse do FIRST?

A home visit begins with the initiation phase: the nurse greets the family, introduces herself, states the purpose of the visit, builds rapport, and obtains consent. The nurse is a guest in the home, so assessment and care come only after this.

Home Visit Initiation Phase

A home visit is not a clinic encounter where the nurse controls the environment. In the community setting, the nurse is a guest in the family's private space, and the visit follows a structured sequence. The first step is the initiation phase, which includes greeting the family, introducing oneself, stating the purpose of the visit, building rapport, and obtaining consent before any assessment or intervention begins ^[1].

The nurse must establish a trusting relationship and obtain the family's permission before touching equipment, taking vital signs, or inspecting the household environment. This principle is foundational to community health nursing practice. The Ghanaian study on home visit challenges highlights that successful visits depend on the nurse's ability to engage the family respectfully from the moment of entry, as perceived intrusiveness or rushing into tasks can undermine cooperation ^[1].

Option	Action	Why It Is Not First
1	Set up the public health bag on a lined table away from children	This is part of the working phase. Preparing equipment before introducing oneself and explaining the visit would be presumptuous and may create anxiety or resistance.
2	Take the father's blood pressure while seated and rested	Assessment begins only after the initiation phase. The father's hypertension is a priority concern, but consent and rapport must come first.
3	Check the water drums near the kitchen for mosquito larvae	Environmental inspection is a core public health nursing task, but entering the kitchen area and examining household items without permission violates the family's autonomy and privacy.
4	Introduce herself and explain the purpose of the visit	Key point! This is the correct first action. It establishes the nurse's identity, clarifies the visit's intent, and sets the foundation for informed consent and cooperation.

The initiation phase is not a formality. It is the mechanism by which the nurse transitions from being an outsider to a welcomed professional guest. The Korean home-visiting program experiences reinforce that standardized visits still require individualized, respectful entry into each home, as the family's acceptance of the nurse determines whether subsequent assessments and interventions can occur at all . The randomized controlled trial protocol for early childhood home visiting similarly assumes that the nurse's first task is to establish a working alliance with the family before delivering any health content .

In community health nursing, the sequence of the home visit is initiation, assessment, planning, intervention, and evaluation. Skipping the initiation phase compromises every subsequent step. The father's blood pressure, the uncovered water drums, and the underweight child are all important findings that the nurse will address, but only after the family has been properly greeted, informed, and given the opportunity to consent. The public health bag setup is a practical task that follows the same principle: the nurse must first be invited into the relational space of the home before occupying its physical space with equipment.

Watch out! In a clinical setting, assessment often precedes introductions because the patient has already consented to care by presenting to the facility. In the home, consent is not implied; it must be actively sought at the door. The nurse's role as a guest means that the family retains control over the visit's pace and scope until they choose to share that control.