# Situation: The public health nurse of a Rural Health Unit (RHU) makes home visits to a couple and their first baby, a healthy 3-week-old girl born at term in a birthing facility. The mother and baby have had no problems since discharge. The nurse is preparing for the first visit. Which plan BEST follows the principles of home visiting?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) makes home visits to a couple and their first baby, a healthy 3-week-old girl born at term in a birthing facility. The mother and baby have had no problems since discharge.

The nurse is preparing for the first visit. Which plan BEST follows the principles of home visiting?

## 보기

1. Arrive unannounced so she can observe the family's usual routine
2. Follow a fixed checklist and finish every item whatever she finds
3. Set a time with the couple and plan objectives from the records **✔ 정답**
4. Plan to examine only the baby, since both parents are healthy

**정답: 3**

## 해설

A home visit has a purpose, is planned from available information such as birth and discharge records, and is scheduled with the family when possible, while staying flexible to what the nurse finds. It also involves the whole family. Arriving unannounced, following a rigid checklist, or seeing only the baby each breaks one of these principles.

## 심화 해설

Core Principles of a Planned Home Visit

A home visit is not a casual drop-in; it is a structured nursing intervention. The visit must have a defined purpose, be based on information already available about the family, and be arranged with the family whenever possible. At the same time, the nurse remains flexible and responsive to what is actually found in the home. The care also extends to the whole family, not just the identified patient. These principles guide the correct answer.

The best plan is to set a mutually agreed time with the couple and formulate objectives from the birth and discharge records before the visit. This approach respects the family's schedule, establishes a clear focus, and uses existing data to anticipate needs. Planning from records allows the nurse to prepare for common postpartum concerns such as feeding, newborn safety, maternal recovery, and emotional adjustment, while still leaving room to address unexpected issues that emerge during the visit [1].

Watch out! Arriving unannounced may seem useful for observing the "usual routine," but it violates the principle of respect and collaboration. It can create anxiety, disrupt the family's day, and undermine the trusting relationship that home visiting depends on [2]. Trust is built through predictable, negotiated contact, not surprise observation.

Key point! A rigid, fixed checklist that must be completed regardless of what the nurse finds is also inappropriate. Home visitors must balance program objectives with the individual family's immediate needs [2]. If the mother is exhausted or the baby is crying inconsolably, forcing through every checklist item is neither therapeutic nor family-centered. Flexibility is a core competency [3].

| Option | Why It Fails | Principle Violated |
| --- | --- | --- |
| 1. Arrive unannounced | No scheduling, may disrupt family, harms trust | Planned and scheduled with family |
| 2. Fixed checklist, finish every item | Ignores family's immediate needs and context | Flexibility and responsiveness |
| 4. Examine only the baby | Ignores maternal recovery, family dynamics, environment | Whole-family focus |

The postpartum period is a time of significant health disparity risk, and structured home visiting is one strategy to improve equity in maternal and infant outcomes [1]. For a first-time mother and a 3-week-old newborn, the visit should assess not only infant growth and feeding but also maternal physical recovery, sleep, mood, and the couple's adjustment to parenting. Public health nurses conducting home visits routinely assess the home environment and family context to enhance care and reduce complications .

Setting a time with the couple and planning objectives from records combines preparation with respect, while leaving room for clinical judgment during the actual visit. This is the only option that honors all core home visiting principles: purpose, planning, scheduling, flexibility, and family involvement.References (research sources)

- [1]Planning, Implementation, and Evaluation of a Postpartum Nurse Home Visit Service to Improve Health Equity.Research articleRousseau JB, Cavenagh Y, Bender KK (2024) · DOI: 10.1016/j.jogn.2024.06.005

- [2]Implementation of coaching and peer learning collaboratives to support home visiting practices.Research articleMcKelvey LM, Rau A, Olson TL, Zimmerman C, Fox LB, Greenwood T, Zhang D, Lewis KN. (2026) · DOI: 10.1002/imhj.70107

- [3]Effective Home Visiting Training: Key Principles and Findings to Guide Training Developers and Evaluators.Research articleSchultz D, Jones SS, Pinder WM, Wiprovnick AE, Groth EC, Shanty LM (2018) · DOI: 10.1007/s10995-018-2554-6

## 임상 시나리오

Planned Home VisitingPurposeful, family-centered, and flexible
A home visit is a structured nursing intervention, not a casual drop-in. It must have a defined purpose and be planned from available information such as birth and discharge records.

Schedule the visit with the family when possible to respect their routine and build trust. Care extends to the whole family, not only the baby or identified patient.

CautionAvoid arriving unannounced or rigidly completing a fixed checklist. Stay flexible and responsive to what is actually found in the home.

## 핵심 개념

- **Home visit** — A structured nursing intervention with a defined purpose, based on available family information and scheduled when possible.
- **Family-centered care** — Care that involves the whole family unit, not just the identified patient.
- **Flexibility in home visiting** — The nurse remains responsive to unexpected issues found during the visit rather than rigidly following a fixed plan.

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